No, There Won’t Be a Doctor Shortage - NYTimes.com

 

The opportunity exists to deliver more services and care with fewer physicians, but it’s not a foregone conclusion. Policy changes will be necessary to reach the full potential of team care.

That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk. New payment models must reward investments in technologies that can save money in the long run. Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.

Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other health care workers while incorporating new technologies and practices that make care more efficient. With doctors, as with drugs or surgery, more is not always better.

Scott Gottlieb, an internist and fellow at the American Enterprise Institute, was a senior official at the Centers for Medicare and Medicaid Services during the George W. Bush administration. Ezekiel J. Emanuel, a former health policy adviser to the Obama administration, is an oncologist, vice provost at the University of Pennsylvania and contributing opinion writer.

No, There Won’t Be a Doctor Shortage - NYTimes.com

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Rooting for Failure - NYTimes.com

 

It’s hard to remember a time when a major political party and its media arm were so actively rooting for fellow Americans to lose. When the first attempt by the United States to launch a satellite into orbit, in 1957, ended in disaster, did Democrats start to cheer, and unify to stop a space program in its infancy? Or, when Medicare got off to a confusing start, did Republicans of the mid-1960s wrap their entire political future around a campaign to deny government-run health care to the elderly?

Of course not. But for the entity of the Obama era, Republicans have consistently been cheerleaders for failure. They rooted for the economic recovery to sputter, for gas prices to spike, the job market to crater, the rescue of the American automobile industry to fall apart.

I get it. This organized schadenfreude goes back to the dawn of Obama’s presidency, when Rush Limbaugh, later joined by Senator Mitch McConnell, said their No. 1 goal was for the president to fail. A CNN poll in 2010 found 61 percent of Republicans hoping Obama would fail (versus only 27 percent among all Americans).

Wish granted, mission accomplished. Obama has failed -- that is, if you judge by his tanking poll numbers. But does this collapse in approval have to mean that the last best chance for expanding health care for millions of Americans must fail as well?

Does this mean we throw in the towel, and return to a status quo in which insurance companies routinely cancel policies, deny health care to people with pre-existing conditions and have their own death panel treatment for patients who reach a cap in medical benefits?

Rooting for Failure - NYTimes.com

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I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

 

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.

I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”

“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”

I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?

UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.

I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

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Opinion: Cancer survivor: Obamacare got me covered - CNN.com

 In January, for the first time since my diagnosis 36 years ago, I will have an individual health plan that offers quality coverage for me and my family. I will save $628 every month on premiums. Best of all -- I wasn't even asked if I've ever had cancer.

Opinion: Cancer survivor: Obamacare got me covered - CNN.com

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In the Health Law, an Open Door for Entrepreneurs - NYTimes.com

 

“In terms of hiring, the health care expenses contribute a huge, huge component to your cost of operation,” Ms. Petrou says. So instead of bringing on full-time employees, she relied on contract workers.

She is looking forward to getting price information online from the Small Business Health Options Program, or SHOP, an exchange that was created by the new law. (Currently, business owners can obtain estimated SHOP prices online, but specific ones are only available by mail after filling out and mailing in a PDF downloaded from Healthcare.gov. Some states, including California, have their own SHOP exchanges, and their procedures vary.)

Ms. Petrou says the law could enable her to hire full-time employees, depending on the new costs of coverage. If so, she will either pay for a portion of the individual plans that her employees shop for on the exchange, or she may take advantage of tax credits and offer a small group plan. “We now have options to explore,” she says.

Some experts say this type of flexibility may have a big impact on the economy over all.

“Assuming we get the website working, it’s going to be the biggest step we’ve had in a long time in the U.S. in terms of changing the structure of the economy,” says Craig Garthwaite, assistant professor of management and strategy at Northwestern University’s Kellogg School of Management. Mr. Garthwaite is a co-author of one of two recent studies that conclude that the Affordable Care Act could spur entrepreneurship by easing job lock — where people stay in a job mainly for the health insurance.

In the Health Law, an Open Door for Entrepreneurs - NYTimes.com

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‘Ground Control to John Goodman’ – A Uwe Reinhardt Appeal | A "HealthTweep" Pulse Check

‘Ground Control to John Goodman’ – A Uwe Reinhardt Appeal | A "HealthTweep" Pulse Check

This is a couple years old, but I just found it and since it has some Uwe "gold," it's worth reading!

John Goodman of the conservative Dallas based think tank National Center for Policy Analysis (NCPA) issued a “William Wallace-esque’ FREEDOM pitch today on his blog entitled Reforming Health Care the Right Way.
This is a man who previously claimed that there are ‘no uninsured’ (from a health insurance point of view) in America; after all Goodman posits that everyone has access to the ER, so what are you complaining about? (paraphrased).
In his blog post today one day after the historic Senate vote to advance the health care bill, Goodman opines on the ‘right’ and ‘wrong’ way to reform US healthcare.
What I find most insightful is his post is the rebuttal comment proferred by Uwe Reinhardt as to the fantasy world this man, and unfortunately many other ideological predisposed converts, apparently inhabit. The health care industry defies over simplification, yet ‘sound byte’ disingenuous over-simplification is the prima facie basis on which the ‘anti-reform crowd has stimulated emotive misunderstanding of the nature of the malady as well as it’s appropriate and quite comprehensive remedies.

Uwe Reinhardt Says:
December 21st, 2009 at 1:12 pm
I hear Richard Branson of Virgin Air is seriously exploring space travel as a commercially feasible project.
Once he has that done, I shall be able to book a flight to the distant planet on which John Goodman lives.
It is the planet on which all physicians always are purely the agent of their patients and do not have any economic conficts of interest — such as making money on tests they prescribe to anxious patients or from referring patients to imaging centers in which they have a state or to collegues with whom they play gold, and so on. Such conflicts of interest do not crop up on John’s planet, not because government forbinds them (there is no government on that planet), but because such conflicts of interest just don’t exist there somehow. Remember: it’s another planet!
On John’s planet it is also easy to have price competition among physicians, because all ill health on that planet can be cured with just one standard, well defined “unit of health care.” What that is I do not know, but John does, because he lives there. He’s probable consumed some, rationally, I wouold assume.
Contrast that with an earthbound hospital charge master with 20,000 itsems in it or the physician fee schedule with 7,000 items in it. How would one make diffenetials in the elements of those huge vectors understandable to patients?
John took on a new religion on that planet to where he actually immigrated — he once lived on earth. On earth he always boldly talked for decades about “Consumer Directed Health Care,” but neither he nor his entire think tanks (the NCPA) every did a stitch of work to help develop the user-friendly price information that patients as “consumers” would need to make rational choices in health care ex ante.
Once on the new planet, John realized that he sinned on earth and swore to do better there. Of course, on his new planet it’s easy: there is only one type of health care and one price. The redemption was a piece of cake.
All people on John’s planet have the same income — in fact, they all have John’s high income and all also have Ph.D.’s. or M.D.s So the problem with poor people not being able to afford high deductibles and therefore stiffing doctors and hospitals for it does not exist on John’s planet. Nor is there a problem with health illiteracry, because everyone on John’s planet has a Ph.D. or M.D. Every patient on John’s planet knows exactly what he or she needs before going to a doctor and simple shops around for a low price.
For the most part, an individual’s need for health care in a coming year on John’s planet is certain and predictable and thus not really insurable. Only the need for about 20% of all health care is stochastic and hence insurable.
On John’s planet, 50% of any large group of people account for 50% of all health spending — 80% of the people account for 80% of all health spending. Here on earth, 20% of the sickest account for 80% of all health spending, and much of that 80% will also be insured. It will be managed by some insurance clerk coming between doctor and patient.
Oh how I long to go to the planet where John Goodman lives, where life is so easy and so simple. I am so tired of the mess here on our planet. Aren’t we all?
Small wonder that John just up and left Mother Earth for a planet where all his theories actually work.

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Selling Health Insurance Across State Lines

Selling Health Insurance Across State Lines:
An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage
By Sabrina Corlette, Christine Monahan, Katie Keith and Kevin Lucia

"Across state lines legislation was largely
unsuccessful because of the localized nature of how
health care is delivered. Respondents universally
reported the enormous difficulty that out-of-state
insurers face in building a network of local providers,
and insurers identified doing so as a significant barrier
to market entry that far surpasses concerns about a
state’s regulatory environment or benefit mandates.
State officials and insurers also noted that across
state lines legislation ignores the primary cause of
high prices—the cost of delivering care—and fails to
account for often dramatic differences in the cost of
care between states and regions."

Followed Wendell Potter's link from http://www.huffingtonpost.com/wendell-potter/romneys-phony-answers-to_b_1948449.html
TO the full pdf file:
http://chis.georgetown.edu/pdfs/Selling%20Health%20Insurance%20-%20fnl.pdf

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Obamacare meets extra resistance in Oklahoma - Page 2 - Los Angeles Times

The cognitive dissonance should make these people’s heads explode, but I don’t think there’s enough cognition to create the dissonance.

In dozens of interviews here, many said they feared they would be forced to buy insurance they couldn't afford. Some said they were told (erroneously) that insurance penalties would come out of their Social Security checks; others said they'd heard the law meant they'd soon have to travel several hundred miles to see a doctor.

"They say it's affordable, but when you ain't got no money, nothing's affordable," said 55-year-old Paul Bush of Midwest City, who accompanied his sister to a clinic for care last week. While he supports efforts in Congress to kill the program — "Heck yeah," he said — he wasn't happy about Fallin's decision to reject the Medicaid expansion: "The state could really have used the money."

Bush's sister, Teresa Springer, might have qualified for care under a Medicaid expansion, but she supported Fallin's decision.

Springer, who has applied for disability assistance, said she worried that fines related to the healthcare law would cut into her disability checks at the same time that some Republicans in Congress were talking about cutting food stamps.

"That's all I have," she said after a visit to the Mary Mahoney Memorial Health Center in Spencer, Okla. "I'm going to either pay my bills or not eat." The law, she added, "is hurting everybody."

Obamacare meets extra resistance in Oklahoma - Page 2 - Los Angeles Times

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Obamacare and part-time jobs: The myth exploded (again) - latimes.com

 

Tuesday's tepid brew of jobs data, delayed more than two weeks by the government shutdown, wasn't worth waiting for. It shows an increase in total nonfarm employment by 148,000 in September over August, which is consistent with economic growth crawling along in second gear.

The report's most notable nugget is the change in part-time work. Over the last month the number of workers in part-time jobs for economic reasons--slack demand, cutbacks in hours--has remained stable. Over the last year, however, it has fallen by 681,000. Those part-timers also constitute a smaller share of all workers--5.5% in September compared to 6% a year earlier.

That puts the lie to the popular conservative meme that Obamacare has transformed America's workforce into part-timers. The idea is that employers wishing to evade the law's requirement that they offer health insurance to employees working more than 30 hours a week will cut their hours to 29 or less. The shorthand about this provided by Sen. Ted Cruz (R-Texas), that one-stop shop for Obamacare disinformation, was "single parents who have been forced into part-time work."

Obamacare and part-time jobs: The myth exploded (again) - latimes.com

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Don’t Blame Health Law for High Part-Time Employment - Real Time Economics - WSJ

 

Don’t blame the health law for high levels of part-time employment. In fact, using the law’s definitions, part-time work isn’t increasing at all as a share of employment, at least not yet.

Nearly 8 million American were working part-time in September because they couldn’t find full-time work. Overall, 27 million people — nearly a fifth of all employees — are working part-time, well above historical norms.

Many critics of the Obama administration have pointed the finger for the prevalence of part-time jobs at the Affordable Care Act, the 2010 law better known to some as “Obamacare.” The law’s so-called “employer mandate” requires most midsize and larger companies to offer health insurance to their full-time employees. That, critics argue, provides companies with an incentive to hire part-timers instead.

The Obama administration earlier this year said it would delay the requirement until 2015 to give companies more time to comply. But some employers have said they are nonetheless cutting back on full-time hiring. Indeed, part-time employment rose early this year, while full-time employment growth stalled.

But a closer look at the data provides little evidence for the notion that the health law is driving a shift to part-time work, although it could as the mandate deadline approaches.

First of all, over a longer time frame, part-time work has actually been falling as a share of employment in recent years. Before the recession, about 17% of employed Americans worked 35 hours or less, the standard Labor Department definition of “part time.” During the recession, that figure rose, briefly hitting 20%. It’s been trending down since then, but only slowly, hitting 19% in September.

Don’t Blame Health Law for High Part-Time Employment - Real Time Economics - WSJ

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Uninsured in Pennsylvania reaches record high - Pittsburgh Post-Gazette

 

Overall the number of uninsured Pennsylvanians increased by 11 percent from 2011 to 2012, while nationally the number decreased by 1.4 percent.

The numbers, based on data from the U.S. Census Bureau and the Centers for Medicare and Medicaid Services, reflect a troubling trend in health care insurance, which people traditionally received through their employer.

"We continue to see a dangerous erosion of employer-based coverage," said Andy Carter, president and CEO of the Hospital and Healthsystem Association that represents the interests of nearly 240 health facilities.

"The number of Pennsylvanians covered by private, employer-based plans hit an all-time low of 59.5 percent in 2012," he said.

And that's not solely because people are out of work, he added.

"Three out of every 4 uninsured Pennsylvanians live in a household with at least one working adult, and nearly 4 out of 5 live in Pennsylvania's suburban and rural regions," Mr. Carter said.

The association has advocated for the expansion of Medicaid as outlined under the Patient Protection and Affordable Care Act.

Uninsured in Pennsylvania reaches record high - Pittsburgh Post-Gazette

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The Myth of the Medical-Device Tax - NYTimes.com

 

Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.

The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.

Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.

Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.

Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.

The Myth of the Medical-Device Tax - NYTimes.com

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Tax the rich? IMF sparks a mini revolution | AFP.com

 

Tax the rich and better target the multinationals: The IMF has set off shockwaves this week in Washington by suggesting countries fight budget deficits by raising taxes.

Tucked inside a report on public debt, the new tack was mostly eclipsed by worries about the US budget crisis, but did not escape the notice of experts and nongovernmental organizations (NGOs).

"We had to read it twice to be sure we had really understood it," said Nicolas Mombrial, the head of Oxfam in Washington. "It's rare that IMF proposals are so surprising."

Guardian of financial orthodoxy, the International Monetary Fund, which is holding its annual meetings with the World Bank this week in the US capital, typically calls for nations in difficulty to slash public spending to reduce their deficits.

But in its Fiscal Monitor report, subtitled "Taxing Times", the Fund advanced the idea of taxing the highest-income people and their assets to reinforce the legitimacy of spending cuts and fight against growing income inequalities.

"Scope seems to exist in many advanced economies to raise more revenue from the top of the income distribution," the IMF wrote, noting "steep cuts" in top rates since the early 1980s.

According to IMF estimates, taxing the rich even at the same rates during the 1980s would reap fiscal revenues equal to 0.25 percent of economic output in the developed countries.

"The gain could in some cases, such as that of the United States, be more significant," around 1.5 percent of gross domestic product, said the IMF report, which also singled out deficient taxation of multinational companies.

In the US alone, legal loopholes deprive the Treasury of roughly $60 billion in receipts, the global lender said.

The 188-nation IMF said that it did not want to enter into a debate on whether the rich should pay more taxes.

But, it said: "The chance to review international tax architecture seems to come about once a century; the fundamental issues should not be ducked."

Tax the rich? IMF sparks a mini revolution | AFP.com

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APPRISE: Older Adult Health Insurance Counseling, Allegheny County, Pennsylvania

Older Adult Health Insurance Counseling

APPRISE

APPRISE 412-661-1438 or APPRISE@fswp.org. 
APPRISE offices are open Monday through Friday from 9:00 a.m. to 4:00 p.m.
SeniorLine 412-350-5460, toll-free 1-800-344-4319, TTY 412-350-2727 or SeniorLine@alleghenycounty.us
APPRISE is a free health insurance counseling program designed to help Pennsylvanians, age 60 years and older. APPRISE volunteer counselors are specially trained to answer consumer questions and offer education about Medicare, HMOs, long-term care insurance, supplemental insurance, and Medicaid benefits. APPRISE services are free, objective and completely confidential.
APPRISE counselors are available to assist an individual in the following ways:

• Determine if a Medicare HMO is right for the individual by explaining the way Medicare HMOs work.
• Understand Medicare benefits by explaining what services are covered under Medicare Parts A and B and the Medicare Summary Notice.
• Select a Medigap insurance policy by explaining the benefits in each plan and providing a list of companies that sell these plans.
• Obtain assistance to pay for prescription drugs through government and private programs that offer this service, and explain the eligibility requirements and how to apply.
• Find government programs that will pay Medicare deductibles, co-payments, and Part B premiums and assist consumers with the paperwork.
• Understand long-term care by explaining eligibility requirements for government long-term care programs and explaining private long-term care insurance and how to select the best policy.

APPRISE services are free and all information is kept completely confidential. To contact a counselor, contact the APPRISE coordinator at 412-661-1438 or APPRISE@fswp.org. For general information on this and other services for older adults, you may contact the DHS AAA SeniorLine at 412-350-5460, toll-free 1-800-344-4319, TTY 412-350-2727 or SeniorLine@alleghenycounty.us.
Pennsylvania Health Law Project (PHLP)
PHLP 1-800-274-3258 works to overcome barriers to accessing health care coverage and services. They provide:

Health Insurance Coverage, Department of Human Services, Allegheny County

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Kasich makes faith argument for Medicaid | The Columbus Dispatch

 

Talking to reporters, Kasich pleaded for legislators to approve the expansion.

“The most-important thing for this legislature to think about: Put yourself in somebody else’s shoes. Put yourself in the shoes of a mother and a father of an adult child that is struggling. Walk in somebody else’s moccasins. Understand that poverty is real.”

Kasich continued: “I had a conversation with one of the members of the legislature the other day. I said, ‘I respect the fact that you believe in small government. I do, too. I also know that you’re a person of faith.

‘Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.’ ”

Kasich makes faith argument for Medicaid | The Columbus Dispatch

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What Do PPACA Standards Mean for Employers’ Health Plans? | Towers Watson - Towers Watson

 

Large employer and self-insured plans

Employers with 101 or more employees may not purchase coverage for their employees through the state insurance exchanges, at least until 2017.⁶ Employer plans need not cover all 10 essential benefits or classify their plans into actuarial value tiers. Nevertheless, the PPACA requires large-employer-insured plans and all self-insured plans, whether offered by large or small employers, to meet similar standards for benefit generosity and plan affordability:

1. Actuarial value: Under the PPACA’s employer pay-or-play mandate, employers with 51 or more full-time employees must offer at least one plan with an actuarial value of at least 60% or face potential penalties. Employees of large firms that fail this “minimum value” standard may become eligible for federal premium assistance tax credits to buy coverage in the exchanges. When employees qualify for these credits, the employer must pay a penalty of $2,000 per full-time employee or $3,000 per full-time employee receiving a premium assistance tax credit, whichever is less. Large firms that do not offer a health plan to all full-time employees also face a penalty of $2,000 per full-time employee.⁷
2. “Core” benefits: Most plans offered by large employers already include benefits similar in scope to the 10 statutory essential health benefits, but the law does not require large-employer-insured plans or any self-insured plans to satisfy this standard. The Internal Revenue Service (IRS) has proposed basing actuarial value calculations for these plans on four “core” categories of health services: physician and midlevel practitioner care, hospital and emergency room services, pharmacy benefits, and laboratory and imaging services.⁸ The four core categories include 95% of the charges covered by a benchmark plan with broad coverage.⁹ In practical terms, this difference is likely to have little material impact on actuarial value estimates.
3. Employer premium contributions: Employees of large firms that offer coverage meeting the minimum value standard are not eligible for premium assistance tax credits or cost-sharing subsidies in an exchange unless their share of the employee-only premium in the employer’s lowest-cost plan exceeds 9.5% of family income. Employers whose coverage does not meet this affordability standard must pay the same financial penalty as firms that fail the minimum value requirement. The IRS proposed regulation applied the affordability standard only to single coverage, but the final regulation suggested that future guidance will address family affordability. The regulation could make nonemployee family members eligible for premium tax credits where the self-only coverage is affordable but the family coverage is not.

How do current employer plans compare with exchange standards?

Figure 1 depicts key cost-sharing provisions for prototypical plans that might be offered in the four exchange tiers in the individual market. These plan designs are largely similar to plans that employers currently offer with the exception of the bronze plan, which has considerably higher cost sharing than most current employer plans. The $3,000 deductible is about $1,100 higher than the average deductible for an account-based health plan (ABHP) in 2010.¹⁰ The PPACA might cap deductibles for all employer-sponsored plans at $2,000 (see sidebar), potentially making it difficult for employers to design a plan with a 60% actuarial value.¹¹

Figure 1. Prototypical health plans in each exchange tier

What Do PPACA Standards Mean for Employers’ Health Plans? | Towers Watson - Towers Watson

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Who Will be Uninsured After Health Insurance Reform? - Robert Wood Johnson Foundation

 

The ACA would reduce the number of nonelderly people without health insurance by 28 million—from 18.9 to 8.7 percent.

Of the 23 million still uninsured, 40 percent would be eligible for, but not enrolled in, Medicaid or the Children’s Health Insurance Program (CHIP). A further 22 percent would be undocumented immigrants.

The majority of those uninsured—19 of the 23 million—would be nonelderly adults:

• Thirty-seven percent—mostly young singles without dependents—would be eligible for Medicaid, but not enrolled.
• Twenty-five percent would be undocumented immigrants.
• Sixteen percent would be exempt from the individual mandate because they would not have an affordable insurance option.
• Eight percent would be eligible for affordable subsidized coverage in the health benefit exchanges.
• The remaining 15 percent—most higher-income families with dependents—would likely be subject to the mandate, having an affordable private insurance option despite not qualifying for a subsidy.

Who Will be Uninsured After Health Insurance Reform? - Robert Wood Johnson Foundation

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Michigan's Approach to Medicaid Expansion and Reform — NEJM

 

Five core principles are evident in Michigan's approach to expanding and reforming Medicaid under the ACA. First, the state must achieve sufficient savings to offset its contributions for the Medicaid expansion when federal funding drops from 100% to 95% in 2017 and to 90% in 2021. Medicaid coverage of some state-financed health services, including mental health and prison health programs, is expected to result in approximately $200 million in savings for the state budget in 2014. If the state's costs are not offset by such savings, Michigan will withdraw from the Medicaid expansion in 2017 or later years. But current projections indicate that the state's cumulative savings should cover the additional costs through 2027.5

Second, Michigan will introduce financial incentives for new Medicaid enrollees to control their use of health care services and to maintain healthy behaviors. For 150,000 new enrollees with incomes between 100% and 133% of the federal poverty level, cost sharing amounting to as much as 5% of their annual income (approximately $580 to $775 for a single adult) is slated to begin 6 months after Medicaid enrollment. After 48 months of Medicaid coverage, cost sharing for these new enrollees will increase to 7% of their annual income, or they can choose to enroll in subsidized private insurance offered through the state's health insurance exchange. A system resembling health savings accounts will be created for individuals or their employers to deposit funds to cover copayments for health care services. Cost sharing can be reduced to 2% of annual income for new enrollees who demonstrate that they engage in healthy behaviors.

Third, the state will enroll newly eligible adults in private health plans rather than in traditional fee-for-service Medicaid. Health plans will be eligible for financial bonuses for effectively managing enrollee cost sharing required by the state and for achieving cost and quality targets. Health plans will also be directed to implement value-based insurance design by varying cost sharing according to the clinical value of services provided.

Fourth, Michigan's new law addresses health care delivery by requiring that new enrollees have access to primary care and preventive services. New enrollees will also be offered the opportunity to complete advance directives for end-of-life care when they enroll in Medicaid — part of a broader state initiative to encourage residents to express their preferences regarding end-of-life care.

Fifth, Michigan's new Medicaid law enhances the state's capacity to monitor the costs and quality of health care. The Department of Community Health, which oversees the Medicaid program, will assess opportunities for improving the Medicaid program and make Medicaid data available to outside vendors that can help participating health plans to pursue innovations in the program. The Department of Insurance and Financial Services will evaluate the effect of the Medicaid expansion on private insurance premiums in the state; some reduction in these premiums is anticipated.3,5 A new Health Care Cost and Quality Advisory Committee will be created to promote greater transparency with respect to the costs and quality of care.

Michigan's Approach to Medicaid Expansion and Reform — NEJM

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Final Word On Obamacare Coverage: Cheaper Than Expected

 

It's the definitive look at the insurance market with less than a week to go until the marketplaces open for enrollment.

"We've done a pretty good job of getting affordable options on the shelves," Jeanne Lambrew, deputy assistant for health policy to Obama, told reporters Tuesday in advance of the report's public release. "That is success that we've gotten to the point where we can say that."

On average, people will have a choice of 56 different insurance plans -- depending on which state you live in, though, that figure could range from seven (in Alabama) to 106 (in Arizona). The average number of insurers in a state is eight, though that again ranges from one to 13 in different states.

As for premiums, before tax credits kick in, they will average 16 percent below the Congressional Budget Office's original estimates for a silver-level plan (which covers 70 percent of costs). The number of insurers in a state is directly tied to how low premiums will be, Lambrew noted. Arizona, with an average of 106 plans to choose from, had the second-lowest average premiums for a 27-year-old adult: $166 a month. Wyoming, with an average of 16 plans, had the highest average premium at $342 a month.

But then the tax credits take effect. Those knock the premium for that 27-year-old, projected to earn $25,000, down to $145 in most states. For a family of four making $50,000, the credits take the premium price down from more than $1,000 in some states to $282.

The numbers before and after tax credits drop even further for bronze-level plans (which cover 60 percent of costs), often below $100 on average when tax credits are accounted for. White House officials routinely note a recent study that found 6 in 10 uninsured Americans will be able to purchase coverage for less than $100 a month.

Some might still find it preferable to pay the individual mandate penalty ($95 for the year or 1 percent of their income, whichever is greater), as Kaiser Health News reported Tuesday.

Final Word On Obamacare Coverage: Cheaper Than Expected

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Primary Payer Status Affects Mortality for Major Surgical Operations

This is the famous “Medicaid is worse than no insurance” study. It’s worth jumping to the full study and reading the Discussion section, as the authors do a pretty good job of pointing out why Medicaid patients, like the uninsured, are so darn sick and do so poorly in the health system. But, it does not say what they (the Right) think it says!

CONCLUSION

In this study, we conclude that Medicaid and Uninsured payer status confers increased risk adjusted in-hospital mortality compared with Private Insurance for major surgical operations in the United States. Medicaid is further associated with higher postoperative in-hospital complications as well as the greatest adjusted length of stay and total costs despite risk factors or the specific major operation. These differences serve as an important proxy for larger socioeconomic and health system-related issues that could be targeted to improve surgical outcomes for US patients.

Primary Payer Status Affects Mortality for Major Surgical Operations

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What is Medicaid’s Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence – Issue Brief | The Henry J. Kaiser Family Foundation

Finding #1:  Having Medicaid is much better than being uninsured.

Consistently, research indicates that people with Medicaid coverage fare much better than their uninsured counterparts on diverse measures of access to care, utilization, and unmet need. A large body of evidence shows that, compared to low-income uninsured children, children enrolled in Medicaid are significantly more likely to have a usual source of care (USOC) and to receive well-child care, and significantly less likely to have unmet or delayed needs for medical care, dental care, and prescription drugs due to costs.^{3 4 5 6}
The research findings on adults generally mirror the patterns for children. A synthesis of the literature on the impact of Medicaid expansions for pregnant women concluded, “…the weight of evidence is that expansions led to modest improvements in prenatal care use, in terms of either earlier prenatal care or more adequate prenatal care, at least in some states and for some groups affected by the expansions.”⁷ Mothers covered by Medicaid are much more likely than low-income uninsured mothers to have a USOC, a doctor visit, and a dental visit, and to receive cancer screening services.⁸ Nonelderly adults covered by Medicaid are more likely than uninsured adults to report health care visits overall and visits for specific types of services; they are also more likely to report timely care and less likely to delay or go without needed medical care because of costs.⁹ Projections from a recent analysis show that, if Medicaid beneficiaries were instead uninsured, they would be significantly less likely to have a USOC and much more likely to have unmet health care needs; except for emergency department care, their use of key types of services would also drop significantly. At the same time, their out-of-pocket spending would increase dramatically – almost four-fold on average.¹⁰ Other research provides evidence of increased access to care and health care utilization for previously uninsured low-income adults who gain Medicaid coverage under state expansions of eligibility.¹¹

Keep reading! (link below)
What is Medicaid’s Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence – Issue Brief | The Henry J. Kaiser Family Foundation

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JAMA Network | JAMA Internal Medicine | Medicare Payment for Cognitive vs Procedural Care: Minding the Gap

 

Importance Health care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment. Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health.

Objective To quantify the Medicare payment gap between representative cognitive and procedural services, each requiring similar amounts of physician time.

…

Results The revenue for physician time spent on 2 common procedures (colonoscopy and cataract extraction) was 368% and 486%, respectively, of the revenue for a similar amount of physician time spent on cognitive care.

Conclusions and Relevance Our analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health care system’s emphasis on procedural care. We demonstrate that 2 common specialty procedures can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day’s work.

JAMA Network | JAMA Internal Medicine | Medicare Payment for Cognitive vs Procedural Care:  Minding the Gap

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JAMA Network | JAMA | Views of US Physicians About Controlling Health Care Costs

 

Physicians’ views about health care costs are germane to pending policy reforms.

Objective To assess physicians’ attitudes toward and perceived role in addressing health care costs.

…

Results A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” …

JAMA Network | JAMA | Views of US Physicians About Controlling Health Care Costs

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10 companies submit health insurance product applications in Pa. - Philadelphia Business Journal

 

Ten insurance companies have submitted products to be included in the Pennsylvania health insurance marketplaces set to open Oct. 1.

• Aetna Health Ins. Co.

• Aetna Life Ins. Co.

• Capital Advantage Assurance Company

• Capital Advantage Insurance Company

• First Priority Life Ins. Co.

• Geisinger Health Plan

• Geisinger Quality Options

• HealthAmerica PA

• Highmark

• HM Health Ins. Co.

• Keystone Health Plan Central

• Keystone Health Plan East

• QCC Ins. Co.

• UPMC Health Network

• UPMC Healthplan Inc.

Keystone Health Plan East and QCC are affiliates of Independence Blue Cross, the Philadelphia region’s largest health insurer.

 

10 companies submit health insurance product applications in Pa. - Philadelphia Business Journal

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Uninsured in Texas and Florida - NYTimes.com

 

A new Census Bureau report documents the alarming percentages of people in Texas and Florida without health insurance. Leaders of both states should hang their heads in shame because they have been among the most resistant in the nation to providing coverage for the uninsured under the Affordable Care Act, the law that Republicans deride as “Obamacare.”

Uninsured in Texas and Florida - NYTimes.com

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“Secretary of ‘splaining” - NYTimes.com

 

“I have agreed to give this talk today because I am still amazed at how much misunderstanding there is about the current system of health care, how it works, how it compares with what other people in other countries pay for health care,” Mr. Clinton told the crowd assembled in a hall around the corner from a montage of black-and-white photographs of the 1992 presidential campaign. The audience of about 250 included Gov. Mike Beebe, a Democrat, and Speaker Davy Carter of the Legislature and Michael Lamoureux, president of the State Senate, both Republicans.

Despite the bipartisan show, health care is a contentious topic in Arkansas politics that conservatives have seized on in local campaigns. Mr. Pryor did not attend the event for risk of being too closely associated with the health care law, according to one person with knowledge of his plans, but who was not authorized to discuss them publicly. A campaign spokesman has said that Mr. Pryor had a scheduling conflict.

With the new insurance markets set to open on Oct. 1 for an initial six-month enrollment period, the White House has asked cabinet officers and other presidential appointees to step up efforts to promote the law. The administration has also recruited actors and entertainers and is seeking athletes and disc jockeys to whip up enthusiasm. Last week, the singer Katy Perry retweeted a Twitter post from President Obama encouraging young people to sign up for coverage. He responded, “Thanks for spreading the word.”

Mr. Clinton’s speech, which the White House broadcast live on its Web site, was not the first time that the former president, whose own attempt to sell a universal health care law failed drastically in his first term, has stepped into the debate over the new law. At the Democratic National Convention last September, Mr. Clinton delivered an endorsement of Mr. Obama that included concrete, well-received explanations of his policies, including on health care. That speech in particular signaled to the White House that Mr. Clinton could be an effective surrogate to sell the highly complicated Affordable Care Act.

On Wednesday, the former president carefully laid out Mr. Obama’s plan without delving into politics. But his mere involvement in selling the law provides him with a platform to reframe the failed battles of “Hillarycare” from his own administration.

“It would not be in her interest to be running for president and have this be a huge controversial issue in 2016,” said Robert J. Blendon, a professor of health policy at Harvard who closely follows public opinion of the law. “The Clintons have a lot of interest in getting this up and working and making it a legacy for the Democratic side.”

Reading glasses perched on his nose, Mr. Clinton struck a professorial tone as he explained in extensive detail the intricacies of the act. He laid out who would qualify for federal subsidies to help pay for the cost of coverage through the new markets and even ticked off Web addresses and phone numbers where Americans could find information.

Clinton Urges Americans to Sign Up for Health Care Exchanges - NYTimes.com

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Community groups feel heat of D.C. health-care battle

 

The letter from Washington arrived on Laura Line's desk Wednesday, three weeks after her nonprofit won a federal grant to help consumers make sense of the health-insurance marketplaces created by the Affordable Care Act and four weeks before they were to open for business.

It gave her nine days to provide Republicans on the House Committee on Energy and Commerce with all details and documents, electronic and paper, in her possession and not, involving the $953,716 her organization is getting to assist with health-insurance enrollment in 10 Pennsylvania counties.

"The letter doesn't concern us; it just adds to our workload," said Line, corporate assistant director for health care at Resources for Human Development, a national social services organization based in Philadelphia. "We are working at an incredible pace to try to be ready for Oct. 1," she said. "It will definitely distract us from what we are trying to do, which is to get health-insurance coverage for uninsured and underinsured residents who qualify in the marketplace."

Republicans said the letter was an attempt to protect tax dollars and personal medical information. Democrats said it was intended to sow confusion and undermine health reform.

The vitriol and hyperpartisanship that accompanied President Obama's health overhaul at first seemed to be largely rooted in Washington, where it was passed on party-line votes in 2010 and largely upheld by the Supreme Court in 2012. When that decision made optional the law's main provision for insuring low-income people - an expansion of Medicaid - much of the battle shifted to state capitals.

Now, with the six-month open-enrollment period approaching for the insurance-exchange marketplaces, opponents are aiming at community organizations that will be working with consumers.

Community groups feel heat of D.C. health-care battle

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Navigators Say GOP Lawmakers’ Information Requests Are 'Shocking' - Kaiser Health News

 

Organizations that received the latest round of health law navigator grants say last week’s letter from House Republicans could have a chilling effect on efforts to hire and train outreach workers to sign up Americans for health insurance by Oct. 1, the opening day for  new online insurance marketplaces.

The letters were signed by 15 Republican members of the House Energy and Commerce Committee and requested that the organizations provide extensive new documents about their participation in the program and schedule a congressional briefing by Sept. 13.  The letters went out to 51 organizations--including hospitals, universities, Indian tribes, patient advocacy groups and food banks—out of 104 that shared $67 million in grants. 

"I find the letter quite offensive," says Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, which received a $1.9 million grant. "It is shocking. It is absolutely shocking."

The organizations, all in states where the federal government will be setting up insurance marketplaces, are already under a difficult time crunch, with just six weeks from the time they received the grants to hire, train and prepare outreach work forces.

"Was this an attempt by members of the committee to basically stop and slow down the navigator process?" Hamler-Fugitt says. "We’re going to stop now and pull together voluminous documents to provide back to the committee?"

Some of those documents don't yet exist, she says. "We weren't required to provide position papers, salary ranges, privacy policies or procedures. You don’t do that until you know that you got the award."

The Obama administration used stronger language in describing the letter last week, characterizing it as a "blatant and shameful attempt to intimidate."

Navigators Say GOP Lawmakers’ Information Requests Are 'Shocking' - Kaiser Health News

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Major New Study On Obamacare Premiums Should End The 'Rate Shock' Hysteria Once And For All | ThinkProgress

 

The most comprehensive study on Obamacare to date finds that Americans’ insurance premiums under the health law will be “lower than expected.” Many Americans will pay even less than the top-line rates after factoring in government subsidies for their health coverage, with some paying nothing at all for crucial medical coverage.

The Kaiser Family Foundation (KFF) looked at individual policy prices in the 17 states, plus the District of Columbia, that have released comprehensive numbers for their Obamacare insurance marketplaces. Since premiums under the law will vary based on factors such as age and geographic location, KFF chose to examine how much the second-least expensive “Silver” mid-level plan and the least-expensive bare-bones “Bronze” level plan would cost for 25-year-old, 40-year-old, and 60-year-old Americans in those 17 states’ largest cities. The report includes both the top-line prices for those demographics, as well as what their costs would be after factoring in government subsidies based on varying income levels.

According to KFF’s findings, a single 40-year-old in Los Angeles could buy the second-cheapest mid-level plan for $255 per month — but if that person makes just under $30,000 per year, he or she will only have to pay $193 per month after receiving a government subsidy.

Strikingly, in every city analyzed, a family of four with two 40-year-old adults and a household income of $60,000 per year would pay $409 per month for the second-cheapest Silver plan after receiving subsidies. That’s more or less in line with the average $4,565 per year that workers currently contribute towards their employer-sponsored health insurance plans.

The report also finds good news for younger and older Americans. In Seattle, a 25-year-old making $28,725 per year will pay $193 per month for a Silver plan after subsidies and $138 per month for the cheapest Bronze plan after subsidies. For a single 60-year-old with the same income, those number would be $193 per month and $44 per month, respectively, after factoring in subsidies. And in Burlington, Vermont, both a single 25-year-old making $25,000 per year and a 60-year-old couple making a combined $30,000 per year would pay nothing at all for the cheapest, bare-bones Bronze plan.

While the KFF researchers emphasized that there will be significant variation in Obamacare premiums depending on geographic location, they concluded that premiums would be lower than what the government expected, writing, “the latest projections from the Congressional Budget Office imply that the premium for a 40-year-old in the second lowest cost silver plan would average $320 per month nationally. Fifteen of the eighteen rating areas we examined have premiums below this level, suggesting that the cost of coverage for consumers and the federal budgetary cost for tax credits will be lower than anticipated.”

Major New Study On Obamacare Premiums Should End The 'Rate Shock' Hysteria Once And For All | ThinkProgress

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Doctors and Their Medicare Patients - NYTimes.com

In the critics’ most dire scenarios, baby boomers nearing retirement age could find that their current doctors are no longer willing to treat them under Medicare and that other doctors are turning them down as well. Those concerns have always been greatly exaggerated. Now a new analysis by experts at the Department of Health and Human Services should demolish that mythology for good.
The analysts looked at seven years of federal survey data and found that doctors are not fleeing Medicare in droves; in fact, the percentage of doctors accepting new Medicare patients actually rose to 90.7 percent in 2012 from 87.9 percent in 2005. They are not shunning Medicare patients for better-paying private patients, either; the percentage of doctors accepting new Medicare patients in recent years was slightly higher than the percentage accepting new privately insured patients.
Medicare patients had comparable or better access to medical services than the access reported by privately insured individuals ages 50 to 64, who are just below the age for Medicare eligibility. Surveys sponsored by the Medicare Payment Advisory Commission, an independent agency that advises Congress, found that 77 percent of the Medicare patients — compared with only 72 percent of privately insured patients — said they never had an unreasonably long wait for a routine doctor’s appointment last year.
The findings from this survey and others can be sliced and diced in many ways. But the overall picture is clear: nationwide there is no shortage of doctors for Medicare patients. It is likely to stay that way, because Medicare is a big insurer that few medical practices can afford to ignore.

Doctors and Their Medicare Patients - NYTimes.com

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Obamacare Showdown Over a Ham Breakfast in Kentucky - NationalJournal.com

 

Beshear's advocacy, by contrast, was striking in its intensity and in how personally he approached the issue, picking up on the idea that many people who don't have health insurance are embarrassed by that and don't talk about it.

The governor compared health insurance to "the safety net of crop insurance" and said farmers need both. He said 640,000 Kentuckians—15 percent of the state—don't have health insurance and "trust me, you know many of those 640,000 people. You're friends with them. You're probably related to them. Some may be your sons and daughters. You go to church with them. Shop with them. Help them harvest their fields. Sit in the stands with them as you watch your kids play football or basketball or ride a horse in competition. Heck, you may even be one of them."

Beshear went on to say that "it's no fun" hoping and praying you don't get sick, or choosing whether to pay for food or medicine. He also said Kentucky is at or near the top of the charts on bad-health indicators, including heart disease, diabetes, cancer deaths, and preventable hospitalizations. He said all that affects everything from productivity and school attendance to health costs and the state's image.

"We've ranked that bad for a long, long time," he said. "The Affordable Care Act is our historic opportunity to address this weakness and to change the course of the future of the commonwealth. We're going to make insurance available for the very first time in our history to every single citizen of the commonwealth of Kentucky."

About half the audience burst into applause at that point while the other half sat on their hands. But he wasn't done. He cited a study that showed the law would inject about $15.6 billion into the Kentucky economy over eight years, create 17,000 new jobs, and generate $802 million for the state budget.

"It's amazing to me how people who are pouring time and money and energy into trying to repeal the Affordable Care Act sure haven't put that kind of energy into trying to improve the health of Kentuckians. And think of the decades that they have had to make some kind of difference," Beshear finished pointedly.

Obamacare Showdown Over a Ham Breakfast in Kentucky - NationalJournal.com

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Health costs are growing really slowly. Americans haven’t noticed.

Health costs are growing really slowly. Americans haven’t noticed.

Ask any health economist and they’ll no doubt tell you that health care cost growth is slowing, growing at a low, unprecedented rate.

They can point to the National Health Expenditures report, which shows health care costs now growing at the same rate as the rest of the economy. Or, they can pull up new data out Tuesday from the Kaiser Family Foundation, showing that premiums grew 4 percent in 2013. That’s way lower than growth in the late 1990s and early 2000s.

Ask any American about what direction health costs are moving, and you’ll likely get a completely different story. Preliminary results for a forthcoming Kaiser Family Foundation poll show that most Americans think that health care costs are actually growing faster than usual right now. Fewer than 10 percent say the growth is slowing down.

“We have a very moderate increase this year, but premiums go up each year,” Kaiser Family Foundation president Drew Altman says. “People see what they pay for their premium going up and perhaps more forms of cost-sharing. We’ve been seeing a quiet revolution from more comprehensive coverage to less.”

Altman said that preliminary results from his group’s survey show that 54 percent of Americans think health care costs are growing faster than average. “A tiny number said they were growing slower,” he says. “I think that’s because, if we look at this as a long term trend, health care costs have increased in excess of wages and inflation.”

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The Affordable Care Act And People With Disabilities - Forbes

 

“ACA changes the world for persons with disabilities and funds who will now have a choice between public or private health insurance. For significant financial as well as health reasons, we believe that private health insurance, not Medicaid, will be soup d’jour for the vast majority of (Special Needs Trusts) SNT clients. We cannot know for certain, but I would not be surprised to see persons with disabilities leaving public health insurance (Medicaid) for the private market in January, 2012.

The most obvious and most significant health industry reform important to our SNT clients is the elimination of pre‐existing conditions as a bar to purchasing private health insurance. However, ACA also eliminates annual or lifetime caps, rescission of insurance policies, non‐renewability, and higher premium costs for persons with pre‐existing conditions. For individuals with significant medical problems, elimination of cost‐containment ceilings is just as important as access to the door of private medical care. It is not unusual to see clients who have maxed out their lifetime cap and are now seeking public health insurance.

Why would clients opt to pay for private health insurance rather than “free” Medicaid? The two major reasons are first, securing health insurance without a payback on death and second, access to significantly better medical care…

Change makes most of us uncomfortable, but change is a constant in our lives. This is one time when special needs attorneys can both lament the negative impact of national legislation on our personal financial well‐being, but rejoice in the concomitant good fortune of our clients with disabilities who can now join the private health insurance market with the rest of us as equal citizens with their dignity intact.”

The Affordable Care Act And People With Disabilities - Forbes

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Engaging confidently on health care reform | Battleground Surveys

 

Republicans will run on health care reform in 2014 and 2016, so get used to it. But do not believe that it will give them a better chance of securing their seats or the best shot at putting competitive Democratic seats in danger.  Democrats in the most rural and the strongest Romney seats will have to be inventive as usual, but Democrats have a lot to say on health care: fix it, don’t repeal it, don’t put the insurance companies back in charge and take your hands off Medicare.

Health care is just not a wedge issue that threatens to change these races very much – as we saw in the 2012 elections where Republicans played out this strategy.  This is basically a 50-50 issue in the battleground districts and the country, and it remains a 50-50 issue after voters have heard all of their toughest attacks, including one on the role of the IRS in the new system.  These attacks have power, and it is important to engage on the issue.  But there is no reason to think the debate changes the dynamic in these competitive House seats: we actually show Democrat members gaining on handling health care reform in their own seats.

Why is it that the popularity of the Republican Congress keeps going down as the Republicans vote now 40 times to repeal the Affordable Care Act, despite that the law is not popular with the public?  We suspect because the House Republicans are associated with gridlock, extreme partisanship, and intense anti-Obama sentiment; because voters have other serious priorities and their steadfast focus on health care alone says Republicans are not focused on them and their issues; because Democrats are more trusted than Republicans on health care; and most important because voters do not want to repeal the law.  The more voters hear “repeal,” the less they are interested in voting Republican.

We know Republican base voters feel intensely about health care reform, but voters rank “government takeover of the health care system” pretty low as a concern about Democrats in Congress.

These results suggest Democrats should engage the issue with some confidence -- they can undermine the Republican attacks and indeed gain an advantage by educating the public on the reforms. 

Engaging confidently on health care reform | Battleground Surveys

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Special Deal by Haley Sweetland Edwards | The Washington Monthly

Another piece on the RUC. Follow the tags to learn more…

Over the past few years, a few well-placed health care figures from both parties have spoken out—at least once they’ve left office—about how crazy this system is. “The RUC is really just a giant cabal run by the AMA,” Thomas Scully, former head of the CMS under George W. Bush, told me. “A private trade association should not have that sort of control over the biggest spending account in the government. It’s an outrageous travesty of democracy.” Bruce Vladeck, former head of the CMS under Bill Clinton, agrees, calling the RUC “a significant part of the problem.”

There have also been scathing reports issued by the Government Accountability Office, and by MedPAC, the agency that advises Congress on Medicare-related issues, as well as some hard-hitting investigative reporting by the Wall Street Journal and the Center for Public Integrity. In 2011, a bipartisan panel participated in a Senate roundtable, during which three former heads of the CMS took turns lamenting the RUC.

Yet, for the most part, the RUC continues to operate exactly as it always has—behind the scenes, without anyone, including actual doctors laboring in the clinics and hospitals across the country, even really knowing about it. (This spring, Scully told me that he went to lunch with a very high-ranking official at the CMS who had no idea how the RUC actually worked.)

The Affordable Care Act, for its part, includes a few lines that could potentially, if incrementally, limit the RUC’s power. But in general, it doesn’t much change the way the reimbursement system works. Taking on the RUC would have “started a nuclear war with the AMA,” as Scully put it, and alienated other key political allies that the administration needed to pass the law to begin with. Fixing the RUC, however, is essential to fixing health care in this country.

Special Deal by Haley Sweetland Edwards | The Washington Monthly

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How a secretive panel uses data that distorts doctors’ pay - The Washington Post

An “expose” on the RUC and physician payment structure. Follow the tag for “RUC” at the bottom to learn more, and “Physician Income” to learn more about what a fair income is, and “IPAB” for a potential solution…

So how much does a physician make on a basic colonoscopy?

A good place to look is Pennsylvania, where the state tracks medical procedures and the profits of the doctor-owned surgery centers.

Even in an otherwise down-at-the-heels former coal town, the procedure can be big business.

At Schuylkill Endoscopy, located in a tidy green building behind the McDonald’s in Pottsville, Pa., three doctors performed thousands of colonoscopies in 2011, taking in more than $700,000, along with hundreds of thousands more for other similar procedures. On top of those physician fees, the endoscopy clinic, which is owned by two of the physicians and a management company, took in $1.5 million in operating profits in 2011, according to state records.

“I am very comfortable — very grateful,” said one of the owner-doctors, Amrit Narula, who lives in a modern-style, 5,000-square-foot house atop a ridge here.

Like other doctors interviewed for the story, Narula noted that he has no role in setting the Medicare value. He does not lobby Medicare and has never filled out one of the RUC surveys. He agreed that the time estimates in his field sound exaggerated.

By itself, the professional fee for a colonoscopy makes him about $260 an hour after his expenses. (That’s a figure that’s based on the clinics’ mix of patients and the Medicare assumptions about overhead.)

Is that too much? In the past, the loudest criticism of the point system has come from primary care physicians who think their work has been undervalued.

The median salary for a gastroenterologist was $481,000 in 2011, according to data from the Medical Group Management Association. By contrast, the median salary for a pediatrician was $204,000 and that of a general internal medicine doctor was $216,000. Those kinds of disparities are leading medical students away from primary care, critics say.

“I didn’t know they got that many RVUs [points] for a colonoscopy — that’s kind of amazing,” said Cynthia Lubinsky, a family practitioner in the next county over from Narula. “Do I believe that the payment system is fair? I would have to say no.”

How a secretive panel uses data that distorts doctors’ pay - The Washington Post

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12 Questions Republicans Need to Answer on Infant Mortality in Ohio

 

Fresh off passing a budget that will increase Ohio’s infant mortality rate, Sen. Shannon Jones is touring the state with the Senate Medicaid, Health & Human Services Committee.

In 2009, the Ohio Department of Health formed the Ohio Infant Mortality Task Force (OIMTF) to address our infant mortality rate, which is currently 3^rd-highest in the nation; our infant mortality rate among African-Americans is the highest in the nation. (In 2009, we were the 12^th-highest. Go Team Kasich!)

The OIMTF made a 10-point recommendation to address the problem, but the Ohio budget systematically undermines each of the 10 recommendations. There’s a chart at the bottom of the [link page] with more detail.

They’ll be hearing “the concerns of constituents… regarding infant mortality rates and health disparities.”

That’s convenient. Here are some sample questions to ask Sen. Jones when she comes to town.

• Early prenatal care is the most effective way to reduce infant mortality, but almost half of Ohio women are uninsured when they become pregnant. Expanding Medicaid would mean that all pregnant Ohioans can get immediate prenatal care without seeking reimbursement. Sen. Jones, how you do propose to lower the infant mortality rate without expanding insurance coverage to all Ohioans?
• In 2009, ODH recommended expanding pre-pregnancy gynecological services. The most popular provider of these “family planning” services is Planned Parenthood, which every year sees 1 in 6 Ohio women. Sen. Jones, you just voted for a budget to take away funding from Planned Parenthood, raising the price of these family planning services. Does that mean that you disagree with the recommendation that women talk to a gynecologist before they get pregnant?
• 10 more at the link below…

12 Questions Republicans Need to Answer on Infant Mortality in Ohio

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Diagnosis - Insufficient Outrage - NYTimes.com

You don’t often see a good rant of moral outrage regarding health care in the Times, so here you go!

RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?

Diagnosis - Insufficient Outrage - NYTimes.com

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Unpacking The Meaning Of ‘Rationing’: A Response To Dowd And Allison – Health Affairs Blog

The Dowd and Allison article appeared in Health Affairs,  and fortunately Uwe Reinhardt has analyzed it in a reality-based context. An excerpt:

The view that private markets — whether or not perfectly competitive — ration goods and services in scarce supply apparently is not shared by Dowd and Allison when they write:

“…rationing involves limits on consumption that are (1) set by someone other than the consumer (such as the supplier) with (2) the intent of limiting choices that some consumers otherwise would be willing and able to make.”

So according to Dowd and Allison, rationing occurs only when limits are placed upon choices that some potential buyer of a good or service would otherwise be willing and able to make, and I emphasize here the words “and able.”

For example, if for some reason government intervened in a reasonably price competitive market for some health care good or service that is in limited supply — e.g., a vaccine — to allocate that scare item to members of society on the basis of some criterion other than price and the recipients’ ability to pay, it would be rationing. On the other hand, if that limited supply were allocated among members of society on the basis of price and ability to pay, and on that basis individuals were denied access to that good or service, that might possibly be an “economic injustice”, but it would not be rationing.

Dowd and Allison certainly are free to posit this as their definition of rationing. They should not assume, however, that their definition is universally shared, even among economists, nor should they assume that in the debate on health policy the more expansive definition of rationing, including price-rationing, is abusive.

Unpacking The Meaning Of ‘Rationing’: A Response To Dowd And Allison – Health Affairs Blog

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'Premium Shock' and 'Premium Joy' Under the Affordable Care Act - NYTimes.com Uwe Reinhardt

Community Rating Under the Affordable Care Act
Under the law, an individual health plan selling policies in the small-group and nongroup market — whether it sells policies through the state’s exchange or not — will be free to set its own premium for a given policy. But within a given age group, it must apply the same premium to all comers, regardless of their health and their gender. Furthermore, the health plan cannot reject any applicant willing to pay that premium, a provision called “guaranteed issue,” or cancel existing policies.
In other words, the X_i based on the individual’s health status in the equation above will be replaced by the average expected health spending per insured, with the average calculated over the insurer’s entire anticipated risk pool of insured members of a given age. To calculate the average, the insurer must consider as one single risk pool all enrollees in all health plans offered by the insurer, whether or not they are offered on the exchange.
This form of premium setting is known as “community rating.” Because it forces healthier individuals to subsidize sicker individuals through the community-rated premiums, it has been much debated.
Community rating invites “cherry-picking” by insurers — i.e., attempts to attract mainly low-risk applicants. To limit the profit potential from cherry-picking, there will be post-enrollment risk adjustments through which funds are transferred from insurers ending up with relatively healthier risk pools to those ending up with relatively higher risk pools.
The community rating under the law is not the pure version found in the social insurance systems of Europe (e.g., Switzerland, the Netherlands and Germany) or Asia, where even age is not considered in setting premiums. Rather, the American version is called adjusted community rating, because it does allow insurers to adjust the community-rated premium for the age of the applicant.
Age-adjusting is done by multiplying the community-rated premium for the youngest members in the expected risk pool by a standard, multiplicative age ratio to be used by all insurers. Thus the quoted premium can increase step by step with age, but only up to a multiplicative factor of 3. At a given age, smokers can be charged up to 1.5 times the regular premium.
The change from what was in place before the Affordable Care Act to post-law arrangements in the nongroup market can be illustrated graphically. In the chart below, we assume initially that all members of a given population are covered by either medically underwritten or community-rated health insurance, with a given package of covered health benefits. The white line represents the premium individuals would have to pay under medical underwriting. The dashed segment of that line is meant to show the actuarial cost and the premium range in which insurers in the real world would reject applicants outright. The green line shows the community-rated premium for this same population. We assume here that age is either not factored into the premium or the population in question is all of the same age, which is why the green line is horizontal.

Premium Shock
As the chart illustrates, a switch from medically underwritten premiums to community-rated ones raises the premiums for the relatively healthier members of the insurer’s risk pool. Many of them will suffer what has come to be called premium shock.
Younger and healthier members of the pool should realize that, in effect, they are buying a call option that allows them to buy coverage at a premium far below the high actuarial cost of covering them when they are sicker. The price charged the healthy for this call option is the difference between the premium they must pay and the current lower actuarial cost of covering them.
Furthermore, for Americans in households with incomes below 400 percent of the federal poverty line, the green and red lines exaggerate the impact of the law on their spending. These Americans will be granted often quite generous, income-dependent federal subsidies toward the premiums they face on the exchanges and their out-of-pocket costs for health care. This makes it well-nigh impossible to make general statements, based on averages, about the net after-subsidy impact of the law.

'Premium Shock' and 'Premium Joy' Under the Affordable Care Act - NYTimes.com

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Wendell Potter: A Rare Bipartisan Idea to Improve Medicaid and Save Money

 

The problem is referred to by policy wonks as "churn." Because of the way Medicaid is administered by the states, millions of Americans enrolled in the program lose coverage temporarily every year because of often minor fluctuations in their income or even a change of address. Many are removed from the rolls simply because they can't take time off from work to go to a Medicaid office to re-verify their incomes every three months, which some states require.

It's called churn because most people who are "disenrolled" -- to use insurance industry jargon -- are eventually reinstated. Their eligibility for Medicaid never changed. They lost coverage solely because of paperwork requirements or a slight and fleeting bump in pay from working overtime during a given week.

This is unknown in the private insurance world because once you enroll in a health plan, you can stay enrolled in that plan for a year, so long as you keep paying the premiums on time. It doesn't matter if you move from one street to another or work an extra shift to make a few extra bucks.

But staying covered for a full year under Medicaid is not a given, and the consequences of this churn are costly, and not just for those most directly affected. The situation is costly to taxpayers, too, because of the unnecessary administrative expense. It costs hundreds of dollars per enrollee to verify income multiple times a year and to process all the paperwork involved in reinstating a beneficiary. When you consider that 58 million of Americans are currently enrolled in Medicaid -- a number that will grow substantially next year when many states expand coverage under the Affordable Care Act -- billions of taxpayers' dollars are being wasted because of churn.

Those who fare the worst, though, are eligible beneficiaries who get dumped into the ranks of the uninsured.

"Even short gaps in coverage can lead to delay or avoidance of needed care," says Leighton Ku, director of the Center for Health Policy Research at George Washington University's School of Public Health and Human Services, who along with colleague Erika Steinmetz studied the effects of churn. They released their findings in a report last month.

Please read on…

Wendell Potter: A Rare Bipartisan Idea to Improve Medicaid and Save Money

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Colonoscopies Explain Why U.S. Leads the World in Health Expenditures - NYTimes.com

By ELISABETH ROSENTHAL | Published: June 1, 2013

MERRICK, N.Y. — Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.
That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.
“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”
In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.
Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories — and often by a huge margin.
Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.

Colonoscopies Explain Why U.S. Leads the World in Health Expenditures - NYTimes.com

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