Bill Moyers Essay: Everyone Should Be Entitled to Medicare
Bill Moyers Essay: Everyone Should Be Entitled to Medicare
Health Care Law Raises Pressure on Public Unions
By KATE TAYLOR
Cities and towns across the country are pushing municipal unions to accept cheaper health benefits in anticipation of a component of the Affordable Care Act that will tax expensive plans starting in 2018.
The so-called Cadillac tax was inserted into the Affordable Care Act at the advice of economists who argued that expensive health insurance with the employee bearing little cost made people insensitive to the cost of care. In public employment, though, where benefits are arrived at through bargaining with powerful unions, switching to cheaper plans will not be easy.
Cities including New York and Boston, and school districts from Westchester County, N.Y., to Orange County, Calif., are warning unions that if they cannot figure out how to rein in health care costs now, the price when the tax goes into effect will be steep, threatening raises and even jobs.
“Every municipality with a generous health care plan is doing the math on this,” said J. D. Piro, a health care lawyer at a human resources consultancy, Aon Hewitt.
But some prominent liberals express frustration at seeing the tax used against unions in negotiations.
“I think it was misguided all along,” Robert B. Reich, the former labor secretary, said in an e-mail.
When the law was being written, he said, he worried that the tax was “a blunt instrument that could too easily become a bargaining chit for cutting back benefits of workers.”
“Apparently, that’s what it’s become,” Mr. Reich, who is a professor of public policy at the University of California, Berkeley, said.
Under the tax, plans that cost above a certain threshold in 2018 — $10,200 annually for individual plans and $27,500 for family plans, with slightly higher cutoffs for retirees and those in high-risk professions like law enforcement — will be taxed at 40 percent of their costs in excess of the limit. (The thresholds will rise with inflation after 2018.)
State and local governments across the country tend to offer more expensive health plans than private businesses do, and workers often accept smaller wage increases to retain their benefits. Because of this, state and local government employees are expected to be disproportionately represented among those whose plans will be subject to the tax.
Mixed Blessings
By THE EDITORIAL BOARD
Pity the poor patient who tries to make sense of federal advisory committee reports that appear headed in opposite directions. For at least three decades, Americans have been told that it’s best to detect cancers early, when they are theoretically most curable. So it was not all that surprising when an authoritative advisory group recommended that very heavy smokers get an annual CT scan to check for early signs of lung cancer. It was much more surprising, however, when a separate group of experts suggested that for several cancers — including potential lung cancers — early scans are detecting too many abnormalities that aren’t dangerous and should not be treated.
Oddly enough, both groups, which issued their recommendations last Monday, may be right.
The recommendation on smokers came from the United States Preventive Services Task Force, independent experts who serve as the federal government’s foremost authority on screening procedures. Screening with chest X-rays, long the standard approach, seldom catches a tumor early enough for surgeons to save a life. In 2010, however, a large clinical trial found that low-dose CT scans, which detect much smaller tumors, could reduce mortality by 16 percent among patients at the highest risk of lung cancer because of their age and smoking history.
That led several prominent medical groups to recommend such screening in high-risk current and former smokers. Now, based primarily on that same study, the Preventive Services Task Force, the final arbiter, has recommended that people ages 55 to 79 who have smoked a pack of cigarettes a day for 30 years or two packs a day for 15 years or the equivalent get annual CT scans. That includes former smokers who have quit within the past 15 years. It estimates that such screening could save 20,000 lives a year, among the 160,000 Americans who die each year of lung cancer.
The task force said it had “moderate certainty” that the screening would produce a “moderate net benefit” in these high-risk smokers but did not know whether the same would be true in lower-risk patients. It gave lung cancer screening a grade of B, on a par with mammography. Under the Affordable Care Act, that would require Medicare and private insurers to pay for the screening tests without any cost to consumers.
Meanwhile, three members of a working group advising the National Cancer Institute, the federal government’s pre-eminent supporter of cancer research,suggested that “overdiagnosis” — the detection of tumors that would not cause illness or death if left unattended — is common in cases of breast, lung, prostate and thyroid cancer. Such overdiagnosis often leads to further tests and biopsies to determine if a tiny tumor looks dangerous, followed by surgery, radiation or chemotherapy to eliminate an abnormality that would never have caused illness. In such cases, the cure is worse than the disease it is trying to prevent.
Maine schools, DHHS in costly dispute over Medicaid
Posted:TodayUpdated: 6:34 AM
DHHS sends Medicaid overbilling notices to districts that thought they were following the rules, and taxpayers may end up with the bill.
AUGUSTA — The state Department of Health and Human Services is notifying more than two dozen Maine school systems that they have overbilled Medicaid for services provided to low-income students with disabilities, errors that could cost some districts tens of thousands of dollars and other districts hundreds of thousands.
In each instance, the agency says the school districts improperly billed for such services as speech therapy, social workers and nursing care, which are mandated by federal guidelines and typically reimbursable by Medicaid. The DHHS said the services were educational in nature and not reimbursable.
School districts blame the state for the problem, saying it has failed to provide adequate guidance for complying with the rules of an arcane and fluid Medicaid billing system that they argue was designed more for health care providers than educators.
Posted Aug. 04, 2013, at 10:48 a.m.
The Affordable Care Act has received so much attention for its potential effects on health insurance, it’s easy to forget the far-reaching law is also about changing how providers deliver health care and patients consume it.
The federal government last month released the first round of data on one of the Affordable Care Act’s most ambitious efforts to change health care itself. The law’s champions and critics could each find something in the data release to bolster their position. But no one should be drawing sweeping conclusions about a new health care model’s viability with such a limited pool of data after just one year of an ambitious pilot program.
The data came from 32 health organizations from across the country that were accepted into the Pioneer Accountable Care Organization Model pilot project, which involves patients enrolled in Medicare, the government-funded insurance program for seniors.
The project is one of a number of initiatives happening in the health care world to try out the accountable care model, in which health care providers are held financially accountable for their patients’ health. They’re rewarded when patients stay healthy and require less care, and they’re penalized when the cost of patients’ care rises.
The current trial initiatives underway help their participants take baby steps away from health care’s current fee-for-service model, in which providers are paid for each procedure they perform and each test they order.
What sets the Pioneer ACO project apart from many other pilot initiatives is that its timeline is aggressive. In its second year — 2013 — participants can share in any savings they produce, but they’re also at risk for losing money if they can’t rein in health care costs.
The first-year results showed overall — though not universal — success for the Pioneer ACO program. Health care costs for the 669,000 patients involved grew by 0.3 percent in 2012, compared with 0.8 percent for comparable Medicare beneficiaries not involved in the program. Thirteen of the 32 organizations produced $87.6 million in savings, returning $33 million of that sum to Medicare. Two participants saw their health care costs rise, forcing Medicare to chip in an additional $4 million.
According to the federal Centers for Medicare and Medicaid Services, the savings came largely from a drop in hospital admissions and readmissions among participating patients.
State details health plans offered on insurance exchange mandated by Obamacare
Posted Aug. 05, 2013, at 6:57 p.m.
AUGUSTA, Maine — State insurance regulators have released a comparison of two dozen health plans that some Maine consumers can expect to buy this fall under the Affordable Care Act.
The side-by-side summary, released late Saturday night by the Maine Bureau of Insurance, gives consumers a first look at how the costs and benefits for the various plans compare. It details plans likely to be sold on Maine’s federally run health insurance exchange, an online marketplace in which consumers and small businesses will be able to shop for coverage under the health reform law.
The plans must now be approved by the federal government before enrollment begins Oct. 1. If approved, the plans will take effect on Jan. 1, 2014.
Last Wednesday, the state insurance bureau approved the rates and submitted hundreds of pages of documents to satisfy a federal deadline. Over the weekend, the bureau followed up with a more consumer-friendly summary of the filings.
While older Mainers and those living in rural areas will pay proportionally more for health coverage, as they do now, the new plans proposed by two carriers will offer a wide range of premiums and cost-sharing options.
“There are going to be real choices for people … It’s really going to take some thinking about what your priorities are and what your unique situation is,” said Mitchell Stein, policy director for the Augusta-based advocacy group Consumers for Affordable Health Care.
The new summary reflects individual plans, or policies for consumers who buy their own insurance, rather than get coverage through an employer. The bureau will soon release a corresponding summary of plans available to small businesses, the other group eligible to shop on the exchange.
Individual plans in Maine often carry steep deductibles — some topping $10,000 — but the new plans have a maximum deductible of $6,350, the limit for out-of-pocket costs under the health reform law. Stein highlighted that as a benefit for consumers, while Joel Allumbaugh, an insurance broker and health policy expert at the conservative Maine Heritage Policy Center, has said it will force insurers to charge much higher premiums.
Basic monthly premiums for the new plans range from about $100 for a bare bones “catastrophic” plan to about $1,450 for a more comprehensive plan with fewer out-of-pocket costs, according to the summary.
The “base rates,” however, reflect only a starting point for how much consumers will actually pay. In practice, rates could be higher or lower depending on each consumer’s age, where they live, whether they smoke, and which plan they select. Many consumers, even some middle-class families, also will get federal subsidies to help offset the costs of their coverage, so they’ll pay less in premiums.
For the most part, people who have health insurance through their employer and those covered by public insurance such as Medicaid and Medicare — groups that make up the majority of Maine’s population — won’t be shopping for insurance on the exchanges.
The Maine Bureau of Insurance estimates that about 5-8 percent of Maine’s population will shop on the exchanges. That includes the uninsured, individuals who buy their own coverage and small businesses.
Maine health plans comparison sketches out options, cost
Although there are only two providers, consumers will choose from a wide array of health care plans.
A side-by-side comparison of what insurance plans on Maine's new health care exchange will cost gives consumers their first look at what they will be able to buy from Anthem Blue Cross Blue Shield or Maine Community Health Options.
RELATED DOCUMENTS
Individual Rate Plans ComparisonPDF: Gold Plan Insurance Rate Comparison
PDF: Silver Plan Insurance Rate Comparison
PDF: Bronze Plan Insurance Rate Comparison
PDF: Catastrophic Plan Rate Comparison
The plans will offer different benefits and costs, but will be similar in many ways, officials said Monday. Most of the premiums – not including federal subsidies that many people will qualify for – will be about $200 to $600 per month, depending on factors such as age, geography, smoking and the type of plan.
Anthem and Maine Community Health are the only two insurance providers on the exchange, where individuals who otherwise don't have health insurance will buy it. People can start purchasing plans Oct. 1 for benefits that will begin Jan. 1, as a key part of the federal Affordable Care Act.
Less than 10 percent of consumers are expected to purchase plans on the exchange, according to the Maine Bureau of Insurance.
The two providers filed rates with the bureau last week. The filings satisfied a federal requirement but did not immediately include the side-by-side comparison.
The Bureau of Insurance released a more user-friendly rate comparison this weekend for "bronze" and "silver" plans on the exchange. It released a rate comparison for "gold" plans on Monday.
Competition for customers between Anthem and Maine Community Health helped keep prices in line, said Mitchell Stein, policy director for Consumers for Affordable Health Care.
"In the grand scheme of things, these numbers are pretty close to each other," he said.
Few buying on health marketplace will pay full rate
As more information emerges about rates for health insurance to be bought on Maine’s new marketplace/exchange, it’s critical to keep in mind that relatively few will pay the full rate.
Most people will get discounts through a subsidy. The amount varies by family income.
Covering more people will reduce cost-shifting, which has increased costs for people who already have insurance.
You can get an idea of how much the premium and subsidy will be by using a calculator created by the Henry J. Kaiser Foundation.
I tried it for a family of four with the median household income in Maine, $47,898. This family has two adults and two children and no one smokes.
If this family buys the Silver plan, they would pay $3,074 a year. The Bronze plan would cost $1,385 but there could be more out-of-pocket expenses.
Another family, a single non-smoking mother or father with one child and a $25,000 annual income, could pay $1,729 annually for health insurance at the Silver level. The Bronze plan would cost this family just $284 a year.
Three more things to keep in mind:
1. Smokers pay more than nonsmokers. That is a federal requirement. The Kaiser calculator includes smoking and nonsmoker rates and subsidies.
2. Premiums are higher in rural areas of Maine. That is due to a state law that was signed into law by Gov. LePage and passed when Republicans controlled the state legislature. The Kaiser calculator does not show different costs by region in Maine.
3. Thousands of very low income Mainers won’t get subsidies because the law was devised to have them receive coverage through Medicaid. Since Gov. LePage vetoed Medicaid expansion and the Maine Legislature came close but didn’t overturn the veto, this is not an option for them.
Many Consumers With High-Deductible Plans Are Concerned About Health Law Changes
Rod Coons and Florence Peace, a married couple from Indianapolis, pay $403 a month for a family health plan that covers barely any of their individual medical care until each reaches up to $10,000 in claims. And that’s just the way they like it."I'm only really interested in catastrophic coverage," says Coons, 58, who retired last year after selling an electronic manufacturing business. Since they're generally healthy, the couple typically spends no more than $500 annually on medical care, says Coons.
"I'd prefer to stay with our current plan because it meets our existing needs."
That won’t be an option next year for Koons and Peace. In 2014, plans sold on the individual and small group markets will have to meet new standards for coverage and cost sharing, among other things. In addition to covering 10 so-called essential health benefits and covering many preventive care services at no cost, plans must pay at least 60 percent of allowed medical expenses, and cap annual out-of-pocket spending at $6,350 for individuals and $12,700 for families. (The only exception is for plans that have grandfathered status under the law.)
http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/080613-Michelle-Andrews-on-high-deductible-insurance.aspx
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