T.J. Kirkpatrick/The Washington Post/Getty Images

The Kaiser Family Foundation's 2014 Employer Health Benefits report says that rate increases are slowing from recession highs that ran far above inflation rates.

A new report suggests that people approaching retirement look at health-care expenses in later life in terms of recurring and nonrecurring services, and it offers some numbers that can be helpful in crafting a retirement budget.

Health care represents the second-largest budget item (after housing costs) for retirees. But planning for those expenses can be challenging, given increasing life expectancy and the possibility that medical bills can increase substantially with age.

A good way to think about such bills might be to separate the more predictable expenses from the less predictable oneswhich is how the Employee Benefit Research Institute in Washington, D.C., frames the issue in a recently published report.

Based on data from the Health and Retirement Study, a survey of U.S. households age 50-plus, EBRI defines predictableor recurringexpenses as doctor visits, prescription-drug use and dentist services. All three have high usage, and that usage is consistent across different age groups.

By comparison, less predictableor nonrecurringevents include overnight hospital stays, overnight nursing-home stays, home health care, outpatient surgery and special facilities.

EBRIs findings: Recurring health-care costs appear to remain stable throughout retirementand across all age groups. Among the Medicare-eligible population (age 65-plus), the average, annual out-of-pocket expenditure for recurring health-care expenses, according to EBRI, was $1,885.

If we assume a 2% rate of inflation and 3% rate of return on savings, a person with a life expectancy of 90 would need almost $41,000 (to be exact: $40,798) at age 65 to fund his or her recurring health-care expenses through end of live. (Note: That figure doesnt include other recurring expenses like insurance premiums or over-the-counter medications.)

With nonrecurring expenses, the math is trickier; thats because, by definition, both the usage and intensity of usage of these types of services are very uncertain, the report states. Here, instead of providing a single figure needed at retirement, EBRI looks at specific services.

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A smarter way to budget for retirement health-care costs

A new report suggests that people approaching retirement look at health-care expenses in later life in terms of recurring and nonrecurring services, and it offers some numbers that can be helpful in crafting a retirement budget.

Health care represents the second-largest budget item (after housing costs) for retirees. But planning for those expenses can be challenging, given increasing life expectancy and the possibility that medical bills can increase substantially with age.

A good way to think about such bills might be to separate the more predictable expenses from the less predictable oneswhich is how the Employee Benefit Research Institute in Washington, D.C., frames the issue in a recently published report.

Based on data from the Health and Retirement Study, a survey of U.S. households age 50-plus, EBRI defines predictableor recurringexpenses as doctor visits, prescription-drug use and dentist services. All three have high usage, and that usage is consistent across different age groups.

By comparison, less predictableor nonrecurringevents include overnight hospital stays, overnight nursing-home stays, home health care, outpatient surgery and special facilities.

EBRIs findings: Recurring health-care costs appear to remain stable throughout retirementand across all age groups. Among the Medicare-eligible population (age 65-plus), the average, annual out-of-pocket expenditure for recurring health-care expenses, according to EBRI, was $1,885.

If we assume a 2% rate of inflation and 3% rate of return on savings, a person with a life expectancy of 90 would need almost $41,000 (to be exact: $40,798) at age 65 to fund his or her recurring health-care expenses through end of live. (Note: That figure doesnt include other recurring expenses like insurance premiums or over-the-counter medications.)

With nonrecurring expenses, the math is trickier; thats because, by definition, both the usage and intensity of usage of these types of services are very uncertain, the report states. Here, instead of providing a single figure needed at retirement, EBRI looks at specific services.

Case in point: nursing-home stays. For individuals ages 85 and older, the average and the 90th percentile of nursing-home expenses were $24,185 and $66,600, respectively, during a two-year period.

Equally important, the report looks at the use of health-care services in, roughly, the 12 to 24 months preceding to examine the extent of backloading in health-care expenses. Among the findings: More than 50% of people in every age group above 65 received in-home health care from a medically trained person before death, according to EBRI. For individuals age 85-plus, 62.3% had overnight nursing-home stays before death, and 51.6% were living in a nursing home before death.

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Encore: A smarter way to budget for retirement health-care costs

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Dennis Wagner, USA TODAY 2:29 p.m. EST February 26, 2015

The Carl T. Hayden Veterans Affairs Medical Center in Phoenix where the veterans health care scandal first erupted.(Photo: Michael Chow, The Arizona Republic)

WASHINGTON A national veterans task force is advocating radical changes in the medical system for America's former military personnel, including a choice to receive subsidized private care and conversion of the Veterans Health Administration into a non-profit corporation rather than a government agency.

The reform measures, if enacted into law, would affect America's roughly 22 million veterans dramatically, especially the 8.5 million enrolled for care through the Department of Veterans Affairs. Repercussions would be even more profound for future veterans.

Concerned Veterans for America, a conservative non-profit, sponsored the study called "Fixing Veterans Health Care" amid a crisis in VA health-care services.

Among key recommendations:

USA TODAY

VA suspends probe of top Phoenix managers

Health care should be reprioritized to focus on veterans with service-connected disabilities and specialized needs. Patients already in the VA medical system would retain their access and eligibility while gaining new options.

All enrolled veterans would be able to continue using VA health facilities or shift to subsidized care through private providers. The government would pay a percentage of medical costs via insurance programs, with coverage levels determined by each veteran's eligibility status. (The VA already provides benefits based on tiered eligibility calculations.)

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Veterans propose major changes in VA health care

Viorel Florescu/Staff photographer

Ariel Cordero helping Ana Morales and her son, Oscar, 6, sign up for health insurance in Passaic in January. The U.S. Supreme Court will hear a challenge to the Affordable Care Act on Wednesday.

The U.S. Supreme Court will hear arguments Wednesday on a challenge to the Affordable Care Act that would end the federal subsidies for people who bought health coverage on the federal marketplace, a decision with enormous potential impact in New Jersey and not just for the 210,000 insured residents directly affected.

The loss of subsidies which average $309 a month for eligible consumers in New Jersey would make it difficult for many recipients to afford to continue insurance coverage, experts say.

The ripple effects could be substantial. Without the subsidies, the ranks of uninsured in New Jersey would grow, leading tens of thousands of people to fall back on charity care and putting more stress on hospitals and other health care providers, according to the state hospital association and groups that have filed briefs with the court.

States that want to protect consumers who have used the financial help to buy insurance will scramble to find ways to maintain the funding. For Governor Christie, who opposes Obamacare and vetoed legislation to establish a state-run marketplace as too costly, an adverse Supreme Court decision would present a difficult situation.

In addition, if residents pull out of the Obamacare plans in large numbers, it would push premiums up for those who continue in them, insurers say. The subsidy shutdown, as some call it, would be especially damaging to the newest insurance companies, for whom the majority of customers come from the federal marketplace, according to briefs filed with the court. If those companies exit the state or fail, competition and choice will be reduced not to mention care disrupted for their members.

A ruling against the Obama administration would be very consequential far beyond the people who would lose their subsidies, said Joel C. Cantor, director of the Rutgers Center for State Health Policy. It would have dramatic consequences for hospital finances and competition in the marketplace.

If the court ended subsidies and chose not to allow a transition period for officials to remedy the situation, there will be chaos in health insurance markets, millions will become uninsured and premiums will spike for millions more across the country, he said. This could happen as early as this summer.

Republicans have long fought the health overhaul as an overreach of government authority that they say drives up health costs, kills jobs and wastes taxpayer money. The most recent of dozens of votes in the House of Representatives to repeal it took place Feb. 3. The challenge to be heard by the justices this week initially was dismissed by the administration and its allies as an insubstantial threat.

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Supreme Court decision on health care subsidies could affect thousands in N.J.

VOL. 130 | NO. 41 | Monday, March 02, 2015

An Arizona-based real estate firm has acquired a Memphis mini-storage facility for $3.8 million.

Phoenix-based AMERCO Real Estate Co. bought the American Mini Storage facility at 7399 U.S. 64 from 7399 US Highway 64 Holdings LLC, which is affiliated with Florida-based LNR Partners Inc., for $3.8 million, according to a Feb. 24 warranty deed.

Built in 1999, the mini-storage site sits on 5.2 acres on the south side of U.S. 64 between Appling Road and Dromedary Drive. The Shelby County Assessor of Propertys 2014 appraisal is $2.7 million.

Source: The Daily News Online & Chandler Reports

Amos Maki

Louisiana Governor and possible presidential candidate Bobby Jindal will speak to Shelby County Republicans next month as part of a leadership series of events for the Tennessee Republican Party.

Jindal is the keynote speaker at the March 20 party fundraiser at the Racquet Club of Memphis.

Jindal is considering a bid for the Republican presidential nomination in 2016.

The Tennessee Republican Party is hosting former Florida Gov. Jeb Bush, another political figure weighing his chances in 2016, at the March 30 Statesmans Dinner in Nashville, the state partys largest annual event and fundraiser.

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Local Health Care Firm to Merge With Indianapolis Firm

WASHINGTON Four little words will make a world of difference when the Supreme Court considers a potentially disabling challenge to President Barack Obamas signature health care law Wednesday.

In a case that concerns language and politics more than the Constitution, the ideologically divided court must divine the meaning of one crucial but arguably ambiguous phrase in the 906-page law. Its future, and insurance coverage for millions of people, might hang in the balance, for neither the first nor the last time.

We will be seeing Affordable Care Act cases before the Supreme Court for decades to come, predicted Jonathan H. Adler, a Case Western Reserve University School of Law professor whos a leading critic of the law.

The oral argument Wednesday morning in King v. Burwell marks the latest return of the Affordable Care Act to the Supreme Court since 2012. Then, in a 5-4 decision authored by Chief Justice John Roberts Jr., the court upheld the laws individual mandate requiring people to buy health insurance or pay a penalty.

This time, too, Roberts might play an important swing role, as the self-appointed protector of the courts reputation.

And, as in 2012, the case has drawn an unusual number of kibitzers. Twenty-one amicus friend of the court briefs, some more trenchant than others, were filed supporting the challengers, and 31 defending the Obama administrations actions.

The Supreme Courts task this time is different from that in 2012 or in 2014, when a 5-4 majority ruled corporations could claim a religious exemption from a mandate to provide contraceptive coverage. Now, instead of determining whether Congress exceeded its constitutional authority in writing the health care law, the nine justices must interpret the statutes meaning.

Under the health care law, states are encouraged, but not required, to establish exchanges to offer one-stop shopping for insurance coverage. Obama has likened the exchanges to an online site such as Amazon, a place where consumers can compare plans.

As inducement, the law offers tax credits to those qualified by income who buy insurance through an exchange established by the State. The challenge turns on this phrase.

Driven primarily by Republican resistance, several dozen states declined to establish health insurance exchanges. Nevertheless, the Internal Revenue Service has extended tax-credit subsidies to residents in these states who buy insurance through the federal exchange, HealthCare.gov.

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Fate of health care law is in justices' hands again

Six days before the B.C. Supreme Court was set to begin a long-awaited trial that could alter the public health-care system in B.C. in fact, in Canada the provincial government uncovered new documents in its own files that forced another delay.

These are not just a few errant scraps of paper that were somehow overlooked in the past six years of pretrial wrangling, but thousands of pages of Ministry of Health documents that have just made their way to the surface. They relate to surgical waiting lists and physicians extra billing the core of the case about the place of private health care in B.C.

Since 2008, the province has sought to tackle illegal billing practices at two private health clinics run by Dr. Brian Day. All the while, the province has been paying annual penalties to Health Canada for violations of the Canada Health Act related to the practices it has not managed to stop.

Dr. Day has made no attempt to hide the fact that, for years, the Cambie Surgery Centre and Specialist Referral Clinic have been breaking the law by charging patients for medically necessary treatment. What is now before the courts is his Charter challenge that argues British Columbians should be allowed to use their own resources to jump to the front of the queue for medical treatment because waiting lists in the public health-care system are unacceptably long.

The trial was set to begin on Monday but now has been postponed as both sides examine the newly found ministry files.

NDP health critic Judy Darcy says she hopes the government will throw everything it can at Dr. Day, because if he wins, she believes, British Columbia will be opening the door to a new two-tiered health-care system for the country.

She isnt convinced the B.C. Liberals wanted to fight this battle.

I think the government is under tremendous pressure to defend the Canada Health Act, she said in an interview. But at least at the outset, the province needed some prodding to engage.

The B.C. Nurses Union led the charge in 2003, challenging the provincial government to enforce the law and stop private clinics from treading on public-health turf.

It was 2008 when the province finally sought an audit of the books of Dr. Days two clinics. The two sides then spent four years arguing about the scope of the audit. Finally, in 2012, the Medical Services Commission concluded the clinics were extra billing patients and threatened an injunction, which is still up in the air.

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New files could raise stakes in B.C.s health-care wait-list fight

WASHINGTON Officials in several Republican states that balked at participating in President Obama's health care initiative are revisiting the issue amid mounting panic over a possible Supreme Court decision that would revoke federal insurance subsidies for millions of Americans.

The discussions taking place in state capitals across the country are part of a flurry of planning and lobbying by officials, insurance and hospital executives and health care advocates to blunt the possible impact of a court ruling.

The justices hear arguments about the matter this week. If the court sides with the plaintiffs, who argue that subsidies are not allowed in the 34 states that opted against setting up their own insurance marketplaces, the ruling could spark an immediate crisis. People could see their insurance bills skyrocket or be forced to abruptly cancel their health insurance.

At least six states where Republican leaders had refused to set up state marketplaces under the Affordable Care Act are now considering what steps they might take to preserve the subsidies being paid to their residents.

Efforts to try to hold on to the subsidies are even under consideration in South Carolina, which supported the challenge now before the Supreme Court. South Carolina Gov. Nikki Haley, a Republican, said her state might consider setting up a marketplace, though it is unclear how such a proposal would fare in the staunchly conservative state.

We're going to start in this next week working on some things statewide, Haley, one of the health law's fiercest critics, said late last week.

A total of nine states now have bills under consideration to set up their own marketplaces, according to the National Conference of State Legislatures, though in some cases these efforts began even before the court accepted the subsidies case.

Lobbyists for insurers, hospitals and consumer groups are alerting legislators in some states to what they call the potentially disastrous consequences if the subsidies are suddenly revoked. In Pennsylvania, for example, hospitals and insurers are trying to coax the Republican-led Legislature to back a state marketplace if immediate action is needed to preserve the subsidies.

But there are enormous logistical and financial barriers to setting up a marketplace this late in the game, experts say. The states that have their own marketplaces took several years to set up the websites, contract with insurance companies and establish call centers. They did so with the help of hundreds of millions of dollars in federal grants that are no longer available.

Insurers are gaming out who is going to drop coverage, and how quickly, if the subsidies dry up. The companies have begun devising strategies to hold on to these customers. Insurers that did major hiring to handle the new business resulting from the marketplaces are figuring out whether layoffs might be needed.

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Supreme Courts health care law ruling worries 34 states

At 10 a.m. Wednesday, the Supreme Court will hold oral argumenton the latest legal challenge to the Affordable Care Act, the new federal health-care law. The oral arguments inKing v. Burwell will featuretwo high-profile lawyers, Michael A. Carvin of the Washington, D.C., law firm of Jones Day, for the challengers, and U.S. Solicitor General Donald B. Verrilli, Jr., defending the subsidy systemdesigned to help millions of consumersafford health insurance. The hearing is scheduled for one hour, but it may be allowed to run longer, especially since no other cases are up for argument that day.

Background

Five years ago, when Congress finishedwriting nearly athousand pages that would becomethe new national health-care law, it was well aware that the finished product would be subject to strong challenges. The Affordable Care Act was passed in both houses with not one Republican lawmaker voting for it. The day after it passed, Republicans introduced a bill to repeal it. The House has since voted some sixty times forrepeal.

Still, the law remains on the books, while controversy goes on,and the Supreme Court has now alloweditself back into the middle of the dispute, for the second time in three years.

Backers of the bill have always said it had three interlocking parts that were vital sometimes referred to as the three legs of a stool. The stool metaphor, they said, was apt: cut off any of the legs, and the thing would collapse.

One legwas not controversial with many people:insurance companiescouldno longer deny coverage or hike premiums just because a person had existingproblems heart disease, for example or a past history of such problems. Insurers, though, were heavily involved in writing the new law, and they were being assured a nationwide pool of customers for their business.

Another leg, to insure that there would be that nationwide pool, was a mandate that every individual in the country would have to buy health insurance or else pay a financial penalty with their tax return. That was the leg that challengers singled out three years ago, but a Supreme Court majority found a way to reinforce that leg constitutionally.

The third leg the one now under challenge in the Court created a system of tax credits, or subsidies, to enable middle- or lower-income people to afford health insurance. It would be available to individuals who did not have coverage through their jobs, and could not qualify for Medicare or Medicaid. They would shop for insurance on marketplaces (formally, exchanges) set up in every state, offeringa smorgasbord of supposedly affordable insurance plans.

If that leg is cut off, the supporters of the ACA have always argued, it would set off a death spiral death, here, in an economic sense. Unable to afford health insurance without a subsidy, millions of healthy people would lose their policies, and the shrinking of the healthy consumer pool would lead insurance companies to escalate premium prices spiraling into the death of the ACA.

The size of that threat may already be clear: in the latest sign-up period for health insurance under ACA, some 11.2 million Americans sought coverage, and eighty-sevenpercent of them did so with the support of a subsidy.

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Argument preview: Now, the third leg of the health-care stool

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