Vermont thinks big on health careOctober 27
The state looks ahead to a universal health care system.
By Dave Gram The Associated Press
MONTPELIER, Vt. — As states open insurance marketplaces amid uncertainty about whether they’re a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.The state has a planned 2017 launch of the nation’s first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.
The plan is especially ambitious in the current atmosphere surrounding health care in the United States. Republicans in Congress balk at the federal health overhaul years after it was signed into law. States are still negotiating their terms for implementing it. And some major employers have begun to drastically limit their offerings of employee health insurance, raising questions about the future of the industry altogether.
In such a setting, Vermont’s plan looks more and more like an anomaly. It combines universal coverage with new cost controls in an effort to move away from a system in which the more procedures doctors and hospitals perform, the more they get paid, to one in which providers have a set budget to care for a set number of patients.
The result will be health care that’s “a right and not a privilege,” Gov. Peter Shumlin said.
Obama under fire as Americans lose prior health plans
By Roberta Rampton
WASHINGTON (Reuters) - President Barack Obama is facing fresh attacks for his pledge that Americans who like their current healthcare plans can keep them under Obamacare after reports that thousands of Americans facing cancellation notices.
Accusations that the pledge was misleading are potentially a deeper threat to Obama than the website glitches that have plagued Healthcare.gov since its October 1 launch and allowed only a trickle of people to sign up on new federal insurance exchanges.
Another technical problem struck on Tuesday evening as Connecticut's health exchange said the federal data hub that serves it as well as Healthcare.gov was "experiencing an outage" - for the second time in three days. A similar outage on Sunday also halted enrollment on Healthcare.gov.
Obama has downplayed the problems with the website, saying it's like a cash register not working, and has stressed that the underlying product of the 2010 Affordable Care Act is "actually really good."
But critics of Obamacare have seized on the hundreds of thousands of Americans due to lose their current plans because they fail to include essential benefits required by the law and are asking whether Obama misrepresented the law.
"Can you understand the level of frustration and concern about what many Americans perceive to be a false claim from the administration?" asked Representative Peter Roskam, an Illinois Republican, during a House oversight hearing on Tuesday featuring Marilyn Tavenner, a top U.S. official overseeing the law's rollout.
Tavenner, the administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), apologized for problems with Healthcare.gov but quickly came under fire about the Americans losing their current coverage plans.
Hours after Tavenner testified, the House Oversight and Government Reform Committee released a September 6 status report from Obamacare contractor CGI Federal that warned of potentially severe performance risks less than a month before the rollout. The report was dated four days before CGI and other contractors told Congress the project was on schedule to open.
Health Site Chief Expects Low Initial Enrollment Number
By ROBERT PEAR
WASHINGTON — Marilyn B. Tavenner, the official in charge of President Obama’s health insurance marketplace, apologized on Tuesday to millions of Americans who have been frustrated in trying to buy insurance under the new health care law.
“I want to apologize to you that the website is not working as well as it should,” Ms. Tavenner said, in remarks addressed to the public during testimony before the House Ways Means Committee.
Ms. Tavenner, the administrator of the federal Centers for Medicare and Medicaid Services, said that “nearly 700,000 applications have been submitted to the federal and state marketplaces” in the last four weeks.
But she repeatedly refused to say how many of those people had actually enrolled in health insurance plans since the federal and state marketplaces, or exchanges, opened on Oct. 1.
“That number will not be available until mid-November,” Ms. Tavenner said. “We expect the initial number to be small.”
The chairman of the Ways and Means Committee, Representative Dave Camp, Republican of Michigan, said that at least 146,000 Michigan residents had recently received notices that their current insurance policies would be canceled because the coverage did not meet requirements of the new health care law.
“In fact,” Mr. Camp said, “based on what little information the administration has disclosed, it turns out that more people have received cancellation notices for their health care plans this month than have enrolled in the exchanges.”
Ms. Tavenner said that existing insurance policies were, in many cases, inferior to the new policies they could get. In compliance with the health care law, she said, new policies will provide more benefits and pay a larger share of medical costs than many existing policies.
Representative Kevin Brady, Republican of Texas, asked Ms. Tavenner what she would tell people who were losing their current insurance but could not get coverage on the balky federal website.
“My constituents are frightened,” Mr. Brady said. “They are being forced out of health care plans they like. The clock is ticking. The federal website is broken. Their health care isn’t a glitch.”
Cancellation of Health Care Plans Replaces Website Problems as Prime Target
By JONATHAN WEISMAN and ROBERT PEAR
WASHINGTON — After focusing for weeks on the technical failures of President Obama’s health insurance website, Republicans on Tuesday broadened their criticism of the health care law, pointing to Americans whose health plans have been terminated because they do not meet the law’s new coverage requirements.
The rising concern about canceled health coverage has provided Republicans a more tangible line of attack on the law and its most appealing promise for the vast majority of Americans who have insurance: that it would lower their costs, or at least hold them harmless. Baffled consumers are producing real letters from insurance companies that directly contradict Mr. Obama’s oft-repeated reassurances that if people like the insurance they have, they will be able to keep it.
“My constituents are frightened,” Representative Kevin Brady, Republican of Texas, told Marilyn Tavenner, the official whose department oversaw the creation of Mr. Obama’s health insurance marketplace, at a House Ways and Means Committee hearing Tuesday. “They are being forced out of health care plans they like. The clock is ticking. The federal website is broken. Their health care isn’t a glitch.”
In the weeks since the health marketplaces opened, insurance companies have begun sending notices to hundreds of thousands of Americans in the individual insurance market informing them that their existing plans will soon be canceled. In many of those cases, the insured have been offered new plans, often with better coverage but also at higher prices.
The cancellation notices are proving to be a political gift to Republicans, who were increasingly concerned that their narrowly focused criticism of the problem-plaguedHealthCare.gov could lead to a dead end, once the website’s issues are addressed. Already they found themselves being pressed to join a Democratic push to fix the problems, not gut the law.
“There’s a little bit of a danger that if we’re just focused on the obvious ineptitude of the web designers and of the system breakdown — I wouldn’t call it a glitch, I’d call it a breakdown — we’re forgetting the bigger picture here,” said Senator Rob Portman, Republican of Ohio. “Once people do get on they’ll find out they’ll be paying more, not less, and won’t be able to keep what they have.”
Senator Tom Coburn, Republican of Oklahoma, called the website criticism “overblown.”
“They’ll fix the problems with the website. I think they won’t fix the problems with the bill,” he said.
Democrats pushed back on the Republican attacks, pointing to problems in the early days of the prescription drug plan Republicans passed in 2003, known asMedicare Part D. Most Democrats opposed that law strenuously, but, they said, once it went into effect, they helped constituents enroll and worked for its success.
“Despite Democrats’ opposition to Part D 10 years ago, we committed to making the best of the program,” said Representative Bill Pascrell Jr., Democrat of New Jersey, rising from his seat at the Ways and Means hearing to excoriate Republicans.
In contrast, with the president’s health care law, Republicans “want this to fail. They want chaos,” said Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate. “Their credibility is not that strong.”
Two Kinds of Hospital Patients: Admitted, and Not
Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said.
As executive director of the Center for Medicare Advocacy, she has gotten all too savvy about this stuff.
“Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?”
But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring with a policy popularly known as the “two-midnight rule.” When a physician expects a patient’s stay to include at least two midnights, that person is an inpatient whose care is covered under Medicare Part A, which pays for hospitals. If it doesn’t last two midnights, Medicare expects the person to be an outpatient, and Part B, which pays for doctors, takes over.
It’s rare to have hospital and nursing home administrators, physicians and patient advocates all agreeing about a Medicare policy, but in this case “there’s unanimity of dislike,” said Carol Levine, director of the Families and Health Care Project of the United Hospital Fund. Despiteprotests, the rule took effect on Oct. 1, but Medicare agreed to delay penalties for 90 days.
Meanwhile, administrators at the Johns Hopkins Hospital in Baltimore have taken to calling the policy the Cinderella Rule, said Amy Deutschendorf, senior director of clinical resource management: “If you cross two midnights, you’re an inpatient. If not, you’re a pumpkin.”
Sebelius Apologizes for Health Site’s Malfunctions
By ROBERT PEAR
WASHINGTON — Kathleen Sebelius, the secretary of health and human services, apologized Wednesday for the frustration that millions of Americans have experienced while trying to shop for insurance on the HealthCare.gov website, even as she defended the problem-plagued rollout of President Obama’s health care law and tried to explain the cancellation of hundreds of thousands of individual insurance policies.
Ms. Sebelius, fighting for her political life at a hearing of the House Energy and Commerce Committee, said she was “as frustrated and angry as anyone with the flawed launch of HealthCare.gov.”
Ms. Sebelius said she was ultimately responsible for “this debacle,” including the website’s problems. But she said that a government contractor, Verizon’s Terremark unit, was responsible for outages that disrupted the website on Sunday and again on Tuesday.
Representative Fred Upton, Republican of Michigan and chairman of the committee, said: “Over the months leading up to the Oct. 1 launch, the secretary and her colleagues repeatedly looked us in the eye and testified that everything was on track. Despite the numerous red flags and lack of testing, they assured us that all systems were a go. But something happened along the way. Either those officials did not know how bad the situation was, or they did not disclose it.”
Moreover, Mr. Upton said: “There are millions of Americans coast to coast who no doubt believed the president’s repeated promise that if they liked their plan, they’d be able to keep it. They are now receiving termination notices.”
Ms. Sebelius said the cancellation of some individual policies was a justifiable byproduct of the 2010 health care law. These policies will be replaced, she said, with new policies that provide better benefits and more consumer protections, often at similar or lower prices.
People in the individual market have never had consumer protections, Ms. Sebelius said, adding, “They can be locked out, priced out, dumped out.”
However, in recent weeks, many consumers have received cancellation notices offering new policies at prices much higher than what they have been paying.
Ms. Sebelius minimized the significance of recent changes in individual insurance policies, which have shocked many consumers.
“In the individual market, plans change every year,” she said, adding, “This market has always been the Wild West.”