ERIK STEELE
America to health care: We want our money back
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Posted May 23, 2013, at 12:34 p.m.
Last modified May 23, 2013, at 2:37 p.m.
Last modified May 23, 2013, at 2:37 p.m.
Last week, for the first time ever, I paid for my health insurance directly out of my bank account; I wrote a check for $1200 to cover our health insurance for the month I am between jobs. For the last 30 years, most of the cost of my family’s health insurance was paid by my employer, and our share was deducted directly from my paycheck. That share was money I never really felt like we had, so somehow felt a lot less like it was coming out of my pocket than when I wrote a check for $1200.
More and more of America is coming to frame our excessive spending on health care the way writing that check made me see it, as the loss of opportunity to spend some of that money on things of greater personal and social value. Money spent on health care is money that could have been spent on food, clothing, vacations, early childhood development, roads and bridges, public transportation development, education, tuition support for young adults to go to college without incurring huge debts, research and development, and much more.
Health care costs are at the root of the federal budget debates, and a huge contributor to federal budget deficits and the national debt. Spending on many other areas of government and social programs is flat — it’s primarily spending on Medicaid and Medicare that is making the work of governing this country progressively about brutally difficult choices among lousy options to cut costs.
There was a time when spending all of that extra money on health care seemed to most of us like a good choice. Better health care for people, after all, was more important than better roads or bridges, or almost anything else. The health care industry has gotten a lot of deference because we are in the business of caring for patients, we supposedly know best what patients need, and patients often rallied to our cause when push came to political shove in spending battles.
But America has learned the dirty secrets of health care, the most important of which is that the idea we could not get better health care unless we spent more on it is a false choice. It is false because so much of what we spend on health care is wasted, and because, for all we spend in America on health care for most of us, other countries get better health care for all of their citizens for a lot less money.
Robert Samuelson: The fog of Obamacare
By Robert J. Samuelson,
You’ve heard of the “fog of war.” Well, now we’ve got the fog of Obamacare. The controversial Affordable Care Act (ACA) has so many moving parts that it’s hard to know how its implementation is proceeding. In 2014, many uninsured are supposed to get coverage either through insurance exchanges, where they can buy subsidized policies if their incomes are less than four times the federal poverty line, or through an expanded Medicaid. The trouble is that 20 or more states may reject the Medicaid expansion, and the exchanges aren’t yet finished. Much is unknown.It’s not just that the ACA’s plumbing is still under construction. Millions of Americans are perplexed. An April poll by the Kaiser Family Foundationfound that one-fifth of respondents didn’t think the ACA was still in force — they thought it had been repealed by Congress or struck down by theSupreme Court. About half the respondents didn’t know how the law affects them personally. President Obama recently called the confusion exaggerated. For the nearly 85 percent of Americans with insurance from large employers or Medicare and Medicaid (programs for the elderly and poor), there would be little change, Obama said.
That’s probably true. But it still leaves a sizable enclave of ignorance — mainly among workers for small and medium-size firms and today’s uninsured. Under the ACA, companies with more than 50 full-time workers are required to provide insurance or pay a fine (now called a tax) of $2,000 per employee (the first 30 are excluded from the tax). Part-time workers, defined as those who work fewer than 30 hours a week, aren’t counted. And uninsured individuals are required to buy insurance or face a tax penalty that begins at $95 in 2014 and increases to $695 in 2016. How will these requirements work? Will smaller companies add insurance or drop it? Will uninsured individuals buy subsidized coverage in the exchanges or pay the tax?
To get some answers, I recently talked with the heads of four “professional employer organizations” (PEOs) — these are companies that act as “human resources” departments for small companies. They provide payroll services and advise on fringe benefits and government regulations. Their customers include construction companies, restaurants, small manufacturers and professional firms. Many of these firms are only now coming to grips with the ACA, because they’d assumed that the Supreme Court would invalidate it or that a Republican White House would repeal it.
To encourage candor, we talked on a not-for-attribution basis. I left with three main takeaways.
http://www.washingtonpost.com/opinions/robert-samuelson-the-fog-of-obamacare/2013/05/23/8ffaf340-c3ad-11e2-8c3b-0b5e9247e8ca_print.html
Kill Bill
By THOMAS B. EDSALL
United Republic, a liberal-leaning campaign finance reform organization dedicated to reducing the influence of money in American politics, recently produced a strikinggraphic that illustrates how corporate America wins huge breaks from Congress at very little cost.
According to statistics United Republic assembled, the prescription drug industry spent $116 million lobbying for legislation to prevent Medicare from bargaining down drug prices — legislation that enabled drug companies to make an additional $90 billion annually. That amounts to an extraordinary 77,500 percent return on investment. Oil companies, in turn, had a return on investment of 5,900 percent, and multinational companies, 22,000 percent.
While the general public may be angered by these reports, the lobbying industry loves them: what could be better publicity for attracting new clients? For example, the Carmen Group, a Washington lobbying firm, boasted on its Web site that for every dollar it collected in fees, clients got $100 in benefits.
Many studies demonstrate the profitability of lobbying. A Sunlight Foundation analysis of 200 corporations found that companies investing heavily in lobbying paid lower tax federal rates. According to Sunlight, seven of the eight companies that invested the most in lobbying between 2007 and 2009 (Figure 2) saw their tax rates lowered, and six of the eight saw rate declines of at least seven percentage points. In contrast, the median tax rate decline among all 200 companies was 0.6 percentage points:
Many studies demonstrate the profitability of lobbying. A Sunlight Foundation analysis of 200 corporations found that companies investing heavily in lobbying paid lower tax federal rates. According to Sunlight, seven of the eight companies that invested the most in lobbying between 2007 and 2009 (Figure 2) saw their tax rates lowered, and six of the eight saw rate declines of at least seven percentage points. In contrast, the median tax rate decline among all 200 companies was 0.6 percentage points:
Fig 2. Changes in Reported Tax Rates as Calculated by the Sunlight Foundation
One key advantage for corporate America in having a network of savvy lobbyists is its ability to capitalize quickly on unexpected developments. In a forthcoming book that he provided to The Times, Lee Drutman, a senior fellow at the Sunlight Foundation and an adjunct professor of political science at Johns Hopkins University and at theUniversity of California, District of Columbia, writes that propitious circumstances like these can arise out the blue:
It is also the case that opportunities come all of a sudden as well. Take the 2004 American Jobs Creation Act. What began as a simple fix to resolve a subsidy dispute with the World Trade Organization eventually evolved into a 633-page bill full of changes to the U.S. tax code. Those companies and industries whose lobbyists were well-placed were able to get their favored provisions into a bill that The Economist magazine dubbed “No lobbyist left behind.”
According to Drutman, with whom I exchanged a number of e-mails, a study in The Journal of Law and Politics, “Measuring Rates of Return for Lobbying Expenditures,” estimated that “companies that lobbied on the [jobs] bill got a return of 22,000 percent on their investment, $220 in benefits for every $1 spent on lobbying.”
UnitedHealth, Aetna and Cigna opt out of California insurance exchange
Kaiser Permanente, Anthem Blue Cross and Blue Shield of California are all expected to participate in the state-run market for individual health coverage.
By Chad Terhune, Los Angeles Times
5:59 PM PDT, May 22, 2013
UnitedHealth, the nation's largest private insurer, Aetna Inc. and Cigna Corp. are sitting out the first year of Covered California, the state's insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law.
Meanwhile, the biggest insurers in the state — Kaiser Permanente, Anthem Blue Cross and Blue Shield of California — are all expected to participate in the state-run market for individual health coverage.
Quiz: Test your healthcare knowledge
Covered California, the state agency implementing the federal Affordable Care Act, is announcing the winning bidders and proposed rates Thursday for its insurance exchange, where as many as 5 million residents are expected to shop for coverage next year.
The state has picked a group of health plans for each of 19 regions across California. The insurers will be selling policies with uniform benefits packaged in four broad categories of coverage. For the first time in the individual market, consumers will be able to make easier price comparisons among companies.
But the threat of higher premiums in next year's revamped market has been a major concern for policymakers who can't risk alienating too many middle-income, healthier customers who are needed to offset the increased costs of covering sicker, poorer people who have been shut out of the healthcare system for years.
UnitedHealth, Aetna and Cigna are small players now in California's individual health insurance market. More of their business is focused on large employers, where most Californians receive their health coverage. But the companies signaled a wait-and-see approach on these new government-run marketplaces.
http://www.latimes.com/business/la-fi-health-insure-20130523,0,7064278,print.story
Medical problem? Wait a minute
Pharmacy clinics are filling a role for patients when physicians can't.
Palm Beach Post
When Akim Reid needed a physical for his job, he couldn't turn to his regular doctor -- he doesn't have one. The Loxahatchee, Fla., resident called around for someone to do the exam. Everyone he called could see him -- next month.
So he went online for a clinic that could take him on short notice. He found one at his local pharmacy.
Wendy Sparapani has a pediatrician for her 16-year-old son Justin. But when Justin's persistent cough became overwhelming, she didn't even bother with the doctor's office. A pharmacy not far from her Jupiter, Fla., home could see him in minutes.
In the past decade, millions of Americans each year have skipped the doctor's office or emergency room and headed to a pharmacy for everything from a flu shot to treatment for strep throat.
The nation's largest drugstore chain, Walgreens, recently announced that staff at its 360 clinics can now assess, treat and manage more chronic illnesses such as asthma and diabetes.
Meanwhile CVS, where Reid and Sparapani sought help, boasts 640 Minute Clinics in the U.S. with plans to have 1,500 by 2017.
All of Maine’s acute-care hospitals have agreed to participate in statewide network that allows health care providers to share and view patients’ health records electronically.
HealthInfoNet, a Portland nonprofit that operates the health records exchange, announced Tuesday that 34 of the state’s hospitals already are connected to the system and four more are under contract to connect by the end of the year.
The exchange was launched in July 2009.
Maine is one of just a few states to have all of its hospitals connected to a health records exchange that allows providers to securely find and request information about patients from other providers, according to HealthInfoNet.
The federal government and many medical providers have urged the adoption of electronic health records as a way to improve patient care. Timely sharing of patient information is expected to help avoid hospital readmissions, medication errors, duplicate testing and improve diagnoses.
In other states, competition among hospitals has forced health information exchanges to slow the rollout of systems like HealthInfoNet, said Devore Culver, HealthInfoNet’s CEO.
“We’re lucky in Maine,” he said in a press release. “Our hospitals and ambulatory provider systems have chosen not to compete on patient data and agreed early on that creating a centralized system was in the best interest of patients.”
In addition to Maine’s hospitals, HealthInfoNet is connected to 376 ambulatory provider sites including primary and specialty care practices, federally qualified health centers, mental health agencies, home-health and long-term care providers.
The four hospitals under contract to connect to the exchange are Redington-Fairview Hospital in Skowhegan, Waldo County General Hospital in Belfast, York Hospital in York, and Northern Maine Medical Center in Fort Kent.
Hospitals that already are connected can choose to both share and view information or only view it. The majority of hospitals and larger physician practices are both sharing and viewing information, according to HealthInfoNet.
Throughout 2013, HealthInfoNet plans to expand the types of data shared by participating hospitals and continue to connect new ambulatory sites.
Loophole in health care law could stick doctors with tab
Published: Wednesday, May. 22, 2013 - 12:00 am
Last Modified: Wednesday, May. 22, 2013 - 7:59 am
A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills.
A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.
Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation - but insurers are responsible only for the first month.
Doctors say the liability might keep many physicians from participating in next year's program. A single prostate cancer patient's course of treatment can cost $93,000, they say.
"I do think there's legitimacy to their concerns," said Diana Dooley, head of the state Health and Human Services Agency and a trustee of Covered California, which is implementing the state's health care overhaul.
"At this point, it's speculation about how much of a problem it might be," she said.
Dooley said the state has discussed doctors' concerns with the federal government but that U.S. law provides no flexibility in the matter.
The U.S. Department of Health and Human Services, in written comments, conceded that nonpayment of premiums would "increase uncertainty for providers and increase the burden of uncompensated care." But it rejected a handful of proposals for cracking down on families whose policies lapse.
California Puts Tentative Price on Health Policies Under New Law
By REED ABELSON
California, widely seen as a model for how individuals will buy health insurance under the new health care law, announced Thursday that 13 insurers had been chosen to sell policies through the insurance marketplace — or exchange — being created under the law.
State officials said that rate increases for individuals who already had insurance would not be as high as some had feared. Blue Shield of California, for example, estimated its current customers would see rate increases of about 13 percent. Some estimates had suggested rate increases could be 30 percent. The increases are largely the result of higher prices and the need to cover people who now have no insurance and are likely to have expensive medical problems.
The new rates for individuals will be about the same — or lower — than the current rates for small businesses, according to officials from Covered California, the group operating the exchange.
“The changes in the market are really making individuals much more like employer groups,” Paul Markovich, the chief executive of Blue Shield, said. Like people who now receive health insurance through their employers, individuals buying policies on their own will be able to enroll next year even if they have a potentially expensive medical condition, and the policies’ benefits and premiums will be more standardized.
“We held insurers’ feet to the fire,” said Peter V. Lee, the executive director of Covered California, who said that the exchange had received interest from 33 insurers and actively negotiated with them over their proposed rates and the kind of network of doctors and hospitals they would offer. Covered California estimates that the plans offered will allow consumers access to about 80 percent of the state’s practicing physicians and hospitals.
While Washington, Vermont and several other states have also announced the details of their respective exchanges, California’s size and previous support for the health care law made it an important test of the law, said Paul B. Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan research group in Washington. “A lot of people will be watching California to see how well it succeeds,” he added.
California chose to behave more like Massachusetts in aggressively negotiating with insurers on behalf of its residents. But other states are, at least initially, taking a more passive approach, in which they do not try to bargain over rates.
The Outrageous Cost of a Gene Test
By DAVID B. AGUS
LOS ANGELES — ANGELINA JOLIE’S revelation that she had had a preventive double mastectomy was eloquent and brave. She had learned that she inherited a faulty copy of a gene, BRCA1, that put her at high risk for invasive breast cancer as well as ovarian cancer. Now women everywhere are asking: Should I get the same test? What will it cost?
Only one in about 400 women carry mutations to BRCA1 or to a related gene BRCA2, though such hereditary defects are implicated in between 5 percent and 10 percent of all breast cancers. The majority of the 230,000 cases of breast cancer diagnosed annually in the United States are not related to these genes. But if you’re that one in 400 women, you’d want to know so you could make informed decisions about your health care.
Unlike routine tests for diabetes or high cholesterol, however, the BRCA gene evaluation — performed by only one company in the United States, Myriad Genetics — is phenomenally expensive, with a “list price” close to $4,000 when a related genomic-rearrangement test is included in the analysis, which oncologists typically recommend.
The question is why? Today, molecular scientists like me can sequence all of an individual’s genes — at least 20,000 of them — for about $1,000. About five cents per gene.
One company, 23andMe, charges people $99 to see if they have gene variants that put them at higher risk for 120 diseases and whether they carry a known heritable mutation in an additional 50, including cystic fibrosis, sickle cell disease and Tay-Sachs disease. (I helped found one of that company’s competitors, Navigenics, which is now owned by Life Technologies. While I have no equity stake in these companies, I am paid a consulting fee by Life Technologies.)
23andMe uses a technology called genotyping, which identifies specific variants (or markers) within the genes that are associated with those diseases rather than sequencing the genes the way Myriad does — which makes the process much easier and, admittedly, less comprehensive in its analysis.
But plenty of other DNA tests are also dirt cheap in comparison. The test that identifies whether a woman carries one of several strains of human papillomavirus — strains that would sharply increase her risk of getting cervical cancer — generally costs under $100.
Myriad says the average patient with insurance coverage pays about the same or less out of pocket for its BRCA test. But lost in this answer is the fact that somebody — private insurance companies, Medicare, Medicaid — pays much of the rest. Ultimately, that means that all of us are paying in the forms of higher insurance premiums, co-payments and deductibles as well as higher taxes.
We’re paying this lofty price in large part because Myriad owns broad patents on these two BRCA genes, which it acquired in 1997 and 1998, respectively — and refuses to license the test to any other American company. (Last month, the Supreme Court heard arguments in a lawsuit challenging the appropriateness of those patents and is expected to deliver its decision by June.)
Maine Medicaid bill meets its fate: passed, vetoed
Minutes after Democrats' symbolic victory, LePage wipes it out and calls for a different bill to repay Maine's hospital debt.
AUGUSTA — Democrats in the Legislature knew that their signature policy achievement – a combination bill to expand public health insurance for the poor and pay off Maine's $186 million debt to its hospitals – was likely temporary
On Thursday, Gov. Paul LePage made it so.
Within minutes of the Senate's final passage of L.D. 1546, LePage and Republican lawmakers gathered in the State House Hall of Flags, where Democrats were preparing to hold their celebratory news conference. The governor, sitting at a desk beneath a bank of television cameras, quickly signed his veto message.
It was only a draft veto; the official bill hasn't yet hit his desk. But it was a symbolic end to what appears to be only a symbolic victory for Democrats, who used a high-risk strategy to get what they hoped would be a high-reward outcome, the expansion of Medicaid.
Shortly thereafter, Democrats gathered on the Hall of Flag's steps. They rolled out the props. A map showing the number of Mainers who would gain health insurance through Medicaid expansion. An oversized check made out to Maine's hospitals, now symbolically voided with LePage's symbolic veto.
Senate President Justin Alfond, D-Portland, and House Speaker Mark Eves, D-North Berwick, proceeded with the news conference, knowing the governor had pre-empted their event.
Eves, delivering his most forceful remarks as speaker, blasted LePage.
"Gov. LePage had an opportunity to prove to Maine people that he could compromise," Eves said. "He failed. He had an opportunity to put politics aside. He failed. Gov. LePage has failed to pay his bills. He failed to provide health care to people whose lives are on the line."
Eves urged Republicans to override the governor's veto. That appears unlikely.
Since taking office in 2011, LePage has vetoed about 20 bills passed by the Legislature. Only two vetoes have been overridden.
Our View: Lawmakers should override Medicaid veto
The governor wants his bill or nothing at all. But nothing would be the wrong choice for Maine.
Gov. LePage did not waste any time vetoing a bill that would pump hundreds of millions of dollars into Maine’s economy through payments of mostly federal money to the state’s 39 nonprofit hospitals.
Republicans in the Legislature should take their time before they decide what to do.
They should ask themselves a hard question: Whether backing the governor this time would really be good for the state.
At issue is about $180 million in state funds to be raised from a renegotiated liquor contract, unlocking federal matching funds to deliver about $500 million to the hospitals to pay for services rendered to MaineCarepatients in the past. In addition, the bill would expand eligibility criteria for Maine-Care so that about 70,000 working poor Mainers would be covered under the federal Affordable Care Act. The federal government would pay 100 percent of the program for the first three years and then no less than 90 percent after that.
Gov. LePage would sign the bill if it were just about paying off the old debt – it was, after all, a proposal he made the centerpiece of his legislative agenda. But he is so violently opposed to the Affordable Care Act that he is ready to reject his own top priority to win on a purely ideological point.
Republican lawmakers should be asking themselves if this is a wise way to move forward.
Bill Nemitz: LePage's tempest in a TV-gate
By Bill Nemitz bnemitz@mainetoday.com
Columnist
Columnist
Dear Governor LePage,
Be still my pounding heart. I'd no sooner sat down Thursday morning with my cup of Dunks when my iPhone lit up with news that you were leaving office.
"No!" screamed my inner journalist (the one that thanks the Good Lord above each and every day that you're Maine's chief executive). "We're barely past the halfway mark in his four-year term and now he's pulling a Sarah Palin? How can he do this to me?"
Turns out, much to my relief, you're not – at least not in the sense that you're stepping down from your position as governor to, say, open a fireworks emporium in Florida. (I'd already written the balloon caption for your smiling mug: "Go ahead ... light my fuse!")
Instead, you merely announced you were vacating your digs on the second floor of the State House because ... let's see here ... they won't let you keep your TV just outside in the Hall of Flags.
Let's go to the news release:
"Now they are saying the Governor of Maine cannot have a TV in the waiting area," you fumed. "Maine Democrats are taking their cue from the Obama Administration in Washington, D.C., which has violated the free-speech rights of American citizens and used the power of the government to silence those who disagree with them. If I have to remove myself from the toxic climate of censorship by Democrats in the State House to defend the taxpayers of Maine, then that's what I will do."
"Toxic climate of censorship" -- now there's a phrase guaranteed to get you some face time with Sean Hannity, huh Big Guy? Reminds me of the good old days when those pesky Dems had no power whatsoever and you yanked that mural from the Department of Labor's lobby because you thought it was too anti-business.
Say what? That wasn't censorship?
Oh right – the mural was an overtly political statement (see: liberal Democratic agenda) that detracts from the dignity and decorum of a hall of state government.
This flap, on the other hand, involves an overtly political statement (see: conservative Republican values) that is perfectly appropriate for ... a hall of state government.
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