Monday, January 14, 2013

Health Care Reform Articles - January 14, 2013

Pa. advocates want single payer; 'Obamacare' doesn't go far enough

'We have to save our health care system for itself,' says Dr. Dwight Michael

By Amy Stansbury
The Evening Sun (Hanover, Pa.), Jan. 12, 2013
Carl Goulden always believed in private health insurance.
"For 40 years I paid into the system," Goulden said, "and now I feel like a fool."
Resting on a chair in the back room of his Littlestown flower shop, Carl's Creations, he recalled his fight against an insurance giant.
Goulden spent most of his life as a factory worker insured by the same large insurance company and, happy with its service, he opted to insure his own business with a subsidiary of that same company when he opened up shop in 1990.
But about five years ago, things changed. Goulden was diagnosed with chronic liver disease and as he watched his insurance premiums skyrocket, he said he realized why he had never before had a problem with the company - he had never been sick.
"They pushed me out," Goulden said. "I faced the possibility of losing everything I had worked for."
Now a member of the local organization, Adams Hanover Health Care 4 All PA, Goulden works to share his story with others and to push Pennsylvania past President Obama's Affordable Care Act toward what the group believes are even stronger health-care reforms.
After his diagnosis, Goulden said, he quickly recognized the need for sweeping changes. His insurance premiums rose from $300 to $3,100 a month. As the company continued to raise its prices, Goulden said, it simultaneously tried to drop his policy.
At first, the insurance agents told Goulden that he was ineligible for continued coverage because his wife didn't make enough money to qualify as a full-time employee of the business, he said. Goulden fought back, countering that because his wife co-owned the business, she did not earn wages like an employee, but instead shared profits with her husband.
"So two days later they came back and said, "We will keep you, but we have raised your premiums to $3,100 a month,'" Goulden recalled. "I was livid, screaming on the phone."
Later, he said, the insurance company demanded he submit his federal tax returns to prove that he had a legitimate business.
"The tax returns show how much money I make, so they could use that information to know how much they could charge me in order to push me out," Goulden said. " I called legislators and asked, 'How can they possibly do this?' And I found out that they can. There is no regulation about what they can require you to submit."
So before long Goulden was forced to drop his policy and go without insurance, despite his critical medical condition.

State should embrace expansion of Medicaid

By Rob Stone, M.D.
Indianapolis Star, Letters, Jan. 3, 2013
The Affordable Care Act is coming. Gov.-elect Mike Pence has said the ACA will “double down on an already broken and unaffordable Medicaid system, and, left unchecked, it will destroy all the progress we have made on health-care access, not to mention our economic competitiveness and fiscal solvency for our state and country.” I disagree.
Out of the 800,000 Hoosiers currently without health insurance,363,000 could be provided Medicaid coverage. According to a Harvard study on preventable deaths due to lack of health insurance, 363 Hoosiers per year, or 1 person a day would be saved from a needless preventable death. In my work toward a national health program, I’ve heard far too many people say that they are afraid to see a doctor because they can’t afford health insurance.
Right now in Indiana if a family of four earns more than $11.50 a day, it’s too much to qualify for Medicaid. Under the ACA the same family of four can earn $30,000 a year and be covered. That’s equal to two adults working 80 hours a week at minimum wage. This would be an incredible boon to working Hoosier families, lifting the threat of financial ruin caused by an accident or illness, and opening the door to preventative care.
Experts argue how much this will cost the state. Estimates range from $50 million to as much as $150 million a year, but none contest the amount of federal money that would come into the state if we proceed – $1.7 billion a year, which would go to Indiana hospitals, doctors, nurses, and into the state’s economy. A study in Missouri predicted 24,000 jobs would be created there.
Congress was aware of how large a chunk Medicaid currently takes out of states’ budgets and made this a deal too good to refuse, with a federal contribution of more than $11 for every $1 of Indiana taxpayers’ money. If Hoosier lawmakers don’t take the deal, our federal tax dollars will go to states that do.

State should go for expansion of Medicaid

By the H-T editorial board
The Herald-Times (Bloomington, Ind.), Jan. 10, 2013
Gov.-elect Mike Pence should support an expansion of Medicaid in Indiana. And while he’s at it, he should name Dr. Rob Stone of Bloomington his chief adviser on medical and health care issues.

Stone’s background includes working 28 years as an emergency room physician and nearly that long as an outspoken advocate for making sure access to health care is within reach of as many people as possible. He’s not a big fan of much of the Affordable Care Act because it doesn’t go far enough for him. He is a fan of the Medicaid expansion, though, because it would provide about 363,000 uninsured Hoosiers a way to afford necessary health care.
Medicaid, don’t forget, is the health care safety net for people with disabilities, the poor and the elderly. The most important reason to expand it is that more individuals who really need help will get help.
But that’s not the only reason. This would be good for the state for a lot of reasons.
As Stone said in a presentation this week, “People live sicker and die younger without insurance.” On the flip side, people who are healthier and — well, alive — have a much better chance at being productive and contributing to society.
And, he estimated, one life would be saved for every 1,000 newly insured people. In other words, 363 Hoosiers a year would not die if 363,000 additional Hoosiers can gain access to health care.
Cost is a main reason opponents cite when encouraging state leaders not to expand Medicaid. It would be an expensive program to expand.
But, Stone points out, the return of federal funds to state money would be at least $11 to $1. And the state money, Stone says — estimated at $50 million to $150 million — could come from a $121 million cigarette tax currently earmarked for the Healthy Indiana Plan, as well as $48 million in a high risk insurance pool. Neither program would be needed with the expansion of Medicaid, meaning state funds would simply be transferred from one use to another.

Anthem's mail-order policy may have crossed a legal line

The health insurer's requirement that some customers get their prescription drugs from a single mail-order pharmacy has caught the eye of the California attorney general's office.

David Lazarus
5:00 PM PST, January 10, 2013

Anthem Blue Cross may be breaking California law by requiring some policyholders to buy their prescription drugs from a single mail-order pharmacy, according to the state attorney general's office.
Anthem, the state's largest for-profit health insurer, had notified members with conditions such as HIV/AIDS and cancer that they will have to buy their medications from the mail-order pharmacy CuraScript or pay full price at a retail drugstore.
Other Anthem members, including those with chronic conditions such as diabetes, face no such requirement.
"California law clearly states that no one can be discriminated against because of a medical condition," said Lynda Gledhill, a spokeswoman for Atty. Gen. Kamala D. Harris. "If patients are being required to get their prescriptions from a certain pharmacy because of their condition, that is likely illegal."
She declined to comment on specific measures officials may take if Anthem proceeds with its policy switch, but stressed that the attorney general's office "treats very seriously cases involving restricting access to care."
Darrel Ng, an Anthem spokesman, said the insurer's policies "do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws." He also said other insurers have similar policies.
I sought the attorney general's opinion after the California Department of Managed Health Care voiced concern that Anthem hadn't done a good enough job informing people about the change, which was scheduled to take effect Jan. 1 but has been delayed until March 1.
Quiz: How well do you remember 2012?
Along with the postponement, Anthem said it would clarify possible exemptions to the new rule. But that didn't mollify critics.
"This is still a very serious issue," said David Balto, a Washington antitrust lawyer and former policy director for the Federal Trade Commission. "It affects some of the most vulnerable people in society."
When I broke the news in November that Anthem was imposing the new requirement for so-called specialty medications used to treat major illnesses, the insurer said the limitation would help keep costs down for patients and businesses.
State healthcare officials didn't challenge that assumption. But they said Anthem failed to make it clear that some members may be able to avoid the mail-order-only requirement.
"That was our primary concern," said Marta Green, a spokeswoman for the Department of Managed Health Care. "There are individuals for whom a mail-order pharmacy may not be appropriate.",0,2308756,print.column

Rural hospitals, prescription aid for seniors suffer cuts in LePage’s proposed budget

Posted Jan. 11, 2013, at 8:04 p.m.
AUGUSTA, Maine — Gov. Paul LePage’s proposed budget for the next two years includes cuts that could be felt by rural hospitals, senior citizens who receive aid to help them pay for prescription drugs, and municipalities whose general assistance funds are in high demand.
Still, LePage’s $6.3 billion, two-year budget proposal increases overall funding for Department of Health and Human Services programs, including Medicaid.
That’s largely a result of rising health care costs in the state’s Medicaid program and a reduction in federal matching funds, Health and Human Services Commissioner Mary Mayhew said Friday as members of LePage’s Cabinet unveiled the governor’s budget proposal. LePage didn’t appear at Friday’s budget presentation.
Also on Friday, Cabinet members introduced a supplemental budget package aimed at plugging a $112 million hole in the current year’s budget, which is in effect until June 30. The bulk of that budget hole is a shortfall in the state’s Medicaid program that the LePage administration is proposing to fill in part by dipping into the state’s budget stabilization, or “rainy day,” fund for more than $40 million, and by delaying $18.5 million in local school aid payments from one fiscal year to the next.
Both the supplemental and two-year budget packages released Friday eliminate funds for the “Drugs for the Elderly” program, saving $1.75 million for the last quarter of the budget year and $7 million annually after that.
The two-year budget proposal also scales back the Medicare Savings Plan to the minimum levels mandated by the federal government. Currently, according to Mayhew, only Maine, Connecticut and Washington, D.C., exceed the federal minimum on that program, which offers senior citizens aid for prescription drugs through the state’s Medicaid program.
“We clearly understand these choices are difficult,” Mayhew said. “At the same time, we understand the importance of making difficult decisions today in order to stabilize future spending.”
Maine received clearance from the federal government earlier this week to make cuts to the Medicare Savings Plan that will affect about 8,300 seniors.
Mayhew said Friday that senior citizens soon will qualify for new prescription drug assistance programs under the Affordable Care Act, the Obama administration’s federal health care law. She said prescription drug assistance is also available through some retailers, including Wal-Mart.
“It is imperative that I underscore the challenge we’re up against to fund core services in the Medicaid state program,” she said.
Sen. Dawn Hill of York, a Democrat and co-chairwoman of the Legislature’s budget-writing Appropriations Committee, said the prescription drug aid cuts concerned her. “Just because the feds said we could go there doesn’t mean we have to,” she said.

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