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Dedicated Insurance Professionals you know and trust...like Family |
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Issue No. 23 |
November 20, 2012
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Greetings!
The Road to 270. After months of campaigning between President Barack Obama and Governor Mitt Romney, the American people have reelected Barack Obama, giving our current President four more years in the White House. Barack Obama, 51, is now the 44th President
of the US, the 4th Democrat in the last 100 years to be elected to a 2nd term. And in a race dominated from the outset by the economy, the Affordable Care Act has now become law.
Timeline:
On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond.
Coming in 2013: Affordable Insurance Exchanges An Exchange is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Open enrollment begins in the Fall of 2013.
Coming in 2014: Tax Credits for Families Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage.
TACT continues to work on your behalf. We will do our best to keep you informed and up to date with the latest in healthcare news. Should you have any questions or concerns, your calls are always welcome.
TACT - Dedicated Insurance Professionals
you know and trust...like Family. |
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Healthcare -
The Law and You
TACT recognizes that the new healthcare law leaves the majority in wonder and still asking many questions. However, the health care law offers clear choices for consumers and provides new ways to hold insurance companies accountable. The most important parts of the law are broken into groups with new features of the law here as they roll out between now and 2014. The information below presents an overview of the different groups affected.
What's Changing and When? Click to view an easy to read timeline.
Information for You:
Families with Children
The health care law expands your family's options for health coverage and makes health care more affordable.
Clinicians
The law enacts comprehensive reforms that benefit clinicians.
Individuals
Whether you are healthy or have a health condition, the law includes strong new protections that include allowing you to appeal denied claims and providing help with your insurance through the Consumer Assistance Program.
People with Disabilities
Find out about programs that cover pre-existing conditions, eligibility for Medicaid, and options for long-term care.
Pregnant Women
Learn about coverage options that are available now for you and your child.
Seniors
The law gives seniors new preventive benefits, prescription drug discounts and more options for long-term care.
Small Business
Your business may be eligible for tax credits to help offset the cost of health insurance.
Women
The law provides women with important health benefits and features comprehensive new guidelines for women's preventive services.
Young Adults
You may be eligible for coverage on your parent's plan if you are under age 26.
Use the interactive FAQ tool at answers.healthcare.gov to find answers to your questions about health care and insurance. Also, find out how the health care law is being carried out across the country by clicking here.
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The Fate of Obamacare
After Reelection
Love it or hate it, Obamacare, the biggest health reform law of our generation, is here to stay, and we need to learn how to implement and improve it.
Op~ed piece by Manoj Jain - The Huffington Post
Our health system is like a car with three flat tires: Millions lack health coverage, quality is inconsistent and costs are unsustainable.
The Affordable Care Act, or ACA, the formal name of Obamacare, helps bring some crucial repairs. In fact, over the next decade, health care will change dramatically -- unlike any change we have seen over the past 50 years. These titanic shifts will be both from the inside, how hospitals, doctors and insurance companies deliver care and receive payment for providing care, and from the outside, how you, the patients, pay for and receive health care.
Coverage
The single largest achievement of ACA is heath insurance reform. Over the next several years, 32 millions Americans will be added to the insurance pool and greater regulations will be placed on insurance companies. No longer will insurers be able to cherry pick healthy individuals for coverage and reject those with pre-existing conditions. And insurers will be required to use 80 percent or more of our premiums for patient care or give us a refund. This summer, $1.1 billion was returned to 12.8 million Americans.
But now the health care debate has shifted. Individual states are in the driver's seat for the next step of the health care reform law. Governors and the legislatures will decide if they want to expand Medicaid and/or create a state insurance exchange. Exchanges are a one-stop shop for health care plans, where consumers can compare benefits and prices.
While those with private insurance and Medicare can keep their insurance, others, especially those families earning less than $80,000, can purchase insurance from exchanges with government subsidies. Small businesses can also purchase insurance through separate state run exchanges. Over time nearly one is three Americans will receive insurance from Medicaid or these exchanges.
Quality
Another area of reform for ACA is quality. The new mantra in health care is value-based purchasing, VBP, and transparency. VBP means that a small percent of payments will be given or withheld to hospitals and doctors based on their performance and patient satisfaction scores. The first set of payment or penalties to hospitals went out last month.
Also, there will be more transparency in hospital and physician performance. Soon we will know performance data on hospitals and physicians. We know that transparency works in improving care. For example, in 2008 after Tennessee's legislature mandated that hospital infections due to central lines (catheters that go into the patients' veins) be publicly reported, we experienced a nearly 40 percent drop in our central line infection rates in intensive care units.
Cost
While the ACA has repaired the "tires" of insurance coverage and quality, it has left the issue of high cost of health care largely unaddressed. In fact, this is what most Americans who have health insurance fear the greatest.
If we wish to look into the future, we can look at Massachusetts, which has served as the model for the ACA. More than five years ago, Governor Romney signed the Massachusetts health law, and this lead to a significant drop in the number of individuals without insurance, but it also caused costs to spiral upward. This year, a staggering 54 percent of the Massachusetts state budget is going for health care, and premiums for their "bronze" plan have gone up nearly 60 percent to $275 per month over five years.
Yet the Massachusetts experiment may offer potential solutions. In February of 2011 the state began to transition from a fee-for-service to a global payment system for hospitals and doctors. Also, accountable care organizations, (ACOs) were encouraged. ACOs are local groups of health care providers and administrators who hold joint responsibly for spending and quality of care.
So when insurance companies wanted to raise premiums by 8 to 32 percent, Massachusetts Governor Deval Patrick refused. This cap on premiums angered insurance companies, doctors and hospitals, but it also arm-twisted them to align and alter the way they delivered care. Instead of fragmented care through visits to individual doctors' offices and hospitals, the physicians and hospitals joined to form "medical homes" and accountable care organizations (ACOs).The ACA does not mandate ACOs but does support them through pilot projects.
It is agreed that most of the cost savings will need to come at a local level, otherwise the specter of rationing and death panels comes into play in national debates.
It will ultimately be the patients, doctors and hospitals in a local community, with pressure from local businesses, who will need to take the initiate to cut waste and reduce cost and build capacity for the million of Americans who are newly insured.
We have moved to a new era in health care in America, and just as Medicare and Medicaid entered our vernacular in the 1960s and HMO in the 1990s now, 2010s will be the age of health exchanges, ACOs, value-based purchasing, and transparency.
Certainly we will have more patients covered on insurance and higher quality of care. What is to be seen is: Will the cost of care go down?
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Facebook Feature

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Obamacare, Employee
Health and Wellness and Associated Costs
Courtesy - The Huffington Post -
The Blog by Ilya Bernstein
A hard look at the evidence indicates that regardless of incentives provided by the new "law of the land", employee health and wellness programs are a positive intervention that benefits both individual health and corporations financial bottom line.
Conservative hopes of repealing the Affordable Care Act of 2009 were dissolved with the reelection of Barack Obama and House Speaker John Boehner conceding that Obamacare is now "the law of the land."
While he went on to explain that he is still against the law, his acceptance of the law was significant, given the Republican party's attempts to frustrate the act in virtually every stage of its passage.
Others opposed to the legislation, which will provide health insurance to about 32 million Americans in 2016, have begun publicly sharing their strategies for circumventing the new law. The most prominently reported on have been Papa John's CEO John Schnatter's claims that his company will be forced to raise prices by $0.11 to $0.14 per pizza, and reduce his employees' hours to less than the 30 per week that requires employers provide health care.
While contributing to underemployment in America may be an option for the restaurant industry, many other businesses, such as those who compete in a complex, global market and cannot simply increase prices, or those who depend on traditional "nine-to-five" work schedules, may not be able to adapt to the Affordable Care Act this way. These employers have little option but to absorb the cost of providing insurance for their employees.
However, by simultaneously investing in also "Employer-Based Wellness Programs," as encouraged by Section 4303 of the ACA, employers can minimize the fiscal effect of this new policy on their businesses. In fact, a 2010 report produced by economists at Harvard University showed that for every dollar spent on an employee wellness program, medical costs decreased by about $3.27 and costs related to employee absenteeism dropped by $2.73.
A more detailed look at employer-employee medical costs -- the total amount spent on health care by both employer and employee -- waspublished this month in the journal Health Affairs. The authors followed a group of 92,486 employees for an average of approximately three years, administering a 47-question survey, as well as record some basic biometric data, such as their blood pressure, cholesterol levels, and so on.
After adjusting for age, gender, and industry, among other things, the findings indicate that nearly a quarter of all employer-employee medical costs are related to a handful of characteristics that can be changed by employer-based wellness programs. The biggest offenders, according to the report, were having a body weight below or above normal limits, which raised an employee's total health cost by 27.4 percent; high blood pressure, an increased cost of 31.6 percent, high blood sugar, an increase of 31.8 percent, and most significantly, depression, which increased employer-employee health costs by an astounding 48 percent.
Additionally, some employees may have more than one condition, thereby compounding their increased cost. The authors are careful to note, though, that changing employment policies based on applicants' health is not only unwise, given that these are all increasingly common conditions in the United States, but also illegal. Thus, rather than screen these individuals, it is of more benefit to employers to design programs that aid employees in becoming healthier individuals, both physically and mentally.
In addition to the aforementioned return on employer investment and improving the health of employees, it may also help companies attract top talent. For the fourth consecutive year, Google, a company renowned for employee perks which include a fitness facility and on-site medical care, was the first choice employeer for business graduates from all over the globe.
A hard look at the evidence indicates that regardless of incentives provided by the new "law of the land," employee health and wellness programs are a positive intervention that benefits both individual health and corporations financial bottom line.
This story is also featured on TACT's Facebook page.
Related Story -
The official pizza of the Dallas Cowboys, Papa John's is about to raise prices. Why? Obamacare.
Click here to read the story in its entirety or visit our Facebook page by clicking the link below!
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Ten Tips to Healthy Holiday Eating
- Be realistic. Don't try to lose pounds during the holidays, instead try to maintain your current weight.
- Plan time for exercise. Exercise helps relieve holiday stress
and prevent weight gain. A moderate and daily increase in exercise can help partially offset increased holiday eating. Try 10- or 15-minute brisk walks twice a day.
- Don't skip meals. Before leaving for a party, eat a light snack like raw vegetables or a piece of fruit to curb your appetite. You will be less tempted to over-indulge.
- Survey party buffets before filling your plate. Choose your favorite foods and skip your least favorite. Include vegetables and fruits to keep your plate balanced.
- Eat until you are satisfied, not stuffed. Savor your favorite holiday treats while eating small portions. Sit down, get comfortable, and enjoy.
- Be careful with beverages. Alcohol can lessen inhibitions and induce overeating; non-alcoholic beverages can be full of calories and sugar.
- If you overeat at one meal go light on the next. It takes 500 calories per day (or 3,500 calories per week) above your normal/maintenance consumption to gain one pound. It is impossible to gain weight from one piece of pie!
- Take the focus off food. Turn candy and cookie making time into non-edible projects like making wreaths, dough art decorations or a gingerbread house. Plan group activities with family and friends that aren't all about food. Try serving a holiday meal to the community, playing games or going on a walking tour of decorated homes.
- Bring your own healthy dish to a holiday gathering.
- Practice Healthy Holiday Cooking. Preparing favorite dishes lower in fat and calories will help promote healthy holiday eating. Incorporate some of these simple-cooking tips in traditional holiday recipes to make them healthier.
- Gravy - Refrigerate the gravy to harden fat. Skim the fat off. This will save a whopping 56 gm of fat per cup.
- Dressing - Use a little less bread and add more onions, garlic, celery, and vegetables. Add fruits such as cranberries or apples. Moisten or flavor with low fat low sodium chicken or vegetable broth and applesauce.
- Turkey - Enjoy delicious, roasted turkey breast without the skin and save 11 grams of saturated fat per 3 oz serving.
- Green Bean Casserole - Cook fresh green beans with chucks of potatoes instead of cream soup. Top with almonds instead of fried onion rings.
- Mashed Potato - Use skim milk, chicken broth, garlic or garlic powder, and Parmesan cheese instead of whole milk and butter.
- Quick Holiday Nog - Four bananas, 1-1/2 cups skim milk or soymilk, 1-1/2 cups plain nonfat yogurt, 1/4 teaspoon rum extract, and ground nutmeg. Blend all ingredients except nutmeg. Puree until smooth. Top with nutmeg.
- Desserts - Make a crustless pumpkin pie. Substitute two egg whites for each whole egg in baked recipes. Replace heavy cream with evaporated skim milk in cheesecakes and cream pies. Top cakes with fresh fruit, fruit sauce, or a sprinkle of powdered sugar instead of fattening frosting.
Enjoy the holidays, plan a time for activity, incorporate healthy recipes into your holiday meals, and don't restrict yourself from enjoying your favorite holiday foods. In the long run, your mind and body will thank you.
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TACT Office Hours
For Thanksgiving
The Holiday Season is upon us! In celebration of Thanksgiving, allowing the TACT staff time for travel and holiday meal preparations, the TACT office will close at noon on Wednesday, November 21 and reopen Monday, November 26 at 8 a.m. Kimberly Holcomb and Cisti Pinkert will be available via cell phone, should assistance be needed outside of these hours. TACT wishes you and your families a very Happy Thanksgiving and a wonderful start to the Christmas season.
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Texas Ag Coop Trust
1802 East 50th St., Ste. 107
Lubbock, TX 79404 806-747-7894
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Texas Ag Coop Trust
Officers, Board of Trustees
George Reed, Chairman United Farm Industries Plainview, TX
Gregg Allen, Secretary Olton Grain Coop Olton, TX
Bret Brown, Treasurer Sunray Coop Sunray, TX
Jim Turner Dalhart Consumers Fuel Association Dalhart, TX
Paul Wilson United Cotton Growers Levelland, TX
Cary Eubanks Slaton Coop Gin Slaton, TX
Dean Sasser Farmers Coop Elevator Levelland, TX
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Reminder!
Prescription Benefit Changes!
Changes have been made to the Preferred Drug Formulary, and the formulary status of several drug products will change effective January 1, 2013. TACT encourages you to review the benefit changes, as they may affect you and your covered dependents. Drug products are evaluated on multiple factors, including safety profile, therapeutic impact, medical necessity and cost-effectiveness. All decisions are based on WellDyneRx's goal of providing the most appropriate and effective therapy at the lowest net cost.
Formulary Changes
During the most recent Pharmacy and Therapeutics (P&T) Committee review process, decisions related to existing drug products were made. For your convenience, we have a list of the changes and provided possible preferred alternatives when appropriate. This is not an all-inclusive list, and formulary changes may occur throughout the year. Benefit designs may vary with respect to drug coverage, quantity limits, step therapy, days supply and prior authorization.
Please contact the WellDyneRx Member Service Department at the number indicated on your member card if you have questions regarding your coverage. You may contact the TACT office for a faxed copy of the drug listings or for a complete listing of the drug formulary and preferred products, please see the updated electronic version of the WellDyneRx Preferred Drug Formulary online at www.welldynerx.com. TACT - Dedicated Insurance Professionals
you know and trust...like Family.
Next Issue: December 4, 2012
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