Cara Paling Cepat Meningkatkan Trafik Blog

Cara Paling Cepat Meningkatkan Trafik Blog | Menjadikan Posisi Blog Nomor Satu Di Googl

Heii Sobat Blogger. Butuh Traffik tinggi dan cepat kan, munkin sobat sudah lelah cari solusi supaya bisa diposisi 1 google dengan cepat ya.hadeh, Jangan Putus asa donk, Tetap semangat okay, saya kasih solusi tepat buat sobat ni, Gratis dan terbukti.Cara ini buat anda yang benar-benar butuh trafick tinggi.
Number one search engine Cara Cepat Blog Nomor Satu di Google

Saran saya….halaman ini sebaiknya anda save dulu. Dan luangkan waktu untuk membacanya saat off-line.Jika anda tidak butuh trafik, anda boleh meninggalkan halaman ini, Namun, jika anda sangat butuh trafik ada baiknya anda membaca artikel ini sampai selesai…

Kemarin waktu saya berkunjung ke blog sahabat, saya membaca artikel ini yang membuat saya tertarik untuk mencobanya dan untuk mencobanya saya copy paste artikel ini.

Dalam artikel ini saya akan memperkenalkan kepada anda sebuah system viral link. Saya sudah banyak menerima tawaran viral link, dan semuanya saya tolak. Mengapa? Saya menolak karena viral link yang datang selama ini memiliki banyak kelemahan. Hal itu dikarenakan Viral link dibuat oleh orang-perorang dalam bentuk artikel. Namun, baru-baru ini saya bertemu dengan system ini secara tidak sengaja, dan setelah saya pelajari sistem viral link ini menutupi kelemahan mayoritas viral link selama ini.

Baiklah, sudah cukup berbicara tentang saya. Sekarang kita akan berbicara mengenai keuntungan yang dapat ditawarkan oleh sistem ini kepada anda. Namun sebelum anda lanjut, mungkin anda bertanya-tanya mengapa anda membutuhkan trafik? Inilah alasannya:

1.Trafik adalah salah satu indikator yang digunakan google dan search engine lainnya untuk menentukan seberapa penting blog atau website anda.

2. Trafik juga menjadi indikator bahwa blog anda adalah blog yang terpercaya, sehingga anda akan jauh lebih mudah meraih posisi di halaman pertama Google.

3.Jika anda sedang mengikuti program posting berbayar maka anda amat sangat memerlukan trafik melebihi anda memerlukan Pagerank. Jika Alexa anda di atas 300.000, maka anda akan sangat mudah memenangkan bid (tawar menawar) dengan pengiklan.

Ok, akan sangat sulit bagi saya untuk menjelaskan kelebihan program ini, sebelum saya menjelaskan cara bermainnya. Saya pastikan cara ini lebih mudah daripada blogwalking setiap hari. Coba hitung berapa waktu yang anda habiskan setiap harinya untuk blogwalking??? Dan berapa banyak yang bisa anda undang setiap kali anda blogwalking? Saya juga blogwalking, dan mungkin itu akan menjadi kegiatan harian hanya untuk mempertahankan posisi alexa rank anda.
Di sistem ini ada beberapa tindakan yang perlu anda lakukan. Lakukanlah tanpa menutup halaman ini (soalnya ini adalah panduan bahasa Indonesia anda).
1.Segeralah menuju ke halaman dengan klikgambar di bawah ini.



2.Segeralah geser halaman dari webpage ini ke bawah sampai anda menemukan tampilan seperti ini (7 gambar thumbnails)seperti di bawah ini.



3.Klik kanan di setiap gambar thumbnails dan pilihlah pilihan untuk membuka di tab baru (open in a new tab). Sehingga terbuka 7 tab baru
4.Di atas jendela setiap Tab akan ada Bar berwarna biru dengan tulisan “AD CODE GENERATION….please wait”. Tunggulah sampai muncul kode angka.


5.Letakkan kode angka yang anda temukan sesuai urutan pada kolom-kolom di bawah gambar


6.Masukkan data anda pada formulir berikut dan klik submit

7.Buka alamat e-mail yang anda masukkan pada formulir tadi dan cari e-mail dari 1millionfreehits.com. Isi e-mail

8.Lalu klik link yang dilingkari merah
9.Anda akan masuk ke halaman ucapan selamat ini
10.Catat ID dan Password anda kemudian klik MEMBER ADMIN AREA yang dilingkari merah
11.Anda akan masuk ke halaman login ini

Masukkan ID dan Password anda kemudian klik submit. Anda akan dibawa ke halaman berikut….
Yang dilingkari merah adalah URL keanggotaan anda yang perlu anda catat. Kemudian yang berwarna biru adalah kotak yang dapat anda gunakan untuk memantau perkembangan sistem anda.

Tampilan inilah yang akan anda gunakan untuk mengukur pertumbuhan sistem ini.

Sekarang anda perlu mempromosikan link keanggotaan anda, layaknya viral service yang lain. Buatlah blog seperti yang sedang anda baca saat ini. Blognya haruslah blog baru dan tidak ada hubungannya dengan blog yang anda ingin promosikan(PENTING!!!). Isilah blog itu dengan artikel semacam ini, tapi jika anda malas, silahkan Copy Paste artikel ini : )
Berapa banyak trafik dari kerja keras kita itu:
Perhatikanlah bahwa ada 6 thumbnail, setiap kali ada yang mendaftar maka dia akan menempati urutan pertama, dan jika ada referal baru mendaftar dia akan turun ke peringkat 2, dst. Anggap saja masing-masing kita mengajak 10 orang saja (sangat mungkin lebih), maka jumlah kunjungan dan backlink anda adalah:

Di posisi 1: 10 link dan kunjungan
Di posisi 2: 100 link dan kunjungan
Di posisi 3: 1000 link dan kunjungan
Di posisi 4: 10000 link dan kunjungan
Di posisi 5: 100000 link dan kunjungan
Di posisi 6: 1000000 link dan kunjungan

Bisakah anda membayangkan jika blog anda dikunjungi 1.000.000 orang dan mendapat 1.000.000 backlink (one-way backlink!). Berapa alexa rank, pagerank dan link popularity anda? Luar biasa besarnya! Tidak akan ada yang menolak bid anda. Banyak yang akan meminta memasang iklan di blog anda, dan itu berarti income dalam jumlah yang besar. Hanya saja anda memang perlu repot melakukan yang diterangkan di sini.

Perhatian: sifat sistem ini mirip bisnis jaringan tapi sebenarnya sangat berbeda, karena tidak akan ada istilah jenuh. Mengapa? Karena setiap saat muncul blog baru, bahkan anda bisa menjadi anggota dari anggota anda sendiri, dengan mendaftarkan blog yang berbeda. Dengan kata lain skemanya bukan piramid melainkan jaring laba-laba

Dapatkah anda melihat angka di atas? Banyak artikel viral link yang diedarkan mengatakan bisa mendapat jutaan link padahal mereka hanya bermain di Indonesia. Blogger serius di Indonesia tidak sebanyak itu….

Backlink yang lebih berkualitas. Mengapa?
Apakah anda memperhatikan bahwa di atas anda diminta untuk membuat backlink dari blog utama anda ke halaman URL keanggotaan anda. Hal ini ditujukan untuk membantu search engine mengindeks halaman keanggotaan anda ini. Untuk 1 link keluar yang menuju URL keanggotaan anda ini, anda berpotensi mendapatkan 1.000.000 backlink yang one way backlink.

Apakah anda merugikan orang lain (mencuri Pagerank orang lain). Tentu tidak! Backlink anda akan berasal dari URL keanggotaan orang tersebut dan bukan berasal dari URL blog utama orang tersebut.

Berapa nilai Backlink dari halaman keanggotaan itu? Meskipun PRnya sangat kecil, namun karena jumlah link yang ada Cuma 7 biji, maka nilai PR yang ditawarkan lebih baik daripada PR yang diperoleh dari blog dengan PR2 yang memiliki 150 link dalam 1 halamannya (Peserta link exchange).

Apakah anda tahu bahwa artikel MLM backlink tidak banyak menguntungkan anda? Mengapa?

Artikel itu ditulis berulang-ulang dan anda harus mempostingnya pada blog utama anda. Bukanlah hal yang baik memiliki artikel yang ditulis berulang-ulang (plagiat) di dalam blog anda.
Link anda dipasang di artikel yang belum tentu akan terindeks oleh Google. Artinya belum tentu jadi backlink, dan sangat sulit mendatangkan trafik. (jarang yang mengklik)
Artikel MLM backlink belum tentu senada dengan tema blog anda, sehingga bisa mengganggu keyword anda saat masih menghuni homepage anda.
Sistem ini memberikan anda alat yang dapat anda gunakan untuk memantau perkembangan, berbeda dengan artikel MLM backlink yang tidak terpantau sama sekali.Jika anda benar-benar membutuhkan trafik dan backlink, maka menurut saya pribadi, cara ini bisa membantu anda. Tinggal mempromosikannya dengan baik ke minimal 10 orang. Jika anda benar-benar ingin melakukan semua prosedur ini, maka akan memakan waktu sekitar 1 jam, yang terdiri dari 10 menit pendaftaran, 20 menit membuat blog promosi, dan 30 menit untuk mempromosikannya ke teman-teman anda. Biarkanlah mereka menentukan apakah mereka membutuhkan Trafik dan Backlink ini. Namun jika anda membaca sampai di titik ini, maka tidak ada keraguan lagi anda MEMANG MEMBUTUHKAN TRAFIK DAN BACKLINK.

Untuk mempromosikan kepada blog anda… ketika anda ada di dalam login area, klik saja tulisan MARKETING CENTER dan nantinya akan ada kode html yang nantinya akan anda pasang di blog anda…

Semoga artikel ini bisa membantu kita untuk meningkatkan trafik Blog kita.

Health Care & Public Policy Books Worth Reading

Having served as a health care and public policy book reviewer for the independent New York Journal of Books, I thought I would share some of the "good reads," with you as NYJB is closing its site.
My latest review, "Breasts, A Natural and Unnatural History," by Florence Williams is featured on the banner page for the site. It is a historical, scientific, and anthropological review of breasts, sociologically, scientifically, and as a bell weather for toxins in our society. Florence Williams will be in Seattle this month reading from her book.
http://www.nyjournalofbooks.com/review/breasts-natural-and-unnatural-history
The best book I have read about the long term problems in United States health care delivery and what the 2010 reforms may mean is "The Battle Over Health Care, What Obama's Reforms Mean," by Rosemary Gibson and Janardan Prasad Singh. Singh is an economist with the World Bank and Gibson is formerly with the Robert Wood Johnson Foundation, so the book is a nonpartisan review.
 http://www.nyjournalofbooks.com/review/battle-over-health-care-what-obama%E2%80%99s-reform-means-america%E2%80%99s-future
Another health care book I highly recommend was written by, Jonathan Wolff, Director of Philosophy, Justice, and Health at University College in London, is "The Human Right To Health," an Amnesty International Global Ethics Series, which explores global health and some of the perversions that happen because of self interest and misguided efforts of public/nonprofit entities.
 http://www.nyjournalofbooks.com/review/human-right-health-amnesty-international-global-ethics-series
Health Professionals and Trust: The Cure for Health Care Law and Policy, by Mark Henaghan, a New Zealand Professor shines the light on how government rules and their administration can interfere with patient safety, among other health care conundrums.
 http://www.nyjournalofbooks.com/review/health-professionals-and-trust-cure-health-care-law-and-policy
El Narco, by Ion Grillo lays bare the morass of the U.S. financed war-on-drugs and is one heck-of-a-ride. Grillo traveled throughout North America, Central America, and South America to research this book.
http://www.nyjournalofbooks.com/review/el-narco-inside-mexico%E2%80%99s-criminal-insurgency
And finally, Robert Pelton's, "Licensed to Kill, Hired Guns in the War on Terror," exposes how war and insurgency is financed globally and is highly profitable to a select few.
 http://www.nyjournalofbooks.com/review/licensed-kill-hired-guns-war-terror
Here is a nod to these thought provoking writers in a time of national attention deficit.
Thanks for reading my column and more importantly, thanks for reading books. To those of us who don't want to surrender our humanity to the "Snookies" of the world this is the healthpolicymaven encouraging you to buy books which raise our consciousness, not dull it

Why We Don't Want To Get Rid of Medicare-Our Best Tool for Health Care Reform

Why We Don’t Want To Get Rid of Medicare-Our Best Tool for Health Care Reform

The pressure is on for federal budget slashing and of course social programs (not defense) are top-of-the-list for cost reductions, including the malignant call for block granting the Medicare program. Having previously analyzed the Bush Administration’s Deficit Reduction Act of 2005, including the odious federal government, “claw back provision” for reducing federal contributions for state Medicaid programs, this article reviews some potential impacts of a block grant or per capita allowance for Medicare participants. Parallels are drawn between the Medicaid changes and what may happen to Medicare if it is schlepped to the states. Finally, Medicare’s impact on overall health care policy making in the United States is analyzed.

Would Block Granting Medicare Look like the Medicaid 1115 Waiver Plans?

As of 2005, half the states already had approved Medicaid 1115 plans including: Alabama, Arizona, Arkansas, California, Colorado, The District of Columbia, Florida, Georgia, Idaho, Illinois, Maine, Massachusetts, Michigan, Missouri, New Jersey, New Mexico, New York, Oregon, Puerto Rico, South Carolina, Tennessee, Texas, Utah, and Washington. Oregon is famous for its health care plan which assesses a clinical and cost/benefit value for treatments covered by its subsidized public health care program. Most of the other states with Medicare 1115 Plans have eliminated benefits under the programs or drastically cut enrollment for poor residents. By example, Missouri eliminated 500,000 people from its Medicaid program. Many of the states with Section 1115 waivers used the provision to charge co-payments and premiums to certain Medicaid eligible constituents.

Impact on Drug Costs-Zip

In addition to cutting back on benefits, one of the trends for state implementation of Medicaid 1115 Waiver Programs is to pass more of the prescription drug costs to their plan participants. This does nothing to contain costs and merely makes low-income people pay more for their medicines. Medicare is also doing this with its drug program, by allowing pharmaceutical companies to charge retail market prices (the highest-in-the-world) for drugs while offering “discounts” to Medicare participants. It doesn’t take a rocket scientist to figure out that the pharmaceutical companies just raise their prices to include the “discounts” to the Medicare set.

Side effects of Medicaid 1115 Waiver Programs

Deferring Health Care

One of the provisions that Medicaid 1115 Opt-Out Plans can make, is to transfer more plan costs to the poor who are enrolled on these plans, however, that may mean people avoid medical care. This is a conundrum, though Medicaid enrollees have health insurance, they may not have enough money to contribute to the co-payment requirement. The Journal of Health Affairs published an analysis of the Utah State Medicaid program which showed that cost sharing up to 10% did have a negative impact on the indigent patient’s ability to obtain health care (AKA they deferred treatment).[1]. 

Clinician Access

Patients enrolled on Medicaid plans have insurance, but may not have a primary care clinician who will see them. Merely having insurance does not mean there are clinicians willing to accept those patients.  Medicaid has notoriously been viewed as paying poorly for medical services, although some states have taken steps to alleviate that road block to care. This problem of access to clinical care, especially for wellness or primary care is also rampant for Medicare participants. If they don’t have private insurance, it is very difficult for a Medicare patient to find a clinician who will accept them into their patient mix. This phenomenon is reflective of the poor reimbursement CMS provides for its primary care clinicians.

Another one of the methods that states have used 1115-Waiver provisions to change their Medicaid plans is to offer private insurance coverage, but this is hardly more cost effective, since the administration costs are three times as high as what the Centers for Medicare and Medicaid (CMS) charge, with no cost containment. This could however increase access to doctors who are willing to treat Medicaid patients.

Medicare as the Policymaker for Health Care Treatment and Payment

CMS, which administers health care for Medicare and Medicaid, is by far the largest health care program in the United States. Administrative cost for CMS run about 6%, as opposed to 18% for the private insurance sector. In addition to administering health care programs for the elderly and the poor, two constituents whom the private insurance sector has historically had little interest in insuring, CMS also finances demonstration projects with clinics throughout the country to figure out how to improve health care. An example of such a project is the Advanced Primary Care Demonstration Initiative[2], which is looking at patient-clinician engagement to improve health outcomes and pay clinicians for coordinating well patient care. There are also similar projects for the Accountable Care mandates, which reward clinics that produce better clinical results than those who are more marginal. These efforts are possible with a large enough patient population and an integrated patient tracking system, which coincidentally, is representative of a national health care program.

Fraud Detection-The Government Has the Bigger Stick

Medicare is the number one detector of fraudulent billing for health services in the country and it is essential that this bully pulpit be preserved. In The Battle Over Health Care[3], big pharmacy is now cited as the number one defrauder of the government and hence the United States people, even ahead of the perennial defense industry. Do any of us really trust the drug companies to police themselves, or for that matter any of the medical suppliers? In a fragmented Medicare system fraud detection would be more difficult not less.

Patient Safety-Do You Want to Leave it up to the Private Sector?

 In Rosemary Gibson’s and Janardan Prasad Singh’s brilliant, The Battle Over Health Care, numerous frightening examples abound of drug company, medical device supplier, and hospitals actually harming patients. Perhaps most egregious are the methods some of these companies (most of the abusers are for-profits) use to avoid accountability when they harm patients. A bright spot on this tarnished map is the University of Michigan Health Systems, which has a protocol mandating that its clinicians/facilities which harm patients; take responsibility, offer transparent information on what occurred, offer a settlement to the patient/family(without litigation), apologize, and provider free ongoing health care.[4]It is this type of candor which would go a long way toward improving patient safety in American health care. Imagine clinicians and hospital administrators who fess up rather than lawyer-up.

Conclusion

Though Medicare certainly has its detractors and is not lithe when it comes to adopting changes, it is more economical than any private sector health insurance program, and it covers  high-risk populations like the elderly and those with end-stage renal disease. Medicare drives policy changes throughout the entire United States health care system by determining how it will pay for services. This is ultimately the way the country can start to reduce its health care costs, by negotiating with drug companies, eliminating fraud, and equally important, unnecessary procedures. Because Medicare changes also impact private sector insurance companies, it is an essential component of health reforms and well as other national health care initiatives. CMS, which administers both Medicare and Medicaid, provides the nationwide health care partnership to test and deploy health care program changes. Through this surveillance process we can learn what works for the disparate U.S. health care system and attempt to lower costs and improve not only primary health care, but also preventive care. Too much of the U.S. health care dollar is spent on late-stage disease treatment versus patient health maintenance. If we hope to be competitive in a world economy, we must bring the per capita cost of our health care in line with the rest of the world and turning it over to the private sector foxes is not the answer.

For more discussion on this health care article, feel free to comment below. This article was written by Roberta E. Winter, the healthpolicymaven, and may be reprinted with her permission. Feel free however to share it voraciously with your friends and family.

Also, for those who want to read more of The Battle Over Health Care go to the New York Journal of Books for my review, by following this link: http://www.nyjournalofbooks.com/review/battle-over-health-care-what-obama%E2%80%99s-reform-means-america%E2%80%99s-future

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[1] http://content.healthaffairs.org/content/25/2/532.full

Samantha Artiga, David Rosseau, Barbara Lyons, Stephen Smith, and Daniel Gaylin, Can States Stretch the Medicaid Dollar Without Passing the Buck? Lessons from Utah, Health Aff., March 26, 2006, vol. 25, no. 2. p. 532-540

[2] http://healthreform.gov/newsroom/factsheet/medicalhomes.html

[3]Rosemary Gibson and Janardan Prasad Singh, The Battle Over Health Care, chapter 2, page 24

[4]Rosemary Gibson and Janardan Prasad Singh, The Battle Over Health Care, chapter 13, page 163

3 Big Mistakes Affiliate Marketer And How To Prevent

3 Big Mistakes Affiliate Marketer and How to Prevent


Affiliate Marketing is one effective and powerful way to monetize online from the Internet. But just like a business, there are many pitfalls that can make us lose the run Affiliate Marketing Business.


Therefore, in this occasion I would like to share with friends all about : 3 Big Mistakes Affiliate Marketer and How to prevent it. Errors that may often occur done, it would be very detrimental to us if not immediately detected and avoided.

Here are three fundamental errors that we need to know and be avoided :

1. Choosing One Affiliate Program

Not a few people who want to earn money in a way that instantly and quickly as possible. With this attitude in a hurry, the Starter immediately joined the business being "HOT", aka the rapidly growing business, or Business is Booming, or also commonly called the Business bandwagon.

I did not say do not join the business being sold, but I'm trying to explain here is Join the business that really match your interest. That's it.

For every business that we do, of course, we need to take the time to make a plan and determine what we need to do. In this case, to promote more products you like and you are interested, it will be much easier and enjoyable than promoting products that only with the motivation of money alone.


2. Too Much Registration in Multiple Programs

Right, because it is a way to earn revenue through multiple channels. But remember, it also will reduce our concentration in every program that we follow. As a result, the maximum revenue potential that we want the possibility of failure we get. The money we get does not match what we expect. And it was inevitable.

The best way is : Participate In One or Two Courses just terlegih first. Then give your best effort to promote the product. Well, once you reach the profit according to the target and maintain it, you will be able to go even further by joining other programs.


3. No or Not to Buy Products and Use

Learn and use the product first before you join as an Affiliate Marketer. Why is that ? Because it is imperative that you can measure whether the product is profitable or not. After that, then you explain the advantages and shortcomings of these products objectively and not with a hoax. Be honest in business, buddy !

Well, the way that this would be a pretty big impact, because potential customers will see and feel your sincerity and honesty. And finally, they may be interested and try the products you offer.


Netter's, third mistake on this, whether consciously or not, in fact already been done by the Affiliate Marketer. Do not fall and get stuck into the same situation. Try to do everything in a positive way so that you avoid these three mistakes.


The key is TIME....

For that, take your time to analyze a variety of your marketing strategy. And continue to evaluate whether you are on the right track or not. If you've done right, of course you will be able to maximize your affiliate marketing program to earn the maximum as well.


OK buddy,
Hopefully there are benefits

source ; celoteh online

State by State Analysis of Health Insurance Exchange Adoption

State By State Analysis of Public Health Service Act Requirements for Employers in the United States

The Public Health Service Act of 2010 requires most employers in the United States to provide group medical insurance for their employees. Employers who choose not to comply with this law will be fined, as authorized in Section 490-H of the Internal Revenue Code. Employers with fifty or more employees are required to offer health insurance to their employees who work, on average, thirty or more hours a week. And the insurance plan must meet certain affordability standards, the employer must pay part of the cost and the plan has to meet certain eligibility requirements for enrollment equity. The global purpose of this act is to increase the proportion of people who have access to health care in the United States.  Evidence of the ability to pay for medical treatment through insurance thus contributes to this goal. The data source for the fifty-state-analysis, came from the National Conference of State Legislatures web site.[1] Also my book, Unraveling U.S. Health Care includes 50-state surveys for health care legislation as well.

Health Insurance Exchanges

Small employers are slated to enroll in regional insurance exchanges by 2014. Large employers may elect to enroll in the exchanges by 2017. The latter is the most intriguing, because initially it is thought that large employers will not choose the insurance exchanges. However, based on my experience as a former insurance broker here are some reasons why employers may ultimately choose insurance exchanges.

1.      1. The insurance exchanges will have federal compliance components built into the design and employers will not have to worry about being fined if they go through that process.

2.      2.  Employers can finance and have their employees enroll in insurance exchange health plans and avoid group health insurance administration hassles by having their employees make individual elections.

3.    3.    The insurance industry will see a shrinking of health care providers over time, especially in some states, so the insurance exchanges will become markets of choice.

4.      4.  Insurance exchanges are slated to include strict criteria for administrative transparency and target levels for allocation of insurance premium contributions to actually pay health care claims(AKA consumers like this)

5.      5.  Applying the law of large numbers, a large association of employers can expect some purchasing power and stability. In any case this is what the insurance industry has been saying for decades.

6.     6.   The insurance exchanges are designed not to discriminate and once again, consumers like that.

States Which Have Authorized Health Insurance Exchanges

Despite the tumultuous cries of calamity about the insurance exchanges, nearly half of the states have already adopted laws to implement them including: Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Nevada, Oregon, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

States Which Have Pending Legislation to Authorize Health Insurance Exchanges

Alaska is working to establish its own insurance exchange. The Georgia governor signed an executive order to authorize a Health Insurance Exchange. Mississippi has a state high risk pool for insurance and it is authorized to serve as a Health Insurance Exchange provider. North Dakota plans to create its own Health Insurance Exchange by 2013, otherwise the federal government will implement one. The Rhode Island governor signed an executive order to create a Health Insurance Exchange on September 19, 2011. The Texas Office of Insurance and the Office of Health & Human Services have partnered together to create its own Health Insurance Exchange. Vermont is working on creating its own state-wide single payer health plan. There are other states with pending legislation, but they were not cited because programs were not yet specified.

States Which Have Outlawed Health Insurance Exchanges

New Hampshire SB 148 became law on July 14, 2011 and it prohibits Health Insurance Exchanges.

It is important to note that a failure to authorize an insurance exchange is not the same as a ban and no other state had banned the exchange as of the end of 2011. Further, nearly all states have accepted money to implement the exchanges, some as much as fifty million dollars, so unless they are planning on giving the money back, they will also be creating their own exchanges.

Exceptions to the Rule

First of all, any employer who wishes to self insurance under the ERISA rules can exempt itself from all of these 2010 insurance plan design requirements. What this basically means is contracting with a third party administrator to pay claims and buying reinsurance through a broker.

Secondarily, the law seeks to provide financial subsidies for small employers who heretofore have had difficulty affording health insurance. This will mean more customers for the profitable insurance industry, which will now benefit by federal government subsidies for customers who are mandated to buy their product.

Thirdly, and perhaps most lucratively, employers who are enrolled or will enroll in “Professional Association Plans” or multiple employer trusts will be able to meet the requirements of the law.  These large employer plans are underwritten and managed by insurance brokerage firms. This is how the large brokerage firms deal with the small business sector; they fit them into their multiple employer association plans.

Though many insurance agents have been whining about the Public Health Services Act, the mandate for this act was promulgated by the insurance industry as a means to avoid obsolescence. Though the national insurance requirement will prove very lucrative for the industry, this does not necessarily mean it will benefit American health care purchasers to the same degree.

This article was written by Roberta E. Winter, MHA, MPA, the healthpolicymaven and may be reprinted with her permission.

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[1] http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx

How Medical Insurance Impacts Access to Health Care in the United States

Without Insurance Access to Health Care is Limited in the United States
Why the Insurance Model Was Chosen for Increasing Health Care Access
One of the things I learned while a student at the School of Public Health and Community Medicine was that people who lacked health insurance also lacked reliable health care. Let us review some of the national data in this regard. In my fifty-state analysis I reviewed the following components for individual health care measures: evidence of employer based health insurance, the state uninsured population, infant mortality and other clinical outcomes. Listed below are the top performers for the criteria, as well as the laggards.

States with the Highest Levels of Health Insurance, Public or Private
Using the latest Kaiser Family Foundation Insurance Survey , the 2010 results show the number one state for health insurance coverage is Massachusetts, with 95% reporting health insurance plans. Massachusetts has been the model for the national insurance exchanges because its state mandate has achieved near universal coverage and is self supporting. Other states deserving honorable mention for securing health insurance for 90% of their residents include: Hawaii, Vermont, and Wisconsin.

States with the Lowest Levels of Health Insurance, Public or Private
Women ages 19-64
In the same survey, the worst state for provision of medical insurance either public or private was Texas, with only 70% of its women reporting medical insurance coverage. The national average for insured women was 80% at the time of the survey. Florida reported that 74% of its adult women had medical coverage. A host of states reported only 75% of their adult female populations had medical insurance including: Arkansas, Mississippi, Nevada, and New Mexico.
Men ages 19-64
The national average for men with medical insurance was 76% by 2010. For Texas men only 65% had medical insurance. Other low fliers for men with medical insurance were: Georgia (71%), New Mexico (67%), and Florida (69%).
Children <18
Across the nation only 50% of our children had health insurance provided through their parent’s place of work. Though 90% of the nation’s children have medical insurance now, 36% of that figure is provided by public programs like Medicaid. For the children’s health survey, Texas also posted an equally poor level of insured children, the lowest in the nation, with 17% of the state’s children lacking medical insurance. This is despite the federally subsidized Children’s Health Insurance Program, so is Texas failing to enroll its children or are their parents making too much money to qualify?
Other states with high levels of an uninsured children included Florida (16%), Nevada (16%), and Arizona (15%). You would think Nevada could come up with something creative like a gambling tax to subsidize health insurance for its residents. Why do some of these states have so many more children without health insurance?
Cost of Deferred Health Care
Since the United States has chosen to finance its health care through a public and private system, the lack of payment for services for the uninsured gets allocated to hospitals and insurance plans. The federal insurance mandate is an attempt to stave the high costs for hospitals and communities from serving the uninsured population. Those states with higher levels of uninsured individuals mean that more health care is either delayed or delivered in emergency settings. Additionally, uninsured patients are not receiving preventive or basic health care. States that are laissez faire place a disproportionate burden on their hospitals to serve uninsured patients and this impacts the overall health care safety net.
Clinical Outcomes
If evidence of insurance is a factor in securing better health care, let’s see what the clinical data shows for these states. Infant mortality is an indication of prenatal and postnatal care and here are the infant deaths per 1,000 babies for the states with high levels of insurance, versus the low levels. These infant mortality rates are drawn from the 2009 Kaiser Foundation Survey. Infant mortality is just one measure of childhood health, but in adherence to brevity I am not going to list the other metrics I used in my full scorecard evaluation.
Infant Mortality
Best in class for both percentage of the population covered for insurance (95%) and the lowest infant mortality rate in the nation at 4.9 deaths is Massachusetts. Way to go mother Mass! This makes their prenatal and postnatal care equal to most of Europe, which is a high standard. And here is how the other well-insured states ranked for infant mortality per 1,000 babies: Hawaii-6.1 deaths, Vermont-5.6, and Wisconsin-6.3. Now let us compare this metric to the states which reported the lowest levels of children with health insurance and here are the infant deaths per 1,000: Texas-6.3, Florida- 7.2, Nevada-6.2, and Arizona-6.6. When you compare the average infant mortality of the states with higher insurance levels to those without, there is a difference of nearly one life per 1,000 babies, which is significant. Also, in case you don’t know, the United States infant mortality rate on average is 47th in the world, behind all of Europe and most of the developed world. And if you don’t already feel bad enough, some countries, including Singapore boast an infant mortality rate which is one third of the U.S. average at 2.31 deaths per 1,000 babies.

As we listen to the harping about Americans not having a right to basic health care, bear in mind that the United States has the highest percentage of children living in poverty in the industrialized world, at nearly one fourth (24%) of our child population. You have to ask yourself, what do our nation’s children have a right to in this wealthy country?

For more information on 50-state performance metrics come to the Northwest Women’s Show on March 2nd to hear excerpts from my book, Unraveling U.S. Health Care.

This article was written by Robert E. Winter, MHA, MPA and may be reprinted with her permission, but feel free to share it virally.

Congressional Wrangling Over Proposed Insurance Exchanges Takes A Nasty Turn

Wrangling Over Proposed Insurance Exchanges and Standard Health Care Benefits Takes a Nasty Turn

Barely recovering from the last congressional gaffe about redefining the rape of a woman in a transparent attempt to get out from under the federal Hyde Amendment criteria for Medicaid payments, the “powers-that-be” have made another mind blowing error in public engagement. In a nutshell and yes, I do mean all of these puns, here is the latest blunder by the Republicans controlling the house.

In a public hearing for testimony on the federal health insurance exchanges and standardized benefits for primary health care, which includes birth control options as benign as birth control pills, no women were allowed to testify at the hearing. It certainly is curious that those who are actually capable of pregnancy are excluded from the hearing. This refusal was despite vigorous opposition by female congresswomen. I actually listened to the hearing in order to believe it. And the woman they refused to allow to testify about the insurance exchange’s proposed standardized women’s health care was a college student. Yah, that is just what we want to discourage in this country, a woman with an education using prudence in reproductive matters.

And if that isn’t enough to befuddle a rational thinker, the reason the committee chairman gave for denying any woman the right to speak was because the meeting was about voting and safe guarding conscience in decision making. Interesting, I wasn’t aware that women lacked conscience, especially when you look at the violent crime statistics. But then again I guess these boys have turned their eyes away from those statistics. One wonders if they also were party to the move to redefine rape of an unconscious woman as a noncriminal event. If this is a matter of conscience, one wonders about theirs.

We are constantly assailed with Republican blather about fighting against big government, yet they seek to prevent birth control services from being covered on private insurance plans. As I have previously reported, several states already have enacted laws which prevent even private insurance plans from covering birth control services. Here are the members of this hall of shame: Kentucky, Missouri, Oklahoma, Idaho, and North Dakota. According to a 2003 Kaiser Foundation survey on contraceptive care, 87% of private employers provided coverage for birth control services, including abortion. So despite the anti-big-government talks, this smacks of big brother to me, or is it daddy?

For more straight talk on health care attend the Northwest Women’s Show on March 2nd, as the healthpolicymaven™ will present findings from her book, Unraveling U.S. Healthcare with my conscience intact.