PBM

While the Obama Administration ratchets up support for government-run healthcare, which would be a new entitlement program, the government trustees who monitor the nation’s two largest entitlement programs, Medicare and Social Security, have reported that they are both less than a decade away from insolvency. 

Congress is poised to pass a massive expansion of the State Children’s Health Insurance Program (SCHIP).  Originally, SCHIP was designed to help low-income families who earn too much to qualify for Medicaid gain access to health insurance for their children.  However, under the bill currently being considered (H.R. 2), SCHIP’s income eligibility level would rise from the current 200 percent to at least 300 percent of the federal poverty level (FPL), or about $63,000 for a family of four.  In addition, some states don’t count certain types of income or have an approved waiver in order to boost eligibility for the program. 

The Centers for Medicare and Medicaid Services (CMS) released its most recent analysis of improper payments in the Medicare program on November 17, 2008.  The good news is that vigorous cost recovery programs have helped whittle the percentage of improper payments in the Medicare fee-for-service program from 3.9 percent in FY 2007 to 3.6 percent this year. 

When President Bush announced the beginning of the President’s Emergency Plan for Aids Relief (PEPFAR) during his 2003 State of the Union speech, the five-year, $15 billion measure was announced as “the largest commitment ever by any nation for an international health initiative dedicated to a single disease.”  Targeting 15 “focus countries,” most of which are in sub-Saharan Africa, the plan embraced a three-pronged strategy based around prevention, treatment and care.