Health law's ailments can be cured by single-payer system
All the shortcomings of the healthcare restructuring result from the decision to leave it in the hands of private insurers.
Michael Hiltzik
6:12 PM PDT, September 10, 2013
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With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you'll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America's healthcare system in our lifetimes. Here are a couple of things to keep in mind:
First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies.
Second, there's an obvious way to correct this flaw: The country should progress on to a single-payer system.
The idea that the ACA is a logical precursor to single-payer, in which the government would be the source of all medical reimbursement, has been gaining traction as key thresholds for healthcare reform approach. The biggest milestone is the Oct. 1 launch of open enrollment for the health insurance exchanges that will offer individual insurance starting Jan. 1.
Last month, Senate Majority Leader Harry Reid made that point in a Nevada news broadcast, calling the ACA "a step in the right direction" but adding that the U.S. would have to "work our way past" private insurance-based healthcare. "We're far from having something that's going to work forever," he said.
"There isn't a popular groundswell yet" for a single-payer plan "because most people haven't seen the ACA at work in detail yet," says David Himmelstein, a professor of public health at the City University of New York and co-founder of Physicians for a National Health Program, the leading advocacy group for single-payer healthcare. But he anticipates that discontent will start in October "and accelerate through the winter."
Among the law's shortcomings, he says, are the lack of effective provisions to control healthcare costs and insurance premiums. Premium regulation remains in the hands of the states, and many don't have strong regulatory oversight of health insurance. In California, health insurance premiums are exempt from prior approval by the insurance commissioner, unlike home and auto insurance. (An initiative to remove the exemption will appear on the November 2014 ballot.)
That's not to say that the ACA won't make health insurance more affordable and accessible to millions of Americans now excluded from the market. Published exchange premiums in 18 states have generally come in below expectations, and the federal subsidies available to most buyers will make them cheaper still.
In some cases the premiums may be higher than those of plans on the market now. But because of exclusions for preexisting conditions — which will no longer be legal — they're actually unavailable at any price to people who will have no trouble qualifying for the exchange plans.
The ACA's critics observe that a plurality of Americans still view the ACA unfavorably (43%, according to an opinion poll released in June by the Kaiser Family Foundation). They rarely acknowledge, however, that nearly 1 in 5 of those critics think the law doesn't go far enough — that is, further toward single-payer.
In its earliest incarnation, the Affordable Care Act included a prototype government single-payer provision — the "public option," a government-sponsored plan to compete with commercial insurers in the exchanges. The public option was deleted at the insurance industry's insistence.
But the U.S. does offer a healthcare program that resembles single-payer. It's Medicare, the broadly popular health plan that covers all Americans over 65. Medicare's administrative costs are only about 2%, and its size gives it the clout to extract large discounts from doctors and hospitals. That's why one oft-proposed version of single-payer is "Medicare for all" — simply expand its coverage beyond the 65-plus.
Canada's single-payer system is another model. It's popular and efficient and costs about one-third of America's system to administer. Don't believe the myths purveyed about Canada's healthcare by the U.S. insurance industry's minions.
As health economist Aaron Carroll has documented, Canadian patients and doctors are satisfied with the program. As for the contention that it "rations" care, he points out that care in the U.S. is rationed by cost: one-third of adult Americans surveyed by the Commonwealth Fund in 2010 said they had put off important treatment because of the cost. In Canada, the figure was 15%.
There's little question that taking private insurers out of the American healthcare system would save hundreds of billions of dollars a year. Dozens of studies of federal and state single-payer proposals have found that single-payer plans could provide universal coverage — not even the ACA does that — and still save money.
Estimates of the administrative costs of commercial health insurers exceed 10%. That doesn't include the costs to doctors and hospitals of maintaining billing staffs to deal with insurers and keep all their rules and peculiarities straight, or the time lost to individuals and their employers of navigating this unnecessarily byzantine system.
Add those, and the overall administrative costs embedded in the U.S. healthcare system come to 31% of all spending, according to a 2003 article co-written by Himmelstein for the New England Journal of Medicine. Administrative and clerical workers accounted for nearly 44% of all employees in doctors' offices, they calculated.
What do Americans receive in return for all this overhead? Practically nothing. The insurance industry says its role is to hold down costs by negotiating for preferential fees from doctors and hospitals and trolling for abuses, but the truth is they're totally ineffective at cost control.
Just last year I reported on an admission by Aetna and United Healthcare, two of our biggest insurers, that they had been snookered to the tune of $60 million by one chain of small surgical clinics in Northern California. That happened because the insurers didn't hire enough staff to give the claims from those clinics decent scrutiny — in other words, their administrative costs, high as they were, didn't buy adequate oversight.
The result, to cite just one example, was that United paid the chain more than $97,000 for a kidney stone operation that it usually covers for $6,851.
"Private insurance is a parasite in the system," says Arnold S. Relman, the former editor of the New England Journal of Medicine and an advocate of healthcare reform. "It adds nothing of value commensurate with its cost."
Relman believes that fixing the healthcare system will require more than single-payer. The delivery of care needs to be reorganized by promoting the formation of more "accountable care organizations" — medium- and large-scale group practices with hospital affiliates whose physicians would be salaried to discourage the overuse fostered by the fee-for-service system.
What's really needed is political will. It would help if big companies, which grouse incessantly about the rising costs of covering their employees, would throw their weight behind a system that would relieve them of that burden.
The forces of opposition won't lie down; the insurance industry won't give up its central role in the healthcare system without a costly and bruising fight, as it showed in Congress and in numerous states, including California, where single-payer plans were on the table.
"It's going to be a slow and painful process," Relman says. "But sooner or later we'll have to turn to single-payer. It's the only logical solution."
Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow@hiltzikm on Twitter.
Copyright © 2013, Los Angeles Times
Unions’ Misgivings on Health Law Burst Into View
By STEVEN GREENHOUSE and JONATHAN MARTIN
LOS ANGELES — When President Obama phoned the president of the A.F.L.-C.I.O. last month, he shared some news that the labor leader had long wanted to hear — the administration would propose measures to reduce workplace exposure to disease-causing silica dust.
But their conversation soon moved to what has become a contentious topic this summer: labor’s renewed anger over Mr. Obama’s health care law and decisions surrounding it, especially the postponement of an employer mandate to ensure coverage for workers and the potential effects of the coming health insurance exchanges on existing plans.
According to officials briefed on the call, the president voiced concern about labor’s criticisms, prompting the union federation’s leader, Richard Trumka, to promise that he would try to soften the harshly worded resolutions that several unions planned to push at this week’s A.F.L.-C.I.O. convention in Los Angeles.
Despite overtures on both sides — with Mr. Obama agreeing on the call to sit down with some union leaders to address their concerns at the White House, and Mr. Trumka initially hoping to quash such a public rift between the president and his party’s traditional allies — labor leaders criticized the administration and Congress on Wednesday at their convention.
While praising the overall legislation, the delegates overwhelmingly passed a sharply worded resolution that demanded changes to some of its regulations, although Mr. Trumka made sure to strip out some proposals that called for repealing the legislation.
At the convention, though, several labor leaders spoke their minds.
“If the Affordable Care Act is not fixed and it destroys the health and welfare funds that we have fought for and stand for, then I believe it needs to be repealed,” said Terence M. O’Sullivan, president of the Laborers’ International Union of North America. “We don’t want it to be repealed. We want it to be fixed, fixed, fixed.
A single-payer system makes economic sense
By Sen. Bernie Sanders
The Hill, Sept. 10, 2013
Americans spend about twice as much per capita on healthcare as almost any other developed nation, but our outcomes are not as good as others that spend much less. We can do better. We must do better.
Today, some 50 million Americans lack health insurance. Many others delay going to the doctor because of high deductibles and unaffordable copayments. While the number of uninsured Americans will go down with the implementation of the Affordable Care Act, widely known as ObamaCare, tens of millions of Americans will remain uninsured.
The goal of an effective healthcare system is to do everything possible to enable people to live long and healthy lives. Sadly, the American system fails to do that and falls behind many other countries. While we devote 18 percent of our gross domestic product to healthcare, we rank 33rd in life expectancy and 34th in infant mortality, and trail in many other health outcomes. A Harvard University study indicated that, incredibly, some 45,000 Americans die needlessly each year because they do not get to a doctor in time.
I start my approach to healthcare from a very basic premise: healthcare is a right, not a privilege. Unfortunately, uniquely among major nations, that statement is not true for the United States, where access to healthcare depends on how much money you have and what your employer is willing to provide.
It is simply unconscionable that the most advanced nation in the world has so many people who lack health insurance. It makes no sense that millions more are one diagnosis or car accident away from financial disaster. And, despite the trillions of dollars we spend on healthcare, the disparity in the quality of care between the rich and everyone else grows wider.
Our system doesn’t make economic sense, and it certainly doesn’t make moral sense. In a civilized, democratic society, every man, woman and child must be able to get the medical care they need regardless of income.
It is incomprehensible that drug companies still get away with charging Americans twice as much — or more — than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still want to hike premiums by as much as 60 percent a year on individual policyholders.
It boggles the mind that approximately 30 percent of every healthcare dollar spent in the United States goes to administrative costs rather than to delivering care. Taiwan, for example, spends only a little over 6 percent of its GDP on healthcare, while achieving better health outcomes on some key indicators than we do. The reason, of course, is that they spend a fraction of what we do on administrative costs.
If our goal is to provide high-quality healthcare in a cost-effective way, what should we be doing?
Clearly, we must move toward a single-payer system.
http://www.pnhp.org/print/news/2013/september/a-single-payer-system-makes-economic-sense
Stem Cell Treatments Overtake Science
By LAURA BEIL
Health law's ailments can be cured by single-payer system
All the shortcomings of the healthcare restructuring result from the decision to leave it in the hands of private insurers.
Michael Hiltzik
6:12 PM PDT, September 10, 2013
| advertisement |
With the Oct. 1 rollout of a major facet of the Affordable Care Act on the horizon, you'll be hearing a lot about the glitches, loopholes and shortcomings of this most important restructuring of America's healthcare system in our lifetimes. Here are a couple of things to keep in mind:
First, the vast majority of these issues result from one crucial compromise made in the drafting of the 2010 law, ostensibly to ease its passage through Congress. That was to leave the system in the hands of private health insurance companies.
Second, there's an obvious way to correct this flaw: The country should progress on to a single-payer system.
The idea that the ACA is a logical precursor to single-payer, in which the government would be the source of all medical reimbursement, has been gaining traction as key thresholds for healthcare reform approach. The biggest milestone is the Oct. 1 launch of open enrollment for the health insurance exchanges that will offer individual insurance starting Jan. 1.
Last month, Senate Majority Leader Harry Reid made that point in a Nevada news broadcast, calling the ACA "a step in the right direction" but adding that the U.S. would have to "work our way past" private insurance-based healthcare. "We're far from having something that's going to work forever," he said.
"There isn't a popular groundswell yet" for a single-payer plan "because most people haven't seen the ACA at work in detail yet," says David Himmelstein, a professor of public health at the City University of New York and co-founder of Physicians for a National Health Program, the leading advocacy group for single-payer healthcare. But he anticipates that discontent will start in October "and accelerate through the winter."
Among the law's shortcomings, he says, are the lack of effective provisions to control healthcare costs and insurance premiums. Premium regulation remains in the hands of the states, and many don't have strong regulatory oversight of health insurance. In California, health insurance premiums are exempt from prior approval by the insurance commissioner, unlike home and auto insurance. (An initiative to remove the exemption will appear on the November 2014 ballot.)
That's not to say that the ACA won't make health insurance more affordable and accessible to millions of Americans now excluded from the market. Published exchange premiums in 18 states have generally come in below expectations, and the federal subsidies available to most buyers will make them cheaper still.
In some cases the premiums may be higher than those of plans on the market now. But because of exclusions for preexisting conditions — which will no longer be legal — they're actually unavailable at any price to people who will have no trouble qualifying for the exchange plans.
The ACA's critics observe that a plurality of Americans still view the ACA unfavorably (43%, according to an opinion poll released in June by the Kaiser Family Foundation). They rarely acknowledge, however, that nearly 1 in 5 of those critics think the law doesn't go far enough — that is, further toward single-payer.
In its earliest incarnation, the Affordable Care Act included a prototype government single-payer provision — the "public option," a government-sponsored plan to compete with commercial insurers in the exchanges. The public option was deleted at the insurance industry's insistence.
But the U.S. does offer a healthcare program that resembles single-payer. It's Medicare, the broadly popular health plan that covers all Americans over 65. Medicare's administrative costs are only about 2%, and its size gives it the clout to extract large discounts from doctors and hospitals. That's why one oft-proposed version of single-payer is "Medicare for all" — simply expand its coverage beyond the 65-plus.
Canada's single-payer system is another model. It's popular and efficient and costs about one-third of America's system to administer. Don't believe the myths purveyed about Canada's healthcare by the U.S. insurance industry's minions.
As health economist Aaron Carroll has documented, Canadian patients and doctors are satisfied with the program. As for the contention that it "rations" care, he points out that care in the U.S. is rationed by cost: one-third of adult Americans surveyed by the Commonwealth Fund in 2010 said they had put off important treatment because of the cost. In Canada, the figure was 15%.
There's little question that taking private insurers out of the American healthcare system would save hundreds of billions of dollars a year. Dozens of studies of federal and state single-payer proposals have found that single-payer plans could provide universal coverage — not even the ACA does that — and still save money.
Estimates of the administrative costs of commercial health insurers exceed 10%. That doesn't include the costs to doctors and hospitals of maintaining billing staffs to deal with insurers and keep all their rules and peculiarities straight, or the time lost to individuals and their employers of navigating this unnecessarily byzantine system.
Add those, and the overall administrative costs embedded in the U.S. healthcare system come to 31% of all spending, according to a 2003 article co-written by Himmelstein for the New England Journal of Medicine. Administrative and clerical workers accounted for nearly 44% of all employees in doctors' offices, they calculated.
What do Americans receive in return for all this overhead? Practically nothing. The insurance industry says its role is to hold down costs by negotiating for preferential fees from doctors and hospitals and trolling for abuses, but the truth is they're totally ineffective at cost control.
Just last year I reported on an admission by Aetna and United Healthcare, two of our biggest insurers, that they had been snookered to the tune of $60 million by one chain of small surgical clinics in Northern California. That happened because the insurers didn't hire enough staff to give the claims from those clinics decent scrutiny — in other words, their administrative costs, high as they were, didn't buy adequate oversight.
The result, to cite just one example, was that United paid the chain more than $97,000 for a kidney stone operation that it usually covers for $6,851.
"Private insurance is a parasite in the system," says Arnold S. Relman, the former editor of the New England Journal of Medicine and an advocate of healthcare reform. "It adds nothing of value commensurate with its cost."
Relman believes that fixing the healthcare system will require more than single-payer. The delivery of care needs to be reorganized by promoting the formation of more "accountable care organizations" — medium- and large-scale group practices with hospital affiliates whose physicians would be salaried to discourage the overuse fostered by the fee-for-service system.
What's really needed is political will. It would help if big companies, which grouse incessantly about the rising costs of covering their employees, would throw their weight behind a system that would relieve them of that burden.
The forces of opposition won't lie down; the insurance industry won't give up its central role in the healthcare system without a costly and bruising fight, as it showed in Congress and in numerous states, including California, where single-payer plans were on the table.
"It's going to be a slow and painful process," Relman says. "But sooner or later we'll have to turn to single-payer. It's the only logical solution."
Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow@hiltzikm on Twitter.
Copyright © 2013, Los Angeles Times
Unions’ Misgivings on Health Law Burst Into View
By STEVEN GREENHOUSE and JONATHAN MARTIN
LOS ANGELES — When President Obama phoned the president of the A.F.L.-C.I.O. last month, he shared some news that the labor leader had long wanted to hear — the administration would propose measures to reduce workplace exposure to disease-causing silica dust.
But their conversation soon moved to what has become a contentious topic this summer: labor’s renewed anger over Mr. Obama’s health care law and decisions surrounding it, especially the postponement of an employer mandate to ensure coverage for workers and the potential effects of the coming health insurance exchanges on existing plans.
According to officials briefed on the call, the president voiced concern about labor’s criticisms, prompting the union federation’s leader, Richard Trumka, to promise that he would try to soften the harshly worded resolutions that several unions planned to push at this week’s A.F.L.-C.I.O. convention in Los Angeles.
Despite overtures on both sides — with Mr. Obama agreeing on the call to sit down with some union leaders to address their concerns at the White House, and Mr. Trumka initially hoping to quash such a public rift between the president and his party’s traditional allies — labor leaders criticized the administration and Congress on Wednesday at their convention.
While praising the overall legislation, the delegates overwhelmingly passed a sharply worded resolution that demanded changes to some of its regulations, although Mr. Trumka made sure to strip out some proposals that called for repealing the legislation.
At the convention, though, several labor leaders spoke their minds.
“If the Affordable Care Act is not fixed and it destroys the health and welfare funds that we have fought for and stand for, then I believe it needs to be repealed,” said Terence M. O’Sullivan, president of the Laborers’ International Union of North America. “We don’t want it to be repealed. We want it to be fixed, fixed, fixed.
A single-payer system makes economic sense
By Sen. Bernie Sanders
The Hill, Sept. 10, 2013
Americans spend about twice as much per capita on healthcare as almost any other developed nation, but our outcomes are not as good as others that spend much less. We can do better. We must do better.
Today, some 50 million Americans lack health insurance. Many others delay going to the doctor because of high deductibles and unaffordable copayments. While the number of uninsured Americans will go down with the implementation of the Affordable Care Act, widely known as ObamaCare, tens of millions of Americans will remain uninsured.
The goal of an effective healthcare system is to do everything possible to enable people to live long and healthy lives. Sadly, the American system fails to do that and falls behind many other countries. While we devote 18 percent of our gross domestic product to healthcare, we rank 33rd in life expectancy and 34th in infant mortality, and trail in many other health outcomes. A Harvard University study indicated that, incredibly, some 45,000 Americans die needlessly each year because they do not get to a doctor in time.
I start my approach to healthcare from a very basic premise: healthcare is a right, not a privilege. Unfortunately, uniquely among major nations, that statement is not true for the United States, where access to healthcare depends on how much money you have and what your employer is willing to provide.
It is simply unconscionable that the most advanced nation in the world has so many people who lack health insurance. It makes no sense that millions more are one diagnosis or car accident away from financial disaster. And, despite the trillions of dollars we spend on healthcare, the disparity in the quality of care between the rich and everyone else grows wider.
Our system doesn’t make economic sense, and it certainly doesn’t make moral sense. In a civilized, democratic society, every man, woman and child must be able to get the medical care they need regardless of income.
It is incomprehensible that drug companies still get away with charging Americans twice as much — or more — than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still want to hike premiums by as much as 60 percent a year on individual policyholders.
It boggles the mind that approximately 30 percent of every healthcare dollar spent in the United States goes to administrative costs rather than to delivering care. Taiwan, for example, spends only a little over 6 percent of its GDP on healthcare, while achieving better health outcomes on some key indicators than we do. The reason, of course, is that they spend a fraction of what we do on administrative costs.
If our goal is to provide high-quality healthcare in a cost-effective way, what should we be doing?
Clearly, we must move toward a single-payer system.
http://www.pnhp.org/print/news/2013/september/a-single-payer-system-makes-economic-sense
The Hill, Sept. 10, 2013
Americans spend about twice as much per capita on healthcare as almost any other developed nation, but our outcomes are not as good as others that spend much less. We can do better. We must do better.
Today, some 50 million Americans lack health insurance. Many others delay going to the doctor because of high deductibles and unaffordable copayments. While the number of uninsured Americans will go down with the implementation of the Affordable Care Act, widely known as ObamaCare, tens of millions of Americans will remain uninsured.
The goal of an effective healthcare system is to do everything possible to enable people to live long and healthy lives. Sadly, the American system fails to do that and falls behind many other countries. While we devote 18 percent of our gross domestic product to healthcare, we rank 33rd in life expectancy and 34th in infant mortality, and trail in many other health outcomes. A Harvard University study indicated that, incredibly, some 45,000 Americans die needlessly each year because they do not get to a doctor in time.
I start my approach to healthcare from a very basic premise: healthcare is a right, not a privilege. Unfortunately, uniquely among major nations, that statement is not true for the United States, where access to healthcare depends on how much money you have and what your employer is willing to provide.
It is simply unconscionable that the most advanced nation in the world has so many people who lack health insurance. It makes no sense that millions more are one diagnosis or car accident away from financial disaster. And, despite the trillions of dollars we spend on healthcare, the disparity in the quality of care between the rich and everyone else grows wider.
Our system doesn’t make economic sense, and it certainly doesn’t make moral sense. In a civilized, democratic society, every man, woman and child must be able to get the medical care they need regardless of income.
It is incomprehensible that drug companies still get away with charging Americans twice as much — or more — than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still want to hike premiums by as much as 60 percent a year on individual policyholders.
It boggles the mind that approximately 30 percent of every healthcare dollar spent in the United States goes to administrative costs rather than to delivering care. Taiwan, for example, spends only a little over 6 percent of its GDP on healthcare, while achieving better health outcomes on some key indicators than we do. The reason, of course, is that they spend a fraction of what we do on administrative costs.
If our goal is to provide high-quality healthcare in a cost-effective way, what should we be doing?
Clearly, we must move toward a single-payer system.
http://www.pnhp.org/print/news/2013/september/a-single-payer-system-makes-economic-sense
Stem Cell Treatments Overtake Science
By LAURA BEIL
TIJUANA, Mexico — Maggie Alejos arrived here in June from St. Anne, Ill., with her husband, her daughter and a cashier’s check for $13,500, payable to the Regenerative Medicine Institute.
Rail-thin, with an oxygen tube anchored above her upper lip, Ms. Alejos, a retired Army nurse, has coped with emphysema for a dozen of her 65 years. Once she came close enough to a lung transplant that doctors prepared her for surgery, only to discover that the donor lung was unfit.
At a hospital here, doctors affiliated with the institute extracted about seven ounces of fat from her thighs, hoping to harvest about 130 million stem cells and implant them in her failing lungs.
Across the Internet — where Ms. Alejos learned about the Tijuana institute — adult stem cells are promoted as a cure for everything from sagging skin to severed spinal cords.
On the surface, the claim is plausible. Scientists have discovered that fat, bone marrow and other parts of the body contain stem cells, immature cells that can rejuvenate themselves, at least in the tissue they are naturally found.
But it has yet to be proved that these cells can regenerate no matter where they are placed, or under what conditions this might occur. Moreover, questions about safety remain unanswered.
These sober realities do not appear to have slowed the rise of an international industry catering to customers who may pay tens of thousands of dollars in cash for their shot at a personal miracle. (Some foreign operators offer creative variations on the theme, like cells from sharks and sheep.)
Domestic providers, too, can push the limits. In July, for example, a former pathologist at the Medical University of South Carolina pleaded guilty to illegally process
A Health Insurance Offer for the Busy Start-Up
By ROBB MANDELBAUM
Start-ups — hungry, lean, facing an uncertain future — are different from other businesses. So it is reasonable to think that start-ups might have different needs when it comes to health insurance. Now, one organization istrying to profit from this distinction, real or imagined, by marketing health insurance specifically to start-ups almost anywhere in the country.
On Monday, the Young Entrepreneur Council, an invitation-only network of successful company founders, introduced StartupInsurance.com, a Web site where nascent companies can buy health insurance and supplemental policies like dental insurance. “We’re trying to bring a level of trust and transparency to a community that we understand very well here,” said Scott Gerber, founder of the Young Entrepreneur Council. “We bring the curation and the knowledge of the need of our constituency.” The council has simultaneously introduced FreelancerHealthcare and SmallBusinessInsurance, Web sites that sell insurance to those segments of the market.
Certainly the effort makes sense for the for-profit Young Entrepreneur Council. It has used its network of nearly a thousand entrepreneurs to build an online brand for helping small businesses and will receive a fee for every client it refers to the insurance carriers marketing the plans, principally Assurant Health. Eventually, the council plans to market other business services to small companies. The question is whether the sites and their health offerings make sense for start-ups and other entrepreneurs.
Mr. Gerber said start-ups wanted insurance that was affordable and transparent and that complied with the requirements of the Affordable Care Act, which take effect in 2014. But desiring these would not seem to distinguish start-ups and other entrepreneurs from anybody else — what company would not want to buy insurance that is inexpensive, easy to understand, and compliant with regulations?
But in fact, some of the individual health plans the freelance and start-up sites are offering will not comply with the health care law’s provisions for providing minimum value. That means that the people who buy them will be subject to the penalty of the individual mandate. Mr. Gerber said that some entrepreneurs might prefer to absorb the mandate penalty in exchange for cheaper, if less extensive, coverage. “It’s important to give a choice,” he said.
In about three weeks, potentially tens of thousands of Maine residents will start shopping for health insurance on newly deployed, online insurance marketplaces, or exchanges, that will help consumers enroll in the plans they can afford and for which they qualify.
About a week before the Oct. 1 open date, the Maine Health Exchange Advisory Committee formed by the state Legislature will have its first meeting. The 16-member group plans to monitor how well the exchange formed under the federal Affordable Care Act is working for the Maine consumers and small businesses expected to use it to purchase insurance.
The group — with representation from the insurance industry, consumers, employers and the Legislature — will focus on a number of questions. Are federal subsidies making coverage affordable? Is needed coordination happening between Maine’s Medicaid program and the health insurance marketplace? Is the marketplace working for small businesses using it to insure their employees?
The state’s superintendent of insurance and Health and Human Services commissioner would do well to participate in such an effort. They run the two state agencies most closely involved in the work of insuring Maine residents. They should want to see the marketplace succeed. But per the policy of their boss, Gov. Paul LePage, Commissioner Mary Mayhew and Insurance Superintendent Eric Cioppa declined their invitations to join the advisory committee.
“Noting that we are not supportive of this particular measure, but also noting that the Bureau of Insurance is working to implement the exchange, we are not participating in that committee,” said LePage spokeswoman Adrienne Bennett.
LePage is also unhappy lawmakers used a special legislative order — rather than conventional legislation, which the unsupportive governor would have vetoed — to appoint the committee.
The insurance marketplaces are one of the key strategies used by the Affordable Care Act, or Obamacare, to cover some of the millions of people in the United States who lack health insurance. In Maine, the Bureau of Insurance expects 5-8 percent of the state’s population to use the marketplace to purchase insurance. The Congressional Budget Office expects about 85 percent of people who use the marketplace to buy insurance — which starts Jan. 1, 2014 — will qualify for subsidies that will cut the cost of monthly premiums.
But LePage wants no part of it, or at least as little to do with it as possible. Late last year, the Republican governor announced Maine wouldn’t run its own insurance marketplace. Instead, Maine — along with 26 other states — will use a marketplace operated by the federal government.
LePage also wanted nothing to do with the law’s other major initiative to grow insurance coverage: an expansion of Medicaid. In Maine, expanding the public insurance program would provide coverage for about 50,000 adults without children and prevent about 25,000 other low-income parents and childless adults from losing their Medicaid coverage on Jan. 1.
Even though Maine isn’t expanding Medicaid, the Kaiser Commission on Medicaid and the Uninsured estimates Maine’s Medicaid program will still add 10,000 enrollees. That’s because as the Affordable Care Act’s individual mandate takes effect, people will explore their insurance options, and many will realize they’re eligible for Medicaid though they hadn’t previously signed up.
The Maine Bureau of Insurance undertook significant work to make sure the private insurance plans offered to Maine residents through the health insurance marketplace met federal requirements. The bureau is holding information sessions across the state to make residents aware of coverage options through the exchange.
The Maine Department of Health and Human Services is making sure its Medicaid computer systems communicate with the health insurance marketplace.
But the LePage administration’s choices against expanding Medicaid, against having Maine operate its own health insurance marketplace and against having administration officials participate in the health exchange advisory committee fit into a broader trend of Republicans across the country — intent on seeing a signature initiative of Democratic President Barack Obama’s fail — undermining the ability of Obamacare to reach its 100 percent insurance coverage goal.
But to what end, other than a bizarre attempt to claim political victory from throwing up obstacles in the way of the uninsured gaining coverage?
The LePage administration might not support Obamacare, but it’s the law. The administration should do everything in its power to make sure the law works, and works well, for Maine residents.
The end result will be more residents with insurance coverage that allows them access to care without going bankrupt.
Anthem health plan draws praise, criticism
Posted Sept. 10, 2013, at 10:34 a.m.
AUGUSTA, Maine — Central Maine Healthcare employees, Anthem Blue Cross and Blue Shield leaders and others spent hours Monday trying to sway the head of the Maine Bureau of Insurance.
Anthem’s plan to move thousands of individual policyholders into a plan that strictly limits their doctors and hospitals is horrible — or great — depending on who was speaking.
“The outcry from the public has been loud and clear,” Paul Dionne, chairman of Central Maine Healthcare’s board of trustees, said. “The public wants to be protected from Anthem and from MaineHealth. In order to serve the public, the [Maine Bureau of Insurance] superintendent must not limit the public’s right to choose.”
“I think that it’s well documented at this point that narrow networks are regaining popularity,” said Colin McHugh, Anthem’s regional vice president for provider engagement and contracting, later in the hearing. “We think that at this point, given the cost pressure and what’s coming with the ACA [Affordable Care Act], that this will be a very attractive set of products.”
At issue is Anthem’s controversial new insurance proposal that would force some current individual policyholders into a network with MaineHealth providers and their affiliates. Under the plan, patients who bought individual policies after March 2010 could no longer use six Maine hospitals, including Central Maine Medical Center in Lewiston, Rumford Hospital, Bridgton Hospital and Parkview Adventist Medical Center in Brunswick, except in the case of an emergency. They also would be prohibited from seeing doctors affiliated with those hospitals.
The state approved a similar Anthem plan for individuals and small groups buying insurance from the upcoming ACA marketplace, or exchange. The federal government still must approve it.
Now Anthem is seeking state approval to move about 9,000 of its 17,000 current individual policyholders to new plans that use that same narrow network. All of the excluded doctors and hospitals are in southern and central Maine. Of those 9,000 policyholders, just over 7,000 live in those areas.
Anthem said fewer than 1,000 of the southern and central Maine policyholders have primary care doctors who would not be in the network.
Maine Bureau of Insurance Superintendent Eric Cioppa held four public comment sessions on this issue in recent weeks, including one in Auburn that drew a crowd of hundreds and lasted for hours.
Resolution 54: AFL-CIO Convention Resolution on the Affordable Care Act
Submitted by the Building and Construction Trades Department, the International Union of Operating Engineers and the American Federation of Teachers
Referred to the Resolutions Committee
Referred to the Executive Council by the Resolutions Committee with the Recommendation that It Be Sent to the Convention for Adoption
Referred to the Convention by the Executive Council with a Recommendation for Adoption
Referred to the Executive Council by the Resolutions Committee with the Recommendation that It Be Sent to the Convention for Adoption
Referred to the Convention by the Executive Council with a Recommendation for Adoption
WHEREAS, in 2009, the AFL-CIO Convention passed two health care resolutions—Health Care Reform Now and the Social Insurance Model for Health Care Reform—which reaffirmed the labor movement’s commitment to health care for all, ultimately through a single-payer system. In 2010, Congress passed the Affordable Care Act (ACA);
WHEREAS, the AFL-CIO continues to support the ACA’s goal of securing high-quality, affordable health coverage for all Americans; three years after the passage of the Affordable Care Act, we reaffirm our commitment to the goal of affordable, quality health care for all but recognize that the ACA remains a work in progress;
WHEREAS, the ACA’s expansion of comprehensive health insurance to 25 million more Americans, support for affordability through expanded Medicaid eligibility and premium subsidies and insurance market reforms are clear gains for working families. The new law also has eliminated some of the worst insurance company abuses, cut costs for seniors, and appears to be contributing to lower rates for individual coverage in states like California and New York;
Selling the Fantasy of Fertility
By MIRIAM ZOLL and PAMELA TSIGDINOS
ON Sunday in New York City, a trade show called Fertility Planit will showcase the latest inventions in the world of reproductive medicine under a banner that reads: “Everything You Need to Create Your Family.” Two dozen sessions will feature many of the sponsors’ products and therapies, with an emphasis on hopeful breakthroughs ranging from genetic testing to embryo thawing techniques to genome sequencing.
But the fair’s most powerful strategy is the suggestion that all your answers can be found within the event hall — and that the power to overcome infertility can be found within yourself.
As former fertility patients who endured failed treatments, we understand how seductive that idea is.
Americans love an uphill battle. “Don’t give up the fight” is our mantra. But the refusal to accept physical limitations, when applied to infertility, can have disturbing consequences.
Medical science has achieved great feats, improved and saved the lives of many. But when it comes to assisted reproductive technologies, science fails far more often than is generally believed.
The European Society of Human Reproduction and Embryology reports that, on average, of the 1.5 million assisted reproductive cycles performed worldwide, only 350,000 resulted in the birth of a child. That is a 77 percent global failure rate. In the United States, the Centers for Disease Control and Prevention puts the overall failure rate at almost 70 percent.
Behind those failed cycles are millions of women and men who have engaged in a debilitating, Sisyphus-like battle with themselves and their infertility, involving daily injections, drugs, hormones, countless blood tests and other procedures.
Phone calls show MaineCare transport mess persists
With DHHS still evaluating the program after six weeks, the companies hired to coordinate rides say service is better. Yet phone calls placed by Rep. Matthew Peterson suggest otherwise.
By Joe Lawlor jlawlor@pressherald.com
Staff Writer
Staff Writer
AUGUSTA — Like thousands of MaineCare patients who have struggled to get rides to doctor's appointments in the past six weeks, state Rep. Matthew Peterson couldn't get through on the phone Wednesday.
While officials from the companies the state hired to coordinate rides told a legislative committee that they have made substantial improvements to the program since it started Aug. 1, Peterson used his smartphone to call the number that most people in the program use to arrange rides.
Producing a moment of stunned silence, he said, "I've called that number a dozen times in the last hour we've been sitting here. I'd just like to tell you what I've been hearing when I call the number."
Peterson held up his smartphone and turned it on speaker so people in the room could hear.
The automated voice said: "I'm sorry for any inconvenience. Goodbye."
Pharmacy groups sue Maine to stop new import law
A law that passed in June and goes into effect in October would allow a Canadian company to resume its mail-order business in Maine.
By Eric Russell erussell@pressherald.com
Staff Writer
Staff Writer
A coalition representing the pharmaceutical industry in Maine has sued the state over a new law that allows consumers to buy mail-order prescription drugs from unlicensed international firms.
The Maine Pharmacy Association, the Retail Association of Maine, the Maine Society of Health System Pharmacists, the Pharmaceutical Research and Manufacturers of America and several individual pharmacists filed the lawsuit late Tuesday in U.S. District Court.
Named as defendants are Maine Attorney General Janet Mills and state Finance Commissioner Sawin Millett.
The 23-page complaint alleges that the law -- which passed in June and is scheduled to take effect Oct. 9 -- was a deliberate attempt to circumvent federal law and could threaten patient safety. And while the law was meant to help just one company, CanaRx, it could open the door for others.
"(The law) was enacted with the avowed purpose of opening the state's borders to foreign pharmacies, after previous iterations of drug importation programs operating in the state ended," the suit states. "Prescription drugs shipped to Maine by foreign pharmacies pursuant to the (law) are not subject to any of the quality and safety controls put in place by the federal government in order to protect persons who rely on prescription medications. The (law) therefore puts Maine residents at risk of serious harm."
In 2012, former Attorney General William Schneider determined that CanaRx, an international firm that had been providing low-cost medication since 2003 to more than 1,000 Mainers, could not be licensed as a pharmacy in Maine.
His decision prompted CanaRx to halt its MaineMeds program, which had been offered to employees of state government, the city of Portland and Hardwood Products of Guilford. Ending the program threatened nearly $3 million in savings under the Maine state employees' health plan and another $200,000 in savings for the city of Portland.
Health overhaul media blitz confuses Medicare beneficiaries
By Kelli Kennedy / The Associated Press
MIAMI — Dear seniors, your Medicare benefits aren't changing under the Affordable Care Act. That's the message federal health officials are trying to get out to elderly consumers confused by overlapping enrollment periods for Medicare and so-called "Obamacare."
Medicare beneficiaries don't have to do anything differently and will continue to go to Medicare.gov to sign up for plans. But advocates say many have been confused by a massive media blitz directing consumers to new online insurance exchanges set up as part of the federal health law. Many of the same insurance companies are offering coverage for Medicare and the exchanges.
Medicare open enrollment starts Oct. 15 and closes Dec. 7, while enrollment for the new state exchanges for people 65 and under launches Oct. 1 and runs through March.
"Most seniors are not at all informed. Most seniors worry they're going to lose their health coverage because of the law," said Dr. Chris Lillis, a primary care physician in Fredericksburg, Virginia. "I try to speak truth from the exam room but I think sometimes fear dominates."
Next month, roughly 50 million Medicare beneficiaries will get a handbook in the mail with a prominent Q&A that stresses Medicare benefits aren't changing. Federal health officials have also updated their training for Medicare counselors, and are prepping their Medicare call center and website.
"We want to reassure Medicare beneficiaries that they are already covered, their benefits aren't changing, and the marketplace doesn't require them to do anything different," said Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services.
Where you live is everything with Obamacare
Glaring differences exist between states that embrace and reject Medicaid expansion.
By Ricardo Alonso-Zaldivar / The Associated Press
Having health insurance used to hinge on where you worked and what your medical history said. Soon that won't matter, with open-access markets for subsidized coverage coming Oct. 1 under President Obama's overhaul.
But there's a new wild card, something that didn't seem so critical when Congress passed the Affordable Care Act back in 2010: Where you live.
Entrenched political divisions over "Obamacare," have driven most Republican-led states to turn their backs on the biggest expansion of the social safety net in a half century. If you're uninsured in a state that's opposed, you may not get much help picking the right private health plan for your budget and your family's needs.
The differences will be more glaring if you're poor and your state rejected the law's Medicaid expansion. Unless leaders reverse course, odds are you'll remain uninsured. That's because people below the poverty line do not qualify for subsidies to buy coverage in the markets.
"We are going to have a new environment where consumers may be victims of geography," said Sam Karp of the California HealthCare Foundation, a nonprofit helping states tackle practical problems of implementation. "If I'm a low-wage earner in California, I may qualify for Medicaid. With the exact same income in Texas, I may not qualify."
Attorney general: Judges’ decision against tobacco companies to save Maine nearly $50 million
Posted Sept. 12, 2013, at 11:29 a.m.
AUGUSTA, Maine — Maine won’t have to forfeit nearly $50 million in payments from tobacco companies following a decision Wednesday by a federal panel of retired judges.
Attorney General Janet Mills on Thursday hailed the decision as a win for Mainers who have fallen victim to the “deceptive practices” of tobacco companies. According to Mills, the decision means Maine won’t have to return $44 million already paid to the state and will receive another $5 million that tobacco companies have withheld pending Wednesday’s decision.
At issue is the 1998 Tobacco Master Settlement Agreement, in which Maine and 47 other states became eligible for annual cash payments from tobacco companies in exchange for states dropping lawsuits against those companies from ongoing costs of treating tobacco-related illnesses.
In 2003, according to Mills, tobacco companies began withholding portions of their payments to states like Maine, claiming that those states were not enforcing laws against tobacco companies who were not part of the 1998 settlement.
“This is a big win for the people of the state of Maine who continue to pay the price due to the deceptive practices of the tobacco companies,” said Mills in a prepared statement. “Every year in Maine thousands of adults will die from tobacco use and thousands more, including kids, will get sick from tobacco-related illnesses. It is unconscionable that cigarette manufacturers are still trying to slip out of their obligations under the Master Settlement Agreement. I am hopeful that this decision will show that these corporations cannot escape liability for the deadly products they sell.”
The panel of retired federal judges who rejected the tobacco companies’ claims on Wednesday found that Maine is one of nine states that are in compliance with the settlement while nine other states are not. The decision affects payments to Maine for 2003; the cigarette manufacturers are also making similar challenges for more recent years. Hearing on those claims by the companies have not yet been held.
The tobacco settlement funds flow into the state’s Fund for a Healthy Maine, a pool of money that is used mostly for health care programs and disease prevention, school-based health centers and offsetting Medicaid costs due to tobacco use. Maine has received approximately $700 million from the tobacco companies since 2000.
Republican leader looks to delay Obamacare in exchange for debt agreement
Posted Sept. 11, 2013, at 9:36 a.m.
WASHINGTON — House Republican leaders on Tuesday floated their strategy for thwarting “Obamacare” health reforms in autumn fiscal debates.
They plan to try to link a one-year delay in funding Obamacare with a deal on raising the debt limit, while seeking to deny implementation money for Obamacare in a stopgap government funding measure.
House Majority Leader Eric Cantor told House Republicans in a closed-door meeting that delaying all or part of Obamacare would be a key goal in the debt limit debate, party aides said.
Cantor is planning to hold a House vote later this week on his plan to deny funds to the health care law while extending government spending authority, but Republican conservatives say that the measure likely will prove ineffective.
The House plan for a stopgap funding measure known as a continuing resolution would be split into two parts, allowing the Senate to reject the portion defunding Obamacare while passing and sending the stopgap funding measure to President Barack Obama. The plan would reduce changes of a government shutdown.
Cantor’s and House Speaker John Boehner’s logic is that the Senate would be forced to take a difficult vote to actively provide funding to launch Obamacare health insurance exchanges, which Republicans believe will be unpopular with voters.
While the House has voted 40 times to repeal, defund or limit Obamacare since its passage in 2010, the Democratic-controlled Senate has chosen to simply ignore most of these measures.
“We will send to the Senate the provision which says up or down, are you for defunding Obamacare or not?” Cantor said of his plan. “The House has taken a stand numerous times on its opinion of Obamacare. It’s time for the Senate to stand up and tell their constituents where they stand on this atrocity of a law.”
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