As Vermont Goes, So Goes the Nation?
WHEN most liberals hear the words “third party,” they have nasty flashbacks to Ralph Nader’s spoiler campaign in 2000. The history buffs among them might think of the populist Greenback Party’s feckless protests against the gold standard in the 19th century or the five presidential campaigns of the Socialist Eugene V. Debs — the last of which, in 1920, he ran from prison.
Third parties seem out of touch with reality, the refuge of idealists with dreams too fragile for the trenches of major party politics. But Democratic skeptics, at least, shouldn’t be too quick to judge. One state is now on the way to single-payer health care, and a third party deserves much of the credit.
Three years ago, Peter Shumlin, the governor of Vermont, signed a bill creating Green Mountain Care: a single-payer system in which, if all goes according to plan, the state will regulate doctors’ fees and cover Vermonters’ medical bills. Mr. Shumlin is a Democrat, and the bill’s passage is a credit to his party. Yet a small upstart spent years building support for reform and nudging the Democrats left: the Vermont Progressive Party. The Progressives owe much of their success to the oddities of Vermont politics. But their example offers hope that the most frustrating dimensions of our political culture can change, despite obstacles with deep roots in American history.
Rube Goldberg Survives
Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.
But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.
Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.
So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.
The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.
Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.
But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.
http://www.nytimes.com/2014/04/04/opinion/krugman-rube-goldberg-survives.html?hp&rref=opinion&_r=0&assetType=nyt_now
Health Care Without End
Law Lifts Enrollment in Medicaid by Millions
WASHINGTON — Enrollment in Medicaid has increased by three million people, to a total of 62 million, largely because of the Affordable Care Act, the Obama administration said Friday.
As expected, the increases have been much greater in states that expanded Medicaid eligibility.
“The increase in Medicaid enrollments across the country is encouraging, but more work is left to do,” said Kathleen Sebelius, the secretary of health and human services, who is trying to persuade more states to expand the program.
The new figures compare February enrollment in Medicaid and the Children’s Health Insurance Program with the average monthly enrollment from July to September 2013, just before the health insurance marketplaces opened.
About half of the states, including California and New York, have expanded Medicaid. In states where the expansion was in effect in February, enrollment increased by 8.3 percent, to a total of 35 million people. In states that have not expanded Medicaid, enrollment was up 1.6 percent.
It was not immediately possible to confirm the government data. But the federal figures are consistent with estimates by independent experts.
Medicaid expansion is one of the two main policies that President Obama and congressional Democrats chose in extending health care coverage to more Americans. The White House reported this week that 7.1 million people had signed up through the other channel: private health plans sold in new insurance marketplaces.
The government numbers do not include people who enrolled in Medicaid last month in response to a publicity campaign by Mr. Obama and other officials. The Affordable Care Act requires most Americans to carry insurance. People seeking coverage had help from a small army of insurance counselors.
Edwin C. Park, an analyst at the Center on Budget and Policy Priorities, a liberal research and advocacy group, said the federal Medicaid data did not distinguish between newly eligible beneficiaries and those who were previously eligible but not enrolled.
Enrollment was up even in some states that have not expanded Medicaid. In Florida, the number of people on Medicaid rose 8.2 percent, to 3.2 million. In Montana, it was up 6.9 percent, to 149,000.
States with the largest percentage increases included Oregon, West Virginia, Vermont and Colorado, all of which have expanded eligibility.
http://www.nytimes.com/2014/04/05/us/politics/health-law-helps-increase-medicaid-rolls-by-3-million.html?hpw&rref=health&_r=0
6:29 PM PDT, April 5, 2014
Computer glitches hamper healthcare delivery to California's poor
Thousands have been unable to get Medi-Cal coverage because state and county computers don't communicate. Some patients are left paying full price for care and drugs.
By Eryn Brown6:29 PM PDT, April 5, 2014
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Reginald Clarke is someone Obamacare was designed to help.
The 55-year-old, who was homeless for a time, now has an apartment in Gardena and a street-cleaning job that pays him $14,000 a year.
He hadn't visited a doctor in four or five years. Then, last fall, his girlfriend told him he would be eligible for Medi-Cal starting Jan. 1.
"I was excited. I could go get a physical," he said. "There are a few things I need."
But joy turned to exasperation when Clarke's application, filed in December, was mistakenly rejected — and then seemed to disappear from county and state computer systems.
By law, counties have 45 days to process Medi-Cal applications. More than three months after Clarke applied for coverage through the Covered California website, he is still waiting for a permanent insurance card he can use at his doctor's office. He's frustrated by how long the process is taking.
"I just don't understand," he said. "These people knew years ago that this was going to happen."
Clarke isn't alone. After thousands expressed frustration with glitches in signing up for insurance through the state's online Obamacare marketplace, CoveredCa.com, an even larger number of patients now are encountering additional roadblocks with the second prong of the system: the state's healthcare program for the poor.
The bottleneck, officials say, has been traced to a new state computer system that for months didn't communicate properly with county computers trying to confirm the eligibility of new applicants like Clarke.
And while the period to apply for private insurance through the state has ended, enrollment in Medi-Cal remains open. About 800,000 applications for that coverage are pending approval statewide, according to the Department of Health Care Services in Sacramento.
In L.A. County, officials said, more than 200,000 Medi-Cal applications filed between Oct. 1 and Dec. 31 were trapped in the state's computer enrollment system until February. Today, the county's Department of Public Social Services can link up to the state system, but workers still face a daunting backlog of applications — and new software glitches have exacerbated the problem.
Uncertain about their Medi-Cal coverage status, some patients are putting off trips to the doctor and drugstore — or paying full price for care they can't delay.
A software problem upended Benjamin Lazcano's Medi-Cal coverage, according to a lawyer working with the 48-year-old's family to fix a number of healthcare application woes. While waiting for county and state workers to resolve the problem, the South L.A. resident drove to Tijuana, Mexico, to refill his blood pressure medication.
San Gabriel Valley resident Ed Rampell, 59, said that he submitted his application in October but wound up paying full price for his medications in January.
One patient wrote The Times to say she has a worrisome growth behind an ovary. She submitted an application in October. County health clinics informed her she won't be able to keep her appointments for blood tests and ultrasound scans until her Medi-Cal coverage is confirmed, she said. Or she can pay full price for the services.
As of Thursday, she was still waiting.
In Hawaii, a healthcare system apart
The state's trailblazing system and widespread insurance coverage mean its residents are some of the nation's healthiest. But that only underscores the disparities across the U.S.
By Noam N. Levey
11:34 PM PDT, April 4, 2014
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HONOLULU — When the giant kapok and nawa trees that tower over the Queen's Medical Center in downtown Honolulu were planted more than a century ago, Hawaii faced a health crisis.
Many on the islands, including the queen who founded the hospital in 1859, feared that native Hawaiians, devastated by smallpox, measles and other illnesses brought by foreigners, were in danger of dying off completely.
Today, the people who walk under these trees are some of the healthiest in America.
Hawaiians live longer than their counterparts on the mainland. They die less frequently from common diseases, such as breast and colon cancers, even though these cancers occur more often here than in most other states. They also pay less for their care; the state's healthcare costs are among the lowest in the country.
Hawaii's success owes much to the state's trailblazing health system and its long history of near-universal health insurance.
Forty years ago, the state became the first to require employers to provide health benefits, codifying a tradition that grew out of Hawaii's agrarian past, when sugar and pineapple plantations employed doctors to care for their workers.
That system has led to some of the highest rates of coverage and best access to medical care in the country.
"There has always been a mentality here that if you are sick, you go to the doctor. It's just part of the culture," said Myra Williams, 64, who has lived in Hawaii for 35 years and was recently treated successfully for early-stage breast cancer.
Nearly 99% of the patients at the cancer center at Queen's have health coverage, a level unheard of at most urban medical centers on the mainland.
Healthcare in America is a tale of two countries.
Residents of the healthiest communities live as much as 14 years longer on average than those in unhealthy places. They are a third less likely to die from treatable illnesses such as breast cancer, childhood measles and diabetes, according to data from the Commonwealth Fund, a foundation dedicated to improving the healthcare system.
Big variations in poverty, education and diet may explain part of this divide. In Hawaii, the large share of residents of East Asian descent, who have lower mortality rates for many diseases, may also have an impact.
But differences in local health systems nationwide — including disparities in insurance coverage — also likely play an important role, according to an analysis of local and national healthcare data, a review of academic studies, interviews with scores of experts, and visits to communities across the country.
Nearly everyone is covered in the nation's healthiest places, including Hawaii, Massachusetts and parts of the Upper Midwest. By contrast, fewer than 7 in 10 working-age adults have health insurance in parts of Texas, Florida and the Deep South — areas with some of the highest rates of death from preventable illnesses.
In Texas, which has the lowest rate of insurance coverage in the nation, residents are 40% more likely to die from breast cancer than they are in Hawaii, according to federal cancer data.
These disparities may grow even larger in coming years as the Affordable Care Act is implemented unevenly around the country. Although the law offers states the opportunity to guarantee their residents insurance, only about half the states have elected to do so.
http://www.latimes.com/nation/la-na-healthcare-coverage-20140406,6620065,7468947,print.story
Fear of penalty a reason for Obamacare's late surge in California
By Soumya Karlamangla8:00 AM PDT, April 4, 2014
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California officials often cited the high demand for health insurance in explaining this week's last-minute surge for Obamacare.
But some of the people who waited in line for hours this week said another big reason was to avoid paying the health law's penalty for being uninsured.
Chris Roca, 23, waited in line for more than three hours to enroll in a health plan at a sign-up event in Panorama City. But he said he doesn't expect he'll get much use from his insurance.
“I’m just happy I don’t have to pay the penalty,” Roca said.
The Affordable Care Act requires most Americans to have health insurance in 2014, or pay a penalty of $95 per adult or 1% of their adjusted gross income, whichever is greater. Those penalties increase in future years.Full coverage: Obamacare rolls out
Monday was the last official day for open enrollment. But California granted an extension until April 15 for people who started their applications before the deadline or ran into technical difficulties as the state website faltered late.
Overall, more than 1.2 million people have enrolled in health plans through the Covered California insurance exchange. An additional 1.5 million Californians are likely to be eligible for Medi-Cal, the state's version of Medicaid.
Nationwide, sign-ups on the new online marketplaces have surpassed the Obama administration's goal of 7 million. Thus far, about 85% of customers have paid their initial premium, so the final enrollment tally may be slightly lower.
In its advertising, Covered California often played up the benefits of Obamacare, such as guaranteed coverage regardless of pre-existing conditions and access to checkups and mammograms.
There was very little talk about the penalties until the enrollment deadline got closer.
Peter Lee, executive director of Covered California, attributed the strong turnout ahead of the deadline largely to residents wanting the peace of mind that comes from having comprehensive health insurance at an affordable price. Federal premium subsidies lowered the rates substantially for many enrollees.
"We saw an enormous surge of applicants during the final week of March," Lee said Thursday after testifying about the state's performance at a congressional hearing in Washington. "This shows how strong the demand is from Californians wanting and needing quality coverage."
College student Hector Escobar showed up at the Cal State L.A. campus during spring break last week just to get Obamacare coverage.
Escobar, who lives in Downey, didn't know about the approaching deadline, but he had heard about the penalty.“I didn’t want to pay the $90-something for the next year,” he said.
http://www.latimes.com/business/healthcare/la-fi-mo-obamacare-penalty-20140401,0,4912989,print.story
Even Small Medical Advances Can Mean Big Jumps in Bills
MEMPHIS — Catherine Hayley is saving up for an important purchase: an updated version of the tiny digital pump at her waist that delivers lifesaving insulin under her skin.
Such devices, which tailor insulin dosing more precisely to the body’s needs, have transformed the lives of people with Type 1 diabetes like Ms. Hayley. But as diabetics live longer, healthier lives and worries fade about dreaded complications like heart attacks, kidney failure, amputations and blindness, they have been replaced by another preoccupation: soaring treatment costs.
“It looks like a beeper,” said Ms. Hayley, a 36-year-old manager here for an environmental services company, referring to the vintage 2007 pump on the waistband of her jeans. “It’s made of plastic and runs on triple-A batteries, but it’s the most expensive thing I own, aside from my house.”
A new model, along with related treatment supplies, prices out at tens of thousands of dollars for this year and will cost her about $5,000, even with top-notch insurance. “It’s great,” Ms. Hayley said, “but it all adds up.”
Traditionally, insurers lost money by covering people with chronic illnesses, because they often ended up hospitalized with myriad complications as their diseases progressed. Today, the routine care costs of many chronic illnesses eclipse that of acute care because new treatments that keep patients well have become a multibillion-dollar business opportunity for device and drug makers and medical providers.
The high price of new treatments for diabetes, rheumatoid arthritis, colitis and other chronic diseases contribute mightily to the United States’ $2.7 trillion annual health care bill.
More than 1.5 million Americans have Type 1 diabetes and cannot survive without frequent insulin doses, so they are utterly dependent on a small number of producers of supplies and drugs, which have great leeway to set prices. (Patients with the far more common Type 2 diabetes — linked to obesity — still produce insulin and can improve with lifestyle changes and weight loss, or on oral medicines.)
That captive audience of Type 1 diabetics has spawned lines of high-priced gadgets and disposable accouterments, borrowing business models from technology companies like Apple: Each pump and monitor requires the separate purchase of an array of items that are often brand and model specific.
| Harvard Pilgrim to Offer Insurance in Maine Marketplace | |||||||||
| 04/04/2014 Reported By: Patty B. Wight | |||||||||
At least one more insurance company will likely offer plans on the online insurance Marketplace in Maine next year. Harvard Pilgrim Health Care plans to join the list that already includes Anthem Blue Cross/Blue Shield and Maine Community Health Options.
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Health advocates said the added competition bodes well for Maine consumers. Edward Kane, the Vice President of Harvard Pilgrim Maine says, as a non-profit dedicated to providing coverage to as many people as possible, his company wanted to join Maine's Marketplace in 2014.
"Frankly we just needed more time to do the adequate necessary preparations." Now, they're ready said Kane, and thrilled to join. Emily Brostek of Consumers for Affordable Health Care said Harvard Pilgrim's decision reflects the success of the Marketplace in Maine, whose approximately $25,000 enrollees by the beginning of March surpassed the overall federal goal of $23,000. With at least three insurance providers offering plans next year, Brostek said consumers will have expanded choice. "Insurers are going to try harder to create products and prices that work for consuemrs so they pick their plans instead of competitors. So it can only be a good thing for consumers, I think." But other insurance companies aren't quite ready to take the plunge. Susan Millerick of Aetna said although the company offered plans in the Marketplace in 17 other states this year, they have learned to proceed with caution. "It was a rocky experience, I think we can acknowledge that, sort of across the board. So what we're needing to do now is really bring some real regulatory certainty and closure to what the rules will be and how the exchanges will function. And right now, we are continuing to evaluate where we stand today." Because open enrollment for the 2014 Marketplace just closed on March 31st. Insurance companies have until May 31st to decide whether to join the Marketplace in 2015. | |||||||||
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