Santa Rosa, CA, United States (KaiserHealth) – With valet parking for patients, video-conferencing for parents of premature babies and a healing garden abloom with azaleas, Santa Rosa Memorial Hospital tries to maintain the amenities of a thriving community hospital.

But chief financial officer Mich Riccioni is focused on the fiscal strains Memorial is facing. Nearly a quarter of the hospital’s patients are on California’s Medicaid program – and the state has been trying for years to cut its reimbursement rates for hospitals and other health care providers.

Memorial, a 278-bed hospital in this city 55 miles north of San Francisco, sued California to try to stop the payment reductions. Now it is part of a case before the U.S. Supreme Court that could redefine states’ responsibilities on Medicaid services and ultimately determine whether Democratic Gov. Jerry Brown can go forward with cuts he says are vital to closing the state’s budget gap. The court is likely to hear arguments in the fall and render a decision by next spring.

Many states are pressing for more flexibility on Medicaid, a joint federal-state health program for the poor and disabled. But Memorial, as well as other hospitals and doctors, counter that the steep cuts violate federal law, which requires that payments be set high enough to ensure providers will see enrollees. They note the state’s reimbursement rates rank 46th among the states.

The Obama administration recently proposed a rule that would require states to consider the impact of payment cuts and to perform reviews to see if patients are getting necessary services.

In 2008, California targeted its Medicaid program, called Medi-Cal, which today has an annual budget of $42 billion. The legislature and Republican Gov. Arnold Schwarzenegger approved a 10 percent cut in payments to Medi-Cal providers.

Riccioni estimated that the proposal would reduce Memorial’s revenue by $17.5 million over three years. The hospital, officials say, already is struggling financially. Memorial has slashed 180 jobs, imposed a one-year salary freeze, closed its inpatient psychiatric ward and its skilled nursing facility and canceled a planned $260 million surgery tower.

Supreme Court Focus

In the legal battle over reimbursement cuts, the U.S. 9th Circuit Court of Appeals ruled against the state in several cases. In January, the Supreme Court agreed to hear the case, based on Memorial’s suit and two others. The court will focus on whether outside groups, such as hospitals and other providers, as well as Medicaid recipients, have the right to sue when they believe the state is violating federal law. For now the state – barred by the 9th Circuit injunction – is holding off on the disputed cuts at issue in the lawsuit.

“This is an extremely important case,” said Charles Luband, a partner with the law firm Ropes & Gray LLP in New York City, which has drafted letters in support of hospitals and doctors in the case. “The Medicaid statute was created to assure payments were sufficient to enlist enough providers to participate in the program. That’s why it’s important providers be able to bring such lawsuits to assure that statute has meaning and relevance.” Sara Rosenbaum, chairwoman of the Department of Health Policy at George Washington University, said the case could have broad ramifications for patients. If California wins, Medicaid recipients wouldn’t be able to sue states to compel them to fulfill an array of duties under the law, such as conducting “fair hearings” for enrollees deemed ineligible, she said. But 22 states, in an amicus brief, asserted that they must be able to control their own Medicaid spending and that a ruling against California would open a spigot of suits from health care providers. “To allow private litigants to bring such actions would devastate amici States’ financing ability to provide assistance to its ever-growing lower income citizens in the current economic climate,” the states said. The Obama administration is backing the states up. In an amicus brief that angered consumer advocates, the Justice Department said that Medicaid patients and providers can’t sue state officials to block payment. It argued that allowing such suits could lead to “a plethora of private actions threatening disparate outcomes.” Federal health officials should decide when cuts go too far, the brief said. The court isn’t expected to rule on whether the proposed provider cuts are legal. If the providers win in the Supreme Court, that issue would likely be sent back to the 9th Circuit. Also, the administration’s proposed Medicaid rule on payment cuts isn’t likely to have much impact; the Supreme Court will be considering the narrow issue of whether private parties have standing to sue states over alleged violations of the Medicaid law. ‘California Must Live Within Its Means’ Medi-Cal – the largest chunk of California general fund expenditures after education – covers 7.5 million people and is growing, according to state officials. Brown and the legislature agreed on a budget that would cut rates by 10 percent for Medi-Cal providers like Memorial that don’t have contracts with the state and up to 5 percent for providers such as doctors. Officials estimate it would save California $567 million this year. “These are not choices we’d make in another environment,” said health department spokesman Norman Williams. “But California must live within its means.”One of the plaintiffs in the Supreme Court case is Norma Jean Vescovo, founder of the Van Nuys-based Independent Living Center of Southern California serving about 6,000 disabled clients a year. She says her clients have trouble finding doctors and druggists who will accept Medi-Cal’s reduced rates. “We’ve had diabetic patients who couldn’t get their medications,” Vescovo said. “When you look around, you see pharmacies closing.” “They want to pay me 10 percent below my costs,” said Gary Avnet, owner of Sayre Medical Pharmacy in Southern California. “What do I do?” Selling pricey drugs for diabetes and HIV below cost means, “I’d be out of business,” he said.

In downtown Los Angeles, Jerry Shapiro runs Uptown Drug and Gift Shoppe, a store his father opened on VJ Day in’45. Shapiro said he breaks even on drugs costing up to $124, but loses money filling costlier prescriptions for serious conditions such as cancer or multiple sclerosis. “I’m having a very tough time,” he said. “I borrowed a lot of money to stay in business.”

While big box stores can better absorb cuts, small pharmacies that offer services like delivery and patient counseling are hurt more by the reductions, Shapiro said. “I had my house completely paid for and now I’m in hock for more than I ever had a mortgage for,” he said.

– Provided by Kaiser Health News.

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Mortgage is the security of the loan to finance the purchase of a property with specified interest rates. Mortgage is the lender’s security for debt. This is the most common method of financing property transactions. The mortgager is the borrower in the mortgage and he transfers the interest. On the other hand, the mortgagee is the investor or a financial institution that provides loan or other interests in exchange of the security interest. As per the residential mortgage law, if the borrower fails to pay, the mortgagee has the right to sell the property to pay off the loan.

Generally the mortgage is paid in installments where the borrower needs to pay the interest as well as the principle amount that was borrowed by the mortgagor. If the mortgagor fails to make payments, then this can result in the foreclosure of the mortgage. As per the acceleration clause in the mortgage, the borrower has to pay off the loan immediately. Foreclosure permits the mortgagee to state that the debt is due. Acceleration clause is applicable in residential and commercial properties. This law can also be imposed if the borrower tries to sell or transfer the property to someone else. In order to avoid foreclosure, the borrower can clear the due payments and the cost incurred for the missed payments.

According to the state law and the terms and conditions of the mortgage agreement, the foreclosure process is carried on. The mortgagee can negotiate with the mortgagors to adjust the terms of the mortgage. There are two kinds of foreclosures that are judicial foreclosures, which require a court order, and non-judicial foreclosures, which can be settled outside the court. If power of sale clause is there in the mortgage, non-judicial foreclosures can be used.

Brokers say that sales of two-bedroom apartments are picking up, especially at the lower end of the market.

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United States (KaiserHealth) – Former President Bill Clinton said Wednesday that a controversial GOP plan to dramatically overhaul Medicare clearly was a factor in the Democrats’ victory Tuesday in a House special election in a heavily Republican Western New York district. But he cautioned both parties not to use the outcome as an excuse to put off seeking ways to contain rapidly mounting government health care costs as part of a long-term debt reduction plan.

Democratic Erie County Clerk Kathy Hochul scored an upset against Republican State Assemblywoman Jane Corwin in a three-way race that many political experts viewed as a referendum on a Republican plan designed by House Budget Committee Chairman Paul Ryan, R-Wis., to convert Medicare to a subsidized voucher program. That proposal, formally approved by the full House as part of a long term budget, has generated political problems for Republicans in many districts throughout the country. Polls have shown the public is skeptical or outright opposed to gradually ending Medicare as it is currently constituted.

Speaking at a Peter G. Peterson Foundation Fiscal Summit in Washington, Clinton blasted the Ryan proposal, saying it was wrong “in principle” and would saddle future seniors with inadequate health care coverage that would discourage them from seeking medical treatment, even in life-threatening situations. “Medical costs will continue to go up, and older people will use less health care and die” or spend more of their saving, he said.

“I don’t think the Democrats or Republicans ought to conclude from the New York results that no change can bemade in Medicare.”

But Clinton, who presided over adoption of four balanced budgets during his two terms as president during the’90s, insisted that lawmakers could still find plenty of opportunities to reduce spending on Medicare for seniors and Medicaid for the poor as part of a comprehensive budget plan. “I don’t think the Democrats or Republicans ought to conclude from the New York results that no change can be made in Medicare” and other entitlement programs.

He added that “There is a real hunger among Americans” for us to do things,” but that the biggest cuts in health care and other domestic programs should be delayed for at least a year – as the president’s fiscal commission recommended – until the economy has improved more. “Most of this stuff should bite next year because the economy is too weak,” he said.

…”The existing Medicare system is a fiscal fantasy that can no longer be sustained and will eventually crash the system.”

Ryan, the Republicans most prominent spokesman on the budget and economy, followed Clinton on stage and defended his Medicare plan -stressing that it wouldn’t affect people 55 and older and that it represents a sensible way to move away from a financially unsustainable fee-for-service program that is driving up the national debt. He complained about TV ads by Democrats and seniors’ advocates that he claims distorted his proposal for providing premium support for vouchers to purchase health care in the private market. Ryan compared the existing Medicare system to a “fiscal fantasy” that no can longer be sustained and will eventually “crash the system.”

“So the question is, what are the kinds of reforms we’re putting in place to get at the root cause of health inflation … [and] to inject competition into the system so we can stretch our dollar farther, and then subsidize people more who need it more and not those who need it less.”

“So what we’re saying is protect those with low-income by supplementing and covering their out of pocket costs,” he added. “And we’re also saying as people get sicker, increase their payments, stabilize their premiums. And as people get wealthier, don’t subsidize them as much.”

The second annual Peterson Foundation Fiscal Summit opened as a bipartisan House and Senate group headed by Vice President Joseph Biden reported substantial progress in negotiating a deal to cut spending and raise the debt ceiling to avert the threat of the Treasury defaulting on debt for the first time in U.S. history. Biden and Treasury Secretary Timothy Geithner have both said the group of six Democratic and Republican lawmakers appear on track to reach agreement on more than $1 trillion in spending cuts in the short term, with an eye to a total of $4 trillion in deficit reduction in the coming decade or so. A spending deal is essential to persuading Republicans to join with Democrats to raise the debt ceiling, which is currently at an historic $14.3 trillion level.

“A year ago, Americans were still arguing whether there was a debt crisis; today more and more Americans are openingtheir eyes, their ears and their minds to the fiscal threat.”

“We meet at a very pivotal and hopeful moment,” Pete Peterson, a former Wall Street financier and Commerce Secretary, said in opening the day-long conference. Peterson noted that a year ago, many Americans were still arguing whether there was a debt crisis, while today “more and more Americans are opening their eyes and their ears and their minds” to the fiscal threat.

Clinton, the keynote speaker, is the only former president who presided over consecutive budget surpluses in the post World War II era. Here are several major points he made during a conversation with Gwen Ifill of PBS’s Washington Week.

On bipartisan support for a budget deal”I think we can have bipartisan cooperation. The Democrats are going to have to be willing to give up maybe some short term political gain by whipping up fears on some of these things if it’s a reasonable Social Security proposal, a reasonable Medicare proposal. We’ve got to deal with these things. You can’t have health care devour the economy. “

On the debt”This debt problem is already constraining our options as a country. It constrains our ability o develop a more diversified economic strategy by undermining our ability to get investment capital as opposed to consumption capital and by undermining our ability to enforce our trade laws which, discourages us from doing new trade agreements. . . . If we defaulted on the debt once for a few days, it might not be calamitous.” The global markets, he said, would likely still have faith that the United States would be able to pay its bills. The calamity would come only “if people thought we weren’t going to pay our bills anymore and … they would stop buying our debt.”

(A Clinton spokesman later sought to clarify the former president’s comments on default, saying he “inadvertently misspoke” in suggesting a short-term default by the U.S. might not be so harmful. Clinton spokesman Matt McKenna said Clinton “did not in any way mean to suggest that a default would not be highly damaging for the economy even for a very short period of time.”)

On corporate taxes(Clinton believes the corporate tax rate and the mortgage interest deduction should be lowered. He suggests imposing a VAT tax or a tax on pollution. Individual tax rates should return to levels when he was president. He said people like him should pay higher taxes. )

“One of the really impressive accomplishments of the Bowles-Simpson commission was pointing out just how much money there was out there in the so-called tax expenditures. I would favor returning individual rates to where they were when I was president and maybe even across the board, certainly for high income people. Then I think you ought to do something on tax expenditures.”

“On corporate taxes I have a little different take. I raised corporate tax rates and I think it was important because the percentage of the federal pie covered by corporate taxation went way down in the 12 years before I was president. It is very important to be internationally competitive so our rates are fairly high compared to all of our competitors, but our loopholes are fairly high. If you can actually lower rates and still raise the same amount of money and that would make us a little more competitive and be more competitive and then everyone would have to pay something.”

In addition to his foundation, Peter G. Peterson funds The Fiscal Times, an independent news and opinion organization.

– Provided by Kaiser Health News.

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In the current recessionary scenario, a large number of homeowners are considering refinancing home mortgage due to various financial constraints. However, it is important to know exactly when and how to refinance your mortgage. Most people do not realize that opting for mortgage refinancing can lower the amount of your monthly payments and switch your adjustable interest rate to a fixed one. The last five years have seen mortgage interest rates fall drastically. So if you took a mortgage on your home when the rates were high, you can now opt for mortgage refinance in order to take advantage of falling interest rates. In simple terms, mortgage refinancing involves applying for and taking on a totally new loan. If your credit history is spotless, there’s nothing to worry about, but if you are saddled with poor credit scores, you may have to overcome a few obstacles during the process of bad credit mortgage refinance. However, there is no need to be intimidated by the seemingly impossible standards set up by lending institutions.

As a bad credit mortgage refinance borrower, you may have faced numerous rejections because potential lenders would consider you a risky credit proposition. And the reason for late or missed payments that mar your credit score may be due to the fact that your employer cut your salary or you lost your job because the company folded. Lenders will nevertheless hesitate before working with you. Refinancing is probably the solution to your problems because it has slightly different criteria as compared to normal mortgage policies, so you might just qualify for approval in spite of a poor credit rating. When you secure refinancing for your home, you put it up as collateral for the loan. This means that if you default on the loan the lender or the bank is entitled to take possession of your home.

Knowing when to go for bad credit mortgage refinancing is as important as knowing how to go about it. You must have seen a number of advertisements on the internet or on television that claim to secure the lowest possible rates of interest and hassle-free refinancing. However, you need to check out other lenders who might offer you a better and more profitable deal on home refinancing. You also need to calculate whether the total amount of projected savings is greater than the cost of mortgage refinancing.

When it comes time to take a look at getting a home mortgage, whether you’re looking at a refinance or if you’re looking to buy your first home, using a mortgage calculator can give you a lot of knowledge and understanding about what you’ll be looking for in a mortgage. Basic mortgage calculators let you put in the price of the home and the interest rate to get an idea of what your monthly payment is. But there are a lot more variables at play than just those two numbers.

More sophisticated calculators enable you to work with the different types of mortgages available. Talking to mortgage companies and getting numbers for all the variables involved gives you a complete picture of what you’ll actually be paying and when. Good fixed rate mortgage calculators enable you to input the price of the house, down payment, months to pay and interest rate to give you a monthly payment. By playing with these numbers, you can eventually come up with a combination that gives you a monthly rate you can afford. Going to this effort enables you to know pretty much exactly what you’re going to be paying initially, how much your monthly payment is going to be and for how long.

While fixed rate mortgages are relatively easy to calculate because the rate of interest is fixed, adjustable rate mortgages, or ARMs, have rates that change over time. This can make a mortgage that’s affordable into one that may be too much to handle. By sitting down with a mortgage calculator can show you if you’ll be able to afford your mortgage when the introductory rate is over. Not only will you be inputting down payments and initial interest rates along with the price of the house, you’ll need to know what the interest rate is going to change to in the future. Depending on whether the new interest rate is based on the original house price or whether it’s based on the amortized price of the house at that point in time, these variables add yet another level of complication to the process.

While mortgage calculators are designed to give you numbers, the best thing they can give you is a much better understanding about your mortgage options. Having access to calculators that can give you a true month to month amount you’ll be paying; they’ll give you a complete overview of the life of the entire loan from initial costs, home equity as the loan matures and the eventual payoff amount. Make sure when you sit down to figure out your mortgage that you’re using a good mortgage calculator that’s designed to give you the help understanding your mortgage you’re looking at.

Standard & Poor’s Ratings Services analyzed distressed sales on non-agency loans originated between 2000 and 2007. S&P found that 4 to 5 percent for loans originated between 2005 and 2007 were discounted by more than 25 percent. “Large variances between loan origination and sale amounts generally suggest … that original home values were overstated on mortgage applications and not corrected during the originators’ review of the property value,” an S&P managing director said in the report.

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Obama’s loan modification plan is available for borrowers facing financial hardship and at risk of losing their home. Under this program, your home loan could be revised so that your monthly payment is reduced to an affordable amount. The goal is to keep families in their homes, stop foreclosures and allow the economy to recover.

The plan is called Home Affordable Modification Program-or HAMP. This home retention plan is paid for by the federal government-your tax dollars-so do not hesitate to take advantage of this helping hand. Over 5 million homeowners are expected to benefit under this $75 billion government program. Here’s the basics of the plan:

1. All homeowners who ask for consideration must be reviewed for eligibility-even if they have been turned down previously
2. Borrowers must show evidence of a financial hardship or the imminent risk of default
3. Lenders must follow a standard formula to determine if a borrower meets the federal qualification guidelines-reducing the interest rate to as low as 2%
4. Homeowners who meet the basic guidelines will be asked to submit a loan modification application, including a financial statement and proof of income

The banks are motivated to modify as many loans as possible for a couple of reasons. The lenders will be paid by the Treasury Department for each loan they modify using the standard federal terms. Also, President Obama has strongly encouraged all banks to reach out to homeowners to offer this plan-whether they are behind on their payments or not. If a financial hardship exists, then a homeowner is encouraged to begin the application process.

What should you do if you need a 2% mortgage modification? The first step is to learn more about the federal guidelines for approval and just what it takes to meet those guidelines. Do not complete your paperwork or disclose your financial information until you understand the 4 step formula your bank will use to qualify you. This is not the time to take any chances. Learn, prepare, then apply-this is too important to risk denial.

Is your current mortgage payment (Including property tax and insurance) more than 31% of your income? The governments “Making Home Affordable” program is incredibly generous, the home equivalent of the “Cash for Clunkers” program.

We (At www.illinoismortgagemods.com) have achieved mortgage payment reductions of over 50% for clients that were never late on their mortgage- they had just experienced or were about to experience a reduction in income. This includes clients that had their new mortgage payments calculated and reset based on their impending pension income rather than current employed income!

There are 37 lenders participating in the “Making Home Affordable” program and working with them makes predicting an outcome easier however, we have also achieved mortgage modification for Non-participating lenders (Including West Suburban Bank and Key Bank). We achieved our first mortgage modification in April of 2008 and have now successfully worked on behalf of our clients with most major lenders. Please contact us ASAP so that we can review your situation and determine whether the “Making Home Affordable” program is likely to be available to you.

Our attorney can be retained for only $500 upfront with any/all remaining funds due AFTER a loan modification has been offered to you. Do not pay ANY upfront loan modification fees to ANYONE that isn’t an attorney licensed to practice law in Illinois. Retain an attorney and pay for results! Please either submit the brief free evaluation request or call us at 630-687-5012. Falling Behind? Don’t Wait! If you are currently delinquent, have experienced a reduction in income or are going through savings to keep up on the mortgage then act now

An announcement from Shore Financial Services Inc. indicated that Hall Financial Corp. will be integrated into Shore. In addition, Hall Financial’s founder was hired as president of Shore’s retail mortgage division. Shore claims to be “one of the top 10 FHA lenders in the entire nation.”

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