Obamacare: The Great Experiment Begins
More than three years after President Obama signed the Patient Protection and Affordable Care Act of 2010, some of the big changes in the nation’s health-delivery system that the legislation mandated are about to go into effect. With the pro and anti forces already claiming victory, there’s a lot of misinformation going around about how the new system will operate. Critics who claimed that the reform, which ran to nearly two thousand pages, was too complicated even to get off the ground have been discredited. But big questions remain about how things will shake out.
The good news is that, in large parts of the country, there’s been substantial progress toward getting the system up and running. Last week, California, the most populous state in the country, rolled out details of its online health-insurance exchange, through which people and families without group coverage will be able to purchase individual plans.
Starting on October 1st, people will start enrolling in new plans through the exchanges, and come next January, all Americans (with a few exceptions) will be legally obliged to acquire some sort of health coverage or face a fine. Some low-income people who aren’t currently eligible will be able to enroll in Medicaid, the federal system for the poor and indigent. Other low-to-middle-income families will be able to obtain federal subsidies covering up to ninety per cent of their monthly insurance payments. Health insurers will be prohibited from denying coverage to individuals, or charging them higher rates, based on gender or preëxisting conditions.
The reform was designed to do two things that might seem, at first glance, contradictory: expand coverage to the estimated forty-five million Americans who are uninsured and hold down costs for everybody else, taxpayers included. When the bill passed, I expressed some skepticism about whether this would prove possible, but that was just speculation. Now, or pretty soon, we will have some actual evidence about how the system will work.
Several things bear watching:
The reform was designed to do two things that might seem, at first glance, contradictory: expand coverage to the estimated forty-five million Americans who are uninsured and hold down costs for everybody else, taxpayers included. When the bill passed, I expressed some skepticism about whether this would prove possible, but that was just speculation. Now, or pretty soon, we will have some actual evidence about how the system will work.
Several things bear watching:
Read more: http://www.newyorker.com/online/blogs/johncassidy/2013/05/obamacare-the-great-experiment-begins.html?printable=true¤tPage=all#ixzz2VALcUgwl
Boston Medical looks to shut a site, cut 85 beds
Would close campus on East Newton St.
Boston Medical Center is weighing a plan to close an aging part of its sprawling campus and eliminate about 85 of its 496 beds, as it braces for state and federal budget cuts and intensified pressure to shift more care to outpatient settings.
Hospital executives stressed that it was premature to estimate how many, if any, of their 4,500 jobs would be shed as part of the plan to shutter the East Newton Street campus, site of the former University Hospital. That hospital merged with neighboring Boston City Hospital in 1996 to create Boston Medical.
Both hospitals had a history of service to poor residents of Boston, and Boston Medical has continued that mission, pledging “exceptional care without exception.” Hospital officials say their plan would allow them to retain their mission by treating more patients in neighborhoods and moving about 60 medical surgical beds — and many workers — to floors in the Yawkey Center and Menino Pavilion at the hospital’s main campus in the South End.
“Boston Medical Center is looking at every way we can to make our hospital efficient,” said chief executive Kate Walsh. “Beds are the most expensive part of our operation. Going from 500 beds to 400 beds is a big decision for our hospital, and we have not made it yet. But we’re evaluating it as part of health care reform, which is going to require fewer patients in beds.”
Godspeed to Obamacare’s Cadillac tax
By Charles Lane, Published: June 3
Last seen predicting a “landslide” win for Mitt Romney in the 2012 presidential election, political “analyst” Dick Morris has resurfaced as a radiopitchman for the paperback “ObamaCare Survival Guide” (only $4.95 plus shipping and handling). His spiel dwells on the health law’s “hidden taxes,” including “a 40 percent tax on some health plans.”
What Morris seemingly has in mind is Obamacare’s “Cadillac Tax” — which is neither hidden nor, as he implies, levied on the entire value of plans. It is an excise tax on gold-plated — or “Cadillac” — coverage that the current tax code wastefully encourages.
Far from a threat, however, this is one provision of Obamacare that liberals, conservatives and everyone in between should be able to agree on. It’s simple, fair and — because it fine-tunes market signals to businesses and consumers — likely to further the law’s avowed purposes of expanding coverage while taming costs.
Nearly half of Americans get health insurance through their employers; a tax exclusion for its value encourages businesses to provide coverage. This is the nation’s largest tax expenditure, expected to cost $760.4 billion over the next five years, according to Congress’s Joint Committee on Taxation.
Many economists hate this provision because it unduly insulates people from the true costs of care and thus encourages excessive consumption — which fuels health-care inflation generally. Wall Street executives and other rich Americans benefit disproportionately but so do labor unions, which have gotten into the habit of extracting tax-free health benefits from employers in lieu of wages.
The ideal solution would be to eliminate or sharply reduce this tax exclusion and use the revenue to finance a health insurance system that does not tie workers to their jobs — another of the policy’s pernicious side effects.
But that idea, which John McCain embraced and Barack Obama opposed during the 2008 campaign, got shot down early in the 2009 debate. Senate Finance Committee Chairman Max Baucus (D-Mont.) floated an excise tax on the priciest 40 percent of plans, only to back down in the face of furious objections from labor.
Parkview hospital in Brunswick lays off 16
The hospital’s CEO blames unpaid government debt and decreased demand for patient services.
Written by Eric Russell, Staff Writer
BRUNSWICK - Parkview Adventist Medical Center, one of two hospitals serving Brunswick, announced Monday that it has reduced staff by 16 positions because of decreased demand for patient services and unpaid MaineCare debt.
“For years, Parkview has been working diligently on lowering costs for care to our patients, while increasing the quality of care they receive,” hospital president and CEO Randee Reynolds said in a statement. “Unfortunately, the government’s unpaid bills combined with fewer patients means we have had no other choice but to make changes.”
The cuts reduced the staff by 5.4 percent, but Reynolds said the reductions should not affect any services at Parkview. Spokeswoman Tory Ryden said she did not have a breakdown on which positions have been cut because some staff members had not been notified. She said some of the positions are part-time positions.
Our View: Legislators playing politics with Mainers’ health
In the session’s last weeks, lawmakers should stop posturing and work to get things done.Politics gets a lot of bad press these days. It’s usually a code word for officials looking out for the next election when they should be looking out for the people they represent.
But it’s also the word we use for the process that government uses to get things done. It’s time in Augusta for less of the first kind of politics and more of the second.
Right now, we are in the middle of a standoff between the governor and Democratic lawmakers over the expansion of Medicaid eligibility to provide health insurance for as many as 70,000 Mainers. The governor has already vetoed it once, and no Republican stepped forward to vote to override it. They will likely get a second chance when a stand-alone Medicaid bill moves through the Legislature. Now it’s time to see the kind of politics that improves people’s lives.
http://www.pressherald.com/our-view-legislators-playing-politics-with-mainers-health_2013-06-03.html
Maine Medical Center plans $40M expansion in Portland
The 40,000-square-foot addition would have glass walls and be built near the emergency department at 22 Bramhall St.
Written by Randy Billings, Staff Writer
PORTLAND – Maine Medical Center has submitted preliminary plans for a $40 million expansion that would add four operating rooms to its Portland campus.
The 40,000-square-foot addition would have glass walls and be built on top of the hospital’s Lower Bean Building, near the emergency department at 22 Bramhall St. Maine Med will also add 49 positions to staff the building.
“The architecture of the building is compatible with the existing structures within the campus,” the application states. “It is intended to promote healing while providing staff and visitors with a pleasant experience.”
The project comes as the state Legislature is embroiled in a battle about how to pay down its $186 million debt to 39 hospitals for Medicaid reimbursements. The state’s reimbursmement would release $298 million federal funds, including $67.7 million in state and federal money owed to Maine Med. Democrats have tied hospital debt repayment to an expansion of Medicaid, which Gov. Paul LePage opposes.
Maine House approves Medicaid expansion
Expansion would provide about 60,000 uninsured Mainers with health coverage as part of the Affordable Care Act.
AUGUSTA — With the legislative session nearing its end, Democratic lawmakers made another push Monday to expand Medicaid, the public health insurance program for the poor.
The House voted 89-51 along party lines to give preliminary approval to L.D. 1066, a bill sponsored by Rep. Linda Sanborn, D-Gorham, that would extend MaineCare, the state's Medicaid program, to about 60,000 residents through the federal Affordable Care Act. The bill will now move to the Senate for a vote.
It is Democrats' second attempt to adopt one of the key components of the federal health care law. Medicaid expansion has become a front in the national political battle over the Affordable Care Act.
Maine Democrats' first attempt was linked to Gov. Paul LePage's plan to pay off Maine's $186 million debt to its hospitals. Republicans objected to the combination, arguing that Democrats, who have majorities in the House and Senate, jeopardized a bipartisan agreement on the hospital payback bill with the divisive Medicaid expansion.
| Maine House Advances Medicaid Expansion Measure | |||
| 06/03/2013 Reported By: A.J. Higgins | |||
Democrats in the Maine House continued today to advance a plan that expands Medicaid benefits to 70,000 more Mainers under the Affordable Care Act. Gov. Paul LePage vetoed a similar proposal last month, but in a vote that divided largely along party lines, Democrats were able to give initial approval to the measure that Republicans say should not be adopted until other health care options are explored. As A.J. Higgins reports, Democrats are making the expansion of Medicaid their top priority this session.
|
LePage: I won’t approve Medicaid expansion until current waiting list is addressed
By Matthew Stone, BDN Staff
Posted June 03, 2013, at 1:15 p.m.
AUGUSTA, Maine — Gov. Paul LePage drew a new line in the sand on expanding the state’s Medicaid program Monday, hours after Democrats in the Maine House moved ahead with their second attempt to expand the low-income health insurance program.
The House voted 89-51 Monday morning to support an expansion of Medicaid under the federal Affordable Care Act. The vote, however, fell short of the two-thirds threshold necessary to override a near certain LePage veto.
Responding to the vote, LePage said he wouldn’t entertain a discussion about expanding Medicaid until the state can address a wait list of 3,100 people with developmental disabilities who can’t access certain services in their homes and communities.
The state’s Medicaid program provides those residents with health insurance but the state has been unable to afford housing and other services for them. LePage’s proposal for a new two-year budget includes enough funds to remove 85 people from the wait list.
“The Legislature has ignored the needs of these citizens for years, but now the Democrats want to expand welfare to able-bodied adults with no children,” LePage said in a prepared statement. “Not only is that bad public policy, it’s a disgrace.”
LePage’s statement echoed comments made last week by his health and human services commissioner, Mary Mayhew, and by Republicans on the House floor Monday.
Democrats called the argument a distraction from the real issue.
“If we do not accept the federal funds, we will still have 3,100 on the wait list,” said Rep. Linda Sanborn, D-Gorham, sponsor of the Medicaid expansion bill. “Talk about stubborn facts. Talk about false arguments.”
Five Republicans — Reps. Jarrod Crockett of Bethel, Sharri MacDonald of Old Orchard Beach, Carol McElwee of Caribou, Thomas Tyler of Windham and Windol Weaver of York — voted with Democrats to support the expansion. One Republican co-sponsor of the expansion bill, Rep. Ellen Winchenbach of Waldoboro, voted against it.
Maine’s budget shortfall threatens health coverage for seniors
By John Hennessy, Special to the BDN
Posted June 03, 2013, at 9:58 a.m.
With less than three weeks left in the regular 2013 legislative session, many of Maine’s seniors are wondering whether they will be able to afford their health care costs and much-needed prescription drug coverage. As Maine continues to address budget constraints, the target for the shortfall is, once again, our most vulnerable elders.
While it is clear that Maine’s budget challenges are daunting, there is no good news in the state budget for seniors and disabled Mainers on low or fixed incomes. These Mainers are grappling, as they do each year, with the crushing everyday costs of buying food, heating their homes and other living expenses. For them, the proposed cuts to the Medicare Savings Program and the elimination of the Drugs for the Elderly Program will be nothing short of devastating. Sadly, many of our leaders do not understand the depth of the impact.
The Medicare Savings Program covers Medicare Part B premiums which pay for doctor visits, preventive care, ambulance services and outpatient care. It also covers Medicare Part D prescription drug costs and co-payments. Under the current proposal, 40,000 seniors and adults with disabilities will be cut from the program. Depending on their circumstances, these at-risk Mainers will lose some or all coverage for prescription drugs, hospital deductibles, skilled nursing care, outpatient medical services and more.
Maine’s seniors cannot absorb these costs. They will stop going to their doctors and taking their medications. They will use the emergency room as their primary care and only as a last resort. They risk institutional placement — a much more costly alternative to staying at home in the communities they love.
If our elected leaders vote to reduce eligibility for the Medicare Savings Program, seniors will not only lose that benefit, they will also lose their low income subsidy. The subsidy offsets premiums, deductibles and copayments for Medicare Part D drug plans.
Cutting the Medicare Savings Program also doesn’t make sense economically because the program is matched with federal dollars. The so-called “savings” to the state of $23.8 million through cuts to the program actually comes with the considerable loss of over $40 million in federal matching funds. In fact, the services provided to Medicare Savings Program participants is estimated to have a value of over $498 million including physician, home health, hospital and hospital outpatient services.
With the proposed elimination of the Drugs for the Elderly program, an even larger number of people will be impacted. The program helps pay for prescription drugs for 80,000 Mainers whose income is below 175 percent of the federal poverty level. The program is paid for by tobacco settlement and racino dollars, not taxpayer dollars. Current beneficiaries are on the cusp of Medicare eligibility — between the ages of 62 and 64 ½. These are the poorest of the poor in Maine. They are counting the days to Medicare eligibility.
Health benefits should not be tied to jobs
By Pamella S. Gronemeyer, M.D.
St. Louis Post-Dispatch, Letters, June 1, 2013
Last week, physicians and a pharmacy student who are members of Physicians for a National Health Program (Illinois and Missouri chapters) and the Illinois Single Payer Coalition joined thousands of United Mine Workers of America members to support their demand for continuation and fulfillment of the health and pension benefits that the miners have earned as benefits from their long years of working in mines while being exposed to the harmful effects of coal dust, which include the development of black lung disease or carcinomas.
The story of Patriot Coal and its pending bankruptcy hearing is not new but represents another effort of a corporation to both destroy a union and to deprive the laborers of their earned health and pension benefits. As physicians, we have all seen the lung disease created by mining and know how much coal miners need their health benefits. We strongly support them in their continued actions to secure their much-deserved earned benefits.
Once again, this fight points out the need for a Medicare for All program in the United States. If health benefits were not tied to jobs, no one would lose their benefits because an industry felt the need to manipulate the structure of interrelated companies and corporations to insure shareholder return and to subsequently inflict pain and suffering on workers who toiled for many years in underground mines.
Unions have worked very hard to make sure that their members have health benefits. However, they are facing increasing obstructions to their efforts. Deductibles and co-pays are being raised. Plans that eliminate coverage for hospital care are being developed.
If single-payer health care became a reality (HR 676), the American people would be the organized bargaining unit demanding and insuring that health care is a human right for all.
Dr. Pamella S. Gronemeyer resides in Glen Carbon, Ill.
http://www.pnhp.org/print/news/2013/june/health-benefits-should-not-be-tied-to-jobs
St. Louis Post-Dispatch, Letters, June 1, 2013
Last week, physicians and a pharmacy student who are members of Physicians for a National Health Program (Illinois and Missouri chapters) and the Illinois Single Payer Coalition joined thousands of United Mine Workers of America members to support their demand for continuation and fulfillment of the health and pension benefits that the miners have earned as benefits from their long years of working in mines while being exposed to the harmful effects of coal dust, which include the development of black lung disease or carcinomas.
The story of Patriot Coal and its pending bankruptcy hearing is not new but represents another effort of a corporation to both destroy a union and to deprive the laborers of their earned health and pension benefits. As physicians, we have all seen the lung disease created by mining and know how much coal miners need their health benefits. We strongly support them in their continued actions to secure their much-deserved earned benefits.
Once again, this fight points out the need for a Medicare for All program in the United States. If health benefits were not tied to jobs, no one would lose their benefits because an industry felt the need to manipulate the structure of interrelated companies and corporations to insure shareholder return and to subsequently inflict pain and suffering on workers who toiled for many years in underground mines.
Unions have worked very hard to make sure that their members have health benefits. However, they are facing increasing obstructions to their efforts. Deductibles and co-pays are being raised. Plans that eliminate coverage for hospital care are being developed.
If single-payer health care became a reality (HR 676), the American people would be the organized bargaining unit demanding and insuring that health care is a human right for all.
Dr. Pamella S. Gronemeyer resides in Glen Carbon, Ill.
http://www.pnhp.org/print/news/2013/june/health-benefits-should-not-be-tied-to-jobs
Medical Debt: A Curable Affliction Health Reform Won’t Fix
By David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H.
Communities & Banking, Summer 2013
Millions of Americans are deep in medical debt. Unfortunately, the Affordable Care Act (ACA) will throw a lifeline to very few. According to the Congressional Budget Office, even after health reform is fully implemented in 2014, 30 million to 36 million people will remain uninsured. And tens of millions who do have insurance will have coverage that is too limited to ensure financial protection against an expensive illness. Many families will remain just one serious illness away from bankruptcy.
Medical Bankruptcies
In 2001, we began studying medical bankruptcy along with our colleagues Elizabeth Warren and Deborah Thorne. We directly surveyed debtors soon after they’d filed for personal bankruptcy. Back then, illness and medical bills contributed to about 50 percent of all personal bankruptcies and involved about 2.2 million debtors and their dependents.[1]
By 2007, when we repeated our study nationwide, medical bankruptcies had risen to 62 percent.[2] Significantly, most medical debtors were middle class. They had owned homes, had attended college, and had held responsible jobs. Seventy-eight percent even had health insurance, mostly private coverage — at least when they first got sick.
Why are so many middle-class, privately insured Americans swamped by medical costs? The reason is that private coverage has holes — unaffordable deductibles and copayments, as well as brief or nonexistent coverage of medical services like physical therapy. Moreover, since illness often reduces work-related income, families may experience a double whammy, as medical bills arrive just when the paychecks stop.
Medical bankruptcy is actually the tip of a much larger iceberg of medical indebtedness. For years, surveys have found that tens of millions of Americans struggle with medical debts and avoid needed care for fear of the cost. Recent surveys by Consumer Reports, for instance, have found that difficulty paying for medical care (including prescription drugs) is the top financial problem for American households.[3]
The number of Americans who struggle to pay for care has trended upward over time as health-care costs have soared and many health insurance companies have reduced the comprehensiveness of coverage. According to surveys by the Commonwealth Fund, the number of working-age adults (those 19 years old to 64 years old) reporting “problems paying” or “unable to pay medical bills within the past year” rose from 39 million to 53 million between 2005 and 2010.[4] In 2010, 30 million Americans were contacted by a collection agency about a medical bill, and 44 million were paying off medical debts over time.
A survey by the Center for Studying Health System Change estimated that 20.9 percent of all Americans lived in families that experienced a medical bill problem in 2010.[5] As in our bankruptcy surveys, insurance failed to offer enough protection. As many as 20.2 percent of nonelderly insured people lived in a family with medical bill problems.
http://www.pnhp.org/print/news/2013/june/medical-debt-a-curable-affliction-health-reform-won’t-fix
Communities & Banking, Summer 2013
Millions of Americans are deep in medical debt. Unfortunately, the Affordable Care Act (ACA) will throw a lifeline to very few. According to the Congressional Budget Office, even after health reform is fully implemented in 2014, 30 million to 36 million people will remain uninsured. And tens of millions who do have insurance will have coverage that is too limited to ensure financial protection against an expensive illness. Many families will remain just one serious illness away from bankruptcy.
Medical Bankruptcies
In 2001, we began studying medical bankruptcy along with our colleagues Elizabeth Warren and Deborah Thorne. We directly surveyed debtors soon after they’d filed for personal bankruptcy. Back then, illness and medical bills contributed to about 50 percent of all personal bankruptcies and involved about 2.2 million debtors and their dependents.[1]
By 2007, when we repeated our study nationwide, medical bankruptcies had risen to 62 percent.[2] Significantly, most medical debtors were middle class. They had owned homes, had attended college, and had held responsible jobs. Seventy-eight percent even had health insurance, mostly private coverage — at least when they first got sick.
Why are so many middle-class, privately insured Americans swamped by medical costs? The reason is that private coverage has holes — unaffordable deductibles and copayments, as well as brief or nonexistent coverage of medical services like physical therapy. Moreover, since illness often reduces work-related income, families may experience a double whammy, as medical bills arrive just when the paychecks stop.
Medical bankruptcy is actually the tip of a much larger iceberg of medical indebtedness. For years, surveys have found that tens of millions of Americans struggle with medical debts and avoid needed care for fear of the cost. Recent surveys by Consumer Reports, for instance, have found that difficulty paying for medical care (including prescription drugs) is the top financial problem for American households.[3]
The number of Americans who struggle to pay for care has trended upward over time as health-care costs have soared and many health insurance companies have reduced the comprehensiveness of coverage. According to surveys by the Commonwealth Fund, the number of working-age adults (those 19 years old to 64 years old) reporting “problems paying” or “unable to pay medical bills within the past year” rose from 39 million to 53 million between 2005 and 2010.[4] In 2010, 30 million Americans were contacted by a collection agency about a medical bill, and 44 million were paying off medical debts over time.
A survey by the Center for Studying Health System Change estimated that 20.9 percent of all Americans lived in families that experienced a medical bill problem in 2010.[5] As in our bankruptcy surveys, insurance failed to offer enough protection. As many as 20.2 percent of nonelderly insured people lived in a family with medical bill problems.
http://www.pnhp.org/print/news/2013/june/medical-debt-a-curable-affliction-health-reform-won’t-fix
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