More than a year after the passage of historic legislation meant to empower local governments in taming their health care spending, the region's cities and towns have joined municipalities across the state in savings millions of dollars, but many could still do more - assuming they want to shift more costs to employees, a delicate prospect.

State-mandated reports, required of those cities and towns that didn't adopt the new law and obtained by the Daily News from the Executive Office of Administration and Finance, show that a number of local cities and towns could save hundreds of thousands of dollars of additional taxpayer money by lowering the portion they contribute to insurance premiums or by implementing the deductibles and higher co-pays of the coverage pool for state workers - the Group Insurance Commission, or GIC.

An extensive survey by the paper also shows many cities and towns still offer plans that don't carry a deductible; don't charge a co-pay for high-tech, costly scans like MRIs; and don't offer tiered out-of-pocket costs to encourage workers to use cheaper hospitals and doctors offering quality care. All state plans include a $250 deductible for individuals and a $750 deductible for families, and 10 of the 11 offerings feature tiering.

"My impression is that communities are going to do this in steps and not go all the way to the GIC level in one bite," said Michael Widmer, president of the business-backed Massachusetts Taxpayers Foundation, which pushed for the legislation after years of research and advocacy.

Also, if cities and towns have not cut services or laid off staff, the need for even further health savings might not be as pressing, Widmer said. There's also the need to weigh budget paring with the desire to treat employees fairly and attract quality talent - though higher-out-of-pocket expenses can lower premium costs for both employer and employee.

"I think the circumstances vary," Widmer said. "I think all of this is kind of a balancing act."

Signed by Gov. Deval Patrick in July 2011, the municipal health care act requires governing bodies like selectmen and city councils to take a vote if they want to change the design of health plans outside normal bargaining. They then have 30 days to negotiate with a committee of union representatives to decide whether to enter the GIC and use state health plans or make changes on their own. Special panels resolve gridlock but have been rarely required.

Locally, Weston and Hopedale had already struck deals with unions to join the GIC. Sudbury adopted the new law and followed suit. Of the remaining 18 cities and towns, just Framingham, Holliston, Milford and Southborough opted for the legislation, though many others have made changes in recent years or saw unions agree to concessions because of the move afoot statewide.

Milford lowered health spending by nearly $1.5 million through the new law. Framingham had already trimmed $1.4 million annually when it followed suit, leading to an additional $2.4 million in savings. The law requires a quarter of first-year municipal savings to go to worker relief, and Framingham has set up a $640,000 pool for employees to draw from for co-pays in times of hardship.

Health care spending has gone from a 16 percent share of the budget to 14.5 percent in Framingham, with the town watching the GIC before potentially seeking further changes.

Read the original here:

Not all communities find ways to save on health insurance costs

SACRAMENTO -- Californians now have a clearer picture of what health insurance will look like when major provisions of the federal health care law debut in 2014.

Acupuncture to treat pain and nausea will be covered, for example, as will tobacco cessation and vision screening.

But the jury's still out on chiropractic care.

State lawmakers this week sent two bills to Gov. Jerry Brown that identify the services health insurance plans must cover starting in 2014 for individuals and small businesses.

The measures -- Senate Bill 951 by Sen. Ed Hernandez, and Assembly Bill 1453 by Assemblyman Bill Monning, D-Carmel -- define what are called "essential health benefits" under the federal health care overhaul and will fundamentally transform the kind of insurance Californians will buy.

"It's historic," Monning said.

The bills, he said, will affect "the millions of Californians who have had limited coverage or no coverage who now will have access to coverage, and it will be comprehensive in nature. It will include preventive services, immunizations, hospitalization. The list goes on and on."

The benefits will apply to insurance plans sold through the state's new health insurance exchange, which will offer federally subsidized plans for individuals and families making between 138 and 400 percent of the federal poverty level.

Unsubsidized plans sold outside of the exchange also must meet these requirements.

Insurance offered by large employers --

More here:

Federal health law clearer for California

While the Supreme Court has spoken, we seem no closer to understanding if there is a tax or penalty regarding the health care overhaul passed recently. Regardless of its classification, it is a fee that we must understand might affect future income tax returns.

The fee changes over time, so for now we can only look ahead to 2016, which is the last year a fixed amount of the fee can be determined for everyone.

The fee in 2016 is $695 per adult and $347.50 for each person under age 18. This translates to a potential $695 fee for those filing single with no dependants. A couple without dependants filing jointly could see a penalty of $1390. A family of four with two children under age 18 could see a penalty of $2,085. This amount will be added to the tax owed on your income tax return.

In years following 2016, the fixed fee is replaced by one that is a percentage of your total gross income.

What Ive just outlined is the maximum fee that can be assessed. There will be complicated formulas that will calculate a reduction or elimination of this maximum fee. The fee does look at the entire household not just individuals with the filer being responsible for paying any fee assessed to that household.

For those of us living in Massachusetts, this is already a routine we perform when completing our own state income tax return. The maximum fee in Massachusetts for last year was $1,212 for any individual over age 18. An uninsured married couple filing a joint return could be looking at an extra $2,424 added to their tax burden. Massachusetts does not assess a fee for those under age 18 who do not have health insurance. Again, there is a complex array of conditions that might reduce or eliminate the fee.

At stake, then, are two fees, which, for a family of four, could represent a $4,509 tax liability in 2016. Now, it is very important to note that those who have a defined level of health insurance would not be required to pay either fee at all. The fee is only imposed for those who do not carry health insurance for themselves or members of their household. Safe to say, seniors enrolled in Medicare will have no need to worry about or be concerned about the fee.

On the other side of the equation, there could be a tax credit applied for those who do have health insurance and cannot really afford it. The tax credit is intended to lower the total cost of health insurance premiums paid. Sadly, it is yet another complex calculation based on income and health care premiums paid.

Surely, there will be taxpayers calculating their cost of compliance verses the cost of non-compliance. But what is really at stake is an ability to obtain professional health care when it is needed. We never know when that will be or which of our loved ones might require it. If ever needed, the fee will probably be an irrelevant concern.

Ron Griffin is a Medfield resident who writes about Medicare. He can be reached at Rongriffin65@Gmail.com.

Link:

Senior Health Matters: Health care -- penalty or tax?

In a landmark decision, the U.S. Supreme Court generally upheld the constitutionality of the controversial 2010 health care law. In addition to preserving mandates for health insurance coverage, certain tax provisions will take effect as scheduled in 2013, barring any subsequent legislation. Here's a summary of the main tax changes for 2013.

Two Medicare surtaxes could affect individual taxpayers:

A 3.8 percent surtax on the lesser of annual net investment income or the amount by which modified adjusted gross income (MAGI) exceeds $200,000 ($250,000 for married couples). "Net investment income" includes interest, dividends, royalties, rents, gains from dispositions of property and income from passive activities, but not tax-free interest or distributions from qualified retirement plans and IRAs.

A 0.9 percent surtax on earned income such as wages that exceeds $200,000 ($250,000 for married couples).

Flexible spending accounts: Currently, there's a $5,000 limit on pretax contributions to a flexible spending account used for dependent care expenses, but there's no such limit on health care FSAs. The law caps health care FSA contributions at $2,500 starting in 2013.

Medical deductions: For 2012, you may deduct unreimbursed medical expenses in excess of 7.5 percent of your adjusted gross income. The law raises this AGI floor in 2013 to 10 percent for taxpayers under age 65.

Other tax-related provisions in the law were also upheld by the Supreme Court. For instance, an individual will generally have to obtain "minimum essential health insurance coverage" or pay a nondeductible penalty, beginning in 2014. Another provision, which took effect in 2010, allows a qualified small business to claim a tax credit for part or all of the cost of providing health insurance.

Contact your accountant regarding your personal circumstances.

Excerpt from:

Sunken: Health care law to trigger tax provisions in 2013

PROTESTERS have marched in Madrid against a a new government measure restricting free health care for some immigrants, which has already provoked a revolt by some doctors and regional health bodies.

Hundreds of people demonstrated noisily against the measure, which will limit access to free health care for immigrants without full legal status in Spain. Other Spanish cities also hosted demonstrations.

Previously, such immigrants had access to free care in the public health system. From Saturday however only children, pregnant women and people needing emergency medical care will be eligible: others will have to pay.

Conservative Prime Minister Mariano Rajoy's government introduced the new restrictions as part of its austerity program to tackle the country's debt crisis.

But seven of Spain's 17 regional health authorities have already said they will not implement the measure and many doctors and nurses have insisted they will continue to treat those affected by the change for free.

Rights groups Medecins du Monde (Doctors of the World) and Amnesty International have also denounced the new measure as a violation of basic rights.

In a joint statement together with several other rights groups, they warned that the cuts "...could cost lives, because they will leave thousands of people without access to the health system".

And an internet petition for Spanish health professionals vowing to stand by those affected by the change has so far attracted 1885 signatures.

"My loyalty towards my patients does not allow me to fail in may ethical and professional duty ...," says the online manifesto.

Health professionals were among those marching in Madrid and so too were some of those hit by the change.

Read more here:

Hundreds protest Spanish health cuts

By WAYNE WILSON

A 65-year-old couple retiring in 2012 will spend approximately $240,000 on health care throughout their retirement, according to a report from Fidelity Investments. This doesnt even include over-the-counter medication, dental care and other add-ons.

Many of us have always received health care coverage through our employers, but as retirement looms near, the reality of choosing and paying for our own health care can become overwhelming. Planning ahead for this change can make all the difference.

Budgeting basics

The first step when budgeting for health care is to consider what youre currently paying through your employer. Use this number as a guide to budget for future payments and choose a plan. Look at what services you use and dont use, how often you use them and how much their cost factors into the total amount. Keep in mind that your trips to the doctor may become more frequent as you grow older. Also be sure to consider inflation when budgeting, which can be up to four times higher for health care. Experts assume annual increases of 6 to 8 percent.

For example, that same 65-year-old couple with annual household income of $75,000 can expect to pay about $10,500 for health care this year. With increases in health care costs and inflation, Fidelity predicts that number could rise to $25,000 in just 15 years.

Picking the right plan

As you plan for retirement, its important to remember that turning 65 makes you eligible for Medicare, which can cost significantly less than buying individual health care before Medicare kicks in.

There are several questions to consider when choosing a Medicare plan. Do you only need the most basic care option? Do you want prescription drug coverage? What works best for you Original Medicare with a Medigap plan or a Medicare Advantage plan?

First, lets look at your options:

Read the original here:

GUEST OPINION: Planning for health care after retirement: What you need to know

Though Florida lost its Supreme Court challenge to President Obamas health care law, state politicians could still have a say in setting minimum health benefits for plans here under the federal Affordable Care Act. And thats what has some health advocacy groups worried.

We have just seen the governor try to thwart the Affordable Care Act at every step he can, said Laura Goodhue, executive director at Florida CHAIN, a statewide consumer health care advocacy organization. We just dont want the governor to submit something that is completely opposite of the spirit and intention of the law.

Florida was the lead state challenging the Affordable Care Act and Gov. Rick Scott, since the ruling, refuses to comply with any part of the part of the law that isnt required. With the federal government promising to offer states flexibility, advocates worry that leaders in Florida will allow their repugnance for the federal law to cheapen the benefits available to its residents.

The Affordable Care Act strives to offer Americans not just affordable coverage, but quality coverage, proponents of the law say.

To ensure that plans dont leave out necessary coverage in the name of saving a buck, the Department of Health and Human Services came up with some parameters to set the low bar for plans offered to small employers and individuals buying insurance on their own.

This part of the law does not apply to plans offered by large employers because the vast majority offer comprehensive coverage already.

For the smaller markets, HHS has established certain categories that must be covered, such as maternity and pediatric care.

But the law leaves the decision of setting the minimum bar in the hands of state officials. States have until Oct. 1 to name their Essential Health Benefits or surrender the decision to the federal government. If that happens in Florida, a plan offered by Florida Blue (formerly Blue Cross Blue Shield) would be the minimum benchmark, per the federal rules.

A group of 15 medical and health advocacy organizations wrote to Scott, the state insurance commissioner and other leaders, asking them to hold public hearings and seek input on what benefits will best serve Floridians.

This is such an important decision that affects literally millions in Florida, said Goodhue, whose group was one of the letters signers.

Read more:

States have power to shape federal health care law if governors want to take it

Protesters marched in Madrid Saturday against a a new government measure restricting free health care for some immigrants, which has already provoked a revolt by some doctors and regional health bodies.

The rest is here:

Hundreds protest Spanish health cuts targetting migrants

The new law promises more will be insured, but some expect a shortage of doctors to see them.

Below: Medicare/Medicaid definitions Looking for a primary care physician? Health care reform timeline

Preparations are under way in York County to extend primary health care access to a possible 38,000 uninsured residents in 2014, which is when the new federal health care law takes full effect.

It is still unknown, however, if the efforts will be enough to absorb all the new patients.

The 2011 Healthy York County Coalition Community Health Needs Assessment found that 9 percent of York County residents do not have health insurance, Jess Ensminger, Family First Health CEO said in an email. That means any health care costs for preventive care, emergency room visits and prescription medications are out-of-pocket expenses for them.

"In addition, 12 percent (of the study's population) responded that they had skipped seeing a doctor because of cost in the previous 12 months," Ensminger said.

Dr. Wanda Filer has been practicing family medicine in York County for 25 years and works at Family First Health. She also is a board member of the American Academy of Family Physicians. There, she said, she has seen evidence of an upswing in patients who delayed seeking medical care because of cost.

But once all those people get access through the federal law, they might not be able to find a primary care doctor.

The Patient Protection and Affordable Care Act makes room to expand Medicaid coverage to income-eligible residents. Not all physicians can afford to accept Medicaid coverage.

Billing concerns doctors

Excerpt from:

York County girds for promise, problems of new health care law