Health Care Enrollment Falls Short of Goal, With Deadline Approaching
WASHINGTON — Almost a million people signed up last month for private health insurance under the Affordable Care Act, federal officials said Tuesday, bringing the total to date to 4.2 million but leaving the Obama administration well short of its original goal, with less than a month to go before the end of the open enrollment period.
White House officials predict a surge in sign-ups just before the six-month enrollment period ends on March 31, but it will be a challenge to make up for the slow start that resulted from technical problems crippling the federal insurance marketplace in October and much of November.
The administration said Tuesday that 943,000 people signed up for coverage last month, down from 1.1 million in January and 1.8 million in December. Officials noted that February was a short month, with fewer days for people to apply.
Administration officials said they were pleased with the pace of enrollment, even though the total fell short of the target initially set by the Department of Health and Human Services. In an internal memorandum in September, federal health officials said they wanted to have 5.6 million people enrolled by the end of February, with a total of seven million signed up by the end of this month. The goal for February alone was 1.3 million.
Maine beats Affordable Care Act enrollment target
Posted March 11, 2014, at 7:12 p.m.
The number of Mainers signing up for private health insurance under the Affordable Care Act dropped off in February, but far surpassed a federal enrollment goal as a March 31 deadline looms.
From the Oct. 1 launch of Healthcare.gov through March 1, 25,412 Maine residents selected a private health plan through the federal government’s gateway for the marketplaces in Maine and 35 other states, according to a new report from the U.S. Department of Health and Human Services. That’s up from 20,511 Mainers at the end of January, but a lag from the previous month’s sign-up rate.
Nationally, about 4.2 million people have signed up for health plans through Healthcare.gov and state-run marketplaces. About 900,000 signed up in February, down from 1.14 million in January and well short of the Obama administration’s enrollment goals. The waning pace could spell trouble for the health care law, which administration officials had hoped would attract 6 million sign-ups by March 31, the last day of open enrollment.
Maine, however, has emerged as a leader in health insurance enrollments compared to other states using Healthcare.gov. The state beat not only the federal target of 18,400 enrollments by the end of February, but also outperformed, ahead of schedule, a goal of 23,000 enrollment by the end of the month.
“Maine’s numbers are looking good,” Ray Hurd, regional administrator for the Centers for Medicare and Medicaid Services, said Tuesday following a Portland health insurance sign-up event.
Christie Hager, regional director for the U.S. Department of Health and Human Services, credited Maine’s “all hands on deck” approach for the state’s enrollment success. Multiple community and health groups partnered to spread awareness of the Affordable Care Act’s health insurance options, she said.
Will Down, who just moved to Portland from San Diego, signed up for a new Anthem health plan at the event, with help from Liz Charles of Maine Migrant Health.
“You’re done,” Charles said, high-fiving Down as the pair completed his application on Healthcare.gov.
Down, 29, said he expected more of a hassle with the site, after hearing about its troubled rollout.
“It was a lot easier than I thought it would be,” he said.
Sitting in front of a laptop at the Charles A. Dana Health Education Center at Maine Medical Center, Down participated in of one of three ACA sign-up events held throughout Maine Tuesday. Down, who qualified for a federal subsidy to help him afford his premium, signed up for a plan that will cost him just shy of $25 a month.
“I don’t want to go bankrupt if something bad or an accident did happen,” he said of his choice to buy coverage.
Report Says Medication Use Is Rising for Adults With Attention Disorder
In Delhi, Hopeful Patients Turn to a Razor Blade for Treatment
By VISHNU VARMA
NEW DELHI — On a brisk winter morning, Dwarka Mistry, 61, sat waiting for a doctor, along with four others, on an iron bench behind Jama Masjid, a Mughal-era mosque in the old part of the capital. Despair covered Mr. Mistry’s face as he clutched his knees and thighs from time to time.
About 10 minutes later, at 9 a.m., Muhammad Iqbal, Mr. Mistry’s doctor, a bearded man wearing a blue cap, walked in. The doctor had neither a traditional doctor’s white coat nor a stethoscope. All he had was a sharp razor blade.
In a city full of world-class hospitals and medical centers, Mr. Iqbal, 40, practices the ancient art of bloodletting, an alternative form of medicine in which “impure blood” is released in small quantities, which Mr. Iqbal says removes clots and ensures regular blood flow.
Mr. Iqbal contends that bloodletting, which he has been performing for the past 17 years, can treat high blood pressure, high blood sugar, polio, gout, heart blockages and pain.
His father, Muhammad Gayas, now 78, also practice bloodletting, for over 30 years. Mr. Gayas said he learned the practice in the early 1960s from a doctor of Unani medicine, which is based on the belief that diseases are mainly caused by an imbalance in the four elements of human body — blood, phlegm, yellow bile and black bile. According to historical accounts, which differ widely, the practice was prevalent first in the Middle East and South Asian countries, and gradually spread to India during Islamic rule around the 14th or 15th century.
At Mr. Iqbal’s open-air clinic, one of the six assistants wraps long, thin cotton strips around a patient’s limbs, chest and waist to help regulate the blood flow, the doctor said. Mr. Iqbal then makes small incisions at specific points on the patient’s feet and hands, a process that takes about 10 seconds. After this, an assistant pours water on the cuts to wash off the blood.
White House Withdraws Plan Allowing Limits to Medicare Coverage for Some Drugs
WASHINGTON — Under pressure from patients, pharmaceutical companies and members of Congress from both parties, the Obama administration on Monday withdrew a proposal that would have allowed insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia.
Medicare officials had said the proposal would have saved money and reduced the overuse of drugs. But it created political problems for the White House, with some Democrats joining Republicans in denouncing the changes, saying they would harm Medicare beneficiaries.
Since the start of Medicare’s prescription drug benefit in 2006, the government has required insurers to cover “all or substantially all” drugs in six treatment areas. The administration proposed in January to lift the requirement for three types of medications: immunosuppressant drugs used in transplant patients; antidepressants; and antipsychotic medicines, used to treat schizophrenia and certain related disorders.
In a letter to lawmakers on Monday, Marilyn B. Tavenner, the administrator of the federal Centers for Medicare and Medicaid Services, said officials would not pursue the proposal. “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,” Ms. Tavenner said.
She said the administration had also decided to hold off on three other proposals. One stipulates that insurers can offer no more than two prescription drug plans to Medicare beneficiaries in the same region. Another would give patients greater access to small community pharmacies by requiring insurers to offer contracts to any retail drugstores willing to accept their terms and conditions. A third would allow the government to intervene in negotiations between insurers and pharmacies.
The National Alliance on Mental Illness and the American Psychiatric Association, among others, had criticized the proposal to roll back the requirement for coverage of three of the six “protected classes” of drugs.
Proponents of MaineCare expansion seek boost from hospitals
Republicans pushed the hospital debt bill last year, but some now question hospitals' claims that expansion will ease their financial burdens.
AUGUSTA — Over a year ago, Franklin Memorial Hospital announced that it was laying off nearly 40 employees, citing a 338 percent increase in free care provided to patients who have no health insurance.
Gov. Paul LePage cited the financial pressures facing hospitals in urging lawmakers to enact his bill to repay the state’s $183 million share of backlogged Medicaid payments to providers. The outcome showed Maine’s 38 hospitals wield significant influence in the Legislature and in lawmakers’ home districts.
Now, majority Democrats and several Republicans hope hospitals can provide a similar boost to expansion of Medicaid, known here as MaineCare. Hospitals argue that extending Medicaid will help keep rising charity care costs in check.
So far, however, the odds of expanding Medicaid coverage to an estimated 60,000 to 70,000 people earning as much as 133 percent of the federal poverty level – just over $15,558 a year for an individual – appear ominous.
Republican leaders who last year blamed the layoffs at Franklin Memorial on stalling by Democrats on the governor’s reimbursement plan are now challenging hospital claims that broadening Medicaid will make them more financially stable.
Maine hospitals are pressing lawmakers to support a compromise bill co-sponsored by moderate Republican Sens. Roger Katz of Augusta and Thomas Saviello of Wilton. The bill would also install a managed care system to reduce costs in a $2.5 billion state program currently serving 320,000 people.
Saviello has said that one of the primary reasons he supports Medicaid expansion is that the hospital in his district – Franklin Memorial – wants it.
Rebecca Arsenault, Franklin Memorial president, said the bill is critical to controlling charity care costs that have climbed to $22 million over the past two years.
Other Maine hospitals, 11 of which are among the state’s top 30 employers, are making similar arguments. Charity care and bad debt from uninsured and unpaid hospital visits has risen to more than $400 million, up from over $100 million in 2000, according to the Maine Hospital Association. Maine hospitals are also expected to lose $730 million in Medicare reimbursements by 2022 because of a now obsolete 2009 deal struck by the American Hospital Association and the drafters of the health reform law.
Such statistics, combined with the hospitals’ roles as employers, have helped tip the scales in the 26 states that have so far chosen to expand Medicaid enrollment. But the hospitals’ argument in Maine has been met with more resistance by Republican lawmakers wary of expanding a program that they oppose philosophically and because of its history of budget overruns.
Uninsured Mainers can enroll in plans Tuesday
Maine ranks first among states using the federally run marketplace, as the March 31 deadline nears.
PORTLAND — Health advocates are making a final push for the uninsured to enroll on the health insurance marketplace by the March 31 deadline, the final day to sign up for insurance and avoid paying a penalty.
Events are being held in Portland and Lewiston on Tuesday, including walk-in hours for the uninsured to get help signing up for subsidized benefits onwww.healthcare.gov.
The penalty for those who decide to forgo health insurance would be $95 or more, depending on income. Many can also avoid paying the penalty under a number of exceptions built into the Affordable Care Act, including if coverage costs more than 8 percent of income and if patients would qualify for Medicaid coverage but their state chose not to expand it. So far, Maine has not expanded Medicaid coverage, although lawmakers are mulling a compromise plan pushed by moderate Republicans that would need to overcome a veto promised by Gov. Paul LePage.
Maine has been one of the success stories for enrollment so far compared to other states, signing up more people than anticipated.
By the end of January, 20,511 Mainers had signed up for insurance in the marketplace, much higher than the 14,260 projected by the U.S. Department of Health and Human Services. Maine was the top state for enrollment of the 35 states using the federally run marketplace. A few states that chose to operate their own health insurance marketplaces, including New York and Connecticut, performed better than Maine.
Alyson Cummings, communications coordinator for the Maine Health Access Foundation, which has spent more than $2.5 million over the past year in enrollment efforts, said much of Maine’s success in signing up patients can be attributed to grass-roots efforts.
Counting paid workers and volunteers, she said, hundreds have been helping people sign up for insurance.http://www.pressherald.com/news/Uninsured_Mainers_can_enroll_in_plans_Tuesday_.html
By expanding Medicaid, Maine lawmakers can make a difference for the uninsured
Posted March 10, 2014, at 1:12 p.m.
Tens of thousands of uninsured Mainers stand to gain access to affordable health coverage — many for the first time. They include hard-working people who do not receive health coverage through their jobs, who lost their jobs due to tough economic times or who have been diagnosed with a serious illness like cancer that prevents them from working full-time.
These individuals generally cannot afford adequate health insurance and are forced to put off needed care. They rely on emergency rooms or free or low-cost clinics for sporadic care. For someone managing a chronic disease such as cancer or cardiovascular disease, this type of patchwork medicine often results in poor health outcomes, and the resulting uncompensated care is a huge economic drain on Maine’s health system.
Gov. Paul LePage and state legislators have the opportunity to change this. At the same time, they could also reduce the burden that chronic diseases like cancer, heart and lung disease, and stroke have on our state. All they have to do is say yes to federal funding already set aside for Maine to increase access to the state’s Medicaid program, MaineCare.
If lawmakers make the right choice and vote to extend life-saving health coverage through Medicaid, nearly 70,000 people, who otherwise will not be able to afford health coverage, will have the security of knowing they have access to proven cancer, heart and lung disease screenings and treatments. Accepting the federal funds that have already been set aside for Maine would make health coverage available to individuals and families up to 138 percent of the federal poverty level ($20,921 for a family of two).
For those uninsured in Maine, this could be the difference between life and death. American Cancer Society research recently released found that uninsured adolescents and young adults are up to twice as likely as those with health insurance to develop late-stage cancer, which is more difficult and expensive to treat and more deadly than cancers caught early. This study builds upon earlier research released by the society that found a link between insurance status and cancer — people without health insurance are more likely to be diagnosed with later-stage cancers.
In addition, according to American Heart Association research, uninsured individuals with cardiovascular disease experience higher mortality rates and poorer blood pressure control than their insured counterparts, while those who suffer a stroke and are uninsured experience greater neurological impairments, longer hospital stays and up to a 56-percent higher risk of death than the insured.
The evidence is clear; increasing access to health coverage will save lives. By choosing to accept the federal funds set aside for Maine, our state’s hard-working, uninsured residents will be able to see doctors regularly, access preventive services such as mammograms, colonoscopies, asthma and blood pressure medication, and smoking cessation programs and avoid expensive and unnecessary visits to the emergency room.
Maine Senate debates Medicaid expansion measure
Posted March 12, 2014, at 9:43 a.m.
AUGUSTA, Maine — The Maine Senate is expected to debate a bill Wednesday offered by a pair of Republicans that would allow the state to accept federal funding while expanding eligibility for its Medicaid system, MaineCare.
The vote on the bill offered by Senate assistant minority leader Roger Katz, R-Augusta, and state Sen. Tom Saviello, R-Wilton, could be an indicator of whether an expansion of the state’s low-income health care program will garner the support of moderate Republicans in the Legislature.
The bill will go before the Maine House of Representatives on Thursday.
“Expanding access to health-care will strengthen our economy and create jobs and save money, but most importantly, it will save lives,” Senate Majority Leader Troy Jackson, D-Allagash, said in a prepared statement released ahead of the debate. “Each one of the 70,000 people waiting to see if we will step up and do the right thing has a story to tell, a family they love, dreams and plans for their future, and a life to live. Let’s not let them down.”
Democrats largely have supported the expansion but rank-and-file conservatives following the lead of Republican Gov. Paul LePage largely have rebuked the idea of an expansion, saying that despite federal funding for the program, the state eventually will face hundreds of millions in additional costs.
A better option, Republicans say, is to allow those eligible to purchase federally subsidized health insurance coverage on the federal insurance exchange before expanding Maine’s free-care system to between 70,000 to 100,000 new recipients.
LePage has made a point of noting the state paid off nearly $500 million in MaineCare debt in 2013 owed to its hospitals and expanding the program will become a new burden on state taxpayers. One study LePage points to shows the expansion, despite federal funding, will cost the state $800 million over the next 10 years.
Under the Affordable Care Act, the federal government would cover 100 percent of expansion costs for the first three years. Over time that reimbursement rate ratchets down to 90 percent. Democrats say refusing the expansion puts the health of thousands in jeopardy and costs the state nearly $1 million a day that would create health care jobs and bolster the state’s flagging economy.
The state Senate is set to convene at 10 a.m. Wednesday.
AUGUSTA, Maine — The Maine Senate is expected to debate a bill Wednesday offered by a pair of Republicans that would allow the state to accept federal funding while expanding eligibility for its Medicaid system, MaineCare.
The vote on the bill offered by Senate assistant minority leader Roger Katz, R-Augusta, and state Sen. Tom Saviello, R-Wilton, could be an indicator of whether an expansion of the state’s low-income health care program will garner the support of moderate Republicans in the Legislature.
The bill will go before the Maine House of Representatives on Thursday.
“Expanding access to health-care will strengthen our economy and create jobs and save money, but most importantly, it will save lives,” Senate Majority Leader Troy Jackson, D-Allagash, said in a prepared statement released ahead of the debate. “Each one of the 70,000 people waiting to see if we will step up and do the right thing has a story to tell, a family they love, dreams and plans for their future, and a life to live. Let’s not let them down.”
Democrats largely have supported the expansion but rank-and-file conservatives following the lead of Republican Gov. Paul LePage largely have rebuked the idea of an expansion, saying that despite federal funding for the program, the state eventually will face hundreds of millions in additional costs.
A better option, Republicans say, is to allow those eligible to purchase federally subsidized health insurance coverage on the federal insurance exchange before expanding Maine’s free-care system to between 70,000 to 100,000 new recipients.
LePage has made a point of noting the state paid off nearly $500 million in MaineCare debt in 2013 owed to its hospitals and expanding the program will become a new burden on state taxpayers. One study LePage points to shows the expansion, despite federal funding, will cost the state $800 million over the next 10 years.
Under the Affordable Care Act, the federal government would cover 100 percent of expansion costs for the first three years. Over time that reimbursement rate ratchets down to 90 percent. Democrats say refusing the expansion puts the health of thousands in jeopardy and costs the state nearly $1 million a day that would create health care jobs and bolster the state’s flagging economy.
The state Senate is set to convene at 10 a.m. Wednesday.
Maine’s Medicaid program is in perpetual crisis. Don’t let expansion make it worse.
Posted March 12, 2014, at 8:54 a.m.
Every day, state agencies make difficult decisions to manage requests for services and programs amid limited resources. This prioritization is not done in a vacuum, and funding one part of state government affects available resources in other programs. Regardless of assertions by this or any other media outlet to the contrary, we know it’s true. We experience this reality with every state budget assembled in Augusta.
Why, then, would anyone question whether the Medicaid expansion being debated in Augusta, which will require more than $800 million in state resources over 10 years — according to an Alexander Group report — will affect spending on other critical programs and services such as investments in job training, support for our children’s education, or improvements in our transportation infrastructure?
Think about your household budget. If your rent or mortgage payment increases, you must make reductions in spending elsewhere or make adjustments to make ends meet. State government must do the same.
This paper’s blatant advocacy for Medicaid expansion has created stories that fail to consider the facts. This department’s estimate of expansion costs is based on actual spending in previous years — not pretend savings assumptions as manufactured by the Legislature. They know — and we know — that nearly 15,000 parents will not receive full federal funding and will cost the state $18 million annually.
This paper fails to inform readers that many who would be covered by expansion are eligible for significant subsidies, resulting in premiums as low as $5 per week, to cover the cost of health care insurance through the federal government.
Maine’s Medicaid program has been in a state of perpetual financial crisis for more than a decade. This administration has wiped out more than $750 million in inherited Medicaid hospital bills and has curbed growth in the program. MaineCare has doubled in size over the last decade with spending increasing more than $1 billion. The governor’s focus on fiscal discipline has limited Medicaid spending growth to just 0.8 percent from fiscal years 2013 to 2014 and a little more than 1 percent from fiscal years 2014 to 2015. This cost containment comes after bailing out the sinking Medicaid ship from the previous administration’s expansions of MaineCare beyond the state’s ability to pay.
Now, there is legislative analysis that predicts this massive expansion of Medicaid will cost just $683,000 over the next three years. This completely ignores reality. The state spent $18 million just to cover the Medicaid expenses of more than 14,000 parents last year and will incur this same expense next year if Maine expands. Maine will not receive any additional federal funding for this group of individuals under the Affordable Care Act.
The state of Maine will incur costs in addition to this $18 million as a result of increased enrollment because of the individual mandate, people dropping their employer-sponsored or commercial coverage to get no-cost Medicaid coverage, and of course the millions in administrative costs to manage another 100,000 people on Medicaid. The $683,000 price tag is simply nonsense.
Every day, state agencies make difficult decisions to manage requests for services and programs amid limited resources. This prioritization is not done in a vacuum, and funding one part of state government affects available resources in other programs. Regardless of assertions by this or any other media outlet to the contrary, we know it’s true. We experience this reality with every state budget assembled in Augusta.
Why, then, would anyone question whether the Medicaid expansion being debated in Augusta, which will require more than $800 million in state resources over 10 years — according to an Alexander Group report — will affect spending on other critical programs and services such as investments in job training, support for our children’s education, or improvements in our transportation infrastructure?
Think about your household budget. If your rent or mortgage payment increases, you must make reductions in spending elsewhere or make adjustments to make ends meet. State government must do the same.
This paper’s blatant advocacy for Medicaid expansion has created stories that fail to consider the facts. This department’s estimate of expansion costs is based on actual spending in previous years — not pretend savings assumptions as manufactured by the Legislature. They know — and we know — that nearly 15,000 parents will not receive full federal funding and will cost the state $18 million annually.
This paper fails to inform readers that many who would be covered by expansion are eligible for significant subsidies, resulting in premiums as low as $5 per week, to cover the cost of health care insurance through the federal government.
Maine’s Medicaid program has been in a state of perpetual financial crisis for more than a decade. This administration has wiped out more than $750 million in inherited Medicaid hospital bills and has curbed growth in the program. MaineCare has doubled in size over the last decade with spending increasing more than $1 billion. The governor’s focus on fiscal discipline has limited Medicaid spending growth to just 0.8 percent from fiscal years 2013 to 2014 and a little more than 1 percent from fiscal years 2014 to 2015. This cost containment comes after bailing out the sinking Medicaid ship from the previous administration’s expansions of MaineCare beyond the state’s ability to pay.
Now, there is legislative analysis that predicts this massive expansion of Medicaid will cost just $683,000 over the next three years. This completely ignores reality. The state spent $18 million just to cover the Medicaid expenses of more than 14,000 parents last year and will incur this same expense next year if Maine expands. Maine will not receive any additional federal funding for this group of individuals under the Affordable Care Act.
The state of Maine will incur costs in addition to this $18 million as a result of increased enrollment because of the individual mandate, people dropping their employer-sponsored or commercial coverage to get no-cost Medicaid coverage, and of course the millions in administrative costs to manage another 100,000 people on Medicaid. The $683,000 price tag is simply nonsense.
Bill Nemitz: Senator’s health-care suggestion may hurt those who listen
I just came across what looks like a conspiracy to commit “welfare fraud” and I can’t wait to alert the ranking Republican in the Maine Legislature.
Oh, wait. It’s his idea.
“Making a conscious commitment to bring yourself above the poverty line allows you to receive these subsidies – with no penalty for falling short of that goal of improving your own economic future and working your way out of poverty,” wrote Senate Minority Leader Michael Thibodeau, R-Winterport, in a recent op-ed in the Kennebec Journal.
Translation: If you live below 100 percent of the federal poverty line and thus are ineligible for health-care subsidies under the Affordable Care Act, you need only nudge up your “projected” income for next year to just above the cutoff – and you’re in!
Asks Thibodeau, “Is it too much to ask of anyone receiving benefits to commit to improving their own economic future?”
Well, senator, if you’re suggesting that people deliberately lie about what they’ll make next year to sneak in under the federal health insurance umbrella, then yes, it is too much to ask.
In fact, it flies in the face of this statement at the bottom of the Affordable Care Act application (just above where the applicant affixes his or her signature): “I’m signing this application under penalty of perjury, which means I’ve provided true answers to all the questions on this form to the best of my knowledge. I know that I may be subject to penalties under federal law if I intentionally provide false or untrue information.”
I just came across what looks like a conspiracy to commit “welfare fraud” and I can’t wait to alert the ranking Republican in the Maine Legislature.
Oh, wait. It’s his idea.
“Making a conscious commitment to bring yourself above the poverty line allows you to receive these subsidies – with no penalty for falling short of that goal of improving your own economic future and working your way out of poverty,” wrote Senate Minority Leader Michael Thibodeau, R-Winterport, in a recent op-ed in the Kennebec Journal.
Translation: If you live below 100 percent of the federal poverty line and thus are ineligible for health-care subsidies under the Affordable Care Act, you need only nudge up your “projected” income for next year to just above the cutoff – and you’re in!
Asks Thibodeau, “Is it too much to ask of anyone receiving benefits to commit to improving their own economic future?”
Well, senator, if you’re suggesting that people deliberately lie about what they’ll make next year to sneak in under the federal health insurance umbrella, then yes, it is too much to ask.
In fact, it flies in the face of this statement at the bottom of the Affordable Care Act application (just above where the applicant affixes his or her signature): “I’m signing this application under penalty of perjury, which means I’ve provided true answers to all the questions on this form to the best of my knowledge. I know that I may be subject to penalties under federal law if I intentionally provide false or untrue information.”
Some really bad advice from Medicaid expansion foes
So many odd things have happened in Maine’s debate about expanding Medicaid, like the no-bid contract for a report that had an arithmetic error of overhalf a billion dollars.
But the oddest by far might be the claim from expansion foes that some should declare they will make a different income next year so they can get coverage. As expansion opponentSen. Michael Thibodeau, the Republican Senate leader, put it, “qualifying is a self-declaration of intent.”
Whom is Thibodeau advising to report a different income to be eligible for government assistance? Maine people who earn too little to qualify for subsidized insurance through the Obamacare marketplace.
Among them are farmers and fishermen, artisans, people working part-time and students who are finishing school. I’ve heard from a man whose wife falls into this category. She is 62, has a heart condition and can’t work more hours.
Effectively, they’ve been counseled to report to the federal government a higher income than they made this year so they can get subsidies for insurance.
You may wonder how anyone can end up without insurance because he or she earns too little. Well, the Affordable Care Act was designed to cover the lowest-income people with Medicaid. The law expanded eligibility for Medicaid coverage.
However, when the Supreme Court ruled that the Affordable Care Act is constitutional, a majority of justices decided that states can decide not to expand Medicaid.
If Maine expanded, people who make up to 138 percent of the federal poverty limit will get coverage through MaineCare. Every state in New England besides Maine has chosen to or is on track to expand.
So many odd things have happened in Maine’s debate about expanding Medicaid, like the no-bid contract for a report that had an arithmetic error of overhalf a billion dollars.
But the oddest by far might be the claim from expansion foes that some should declare they will make a different income next year so they can get coverage. As expansion opponentSen. Michael Thibodeau, the Republican Senate leader, put it, “qualifying is a self-declaration of intent.”
Whom is Thibodeau advising to report a different income to be eligible for government assistance? Maine people who earn too little to qualify for subsidized insurance through the Obamacare marketplace.
Among them are farmers and fishermen, artisans, people working part-time and students who are finishing school. I’ve heard from a man whose wife falls into this category. She is 62, has a heart condition and can’t work more hours.
Effectively, they’ve been counseled to report to the federal government a higher income than they made this year so they can get subsidies for insurance.
You may wonder how anyone can end up without insurance because he or she earns too little. Well, the Affordable Care Act was designed to cover the lowest-income people with Medicaid. The law expanded eligibility for Medicaid coverage.
However, when the Supreme Court ruled that the Affordable Care Act is constitutional, a majority of justices decided that states can decide not to expand Medicaid.
If Maine expanded, people who make up to 138 percent of the federal poverty limit will get coverage through MaineCare. Every state in New England besides Maine has chosen to or is on track to expand.
Geographic Variation in Medicare Spending
Researchers continue to study why Medicare spending per beneficiary varies significantly from one part of the country to another.
| What's the issue? | ||
While geographic variation in Medicare spending per beneficiary is itself well documented, the causes of that variation, whether it is appropriate, and what can be done to reduce spending in high-cost areas are less clear. This brief describes the research on geographic variation in Medicare spending and different interpretations of what it suggests for Medicare payment policy.
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| What's the background? | ||
Medicare is the largest single payer in the United States, providing health insurance for 52 million elderly and disabled beneficiaries. Three out of four Medicare beneficiaries are in traditional fee-for-service (FFS) Medicare, which covers a wide range of acute and post-acute care services including inpatient and outpatient hospital services, physician visits, stays in skilled nursing facilities, home health care, durable medical equipment, and prescription drugs. The types of services covered by FFS Medicare are essentially the same across the country.
Despite consistent benefits, the amount that Medicare spends per beneficiary in its traditional program is not constant nationwide. John Wennberg and researchers at the Dartmouth Institute focused attention on geographic variation in Medicare spending with publication of the first Dartmouth Atlas of Health Care in 1996. They demonstrated that marked differences in spending occur at both state and regional levels. The Dartmouth Atlas evaluates regional spending by looking at Hospital Referral Regions (HRRs), which are determined by where patients in an area are referred for major cardiovascular surgical procedures and neurosurgery. Raw spending numbers from the Centers for Medicare and Medicaid Services (CMS) show that in 2012, Medicare spent an average of $9,503 nationally per beneficiary but spending varied considerably from one HRR to another. Medicare spent almost 2.5 times as much per beneficiary in Miami, Fla. ($1
MedPAC Iffy on Patient-Centered Medical Homes
WASHINGTON -- A congressional advisory body on Medicare cast doubt on the patient-centered medical home model, including some of its payment mechanisms.
Several members of the Medicare Payment Advisory Commission (MedPAC) said during a public meeting Thursday that the patient-centered medical home (PCMH) model may not be all it's cracked up to be.
Members voiced issues with PCMH recognition standards and the per-member-per-month bonuses practices receive from certain payers for treating patients in a medical home model.
"In order to meet all the [National Committee for Quality Assurance] NCQA requirements, there are a lot of bells and whistles that have been added," said MedPAC Chair Glenn Hackbarth, JD. "My impression is that not all of them have really been validated as added value, but they add cost. I'm worried that maybe the medical home model has a real cost disadvantage."
The NCQA has developed recognition standards for PCMHs, and many health insurers these will pay bonus, based on the number of patients on those plans, to have practices better coordinate care. The hope is that practices will use the extra money to keep patients healthier, and out of the hospital and emergency department where care is much more expensive.
Commissioner Jon Christianson, PhD, from the School of Public Health at the University of Minnesota in Minneapolis, reminded the panel that it was wrong to assume the money from payers is going to physicians to help transform their practices.
"It's going to organizations that employ physicians, and they're going to use that money however they see fit," Christianson said. "That may be putting it into specialty care."
Commissioner Rita Redberg, MD, editor of JAMA Internal Medicine, said that she is seeing a lot of manuscripts stating the PCMH model isn't giving the return providers had hoped.
"They're not an inexpensive way to increase patient access," added Redberg, who is from the University of California San Francisco.
Last week, the Journal of the American Medical Association published a study reporting that a PCMH demonstration project in Pennsylvania did little to reduce costs and utilization, or improve the quality of care. Other studies have yielded similar results.
MedPAC discussed possible recommendations to the way Medicare pays primary care physicians and the per-member-per-month method, as well as the Affordable Care Act's Medicare pay bump.
The preceding article demonstrates that total confusion continues to reign when it comes to understanding the causes of geographic variations in the costs and rates of provision of health care and even more about what to do about them - over forty years after Gittelsohn and Wennberg first described the phenomenon.-SPC
ACA won't control health care costs
By Henry J. Waters III
Columbia (Mo.) Daily Tribune, March 8, 2014
Recently a group of physicians sponsored a visit by a University of Massachusetts professor of economics who goes about the country touting the advantages of single-payer health care, using numbers as his forte. Gerald Friedman appeared at the University of Missouri School of Medicine at the behest of the Missouri chapter of the Physicians for a National Health Program.
His thesis: the Affordable Care Act, otherwise known as Obamacare, does a lot of good things but does not control costs. The answer is a single-payer system in which the government acts as insurer.
I have made the same argument here based on the obvious premise health insurance can operate most efficiently and inexpensively only if the risk pool includes the entire population. We are seeing problems inherent in the hybrid ACA approach. For political reasons, elements of the old system are being preserved while tomorrow's fix is held at bay.
We know the better model. Often referred to as Medicare for all, the best new system will operate like the familiar and popular Medicare system, expanded to include people of all ages and means.
Models in other nations show continuing roles for private insurance companies but not as designers of universal coverage. Indeed, universal coverage is contrary to the economic principles of private health insurance, which profits by maximizing revenue and minimizing costs. The role of government in a national health system is the opposite, resulting in more effective care at lower overall cost, which Friedman regards as a hugely important economic boon.
In years past, physicians and other health care providers have not wanted to lose the fee-for-service system, but growing numbers now look forward to a more rational system. They are tired of private insurance hassles and recognize fee-for-service to put profit over best-care practices. Of course, they should be well compensated, but with a nationally managed system, providers can be incentivized to emphasize wellness and health outcomes rather than proliferation of services and procedures.
As Friedman points out, the substantial money saved in a single-payer system can go back into the economy. Health care costs can be reduced by billions. He cited numerous examples of lower costs and superior health outcomes in other countries.
"Get the profit out of health care, and everybody wins," he says.
Well, not everybody. Sellers of insurance, drugs and other health care products and services have profited through the years with the disappearing system. You can't blame them for working the territory and wanting the status quo to last, but by now evidence is clear the United States should join the other developed countries of the world with a better system. Examples are everywhere, including in our own country.
Let's call it Medicare if we don't like "single-payer," but let's get on with it.
Condition criticalNavigating a dizzying list of doctors, hospitals and rehab centers, Arnold and Corinne Murray have seen firsthand a health care system ill-suited to meet the needs of the elderly. The growing shortage of geriatricians will only compound the problem in a state where the aging population is exploding.
CAPE ELIZABETH — Corinne Murray doesn’t remember much about the day she almost died.
Her husband, Arnold, recalls quite clearly the afternoon two years ago when he nearly lost the love of his life.
Corinne, then 85, was in the bathroom. It was about 4:30 p.m. and she hadn’t been feeling well all day. Arnold helped her to the toilet and went into the kitchen to warm up some soup for their supper.
Suddenly, Corinne let out a scream.
“I ran into the bathroom,” Arnold Murray recalls vividly. “She was standing up. I caught her as she fell and kept her head from hitting the tub. The ambulance came. They didn’t think they were going to make it to the hospital in time.”
Corinne Murray survived the trip to Maine Medical Center in Portland, where she was diagnosed with a ruptured abdominal aortic aneurysm and had emergency surgery that saved her life. But over the next year and a half, she wound up in the hospital five more times and stayed in three different rehabilitation facilities. Her sudden illness set the elderly couple on a long, often overwhelming and sometimes troubling path that many Maine seniors experience when they have catastrophic health problems.
Juggling meds:
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