Canadians pay taxes for universal health care, and now they’re richer than us
Posted June 20, 2013, at 1:02 p.m.
I’ve been watching with some dismay the wrestling match going on between the governor and the Maine Legislature over the opportunity offered by the federal Affordable Care Act to expand our MaineCare program.
Proponents of expansion of MaineCare make their argument on both moral and economic grounds. Such expansion would provide health care coverage for almost 70,000 low-income Mainers who will otherwise receive no assistance from the ACA. More coverage would result in better management of our burgeoning level of chronic illness as our population ages. That will drive down the use of expensive crisis-oriented emergency services as well as the illness-inducing stress produced by out-of-control health care bills in low-income patients already afflicted by poor health.
Since 100 percent of the costs of the proposed expansion would be borne by the federal government for at least the first three years of the program (gradually reduced to 90 percent by 2020), MaineCare expansion under the ACA would also provide significant economic benefits to Maine in the form of federal dollars and the jobs they will create in every county in the state. According to a new study released last week by the Maine Center for Economic Policy and Maine Equal Justice Partners, if MaineCare were expanded under the terms of the ACA it would stimulate more than $350 million in economic activity, lead to the creation of 3,100 new jobs, and result in the generation of up to $18 million in state and local taxes.
Since the Legislature has now refused to override the governor’s veto of the expansion, those federal dollars (including those originating from Maine taxpayers) and their associated benefits will go to other states that accept the deal.
Some opponents of expansion claim that they don’t trust the feds to keep their word (even though it’s now written into law) and that we won’t be able to get rid of the extra costs should they renege on their commitment. Others are simply philosophically opposed to bigger government. It seems as though some are opposing MaineCare expansion simply out of spite.
This fight could be avoided, and is just a symptom of a more fundamental underlying disease — the way we pay for health care in the U.S. Our insurance-based system requires that we slice and dice our population into “risk categories.”
This phenomenon was made worse by PL 90, the “pro-competition” health insurance reform law passed by the Republican legislature in 2011. Now we’re seeing older, rural Mainers pitted against younger, urban ones. This type of discrimination is the very basis of the insurance business.
GAO Report Points To Challenges In Setting Up Federal Health Insurance Marketplaces - Kaiser Health News
Testing of computer systems and training of consumer assistance guides are behind schedule, but the Obama administration has met other deadlines in its efforts to open new marketplaces where millions of consumers might shop for insurance starting this fall, according to a Government Accountability Office report released Wednesday.
The report said that the Centers for Medicare & Medicaid Services, or CMS, "has many key activities remaining to be completed," including those that deal with eligibility and enrollment in the exchanges, development and implementation of a "data hub" that will connect the exchanges with other federal and state agencies to determine applicants' eligibility, and review and certification of the health insurance plans offered to consumers.
Tax, Accounting Firms See Opportunity In Health Law
By Eric Pianin and David Francis, The Fiscal Times
Early this year, officials at Littler Mendelson, the largest U.S.-based law firm representing management in employee benefits and labor law, surveyed the landscape as the Obama administration began implementing the Affordable Care Act. They knew big money was to be made.Businesses large and small were grappling with how – or even whether – to comply with the new federal mandates for providing health insurance to full-time workers. Many feared the costs would be staggering and could put them at a competitive disadvantage or drive them out of business.
Littler Mendelson responded by forming a separate health care consulting group with over 20 top attorneys to advise clients on how to minimize their costs and taxes. The giant firm – with more than 900 lawyers operating from 55 offices nationwide – also created an online service to help companies determine liabilities and costs under Obamacare. New business started pouring in.
“We’re advising hundreds and hundreds if not thousands of businesses,” Steven Friedman, co-chair of the firm’s employee benefits practice group, told The Fiscal Times. “We’re working with employers to determine if there are strategies they can employ to somehow mitigate the effects of the law . . . and we’re coming up with some innovative solutions.”
It all costs money, folks! But what value does it Add?
- SPC
The Heart Perils of Pain Relievers
By RONI CARYN RABIN
Common pain relievers like ibuprofen and naproxen — called nonsteroidal anti-inflammatory drugs, or Nsaids — are the go-to drugs for headaches and pulled muscles, arthritis and menstrual cramps. Their labels have long warned that overuse may increase the risk of heart attack and stroke, but we rely on them as we do on few other medications. And for good reason: They work.
Occasional use of Nsaids is not likely to lead to cardiovascular consequences. But an authoritative and ambitious new analysis that included data from over 600 trials, including detailed case histories of more than 350,000 patients, concludes that people who take high doses of Nsaids daily increase their cardiovascular risk by as much as a third, compared with those taking a placebo. The one exception is naproxen, which may actually have a protective effect against heart attacks.
The absolute risk of cardiovascular trouble for those who take high doses of other Nsaids regularly is still quite small. Nonetheless, the findings suggest that people who rely on them may want to explore alternative pain management methods, especially if they have other risks for heart disease, or a family history of it.
“There aren’t really good choices for chronic pain,” said Dr. Marie R. Griffin, a preventive medicine specialist at Vanderbilt University Medical Center who wrote a commentary on the new study, published last month in The Lancet. In addition to the potential harm, Dr. Griffin said, painkillers like Nsaids often don’t really do the job when it comes to chronic pain.
“If these drugs are making your life a lot better, that may be worth the risks,” she said. “But a lot of people will tell you, ‘I can’t tell if they’re doing anything, I just take them every day anyway.’ ” Nsaids include ibuprofen, sold under the brand names Motrin and Advil; naproxen, sold as Aleve, Naprosyn, Anaprox and Naprelan; and celecoxib, sold as Celebrex and available only by prescription.
Aspirin, also an Nsaid, is primarily used in low doses to prevent heart disease and was not included in the analysis.
A.M.A. Recognizes Obesity as a Disease
By ANDREW POLLACK
The American Medical Association has officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition and spur more insurers to pay for treatments.
In making the decision, delegates at the association’s annual meeting in Chicago overrode a recommendation against doing so by a committee that had studied the matter.
“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 diabetes and heart disease, which are linked to obesity.
To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority.
Still, some doctors and obesity advocates said that having the nation’s largest physician group make the declaration would focus more attention on obesity. And it could help improve reimbursement for obesity drugs, surgery and counseling.
“I think you will probably see from this physicians taking obesity more seriously, counseling their patients about it,” said Morgan Downey, an advocate for obese people and publisher of the online Downey Obesity Report. “Companies marketing the products will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized obesity as a disease.’ ”
Two new obesity drugs — Qsymia from Vivus, and Belviq from Arena Pharmaceuticals and Eisai — have entered the market in the last year.
Qsymia has not sold well for a variety of reasons, including poor reimbursement and distribution restrictions imposed because of concerns that the drug can cause birth defects. Those restrictions are now being relaxed. Belviq went on sale only about a week ago, so it is too early to tell how it is doing.
Aetna to exit a key market in California
Nearly 50,000 Aetna customers with individual health policies in California will need to find new coverage.
By Chad Terhune, Los Angeles Times
June 19, 2013
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Facing tougher price competition from a state-run marketplace, Aetna Inc. said it would exit California's individual health insurance market by year-end and leave nearly 50,000 customers searching for new coverage.
Aetna, the nation's third-largest health insurer, will maintain a major presence in California with a focus on large and small employers. But the move reflects how the federal healthcare law and its rollout in different states is rapidly reshaping the health insurance landscape for millions of consumers.
California Insurance Commissioner Dave Jones expressed concern about reduced competition from Aetna's departure, but other industry experts predicted that the company wouldn't be missed much given its small share of the individual market. They viewed Aetna's retreat as a sign the company didn't have enough market power in California to aggressively compete on price against a lineup of new and established rivals in the state's health exchange.
Aetna and two other big insurers, UnitedHealth Group Inc. and Cigna Corp., chose not to participate in Covered California, the state-run market opening Jan. 1 as part of the Affordable Care Act. Instead, the state selected 13 other health plans last month and announced proposed rates that were lower than expected.
California, more so than other states, is forcing insurers to compete for consumers more directly on price by requiring them next year to offer uniform deductibles and benefits across four main product categories. In turn, insurers have resorted to squeezing hospitals and physician groups for better rates and forming smaller networks of medical providers to hold down premiums.
"National companies that don't have a strong local presence may not be able to compete on price very well if they don't have the best networks or best discounts," said Gary Claxton, a vice president at the Kaiser Family Foundation, a nonpartisan research group. "Aetna has places where it is stronger."
http://www.latimes.com/business/la-fi-aetna-health-insurance-20130619,0,3823146,print.story
Blue Shield may take L.A. contract from Anthem Blue Cross
The health insurer wins a benefits panel's support. If finalized, about 27,000 L.A. workers and their families with Anthem coverage would face a change.
Blue Shield of California, already facing a Los Angeles ethics complaint over potential conflicts of interest, is poised to take a lucrative health insurance contract for city workers away from rival Anthem Blue Cross.The proposed three-year deal is still subject to approval by L.A. Mayor Antonio Villaraigosa. Under Blue Shield's offer, the city would pay 2% more, or $112 million, in premiums next year for these HMO and PPO plans.
That was nearly $9 million less than Anthem's $121-million bid, which represented a 10% increase over the current year. Despite those initial savings, city staff and their outside advisors twice recommended Anthem's bid as the better choice.
But last week a benefits committee of city officials and labor leaders overruled the staff's recommendation and voted 8 to 1 in favor of Blue Shield's bid.
About 27,000 city workers and their families with Anthem coverage face a change if the city goes forward with Blue Shield. It's estimated 7% of Anthem's members would lose access to their current doctor because of the switch.
An additional 32,000 city employees and dependents who have coverage with Kaiser Permanente aren't affected because the city plans to renew its Kaiser contract. Most Los Angeles police officers, firefighters and employees at the Department of Water and Power are covered by separate contracts.
The city pays 98% of its employees' health insurance costs, and the proposed contract with Blue Shield reduces the likelihood that workers will be asked to pay more for their healthcare next year.
That was a major reason the Service Employees International Union Local 721, which represents 10,000 city workers, heavily promoted Blue Shield. And an SEIU leader who sits on the city's benefits panel voted in favor of Blue Shield. "Give Blue Shield's cost-efficient proposal the fair consideration it deserves. Don't rush to hand costly Anthem our business," SEIU said in a flier last week.
SEIU has close ties with Blue Shield. The union's state office employs a Blue Shield executive, Mark Weideman, as a lobbyist, paying him $376,000 since 2011. That same Blue Shield executive worked previously as a lobbyist for the city's Department of Water and Power.
http://www.latimes.com/business/la-fi-city-health-contract-20130618,0,300288,print.story
Legislature fails to override LePage Medicaid veto
It passes with a strong majority, but not enough to be veto-proof and expand health care to 60,000 more Mainers.
By Steve Mistler smistler@pressherald.com
Staff Writer
Staff Writer
AUGUSTA – Democrats' last-ditch effort to extend public health insurance to more than 60,000 low-income Mainers failed in the Legislature on Wednesday, ending, at least for now, one of the more heated battles of this legislative session.
The outcome was sealed in the House when a majority of Republicans sided with Gov. Paul LePage in upholding his veto of L.D. 1066, a bill that would have broadenedMedicaid, the public insurance program for the poor, through the federal Affordable Care Act.
The final 95-52 vote fell three votes short of overriding the veto. Four Republicans voted with the Democratic majority to override the veto.
It takes two-thirds of the lawmakers present and voting in both chambers to override a veto.
After the vote, House Speaker Mark Eves, D-North Berwick, said supporters of expansion did everything they could.
He said expansion failed "because of one person -- and that person is Gov. Paul LePage."
Rep. Kenneth Fredette, R-Newport, the House minority leader, said the vote showed that Democrats had not convinced Republicans of the merits of Medicaid expansion. He accused the majority party of attempting to "muscle it through" the Legislature.
Maine House deals final blow to Medicaid expansion
Posted June 19, 2013, at 3:01 p.m.
AUGUSTA, Maine — In two votes Wednesday, the Maine House fell short of overriding Gov. Paul LePage’s veto of a bill calling for the state to expand eligibility for Medicaid, the state-federal low-income health insurance program, as allowed by the federal Affordable Care Act.
The House voted 97-52 Wednesday afternoon and 95-52 Wednesday evening to override LePage’s veto of LD 1066, a bill calling for the expansion. Those tallies fell short of the two-thirds threshold needed to override a veto, effectively killing the measure, which was one of the Democrats’ top priorities this session.
Following the afternoon vote, House Democrats used parliamentary maneuvers to push for reconsideration of the veto later Wednesday. But the bill died in a hastily called vote that occurred without debate as soon as the House reconvened just before 8 p.m.
The Democratic majority pulled out all the stops to keep the Medicaid expansion bill alive.
Two Democratic House members who have been absent much of the session for health reasons — Reps. Matt Peterson of Rumford and Paulette Beaudoin of Biddeford — turned out for the first veto override vote. And Democratic Leader Seth Berry voted at first to sustain the veto, a procedural move that allowed him to push for reconsideration of the override vote.
Republicans objected to the reconsideration move. “The final tally was recorded,” said House Republican Leader Kenneth Fredette. “This action has been resolved.”
Two Republicans were absent for the initial vote — Reps. Peter Doak of Columbia Falls and Thomas Tyler of Windham. Tyler has been among a small group of Republicans who have repeatedly voted for the Medicaid expansion measure.
Wednesday’s House votes represent another victory for LePage, who has opposed Medicaid expansion as a financially unsustainable broadening of “welfare.” He previously vetoed an earlier bill that linked Medicaid expansion to repaying a $484 million Medicaid debt to the state’s hospitals. The Senate sustained that veto.
The Legislature subsequently passed a bill to repay the state’s remaining Medicaid debt to hospitals. Democratic legislative leaders also advanced another bill, LD 1066, in a second attempt to pass Medicaid expansion. LePage vetoed that bill Monday evening, setting up Wednesday’s showdown in the House.
Expanding the state’s Medicaid program would provide coverage for about 50,000 adults without children who earn up to 133 percent of the federal poverty level, or $20,628 for a two-person household. The expansion also would prevent about 25,000 parents and childless adults from losing their Medicaid coverage starting Jan. 1, 2014.
Democrats have argued that Medicaid expansion wo
MaineCare’s payday will help hospitals but patients unlikely to see lower rates
Posted June 18, 2013, at 6:20 p.m.
AUGUSTA, Maine — Last week Gov. Paul LePage signed a bill to pave the way for Maine to cover its $183.5 million tab to 39 hospitals for services provided over the years to patients enrolled in the state’s Medicaid program. Once paid, the federal government will kick in $300 million.
Now that the state plans to pay back its longstanding MaineCare debt to hospitals, how will the institutions spend the money?
The shortlist includes capital investment projects, bolstering finances and covering operating costs, according to hospital spokespeople. The debt payments, however, will not lead to changes in rates for patients with private insurance.
Eastern Maine Healthcare Systems’ seven member hospitals expect to receive a combined $115 million, which covers bills going back to 2005, according to Derrick Hollings, the health care system’s chief financial officer.
The network will use the funds to repay credit lines hospitals had to draw on to cover operating costs it struggled to pay with the outstanding debt, Hollings said.
“And of course we have a workforce that have not received pay increases regularly since 2005,” Hollings said. “This is going to position us so we could look at that.”
The nine hospitals in MaineHealth’s system will receive a combined $133 million, which will be used for capital improvements and help shore up finances, according to Katie Fullam Harris, MaineHealth’s vice president of employer and government relations.
“These payments will allow our hospitals and health system to continue to provide high quality care,” Fullam Harris said.
Faced with a $13.4 million operating loss, Maine Medical Center, the largest MaineHealth hospital, instituted a hiring freeze in May. The state owes the hospital approximately $67 million for years of underpayments from the MaineCare program, according to Albert Swallow, the hospital’s vice president of finance.
“Over that time we have lost the opportunity to use those funds for capital investment purposes and to earn investment income,” Swallow said in an email.
State releases details of new Anthem health insurance plan
Posted June 19, 2013, at 9:16 a.m.
LEWISTON — The state on Tuesday released the list of doctors and hospitals that Anthem Blue Cross and Blue Shield will allow patients to use in its newly proposed insurance plan.
The provider list includes some Central Maine Healthcare medical employees, including audiologists, dietitians and nurse practitioners, but it does not include Central Maine Medical Center in Lewiston, Rumford Hospital or Bridgton Hospital as allowed hospitals.
At issue is a proposal by Anthem, the state’s largest health insurer, to partner with MaineHealth, the state’s largest health-care organization, to offer new individual and small-group insurance plans for the upcoming Affordable Care Act health insurance exchange. Thousands of Mainers could be eligible to receive federal subsidies to pay for insurance.
Anthem has asked the Maine Bureau of Insurance to keep secret much of its proposal — including the provider network — as it seeks approval for the new insurance plan.
Officials from Central Maine Healthcare, the parent organization of Central Maine Medical Center, Rumford and Bridgton hospitals, believe the public hasn’t had the time or the information necessary to comment on the proposal.
CMHC filed suit in Kennebec County Superior Court late last week against Eric Cioppa, superintendent of the Bureau of Insurance, and the Maine Department of Professional and Financial Regulation, in an effort to get provider network and other Anthem insurance plan information released to the public.
CMHC officials believe a restricted provider network would limit patient choice and force some to drop their doctors and seek medical care out of town.
When Fear Is a Barrier to Good Care
By MIKKAEL A. SEKERES, M.D.
“Good luck; I told him you were on your way in,” one of the nurses said to me, not a little ruefully, before I walked into the young man’s hospital room. I had heard the stories and steadied myself before entering.
At 20 years old, my patient had already done a couple of stints in jail, fathered several children and had no permanent address, bouncing from one girlfriend’s apartment to another’s. Then he developed leukemia and was confined to the hospital for weeks, the last two of which he had spent cursing the staff and refusing many of the medications and tests that had been prescribed.
“Good morning,” I said, turning on the light in his room as my residents and fellows waited just inside the door. He was covered head to toe in his bedsheet, awake but ignoring me. I repeated my salutation, only louder.
“Why you got to shout at me?” he barked.
I apologized, telling him I wasn’t sure if he could hear me through the sheet. He got the hint and pulled it down, opening one eye halfway.
“How are you doing today?” I asked. He ignored me. “How was your night?” No answer. “Anything we can do for you?” Again, silence. “Alrighty then, have a good day!”
I left the room, frustrated. “I think you two really bonded,” one of the nurses joked.
This pattern went on for a couple of days. On the third day I went in alone, pulled a chair over to his bed and sat down.
“Hey,” I said quietly. Nothing. “Hey, why won’t you talk to me?”
“You’re disrespecting me. You come into my room and shout at me, turn on the light. This is my room,” he said.
I thought about this for a moment. He had a point. Because of what I had heard about him, I had entered his room full of bluster. And he delivered the attitude I expected, as if on cue.
“I’m sorry; you’re right,” I told him. “I shouldn’t have done that. While you’re here, this is your home, and I was rude to you in your home.”
He looked me straight in the eyes as I spoke. “O.K. if we start fresh?” I asked.
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