7 Ways Obamacare's Surrender to Hospital and Big Pharma Profits May End Up Coming Out of Our Wallets | Alternet
With the one-year anniversary of the Supreme Court ruling upholding the Affordable Care Act near, it’s time to ask if the decision to put the burden of cutting costs on patients, not corporate healthcare profiteering, is the fatal flaw in the plan.
The law’s tepid cost control measures targeted at healthcare spending that is gobbling up an increasing percentage of the economy and pricing more people than ever out of access to care have been widely viewed as the ACA’s biggest pitfall. But from the outset, the Obama administration dismissed the most effective means to reduce costs by a) refusing to consider a single payer alternative that combines genuine universal coverage not based on ability to pay with global budgeting, b) rejecting a proposal to authorize the federal government to negotiate bulk purchasing (a concession to the drug companies), and c) failing to regulate price gouging by hospitals, drug companies, insurers and other healthcare corporations. Those fateful decisions left only one option for significant reduction of overall health expenditures – saving money in the delivery of care by shifting costs to those who use health services and discouraging them from getting care even if they have insurance. Perhaps that’s not surprising given the decision to craft the ACA in concert with pharmaceutical, insurance, hospital, and Chamber of Commerce lobbyists, and, as recently reported, top Wall Street investment firms and hedge fund executives. Here are several ways the ACA shifts the hardship of cost cutting to those who need care, and promotes delivery models that result in limiting care, even among those with health insurance.
Kaiser's Obamacare rates surprise analysts
Kaiser Permanente has offered some of the highest rates in the California health exchanges next year. It denies that it is doing so to avoid treating many of the sickest newly insured patients.
By Chad Terhune, Los Angeles Times
6:28 PM PDT, June 12, 2013
The healthcare giant has the highest rates in Southern California and some other areas of the state, surpassing rivals such as Anthem Blue Cross and other smaller competitors. The relatively high premiums from such a strong supporter of the federal healthcare law surprised industry analysts, and it has sparked considerable debate about the company's motives.
Some experts say Kaiser intentionally bid high to avoid drawing too many customers next year who are sick or who have been uninsured for years and may be costlier to treat. Others suspect Kaiser was worried that lower premiums would bring an influx of newly insured patients that could overwhelm its in-house roster of doctors and hospitals.
Making health insurance affordable is a crucial factor in the expansion of coverage to an estimated 5 million Californians — many of them lower-income and the uninsured — who will be eligible for a state-run exchange next year. Price will be paramount to many consumers, even for those who receive federal subsidies to help lower their costs.
In one key barometer of rates, Kaiser has the most expensive premiums for a 40-year-old in Los Angeles, Orange, San Bernardino and Riverside counties for a mid-level Silver plan. Statewide, the nonprofit company has the highest or second-highest premiums for a Silver plan in 12 of the 18 regions where it's selling HMO policies in Covered California, the state market that opens for enrollment Oct. 1.
Kaiser's Silver plan premium for a 40-year-old in southern Los Angeles County is $325 per month, 34% higher than the cheapest policy in the area, from Health Net Inc., at $242.
"Kaiser is not as low cost as many people think," said Glenn Melnick, a USC health policy professor. "They appear to be protecting themselves because the people signing up in the first year are likely to be the sickest ones."
For its part, Kaiser says it was as surprised as others were when the state announced the 13 winning health insurers and their proposed rates for 19 regions last month. These rates are scheduled to be finalized this month after a regulatory review. Individual premiums will vary based on people's age, location and family size.
Despite its higher rates, Kaiser said it wants to enroll a large number of people in the state exchange. It blamed its lackluster showing, in part, on rivals offering cheaper plans that give consumers far less choice of doctors and hospitals.
Blue Shield of California, for instance, is offering 36% of its physician network in Covered California plans.
"We were surprised to see some of the rates," said Bill Wehrle, Kaiser's vice president of health insurance exchanges. "We were surprised at what looked like very narrow networks from our competitors. We don't cut off any slice of our network."
http://www.latimes.com/business/la-fi-kaiser-health-rates-20130613,0,258866,print.story
Central labor councils to AFL-CIO: Strengthen Social Security & pass Improved Medicare for All
By Kay Tillow
Single Payer News, June 2, 2013
Four central labor councils have passed an identical resolution calling upon the September AFL-CIO convention to organize an offensive campaign for expanding Social Security financing and passing improved “Medicare For All” legislation.
The resolution, which was initiated by the Troy Area Labor Council, has also been passed by the Greater Louisville Central Labor Council, the Greater Green Bay Central Labor Council and the Capital District Area Labor Federation in Albany, N.Y.
The resolution calls upon the AFL-CIO to organize a Solidarity Day march on Washington and on the West Coast “to demand an expansion of Medicare to cover everyone and to defend Social Security by removing the cap on income and tax all income in a similar fashion.”
The resolution calls for taxing all income for the purpose of Social Security including dividends, interest, capital gains, and rental income as well as removing the cap on wages and salaries now set at $113,700. Currently, those who earn up to $113,700 pay 6.2 percent in Social Security taxes on every dollar. Those who earn over that amount do not pay taxes on their earnings above that level even if they make millions. Currently the income of the wealthy in dividends, interest, capital gains, etc. is not taxed at all for Social Security.
On Medicare the resolution calls for “implementing a single Payer Medicare for All system as outlined in H.R. 676,” Congressman John Conyers’ single-payer legislation which has 43 House co-sponsors. The legislation would cover everyone for all medically necessary care without co-pays, deductibles or premiums. The removal of the private health insurance industry would bring costs under control while expanding care.
http://www.pnhp.org/print/news/2013/june/central-labor-councils-to-afl-cio-strengthen-social-security-pass-improved-medicare-f
Single Payer News, June 2, 2013
Four central labor councils have passed an identical resolution calling upon the September AFL-CIO convention to organize an offensive campaign for expanding Social Security financing and passing improved “Medicare For All” legislation.
The resolution, which was initiated by the Troy Area Labor Council, has also been passed by the Greater Louisville Central Labor Council, the Greater Green Bay Central Labor Council and the Capital District Area Labor Federation in Albany, N.Y.
The resolution calls upon the AFL-CIO to organize a Solidarity Day march on Washington and on the West Coast “to demand an expansion of Medicare to cover everyone and to defend Social Security by removing the cap on income and tax all income in a similar fashion.”
The resolution calls for taxing all income for the purpose of Social Security including dividends, interest, capital gains, and rental income as well as removing the cap on wages and salaries now set at $113,700. Currently, those who earn up to $113,700 pay 6.2 percent in Social Security taxes on every dollar. Those who earn over that amount do not pay taxes on their earnings above that level even if they make millions. Currently the income of the wealthy in dividends, interest, capital gains, etc. is not taxed at all for Social Security.
On Medicare the resolution calls for “implementing a single Payer Medicare for All system as outlined in H.R. 676,” Congressman John Conyers’ single-payer legislation which has 43 House co-sponsors. The legislation would cover everyone for all medically necessary care without co-pays, deductibles or premiums. The removal of the private health insurance industry would bring costs under control while expanding care.
http://www.pnhp.org/print/news/2013/june/central-labor-councils-to-afl-cio-strengthen-social-security-pass-improved-medicare-f
Compromise on Medicaid expansion at risk of LePage veto
AUGUSTA — A compromise bill to expand the public health insurance program for the poor passed in the House on Wednesday without significant support from Republicans, who have been urged by Gov. Paul LePage to reject the key component of the federal health care law.
The House voted 97-51 to approve an amended version of L.D. 1066, a bill that supporters say would extend health insurance to more than 60,000 Mainers through MaineCare, the state’s Medicaid program.
The amended bill is identical to the proposal that the Senate passed 23-12 last week. Three Republican senators supported the measure after Sen. Roger Katz, R-Augusta, proposed the amendment to address Republicans’ concerns.
Five House Republicans voted for the original version of L.D. 1066 last week. Six supported the amended bill Wednesday. Democrats, who have majorities in the House and Senate, are still hopeful that Republicans will help them override an almost certain veto by LePage.
“We were able to come together with Republicans to get a good deal for Maine,” said Rep. Linda Sanborn, D-Gorham, the bill’s lead sponsor. “We can’t pass up this deal. If we don’t accept this money, Maine people will lose health care while other states accept these dollars.”
http://www.pressherald.com/politics/house-republicans-remain-cool-to-maine-medicaid-expansion-compromise_2013-06-12.html
Our View: Lawmakers will have one last chance to expand MaineCareIrrational GOP threatens Medicaid expansion
Posted June 12, 2013, at 10 p.m.
Once again, Maine Republican lawmakers have shown they will withhold health care coverage from this state’s poorest residents to spite federal health reform. The arguments that members of the Maine House made Wednesday in opposition to Medicaid expansion were appalling.
It won’t matter that 97 representatives voted to support a Medicaid expansion compromise measure on Wednesday, while 51 were opposed. The House needs four more votes to override an anticipated veto from Gov. Paul LePage. Apparently just enough members are listening to the ill-informed rhetoric of their House colleagues.
Rep. Richard Malaby, R-Hancock, spoke on the House floor of how increasing Medicaid eligibility under the Affordable Care Act would be “expanding a program I feel is broken.” There’s no doubt Maine’s Medicaid program for the poor and disabled, MaineCare, can deliver services more efficiently. Lawmakers have the power to suggest and approve changes, and improvements don’t have to happen separate from expansion.
Rep. Michael Nadeau, R-Fort Kent, meanwhile, argued that the state should not expand Medicaid when as many as 3,100 people remain on a waitlist for services. “My constituents are going to say, ‘We’ve neglected this group of people,’” he said.
Of course Medicaid expansion and taking care of people with developmental disabilities on the waitlist are not mutually exclusive options. To be clear, the people on the list already have health care. They are waiting for services to help them be as independent as possible in their homes, work and communities. Using them as an excuse to not provide health care to others is a cruel diversionary tactic.
Rep. Ken Fredette, R-Newport, the House minority leader, used an unfortunate analogy to convey a point about the cost of expansion — and later apologized. He said the Medicaid expansion debate reminded him of the relationship guide, “Men are from Mars, Women are from Venus.”
“Now my brain, being a man’s brain, sort of thinks differently because I say, ‘Well, it’s not, if it’s free, is it really free?’ because I say, in my brain, ‘There’s a cost to this.’”
The federal government would cover 100 percent of the costs of newly eligible individuals for three years and then slowly drop down to 90 percent. Even though the reputable Kaiser Family Foundation has estimated Maine would be one of 10 states likely to save money on Medicaid over the next decade if it expands, people have said it doesn’t matter because federal spending comes from taxpayer dollars, too.
Aside from the fact that Maine receives more dollars than it sends to the federal government, the point of expansion is to not only improve health but actually reduce health care costs — a benefit to everyone. A study by the Rand Corporation, a nonpartisan research institution, analyzed the effect of 14 states opting out of expansion.
http://bangordailynews.com/2013/06/12/opinion/editorials/irrational-gop-threatens-medicaid-expansion/print/
Maine lawmakers will get one more chance to do the right thing when it comes to providing health care to people in need.
On Tuesday, the House voted 97-51 to accept federal funds under the Affordable Care Act to insure as many as 70,000 people under the MaineCare program. That follows a 23-12 vote in the state Senate to expand the program. Normally, that would show strong support for a measure that was on its way to becoming a law, but no one expects it to be that easy.
The bill is headed for a likely veto by Gov. LePage, who has voiced his ideological opposition to the Affordable Care Act and the belief he shares with a handful of other tea party governors that the states can kill the program by refusing to participate in it.
He has already vetoed it once, and if he does it again, the proposal will then come back to the Legislature, where it would take a two-thirds vote from both houses to override. If the last votes don’t change, the bill will be a couple of votes short in both houses.
Republicans should not let that happen. The Maine people they represent have too much to lose.
“Man’s brain” means no health expansion? Barbie might agree
Earlier today, House Minority Leader, Republican Ken Fredette attributed his opposition to Medicaid expansion to having a “man’s brain.”
Evidently, having a “man’s brain” means he “thinks differently” so he understands “there’s a cost to this.”
Now, the nonpartisan Kaiser Foundation analysis found that Maine will come out way ahead financially if we expand Medicaid. That analysis was repeated in a report by the far-right Heritage Foundation. It’s also been established that Medicaid expansion improves health and reduces deaths.
Besides the policy realities, this comment was insulting to both women and men. It’s obvious why that’s so for women. It’s also insulting to men because it means that if they support Medicaid expansion they’re somehow unmanly, as they’re like a woman. That’s how misogyny works.
But what do I know? I have a woman’s brain.
As Teen Talk Barbie once said, “Math class is tough!”
http://pollways.bangordailynews.com/2013/06/12/maine-politics/mans-brain-means-no-health-expansion-barbie-would-agree/
Despite strong majority, LePage ‘good Samaritan’ veto stands
AUGUSTA – Gov. Paul LePage’s streak was extended Wednesday when 14 Republicans in the Senate voted to uphold his veto of a bill offering protection from prosecution when someone seeks medical help for a drug overdose.On Tuesday, by a 97-47 margin, the House overrode the governor’s veto of L.D. 1044, sponsored by Rep. Ann Dorney, D-Norridgewock. That was one vote more than the two-thirds majority needed to override.
But the Senate’s 21-14 tally fell three votes short, leading Democrats to criticize Republicans for sticking with LePage.
“In essence, this is a good Samaritan law,” said Sen. Geoffrey Gratwick, D-Bangor, a rheumatologist.
“The unfortunate fact is that overdoses and drugs are a scourge on our state, but also a fact of life. The sooner you dial 911, the sooner you get help, the better off you are.”
The House has voted to override three LePage vetoes -- on this bill, a school CPR training bill and a bill that would have required government agencies to make good on payment agreements with county registries of deeds.
In each case, Senate Republicans voted to uphold the vetoes.
Maine Senate approves hospital repayment plan
Posted June 13, 2013, at 6:53 a.m.
AUGUSTA, Maine — The state Senate unanimously passed a bill that uses funds from the state’s wholesale liquor business to finance a bond to pay off Maine’s $183.5 million hospital debt.
The debt, which arises from services provided under MaineCare, the state and federal health insurance program for low-income individuals and families, triggers another $300 million federal matching payment.
The debt repayment plan was first offered by Gov. Paul LePage five months ago. In May, LePage vetoed a bill that included his payment proposal because it also expanded the state’s MaineCare program, making an estimated 70,000 childless adults eligible for the program.
The Senate passed the legislation without debate and “under the hammer” late Wednesday night.
The bill will move next to the House and will face at least one additional vote in the Senate before going to LePage for his signature.
A press release issued by Senate Democrats late Wednesday said the measure, if approved before Oct. 1, will save the state an estimated $5 million as the federal matching rate for the services provided will decrease then.
“We cannot use political reasons to dodge paying our hospitals,” Senate Majority Leader Seth Goodall, D-Richmond, said in a prepared statement. “We are all in agreement that we will make our final payment to the hospitals, which is exactly what today’s vote will do.”
Goodall noted the previous bill sent to LePage and urged him to accept the bill, which is largely LePage’s proposal.
EMHS on budget as other Maine hospitals struggle financially
Posted June 13, 2013, at 9:26 a.m.
BREWER, Maine — About 60 percent of Maine hospitals are operating at a loss, but Eastern Maine Healthcare Systems isn’t among them, according to EMHS President and CEO Michelle Hood.
Hood, citing 2012 figures compiled by the Maine Hospital Association, laid out the system’s financial picture Wednesday at an annual meeting of EMHS corporators, a group of volunteer community members who provide oversight of the health organization.
The tough economic climate has contributed to financial struggles at some hospitals in Maine, and many are likely to respond by downsizing, joining bigger systems and looking for new business models, Hood said.
The Maine Hospital Association described the 60 percent figure as “an unusually high number of hospitals” operating at a loss last year.
“We are very proud of the fact, and a lot of hard work has gone into this, that as a system at mid-year of our current fiscal year that we are close to our budget and producing a nice, healthy bottom line,” Hood said.
During the last fiscal year, EMHS brought in revenues of just more than $1 billion, up from $954 million in 2011. The system’s operating margin, an indicator of how efficiently its hospitals are run, totaled 5.65 percent, meaning the system made, on average, just under 6 cents for every dollar in patient revenue it collected. That’s a jump from a 2.03 percent operating margin in 2011.
The national average is 5.5 percent, according to the American Hospital Association.
EMHS officials attributed much of the increase to one-time income, including $16.7 million in federal money the system was awarded for implementing electronic health records and a $25 million settlement with the state over MaineCare reimbursements. The settlement, which involved costs due to the system through MaineCare, is separate from the MaineCare money owed to hospitals now being hotly debated in the state Legislature.
Hood also updated the corporators on the system’s proposed merger with Portland’s Mercy Health System of Maine. EMHS hopes the deal, which won federal approval in late February, will win a greenlight from state regulators in August, she said.
Dr. Philip Caper of Brooklin, an EMHS corporator and Bangor Daily News columnist, asked Hood how the merger could affect care as EMHS seeks to keep patients within its network of providers. EMHS has informed both Mercy and its Portland competitor, MaineHealth, that patients aren’t expected to travel from southern Maine to Bangor for treatment, she said.
“It does call on us to have difficult discussions with the Portland market providers as to how a patient experiences care in that community in a less competitive and more collaborative fashion,” she said. “Not easy.”
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