A Formula for Cutting Health Costs
No matter what happens to President Obama’s health care reforms after the November elections, the disjointed, costly American health care system must find ways to slow the rate of spending while delivering quality care. There is widespread pessimism that anything much can be achieved quickly, but innovative solutions are emerging in unexpected places. A health care system owned and managed by Alaska’s native people has achieved astonishing results in improving the health of its enrollees while cutting the costs of treating them.
At a recent conference for health leaders from the United States and abroad at the native-owned Southcentral Foundation in Anchorage, the Alaskans described techniques that could be adopted by almost any health care organization willing to transform its culture. Such a transformation would require upfront financing for training, data processing and the like, but the investment should rapidly pay off in reduced costs.
The foundation, established in 1982, provides primary outpatient care to Alaska natives and American Indians who had previously been the responsibility of the federal government’s Indian Health Service. It serves 45,000 enrollees in the Anchorage area and 10,000 more scattered in remote villages, most reachable only by air, on an annual budget of $200 million. It also jointly owns and manages (with a consortium of native tribes) a small hospital, and has built a modern campus of outpatient clinics with the help of loans, grants, bonds and retained earnings.
About 45 percent of its revenue comes in what amounts to an annual block grant from the Indian Health Service, a source unavailable to most health systems; another 45 percent comes from Medicaid, Medicare and private insurers, and the rest from philanthropy and grants.
Only the First Step in Containing Health Costs
By CHRISTINA D. ROMER
HERE’S a frightening thought: Despite the recent Supreme Court decision upholding the Affordable Care Act, serious work on more health care legislation is still needed.
Don’t get me wrong: the new law is a great step forward. It is expected to expand health insurance coverage to more than 30 million uninsured Americans without increasing the deficit, and it makes an important start on reining in the rapid growth of health care costs.
But it’s only a start. Even with the law, health care spending is still projected to rise rapidly over coming decades, so more steps to contain costs will have to be taken.
Supporters of President Obama’s plan usually talk about the expansion in coverage and the new consumer protections: the large decline in the number of uninsured people, more preventive care and the prohibition on denying coverage for pre-existing conditions. These huge accomplishments deserve to be shouted from the rooftops.
But there’s a side that’s often forgotten: the so-called pay-fors and the cost-containment measures. These components — provisions to finance the new expenditures and tax credits, as well as to slow the rapid rise of health care costs — help explain why the act was so hard to pass, and why it remains the subject of so much debate. Unfortunately, they are also the parts that need to be expanded and built upon.
Romney Aide Helps States Comply With Health Care Law
By ROBERT PEAR
WASHINGTON — If Republicans in Congress agree on anything, it is their desire to eradicate President Obama’s health care law. But one of the top advisers to Mitt Romney, the party’s likely presidential nominee, has spent the last two years advising states and private insurers on how to comply with the law.
The adviser, Michael O. Leavitt, gets high marks from state officials and policy experts, who describe him as a pragmatist with a voracious appetite for information. But his work has caused consternation among some conservatives, who want states to resist the health care law.
Mr. Romney has named Mr. Leavitt — a longtime friend, former governor of Utah and former federal health secretary — to plan the transition for what both hope will be a Romney administration.
Mr. Leavitt’s full-time job is running his consulting company, Leavitt Partners, which is based in Salt Lake City and has advised officials in Mississippi, New Mexico and Pennsylvania, among other states. He shows them how to set up health insurance exchanges and where low- and middle-income people and small businesses can buy subsidized private insurance from competing carriers. He has also helped states prepare for the influx of millions of low-income people into Medicaid.
Mr. Leavitt represents one pole in a debate among Republicans. Some want nothing to do with the federal law. Others, like Mr. Leavitt, say it is better for states to take the initiative and set up exchanges rather than cede control to the federal government. Under the 2010 health care law, if a state does not set up and operate an exchange, the federal government will do so in the state.
Maine Debate Hints at Rift on Medicaid After Ruling
By ABBY GOODNOUGH and ROBERT PEAR
AUGUSTA, Me. — As some Republican governors declare that they will not expand Medicaid under the national health care law, Gov. Paul R. LePage is going a step further. In what could lead to a direct confrontation with the Obama administration, he is planning to cut thousands of people from Maine’s Medicaid rolls, arguing that the recent Supreme Court ruling on the law gives him license to do so.
Mr. LePage, a Republican, says the ruling gave states leeway to tighten eligibility for Medicaid, the joint state-federal program that provides health care to low-income and disabled people. Federal officials insist that while the ruling allowed states to opt out of a planned expansion of Medicaid, it left intact all other aspects of the law affecting the program.
“The court’s decision did not affect other provisions of the law,” Kathleen Sebelius, the secretary of health and human services, said in a letter to all governors last week.
The debate here may presage political and legal conflicts between the federal government and other states as they grapple with implications of the Supreme Court decision.
Ever since the law was enacted in 2010, governors of both parties have complained about its requirement to maintain Medicaid eligibility levels, saying it has hamstrung their efforts to balance budgets during a period of excruciating economic pressures. But the federal government has generally not relented on the so-called maintenance-of-effort requirement.
Before last month’s ruling, Mr. LePage had planned to seek a federal waiver to remove more than 20,000 people from MaineCare, the state’s Medicaid program. But he now says that the ruling made a waiver unnecessary.
“Maine believes the Supreme Court decision confirms that states have the flexibility to manage their Medicaid program without risking the loss of federal funds,” Adrienne Bennett, Mr. LePage’s spokeswoman, said in an e-mail.
Public’s Opinion of Supreme Court Drops After Health Care Law Decision
By ADAM LIPTAK and ALLISON KOPICKI
WASHINGTON — The American public’s satisfaction with the Supreme Court, which had already been low by historical standards in recent polls, dropped further in the wake of the court’s 5-to-4 ruling last month upholding President Obama’s health care overhaul law.
The nation is now evenly divided, with 41 percent of Americans saying they approve of the job the court is doing and the same share voicing disapproval, according to a new poll conducted by The New York Times and CBS News. In a poll a few weeks before the health care decision, the court’s approval rating was 44 percent and its disapproval rating 36 percent.
More than half of Americans said the decision in the health care case was based mainly on the justices’ personal or political views. Only about 3 in 10 of them said the decision in the case was based mainly on legal analysis.
Since the ruling, support for the court among Republicans and independents has slipped, while support among Democrats is largely unchanged.
More than half of Republicans now express disapproval of its work, compared with just over a third in early June. Among Democrats, the court continues to be somewhat more popular, with about half approving and a third disapproving.
Among independents, positive views of the court also held steady, with about 4 in 10 Americans approving. But disapproval among independents rose, to 43 percent from 32 percent.
Buying Time
By CATHI HANAUER
As Bennett writes in her memoir, “The Cost of Hope,” the shadow was looked at. It was rescanned, removed and sent to a lab. It was diagnosed twice — first as “collecting duct” cancer, then as “papillary” cancer (doctors still disagree over what it was) — and treated with drugs bearing price tags of $200 per daily pill and $109,440 for four one-hour intravenous drips. It also spread to Foley’s lungs, and in December 2007, it took his life. He was 67. The bill for his seven years of treatment totaled $618,616.
Bennett is a Pulitzer Prize-winning journalist and an executive editor at Bloomberg News (this book grew out of an article she wrote for Bloomberg). Her memoir is equal parts marriage confessional and skilled investigative report. It’s a story of the sometimes amusing, sometimes baffling relationship and hectic but rewarding life she shared with Foley for over two decades. It’s also the fascinating account of an illness — its origins, composition and progression — and of the cost (mental, physical and financial) of trying to treat it via the complicated, frustrating, outrageously expensive American health care system.
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