Wednesday, February 26, 2014

Health Care Reform Articles - February 26, 2014

Medicaid compromise drafted by two GOP senators to hit State House this week

Posted Feb. 25, 2014, at 9:48 a.m.
AUGUSTA, Maine — A bill drafted by two moderate Republican senators, meant to be a compromise on the divisive issue of Medicaid expansion, is slated to be unveiled to lawmakers as soon as today.
Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton drafted the proposal, which they hope will sway enough of their GOP colleagues to make expansion happen. It accepts federal funds in exchange for expanding Medicaid — a top Democratic priority this legislative session — and incorporates several other proposals meant to alleviate concerns by Republicans wary of expanded welfare costs.
Katz has proposed an amendment that would implement aspects of “managed care,” under which the state would contract with a handful of managed care organizations — both for-profit and nonprofit — that would take over care of the entire Medicaid population. The organizations would be paid a flat rate per patient served, rather than the current model, in which the state pays providers on a per-procedure basis.
The framework of Katz’s managed care amendment is expected to form the core of the two Republicans’ Medicaid expansion compromise scheme.
Democratic lawmakers are expected to support the proposal. The Maine Hospitals Association and state Chamber of Commerce were involved, to one degree or another, with crafting the plan, and so are also expected to throw their weight behind it.
However, many Republicans — especially in the House — are sure to oppose any proposal that accepts federal money in exchange for expansion. Gov. Paul LePage and others in recent weeks have turned to increasingly dire rhetoric in their opposition.
On Saturday, House Minority Leader Ken Fredette, R-Newport, called the compromise a “fool’s errand.”
“I suspect they will throw everything and the kitchen sink to make this look acceptable to Republicans, but it’s Medicaid expansion. That’s the bottom line,” Fredette said.
The official line from House Republicans and the LePage administration is that MaineCare spending — which represents 25 percent of General Fund expenditures and is expected to grow by about 1 percent each year for the next two years — is crowding out other state programs. LePage says that situation will only worsen if the state accepts Medicaid expansion.
On Monday, LePage released a statement decrying the way Medicaid spending is “cannibalizing” other state programs. Attached were statements from communications directors of many state departments, outlining where budget shortfalls — which LePage attributes to ever-growing costs of MaineCare — had left their programs wanting. The missive was a response to a coordinated campaign by LePage’s administration to solidify every state department behind the governor’s “cannibalization” message.
“My challenge as governor and our challenge as a state is to find ways to help Maine families prosper, improve the business climate, foster better educational opportunities, while still protecting those most in need with limited resources,” LePage wrote. “We cannot do that while Medicaid is consuming an inordinate amount of our finite financial resources.”
Katz and Saviello are expected to present their proposal to the Legislature’s Health and Human Services Committee sometime this week.

Support managed care, expand Medicaid, keep patients front and center

Posted Feb. 25, 2014, at 2:45 p.m.
Republican Maine Sens. Roger Katz of Augusta and Tom Saviello of Wilton rolled out legislation Tuesday that would overhaul the state’s health insurance program for low-income residents. It would permit the state to expand Medicaid under the Affordable Care Act for three years, and it would fundamentally change the way Maine administers Medicaid for all recipients by contracting the program out to private companies or nonprofits, a model known as managed care.
As with any complex change, a successful managed care system would depend on how it’s organized and overseen. As the bill makes clear, the change would require years of work and effort, sustained collaboration, expert help, and buy-in not just from both political parties, physicians and patients’ groups but the public.
As long as rulemaking resulting from the bill ensures greater access to care for Maine’s low-income patients and fair rates for providers, there’s no reason not to pursue the new health care delivery system. Maine’s Medicaid program, MaineCare, has been plagued for years with cost overruns and inadequate oversight. Having organizations coordinate and finance care for Medicaid recipients has been done successfully elsewhere, and it can be done in Maine. Katz and Saviello have set up a way to pursue the process thoughtfully.
The managed care model is by no means new. In some form or another, organizations are now charged with coordinating care for 74 percent of Medicaid recipients across the country, up from 58 percent in 2002 and 10 percent in the early 1990s.
Maine is now discussing implementing the most common arrangement, called comprehensive risk-based managed care. It would have the state pay three or four successful bidders a fixed, per-enrollee payment each month — based on actuarially sound numbers — in exchange for furnishing a range of health services. Medicaid recipients would be able to get those services through a network of participating providers. One benefit would be having more predictable Medicaid costs for the state.
Some say that managed care will save the state money, as managed care organizations will have an incentive to contain costs and keep patients healthy. While it is possible, and the bill currently builds in a 5-percent cost savings, one study by the National Bureau of Economic Research found that managed care plans do not always reduce Medicaid spending — and that when they reduce Medicaid spending, it’s not always because of improved health among Medicaid enrollees and reduced health care use.
That doesn’t mean Maine shouldn’t pursue managed care or even that the state can’t find a way to save money. It does mean managed care shouldn’t be reduced to a soundbite touting it will save money no matter what. How well a managed care system works depends on how it’s set up.
Setting up an effective system would require expert guidance from other states that have been using the model well for years, such as Michigan or Wisconsin. Maine would need direction on the best ways to analyze data and measure the results of managed care. It would need to determine the problems it wishes to address: Reduced emergency room use? More flexibility on when patients can get help? Improved birth outcomes? The bill allows for all these issues and questions to be addressed by a stakeholder group, rulemaking and the contract process itself.
A managed care model has great potential to benefit Medicaid recipients, especially the 70,000 newly eligible with expansion, as they would have defined provider networks to turn to for care, and more services would likely be covered. Switching to a managed care system should not only be about money but about ensuring that people in need get quality care delivered in ways that are monitored and improved over time. Maine hasn’t done this well with its current fee-for-service system.
Expanding Medicaid and switching to a managed care model are changes that could substantially improve the lives of thousands of Maine residents. Those residents deserve to have their lawmakers put aside philosophical differences, come to an informed decision and support the efforts of Katz and Saviello.

Maine lawmakers give initial approval to wider use of overdose-halting drug

Posted Feb. 24, 2014, at 4:34 p.m.
AUGUSTA, Maine — A legislative committee has approved a bill to put medication that counteracts the life-threatening effects of opiate overdose into the hands of police, firefighters and drug users’ loved ones.
In a party-line vote, members of the Legislature’s Health and Human Services Committee backed LD 1686, An Act to Address Preventable Deaths from Drug Overdose, sponsored by Rep. Sara Gideon, D-Freeport. The vote followed passionate testimony on the bill on Feb. 12 by lawmakers, medical professionals, law enforcement officers and those who have lost friends and relatives to heroin.
Last month, Maine Attorney General Janet Mills sounded the alarm about a startling increase in fatal heroin overdoses in Maine, which jumped from seven in 2011 to 28 in 2012.
The bill would expand the availability of naloxone, a prescription medication that blocks opioid receptors in the brain, halting the euphoria and effects of heroin or other opiates and triggering an immediate and severe withdrawal.
Also known by the brand name Narcan, naloxone is already used in Maine hospitals and ambulances. The legislation would put the medication into the hands of police, volunteer firefighters, drug users and their friends and families, freeing doctors to dispense the medication not only to a drug user at risk but also to anyone likely to witness their potential overdose.
An overdose of heroin or other opiates such as prescription painkillers and methadone can depress breathing and the body’s nervous system, leaving users unconscious. Naloxone restores breathing, allowing users to potentially survive an otherwise fatal overdose. Administered through a nasal spray or injection, naloxone does not provide a high. Drug abusers still must be hospitalized after the medication is administered.
In a work session on the bill Monday, Republicans on the committee voiced concerns about laypeople without medical training administering the drug, which results in sudden and violent withdrawal and can cause vomiting and aspiration. Republicans supported distribution and use of the drug among police, firefighters and other first responders, however.
Last year, Gov. Paul LePage vetoed a similar bill, saying that widening access to naloxone would provide “a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby.”
“I just think it sends a message that I’m not comfortable with, to have other than first responders with this medication,” said committee member Rep. Heather Sirocki R-Scarborough.
Democrats argued in favor of putting naloxone into the hands of drug users’ friends and loved ones, noting that other states have found success expanding naloxone’s availability.
“The alternative is that people are dying. … There is a way to save those people’s lives,” Gideon said.
Lawmakers have expanded access to the medication in 17 states and Washington, D.C.
Naloxone already can be prescribed to drug users in Maine, but proponents of the bill argued that addicts in the throes of an overdose can’t administer the drug to themselves. LD 1686 would allow a drug user’s friends and family members to obtain, possess and administer the drug.
The original bill would have provided civil and criminal immunity for those who administer naloxone to someone they believe to be experiencing an opiate overdose. Committee members adjusted that language to authorize individuals to possess and administer the medication.
In an amendment, the committee voted to require pharmacies to provide instructions about naloxone’s use and effects to inform drug users and their loved ones about the medication.
The bill now heads to the Maine House of Representatives for further votes.

New Fed study says health reform can reduce financial stress

Commentary: Study of Massachusetts health law cited personal bankruptcy reduction, fewer delinquencies, improved credit scores



Rethinking Our ‘Rights’ to Dangerous Behaviors

Experts disagree about job losses and the moral status of Obamacare

Medicare Data Show Wide Differences In ACOs’ Patient Care

FEB 21, 2014
Networks of doctors and hospitals set up under the Affordable Care Act to improve patients’ health and save money for Medicare are having varying rates of success in addressing their patients’ diabetes and heart disease, according to government data released Friday. 
The release is the first public numbers from Medicare of how patient care is being affected by specific networks. These accountable care organizations, orACOs, are among the most prominent of Medicare’s experiments in changing the ways physicians and health care facilities work together and are paid. The ACOs will be able to keep some of the money they save, but they also take on some of the financial risk if their patients end up being costly. 
To make sure the ACOs are not stinting on care in their quests to earn bonuses, Medicare is tracking 33 different quality measures. These look at how well doctors coordinate with each other, whether patients receive appropriate preventive services, whether they suffer unnecessary harm and how patients experience their treatments. 
On Friday, the Centers for Medicare & Medicaid Services (CMS) released data on five of these measures for 141 ACOs during 2012. Four evaluate how well the ACOs helped patients with diabetes. The fifth examined how many patients with arteries packed with plaque received appropriate medicines to relax their blood vessels. Medicare said it did not release more measures because it did not think some of them could be easily understood by consumers or would be useful. Other measures, such as ones about cholesterol levels, were not released because the clinical standards have changed. 

Obamacare enrollment hits 4 million

By Noam N. Levey
5:32 PM PST, February 25, 2014
WASHINGTON – Enrollment in health plans sold on marketplaces created by President Obama’s healthcare law has hit 4 million, the administration announced Tuesday, marking another milestone in the law’s implementation.
The number suggests sign-ups have continued at a brisk pace in February, with about 700,000 people selecting an insurance plan so far this month.
How many of the people who have selected coverage have also paid the premiums remains unclear, a key metric the administration has declined to release.
It is also unclear whether the Obama administration will hit its original target of 7 million sign-ups in 2014, the first year for the new online marketplaces created by the Affordable Care Act.
But administration officials and other supporters of the law have been heartened by the steady enrollment growth since problems with the enrollment site were repaired after its disastrous launch.
“With individuals and families enrolling in coverage every day, we continue to see strong demand nationwide from consumers who want access to quality, affordable coverage,” Marilyn Tavenner, the head of the Medicare agency overseeing implementation of the law, wrote in a blog post Tuesday.
“Our outreach efforts are in full force with community partners and local officials participating in hundreds of events each week and enrollment assistors are helping more and more people enroll in coverage.”
The open enrollment period, which began Oct. 1, is scheduled to close at the end of March. Many experts believe there will be a surge of enrollments as the deadline approaches.
The state-based marketplaces -- a centerpiece of the Affordable Care Act, also known as Obamacare -- enable Americans who do not get coverage at work to select among plans that offer at least a basic set of benefits. The plans cannot turn away sick people.
Consumers who make less than four times the federal poverty level, or about $94,000 for a family of four, qualify for government subsidies to offset the cost of their premiums.

LePage, lawmakers continue Medicaid debate

While the administration describes the cannibalization of environmental spending to support Medicaid, legislators take up a Republican plan to institute managed care while expanding the Medicaid program.

AUGUSTA — Members of the Legislature and the LePage administration on Wednesday continued the long and wide-ranging debate over a proposal to expand Medicaid, the public health insurance program for the poor.
Lawmakers on the Health and Human Services Committee were set to review a new proposal sponsored by Assistant Senate Minority Leader Roger Katz of Augusta. Meanwhile, the LePage administration scheduled a press conference with officials from the Department of Environmental Protection to discuss how spending on MaineCare, the state’s version of Medicaid, had “cannibalized” spending for natural resource protections.
The DEP event is part of a coordinated campaign by the administration to use the strapped budgets of state agencies as a reason to oppose expansion.
The communications strategy was foreshadowed in emails obtained by the Portland Press Herald. The emails showed discussions among high-level officials at the Department of Health and Human Services about the approach, and how to downplay attention to a controversial taxpayer-funded report that the administration had hoped would bolster its anti-expansion position. In one email, the communications director at DHHS wrote that public relations staff in each state agency had been asked by LePage officials to write newspaper opinion columns about the effect of Medicaid spending on their respective budgets.
Since then the administration’s strategy has played out publicly with a number of press statements from state agency officials about the effects of Medicaid.

DHHS commissioner blasts Medicaid expansion during Bangor breakfast

Posted Feb. 26, 2014, at 12:25 p.m.
BANGOR, Maine — Anyone who needed convincing that the issue of Medicaid expansion is contentious need look no further than Wednesday’s Bangor Region Chamber of Commerce breakfast.
The normally serene Early Bird Breakfast was the scene of a sometimes heated three-way debate over whether the state should accept federal funds to expand Medicaid.
Maine Department of Health and Human Services Commissioner Mary Mayhew, Shawn Yardley, director of community services for Penobscot Community Health Care and Harrison Clark, president of ServiceMaster Contract Services, faced off over expansion in front of a capacity crowd of local politicians, city and business officials at the Hilton Garden Inn in Bangor.
Mayhew, a vocal expansion opponent, sat between Yardley and Clark, who want the state to take the federal match and provide health care for more Mainers.
The commissioner opened her comments by saying expansion would be “terrible for the economy and terrible for the state of Maine,” forcing her department and others to sacrifice other critical priorities in order to cover the long-term costs associated with expansion.
State agencies are competing for a pool of limited resources and “adding dependency on DHHS services isn’t going to improve that,” she added.
“Democrats say that adding 100,000 people to Medicaid is somehow free, but we all know better,” Mayhew said in a statement released shortly after Tuesday’s debate. “Medicaid has grown by more than $1 billion over the last 10 years because of previous expansions and the reality of healthcare cost increases. It is nonsensical to believe that after years of financial crisis in Medicaid, that the answer today is to add another 100,000 people to the program.”
Yardley and Harrison argued that Maine should take advantage of the federal government’s pledge to help Maine invest in getting more people insured.
Clark said too many low-income Mainers don’t seek medical care when they start showing signs of illness because they don’t have the coverage they need. Even fewer take part in preventative care needed to stem serious illness.
When people get too sick, they go to emergency rooms or seek help from groups like PCHC, driving up costs for those organizations and costing the state more money down the line, Yardley argued.
“I think it’s important that we don’t pit potholes against people,” Yardley said, adding that “health care should be a right and it’s an appropriate investment for our state.”
Mayhew argued that most of those uncovered Mainers should seek out coverage on the Obamacare exchange. She said her agency should not add to its costs when it already has been “rocked with financial crises over the past couple decades.”

Tuesday, February 25, 2014

Health Care Reform Articles - February 25, 2014

Local aid, student hunger bill, Medicaid: LePage opposes all that helps people

Posted Feb. 24, 2014, at 12:54 p.m.
State Sen. Geoff Gratwick of Bangor hit the nail on the head in his Feb. 9 BDN OpEd about the importance of keeping a promise to local governments — the promise of revenue sharing with every community in the state. By returning a portion of sales and income taxes collected back to municipalities, the Legislature provides direct help to hard-pressed towns. This money is spent on a myriad of needed services locally, allowing communities to survive, even in trying times.
By contrast, Gov. Paul LePage, who loves to talk about cutting taxes, eliminated revenue sharing in his last year’s budget plan, thereby clobbering towns and shifting the tax burden back to local property owners. As an example, my hometown of Brooklin, population 824, would have lost $12,759 this year thanks to the governor’s refusal to continue revenue sharing. After all, it’s “welfare for municipalities.” While Brooklin’s $12,759 is a minuscule amount compared to the $2.3 million Bangor would lose, every dollar counts.
In the governor’s world, looking out for everyone’s welfare is, apparently, a bad thing. He seems not to realize that revenue sharing is equal to a tax cut to the towns, something that’s supposed to be near and dear to his heart. Fortunately, most of our state legislators live in the real world, and they voted to continue revenue sharing.
Another theme for the governor is “compassion,” which he addressed extensively earlier this month in his State of the State address. Apparently, it is out of compassion that he wants to lower the legal working age to 12, and generally loosen child labor laws. After all, he started work when he was 11! “It’s not a big deal. Work doesn’t hurt anybody,” he is quoted as saying. Why else would he promote a “training wage” of $5.25 for working children? This, at a time when when poverty is increasing, and 200,000 children and adults in Maine face “food insecurity.”
A partial solution, LD 1353, which aimed to make summer food programs more common for the 84,000 kids who qualify for free or reduced-cost lunches at their local schools, was vetoed by the governor. He called it another “irresponsible unfunded mandate.” Our legislators took a different tack. With bipartisan support they overrode the governor’s veto, and in doing so, encouraged more school districts to accept federal funds that pay for the summer lunch program.
An equally far-reaching issue facing the Legislature is the expansion of Medicaid to about 70,000 qualified, low-income Mainers who do not currently have health insurance. These are folks whose income is under 138 percent of the federal poverty level; many do not qualify for subsidies. The federal government would pick up 100 percent of the cost for the first three years, and ratchet down funding to 90 percent thereafter. Imagine the newly found peace of mind and improved health these families would experience if they had reliable health care, including a primary care provider who can guide them toward preventive care.
It seems that LePage is against virtually everything that is designed to help individuals. Worse, he demeans people in need. He, along with a chorus of his political supporters continue to refer to potential beneficiaries of the Medicaid expansion as “able-bodied,” implying, in other words, lazy and undeserving, and MaineCare as “welfare.”
What is the governor thinking? He says he is for job creation, but apparently not if the government initiates it. However, handing out millions of dollars in tax breaks — corporate welfare by any other name — to some imaginary big business is just fine with him.
Expanding Medicaid would create thousands of new jobs that cannot be outsourced. It is a good business decision, as well as an ethical one. Refusing hundreds of millions of dollars in federal funds — more than a quarter of a billion in new funds in 2016 and $82 million annually — makes no sense and punishes people who need our help most.

Governors: ‘Obamacare’ here to stay

Governors of both parties shared a more pragmatic outlook on the controversial program known as “Obamacare” as millions of their constituents begin to be covered.

By Steve Peoples and Ken Thomas
The Associated Press
WASHINGTON – The explosive politics of health care have divided the nation, but America’s governors, Republicans and Democrats alike, suggest that President Barack Obama’s health care overhaul is here to stay.
While governors from Connecticut to Louisiana sparred on Sunday over how best to improve the nation’s economy, governors of both parties shared a far more pragmatic outlook on the controversial program known as “Obamacare” as millions of their constituents begin to be covered.
“We’re just trying to make the best of a bad situation,” said Republican Gov. Terry Branstad of Iowa, who calls the health care law “unaffordable and unsustainable,” yet something he has to implement by law. “We’re trying to make it work as best we can for the people of Iowa.”
As governors gathered in Washington this weekend, Democratic governors such as Maryland’s Martin O’Malley and Connecticut’s Dannel Malloy made pitches to raise the minimum wage, while Republican governors such as Louisiana’s Bobby Jindal and Indiana’s Mike Pence called for more freedom from federal regulations, particularly those related to the health insurance overhaul. But governors from both parties report that a full repeal of the law would be complicated at best, if not impossible, as states move forward with implementation and begin covering millions of people – both by expanding Medicaid rolls for lower-income resident or through state or federal exchanges that offer federal subsidies to those who qualify.
Republican opposition to the law is the centerpiece of the GOP’s political strategy ahead of the midterm elections. And to be sure, not every GOP leader embraced the inevitability of the law’s implementation.
“I don’t think that it’s so deeply entrenched that it can’t be repealed,” Louisiana Gov. Bobby Jindal said. “But I do think, as we argue for repeal, we have to show folks what you replace it with.”

Maine bills seek clarity on hospitals left out of insurance networks

The sponsors want patients who sign up for Obamacare and the providers to be fully informed of exclusions like those not in Anthem’s network.

By Alanna Durkin
The Associated Press
AUGUSTA — When Roberta Lane went to her local hospital emergency room, where the doctors she’s seen for years practice, she was shocked to find out her insurance wouldn’t cover treatment.
The Auburn resident had bought a plan on the Affordable Care Act exchange through Anthem Blue Cross and Blue Shield, unaware that Central Maine Medical Center was one of the six excluded in the insurer’s “narrow network,” Lane wrote to lawmakers last month. Unable to immediately transfer to another hospital, she spent several days at the medical center in Lewiston worrying about how she’d pay the mounting costs.
“I was quite irritated and angry and obviously had some anxiety because I was like, this is a $15,000 bill,” said Lane, who declined to say why she was receiving treatment. “To have to worry about that on top of dealing with a serious illness ... that’s really the last thing I need to worry about.”
Lane said it appears that Anthem will cover the costs after all, thanks to a built-in grace period, but Maine lawmakers hope they can help others avoid that headache.
Two bills that the Insurance and Financial Services Committee will examine again on Tuesday aim to bring more transparency to these narrow provider networks – both for the consumers and the hospitals that are being excluded.
Rep. Paul McGowan, D-York, wants to require insurers to clearly show in their marketing and informational materials what hospitals aren’t included in plans. He also wants insurers to explain publicly how their plans provide reasonable access to care for their members. Under another measure the committee is examining, introduced by Sen. Dawn Hill, D-Cape Neddick, insurers would have to disclose to providers why the providers weren’t included in the network.


July 30, 2010
- See more at:
It was 45 years ago today that President Lyndon Johnson enacted national health insurance for millions of elderly Americans with the stroke of a pen – a pen handed to him by Harry Truman.
Immediately afterward, Johnson signed the paperwork that would make Truman and his wife, Bess, the very first Medicare enrollees.
“They told me, President Truman, that if you wish to get the voluntary medical insurance you will have to sign this application form, and they asked me to sign as your witness,” Johnson told the former president. “You’re getting special treatment, since cards won’t go out to the other folks until the end of this month – but we wanted you to know, and we wanted the whole world to know, who is the real daddy of Medicare.”
While Teddy Roosevelt was the first president to publicly endorse national health insurance, Truman did more than any other to advance the concept that would become Medicare. During World War II, Truman was troubled by the number of draftees who failed their induction physicals due to untreated medical conditions. Truman saw this as evidence that too many ordinary Americans couldn’t afford adequate care. “That is all wrong in my book,” he said. “I am trying to fix it so the people in the middle-income bracket can live as long as the very rich and the very poor.”
With the war’s end in 1945, Truman proposed the first national health care plan to Congress. Originally conceived to cover most Americans, the proposal was gradually scaled back until, by the end of his presidency in 1953, it was roughly equivalent to Medicare.
President John F. Kennedy resurrected the Medicare concept in a 1962 speech, but it continued to face formidable opposition from most Republicans and from the American Medical Association, which regarded any government involvement in health care as “socialized medicine.” At the height of its campaign against Medicare in 1963, the AMA hired actor-turned-pitchman Ronald Reagan as its spokesperson, just a year before Reagan launched his political career with an energetic pitch for Barry Goldwater at the Republican National Convention.
In 1964, Johnson defeated Goldwater in a landslide – and with large Democratic majorities riding Johnson’s coattails into both houses of Congress, the stage was set for Medicare’s passage.
President Harry Truman's Medicare enrollment card
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How Health Care Costs Affect Small Town Living

By the time people feel the effects of reduced city services, it's hard to tell that medical spending is a part of the problem.

A half century of rapidly escalating health care costs has taken a toll on every village, town and city in America, including China, Maine. The town in the far northeast corner of the country has a population of about 4,500 in the off-season, 5,500 when the fish are biting in China Lake. Town officials face the same economic challenges in maintaining roads and infrastructure and in providing education, library, recreation and emergency services as any other place in America.
Spending $2.8 trillion on healthcare in America has ripple effects that spread far and wide. And the town manager of China, Maine, Dan L’Heureux, who is also a member of Maine Quality Counts, an independent healthcare collaborative focused on improving health and health care in the state, has spent a lot of time thinking about the trade-offs in his town’s budget decisions forced by rising health care costs.
Health insurance premiums have grown nationally by 138 percent between 1999 and 2010, while wages have gone up 42 percent in that same period. Of the estimated $765 billion in wasteful healthcare spending in the U.S. in 2009, $210 billion was attributed to overuse of medical services. Health care spending has roughly doubled between 2000 and 2010 while simultaneously citizens and governments have struggled with recession, unemployment and a slow economy. Everyone feels the pain.
It’s nearly impossible to connect the dots to show a direct line between the high cost of medical services and cutbacks in everyday needs like schools, fire departments, public safety, roads, parks and public transportation. There are countless other variables—national, regional and local--in a struggling economy. By the time most people feel the effects of stagnant or diminished paychecks and reduced city services, they are scarcely aware that medical spending is a big part of the problem.
Yet it’s more than just instinctive to feel that rising medical costs have far-reaching consequences. L’Heureux and Rosemary Gibson, a senior advisor at the Hastings Center and author of “The Treatment Trap,” about the overuse of unnecessary medical services, met at a meeting of Maine Quality Counts last year, and L’Heureux opened the meeting with some remarks about his picturesque but struggling town. “Dan said that in his small town in rural Maine, there were 11 municipal employees,” Gibson says. “And the cost of providing health insurance was close to $200,000.”
To put in another way, L’Heureux says, the cost of health insurance for one individual with dependents is equal to the town’s entire annual parks and recreation budget or the operation’s budget for one of the town’s three volunteer fire departments.

New MaineGeneral hospital ‘doing its best’ amid bed shortage

CEO Chuck Hays says the hospital in north Augusta, which opened in November, is at full capacity 26 percent of the time.

By Amy Calder
Kennebec Journal
AUGUSTA — In the four months MaineGeneral Medical Center’s new hospital in north Augusta has been in operation, all of its patient beds have been full a quarter of the time.
That bed shortage has created a challenge for staff when people come into the emergency room and need to be admitted to the hospital, officials said.
Those patients are placed on hospital beds in emergency department rooms until beds open up on the floors, according to Chuck Hays, chief executive officer of MaineGeneral Health, the parent organization of MaineGeneral Medical Center.
“We move stretchers out into the hall (in the emergency department) and we move an inpatient bed into the room,” Hays said.
The $312 million, 192-bed hospital opened Nov. 9 and replaced inpatient care at MaineGeneral hospitals in Augusta and Waterville, which together had a total of 226 beds. MaineGeneral officials initially had asked the state for 226 beds in the new hospital, but were denied the request in 2010 and it was instead OK’d for 192.
Hays said MaineGeneral officials wanted the higher number of beds because that’s what they expected the hospital’s need to be.
The bed number was set in a certificate of need MaineGeneral received for the hospital project in 2009, a review that was handled by the Licensing and Regulatory division of the Department of Health & Human Services. DHHS spokesman John Martins did not respond to requests for comment Monday on the number of beds authorized by the state.

Planned Medicare Advantage Cuts Get Mixed Reaction in Maine
02/24/2014   Reported By: Patty B. Wight

On Friday, the Obama administration announced that it plans to cut funding to the Medicare Advantage program in 2015. The cuts are part of the Affordable Care Act. And while some say the move will take money away from some effective health programs, others say it's needed to bring overall health care costs down. Patty Wight reports.
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Medicare Advantage Cuts Get Mixed ReactionListen

Medicare Advantage is a private version of Medicare, through which insurance companies contract with the government to provide Medicare benefits. Portland-based Martins Point Health Care is one of those contractors, with their Generations Advantage program. And COO Larry Henry gives a thumbs down to the proposed 2 percent cut to the program.

"Well, as a health plan that covers nearly one out of 10 Medicare beneficiaries here in the state of Maine, these cuts are troubling," Henry says.

Troubling because they will likely result in higher premiums for consumers, says Henry. But health advocates like Wendy Wolf, of the Maine Health Access Foundation, say the cuts are warranted.

"When the Affordable Care Act was passed, one of the things that the legislation intended to do is bring down health care spending. And one of the ways that it was aiming to do this, was to look for areas where we're overpaying," Wolf says.

One of those places, says Mitchell Stein of Consumers for Affordable Health Care, is Medicare Advantage. If the program had lived up to its original intent, says Stein, it would never have faced the chopping block, because the whole idea behind it was to give private insurance companies a chance to do things more efficiently than the U.S. government. 

How can the physician workforce be diversified?

By Lyndonna Marrast, M.D., and Danny McCormick, M.D., M.P.H., Feb. 22, 2014
The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be.
While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state program that the ACA will expand), these incentives are likely to be too small to dramatically boost physicians’ willingness to care for disadvantaged patients or to affect the underlying national shortage of primary care physicians.
How then can we help ensure that the health care needs of disadvantaged patients are better met as ACA implementation proceeds? In the February 1st, 2014 print issue of JAMA Internal Medicine we reported the results of a study that may provide part of the answer: train more minority physicians.
Our study analyzed data from a federal survey of 7,070 patients and found that compared to other patients, the disadvantaged were more likely to be cared for by a minority physician. This was true regardless of how “disadvantaged” was defined, i.e. by low income, minority race/ethnicity, having Medicaid, being uninsured, being non-English speaking, or being in less-than-good health. For instance, patients with Medicaid were one and a half to two times more likely to be cared for by a minority physician than a white physician. Black, Hispanic and Asian patients were 19-26 times more likely to be cared for by a minority physician of the same race. And patients in fair to poor health were 20-44 percent more likely to see a minority physician.
We hope to one day live in a fully integrated society where everyone has the same, comprehensive health coverage, race and ethnicity matter less, and everyone has access to high quality health care professionals. However, until that day comes, we need to recognize the disproportionate role of minority physicians in meeting the health care needs of the poorest and sickest Americans.
Organizations such as the Institute of Medicine, the American Medical Association and the Association of American Medical Colleges have affirmed a need to train more minority physicians. In spite of this, African-Americans, who represent 12 percent of the population, only account for 6.3 percent of U.S. physicians. Hispanics make up 16 percent of the population but account for just 5.5 percent of physicians. These proportions have changed little in 20 years.
How can the physician workforce be diversified? Increased efforts to identify talented minority students and help prepare them for medical careers are needed. In addition, decreasing the exorbitant tuition costs of medical schools would disproportionately benefit minority students.
However, the change that would have the most direct impact is a revamping of medical school admissions priorities. Although a recent Supreme Court decision requires admissions committees to show that diversity could not be achieved by other means before resorting to race-conscious selection criteria, it nonetheless affirmed a compelling government interest in achieving diversity. All medical schools should set diversity as an explicit institutional priority and adopt admissions criteria that give preference to students (of any race/ethnicity) who bring diversity to the profession. Such policies might also favor students with a history of volunteering or working in underserved communities and those who seek careers serving disadvantaged patients.

On Obamacare: a med student's view

By Jawad Husain
The Daily Free Press (Boston University), Feb. 23, 2014
I voted for Barack Obama in 2008 because he promised to sign a universal health care law. This aligned with my ambitions to become a doctor who treats patients based on their medical need, not their ability to pay. Finally, the time had come for us to fix our inequitable system and offer our citizens the human right to health.
Six years later, most of the provisions of the Patient Protection and Affordable Care Act have been implemented. However, it’s apparent that political pressure from the private insurance industry and the big drug companies has thwarted the goal of the universal health care.
Obamacare is expected to help an additional 20 million Americans obtain health insurance, mostly through Medicaid expansion and subsidized private insurance, but about 30 million Americans will remain uninsured. According to the American Journal of Public Health, this translates to approximately 30,000 preventable deaths a year.
Mandating Americans who don’t qualify for Medicaid and who don’t have employer-based coverage to buy private insurance policies benefits insurance companies, but does little to make health care affordable.
For example, those enrolling in an exchange-based Bronze Plan will have only 60 percent of their actual health care costs covered by insurance. According to a report by the Kaiser Family Foundation, even after paying premiums, a family may have to spend up to $12,700 out of pocket.
When patients have “more skin in the game,” e.g. higher co-pays and deductibles, they often forgo necessary medical care. Medical costs caused 37 percent of Americans to forgo seeing a doctor or skip filling a prescription in 2013, according to findings by The Commonwealth Fund.
The private insurance industry’s profit-making incentive makes health care a commodity that is unaffordable for the poor. However, there are promising solutions currently being proposed at the state level.
Vermont is already in the process of setting up a statewide single-payer health insurance system.
Vermont’s legislature has declared health care a “public good” and assumes the responsibility to, “ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters.” This is not “socialized medicine;” doctors and hospitals will remain independent. All medical needs are covered for everyone, and patients are free to choose their doctor.
Canada’s single-payer system has resulted in high-quality universal coverage at a cost that is about half of what the United States spends on health care. Risk is shared across the entire population, administrative costs drop and zero profits go to insurance companies.
If Vermont’s approach succeeds, we can expect other states to follow. Massachusetts gubernatorial candidate Dr. Donald Berwick intends to establish a single-payer system if elected. Congressional Representative John Conyers, Jr. has sponsored a single-payer bill in the House and Senator Bernie Sanders has as similar bill in the Senate.
Single-payer national health insurance is not impossible. Canadians did not always have a single-payer health care system — they demanded it. Their single-payer movement started with a single province.

Rep. John Dingell, Long-Time Champion Of Health Legislation, Will Not Seek Re-Election

By Mary Agnes Carey
FEBRUARY 24TH, 2014, 2:33 PM
Rep. John D. Dingell, a Michigan Democrat who was a key player in many health care battles in Congress, including enactment of the 2010 health care law and his push for a “Patient’s Bill of Rights” in the late 1990s and early 2000s, said Monday he will retire at the end of his current term.
“I’m not going to be carried out feet first,” Dingell told the Detroit News in a story published Monday morning. “I don’t want people to say I stayed too long.”
The 87-year-old, who has served in the House for nearly 60 years, is known in the health care world for championing a variety of issues, including Medicare (hepresided over the House when it passed the bill), children’s health care and the quality and safety of the nation’s drug supply.
Every year since he joined Congress in 1955, Dingell has sponsored universal health insurance legislation first introduced by his late father, John Dingell Sr., whom he succeeded in the HouseA former chairman of the Energy and Commerce Committee, Dingell also worked with the late Rep. Charlie Norwood, R-Ga., and former Rep. Greg Ganske, R-Iowa, to find a compromise to move a Patients’ Bill of Rights. Many of the elements of that bill eventually were incorporated into the health care law.

New ACA Insurance Causes Headaches In Some Doctors' Offices

FEB 25, 2014
This story was produced in collaboration with NPR
Sheila Lawless is the office manager at a small rheumatology practice in Wichita Falls, Texas, about two hours outside of Dallas. She makes sure everything in the office runs smoothly – scheduling patients, collecting payments, keeping the lights on. Recently she added another duty--incorporating the trickle of patients with insurance plans purchased on the new Affordable Care Act exchanges
Open enrollment doesn’t end until March 31, but people who have already bought Obamacare plans are beginning to use them. “We had a spattering in January—maybe once a week. But I think we’re averaging two to three a day now,” says Lawless. 
That doesn’t sound like many new customers, but it’s presented a major challenge: verifying that these patients have insurance. Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company. “We’ve been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process,” she explains. Those sorts of hold times add up fast. 
In the past, offices have been able to make sure patients are insured quickly, by using an online verification system. But for exchange patients, practices also have to call the insurer to make sure the patient has paid his premium. If he hasn’t, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made. 
That’s because of a provision of the law that gives exchange patients who neglect to pay their premium a “grace period” of up to 90 days. During the first 30 days, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – that is, wait to pay the doctor until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made.  And that puts the doctor’s office at risk. 
So Lawless is checking first with the insurer to make sure that everything is in order before proceeding with the visit. If the premium has not been paid, Lawless gives the patient the option of rescheduling the appointment or paying in cash and then applying to his insurer for the payment. 
“Most small practices run lean and mean – you’ve got one or two people to do this process plus do their other job duties that day as well, which is tend to the patients in front of them,” says Lawless. To manage the new workload, she’s had other staffers, including nurses, step in to answer the phone. And that means longer hours, more overtime, and higher overhead expenses. And then there’s the plain old annoyance factor.