Thursday, November 28, 2013

Health Care Reform Articles - November 28, 2013

Happy Thanksgiving!

The Single-Payer Alternative

By Nancy Folbre
The New York Times, Economix blog, Nov. 25, 2013
Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance.
The conspiracy charge sounds deranged, but problems with the new health insurance system may indeed revitalize demands for more substantive reforms, which many policy makers and voters set aside in the putative interests of political pragmatism. Whatever the advantages of a single-payer system such as that currently administered by Medicare, one view held, American voters were unlikely to get behind it.
Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges.  Andwhile Republicans despise the Affordable Care Act despite its conformity with many of their earlier proposals, their proposed changes (other than simple rollback) look complicated, kludgy and costly to administer.
The malfunctioning website has magnified problems inherent in coordinating enrollment across many different companies in many different exchanges in cooperation with many different government agencies. The harmonization challenges are orders of magnitude greater than those faced by a single company or a single state, making streamlining difficult. Improved software can do only so much.
In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult.
Lack of clear information about the prices of medical procedures, combined with a proliferation of insurance options whose potential benefits will be strongly affected by unpredictable events (such as being involved in an automobile accident or developing cancer), put consumers in a weak position.
The process of negotiating relationships with new health care providers because old ones are “out of network” is physically and emotionally exhausting. Insurance companies benefit from promoting policies that are difficult to understand and make consumers fearful of any change in their coverage. That fear and aversion has spilled over into the transactions required for many people to benefit from the Affordable Care Act.

Online Health Law Sign-Up Is Delayed for Small Business

WASHINGTON — The Obama administration on Wednesday announced a one-year delay in a major element of the new health care law that would allow small businesses to buy insurance online for their employees through the new federal marketplace.
It was yet another setback for the rollout of the health care law and resulted, in part, from the well-documented problems of the insurance marketplace website. Administration officials said they had to focus on the basic functions of the website, so that individuals could shop for insurance, before offering online enrollment for small businesses. In the meantime, businesses and their employees can apply through brokers.
Many employees of small businesses are uninsured, and the businesses themselves are much less likely than big companies to provide coverage to workers and their families.
The latest delay, coming just as the White House was boasting of major improvements in the health insurance website,, opens the door to more complaints about the health care law and could increase pressure to delay other provisions.
“The president bit off more than he can chew with this health care law, and small businesses are now forced to bear the consequences,” said Speaker John A. Boehner of Ohio. “Business owners across the country are already having health care plans for their employees canceled by this law, and now they’re told they won’t have access to the system the president promised them to find different coverage. Instead, they’ll have to resort to a system you’d expect to see in the 1950s.”
It was not the first delay for small businesses. The administration had previously delayed online enrollment for them to the end of this month from Oct. 1.
The date has now been pushed back to November 2014 for coverage that takes effect in January 2015, according to the Health and Human Services Department.
The announcement, just before Thanksgiving, was reminiscent of the way the White House announced, just before the Fourth of July weekend, a one-year delay in the requirement for larger employers to offer health insurance to employees.
The marketplace for small businesses — the Small Business Health Options Program, or SHOP exchange — was one of the few provisions of the 2010 law with some Republican support, and it was originally championed by Senator Olympia J. Snowe, Republican of Maine.
John C. Arensmeyer, the chief executive of Small Business Majority, an advocacy group that supports the health care law, said, “It’s disappointing that the online portion of the federal small business marketplace through will be delayed, and it’s important it get up and running as soon as possible.”
The marketplace, he said, “is still the most important provision in the Affordable Care Act for small businesses.”
Vermont Approves Single-Payer Health Care: ‘Everybody in, nobody out’

The Affordable Care Act continues to plow ahead, despite Republican attempts to fight it at every turn.  What is unfolding in front of us is nothing short of spectacular.  The problems with are slowly being resolved which is helping more and more people sign up for affordable healthcare, many for the first time in their life.  The law provides so much more than that, including standards for even the lowest level plans, protections for young adults 26 and younger, and the elimination of pre-existing plans.  Of course, you will not hear the success stories on the news, because those stories are not nearly as sexy as the “Obama Lied” slogan they are so fond of.
The biggest downside of the ACA is the reliance on the private insurance industry.  It does not have to be this way, however.  There is yet another provision in the Affordable Care Act that can open the door for states to institute their own single-payer healthcare system.  Other states have a public option, especially for those below a certain income level, but no state had instituted a true single-payer system.  All of this has changed thanks to President Obama and the Affordable Care Act.
Vermont—Home of Ben and Jerry’s, Maple Syrup, Bernie Sanders and the first state to pass marriage equality.  Now, Vermont will be known for something that will impact every resident in the state.
The ACA provided states with federal funds to institute a Medicaid expansion.  The states chose to expand the program also were able to set up their own state exchanges, which were relatively free from the problems the federal site had.  Vermont decided to take it a step further by setting up their very own single payer system.
The slogan of the program: Everybody in, nobody out.

Doctors: New Health Care Plans Raise Red Flags

Physicians groups told Obama administration officials Tuesday that they are worried that new insurance plans under the Affordable Care Act offer only limited networks of providers and low reimbursement rates for doctors, and that could make it difficult for millions of those enrolled to actually get health care.
As the Journal has reported, some health plans don’t include big brand-name health providers in their networks and are slashing how much they’ll pay medical practicesfor treating the newly covered.
Representatives from the major physician lobbying groups raised these issues Tuesday in a White House meeting with health officials includingChris Jennings and Jeanne Lambrewof the White House, and Chiquita Brooks-LaSure of the Centers for Medicare & Medicaid Services.
“Some of the things were not a surprise to them… they’re acutely aware,”Shawn Martin, a top lobbyist for the American Academy of Family Physicians, said after the noon meeting.
Bob Doherty, who represents the American College of Physicians, said that another topic of discussion was the accuracy of the provider lists that consumers see when they try to compare insurance plans. Mr. Doherty said the doctors in his group are worried about facing confused patients starting Jan. 1.
For their part, the administration officials talked about ways that physicians could help patients sign up for coverage. Participants described the meeting as “good dialogue,” but one with no immediate resolutions.

NOVEMBER 27, 2013, 5:00 PM

The Vaccination Effect: 100 Million Cases of Contagious Disease Prevented

Vaccination programs for children have prevented more than 100 million cases of serious contagious disease in the United States since 1924, according to a new studypublished in The New England Journal of Medicine.
The research, led by scientists at the University of Pittsburgh’s graduate school of public health, analyzed public health reports going back to the 19th century. The reports covered 56 diseases, but the article in the journal focused on seven: polio, measles, rubella, mumps, hepatitis A, diphtheria and pertussis, or whooping cough.
Researchers analyzed disease reports before and after the times when vaccines became commercially available. Put simply, the estimates for prevented cases came from the falloff in disease reports after vaccines were licensed and widely available. The researchers projected the number of cases that would have occurred had the pre-vaccination patterns continued as the nation’s population increased.
The journal article is one example of the kind of analysis that can be done when enormous data sets are built and mined. The project, which started in 2009, required assembling 88 million reports of individual cases of disease, much of it from the weekly morbidity reports in the library of the Centers for Disease Control and Prevention. Then the reports had to be converted to digital formats.
Most of the data entry — 200 million keystrokes — was done by Digital Divide Data, a social enterprise that provides jobs and technology training to young people in Cambodia, Laos and Kenya.
Still, data entry was just a start. The information was put into spreadsheets for making tables, but was later sorted and standardized so it could be searched, manipulated and queried on the project’s website.
“Collecting all this data is one thing, but making the data computable is where the big payoff should be,” said Dr. Irene Eckstrand, a program director and science officer for the N.I.H.’s Models of Infectious Disease Agent Study.
The University of Pittsburgh researchers also looked at death rates, but decided against including an estimate in the journal article, largely because death certificate data became more reliable and consistent only in the 1960s, the researchers said.

Where Is the Love?

When I’ve written recently about food stamp recipients, the uninsured and prison inmates, I’ve had plenty of pushback from readers.
A reader named Keith reflected a coruscating chorus when he protested: “If kids are going hungry, it is because of the parents not upholding their responsibilities.”
A reader in Washington bluntly suggested taking children from parents and putting them in orphanages.
Jim asked: “Why should I have to subsidize someone else’s child? How about personal responsibility? If you procreate, you provide.”
After a recent column about an uninsured man who delayed seeing a doctor about a condition that turned out to be colon cancer, many readers noted that he is a lifelong smoker and said he had it coming.
“What kind of a lame brain doofus is this guy?” one reader asked. “And like it’s our fault that he couldn’t afford to have himself checked out?”
Such scorn seems widespread, based on the comments I get on my blog and Facebook page — as well as on polling and on government policy. At root, these attitudes reflect a profound lack of empathy.
A Princeton University psychology professor, Susan Fiske, has found that when research subjects hooked up to neuro-imaging machines look at photos of the poor and homeless, their brains often react as if they are seeing things, not people. Her analysis suggests that Americans sometimes react to poverty not with sympathy but with revulsion.
So, on Thanksgiving, maybe we need a conversation about empathy for fellow humans in distress.
Let’s acknowledge one point made by these modern social Darwinists: It’s true that some people in poverty do suffer in part because of irresponsible behavior, from abuse of narcotics to criminality to laziness at school or jobs. But remember also that many of today’s poor are small children who have done nothing wrong.
Some 45 percent of food stamp recipients are children, for example. Do we really think that kids should go hungry if they have criminal parents? Should a little boy not get a curved spine treated properly because his dad is a deadbeat? Should a girl not be able to go to preschool because her mom is an alcoholic?
Successful people tend to see in themselves a simple narrative: You study hard, work long hours, obey the law and create your own good fortune. Well, yes. That often works fine in middle-class families.
But if you’re conceived by a teenage mom who drinks during pregnancy so that you’re born with fetal alcohol effects, the odds are overwhelmingly stacked against you from before birth. You’ll perhaps never get traction.

Right vs. Left in the Midwest

MINNESOTA and Wisconsin share much more than bone-chilling winters: German and Northern European roots; farming; and, until recently, a populist progressive tradition stretching back a century to Wisconsin’s Fighting Bob La Follette and the birth of Minnesota’s Democratic-Farmer-Labor Party.
But in 2010 these cousin states diverged. By doing so they began a natural experiment that compares the agendas of modern progressivism and the new right. Wisconsin elected Republicans to majorities in the Legislature and selected a bold and vigorous Republican governor, Scott Walker. Minnesotans elected one of the most progressive candidates for governor in the country, Mark Dayton of the Democratic-Farmer-Labor Party.
A month after Mr. Walker’s inauguration in January 2011, he catapulted himself to the front ranks of national conservative leaders with attacks on the collective bargaining rights of Civil Service unions and sharp reductions in taxes and spending. Once Mr. Dayton teamed up with a Democratic Legislature in 2012, Minnesota adopted some of the most progressive policies in the country.
Minnesota raised taxes by $2.1 billion, the largest increase in recent state history. Democrats introduced the fourth highest income tax bracket in the country and targeted the top 1 percent of earners to pay 62 percent of the new taxes, according to the Department of Revenue.
Which side of the experiment — the new right or modern progressivism — has been most effective in increasing jobs and improving business opportunities, not to mention living conditions?
Obviously, firm answers will require more time and more data, but the first round of evidence gives the edge to Minnesota’s model of increased services, higher costs (mostly for the affluent) and reduced payments to entrenched interests like the insurers who cover the Medicaid population.
Three years into Mr. Walker’s term, Wisconsin lags behind Minnesota in job creation and economic growth. As a candidate, Mr. Walker promised to produce 250,000 private-sector jobs in his first term, but a year before the next election that number is less than 90,000. Wisconsin ranks 34th for job growth. Mr. Walker’s defenders blame the higher spending and taxes of his Democratic predecessor for these disappointments, but according to Forbes’s annual list of best states for business, Wisconsin continues to rank in the bottom half.

Stores selling Obamacare policies popping up across California

With enrollment deadlines approaching, California officials, insurers and agents are opening stores in outlets across the state to sign up individuals for Obamacare policies.

By Chad Terhune
5:17 PM PST, November 27, 2013
As shoppers hunt for holiday bargains this season, they may find something unusual for sale at the mall: Obamacare.
With enrollment deadlines looming, California officials, insurance companies and agents are staking out retail space to sign up thousands of people as part of the Affordable Care Act. These sales tactics reflect how dramatically the healthcare law is changing the insurance industry.
Until recently, most health insurance companies and agents didn't put much time into selling policies to individuals and focused more on catering to employers and large groups in the workplace. But the health insurance mandate and billions of dollars in federal premium subsidies have made individual policies a far more attractive market.
California's health insurance exchange and other government-run marketplaces are rushing to sign up people by Dec. 23, the deadline to have coverage in effect Jan. 1. Open enrollment lasts until March 31.
A state lawmaker and union organizers last week opened a mall store in a predominantly African American area of Los Angeles. In Orange County, insurance agents are signing up dozens of people each week at Laguna Hills Mall, and healthcare giant Kaiser Permanente has rented five retail locations in Northern California to sell exchange policies.
The Covered California exchange has posted solid enrollment since opening Oct. 1, primarily through its website and call centers. It has signed up nearly 80,000 people in private health plans through Nov. 19 and an additional 135,000 people have applied for Medi-Cal, the state's Medicaid program for the poor.
But the exchange estimates that about 80% of people will want in-person help to figure out their insurance options. Rather than set up storefronts itself, Covered California has focused more on training people who then go out to farmers markets and health fairs to promote the exchange and do enrollment.
Some consumer advocates welcome the increased retail exposure, but they worry that stores run by insurers or agents might push certain health plans and leave out other choices on the exchange.
"Having a lot of venues where people are running errands is a good thing," said Betsy Imholz, special projects director at Consumers Union. "But we want to avoid inappropriate steering. There are upsides and downsides to this."
State Sen. Holly Mitchell (D-Los Angeles) said she pushed for a Covered California store at the Baldwin Hills Crenshaw mall because many lower-income people who stand to benefit most from the healthcare law aren't likely to click on a website.
"There are still people who don't have access online," Mitchell said. "We want to bring health insurance to where people are naturally, and the clock is ticking on the enrollment window."

Posted Nov. 28, 2013, at 7:42 a.m.
President Barack Obama’s healthcare law is facing its biggest test this weekend since its disastrous Oct. 1 launch, as Americans find out whether the administration has met a self-imposed deadline to fix its insurance shopping website.
Another major outage of glitch-ridden could spell more political trouble for the president, who was forced to apologize for the botched rollout and admit burdening Democratic Party allies in their bids for re-election to Congress in 2014.
If the website does not work on Saturday’s deadline, that could turn off millions of uninsured Americans, especially young and healthy consumers whose participation in the new insurance exchanges are critical for keeping costs in check.
Democratic leaders in Congress might also find it necessary to extend open enrollment beyond the March 31 deadline and delay fines mandated by the law for people who do not have insurance by that date — a prospect that insurers warn would destabilize the market.
Obama officials are confident that this second coming of will be much improved from the Oct. 1 debut. Millions of people looked into the website in its first month, but only about 27,000 cleared the gauntlet of technical obstacles to sign up for insurance.
The portal is the gateway for health insurance plans in 36 states under the Patient Protection and Affordable Care Act, commonly called Obamacare, which was passed in 2010. It is intended to move the United States closer to universal care by subsidizing insurance sold by the private sector for less affluent families.
Officials have said that by Saturday the website will be able to load quickly and work accurately for at least 80 percent of users. They have said it will be able to handle 50,000 simultaneous visitors, for a daily total of about 800,000, twice the capacity seen even on Wednesday before a final flurry of hardware and software fixes over the Thanksgiving holiday.

Wednesday, November 27, 2013

Health Care Reform Articles - November 27, 2013

A Plea to Avoid Crush of Users at Health Site

WASHINGTON — White House officials, fearful that the federal health care website may again be overwhelmed this weekend, have urged their allies to hold back enrollment efforts so the insurance marketplace does not collapse under a crush of new users.
At the same time, administration officials said Tuesday that they had decided not to inaugurate a big health care marketing campaign planned for December out of concern that it might drive too many people to the still-fragile
With a self-imposed deadline for repairs to the website approaching on Saturday, the administration is trying to strike a delicate balance. It is encouraging people to go or return to the website but does not want to create too much demand. It boasts that the website is vastly improved, but does not want to raise expectations that it will work for everyone.
“We are definitely on track to have a significantly different user experience by the end of this month,” Kathleen Sebelius, the secretary of health and human services, said Tuesday. “That was our commitment.”
Ms. Sebelius, who supervised development of the troubled website, tried to rally state and local elected officials in a conference call organized by the White House. “I would urge you and your folks on the ground to not hesitate to recommend that people go to and get signed up,” she said.
Officials said the website was now able to handle 50,000 users at a time, providing enough capacity on a daily basis to enroll millions of people in the next four months.
But those charged with fixing the site worry that 250,000 people might try to use the site simultaneously at times on Saturday and in the days ahead. They say that pent-up demand for insurance in the federal marketplace, combined with a surge of interest among people merely curious about whether it is working, could bring the website to a crawl.
“Our concern is that we want to make sure that people have the right expectation going into this,” said Jennifer Palmieri, the White House communications director. 

To Changing Landscape, Add Private Health Care Exchanges

Listen to the Story

4 min 21 sec

We've been reporting a lot lately on the troubled rollout of President Obama's signature health care law. But at the same time, there are rumblings of a major shift in the way companies offer private health insurance to workers.
It involves what are called "private health care exchanges." These are similar to — but completely separate from — the public exchanges you've heard so much about.
Some experts say this new approach soon could change how millions of Americans receive their health care.
Dean Carter is the chief human resources officer for Sears Holdings, which means he's shifted more than 50,000 employees onto this new kind of health care system. And he thinks this is the future. "In my 20 years of HR and working with benefits," Dean says, "this fundamentally changes the game."
The change Dean's talking about is kind of like what happened when most companies stopped offering pensions. Instead, many just contribute money to their workers' retirement accounts.
With health care now, some companies are saying: "Here's $300 to $400 a paycheck. Go use that toward buying insurance on a 'private exchange.' "
For years at big conferences that benefits managers attend, there has been talk about private health care exchanges with four, five or six different carriers competing on price to offer people insurance. But it seemed to be something maybe 10 years in the future. Then the Affordable Care Act passed. And that made exchanges seem more doable right away for the private sector, too.
"When we began to look at it, and it looked like it was a good idea for our associates and Sears holdings, we leaned in fast," says Carter.

Medicaid Drives Expansion Of Health Care Coverage

Listen to the Story

After years of wide spread fretting about the size of the federal debt and angst about new federal regulations for health care, one federal program is enjoying widespread popularity: Medicaid. Morning Edition examines this political paradox.

People are Signing up in Droves for Obamacare, but not for Private Insurance

Much of the news lately about the Affordable Care Act, also called Obamacare, has been about the troubled rollout of the web marketplace enrollment and the cancellation notices going out to a segment of the 5% of Americans who get coverage from the individual health insurance market. (Read this for an accurate explanation of what is going on with the cancellations. And this about President Obama’s announcement of a policy change that may allow some people to keep their cancelled policies for at least another year.)  But there is another Obamacare story that has gotten much less attention: enrollment in Medicaid, which is being expanded in many states, is going like gangbusters.
Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”
This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.

The Power of a Daily Bout of Exercise

This week marks the start of the annual eat-too-much and move-too-little holiday season, with its attendant declining health and surging regrets. But a well-timed new study suggests that a daily bout of exercise should erase or lessen many of the injurious effects, even if you otherwise lounge all day on the couch and load up on pie.
To undertake this valuable experiment, which was published online last month in The Journal of Physiology, scientists at the University of Bath in England rounded up a group of 26 healthy young men. All exercised regularly. None were obese. Baseline health assessments, including biopsies of fat tissue, confirmed that each had normal metabolisms and blood sugar control, with no symptoms of incipient diabetes.
The scientists then asked their volunteers to impair their laudable health by doing a lot of sitting and gorging themselves.
Energy surplus is the technical name for those occasions when people consume more energy, in the form of calories, than they burn. If unchecked, energy surplus contributes, as we all know, to a variety of poor health outcomes, including insulin resistance — often the first step toward diabetes — and other metabolic problems.
Overeating and inactivity can each, on its own, produce an energy surplus. Together, their ill effects are exacerbated, often in a very short period of time. Earlier studies have found that even a few days of inactivity and overeating spark detrimental changes in previously healthy bodies.
Some of these experiments have also concluded that exercise blunts the ill effects of these behaviors, in large part, it has been assumed, by reducing the energy surplus. It burns some of the excess calories. But a few scientists have suspected that exercise might do more; it might have physiological effects that extend beyond just incinerating surplus energy.
To test that possibility, of course, it would be necessary to maintain an energy surplus, even with exercise. So that is what the University of Bath researchers decided to do.
Their method was simple. They randomly divided their volunteers into two groups, one of which was assigned to run every day at a moderately intense pace on a treadmill for 45 minutes. The other group did not exercise.

Curing Insomnia to Treat Depression

Psychiatrists have long thought that depression causes insomnia, but new research suggests that insomnia can actually precede and contribute to causing depression. The causal link works in both directions. Two small studies have shown that a small amount of cognitive behavioral therapy to treat insomnia, when added to a standard antidepressant pill to treat depression, can make a huge difference in curing both insomnia and depression in many patients. If the results hold up in other studies already underway at major medical centers, this could be the most dramatic advance in treating depression in decades.
A study of 66 patients by a team at Ryerson University in Toronto found that the cognitive therapy for insomnia, a brief and less intense form of talk therapy than many psychiatric patients are accustomed to, worked surprisingly well. Some 87 percent of the patients whose insomnia was resolved in four treatment sessions also had their depression symptoms disappear, almost twice the rate of those whose insomnia was not cured. The new results were reported by Benedict Carey in The Times last Tuesday.
The brief course of sleep therapy teaches patients to establish a regular wake-up time; get out of bed during waking periods; avoid reading, watching TV or other activities in bed; and eliminate daytime napping, among other tactics. It is distinct from standard sleep advice, like avoiding coffee and strenuous exercise too close to bedtime.
The Toronto study is consistent with a 2008 study of 30 patients at Stanford University, all of whom suffered from insomnia and depression and were taking an antidepressant pill. Some 60 percent of those given seven sessions of behavioral therapy for insomnia in addition to the pill recovered fully from their depression, compared with only 33 percent in a control group that got the standard advice for treating sleeplessness.
Other studies involving roughly 70 patients each are being conducted at Stanford, Duke University and the University of Pittsburgh, all financed by the National Institute of Mental Health. Those results are expected to be published next year.

LePage’s study on Medicaid expansion is a wasteful sham

Posted Nov. 27, 2013, at 7:55 a.m.
Most would agree that while the nation’s financial crisis is behind us, Maine has not yet recovered. Financial resources are stretched; budgets are cash-strapped. And we are all being asked to do more with less.
In state government, there’s an even higher responsibility to ensure judicious spending — because our budget is a budget of the people, the taxpayer.
Last week, the Legislature and the people of Maine discovered through newspaper reports that Gov. Paul LePage paid nearly $1 million to hire a tea party consultant to review the state’s health insurance program, MaineCare.
In a time when every dollar is being stretched, we have to ask: Can the state afford to pay $1 million to an out-of-stater to write a report, especially when we already know what that report will say?
In the Legislature, when we draft budgets, we expect, and we know, that every penny will be scrutinized — and it should be. Over the last few years, structural changes have been made. And, as a result, we haven’t been able to fund everything we want — or even everything that needs to be funded.
So why then, is LePage spending $1 million on a no-bid contract to a man whose stance on MaineCare is already well-known and well-documented? In fact, under his direction, the state ofPennsylvania kicked nearly 90,000 children off of its state-run health care program.
This $1 million out-of-state consultant is cut from the same tea party cloth as LePage. So it’s not clear why we need to pay someone else $1 million to hear the same rhetoric we hear every day from LePage.
The state’s financial priorities need to reflect the priorities of the people of Maine — not the ideology of a fringe group.
A million dollars can go a long way.
It could go toward providing property tax relief to Maine homeowners.
As we approach another cold Maine winter, it could go toward fuel assistance for needy Maine families.
It could go toward worker retraining for Mainers who were laid off and haven’t yet returned to the workforce.
It could help more Maine children enroll in early childhood programs such as Head Start. Or it could provide more free lunches to hungry students.

Maine allows Anthem to renew health plans due for cancellation under Obamacare

Posted Nov. 26, 2013, at 4:22 p.m.
AUGUSTA, Maine — Many Mainers facing cancellation of their health insurance can keep plans that don’t comply with Obamacare for another year, under a decision issued Tuesday by Maine’s top insurance official.
The decision by Maine Insurance Superintendent Eric Cioppa affects at least 8,500 Mainers who buy their health insurance from Anthem BlueCross BlueShield in the “individual market,” made up of consumers who can’t access coverage through work or government programs such as Medicaid and Medicare. Those Anthem policyholders now have another year to find a plan that complies with the Affordable Care Act, often called Obamacare.
“This decision is meant to give several thousand Maine policyholders another option for 2014,” Cioppa said in the release. “It will also result in a smaller premium increase for those choosing to continue their current plan, and provide more time for those individuals to evaluate plans for future years.”
Cioppa’s decision to allow Anthem to renew plans due for cancellation came two weeks after President Barack Obama asked states to allow insurance companies to renew through 2014 policies that fall short of new requirements set forth in his signature health reform law. The move was a retreat from a central goal of the law, to put an end to insurance plans that don’t offer adequate coverage. Obama proposed the fix amid the prospect that millions of Americans could see their plans canceled, despite his promises that Americans could keep their plans if they liked them.
The onslaught of cancellations nationally came about because insurers must stop selling plans that don’t meet certain requirements of the health reform law. The existing plans may not cover maternity care, for example, one of several required health benefits, or may carry overly high deductibles.
While the federal government won’t punish insurers for renewing the noncompliant plans, carriers also need the greenlight from state regulators. Insurance officials are under the gun to decide, with just five weeks to go before the policies would take effect on Jan. 1, 2014.
Even with Cioppa’s decision, Anthem could have chosen not to renew the plans, but the health insurer said in a statement late Tuesday that it will keep offering the noncompliant plans in Maine.
Some of Anthem’s individual policyholders already could choose to keep their plan, provided their coverage was “grandfathered” — or in place before the health reform law passed in March 2010 and unchanged since then — and exempt from many of its provisions.
For 8,500 other “nongrandfathered” Anthem customers with newer plans, their coverage faced cancellation. The largest insurer in Maine’s individual market, Anthem notified its Maine policyholders that their plans would be canceled and replaced with the most comparable ACA-compliant plan, according to the state insurance bureau.
Those cancellations are now on hold for a year.

Affordable Care: Separate plans for domestic partners

“My domestic partner and I are not legally married in any state and the state in which we live does not allow gay marriage.  We are both 22 years old.  Will we need to apply for two separate insurance plans, or may we purchase one and have both of on the plan?”
Two South Carolina Peaches
Dear South Carolina Peaches,
Since you are not legally married (and not living in a state that recognizes same-sex marriage), you will be buying two separate plans.  This is not a huge disadvantage, however.  The rates for a married couple are two times the individual rate; they don’t get a “discount” for having a legal union.  The deductible for the plan also applies to each person separately.  So, there is no extra benefit here either.
Because you will be under age 30 as of January 1, 2014, you may be able to choose a catastrophic plan.  This plan has a $6,350 deductible.  In addition to being under 30, you also have to get a hardship exemption showing that you cannot afford another plan.  To check this out, call 800-318-2596 or go to when it is working.
Your state is not expanding Medicaid to new groups, but you may want to keep an ear to the ground on this.  Health economists believe that eventually all of the states will expand Medicaid.  This means that people would be able to join based simply on their income, not based upon whether they are pregnant, have small children, etc. etc.

Even Without Expansion, S.C. Will See 16% Jump In Medicaid Enrollment

NOV 26, 2013
This KHN story was produced in collaboration with mcclatchy
Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program’s high costs and inefficiency.
Yet, state officials still forecast a 16 percent enrollment jump by the end of June, 2015, triple that of a typical year and even higher than the 12 percent average increase expected in states that are expanding eligibility.
What’s going on?
South Carolina officials say publicity for the Affordable Care Act and its requirement that most people get insurance will attract tens of thousands of people who are currently eligible for Medicaid but have not enrolled.