Rough sailing ahead for health care reform, but it’s not our only option
Posted May 16, 2013, at 11:45 a.m.
You know another storm is brewing when Washington politicians start looking for somebody else to blame for problems they themselves created.
That’s what happened recently at a Senate budget hearing when Finance Committee Chairman Max Baucus unloaded on Kathleen Sebelius, President Barack Obama’s health and human services secretary. He berated her for failing to adequately educate the public or competently implement the 2,000-plus page Patient Protection and Affordable Care Act, or Obamacare. During the hearing, Baucus worried aloud about “a huge train wreck coming down” if the Obama administration didn’t clean up its act. Other Democrats soon piled on.
Aside from being known as one of the most prolific producers of lobbyists from among his staffers in the Senate, Baucus is probably best known as one of Obamacare’s prime architects.
Baucus is right to worry that the law may in fact run into extreme turbulence. It is far too complex. It has too many moving and interdependent parts to be smoothly implemented by anybody, no matter how talented or highly motivated, and it is too controversial.
There are a lot of people in and out of Congress — about 50 percent of Americans, according to the latest polls — who do not want to see the law implemented and will find ways to sabotage it. The law itself provides no shortage of opportunities to do so.
First, there is the challenge of setting up the health insurance exchanges in every state, when almost half the states, including Maine, have indicated no interest in doing it themselves. In those states, that job will fall on the federal government.
Then there is the law’s expansion and standardization of Medicaid — optional for each state, since the Supreme Court last year found making it mandatory to be unconstitutional. A large number of Republican governors, including Maine’s, have so far shown little interest in expanding that program.
The law also intends to expand the federal Community Health Center program. Republicans and others opposed to an expansion of government can be relied on to resist funding that program every chance they get. They will also resist expanding funding for the law’s subsidies for the purchase of private insurance.
In addition, the complexity of the law has created a huge number of unknowns. Each unknown creates plenty of opportunities for mischief in the future. Some examples: How many healthy young people will sign up for the exchanges (thus keeping premiums down for others) instead of simply paying or dodging the tax penalties? How many businesses will choose not to hire that 50th employee to avoid the mandatory coverage provisions of the law?
It now appears that federal subsidies in the exchanges may apply only to employees, and not dependents. How will this affect employees’ willingness to sign up for increasingly expensive family health insurance coverage? How will mid-year changes in employment or income affect the operation of the program and those covered by it? How will labor mobility be affected by this new system, and how will that affect the general economy?
There are lots more unknowns, but you get the idea. Complexity, not implementation, is the underlying pathology of Obamacare. Congress, not the administration, bears the brunt of the responsibility for that.
Millions eligible for Obamacare subsidies, but most don't know it
@Luhby April 23, 2013: 5:56 AM ETNearly 26 million Americans could be eligible for health insurance subsidies next year, but most don't know it.
That's because relatively few people are familiar with provisions in the Affordable Care Act, aka "Obamacare," that will provide tax credits to low- and middle-income consumers to help them purchase health coverage through state-run insurance exchanges.
Most of those who will be able to claim the subsidies are in working families with annual earnings between $47,100 and $94,200, according to a recent analysis byFamilies USA, a consumer advocacy group. More than a third of those eligible will be young adults between ages 18 and 34.
"There's a huge number of people who can get coverage this way and can get significant help," said Ron Pollack, executive director of Families USA. "It's not just for the poor. It reaches deeply into the middle class."
Here's how the subsidies will work:
Starting in October, those looking to buy individual health insurance can enroll in plans offered through state-based exchanges, with coverage beginning in January. Consumers buying individual plans will be able to choose between four levels of coverage: platinum, gold, silver and bronze. The plans will differ in their premiums and out-of-pocket expense burdens.
People who are not in a government health insurance program, such as Medicaid orMedicare, and do not have access to an affordable plan at work may be eligible for help paying their premiums. The assistance is available to those with incomes of up to four times the federal poverty level -- this year, that's $45,960 for an individual or $94,200 for a family of four -- and will be scaled to ensure that folks don't pay more than a designated percentage (the exact target varies by income level) of their earnings toward the premium. The subsidy will be paid directly to the insurance company.
Seeking Calm on the Cancer Ward
By MIKKAEL A. SEKERES, M.D.
When people choose to have their leukemia treated aggressively, it’s a big commitment, more so than for almost any other cancer.
With this therapy — three days of the drug daunorubicin, which comes in a reddish color so distinctive that one of my patients, a former chemist, used it in his professional life as a dye for plastics, and seven days of the drug cytarabine, which is infused continuously over 168 hours — we offer them the chance to be cured of a disease moving like wildfire with a stiff breeze behind it at the height of drought.
The offer can be seen as a Faustian bargain, though. In return comes the very real possibility of dying from our treatment, along with immersion into a kind of purgatory of a hospital stay lasting four to six weeks. We joke with our patients that we love boring — it is, in fact, a medical ideal that our patients complain of nothing more than ennui on a daily basis. But the psychological mettle it takes to endure this experience is remarkable, and there’s little that can prepare a person for it.
We make our rounds as a group — nurses, physician assistants, residents, a fellow, a pharmacist, a case manager, me and occasionally additional observers. It can be quite absurd, really, this thundering herd walking slowly down the hallway of the leukemia unit, stopping at each doorway. A few weeks ago, when I was attending on the leukemia service, we came to our eighth patient of 25, a 72-year-old man whose leukemia persisted despite our first round of chemotherapy, so we gave him more. It was now his 36th day in the hospital, and his blood counts showed no signs of recovery, a wasteland of emptiness.
A few of us walked into his room, where his wife sat in a chair by his bed, reading. She looked up and gave us a half-smirk as we glanced over at him. His sheets were pulled completely over his head and then tucked underneath it, creating the image of a starched white cocoon.
“Don’t mind him. He always sleeps like that,” she said. “On the ship, the couch where he rested was directly under a vent, and this was the only way he could ever grab any shut-eye.” He stirred and pulled the sheets down, squinting against the room’s lights.
Maine Democrats meld Medicaid expansion, hospital payback
The Maine Hospital Association supports both concepts, but Republicans are angry about tying the two together and hospitals fear a LePage veto.
The federal government would pay 100 percent of the cost of the expansion from 2014 to 2016. In subsequent years, reimbursements would decline gradually to 90 percent of the cost, with the state paying the rest.
On Wednesday, Eves said the Health and Human Services Committee will send a letter to the Veterans and Legal Affairs Committee recommending that Sanborn's bill to expand Medicaid be considered alongside the hospital repayment bill.
"We're excited that this is all coming together and it's happening right now," he said. "It's a follow-through on what we've been talking about related to paying back our hospitals and making sure that we don't get back here in the same situation, covering nearly 70,000 Mainers and addressing charity care, a major cost driver in our health care system."
Sen. John Tuttle, D-Sanford, the Senate chair of the Veterans and Legal Affairs Committee, told the Portland Press Herald last week that he didn't support linking Medicaid expansion to the hospital repayment bill, which relies on revenue from the state's next wholesale liquor contract.
However, Senate President Justin Alfond, D-Portland, said Wednesday that "through many reflections and hearing from many in his district," Tuttle has changed his mind.
"He fully understands the consequences of not accepting these dollars," Alfond said. "It means people's lives are at risk."
Posted May 15, 2013, at 2:43 p.m.
AUGUSTA, Maine — The Legislature’s Health and Human Services Committee voted largely along party lines Wednesday to recommend that an expansion of the state’s Medicaid program be tied to Gov. Paul LePage’s top legislative priority: the payback of Maine’s $484 million debt to its hospitals.
The move came as a surprise to Republican committee members and legislative leaders, and it drew a sharp rebuke from LePage. House Republican Leader Kenneth Fredette of Newport said the surprise move “poisons the well” for conducting other legislative business.
“There are implications for this beyond this one issue because of the way it’s been handled,” Fredette said. “The issue is whether we do this in a fair, open process. I don’t think it’s been fair, nor has it been open.”
The vote marked the first procedural move by Democrats in the Maine Legislature to include an expansion of Maine’s Medicaid program in a bill that provides for the state’s 39 hospitals to be repaid and for the state to fund the repayment through a renegotiated wholesale liquor contract.
Ultimately, the Legislature’s Veterans and Legal Affairs Committee will decide whether a bill that incorporates all three measures will make it to the full Legislature.
The Senate chairman of that committee, Sen. John Tuttle, D-Sanford, bucked his party’s leadership last week in saying he didn’t support linking Medicaid expansion and a payback of the hospitals. Tuttle partially backed away from that position Wednesday, saying more than 100 constituents had contacted him in the past week to urge him to back an expansion of Medicaid.
He said he hopes to gauge the opinions of his fellow committee members in the next day before deciding how to move ahead.
“I just want to allow some time for calmer heads to prevail and to allow the process to go forward,” he said. “I’m not sure what’s going to happen, but we’re going to take it one day at a time.”
The Health and Human Services Committee voted 10-4 in favor of incorporating the Medicaid expansion into the hospital debt payback bill. The committee’s Democrats and one Republican, Rep. Carol McElwee, R-Caribou, supported the move while the remaining Republicans on the committee opposed it. McElwee said in a statement later that her vote was in support of expanding Medicaid, not in support of linking the issue with the hospital debt payback.
As a result of the vote, the Health and Human Services panel will send a letter to the Legislature’s Veterans and Legal Affairs Committee with its recommendation.
New health insurer prepares to sell policies in Maine, reaches agreement with physicians group
Posted May 15, 2013, at 3:01 p.m.
One of two carriers that will offer policies through Maine’s health insurance exchange has lined up a group of central Maine physicians to treat patients with the new coverage.
Maine Community Health Options, a consumer-run health insurer based in Lewiston, announced this week that it has contracted with the Kennebec Region Health Alliance, a physician group operated by MaineGeneral Medical Center. MCHO plans to add other health providers and hospitals as it assembles a statewide network of preferred providers to serve its future policyholders, according to a press release.
MCHO will offer policies to individuals, families and employers. Enrollment will begin in October, with the policies taking effect in January 2014. MCHO has set a goal of attracting 50,000 members.
The plan would be offered both on its own and through Maine’s exchange, an online marketplace where consumers will be able to shop for health coverage. The exchanges are a key component of President Barack Obama’s health reform law, which aims to widen coverage to 30 million people.
Maine’s exchange will be run by the federal government.
MCHO is a private nonprofit organization known as a “consumer operated and oriented plan” that will be governed by its policyholders, much like a mutual insurance company. It’s one of 24 “co-op” health plans across the country funded under the federal health reform law.
By partnering with MaineGeneral of Augusta and Waterville, Maine’s third-largest health system, MCHO expects to lower health costs by improving access to care, better coordinating patients’ treatment, and supporting community health and wellness efforts, MCHO said in the release
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