National Health Costs vs. Your Health Costs
By ANNIE LOWREY
Health care spending growth has plummeted to the lowest levels ever recorded. But many Americans insist that they are paying more and more.
It is jarring, but both of those things are true, as a report from the Health Care Cost Institute helps to show. Out-of-pocket spending on things like deductibles and co-payments has shot up faster than overall spending of late. That means that even while hospitals and insurers have wrung billions of dollars out of the system, many individuals are feeling a heavier and heavier burden.
In its 2012 Health Care Cost and Utilization Report, the nonprofit research group found that health spending grew slowly last year, at a 4 percent annual rate. (The institute looks at the 156 million Americans under the age of 65 with employer-sponsored insurance.)
“Although average health care expenditures grew at nearly the same rate in 2012 as 2011, the causes of the 4 percent increase in spending each year were quite different,” David Newman, the institute’s executive director, said in a statement. “In prior years, rising health care prices drove up spending. In 2012, we saw utilization start to change health care trends for prescription drugs and professional procedures. Preliminary evidence suggests this may be indicative of a larger shift in care as people search for lower-cost care alternatives.”
The institute found that out-of-pocket spending growth outpaced overall spending growth, jumping about 4.8 percent to $768 a person. Older adults, 55 to 64, spent about $1,265 out of pocket, with those under 18 incurring just $427 in uncovered costs. Women also had greater out-of-pocket expenses than men, by more than $200 a year.
Those rising out-of-pocket costs are a major reason that the slowdown in cost growth feels so alien to so many Americans. Health care providers and insurers may see it in their data and their bottom lines. But millions of working Americans don’t. Moreover, economists believe that rising out-of-pocket spending is a majorreason that the health care cost curve seems to be bending, accounting for about 20 percent of the slowdown, according to one study published in the venerable journal Health Affairs.
Obamacare’s real danger for the GOP is that it will succeed
By Eugene Robinson,
To understand the crisis in Washington, tune out the histrionics and look at the big picture: Republicans are threatening to shut down the federal government — and perhaps even refuse to let the Treasury pay its creditors — in a desperate, last-ditch attempt to keep millions of Americans from getting health insurance.Seriously. That’s what all the yelling and screaming is about. As my grandmother used to say, it’s hard to know whether to laugh or cry.
The GOP has tried its best to make Obamacare a synonym for bogeyman and convince people that it’s coming in the night to snatch the children. In fact, and I know this comes as a shock to some, Obamacare is not a mythical creature. It is a law, incorporating what were originally Republican ideas, that will make it possible for up to 30 million people now lacking health insurance to obtain it.
Officially, the law in question is the Patient Protection and Affordable Care Act. Republicans intended the term “Obamacare” to be mocking, which is perhaps why President Obama started using it with pride.
It is, indeed, an achievement of which the nation can be proud. About 48 million individuals in this country lacked health insurance in 2012, according to the Census Bureau, representing about 15 percent of the population. Other industrialized nations provide universal health care — and wonder if this is what we mean when we talk about American exceptionalism.
About 25 percent of people in households with annual incomes below $25,000 are uninsured, compared with just 8 percent in households earning more than $75,000. Do the working poor not deserve to have their chronic medical conditions treated as punishment for not making enough money?
Other rich countries provide truly universal care through single-payer systems of various kinds. Obama chose instead to model the Affordable Care Act after a program implemented on the state level by the Republican governor who became Obama’s opponent in the 2012 presidential election. Yes, before Obamacare there was Romneycare, a private-sector, free-market solution designed to be in accord with the GOP’s most hallowed principles.
But in the years between Mitt Romney’s tenure in Massachusetts and his presidential run, the Republican Party lost its way, or perhaps its mind.
Posted Sept. 23, 2013, at 11:27 a.m.
Should states expand Medicaid under the Affordable Care Act? Maine has wrestled with this question, as have many states. The answer to this question reflects both policy and politics — which can vary considerably from state to state.
As a primary care doctor and health policy researcher, I recently published a paper to shed light on the policy question at the heart of the matter: Will expanding Medicaid help more than it hurts, or hurt more than it helps? Last week, Gov. Paul LePage interpreted the research study in his public remarks, and as the lead author of that study I would like to clarify several statements that have been circulating ever since.
The study, published in the Annals of Family Medicine by coauthor Dr. Matthew Davis and me, describes the characteristics of Americans potentially eligible for the Medicaid expansion under the Affordable Care Act.
Using a national source of data used by many other researchers who look at national trends, such as high blood pressure and obesity, we illustrated that these potential new Medicaid enrollees on average are just as healthy, if not healthier, than the current Medicaid population. In contrast, they will have higher rates of current smoking and heavy drinking than people currently on Medicaid. These new enrollees will also likely be younger, with more males, and more white than black individuals.
We concluded that providing affordable health care for these uninsured, poor and low-income Americans is a key opportunity to keep people healthy and prevent future health problems related to smoking and heavy drinking. Helping people with unhealthy habits today can address the high costs of health care in the U.S. by preventing life-threatening, expensive diseases in the future.
A natural question about our research is: How do these findings apply to Maine? After all, Maine has a higher-than-average proportion of residents already enrolled in Medicaid (31 percent, compared with the national average of 21 percent). Higher enrollment rates can make policymakers cautious about program expansion.
LePage alluded to such concerns in his statements, saying that a Medicaid expansion would “provide services to a younger population,” while depleting resources for “the elderly and disabled.” The age and disability-related concerns that LePage raised are not part of our study, however. In fact, we did not consider the elderly in our study because more than 99 percent of seniors (including Mainers) already have coverage through Medicare.
It is essential for me to emphasize that our study does not and cannot show how states should implement their individual Medicaid programs, or decide who will receive coverage. States work directly with the federal government on such matters. As a family physician and policy researcher, my goal in publishing this study was to contribute helpful information to inform the current discussion around Medicaid expansion. This is what I tell patients about what we found:
Married Cancer Patients Live Longer
By TARA PARKER-POPE
Married cancer patients live longer than single people who have the disease, suggesting that logistical and emotional support from a loved one may be far more critical to cancer care than previously recognized.
Numerous studies have suggested that married people have better overall health than single people, but those data likely are skewed by the fact that healthy people are more likely to have opportunities to marry. However, the latest study did not look at overall health, and instead focused on what happens to married and single people who become ill with cancer. The findings offer a glimpse into the crushing logistical burden that cancer treatments impose on patients, particularly those who are single.
“When you have a spouse who is present when the patient is diagnosed, they are an invested party and they are going to more than likely make sure the patient goes to the doctor, that they get the necessary treatments,’’ said Dr. Ayal A. Aizer, chief resident of the Harvard Radiation Oncology Program and the study’s first author. “We don’t think there’s something intrinsic about people who are married, but we do think it’s the support marriage is providing that makes a difference.”
Researchers from several institutions, including Harvard Medical School and the Dana Farber Cancer Center, analyzed nearly 735,000 people who received a cancer diagnosis between 2004 and 2008. The study, which used data from the National Cancer Institutes Surveillance, Epidemiology and End Results (SEER) Program, focused on the 10 leading cancer killers: lung, colon, breast, pancreatic, prostate, liver, non-Hodgkin lymphoma, head and neck, ovarian and esophageal cancers.
The study, published in The Journal of Clinical Oncology, found that single patients were 53 percent less likely to receive appropriate therapy than married patients. The finding suggests that maintaining grueling chemotherapy and radiation schedules and taking medication as prescribed is easier for people who have help from a spouse compared with single people who must manage the logistics of cancer treatment on their own.
Officials Detail Premium Costs of Health Plan
By ROBERT PEAR and REED ABELSON
WASHINGTON — The Obama administration on Tuesday provided the first detailed look at premiums to be charged to consumers for health insurance in 36 states where the federal government will run new insurance markets starting next week, highlighting costs it said were generally lower than previous estimates.
Administration officials released the information, central to their campaign to persuade millions of uninsured Americans to sign up for coverage, even as Senator Ted Cruz, Republican of Texas, waged a fierce fight on the Senate floor, risking a government shutdown if necessary to eliminate financing for the expansion of coverage under President Obama’s health care law.
The White House sought to focus attention on what it portrayed as the financial advantages of the health insurance program, which is set to start accepting customers on Oct. 1.
“I can tell you right now that in many states across the country, if you’re, say, a 27-year-old young woman, don’t have health insurance, you get on that exchange, you’re going to be able to purchase high-quality health insurance for less than the cost of your cellphone bill,” Mr. Obama said Tuesday, speaking at a health care forum in New York City with former President Bill Clinton.
For a benchmark plan — the second-lowest-cost “silver plan,” covering 70 percent of projected medical costs for a typical consumer — the average premium nationally will be $328 a month for individuals, the administration said in a new report.
For a family of four with an annual income of $50,000, the administration said, monthly premiums for the second-cheapest plan will vary widely, averaging $600 in Arizona, $800 in Georgia, $961 in Indiana, $1,069 in Mississippi, $859 in New Hampshire, $943 in New Jersey and $656 in Utah.
However, the data provided only a partial picture of the reality that consumers will face. The government did not identify the insurance companies offering policies in the federal marketplaces, also known as exchanges. Nor did it provide any information about the many policies that will cost more than the amounts cited in its report. Such information will not be available until the exchanges open, federal health officials said. Republicans and other critics of the health program were likely to take issue with the financial picture painted by the administration as the new premium information became more widely known.
Online Obamacare marketplaces offer ample options, report says
Most Americans will have a wide variety of choices for health insurance and young people may find plans costing $100 a month or less, the Department of Health and Human Services says.
By Noam N. Levey6:44 PM PDT, September 24, 2013
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WASHINGTON — Most Americans who shop for health insurance on new online marketplaces set up under President Obama's health law will have a wide variety of choices, a new report from the Department of Health and Human Services indicates.
And many young consumers will be able to select health plans that cost $100 a month or less, according to the report, which is based on a preliminary analysis of premiums that insurers will charge when the insurance becomes available Jan. 1 in 36 states.
Premiums will be even less expensive — and free in some places — for low-income consumers who qualify for government subsidies through the Affordable Care Act, commonly known as Obamacare.
Obama administration officials did not release exact figures for each health plan being sold, explaining that rates will not be final until Tuesday, when consumers are scheduled to be able to start shopping on the marketplaces.
The report also includes specific data only from the 36 states that have elected to have the federal government run their marketplaces. Premium information from the 14 states operating their own insurance marketplaces — including California, Maryland and Connecticut — in most cases is available through state websites.
Despite that missing data, the new report provides an important overview of the kind of options that millions of consumers will have. The report also demonstrates that many consumers will probably find an affordable option, though some may face higher premiums, as critics are quick to point out.
"We are seeing, across the board, fairly competitive prices," said Caroline Pearson, vice president of Avalere Health, a consulting firm that has been closely following the rollout of the marketplaces. "The health plans are convinced that people will buy based on price, and they are working very hard to put low-cost products in the markets."
Senator Persists Battling Health Law, Irking Even Many in His Own Party
By JEREMY W. PETERS and JONATHAN WEISMAN
WASHINGTON — Senator Ted Cruz, the Republican from Texas who took to the Senate floor Tuesday afternoon and declared he would speak “until I cannot stand,” was still standing more than 14 hours later as he pressed ahead with his impassioned and often lonely verbal assault on President Obama’s health care law.
It is a fight he will almost certainly lose later on Wednesday when both Republicans and Democrats are expected to vote overwhelmingly to move ahead so the Senate can begin considering a bill, approved by the House last week, that would fund most of the government but not the Affordable Care Act.
The scene inside the Senate chamber in the late night and early morning hours was sometimes an unusual one for the staid body, especially when Mr. Cruz paused briefly in his attack to read his two young daughters a bedtime story — “Green Eggs and Ham” by Dr. Seuss.
At other times, he compared his fight to efforts by leaders who stood against the Nazis, ended the cold war or started the American Revolution.
“Everyone in America knows Obamacare is destroying the economy,” said Mr. Cruz, who began speaking at 2:41 p.m. “Where is the urgency?”
His speech was already rivaling some of the longest Senate filibusters on record, including those by Robert M. La Follette, who spoke for 18 hours and 23 minutes in 1908 and Alfonse D’Amato, who went on for 23 hours and 30 minutes in 1986. The record was set by Strom Thurmond at 24 hours and 18 minutes in 1957.
Mr. Cruz called on his colleagues to stonewall the House measure they technically supported, arguing that Senate Democrats would be successful in stripping the health care provision from the funding bill once the way was cleared to a Senate vote on the issue. His basic demand was an agreement that a final vote require 60 supporters, a demand Democrats rejected.
Other Republicans said they saw no reason to oppose debating a measure they actually backed.
“We’d be hard-pressed to explain why we were opposed to a bill we’re in favor of,” said Senator Mitch McConnell of Kentucky, the Republican leader.
Sen. Ted Cruz digs in as shutdown looms
Sen. Ted Cruz is growing increasingly isolated, even from fellow Republicans, as he digs in to keep Senate Democrats from restoring Obamacare funding that the House spending bill cut.
By Michael A. Memoli10:54 PM PDT, September 24, 2013
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WASHINGTON — Three hours into his Senate speech-a-thon, Sen. Ted Cruz recalled that Sen. Rand Paul's filibuster criticizing U.S. drone policy was seen at first as "curious if not quixotic," but ultimately "transformed the debate."
Cruz, a Texas Republican, took control of the Senate floor Tuesday to herald his campaign to eliminate the money needed to implement President Obama's healthcare law. He hoped for a galvanizing moment similar to the one sparked by his Kentucky colleague in March.
Congress "is held in such disrepute" because both parties "have refused to listen to the people," Cruz said, arguing that Americans oppose the healthcare law. "We need to make D.C. listen."
He spoke to a near-empty Senate chamber, save for several dozen staff members, some observers in the galleries and a Democratic senator who was presiding.
Cruz has vowed to use any means necessary to keep the Democratic-controlled Senate from restoring the money for Obamacare to the spending bill that passed the Republican-led House. His strategy could lead to a government shutdown on Oct. 1, when the new fiscal year begins.
But Cruz is finding himself increasingly isolated. A quirk in the way the Senate will vote on the measure has allowed his opponents to claim, as even Minority Leader Mitch McConnell (R-Ky.) did, that Cruz's approach would "shut down the government and keep Obamacare funded. And none of us want that."
The episode appears to be another example of the limits of the conservative insurgence in Washington, where Democrats control the Senate and the White House. It also has magnified Republican unease with Cruz's style and tactics.
Cruz has been in the Senate less than a year, but already is seen as a potential GOP presidential contender. He has defied the unspoken Senate rule that new lawmakers maintain a low profile and defer to senior colleagues.
Just weeks into his term, Cruz drew a rare public rebuke from colleagues during an open committee hearing after he suggested — admitting that he had no evidence — that Defense secretary nominee Chuck Hagel may have received income from hostile governments.
During a Senate Judiciary Committee hearing on gun safety legislation, Sen. Dianne Feinstein (D-Calif.) sharply admonished Cruz for what she viewed as his lecturing tone in a question about the 2nd Amendment. "Senator, I've been on this committee for 20 years," she said.
The "Defund Obamacare" campaign is not Cruz's passion alone — fellow Republican Sens. Mike Lee of Utah and Marco Rubio of Florida have championed the strategy as well. It has wide support among House Republicans, who forced their leaders to adopt it.
But Lee, after more than two years in the Senate, lacks the national profile that Cruz has generated. Rubio, another possible presidential contender, has not invested as much political capital as Cruz on the issue.
http://www.latimes.com/nation/la-na-government-shutdown-20130925,0,3609302,print.story
Free Rx drug card promises Mainers healthy discounts
A free pharmacy discount card officially launched in Maine on Tuesday promises consumers steep discounts on prescription drugs.
The Maine Rx Card aims to help both uninsured and insured residents nab savings averaging 30 percent on prescription medications at local pharmacies. The card, free and open to all regardless of age or income, offers perks, but one expert in the field advises consumers to approach such cards with a healthy dose of skepticism.
The Maine Rx Card has been available in Maine for two years, but the program is just now stepping up efforts to get the word out by partnering with the Maine Medical Association, said Alix Cousins of Maine Rx Card.
The program’s website boasts savings of up to 75 percent at more than 56,000 pharmacies nationwide, including CVS, Hannaford, Target, Walgreens and many others.
What’s the catch?
“There is no catch,” Cousins said. “It’s actually funded through the participation of pharmacies and pharmaceutical companies. That’s why it’s available free to the public. It’s not funded by taxpayer dollars, there’s no applications or restrictions, anyone can use it.”
Like the many other drug discount cards on the market, the Maine Rx Card is backed by a company known as a “pharmacy benefits manager” that negotiates discounts with participating pharmacies. The discounts can vary from medication to medication.
Sen. Collins’ view on Obamacare funding, shutdown is probably the same as yours
Posted Sept. 23, 2013, at 1:41 p.m.
In a Congress defined by the actions of members at the extremes, Sen. Susan Collins has staked out a position that falls firmly in the mainstream of American public opinion.
Maine’s Republican senator said Friday it’s a mistake to risk a federal government shutdown over attempts by Republicans in Congress to deprive President Barack Obama’s signature health care law of funding.
“We have an obligation to govern in Washington, and it would create chaos if government were to shut down,” Collins told reporters after landing at Bangor International Airport following a week in Washington, D.C.
Collins’ statement puts her at odds with members of her own party in the U.S. House, which voted 230-189 on Friday to pass a resolution providing funds for federal agencies to continue operations after the Sept. 30 end of the fiscal year but without funds needed to implement Obamacare.
But the senator’s position appears to be one shared by most Americans. And Collins is no supporter of Obamacare, a law that continues to be unpopular among the public.
A Washington Post-ABC News poll released last week found support for the health care law among 42 percent of respondents, while 52 percent opposed it. That’s consistent with a long-term tracking poll by the Kaiser Family Foundation that finds the law has rarely attracted more favorable than unfavorable views. In August, 42 percent of respondents held unfavorable views of the law, while 37 percent favored it.
While the law isn’t popular, Americans firmly oppose attempts to cut off its funding when the consequence could be a government shutdown and a national debt default (next month’s Washington showdown). A CNBC poll released Monday found 59 percent of respondents opposed defunding Obamacare if it meant shutting down the federal government. Some 19 percent supported that approach.
Collins is right that Congress’ responsibility is to govern, and governing — regardless of one’s opinion on the Affordable Care Act — does not mean putting the government’s core operations at risk for the singular purpose of undermining a law congressional Republicans oppose.
Collins is also taking a realistic view of the matter, recognizing that the government funding approach supported by House Republicans is a nonstarter when the Senate is controlled by Democrats and the White House is occupied by the man whose legacy will be defined by the health care law.
“The fact is that strategy is not going to be successful,” Collins told McClatchy last week. “The president’s never going to say, ‘OK, I’ll sign a repeal measure.’”
Waiting for Obamacare
Posted Sept. 24, 2013, at 10:49 a.m.
News consumers by now have absorbed the message that Republicans are going to defund Obamacare, shut down the government, ruin the economy and starve the poor.
This is what Democrats would have you believe and, given the GOP’s recent obstructionist history, it would not be a stretch. However, there is an alternative scenario that bears fair consideration.
Not defund, as the House voted to do Friday, but delay.
Democrats and President Barack Obama see delay as just another maneuver to upend Obamacare. “Extortion” is the word Obama recently used. But let’s step back a moment and examine some of the reasoning. Sometimes even partisans are right.
Topping the list is the fact that the Affordable Care Act, or ACA, is becoming increasingly unpopular. Only 39 percent of Americans currently favor the health care program, compared with 51 percent in January, according to a recent CNN-ORC International poll.
Some of the reasons:
— Many companies are cutting worker hours to below the threshold — 30 hours — requiring them to comply with Obamacare. (SeaWorld is cutting hours for thousands of workers.)
— Others are cutting workers completely to avoid compliance or to reduce costs associated with the expanded coverage. (The Cleveland Clinic cited Obamacare as one reason for offering early retirement to 3,000 workers and hinting at future layoffs.)
— Many young people, unemployed or earning little, will have trouble paying premiums once open enrollment for health insurance exchanges begins Oct. 1. Even discounts won’t be enough for some, who then will face fines or have to turn to parents who face their own insurance challenges. List-price premiums for a 40-year-old buying a mid-range plan will average close to $330 per month, according to a recent Avalere Health study. For someone who is 60, premiums will run about $615 a month. Forget retirement.
One of the most popular aspects of Obamacare has been that children can remain on their parents’ policy until they’re 26, but there’s nothing magical about 27 if you don’t have a job, are still in school or are otherwise dependent. Expect many under-30s to decline to buy insurance, whereupon America’s youth will be under the thumb of the IRS. Remember, the Supreme Court ruled that the individual mandate to purchase insurance is a tax.
The other most-popular item was the requirement that pre-existing conditions not preclude insurance coverage. Under a proposed alternative plan unveiled recently by the Republican Study Committee — the American Health Care Reform Act (H.R. 3121) — this provision would be protected and funded through state-based, high-risk pools and other reform measures.
The biggest concern across all demographics is the likely effect on the larger economy. What happens when so many people lose hours and work and, therefore, income?
Some Say Obamacare’s ‘Affordable’ Coverage Isn’t Affordable For Them - Kaiser Health News
Michelle La Voie wants health insurance, but as a single mom making $38,000 a year and supporting two teenagers, she's not sure she can afford it -- even with a subsidy through the federal health law known as Obamacare.
“What’s the point of having [a policy] if I can’t afford to use it?” asks the 47-year-old librarian in upstate Franklinville, New York, referring to the co-pays and deductibles that she might incur if she sought treatment.
How consumers judge the affordability of the new health plans remains one of the biggest unknowns on the eve of the rollout of the health law’s insurance marketplaces. Those marketplaces, aimed at people without group coverage, are predicted to sign up 7 million enrollees by the end of next March. Will shoppers regard the plans as a good value? Will they be able to afford the monthly premiums and other out-of-pocket costs built into most plans?
http://www.kaiserhealthnews.org/Stories/2013/September/25/obamacare-affordability-insurance-costs.aspx
House GOP may attach Obamacare delay to CR
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| The House Republican leadership is seriously considering attaching a one-year delay of Obamacare’s individual mandate to the Senate bill to avert a government shutdown, according to senior GOP aides. If House Republicans decide to go this route, it would all but provoke a government shutdown, since Senate Democrats might not even schedule a vote on a bill that includes that provision, Senate leadership staffers say. Even if the Senate schedules a vote, there might not be time to move the legislation through the slow-moving chamber. The House Republican leadership is planning its next move as it becomes abundantly clear that Texas Sen. Ted Cruz’s gambit to defund Obamacare will fall short. The federal government is set to shut down Tuesday unless a new funding bill is enacted, and the Senate might not even send a bill to the House until Sunday — leaving a hot potato on Speaker John Boehner’s lap shortly before a government shutdown. The Senate bill will fund the government through Nov. 15. (WATCH: Kentucky residents react to Obamacare roll-out) Boehner and his leadership team have been preparing options to present to House Republicans when they return on Wednesday from a brief recess. The process, leadership aides say, will be driven by members of the House Republican Conference. Their first closed party meeting is Thursday. Several different tactics are under discussion within the top levels of House GOP leadership, and the path Republicans choose depends on several factors — chiefly the mood of rank-and-file Republicans when they return to Washington, and when the House gets the continuing resolution back from the Senate. For example, if there isn’t time to send a funding bill back to the Senate without shutting down the government, House Republicans might simply pass the Senate’s version of the legislation and reserve their attacks on Obamacare for future pieces of legislation like a debt ceiling increase. House Republicans begin their quest to lift the debt limit this week, with a similar delay of the health care law attached. This comes after the House passed a CR completely defunding Obamacare. (PHOTOS: 25 unforgettable Obamacare quotes) “We’ll deal with whatever the Senate passes when they pass it,” said Michael Steel, a Boehner spokesman. “There’s no point in speculating before that.” House Republicans see tremendous upside in attempting to delay the individual mandate. First, they think it is easy to communicate the policy to voters. President Barack Obama has already delayed the employer mandate — the provision in the health care bill that requires businesses with more than 50 employees to provide health care for their workers. House Republicans ask: Why not institute that same delay for individuals? Delaying the individual mandate also poses a difficult political problem for some House Democrats, especially those from red states. In July, when similar legislation came up in the House, 22 Democrats voted with 229 Republicans to pass the bill. One Republican voted against that bill: Rep. Morgan Griffith of Virginia. http://dyn.politico.com/printstory.cfm?uuid=E0FA1B57-AA58-4406-9B86-D8C48D6D30E2 |
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