Health Care Reform Articles - June 14, 2013

Coverage may be unaffordable for low-wage workers

By RICARDO ALONSO-ZALDIVAR | Associated Press – 15 hrs ago

WASHINGTON (AP) — It's called the Affordable Care Act, but President Barack Obama's health care law may turn out to be unaffordable for many low-wage workers, including employees at big chain restaurants, retail stores and hotels.

That might seem strange since the law requires medium-sized and large employers to offer "affordable" coverage or face fines.

But what's reasonable? Because of a wrinkle in the law, companies can meet their legal obligations by offering policies that would be too expensive for many low-wage workers. For the employee, it's like a mirage — attractive but out of reach.

The company can get off the hook, say corporate consultants and policy experts, but the employee could still face a federal requirement to get health insurance.

Many are expected to remain uninsured, possibly risking fines. That's due to another provision: the law says workers with an offer of "affordable" workplace coverage aren't entitled to new tax credits for private insurance, which could be a better deal for those on the lower rungs of the middle class.

Some supporters of the law are disappointed. It smacks of today's Catch-22 insurance rules.

http://news.yahoo.com/coverage-may-unaffordable-low-wage-workers-151922273.html

An ‘Up’ Outlook Can Improve Our Health

By PAULINE W. CHEN, M.D.

Taciturn, wiry and in his 50s, the patient was hospitalized because of a diabetic toe infection. He had no other pressing health issues, so those of us in training at the time expected him to go home after a few days of intravenous antibiotics.

Instead, he died in the hospital.

A second infection took hold in his other foot. The first infection never responded to antibiotics, so he needed progressively higher amputations to control its spread. All the antibiotics gave him uncontrollable diarrhea. And before long, he was losing weight and needed nutritional supplements like the ones sometimes administered to advanced cancer patients.

But he seemed oddly indifferent to all the pain and discomfort; it was as if he expected only to get worse.

“He’s not depressed,” a consulting psychiatrist told us when we became worried that he was sliding into a depression. “It’s just the way he is.”

When his heart stopped one night without warning, we were left wondering why a man who should have walked out of the hospital had died instead. We reviewed and analyzed the decisions we made, searching for some plausible physical causes. Finally one of the most senior doctors in the hospital suggested the one we would come to accept: the patient never believed he would live.

I remembered that patient and the senior doctor’s explanation this week while reading a new book on outlook and health called, appropriately enough, “Up.”

There is no shortage of books for anyone even vaguely interested in the mind-body connection. Most are brimming with breezy narratives and inspirational tales, helpful tips and well-worn truisms. But few offer discerning analyses, evidence-based recommendations or even the simple acknowledgment of just how hard believing in oneself can sometimes be.

http://well.blogs.nytimes.com/2013/06/13/an-up-outlook-can-improve-our-health/?emc=tnt&tntemail0=y&pagewanted=print

Obamacare? We were just leaving … By: Anna Palmer and Jake Sherman June 13, 2013 05:13 AM EDT

Dozens of lawmakers and aides are so afraid that their health insurance premiums will skyrocket next year thanks to Obamacare that they are thinking about retiring early or just quitting. The fear: Government-subsidized premiums will disappear at the end of the year under a provision in the health care law that nudges aides and lawmakers onto the government health care exchanges, which could make their benefits exorbitantly expensive. Democratic and Republican leaders are taking the issue seriously, but first they need more specifics from the Office of Personnel Management on how the new rule should take effect — a decision that Capitol Hill sources expect by fall, at the latest. The administration has clammed up in advance of a ruling, sources on both sides of the aisle said. (PHOTOS: Supreme Court upholds health care law) If the issue isn’t resolved, and massive numbers of lawmakers and aides bolt, many on Capitol Hill fear it could lead to a brain drain just as Congress tackles a slew of weighty issues — like fights over the Tax Code and immigration reform. The problem is far more acute in the House, where lawmakers and aides are generally younger and less wealthy. Sources said several aides have already given lawmakers notice that they’ll be leaving over concerns about Obamacare. Republican and Democratic lawmakers said the chatter about retiring now, to remain on the current health care plan, is constant. http://dyn.politico.com/printstory.cfm?uuid=B768A8D8-951B-476C-95AF-2871C2A8B174 Small-business exchanges draw few insurers By: Jason Millman June 13, 2013 05:24 AM EDT Obamacare’s new insurance marketplaces for small businesses, which have already stumbled before getting out of the gate, are facing another pressing question just months before millions can sign up for benefits: What happens if insurers don’t show up to sell? Early looks at insurance offerings on the Obamacare exchanges show that insurers aren’t exactly signing up in droves to sell on the new Small Business Health Option Program exchanges. In some states, just one insurer has signed up for the SHOP exchanges, which are supposed to foster competition and make it easier for small businesses to purchase coverage. The SHOP exchanges exist alongside the exchanges for individuals, which have gotten more attention in preparation for the health law’s rollout. The Obama administration is still trying to recruit insurers to states where there’s been little interest in exchanges. But some health law advocates believe administration health officials have put a greater emphasis on standing up the individual exchanges, where they hope premium tax credits will be a big draw for millions to sign up for coverage next year. In many cases, they also see little incentive for SHOP exchanges in 2014. A limited tax credit for small businesses available only in the SHOP exchanges has so far received less interest than expected, and a key feature providing employees with more freedom to pick their health plan has been delayed in most states. “I think the SHOP exchanges are basically a 2015 issue, but we will see how they work out in the states that are doing them, and they might turn out to be a bigger factor going forward,” said Tim Jost, a Washington and Lee University law professor and supporter of the health law. That’s the hope in Washington state. Just one insurer will sell exchange plans to small businesses in 2014, even as nine signed up for the state’s individual exchange. So the Washington exchange is scaling back the SHOP rollout, making the program available in only some counties in the first year. http://dyn.politico.com/printstory.cfm?uuid=15349C90-9D2D-4E20-A422-376C00AF3B82 JUNE 13, 2013, 4:12 PM Life, Interrupted: The Cost of Cancer By SULEIKA JAOUAD When I blow out my birthday candles next month, I’ll celebrate being alive. But my 25th birthday will also mark a one-year countdown to the date when I will no longer have health insurance. Like many, many other young adults who don’t have insurance through an employer, I rely on the insurance provided by my father’s job to cover my health care. But young adults are allowed to stay on a parent’s health plan only until age 26. So in one year, like many other young adults, I will have to figure out how to afford my own health insurance. Still, I’m one of the luckier ones. Up to now, I’ve been fortunate never to have to choose between groceries, rent and medical care. But even with good health insurance on my parents’ plan, the cost of my cancer treatment has been overwhelming. Between co-payments, out-of-network costs, renting an apartment in New York City for my bone marrow transplant and the loss of two incomes (mine and that of my mother, who graciously took on the role of my primary caregiver), the out-of-pocket costs of my care have already amounted to tens of thousands of dollars. Despite all of this, I’ve been reluctant to talk about the cost of my care with the people who provide it: my doctors. I get along well with my medical team and I have a tremendous amount of respect for them. But the idea of discussing my finances during a doctor’s appointment makes me uncomfortable. I’ve been asking myself why lately, and I’m still not sure of the answer. The one thing I do know is that I’m not alone in feeling this way. A recent study that showed that while most patients want to talk with their doctors about the price tag of treatment, only about one in five actually do. The study, which surveyed about 300 insured patients treated at Duke Health and affiliated clinics in rural North Carolina, found that almost 60 percent of the participants had private insurance, but that the average out-of-pocket cost for patients was nearly $600 a month. Why the hesitancy to talk about the steep price of cancer treatment? “Patients link cost to quality, and they fear that if they broach the topic of cost with their doctors they are going to get lower-quality care,” said Dr. Yousuf Zafar, an assistant professor at the Duke Cancer Institute and lead author of the research. Maybe the most remarkable thing about the study is that 57 percent of the patients who did bring up their financial concerns found that the discussion helped reduce the cost of treatment. It’s a small but profound insight that suggests that communicating financial concerns to a doctor can be important in reducing treatment costs. Doctors may be able to prescribe cheaper medications or refer patients to hospital assistance programs. Hospital social workers and advocacy organizations like the Cancer Legal Resource Center, the HealthWell Foundation, the American Society of Clinical Oncologists and the American Cancer Society also provide resources for cancer patients who are struggling financially. http://well.blogs.nytimes.com/2013/06/13/life-interrupted-the-cost-of-cancer/?src=rechp&pagewanted=print Maine lawmakers send Medicaid expansion compromise to LePage Posted: June 13 Updated: Today at 8:10 AM  But the Legislature is still three votes short of a veto-proof majority for a bill that would provide 60,000 low-income Mainers with health insurance. By Steve Mistler smistler@pressherald.com State House Bureau AUGUSTA – A bill to extend health insurance to more than 60,0000 low-income Mainers was enacted by the Legislature on Thursday, but it's still a long shot to become law. The Senate voted 23-12 to pass L.D. 1066, which would expand Medicaid, the public insurance program for the poor, through the Affordable Care Act. Medicaid expansion's link to the federal health care law has produced partisan battles in state legislatures nationwide as Democrats have tried to enact the key component of the law and Republicans, with some exceptions, have opposed it. The debate in Maine has been no different. http://www.pressherald.com/politics/Lawmakers-send-Medicaid-expansion-to-LePage-veto-expected.html Plan to repay Maine hospital debt approved Posted: June 13 Updated: Today at 12:18 AM The bill, passed unanimously by the state House and Senate, now awaits Gov. LePage's signature. By Michael Shepherd mshepherd@mainetoday.com State House Bureau AUGUSTA — A plan to pay off Maine's debt to its hospitals, an issue that has been a political football throughout this legislative session, was finally passed Thursday by the Maine Legislature. L.D. 1555 calls for borrowing to pay the state's $183.5 million share of debt to 39 hospitals and repaying it with revenue from a soon-to-be negotiated wholesale liquor contract. Payment of the debt has been a key goal for Gov. Paul LePage, who has frequently berated Democratic leaders for not acting sooner. "What would you rather collateralize your debt with?" asked Rep. Richard Malaby, R-Hancock, on the House floor. "U.S. treasuries ... or Allen's Coffee Brandy?" referring to the drink perennially named Maine's most popular spirit. http://www.pressherald.com/politics/Hospital-debt-payment-bill-gets-initial-OK-from-House.html Ariz. Gov. Claims A Win As House Approves Medicaid Expansion Plan TOPICS: MEDICAID, POLITICS, HEALTH REFORM, STATES JUN 13, 2013 The Arizona House early Thursday passed an $8.8 billion state budget that includes a proposal to pursue the health law's Medicaid expansion. News outlets also report on related action in Ohio and Michigan. Arizona Republic: House Approves Medicaid Expansion, $8.8 Billion Budget Five months after Gov. Jan Brewer vowed to expand Medicaid, a bipartisan Arizona House coalition voted early today to approve her high-stakes proposal, along with a budget that gives significant new funding to education and child welfare. The mostly 33-27 votes followed nine hours of debate and vitriolic speeches by conservative Republicans, who lashed out at fellow GOP members and Brewer for teaming with Democrats to steamroll them to approve a key piece of the federal health-care overhaul and the governor's top legislative priority (Reinhart, Sanchez, Rau, Pitzl, 6/13). The Associated Press/Washington Post: Ariz. House Passes Budget And Medicaid Expansion In Victory For Gov. Brewer; Senate Votes Next The Arizona House passed an $8.8 billion state budget that includes Medicaid expansion early Thursday and puts Gov. Jan Brewer one Senate vote away from a huge political victory as she embraces a signature part of President Barack Obama's health care overhaul law. A newly formed coalition of Democrats and GOP moderates forced the budget and Medicaid expansion proposal to move in the Arizona Senate and House during a day filled with debate. The Senate took a break after giving its initial approval Wednesday afternoon, while the House toiled into the night as conservative Republicans railed against the Medicaid proposal and accused members of their party who supported Brewer of being turncoats before taking a final vote that ended after 1:30 a.m. PDT (6/13). http://www.kaiserhealthnews.org/Daily-Reports/2013/June/13/medicaid-expansion.aspx Affordable Care Act's Achilles Heel? Blaming Patients, Not Profiteering By Karen Higgins Common Dreams, June 12, 2013 With the one-year anniversary of the Supreme Court ruling upholding the Affordable Care Act near, it's time to ask if the decision to put the burden of cutting costs on patients, not corporate healthcare profiteering, is the fatal flaw in the plan. The law’s tepid cost control measures targeted at healthcare spending that is gobbling up an increasing percentage of the economy and pricing more people than ever out of access to care have been widely viewed as the ACA’s biggest pitfall. But from the outset, the Obama administration dismissed the most effective means to reduce costs by: refusing to consider a single payer alternative that combines genuine universal coverage not based on ability to pay with global budgeting rejecting a proposal to authorize the federal government to negotiate bulk purchasing (a concession to the drug companies), and failing to regulate price gouging by hospitals, drug companies, insurers and other healthcare corporations. Those fateful decisions left only one option for significant reduction of overall health expenditures – saving money in the delivery of care by shifting costs to those who use health services and discouraging them from getting care even if they have insurance. Perhaps that’s not surprising given the decision to craft the ACA in concert with pharmaceutical, insurance, hospital, and Chamber of Commerce lobbyists, and, as recently reported, top Wall Street investment firms and hedge fund executives. Here are several ways the ACA shifts the hardship of cost cutting to those who need care, and promotes delivery models that result in limiting care, even among those with health insurance. http://www.pnhp.org/print/news/2013/june/affordable-care-acts-achilles-heel-blaming-patients-not-profiteering