The healthcare reform law comes into effect piecemeal, as the provisions of so many laws do. Today, the first of 2011, marks the coming of age of new provisions. The most notable of first may be a national medical loss ratio cap.
Today , many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.
Thanks to the Affordable Care Act, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs, starting in 2011. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.
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Over 20 percent of consumers who purchase coverage in the individual market today are in plans that spend more than 30 cents of every premium dollar on administrative costs. An additional 25 percent of consumers in this market are in plans that spend between 25 and 30 cents of every premium dollar on administrative costs. And in some extreme cases, insurance plans spend more than 50 percent of every premium dollar on administrative costs. This regulation will help consumers get good value for their health insurance premium dollar.
Essentially the law requires 80% of premiums coming from individual plans to go to actual policyholder health care costs. For those in large employer based plans the law requires an even higher medical loss ratio of 85%. Dollars falling short of that must be given back to policy holders.
The law allows for the various states to ask for a waiver to individualize their medical loss ratio requirements. So far only Maine has done so.
MegaLife…threatened to leave Maine if the new loss ratio is imposed.
“Based on preliminary discussions I had with [MegaLife],” Kofman wrote in her July letter, “the company … would probably need to withdraw from this market if the minimum loss ratio requirement were increased.”
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In November, Sen. Olympia Snowe added her support to Kofman’s waiver request, reiterating the concern about losing what little competition exists for Maine’s individual insurance market. Still, there has been no answer from Washington, D.C. Snowe could not be reached Friday for comment.
To be fair a lot of states require certain medical loss ratios already, but few at levels like the Affordable Care Act requires. I’m not sure how tenable the medical loss ratio requirement will be at 80-85% if the individual health insurance mandate doesn’t survive come 2014.
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We All Know How I Feel About Reform, And The Medical Loss Ratio Requirements In Particular
There are other new provisions coming into force. Maybe none as significant as the national, standardized restrictions on what health insurers can spend their revenue on but important none the less. You can look over some of the other provisions here.
[...] recently talked about what changes came into effect on the New Year under the Affordable Care Act. One of the tangential things I didn’t comment on was an [...]
< HIV SitesJulian@DoctorLieb.com
HOPE
STIMULATING IMMUNE FUNCTION TO DEFEAT HIV
Stimulating defective immune function to perform efficiently is a desirable approach to defeating pathogens. Such stimulation is represented as unavailable, while in truth the immunostimulating properties of lithium and antidepressants were documented many years ago.1-4 A therapeutic claim is reinforced when the mechanism is known. Prostaglandins, when produced excessively, depress every component of immune function, and induce microbial replication. Wherever HIV comes into contact with arachidonic acid, an envelope glycoprotein powerfully converts this precursor to prostaglandin E2, depressing immune function and promoting viral replication, excessive prostaglandin E2 a leading candidate for the immunosuppression that is the hallmark of AIDS.5-7Antidepressants inhibit the synthesis of prostaglandin E2, antagonize its actions, and stimulate the primary prostaglandin-degrading enzyme.8-10
Collective evidence shows that lithium has immunostimulating, antiviral, and antibacterial properties,11 antidepressants immunostimulating, antiviral, antibacterial,1-4 anti-parasite, and fungicidal properties.12-15 Lithium is often effective for bacterial skin infections, aphthous ulcers, cold sores, and genital herpes,11 antidepressants for aphthous ulcers, cold sores, and genital herpes.11Tuberculosis, now the #1 killer of the HIV infected, is developing resistance to standard treatment. In the late nineteen forties, physicians working in tuberculosis sanitaria observed patients with elevations of mood and energy. Their charts revealed that all were taking the monoamine oxidase inhibitors isoniazid or iproniazid, an observation from which antidepressant therapy developed. If antituberculotics double as antidepressants, surely antidepressants must double as antituberculotics? The antimalarial properties of antidepressants in vitro are supported by many studies.12When added to antiretrovirals, antidepressants can reduce HIV viral loads to undetectable.16 The authors of this study attribute this to adherence, seemingly unaware of the antiviral properties of antidepressants. The advantage of immunostimulation is its non-specificity, a stimulated immune system indifferent to antigenicity.
People with intact immune function are relatively invulnerable to pathogens and toxins, compared to those with defective function. Depression is a seldom mentioned cause of defective immunity, although indices of immune function indicate that it does so.17In a study of 405 HIV-positive gay and bisexual men, those who reported being depressed throughout the eight-year study period, were two-thirds more likely to die than those who were never significantly depressed.18
Forty years ago, prostaglandins were shown to regulate immune function, and lithium and antidepressants to inhibit prostaglandins. Gradually, prostaglandins were found to regulate every aspect of HIV replication, and HIV to stimulate prostaglandin E2 production, to a greater degree than other viruses. This prostaglandin, when produced excessively, is thought to be responsible for the immune depression that is the hallmark of AIDS. Twenty five years ago, I believed that lithium and antidepressants could be used as heavy artillery against HIV, but when lithium failed to improve patients with AIDS in two small clinical trials, came to favor antidepressants for this purpose.19,20,21
1. Lieb J. Remission of herpes virus infection and immunopotentiation with lithium carbonate: inhibition of prostaglandin E1 synthesis by lithium may explain its antiviral, immunopotentiating, and antimanic properties. Biol Psychiatry 1981; 695-698.
2. Lieb J. Remission of rheumatoid arthritis and other disorders of immunity in patients taking monoamine oxidase inhibitors. Int J Immunopharmacol 1983; 5(4): 353-357.
3. Rosenthal S, Fitch W. The antiherpetic effects of phenelzine. J Clin Psychopharmacol 1987; 7(2):119.
4. Murphy D, Donnelly C, Moskowitz J. Inhibition by lithium of prostaglandin E1 and norepinephrine effects on cyclic adenosine monophosphate production in human platelets. Clin Pharmacol Ther 1973; 14(5):810-814.
5. Lee R. The influence of psychotropic drugs on prostaglandin biosynthesis. Prostaglandins 1974; 5(1):63-68.
6. Manku MS, Horrobin DF. Chloroquine, quinine, procaine, quinidine and clomipramine are prostaglandin agonists and antagonists. Prostaglandins 1976; 12: 789-801.
7. Mak O, Chen S. Effects of two antidepressant drugs imipramine and amitriptyline on the enzyme activity of 15-hydroxyprostaglandin dehydrogenase purified from brain, lung, liver and kidney of mouse. Prog Lipid Res 1986; 25: 153-155.
8. Fernandez-Cruz E, Gelpi E, Longo N, Gonzalez B, de la Morena, MT, Montes, MG, Rosello , J, Ramis I,Suarez A, Fernandez, A. Increased synthesis and production of prostaglandin E2 by monocytes from drug addicts with AIDS. AIDS 1989; 3: 93-96.
9. Wahl L, Corcoran M, Pyle S, Pyle SW, Arthur LO, Harel-Bellan A, Farrar WL. Human immunodeficiency virus glycoprotein (gp120) induction of monocyte arachidonic acid metabolites and interleukin 1. Proc. Natl Acad. Sci. USA 1989; 86:621-625.
10. Dumais N, Barbeau B, Olivier M, Tremblay MJ. Prostaglandin E2 up-regulates HIV-1 long terminal repeat-driven gene activity in T cells via NF-kappa B-dependent and – independent signaling pathways. J Biol Chem 1998; 273(42): 27306-27314
11. Dutta P, Pinto J, Rivlin R. Antimalarial properties of imipramine and amitriptyline. J Protozool 1990; 37(1): 54-58.
12. Lieb,J."The immunostimulating and antimicrobial properties of lithium and antidepressants." J Infection (2004) 49; 88-93
13. Lass-Florl C, Dierich MP, Fuchs D, Semenitz E, Ledochowski M. Antifungal activity against Candida sp. by the selective serotonin reuptake inhibitor sertraline. Clin Infect Dis 2001; 33(12):E135-136.
14. Munoz-Bellido J, Munoz-Criado S, Garcia-Rodriguez J. Antimicrobial activity of psychotropic drugs: selective serotonin reuptake inhibitors. Int J Antimicrob Agents 2000; 14(3): 177-180.
15. Tsai A, Weiser S, Petersen M, Ragland K, Bangsberg D. Effect of antidepressant medication treatment on ARV adherence and HIV-1 RNA viral load in HIV+ homeless and marginally housed individuals. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montreal, Canada. Abstract 584
16. Frank M, Hendricks S, Johnson D, Wiesler J L, Burke WJ. Antidepressants augment natural killer cell activity: in vivo and in vitro. Neuropsychobiology 1999; 39(1):18-24.
17. Mayne TJ, Vittinghoff E, Chesney MA, Barrett DC, Coates TJ. Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med. 1996 Oct 28; 156(19):2233-8.
18. Lieb,J."Stimulating immune function to kill viruses." (And bacteria, parasites, and fungi). 2009, Amazon
19. Evans DL, Ten Have TR, Douglas SD, Gettes DR, Morrison M, Chiappini MS, Brinker-Spence P, Job C, Mercer DE, Wang YL, Cruess D, Dube B, Dalen EA, Brown T, Bauer R, Petitto JMAssociation of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry. 2002 Oct; 159(10):1752-9.
20. Evans DL, Lynch KG, Benton T, Dube B, Gettes Tustin NB, Lai JP, Metsger D, Douglas SD Selective serotonin reuptake inhibitor and substance P antagonist enhancement of natural killer cell innate immunity in human immunodeficiency virus/ acquired immunodeficiency syndrome. Biol Psychiatry 2008 May 1:63(9):899-905. Epub 2007 Oct 22.
21. Benton T, Lynch K, Dube,B, Gettes DR, Tustin NB, Lai JP, Metsger DS, Blume J, Douglas SD, Evans DL. Selective Serotonin Reuptake Inhibitor Suppression of HIV Infectivity and Replication Psychosom Med 2010 Oct 14
Date: Dr. Lieb submitted Hope to HIVSites.com on December 3, 2010.
Disclaimer: This article is for educational purposes only. All treatment decisions to be made with a physician.
Retired Yale medical school professor
One of many resisted innovations.