1. Placing ads in newspapers, magazines or other publications
   Monetary cost: ranges from free to $50,000 Time cost: varies, depending on if your are creating your own ad Benefits: No one can predict if an ad will work or not.
2. Bookmarks/flyers/give aways Monetary cost: ranges from free and up, depends on Benefits: having something to give to someone during a conference or promotion setting is important; this reinforces your business but doesn’t necessarily mean they will purchase something from you.
3. 

   Postcards and letters Monetary cost: between 35 and 85 cents each to print and send Time cost: depends on how much of the printing and mailing you are doing yourself Benefits: alerts audience to new services, products or other information about your company and reinforces your business

Before you begin any printing advertising you may want to do a cost benefit analysis. A cost benefit analysis is done to determine how well, or how poorly, a planned action will turn out. Although a cost benefit analysis can be used for almost anything, it is most commonly done on financial questions. Since the cost benefit analysis relies on the addition of positive factors and the subtraction of negative ones to determine a net result, it is also known as running the numbers. A cost benefit analysis finds, quantifies, and adds all the positive factors. These are the benefits. Then it identifies, quantifies, and subtracts all the negatives, the costs. The difference between the two indicates whether the planned action is advisable. The real trick to doing a cost benefit analysis well is making sure you include all the costs and all the benefits and properly quantify them. You may have to try different things and figure out what works best for your business and what doesn’t. Adjust your time and money accordingly.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.

In the presidential campaign last year and in a letter to Congress last week, Mr. Obama called for a new “public health

insurance option,” which he said would compete with private insurers and keep them honest.

Speaker Nancy Pelosi of California said Wednesday that she supported that goal. “A bill will not come out of the House without a public option,” she said Wednesday on MSNBC.

But in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A.

does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

While not the political behemoth it once was, the association probably has more influence than any other group in the health care industry. Lawmakers seek its opinion and support whenever possible. It has repeatedly persuaded Congress to cancel or postpone cuts in Medicare payments to doctors, though it has not secured a “permanent fix.”

If the doctors are too aggressive in fighting the public plan, they risk alienating Democrats whose support they need for legislation to increase their Medicare fees.

The group has historically had a strong lobbying operation, supplemented by generous campaign donations. Since the 2000 election cycle, its political action committee has contributed $9.8 million to Congressional candidates, according to data from the Federal Election Commission and the Center for Responsive Politics. Republicans got more than Democrats in the four election cycles before 2008, when 56 percent went to Democrats.

Robert Gibbs, the White House press secretary, said that in his address to the group next week, Mr. Obama would “outline the case for health care reform and make clear why we can’t afford to wait another year, or another administration, to bring down costs that are crushing families, businesses and government.”

Mr. Gibbs did not say whether Mr. Obama would discuss a public insurance plan, the most contentious issue in the debate.

The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals. In recent years, some doctors have become so fed up with the administrative hassles of private insurance that they are looking for alternatives.

Until now, stakeholders in the health care industry have generally muted their criticism of Democratic proposals. But as details of the legislation have emerged, the criticism has become more pointed.

America’s Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could “dismantle employer-based coverage and significantly increase costs for those who remain in private coverage.”

Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.

The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”

“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”

In an interview, Dr. Nancy H. Nielsen, president of the American Medical Association, said she was delighted by Mr. Obama’s plan to address the doctors.

“Health care reform is as important to us as it is to him,” Dr. Nielsen said. “We will be engaged in discussions in a constructive way. But we absolutely oppose government control of health care decisions or mandatory physician participation in any insurance plan.”

complete article at NY Times

The issue of cost containment is at center stage in the national discussion on modernizing health care, with a focus on attempting to find the necessary savings to fund coverage expansions. The new research paper provides policymakers and health care leaders with a range of “real world” savings options, based on empirical data and actual results from a selection of UnitedHealth Group programs. The report focuses on possible savings in future federal spending that could help fund health care reform legislation. Most of the savings estimates derive from applying more broadly the approaches UnitedHealth Group has found to work either in its commercially-insured or Medicare programs. The 15 cost-containment options are in four categories: incentivizing beneficiaries to use high-quality care providers, reducing avoidable and inappropriate care, supporting and incentivizing physicians to deliver high-quality appropriate care, and applying evidence-based standards to reimbursement policies. The report projects a number of areas where savings could be significant over the next 10 years including:

• $166 billion could be saved by reducing the need for people living in nursing homes to be admitted to a hospital. 

• $55 billion could be saved by reducing seniors’ avoidable readmissions to hospitals partly by providing “transitional care” support.

• $37 billion could be saved through voluntary programs that help seniors choose to receive care from high quality and efficient care providers.

UnitedHealth Center for Health Reform and Modernization Releases First Research Paper

The cost containment working paper is the first publicly-available product of UnitedHealth Group’s new Center for Health Reform and Modernization, a long-term commitment by the company to support those actively engaged in the modernization of the U.S. health care system. The Center will study and analyze leading health reform issues and develop innovative new solutions to the health care challenges facing the nation.  In addition, it will serve as a vehicle for UnitedHealth Group’s collaboration with external organizations, including the funding of relevant research.

The Center’s initial work program falls into six priority areas:

• Practical cost containment strategies to slow the growth of U.S. health care costs.

• Payment reform strategies that better support physicians, hospitals and other providers deliver high quality patient-centered care.

• Reducing health disparities, particularly in underserved communities.

• Innovative approaches to universal coverage and health benefits, grounded in evidence-based care and consumer engagement.

• Modernizing the care delivery system, including strengthening primary care.

• Modernizing Medicare, including chronic disease management and end-of-life care.

To learn more about the Center and to view the report on federal health care cost containment visit:  www.unitedhealthgroup.com/reform.

If an employer denies an employee’s request for the premium reduction because the employee was not involuntary terminated, can that employee still appeal?
Yes. Any individual who is denied treatment as an assistance eligible individual and thus denied eligibility for the COBRA subsidy may request an appeal of the denial. The U.S. Department of Labor will handle appeals related to private sector employer plans, and the Department of Health and Human Services will handle appeals for federal, state and local government employees.

Those departments will make a determination within 15 business days of receipt of a completed request for review.

Are dependents added at annual enrollment considered qualified beneficiaries eligible for the subsidy?
The only individuals who can be added during a period of COBRA coverage as qualified beneficiaries are newborns or adopted children of a covered or former employee.

Dependents that are added at annual enrollment are not qualified beneficiaries and are not eligible for the COBRA subsidy. Newborn or adopted children of a covered or former employee on COBRA must be added to the health plan within the proper timeframes as defined by the plan, but in no case less than 30 days from the date of the qualifying event.

There is an employee who elected COBRA for November and December of 2008 and then dropped coverage and still does not wish to take COBRA at this point. Do we need to send the employee a check to reimburse them for 65% of what they paid when they were on COBRA?
No, you do not need to reimburse the employee. The subsidy does not require reimbursement of fully paid COBRA premiums for any period of coverage that occurred prior to 2/17/09. However, you must still offer the person a second chance to enroll in COBRA if they were involuntarily terminated from employment.

Does the subsidy apply to medical and dental plans?
Yes, the COBRA subsidy is generally available for COBRA continuation coverage under any group health plan, including medical, dental and vision coverage, to name a few. However, it does not apply to a Flexible Spending Account offered under a cafeteria plan.

Several clients have recently asked about a new poster created by the DOL about COBRA coverage. Please click here to access the poster if you want to print and display it in your workplace.

THE WHITE HOUSE

Office of the Press Secrectary
___________________________________________________________
For Immediate Release                                            April 9, 2009

President Obama Announces the Creation of a Joint Virtual Lifetime Electronic Record

Taking Care of America’s Greatest Strategic Asset and Improving the Health Care System for America’s Veterans

WASHINGTON – Today, the President, along with Secretary Gates and Secretary Shinseki, announced that the Department of Defense and the Department of Veterans Affairs have taken the first step in creating a Joint Virtual Lifetime Electronic Record. Currently, there is no comprehensive system in place that allows for a streamlined transition of health care records between DOD and the VA. Both Departments will work together to define and build a system that will ultimately contain administrative and medical information from the day an individual enters military service throughout their military career, and after they leave the military.

Access to electronic records is essential to modern health care delivery and the paperless administration of benefits. It provides a framework to ensure that all health care providers have all the information they need to deliver high-quality health care while reducing medical errors. The creation of this Joint Virtual Lifetime Record by the two organizations would take the next leap to delivering seamless, high-quality care, and serve as a model for the nation.

The President understands that those who serve and have served our country in uniform are America’s greatest strategic asset. The President’s commitment to the sacred trust we have with those who serve is clear in both the Department of Defense and the Department of Veterans Affairs budgets and in the strong leadership of Secretaries Gates and Shinseki.

The President believes that the quality of care that our veterans receive should never be hindered by budget delays. He has shared this concern with Secretary Shinseki, and they have worked together to support advanced funding of veterans medical care. What that means is a timely and predictable flow of funding from year to year, but more importantly, that means better care for our veterans. The President was pleased to see that the Senate-passed budget supported this concept in a bipartisan manner.

The Department of Defense Budget will:

• Fully protect and properly fund the growth in military end strength in the base budget. This means completing the growth in the Army and Marines while halting reductions in the Air Force and the Navy.
• Continue the steady growth in medical research and development by requesting $400 million more than last year.
• Recognize the critical and permanent nature of wounded, ill and injured, traumatic brain injury, and psychological health programs. This means institutionalizing and properly funding these efforts in the base budget and increasing overall spending by $300 million. The department will spend over $47 billion on healthcare in FY10.
• Increase funding by $200 million for improvements in child care, spousal support, lodging, and education.

The Department of Veterans Affairs Budget will:

• Increase funding for the Department of Veterans Affairs by $25 billion above baseline over the next five years.
• Dramatically increase funding for veterans health care.
• Expand eligibility for veterans’ health care to over 500,000 veterans who were previously denied care by 2013.
• Enhance outreach and services related to mental health care and cognitive injuries, including post-traumatic stress disorder and traumatic brain injury, with a focus on access for veterans in rural areas.
• Invest in better technology to deliver services and benefits to veterans with the quality and efficiency they deserve.
• Provide greater benefits to veterans who are medically retired from service.
• Combat homelessness by safeguarding vulnerable veterans.
• Facilitate timely implementation of the comprehensive education benefits that veterans earn through their dedicated military service.

Experts worry that the highest unemployment rate in 16 years, combined with a health care system dependent on employer-sponsored health insurance is a recipe for disaster, and will swell the ranks of the uninsured, particularly if people aren’t using COBRA.  About 46 million people in the United States (18 percent of thes under 65) lacked health insurance in 2007.

The new report is based on a 2007 survey of 3,501 people.  The researchers found that two-thirds of workers, if they were laid off, would be eligible for COBRA.  Data from 2006 suggest that only 9 percent would opt into the program.

COBRA (Consolidated Omnibus Budget Reconcilliation Act) was passed in 1985 to allow laid-off workers to continue their health insurance if they lost their job.  However, most employers pick up 75-80 percent of the tabe for their workers’ health insurance, and once a person has been laid off, the entire bill falls on the ex-employee’s shoulders.

The Commonwealth Fund estimates that the cost of COBRA is four to six times as high as what people pay when they are employed.

Because of it’s guaranteed-issue provision COBRA is attractive to departing employees who have pre-existing conditions and may be unable to obtain health insurance on their own.  As for the healthy majority, why would they opt for COBRA when they can obtain an individual policy, or at least a short-term policy while waiting for a new job opportunity to arise or for the waiting period to expire on their newly found position.

While sponsors of health care price and quality transparency initiatives often identify all consumers as belonging to their target audience, the true markets for these programs are much more limited, the study found.

In 2007, only 11 percent of American adults looked for a new primary care physician.  Twenty-eight percent needed a new specialist physician, and 16 percent underwtnt a medical procedure at a new facility, according to findings from HSC’s 2007 “Health Tracing Household Survey,” containing information on 13,500 adults.

When selecting new primary care physicians, half of all consumers relied on word-of-mouth recommendations from friends and relatives, but many also used doctor recommendations (38 percent) and health plan information (35 percent), the study found.  Nearly two in five used multiple sources of information when choosing specialists and facilities for medical procedures, most consumers relied exclusively on physician referrals.

Use of online provider information was also low, ranging from 3 percent for consuemers who were undergoing procedures to 7 percent for consumers who were choosing new specialists and 11 percent for consumers who were choosing new primary care physicians (PCPs).

About 35 million adults – nearly one in six – reported undergoing a medical procedure at a new facility in the past year.  Nearly three in four consumers who had procedurs relied on the referral of the physician performing the procedure; almost all of these consumers used no other source of information.

Here are some key highlights:

• COBRA: Health Insurance Continuation Subsidy. The IRS has extensive guidance for employers, including an updated Form 941, as well as information for qualifying individuals.
• First-Time Homebuyer Credit Expands. Homebuyers who purchase in 2009 can get a credit of up to $8,000 with no payback requirement.
• Payroll Checks Increase This Spring. The Making Work Pay Tax Credit will mean $400 to $800 for many Americans. The IRS has issued new withholding tables for employers.
• $250 for Social Security Recipients, Veterans and Railroad Retirees. The Economic Recovery Payment will be paid by the Social Security Administration, Department of Veterans Affairs and the Railroad Retirement Board.
• Money Back for New Vehicle Purchases. Taxpayers who buy certain new vehicles in 2009 can deduct the state and local sales taxes they paid.

More information on these and other provisions of the recovery program will be available on this Web site, IRS.gov, as it become available.

Following are a few general questions and answers regarding the new recovery package:

Could the new law affect 2008 tax returns? Generally, no. The new law does not have any major impact for the vast majority of individuals preparing their 2008 tax returns due April 15. Instead, these changes will largely impact 2009 tax returns filed next year, in 2010. Taxpayers should continue to prepare their 2008 tax returns as they normally would.

There are a few limited areas in the law that could impact 2008 tax returns. For some small businesses, changes in the net operating loss provisions could affect 2008 tax returns. And for first-time homebuyers there is an expanded credit available on 2008 tax returns.

Does this new recovery program have any impact on the recovery rebate credit for 2008 tax returns being filed now? No. But the IRS reminds taxpayers and tax preparers to make sure they properly determine eligibility for the recovery rebate credit before they file their 2008 federal tax returns.

Where are more details on the tax provisions of the recovery law?
The IRS will be providing more details on this web site as they become available. A summary of the key provisions is available from the Senate Finance and House Ways and Means committees.