Obamacare: Good intentions won’t make health care affordable
Posted Nov. 15, 2012, at 4:20 p.m.
Mercifully, the election is over. Obamacare is here to stay. A strong role for the federal government in moving toward the goal of health care as a right of everybody in the United States is now firmly and, in my opinion, irreversibly established.
Obamacare was a monumental political achievement in that it established an aspiration to health-care coverage for all Americans in federal law for the first time. President Barack Obama and former House speaker Nancy Pelosi deserve great personal credit for taking on this politically radioactive task.
But as a mechanism for providing access to health care for everybody at a reasonable cost, Obamacare has a number of serious shortcomings. Even if it works entirely as intended, it will still leave 25 million to 30 million people without any coverage at all. It lacks any persuasive mechanism for controlling the costs of public or private programs, meaning that insurance, even with federal subsidies, will likely become increasingly unaffordable.
It is way too complicated, and complications are expensive. To make it work will require thousands of federal regulations.
Deficit hawks will resist the expansion of Medicaid, the subsidies for the purchase of private insurance, the boost to community health centers, and funding for the exchanges that must be set up to create a more functional health insurance “marketplace.” The new law even includes funding for “navigators” to help people sort through the maze of insurance plans it creates.
Our fractured and fragmented health-care system will become even more so as Americans are further divided by income, employment status, and the type of insurance they choose in the exchanges. Despite the modest tax penalties, many will choose to remain uninsured, shifting the cost of care they may need to everybody else.
In previous columns, I have argued for a right to health care on moral grounds and on economic grounds. It’s actually cheaper to cover everybody than to figure out how not to cover some.
I would now like to make a case for less complexity in our health-care system. Much of the complexity of our existing system is defended as a way to preserve choice. But the virtues of choice are being vastly oversold, especially when it comes to how it’s paid for.
Medicaid personal-care programs are targets for fraud, investigators say
By Joe Eaton,
Keith Foreman, like a growing number of disabled Americans on Medicaid, qualified for a personal caregiver to help him with daily activities such as dressing, shaving and preparing meals.Foreman, 57, who has a spinal injury, hired his girlfriend, Sheila McDonald. In 2011, McDonald received almost $5,000 from Medicaid for six months of care she provided to Foreman.
These personal-care services, which are available in all 50 states, are designed to help the sick, elderly and disabled remain in their homes and out of expensive nursing facilities. But Foreman was not living at home. During the days marked on McDonald’s time sheets, he was housed in the Massac County jail in Metropolis, Ill., serving time for using a stolen debit card at a local liquor store. Foreman and McDonald pleaded guilty to making false statements.
Lax requirements for both caregivers and patients, along with poor state and federal oversight, have made the rapidly growing Medicaid personal-care programs an increasingly lucrative target for fraud, according to a federal report scheduled for release Thursday.
The report, by the Office of the Inspector General of the Health and Human Services Department, brings together six years of OIG investigations and 23 reports. It describes programs hindered by poor claims documentation, insufficient monitoring of claims data for fraud and waste, and a crazy-quilt of requirements for care workers in different states.
In particular, it faults the federal Centers for Medicare & Medicaid Services for inadequate oversight of the programs, whose costs are shared by states and the federal government, as is the norm for Medicaid.
http://www.washingtonpost.com/national/health-science/medicaid-personal-care-programs-target-for-fraud-say-investigators/2012/11/14/9776aba4-2e99-11e2-9ac2-1c61452669c3_print.html
Health Care Cuts Are Coming: Here's Where Liberals Say You Can Slice
Julie Rovner - NPR
A liberal think-tank closely allied with the Obama administration is proposing a health care spending plan it says could save hundreds of billions of dollars in entitlement spending without hurting middle- and low-income patients.
The plan from the Center for American Progress comes as Congress prepares for a battle royal over the so-calledfiscal cliff. That's the combination of tax increases and spending cuts that happen automatically unless lawmakers and the president can reach a deal before the end of the year.
Democrats have been demanding higher taxes on the rich, while Republicans say they won't budge without big changes to programs like Medicare and Medicaid.
Senate Minority Leader Mitch McConnell didn't mince any words in his first floor speech of the lame-duck session Tuesday afternoon: "Republicans like me have said for more than a year now that we're open to new revenue in exchange for meaningful reforms to the entitlement programs that are the primary drivers of our debt."
In choosing a health plan, be wary of unexpected bills with a high-deductible policy
Posted Nov. 13, 2012, at 9:47 a.m.
Alison Mitisek was at a Denver pediatrician’s office with her 15-month-old son last August when she passed out. The doctor’s office staff called an ambulance, which rushed her to a nearby emergency department.
Doctors were not able to determine why Mitisek, a 30-year-old schoolteacher, lost consciousness. Still, the bills for the ambulance and the diagnostic testing and other care came to $5,800. Mitisek’s group health plan had a $5,600 annual deductible, on which she and her husband, Mark, had already paid $800. Their share of the $5,800 bill before their insurance kicked in was $4,800.
In general, the higher a health plan’s deductible, the lower the premium. “Taking that gamble is appealing,” Mark Mitisek says of the choice to pay lower premiums and hope to avoid needing pricey medical care. “But when you lose the gamble and you’re stuck with that expense, it makes you think twice.”
“People get caught all the time,” says Martin Rosen, co-founder of Health Advocate, a company that helps consumers resolve medical billing problems and provides support for health-care decisions. “If you come from a traditional health plan and you paid a flat $100 co-pay for a visit to the emergency room, the assumption is that you’re going to pay the same in a high-deductible plan.”
In a high-deductible plan, preventive care is typically not subject to the deductible. But all other care, including prescription drugs and emergency care, may be.
During this year’s annual enrollment season, more people than ever will have the option to choose a health plan with a deductible that may exceed $1,000. These plans are often also linked to a savings account that offers tax benefits; employers and the employee may contribute to these accounts to help cover medical expenses.
Fifty-nine percent of employers offered so-called account-based health plans this year, up from 53 percent in 2011, and 11 percent said they will begin offering them by next year, according to an annual employer survey conducted by benefits consultant Towers Watson and the National Business Group on Health.
Some employees don’t have a choice: Twelve percent of employers who responded to the survey said account-based plans are the only type of plan they offer.
“When people are considering a high-deductible plan, I always say, ‘Could you come up with the whole deductible all at one time?’” says Amelia Haviland, an associate professor of statistics and health policy at Carnegie Mellon University who has published studies on the effect of high-deductible health plans on health-care spending. “If it’s going to keep you from going to the emergency department when you really need to go, don’t choose that plan.”
Computer Issues May Hamper Online Insurance Markets
New online insurance markets set to begin selling health coverage to consumers next October may be hampered by delays in launching a key computer program, according to state consultants and insurance regulators.
State regulators learned late last week that an electronic system most insurers will use to submit their policies for state and federal approvals won’t be ready for testing next month, as originally planned. The lag is being blamed on the wait for several regulations from the Obama administration, which are needed to update the software.
Others believe the delay, while not necessarily critical, will further squeeze insurance regulators and insurers, who still have much work to complete before next fall when enrollment is slated to start in the exchanges, a critical part of the health law. Enrollment is set to begin Oct. 1 for policies that go into effect Jan. 1, 2014.The slowdown "creates another three-month delay," said Dan Schuyler, a director at Leavitt Partners, a consulting firm working with states to set up the markets, called exchanges. "They're not going to be ready."
Report: Lack of prioritization, too much latitude for state contractor led to $10.6 million in MaineCare overpayments
Posted Nov. 15, 2012, at 1:43 p.m.
AUGUSTA, Maine — Officials at the state’s Department of Health and Human Services had no firm system in place to determine which problems facing the state’s new MaineCare claims and billing system were most pressing, according to a report released to legislators Thursday. The department also left too much discretion to the contractor building the claims system, Molina Healthcare, to determine which problems required the most urgent attention, the report said.
Those were among a number of factors that contributed to the state’s making $10.6 million in payments to health care providers for patients who were no longer eligible for services from the state’s MaineCare program. The improper payments were made between September 2010 and March 2012 and resulted in MaineCare payments to health care providers for 7,730 patients who were no longer eligible for services.
The findings are included in a review conducted by the Legislature’s investigative arm, the Office of Program Evaluation and Government Accountability, that was delivered Thursday to lawmakers on the Legislature’s Government Oversight Committee.
Lawmakers had requested the review in April, about a month after Health and Human Services Commissioner Mary Mayhew told lawmakers about the $10.6 million in overpayments while legislators were considering measures to address a $121 million MaineCare funding shortfall.
Mayhew told lawmakers that DHHS staff had been aware of a problem with the bill-paying computer system since 2010. It was not brought to the attention of her and other agency leaders until January 2012, however.
Essentially, Mayhew has said, the bill-paying computer system could not communicate with the MaineCare eligibility system, so individuals who were no longer eligible for benefits weren’t being removed from the billing system.
No comments:
Post a Comment