By Dan Goldberg
The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure.
The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. The bill now heads to the Republican-controlled Senate where it is not expected to pass.
Assemblyman Richard Gottfried, chair of the health committee, gave an impassioned speech on the floor in support of the New York Health Act, arguing that it was long past time for New Yorkers to rid themselves of the intrusive insurance companies whose goal is to deny claims rather than provide care.
"You do not have to be an Einstein to understand New York Health is the right choice for New York," Gottfried said.
Gottfried, a Democrat from Manhattan, spent the legislative session barnstorming the state, trying to gain support for his bill, which would be funded through a progressive income tax and payroll assessments. There would be a net savings of $45 billion in health spending by 2019, Gottfried said, based on an analysis from Dr. Gerald Friedman, a professor at the University of Massachusetts at Amherst, though that figure was attacked by Republicans.
The bill, Gottfried said, would lower costs by getting rid of insurance companies. It would lower administrative costs and allow doctors to focus their time on treating patients instead of fighting for reimbursements.
"What will bring down health care costs is taking out of the equation the more than 20 percent we now spend on administrators whose job it is to fight with insurance companies," he said.
The plan's benefits, Gottfried said, would be more generous than any plan on the current market, and there would be no co-pays or deductibles. The bill would also require a care coordinator for every member, though that coordinator is not empowered to choose the type of care a patient receives.
Koch –funded “Nonprofit” Stomps Down Hard on Health Care Initiative
You’ve probably never heard of Initiative 20….unless you listen to right wing talk radio, or hang out on right wing websites. Then, you might believe that Initiative 20 is a Communist plot to ration your health care, run all private insurors out of Colorado, take away your Medicaid, and generally make your life miserable.
Initiative 20, the ColoradoCareYes plan, is the beginning of the end of the Federal Affordable Care Act (ACA or Obamacare) in Colorado, and Koch-funded attack groupsare trying to stop it before it begins.
Republicans, after having tried to repeal the ACA 54 times, (but still having no plan to replace it) should be rejoicing that a coalition of nonprofits in Colorado, inspired by Senator Irene Aguilar, M.D, is promoting an alternative to the ACA. I mean really…the end of mandates? The end of Obama’s name on your health care plan? No price discrimination against rural consumers? No deductibles? It’s a Tea Party dream!
In the original ACA legislation is an “innovation” provision, article 1332, which allows states to opt out of the ACA, if they can prove that their own programs have as good or better outcomes for consumers. The ColoradoCare plan as written would be simpler, more fair, and less expensive than the ACA.
Instead of rejoicing that Democrats are accomplishing their goal of replacing the ACA, however, Republican operatives and organizations quickly stomped on the rollout of Initiative 20 with a Koch-brothers funded website, and talk radio diatribes about how the ColoradoCareYES Initiative must be stopped.
Some background information:
Why replace Colorado’s Health Exchange?
- Colorado’s Exchange, ConnectforHealthColorado, has met most of its goals.
- The numbers of uninsured are down– 90% of Americans are now covered by health insurance. Colorado has seen a 6% drop in uninsured people. This is the lowest uninsured rate since 2008, according to Gallup.
- Premium rates have decreased 9-22% overall since implementing the ACA, according to an Anthem study. The increase rate is the slowest in a decade.
- The exchange is on track to be self-sufficientfinancially.
- Enrollment in Colorado’s exchange is still increasing.
Yet, problems persist with Colorado’s implementation of the ACA
- There are still Website glitches.
- Many people are unhappy with the Mandate
- Insured has to change carriers when changing jobs. (This happened to me – I liked my plan, but I couldn’t keep it. I’ll have to change again this year.)
- Rural and mountain areas still have higher premiums, and vary widely.
- Costs of premiums have slightly increased overall, (average 4%) , according to left wing rag Forbes, but this is the slowest increase in decades.
- Most people still want a universal health care system – like every other industrialized country in the world has. We want a simple, affordable system which is easy to access, fair, covers basic healthcare for everyone , and continues uninterrupted through jobs and life changes.
- T.R. Reid, spokesman for the ColoradoCare Initiative 20, said,”There is absolutely no question that this will save Coloradans money. Corporations, individuals and the state government will all save money with this plan. The reason for high costs (of health care) is the enormous administrative costs. Our plan replaces this with a much cheaper approach to health insurance. Everybody pays for it. Everyone is covered by it.”
What will Initiative 20 do?
The Initiative 20 signature drive will need to collect 99,000 valid signatures by October 23rd to get on the ballot in November 2016. As a kick-off activity, ColoradoCare volunteers danced as a “flash mob” at Union Square and on the 16th Street mall.
Initiative 20, if passed in November 2016 election, would set up a process by which Colorado would gradually opt out of the Affordable Care Act and discontinue the ConnectforHealth Colorado Exchange. Twenty-one trustees would be elected to administer it, representing all parts of Colorado.
The Insecure American
by Paul Krugman
America remains, despite the damage inflicted by the Great Recession and its aftermath, a very rich country. But many Americans are economically insecure, with little protection from life’s risks. They frequently experience financial hardship; many don’t expect to be able to retire, and if they do retire have little to live on besides Social Security.
Many readers will, I hope, find nothing surprising in what I just said. But all too many affluent Americans — and, in particular, members of our political elite — seem to have no sense of how the other half lives. Which is why a new study on the financial well-being of U.S. households, conducted by the Federal Reserve, should be required reading inside the Beltway.
Before I get to that study, a few words about the callous obliviousness so prevalent in our political life.
I am not, or not only, talking about right-wing contempt for the poor, although the dominance of compassionless conservatism is a sight to behold. According to the Pew Research Center, more than three-quarters of conservatives believe that the poor “have it easy” thanks to government benefits; only 1 in 7 believe that the poor “have hard lives.” And this attitude translates into policy. What we learn from the refusal of Republican-controlled states to expand Medicaid, even though the federal government would foot the bill, is that punishing the poor has become a goal in itself, one worth pursuing even if it hurts rather than helps state budgets.
But leave self-declared conservatives and their contempt for the poor on one side. What’s really striking is the disconnect between centrist conventional wisdom and the reality of life — and death — for much of the nation.
Take, as a prime example, positioning on Social Security. For decades, a declared willingness to cut Social Security benefits, especially by raising the retirement age, has been almost a required position — a badge of seriousness — for politicians and pundits who want to sound wise and responsible. After all, people are living longer, so shouldn’t they work longer, too? And isn’t Social Security an old-fashioned system, out of touch with modern economic realities?
Why doctors quit
by Charles Krautnammer
About a decade ago, a doctor friend was lamenting the increasingly frustrating conditions of clinical practice. “How did you know to get out of medicine in 1978?” he asked with a smile.
“I didn’t,” I replied. “I had no idea what was coming. I just felt I’d chosen the wrong vocation.”
I was reminded of this exchange upon receiving my med-school class’s 40th-reunion report and reading some of the entries. In general, my classmates felt fulfilled by family, friends and the considerable achievements of their professional lives. But there was an undercurrent of deep disappointment, almost demoralization, with what medical practice had become.
The complaint was not financial but vocational — an incessant interference with their work, a deep erosion of their autonomy and authority, a transformation from physician to “provider.”
As one of them wrote, “My colleagues who have already left practice all say they still love patient care, being a doctor. They just couldn’t stand everything else.” By which he meant “a never-ending attack on the profession from government, insurance companies, and lawyers . . . progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.
I hear this everywhere. Virtually every doctor and doctors’ group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”
You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.
And for what? The newly elected Barack Obama told the nation in 2009 that “it just won’t save billions of dollars” — $77 billion a year, promised the administration — “and thousands of jobs, it will save lives.” He then threw a cool $27 billion at going paperless by 2015.
It’s 2015 and what have we achieved? The $27 billion is gone, of course. The $77 billion in savings became a joke. Indeed, reported the Health and Human Services inspector general in 2014, “EHR technology can make it easier to commit fraud,” as in Medicare fraud, the copy-and-paste function allowing the instant filling of vast data fields, facilitating billing inflation.
That’s just the beginning of the losses. Consider the myriad small practices that, facing ruinous transition costs in equipment, software, training and time, have closed shop, gone bankrupt or been swallowed by some larger entity.
This hardly stays the long arm of the health-care police, however. As of Jan. 1, 2015, if you haven’t gone electronic, your Medicare payments will be cut, by 1 percent this year, rising to 3 percent (potentially 5 percent) in subsequent years.
Then there is the toll on doctors’ time and patient care. One study in the American Journal of Emergency Medicine found that emergency-room doctors spend 43 percent of their time entering electronic records information, 28 percent with patients. Another study found that family-practice physicians spend on average 48 minutes a day just entering clinical data.
Forget the numbers. Think just of your own doctor’s visits, of how much less listening, examining, even eye contact goes on, given the need for scrolling, clicking and box checking.
The geniuses who rammed this through undoubtedly thought they were rationalizing health care. After all, banking went electronic. Why not medicine?
Because banks deal with nothing but data. They don’t listen to your heart or examine your groin. Clicking boxes on an endless electronic form turns the patient into a data machine and cancels out the subtlety of a doctor’s unique feel and judgment.
Why did all this happen? Because liberals in a hurry refuse to trust the self-interested wisdom of individual practitioners, who were already adopting EHR on their own, but gradually, organically, as the technology became ripe and the costs tolerable. Instead, Washington picked a date out of a hat and decreed: Digital by 2015.
As with other such arbitrary arrogance, the results are not pretty. EHR is health care’s Solyndra. Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patients neglected, good physicians demoralized.
Like my old classmates who signed up for patient care — which they still love — and now do data entry.
Texas Politicians And Businesses Feud Over Medicaid Expansion
May 29, 2015 4:19 PM ET
"So you can see we have every treatment area filled up. Beds are in the hallways and the rooms are all full," says Dr. John Pease, chief of emergency services.
Last year it cost Parkland Hospital three quarters of a billion dollars to provide what is called "uncompensated care" — mostly treating patients without health insurance. Parkland is hardly some 90-pound weakling, but $765 million of red ink will strain any hospital. Dallas County Judge Clay Jenkins, who oversees the county hospital, says it doesn't have to be this way.
"A huge chunk of that could be paid for," Jenkins says. "It's about $580 million a year that would be brought in by the Medicaid expansion monies."
Expanding Medicaid was intended to be a key element of the Affordable Care Act. Medicaid expansion covers uninsured adults, mostly working poor, who don't make enough to buy health insurance on the exchanges. Twenty-nine states and the District of Columbia have taken up the charge of Medicaid expansion. But when the U.S. Supreme Court gave the individual states the option to opt of Medicaid expansion, then-Texas-Gov. Rick Perry could not opt out fast enough.
Texas hospitals had to eat $5.5 billion in uncompensated care last year. The reason is this: After the Affordable Care Act passed, the amount of money the federal government provides to hospitals for uncompensated care was significantly reduced.
In 2013, while contemplating a second run at the presidency, Perry had a message for Tea Party conservatives across the nation.
"Thank you all for being here," he started. "The first day of April. Seems to me an appropriate April Fool's Day — makes it perfect to discuss something as foolish as Medicaid expansion and to remind everyone that Texas will not be held hostage by the Obama administration's attempt to force us into this fool's errand of adding more than a million Texans to a broken system."
Perry's speech was a clear message to the Republican-dominated state Legislature: Medicaid expansion is part of Obamacare, and Texas hates Obamacare. The problem is that in hating the Affordable Care Act, the state is leaving on the table as much as $100 billion of federal money over 10 years — money that could pay for health insurance for more than 1 million of its working poor.
This is driving many in the state's business community bonkers.
"It's our money that we are sending to Washington, D.C.," says Bill Hammond, CEO of the Texas Association of Business, which includes many of the state's richest and most powerful business owners. "We are not getting it back," he says. "We pay for it with corporate income tax, we pay for it with our personal income tax and we pay it in the fact that our premiums are higher than they would be if everyone was insured."Texas has the second-highest health insurance premiums in the country, right behind Florida. And Texas has the third-highest property taxes in the country. In Dallas, for example, more than half of property owners' county property tax bill goes to reimburse Parkland Hospital for the uncompensated care it has to provide.
"Texas businesses pay almost 63 percent of all state and local taxes," Hammond says.
He says if the state expanded Medicaid it would save Texas business billions of dollars a year that could be invested in upgrading equipment, hiring new employees, providing raises and rewarding shareholders.
For every dollar the state would pay into Medicaid expansion, it would earn back $1.30 from the economic activity created, according to an analysis by Ray Perryman. He's an economist who has consulted for the Texas Legislature and six governors. That economic activity would top out at $3 billion in 10 years, creating 300,000 new jobs each year, he says."It's infused in some areas that have direct impact on the economy in a lot of fundamental ways that extends beyond the year in which it occurs," Perryman explains. "You may be prolonging someone's work life 10 or 15 years, or maybe solving a chronic illness problem that's going to drain hundreds of thousands of dollars from the system over time that's avoidable if people get health care earlier."Totally aside from the health benefits, Perryman says, when you look at the numbers, "You look at them and you say, 'This is a no-brainer. We need to be doing this.' It's really an apolitical situation. It's just math."
But it's much more than just the math. As the 84th session of the Texas Legislature comes to a close, there's been no debate at all about Medicaid expansion. The issue seems to be settled and the answer is an unqualified no.
"We've got a very conservative Legislature which would like to prioritize tax relief over meeting some of the infrastructure needs of the state," says John Hawkins, a vice president with the Texas Hospital Association.
Hawkins says the state's uncompensated bills cost everybody. The hospitals can't eat that kind of loss, so they shift some of that cost to their insured patients. "Probably $1,800 of the family premium each year can be attributable to the cost of the uninsured in the state," he says.
It's fair to say that Texas Republicans are not big on entitlements. Nevertheless, $100 billion is a lot of money to turn your back on.
Texas Loses Billions To Treat The Poor By Not Expanding Medicaid, Advocates Say
When the Supreme Court ruled that the federal government could not compel states to expand Medicaid programs, many Southern and Midwestern states opted out. One quarter of the uninsured live in Texas.
DAVID GREENE, HOST:
We're digging deeper into the debate over the Affordable Care Act. A key part of that law has been expanding Medicaid to extend health coverage to more uninsured adults. Mostly it's working-poor Americans who don't make enough to participate in the health insurance exchanges.
RENEE MONTAGNE, HOST:
In all, 29 states have expanded Medicaid. But when the U.S. Supreme Court ruled in 2012 that the federal government could not compel them to do so, many Southern and Midwestern states opted out.
GREENE: And one of them is Texas. A quarter of low-income adults without insurance in this country live in Texas - more than a million people. Here's NPR's Wade Goodwyn.
WADE GOODWYN, BYLINE: For 121 years, Parkland Hospital has been the heart of Dallas's health care system. On a November day in 1963, emergency room doctors at this county hospital frantically tried to save an American president who could not be saved. These days, emergency room doctors frantically try to treat 240,000 patients every year.
DR. JOHN PEASE: Let me bring you out to where it all happens. These are the triage rooms.
GOODWYN: Dr. John Pease is the chief of emergency services. Parkland Hospital divides its emergency department into five different pods separated by symptoms and acuity.
UNIDENTIFIED ANNOUNCER: Patient, last name Aniyaku, first initial L, please return to Pod 5 for treatment.
GOODWYN: By federal law, the county's hospital emergency room cannot turn sick patients away, no matter their ability to pay. And so Parkland opens its arms.
PEASE: So you can see we have every treatment area filled up, beds along the hallways and rooms are all full.
GOODWYN: Last year, it cost Parkland Hospital a staggering three quarters of a billion dollars to provide what is called uncompensated care - mostly treating patients without health insurance. Parkland is hardly some 90-pound weakling, but $765 million of red ink will strain any-sized hospital. Dallas County judge, Clay Jenkins, oversees the county hospital. He says it doesn't have to be this way.
JUDGE CLAY JENKINS: A huge chunk of that could be paid for. It's about $580 million a year that would be brought in by the Medicaid expansion monies.
GOODWYN: Statewide, Texas hospitals had to eat 5.5 billion dollars in uncompensated care last year. The reason is this - after the Affordable Care Act passed, the amount of money the federal government provides to hospitals for uncompensated care was significantly reduced. It's cause and effect; if 9 out of 10 Americans have health insurance, the amount of uncompensated care hospitals have to provide goes down. But when the U.S. Supreme Court gave the individual states the option to opt out of part of the Affordable Care Act, then-Texas Governor Rick Perry could not opt out fast enough.
(SOUNDBITE OF ARCHIVED RECORDING)
RICK PERRY: Thank you all for being here. And the first day of April seems to me an appropriate April Fools' Day - makes it perfect to discuss something as foolish as Medicaid expansion.
GOODWYN: In 2013, while contemplating a second run at the presidency, Perry had a message for Tea Party conservatives across the nation.
(SOUNDBITE OF ARCHIVED RECORDING)
PERRY: And to remind everyone that Texas will not be held hostage by the Obama administration's attempt to force us into this fool's errand of adding more than a million Texans to a broken system.
GOODWYN: Perry's speech that day was a clear message to the Republican-dominated state legislature - Medicaid expansion is part of Obamacare, and Texas hates Obamacare. The problem is in hating the Affordable Care Act, the state is leaving on the table as much as $100 billion of federal money over 10 years - money that would pay for health insurance for more than a million of its working poor. This is driving many in the state's business community bonkers.
44% of Covered California customers report difficulty paying premiums
A new survey shows that 44% of Covered California policyholders find it difficult paying their monthly premiums for Obamacare coverage.
And a similar percentage of uninsured Californians say the high cost of coverage is the main reason they go without health insurance.
The issue of just how much people can afford will loom large as the state exchange prepares to negotiate with health insurers over next year's rates.
Many analysts are predicting bigger premium increases for 2016 in California and across the country. Insurers have more details on the medical costs of enrollees, and some federal programs that help protect health plans from unpredictable claims will be winding down.
This latest pulse on consumer attitudes is drawn from a Kaiser Family Foundation survey of 4,555 Californians from September to December 2014. It examined the experiences of people in Covered California, Medi-Cal, other private coverage and the uninsured.
Forty-four percent of exchange policyholders surveyed said it's somewhat or very difficult to afford their premiums. That's compared with 25% of adults who had employer-based or other private health insurance.
Peter Lee, executive director of Covered California, acknowledged that many Californians find it hard to fit health insurance premiums into their household budget, even when they qualify for generous federal subsidies.
"If you are making $25,000 a year that $70 premium is still a struggle," Lee said. "The Affordable Care Act is providing nobody with a free lunch. This issue of making healthcare affordable is not easy."
Anthem Blue Cross, Kaiser Permanente and other health insurers have submitted their proposed 2016 rates for individual policies to Covered California, and negotiations are expected to begin next month.
The final statewide rates should be announced in July, Lee said. For 2015, the average rate increase was 4.2%.
The consumer survey also delved into patient satisfaction with their health insurer and access to care.
Among Covered California members, 74% rated their coverage as excellent or good. It was 88% among people with other private coverage.
Ninety-one percent of exchange customers said it was easy to get to their usual source of medical care, matching the response among people with other types of private coverage.
And 59% of Covered California enrollees had a checkup or preventive care visit by the fall of 2014. But 18% of exchange policyholders said a medical provider would not accept them as a new patient.
Bill 20's Band-Aid solution: Montreal doctors still weighing their future