Chapter 9.A (or 3.A)--Sources of Health Insurance
This page has resources and notes on the following topics:
For updates on coverage and spending statistics, see Chapter 1.B.1
For updates on the Affordable Care Act, see Chapter 1.B.3
As part of health care reform, the federal government has created this website for navigating various health insurance options: http://www.healthcare.gov/ (click link for "Explore Your Coverage Options")
To get a sense of what health insuarnce costs at different benefit levels, go to EHealthInsurance.Com.
The Georgetown Institute for Health Care Research and Policy has produced a very useful set of consumer guides that describe in each state all of the various state and federal provisions that affect the availability, pricing, and coverage of private health insurance. These guides can be found at: http://www.healthinsuranceinfo.net/. Although they are very user friendly and clearly written, the dominant impression one takes away from reading them is how incredibly complex the fragmented health insurance system is in the U.S. See also University of Houston Health Law and Policy Institute, Choosing a Health Care Plan.
Various other resources relating to insurance market regulation are collected at: Wake Forest University Health Insurance Market Reform Study.
Two good sources for learning about state and local obligations to provide or fund care for the indigent are Community Catalyst’s Free Care Compendium, and the National Health Law Program’s State and Local Responsibility for Indigent Care files.
For additional discussion of consumer-directed health plans and increased patient cost-sharing, see updates to Chapter 1.B.3;
The Treasury Department has a useful website on Health
Savings Accounts, at http://www.treas.gov/offices/public-affairs/hsa/.
A good source for Medicare/Medicaid statutes and regulations is: http://hippo.findlaw.com/hippomed.html
Information about the current status of Medicare and Medicaid can be found on these two government web sites, www.cms.hhs.gov and www.Medicare.gov. See also Kaiser Family Foundation, Medicare at a Glance; Eleanor Kinney, ed., Guide to Medicare Coverage Decision-Making and Appeals (2002); Terry Coleman, Medicare Law (AHLA, 2nd ed. 2006).
From Tom Mayo on the Health Law Professors blog: “Kaiser Family Foundation has a slick website to commemorate the 40th anniversary of the passage of Titles XVIII and XIX of the Social Security Act - the Medicare and Medicaid laws. What caught my eye were video documentaries on the political history of the two programs, from the 1930s to the mid-1960s. The documentaries (one on Medicare, one on Medicaid, one on both) are quite well done, partly because of some compelling excerpts of interviews with some of the principal players in 1965. Of course, Wilbur Mills and LBJ are long gone, but there are still some terrific interviews with the president of the AMA at that time, Edward Annis; Joe Califano, a White House staffer at the time; LBJ's chief of staff, Jim Jones, and others. Best of all, longer (7- to 9-minute) interviews with each of these fellows are available on the same page. I like the way these videos really make the federal health care programs come alive.”
Excellent information about Medicaid, including a primer, program overview, and detailed fact sheets, can be found on the web site for the Kaiser Family Foundation. See also Murphy's Unofficial Medicaid Page and the AHLA's question and answer Guide to Medicaid Basics.
Further analyzing the "Kyl Amendent," which restricts physicians' ability to charge Medicare patients extra, see Kent Masterson Brown, The Freedom to Spend Your Own Money on Medical Care, Cato Policy Analysis No. 601 (Oct. 2007).
Capturing the maddening complexity of all of this is a diagram, prepared by Yaniv Hanoch & Thomas Rice, Can Limiting Choice Increase Social Welfare? The Elderly and Health Insurance, 84 Milbank Q. 37, 56 (2006).
Georgetown University has a very informative website as part of its Long-Term Care Financing Project.
Medicaid rules intended to make "spending down" more difficult, the look-back period for asset transfers is now three to five years, depending on the type of transfer. The following is an example of how Medicaid estate planning could be used to pay for long term care for the middle class elderly. It was prepared by Wake Forest University law student Daren McDonough (class of 1999), so it may not be fully current, but it illustrates the gist of this type of planning. Do you think this use of Medicaid funds is proper, or does this constitute abuse?
Example: Medicaid Estate Planning
Widow is a 70 year old woman who has recently been diagnosed with Alzheimer's disease. She owns a lovely home in suburban Charlotte, North Carolina. The home is completely paid off with a fair market value of $250,000. This does not include the value of the half acre garden which is adjacent to the property and which is used to produce vegetables which Widow consumes herself. She has one car, a 1991 Cadillac El Dorado. Widow has never worked, she was supported by her husband, Dirk, who was a pilot for U.S. Air. Dirk owned a restaurant as a tenant in common with two other individuals, and upon his death he transferred his interest in the business to Widow, along with $500,000 in the form of proceeds from a life insurance policy and other cash savings.
Widow has recently used her money to buy a new 1997 Lexus (after trading in her El Dorado), titled in only her name, a new bedroom setting, a new kitchen lay out, as well as three new pieces of jewelry. Upon learning that she has Alzheimer's, Widow contacted a local attorney, Will Mack, who advised Widow she had a number of options concerning her estate. At the time of her meeting with Mr. Mack, Widow received $800/month in social security and $300/month from Dirk's pension fund. Widow has four children, all over 22, one child has severe mental retardation and currently lives in an assisted living home. (This is paid for by a trust set up by Dirk, which has Mercantile Bank as the trustee, and upon the child's death the remainder is to be given to a stated charity.)
Widow is worried about losing her home. She currently has the home willed to one of her children. Widow has over $100,000 dollars invested in stocks and bonds and plans on giving these assets along with proceeds from her full life insurance policy to her three able bodied children at her death.
Mr. Mack informs Widow that there is a way she can keep her home, give away her other assets as she sees fit, and let Medicaid pay for her upcoming nursing home care. Mr. Mack informs Widow that in order to qualify for Medicaid assistance some assets may need to be transferred and some assets may need to change form or be liquidated and invested into other areas. Mr. Mack's proposal sets out:
Once this is done, Widow's assets will be below $2,000. Her income is $1,100/ month and she would be entitled to receive Medicaid reimbursement.
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