State prefers own health-care solution to fed's
Maine's fledgling program to reduce health insurance premiums is the better deal, say state officials.
Maine may be forced to shelve a new, state-sponsored health insurance program that aims to reduce premiums on individual plans when a similar, more costly federal program starts next year under the Affordable Care Act.
The state's so-called "reinsurance" program, which started last July, is funded by a $4 monthly tax on about 532,000 Mainers who are covered by group and individual private plans. The $25 million annual program appears to be working as planned, leading some to question why Maine must participate in the federal program.
The federal program will charge a $5.25 monthly fee and operate for only three years, reducing individual premiums across the nation. After that, various cost-leveling features of the Affordable Care Act are expected to make reinsurance for individual plans unnecessary.
"We don't want to pay twice for the same thing," said Eric Cioppa, Maine's insurance superintendent. "But the money that Maine is raising for reinsurance ought to stay in Maine. There's no guarantee that what Maine contributes to a national pool would come back to us."
Obamacare: A Deception
Introduction by Paul Craig Roberts
The article below is the most comprehensive analysis available of “Obamacare” – the Patient Protection and Affordable Care Act. The author, a knowledgeable person who wishes to remain anonymous, explains how Obamacare works for the insurance companies but not for you.
Obamacare was formulated on the concept of health care as a commercial commodity and was cloaked in ideological slogans such as “shared responsibility,” “no free riders” and “ownership society.” These slogans dress the insurance industry’s raid on public resources in the cloak of a “free market” health care system.
You will learn how to purchase a subsidized plan at the Exchange, what will happen when income and family circumstances change during the year or from one year to the next, and other perils brought to you by Obamacare. It is one of the most important articles that will be posted on my website this year. Americans will be shocked to learn the extent to which they have been deceived. The legislation neither protects the patient nor are the plans affordable.
The author shows that for those Americans whose income places them between 138% and 400% of the Federal Poverty Level, the out-of-pocket cost for one of the least expensive (lower coverage) subsidized policies ranges from 2% to 9.5% of Modified Adjusted Gross Income (MAGI), a tax base larger than the Adjusted Gross Income used for calculating federal income tax.
What this means is that those Americans with the least or no disposable income are faced in effect with a substantial pay cut. The author provides an example of a 35 year-old with a MAGI of $27,925. The out-of- pocket cost to this person of a Silver level plan (second least expensive) is $187.33 per month. This cost is based on pre-tax income, that is, before income is reduced by payroll and income taxes. There goes the car payment or utility bill. The lives of millions of Americans will change drastically as they struggle with a new, large expense – particularly in an era of no jobs, low-paying jobs and rising cost of living.http://www.paulcraigroberts.org/2013/02/03/obamacare-a-primer/
State lacks doctors to meet demand of national healthcare law
Lawmakers are working on proposals that would enable physician assistants, nurse practitioners, optometrists and pharmacists to diagnose, treat and manage some illnesses.
By Michael J. Mishak, Los Angeles Times
6:03 PM PST, February 9, 2013
Some lawmakers want to fill the gap by redefining who can provide healthcare.
They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.
"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"
Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.
Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.
"Patient safety should always trump access concerns," said Dr. Paul Phinney, president of the California Medical Assn.
Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states.
http://www.latimes.com/health/la-me-doctors-20130210,0,3664230,print.story
How Obamacare and sequestration will affect Maine hospitals
Posted Feb. 10, 2013, at 4:22 p.m.
Hospitals thank Maine Sen. Susan Collins and former Sen. Olympia Snowe for their support in fighting cuts that threaten rural Mainers’ abilities to see physicians close to home. At a crucial point during the New Year’s fiscal cliff negotiations, our senators stood up for Maine hospitals and we appreciate their efforts.
Hospitals in Maine already face millions of dollars in cuts.
To finance the Medicaid eligibility expansions in the Affordable Care Act, the law reduced hospital reimbursements. According to the Maine Hospital Association, from 2011 to 2019, the aggregate amount of those cuts to hospitals in Maine is $879 million. In 2013, the cuts total $33 million.
A recent deal to prevent rate cuts to physicians who see Medicare patients included hospital reimbursement reductions. The loss to Maine hospitals was $50 million over four years.
The fiscal cliff deal was temporary and the “sequestration” cuts will take effect March 1. Maine hospitals would lose $21 million in 2013 as a result of the proposed sequestration cut and a total of $230 million over a 10-year period.
In order to prevent these cuts, Congress needs to find alternatives. Unfortunately, even worse ideas are being considered. One such idea is capping total Medicare payments to hospitals for evaluation and management services.
Such a cut would be devastating to the Franklin Community Health Network, the rural integrated health network led by 65-bed Franklin Memorial Hospital in Farmington. The health network employs about 85 percent of the physicians and other providers in our service area, often subsidizing their practices to enable access to essential medical services for the community. Of our total caseload, 45 percent receive Medicare and 20 percent receive Medicaid.
The system has five provider-based facility locations, all of which abide by our hospital’s charity care and financial assistance guidelines. While some private providers in our area have been able to remain open by limiting access to Medicaid and uninsured patients, the network’s clinics have experienced a significant increase in overall charity care. In the past 12 months, our provider-based clinics provided $750,000 in charity care and financial assistance (3.5 percent of costs).
Price for a New Hip? Many Hospitals Are Stumped
By ELISABETH ROSENTHAL
Jaime Rosenthal, a senior at Washington University in St. Louis, called more than 100 hospitals in every state last summer, seeking prices for a hip replacement for a 62-year-old grandmother who was uninsured but had the means to pay herself.
The quotes she received might surprise even hardened health care economists: only about half of the hospitals, including top-ranked orthopedic centers and community hospitals, could provide any sort of price estimate, despite repeated calls. Those that could gave quotes that varied by a factor of more than 10, from $11,100 to $125,798.
Ms. Rosenthal's grandmother was fictitious, created for a summer research project on health care costs. But the findings, which form the basis of a paper released on Monday by JAMA Internal Medicine, are likely to fan the debate on the unsustainable growth of American health care costs and an opaque medical system in which prices are often hidden from consumers.
"Transparency is all the rage these days in government and business, but there has been little push for pricing transparency in health care, and there's virtually no information," said Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa, who wrote the paper with Ms. Rosenthal. He added: "I can get the price for a car, for a can of oil, for a gallon of milk. But health care? That's not so easy."
President Obama's Affordable Care Act focused primarily on providing insurance to Americans who did not have it. But the high price of care remains an elephant in the room. Although many experts have said that Americans must become more discerning consumers to help rein in costs, the study illustrates how hard that can be.
"We've been trying to help patients get good value, but it is really hard to get price commitments from hospitals - we see this all the time," said Jeff Rice, the chief executive of Healthcare Blue Book, a company that collects data on medical procedures, doctors visits and tests. "And even if they say $20,000, it often turns out $40,000 or 60,000."
There are many caveats to the study. Most patients - or insurers - never pay the full sticker price of surgery, because insurance companies bargain with hospitals and doctors for discounted rates. When Ms. Rosenthal balked at initial high estimates, some hospitals produced lower rates for a person without insurance.
But in other ways the telephone quotations underestimated prices, because they did not include the fees for outpatient rehabilitation, for example.
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