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Friday, June 7, 2013

Health Care Reform Articles - June 7, 2013


June 5, 2013

The Split Between the States


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Wisconsin and Minnesota are neighboring states with long traditions of caring for the least fortunate, but, at the moment, only one of them is concerned about the health of the poor and uninsured.
In February, more than 130,000 Minnesota residents who lack health insurance became eligible for coverage when the state expanded its Medicaid program under the health care reform law. That will save the state $129 million in the first two years alone.
Wisconsin, however, has chosen to take the path of indifference. On Tuesday, the Republicans who control the State Legislature’s Joint Finance Committee voted to reject the expansion of Medicaid, even though it would have covered 85,000 people at less cost to the state. The committee was marching in lock step behind the governor, Scott Walker, who claims to be worried that federal financing will run out. What’s really going on, of course, is that state Republicans have made poor people the victims of their ideological resistance to President Obama and his health care law.
That infection has spread to 25 states, mostly with Republican leaders, that have said no to the Medicaid expansion or are resisting it. As Robert Pear of The Times recently reported, more than half of all people without health insurance live in states that are not planning to expand coverage. Many of those states already do a terrible job of covering the poor and have no interest in changing their ways, no matter the financial incentive.
On Medicaid, education and many other issues, the map of the United States is becoming a patchwork of conscience and callousness. People on one side of a state line have access to health care, strong public schools and colleges, and good transportation systems, while those on the other side do not. The breakdown of a sense of national unity in Washington is now reflected across the country, as more than two dozen states begin to abandon traditions of responsible government.
This is not entirely a partisan issue; several Republican governors, including Jan Brewer of Arizona and Rick Scott of Florida, have crunched the numbers and decided to support the Medicaid expansion, though their legislatures refuse to go along. But most states dominated by Republicans are cutting back on their responsibilities, while states dominated by Democrats continue to believe that government has a large role to play in maintaining the safety net.

Why Health Care Costs Are So High



To the Editor:
The American College of Gastroenterology is disappointed that “The $2.7 Trillion Medical Bill” (“Paying Till It Hurts” series, front page, June 2) unfairly casts outsized blame for high medical care costs on colonoscopy and by extension on gastroenterologists.
The roots of the problem of high medical costs are many, varied and complicated. The fact that the article focuses attention on the one and only preventive cancer test that has been demonstrated to significantly reduce the incidence of colon cancer and death from the disease is disappointing. The evidence suggests that colonoscopy is a public health success story.
Indeed, an article in The Times last year, “Report Affirms Lifesaving Role of Colonoscopy,” reported on a study published in The New England Journal of Medicine that showed a 53 percent decline in deaths for patients who underwent colonoscopy and had precancerous polyps removed.
The American College of Gastroenterology is proud to have led the way on the issue of advancing colorectal cancer screening by colonoscopy. This is the test we recommend for our friends and family, as well as our patients. It is correct that there are screening strategies other than colonoscopy and likewise there are varied patient preferences, so while colonoscopy is our preferred screening strategy, we agree that the best test is the one that actually gets taken.
RONALD J. VENDER
President
American College of Gastroenterology
New Haven, June 2, 2013
To the Editor:
I suspect that if physicians were salaried there would be a substantial decrease in the number of medical procedures performed, including colonoscopies. Money has an insidious way of biasing medical judgment. When physicians profit from every procedure, it is too easy for some to justify it as in the patient’s best interest even when sound clinical judgment argues the contrary.
Second: There is a yawning and unjustifiable gap between payment for procedures and consultations. When I spend an hour to an hour-and-a-half with a patient who brings a stack of medical records and many imaging studies, I must often answer to Medicare for charging its highest consultation fee, which is but a fraction of the amount allowed for endoscopy.
Third: Overcoming an American culture that believes that more medical testing is better is a daunting challenge.
There is so much that is wrong with the byzantine and arbitrary way our doctors and hospitals are paid, and so many powerful entrenched interests arguing for the status quo, that it’s easy to be pessimistic about meaningful reform.
KENNETH PRAGER
Englewood, N.J., June 2, 2013
The writer is a professor of clinical medicine at Columbia College of Physicians and Surgeons.



Posted June 05, 2013, at 3 p.m.
We have tried to present reasonable arguments to Maine’s Republican lawmakers to urge them to accept federal funding to expand Medicaid. We have emphasized the good financial deal Maine is projected to get, according to independent, outside analyses. We have highlighted the obvious, practical health reasons why tens of thousands more Mainers should have access to care. We criticized lawmakers when they blocked a previous Medicaid expansion proposal.
Some GOP lawmakers have changed their minds and their votes. A revised bill before the Legislature is simpler now, as it no longer ties expansion to a plan to pay Maine’s hospital debt. It also now addresses a concern voiced among Republicans — that the federal government won’t abide by the Affordable Care Act and pay 100 percent of expansion costs for three years and then ratchet down to and remain at 90 percent funding thereafter — and adds a provision to repeal expansion if federal funding drops below those prescribed levels.
Is it enough? The Maine House did not cast enough votes in favor of the measure on Monday to override an anticipated veto by Gov. Paul LePage. And previous legislative override votes this year don’t offer hope: Every time, even if bills garnered unanimous support, Republican legislators have stepped aside and allowed LePage’s vetoes to stand. By doing so, they have shown their constituents they are more willing to bend to an unreliable leader than stick up for what they know is just.
There is still a little time, however, for a few Republicans to stand up for their communities’ poorest — on whose doors they’ve knocked and asked for votes. It will take only 12 Republicans in the House and Senate for the bill to be veto-proof; five are already on board. Additional votes on LD 1066 will be scheduled in the coming days.
As Republicans negotiate and weigh their options, we offer the following scenario for their consideration, which will happen if Maine does not expand Medicaid. One of their neighbors, who earns less than $11,490 per year, will read about or see an advertisement on TV this fall encouraging Maine residents like her to sign up for health insurance. Under the federal health reform law, she will learn, the U.S. is trying to cover all people, to help lower the costs of health care. She will also learn that assistance is available to help low-income individuals afford insurance.
She will try to sign up. She will be denied. Why? Because she is among the poorest of the poor. Meanwhile, she will come to know about friends or neighbors who earn more than she. She will learn they applied for insurance and were eligible for subsidies to help them pay for coverage.
Whether she is sick or not, she will be upset. She will ask state officials to explain why people who earn more than she does are eligible for assistance, while they reject coverage for the state’s most vulnerable population. She will ask why she would be eligible for assistance if only she earned more money. What will officials say to the thousands of others also in her situation? Trying to explain will be a nightmare, especially since the federal government would pay for all the costs of insuring this population for three years.

The Spite Club


By 


House Republicans have voted 37 times to repeal ObamaRomneyCare — the Affordable Care Act, which creates a national health insurance system similar to the one Massachusetts has had since 2006. Nonetheless, almost all of the act will go fully into effect at the beginning of next year.
There is, however, one form of obstruction still available to the G.O.P. Last year’s Supreme Court decision upholding the law’s constitutionality also gave states the right to opt out of one piece of the plan, a federally financed expansion of Medicaid. Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first.
And why would they do this? They won’t save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I’ll explain later, it will probably hurt Republicans for years to come.
No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won’t just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens.
Some background: Obamacare rests on three pillars. First, insurers must offer the same coverage to everyone regardless of medical history. Second, everyone must purchase coverage — the famous “mandate” — so that the young and healthy don’t opt out until they get older and/or sicker. Third, premiums will be subsidized, so as to make insurance affordable for everyone. And this system is going into effect next year, whether Republicans like it or not.


Maine Senate strikes deal to expand Medicaid

The bipartisan vote could reinvigorate efforts to provide 60,000 more Mainers with health insurance using federal dollars.

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Written by Steve Mistler, State House Reporter
AUGUSTA — The Senate’s approval Thursday of an amended bill to expand Medicaid through the federal health care law could reinvigorate efforts to broaden the public health insurance program for the poor.
The Senate voted 23-12 for the amended version of L.D. 1066, a proposal that supporters say would extend health insurance to more than 60,000 Mainers through MaineCare, the state’s Medicaid program.
Coverage would be available to adults without children who earn as much as $20,500 a year. But unless the Legislature takes additional action, eligibility would expire after three years, when federal reimbursements for the program are scheduled to decline from 100 percent to 90 percent.
That “sunset” provision, together with language requiring an audit of the broader financial effects of the expansion, are part of an amendment intended to ease Republicans’ concerns about the impact of expansion on state spending.
Three Republicans and one independent voted with the Democratic majority Thursday to support the amended bill. The Republican support is critical to the bill and could change the debate on expansion, a key component of the Affordable Care Act. The federal law has become a hyperpartisan issue in states that are considering whether to broaden their Medicaid programs.
http://www.pressherald.com/Placement/top-stories/maine-senate-strikes-deal-to-expand-medicaid_2013-06-06.html

Amendment Garners More GOP Support for Expanding Medicaid in Maine
06/06/2013   Reported By: A.J. Higgins
Republicans in the Maine Legislature are moving closer toward supporting a Democratic measure that expands Medicaid benefits to 70,000 more Mainers under the federal Affordable Care Act. But it's not clear whether that support will be enough to override a promised veto from Gov. Paul LePage. The Maine Senate came within a single vote of reaching the veto-proof threshold today, and only after a Republican leader advanced an amendment aimed at appeasing the GOP rank and file. A.J. Higgins reports.


Compromise on Medicaid expansion in sight

Posted June 06, 2013, at 6:45 p.m.
If Maine’s legislative Republicans were looking for a compromise on Medicaid expansion, they got it Thursday.
Sen. Roger Katz, R-Augusta, offered an amendment on the Senate floor to LD 1066 that would allow the state to collect 100 percent federal financing for expansion under the Affordable Care Act for three years and then re-evaluate the effectiveness of the program. The hard sunset provision should hypothetically be enough to draw the support of legislators who seek more state control over extending coverage to low-income individuals.
Still, the 23-12 Senate vote on the amended bill does not show enough backing to override an anticipated veto from Gov. Paul LePage. Even though Katz, along with Sens. Tom Saviello of Wilton and Patrick Flood of Winthrop, voted in favor, they need one more moderate Republican to join them. The Maine House likely needs three. The measure is so close to getting two-thirds support.
The amendment put forward by Katz, who is the assistant Republican leader in the Senate and a former mayor of Augusta, may be workable, though there are reasonable legal questions about whether a state can take 100 percent funding and then run. It’s also not ideal because it doesn’t provide long-term certainty to Medicaid recipients. But we recognize it as an effort to bring conservatives to the table.
In addition to requiring another vote in 2016 about whether to continue expansion, the amendment would create a savings account. Any money that Medicaid expansion saves the state would be placed in the account and used to offset future costs, when the federal government ratchets down matching funding for newly covered individuals to 90 percent. Also, a nonpartisan organization would examine the effects of expansion, so the state can have empirical data on which to base a decision about whether to sign up again.
The changes also would require Medicaid recipients to contribute more of their own money toward their care. The amendment would have them pay co-payments at the maximum level under federal law and would double co-payments if they use the emergency room inappropriately. These are reasonable requests, and a concession on the part of majority Democrats, that should satisfy at least a few more Republican legislators.
Katz clearly addressed the arguments Republicans have made in opposition to expansion. Some people say Maine should wait and try to get a better deal, he said, but the state has received notification from the federal government that it will not provide 10 years of full funding, as LePage had requested.
He told his fellow lawmakers to think of the impact of injecting millions of federal dollars into Maine. Medicaid expansion dollars won’t go to recipients, he said. They will go to physical therapists, nurses and other hospital employees who spend that money in their communities.
He pointed to Republican Florida Gov. Rick Scott who said he could not “in good conscience deny Floridians that needed access to health care” and referenced words by Republican Arizona Gov. Jan Brewer, who said, “We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured.” Medicaid expansion is not a problem for Republican governors in North Dakota, Ohio, Michigan, Nevada, New Mexico or New Jersey.
Others spoke against Katz. Sen. Andre Cushing, R-Hampden, said Maine should not choose to “embolden” the federal government’s plan to “offer more than they can.”


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