2 Campaigns Differ Sharply on Medicaid, Seeking Vast Growth or Vast Cuts
By ABBY GOODNOUGH
The way Mitt Romney and Representative Paul D. Ryan frame it, the debate over social programs that has become a dominant theme of the presidential race is all about the future of Medicare, the government health insurance program for retirees.
But the outcome of the election will probably have a more immediate and profound effect on Medicaid, the joint state-federal program that provides health care to poor and disabled people.
Few other issues present a starker difference between the Republican and Democratic tickets. President Obama, through the health care law that was a centerpiece of his domestic agenda, seeks a vast expansion of Medicaid, which currently covers more than 60 million Americans — compared with 50 million in Medicare — and costs the states and the federal government more than $400 billion a year.
To fulfill the law’s goal of near-universal coverage, the president envisions adding as many as 17 million people to the rolls by allowing everyone with incomes up to 133 percent of the poverty level to enroll, including many childless adults. While the Supreme Court ruled in June that states could opt out of the expansion, Medicaid — and federal spending on it — is still likely to grow significantly if Mr. Obama wins a second term.
Mr. Romney and Mr. Ryan would take Medicaid in the opposite direction. They would push for the repeal of the health care law and replace the current Medicaid program with block grants, giving each state a lump sum and letting them decide eligibility and benefits. (Currently, the federal government sets minimum requirements, like covering all children under the poverty level, which some states surpass. It also provides unlimited matching funds.) The grants would grow at the rate of inflation, with adjustments for population growth. Critics say annual increases would not keep up with rising health care costs.
Feds still mulling LePage's Medicaid waiver request
Gov. LePage would like to tighten eligibility requirements and remove 24,000 low-income parents and 1,800 elderly people from the program.
AUGUSTA — Federal regulators told Gov. Paul LePage on Friday that the government needs more time to decide whether to approve changes that Maine has proposed in itsMedicaid eligibility requirements.
http://www.pressherald.com/news/Feds-still-mulling-LePages-Medicaid-waiver-request.html
http://www.pressherald.com/news/Feds-still-mulling-LePages-Medicaid-waiver-request.html
Feds won’t rule on $20 million in Medicaid cuts on LePage’s timeline, throwing cuts into question
Posted Aug. 31, 2012, at 5:11 p.m.
AUGUSTA, Maine — The LePage administration won’t get a decision from the federal government as soon as it wanted on its request to make about $20 million in cuts to the state’s Medicaid program.
The federal Centers for Medicare and Medicaid Services said Friday it’s still reviewing Maine’s request for an amendment to its so-called Medicaid state plan. In a letter to LePage, acting administrator Marilyn Tavenner noted that the Medicare and Medicaid office has 90 days to review such a request.
“I appreciate that your budget is predicated on the savings anticipated from ending the Medicaid coverage of the groups of individuals at issue in the proposed [state plan amendment], but your request raises issues that require careful consideration by HHS,” she wrote.
The LePage administration submitted its request for the Medicaid plan amendment on Aug. 1 and requested an expedited decision, by Sept. 1, so the state could implement the cuts by Oct. 1. Since the federal government is allowed 90 days to rule on the amendment request, Maine should have a decision in hand by the end of October, well after the cuts were to have taken effect.
The administration had been counting on the Medicaid cuts — approved by Republican lawmakers as part of a spring supplemental budget package — to balance the state budget.
But it has been uncertain from the start whether many of the cuts would be legal under the Affordable Care Act, which largely prohibits states from making cuts to existing Medicaid services in advance of a 2014 expansion of Medicaid, a program funded by states and the federal government that provides health insurance to low-income residents.
The state cuts would eliminate coverage for 19- and 20-year-olds, tighten income eligibility requirements for low-income parents and scale back Medicaid access for elderly residents who also qualify for Medicare benefits.
While the Supreme Court in June largely upheld the federal health care reform law, the court ruled it unconstitutionally coercive for the federal government to withhold all Medicaid funds from a state that doesn’t participate in the Medicaid expansion.
Ex-Obama advisers seek health care cost control
By | Associated Press – 2 mins 2 secs ago
WASHINGTON (AP) — Some of President Barack Obama's former advisers are proposing major changes aimed at controlling health care costs as political uncertainty hovers over his health law.
Call it Health Care Overhaul, Version 2.0. Their biggest idea is a first-ever budget for the nation's $2.8-trillion health care system, through negotiated limits on public and private spending in each state.
The approach broadly resembles a Massachusetts law signed this summer by Democratic Gov. Deval Patrick that puts pressure on hospitals, insurers, and other major players to keep rising costs within manageable limits. It could become the Democratic counterpoint to private market strategies favored by Republican presidential nominee Mitt Romney and running mate Paul Ryan.
Tackling Rising Health Care Costs in Massachusetts
N Engl J Med 2012; 367:790-793August 30, 2012
Unfinished Journey — A Century of Health Care Reform in the United States
N Engl J Med 2012; 367:585-590August 16, 2012
Comments open through December 31, 2012- Article
- In 1915, reformers issued the first major proposal for national health insurance in the United States (see timeline
Timeline — A Century of Health Care Reform in the United States.). They believed that America should follow European countries such as Germany and England in securing access to medical care for workers and protecting them against the economic burdens of illness. The leadership of the American Medical Association (AMA) initially agreed, and the prospects for reform appeared promising.Yet by 1920, the health care reform campaign had failed, the victim of intense opposition (from businesses and the insurance industry, among others), bad timing (the American entry into World War I), demagoguery, and xenophobia (charges that the health care proposals were “Made in Germany,” “Bolshevik,” and “un-American”). After an internal revolt, the AMA became a steadfast opponent of national health insurance. The issue briefly disappeared from the agenda.1Healthcare for All!
SPCBeauty bonanza
Health professionals answer the demand for cosmetic procedures – especially from baby boomers – with easy-access medical spas.
Radio ads for Sarasota, Fla.-based Venus Mini Med Spa tout the beauty benefits of getting facial fillers at the mall.A Fort Lauderdale, Fla., dental spa invites women to a cocktail soiree to sip champagne, taste hors d'oeuvres, sample Botox and try eyelash extensions.They are cashing in on the desire to turn back the clock.Once strictly the purview of plastic surgeons and dermatologists, medical professionals of nearly every ilk -- from ophthalmologists to dentists to gynecologists, as well as physician assistants and nurse practitioners -- are now jumping on the youth-enhancing bandwagon.Their medical spas offer nonsurgical -- and sometimes even surgical -- cosmetic procedures for women and men."It is a bit of a Wild West out there," said Dr. Leo McCafferty, a Pittsburgh plastic surgeon and president of the American Society of Aesthetic Plastic Surgery. "It doesn't mean that all med spas are bad, but it certainly behooves the consumer to do due diligence."Health Care Where You Work In the scramble to find ways to slow rising health care costs, experts are finding good ideas from organizations that are virtually unknown beyond their hometowns.Consider Bellin Health, a not-for-profit health care system based in Green Bay, Wis. It has managed to rein in costs while improving the availability and quality of care — in large part by making it easier for patients to see nurses and primary care doctors. For employers, it builds clinics right at the workplace so workers can have minor ailments treated before they become serious, as well as many kinds of preventive care.Although it is relatively modest in size, with a 178-bed community hospital and a primary care practice staffed by 95 doctors, Bellin, in partnership with a neighboring health care system, has been chosen by the federal government as one of 32 pioneering groups to test a new Medicare payment system that rewards providers if they reduce spending but penalizes them if costs soar. If successful, this program could be copied by private insurers.Bellin ranks in the top 4 percent of hospitals in holding down costs in the last two years of life, with its overall spending per Medicare beneficiary 20 percent below the national average, according to data compiled by the Dartmouth Atlas of Health Care. Bellin has also cut health costs for its own employees. In 2002, its annual spending on health care had reached $10 million and was projected to jump to $13 million in 2003. With a vigorous effort to improve efficiency, between 2003 and 2011 it squeezed the growth of its annual health care spending per employee to well below the national average.Yet despite cost containment, Bellin ranks among the best in quality of care. For the three years ending June 2011, Bellin was 16th in the nation in preventing deaths from heart attacks, ninth in preventing readmissions to the hospital within 30 days of a heart attack, and 23rd in preventing readmissions for heart failure patients, according to comparative data for thousands of hospitals compiled by the Centers for Medicare and Medicaid Services. Bellin’s rates of catheter-related bloodstream infections and ventilator-associated pneumonia are a fraction of the national rates. http://www.nytimes.com/2012/09/03/opinion/health-care-where-you-work.html?pagewanted=print Few Winners, Many Losers: Evaluating the Impact of Maine's New Health Insurance Law to Date. http://www.mainecahc.org/publications/fewwinnersmanylosers.pdfReport: Young Mainers pay less for health coverage, elderly pay more under insurance law
Posted Sept. 04, 2012, at 4:37 p.m.Even as many states gear up for tougher insurance regulations under the federal health law, Maine lawmakers last year bucked the trend, loosening rules they blamed for some of the highest premiums in the nation.Proponents promised lower rates for all Maine residents, with increased competition among insurers. But six months after the state’s rules took effect, no new insurers have entered the state – and premiums have gone up for the vast majority of small businesses.The results have been mixed for individuals: Everyone under 40 saw rate cuts, while most people over 55 received increases, some as high as 18 percent, according to an analysis of state data released today by advocacy group Consumers for Affordable Health Care, which opposed the law changes. Overall, a little more than half of individuals saw their rates rise, albeit by a relatively low 1.7 percent average.Both sides say the early results buttress their arguments amid a national debate over the role of regulation in rising coverage costs.“The data are pretty clear: (The changes) raised rates on the elderly and did not significantly lower them for the young and healthy,” said Joseph Ditre, executive director of the advocacy group, which opposed the changes.But Joel Allumbaugh of the conservative Maine Heritage Policy Center called the early results “promising” and predicted rates would come down as more young people purchased insurance.Outside experts say the one indisputable conclusion from the state’s experiment may be how difficult it is to reduce premiums across the board just by tinkering with insurance rules.“Insurance reform [whether in Maine or the federal law] is about ways to make what we charge consumers more fair, but it’s not a means to reduce the cost of insurance,” says Robert Laszewski, a former insurance industry executive who now runs an Alexandria, Va.-based consulting firm. “It’s simply shifting the cost of insurance to different populations.”Is It A Market-Based Approach?New health care law has devastating consequences for rural Mainers
Posted Sept. 03, 2012, at 9:43 p.m.For many Maine families and small businesses in rural parts of the state, the cost of going to the doctor or filling a prescription has gotten more expensive in the past year. Part of the reason for the increase is a new law passed by the Republican-controlled Legislature, which deregulated the insurance market and eliminated critical consumer protections.Small businesses and individuals across the state, especially in rural areas, have seen their health insurance skyrocket. Individuals in rural Maine, those over the age of 50 and small companies with a handful of employees have been hit the hardest.Econo Electric in Skowhegan experienced sticker shock when it was quoted a 42-percent increase by its Anthem broker for less comprehensive coverage, according to news reports on the rate hikes. The company’s per-person costs rose by hundreds of dollars per month, and its deductible doubled.In Bath, Briggs Advertising saw a 67-percent increase in their rates. A flagship store in Ellsworth, The Grasshopper Shop, saw its premiums rise from $900 per month to more than $1,600 per month in the aftermath of the law. The stories of skyrocketing rates are cropping up across the state, and they are making it harder for small businesses to turn a profit and for families to pay the bills. The law allows insurance companies to charge significantly higher rates based on where you live, on your age or on what kind of job you have. In fact, insurance companies can hike rates five times as much (or 500 percent more) based on your age.So, if you are a 55-year-old retiree who no longer has company health insurance and isn’t eligible yet for Medicare, you are really feeling the squeeze. While younger, healthier Mainers in urban areas like Portland and Scarborough are getting less expensive health insurance, older Mainers, small businesses and most everyone in rural areas are paying the price. This is exactly what the for-profit insurance industry wants; to avoid covering those who may be older and more likely to get sick. This is a race to the bottom in health care.Farm Use of Antibiotics Defies Scrutiny By SABRINA TAVERNISE
The numbers released quietly by the federal government this year were alarming. A ferocious germ resistant to many types of antibiotics had increased tenfold on chicken breasts, the most commonly eaten meat on the nation’s dinner tables.But instead of a learning from a broad national inquiry into a troubling trend, scientists said they were stymied by a lack of the most basic element of research: solid data.Eighty percent of the antibiotics sold in the United States goes to chicken, pigs, cows and other animals that people eat, yet producers of meat and poultry are not required to report how they use the drugs — which ones, on what types of animal, and in what quantities. This dearth of information makes it difficult to document the precise relationship between routine antibiotic use in animals and antibiotic-resistant infections in people, scientists say.Advocates contend that there is already overwhelming epidemiological evidence linking the two, something that even the Food and Drug Administration has acknowledged, and that further study, while useful for science, is not essential for decision making. “At some point the available science can be used in making policy decisions,” said Gail Hansen, an epidemiologist who works for Pew Charitable Trusts, which advocates against overuse of antibiotics.But scientists say the blank spots in data collection are a serious handicap in taking on powerful producers of poultry and meat who claim the link does not exist.“It’s like facing off against a major public health crisis with one hand tied behind our backs,” said Keeve Nachman, an environmental health scientist at the Johns Hopkins Center for a Livable Future, which does research on food systems.http://www.nytimes.com/2012/09/04/health/use-of-antibiotics-in-animals-raised-for-food-defies-scrutiny.html?pagewanted=2&nl=health&emc=edit_hh_20120904&pagewanted=printMaine asks court to help with LePage's Medicaid cuts
Gov. LePage would like to remove 24,000 low-income parents, some elderly people and 19- and 20-year-olds from the program in order to balance the budget.
By Steve Mistlersmistler@pressherald.com Staff WriterAUGUSTA — The standoff between the state and federal government over an estimated $20 million in Medicaid cuts has escalated to a court battle.
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