By TARA SIEGEL BERNARD
Once the cardiologist figured out why Raquel and Michael D’Andrea’s 9-week-old daughter was so frail and unable to eat, he immediately sent her to the hospital for heart surgery.
“He told us to go home, get packed and get to the hospital, where they will be waiting for us,” Ms. D’Andrea said. “That was very shocking, but we did it.”
There was little time to think about the intricacies of their insurance plan, but Ms. D’Andrea knew she had already selected a comprehensive plan a few years earlier. She gave her insurance card to the hospital staff, but her daughter, Sienna, was ultimately treated by several doctors who were not in their plan’s network.
“We assumed that because we showed them our insurance card and nobody had any objections, we were covered,” said Ms. D’Andrea, 35, of Farmingdale, N.Y. “But I also wasn’t in the mind-set to ask, or to have them stop doing heart surgery on her.”
Sienna left the hospital in early March, two weeks after a successful operation repaired her aorta. But she had a rough road ahead. She went home with a feeding tube in her nose.
And just a few weeks later, after vomiting through the night, she spent another 17 days in the hospital. As the family finally arrived back home in mid-April, piles of bills from out-of-network doctors started to roll in.
It’s not uncommon for patients who visit an in-network hospital to learn later that they’ve been treated by out-of-network providers, resulting in thousands of dollars in charges. And while the Affordable Care Act generally caps what consumers must spend out of pocket when using providers within their plan’s network, it doesn’t protect consumers from large bills from outside providers. Those providers may be free to charge the consumer for the balance of the bill that the insurer did not pay, known as “balance billing.”
“When the doctors work in the hospital, not for the hospital, which is often the case, they’re not obliged to join the same networks as the hospital,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “And patients generally have no say in selecting those doctors. Sometimes the patients don’t even see them — for instance, if their X-rays get sent to a radiologist or their tissue to a pathologist,” patients won’t even know the name of that doctor until the bill comes.”
Lousy Medicaid Arguments
By PAUL KRUGMAN
For now, the big news about Obamacare is the debacle of HealthCare.gov, the Web portal through which Americans are supposed to buy insurance on the new health care exchanges. For now, at least, HealthCare.gov isn’t working for many users.
It’s important to realize, however, that this botch has nothing to do with the law’s substance, and will get fixed. After all, a number of states have successfully opened their own exchanges, doing for their residents exactly what the federal system is supposed to do everywhere else. Connecticut’s exchange is working fine, as is Kentucky’s. New York, after some early problems, seems to be getting there. So, a bit more slowly, does California.
In other words, the technical problems, while infuriating — heads should roll — will not, in the end, be the big story. The real threat remains the effort of conservative groups to sabotage reform, especially by blocking the expansion of Medicaid. This effort relies heavily on lobbying, lavishly bankrolled by the usual suspects, including the omnipresent Koch brothers. But it’s not just money: the right has also rolled out some really lousy arguments.
And I don’t just mean lousy as in “bad”; I also mean it in the original sense, “infested with lice.”
Before I get there, a word about something that, as far as we can tell, isn’t happening. Remember “rate shock”? A few months ago it was all the rage in right-wing circles, with supposed experts claiming that Americans were about to face huge premium increases.
It quickly became clear, however, that what these alleged experts were doing was comparing apples and oranges — and as Ezra Klein of The Washington Post pointed out, oranges that, in many cases, you can’t even buy. Specifically, they were comparing the premiums young, healthy men were paying before reform with the premiums everyone — including those who previously couldn’t get insurance because of pre-existing conditions — will pay under the new system. Oh, and they also weren’t taking into account the subsidies many Americans will receive, reducing their costs.
Now people are signing up for policies on state exchanges and, to a limited extent, on the federal exchange. Where are the cries of rate shock? Anecdotal evidence, which is all we have so far, says that people are by and large happily surprised by the low cost of their insurance. It was telling that when Fox News eagerly interviewed some middle-class Americans who said they had been hurt by the Affordable Care Act, it turned out that none of their guests had actually checked out their new options — they just knew health reform was terrible because Fox News told them so.
Obama Pushes Health Law but Concedes Web Site Problems
By MICHAEL D. SHEAR
WASHINGTON — President Obama declared Monday that “nobody is madder than me” about the failures of the government’s health care Web site, but said the technical problems did not indicate a broader failure of the Affordable Care Act.
“We did not wage this long and contentious battle just around a Web site. That’s not what this was about,” Mr. Obama told supporters during 25-minute remarks in the Rose Garden.
The president acknowledged that HealthCare.gov had not provided the easy opportunity to sign up for health insurance that White House officials promised for months. But he said that some people had managed to get insurance, and he urged critics of the law to support it.
“It’s time for folks to stop rooting for its failure, because hard-working, middle-class families are rooting for its success,” he said.
The White House event was intended as a response to mounting criticism of the health care law in the wake of the Web site’s failures. Many people have been unable to sign on to the site or create accounts, and technical advisers who have worked on the site say it could take weeks or months to fix.
Mr. Obama said there was “no excuse” for the problems, but he did not say whether anyone in the government would be fired because of the failures. Some Republicans have called for Kathleen Sebelius, the secretary of health and human services, to be dismissed over the site’s technical problems.
Mr. Obama also sought to highlight other ways to sign up for insurance, including expanded call centers and in-person “navigators” who are at hospitals and health care centers around the country. People can also download a form to fill out and mail in, he said.
Mr. Obama read out a toll-free telephone number — 800-318-2596 — that people could call to sign up for insurance instead of going to the Web site. He said waiting times had been only one minute on the phone, though he acknowledged that his reading the number on television could change that.
Several calls to the number immediately after he read it produced busy signals.
Still, Mr. Obama urged people to separate the Web site’s problems from the purpose of the law, which he said was to find a way to provide affordable health insurance to millions of Americans who do not have it.
“The product is good. The health insurance that is being provided is good. It’s high quality and it’s affordable,” Mr. Obama said. “We know that the demand is there. People are rushing to see what’s there.”
Contractors See Weeks of Work on Health Site
By SHARON LaFRANIERE, IAN AUSTEN and ROBERT PEAR
Federal contractors have identified most of the main problems crippling President Obama’s online health insurance marketplace, but the administration has been slow to issue orders for fixing those flaws, and some contractors worry that the system may be weeks away from operating smoothly, people close to the project say.
Administration officials approached the contractors last week to see if they could perform the necessary repairs and reboot the system by Nov. 1. However, that goal struck many contractors as unrealistic, at least for major components of the system. Some specialists working on the project said the online system required such extensive repairs that it might not operate smoothly until after the Dec. 15 deadline for people to sign up for coverage starting in January, although that view is not universally shared.
In interviews, experts said the technological problems of the site went far beyond the roadblocks to creating accounts that continue to prevent legions of users from even registering. Indeed, several said, the login problems, though vexing to consumers, may be the easiest to solve. One specialist said that as many as five million lines of software code may need to be rewritten before the Web site runs properly.
“The account creation and registration problems are masking the problems that will happen later,” said one person involved in the repair effort.
The scrambling underscores the pressures on the administration to fix what is widely viewed as the president’s biggest domestic achievement. Millions of Americans have spent countless hours in frustration trying to use the federal Web site, healthcare.gov, and its extensive problems have become a political crisis for the administration, providing new opportunities for Republicans who want to roll back the health care law.
Over the weekend, officials sought to counter pronouncements of failure by announcing that almost half a million people have submitted applications for health insurance through the federal and state marketplaces, about half of them through state exchanges. But officials declined to say how many have actually enrolled in insurance plans, and executives from insurance companies, which receive the enrollment files from the government, say their numbers have been low. The enrollment period ends March 31; those who go without coverage may be subject to fines.
On Monday, Mr. Obama will host a Rose Garden event with people who have successfully enrolled in the health care exchanges. White House aides said he will acknowledge that the technical problems are “inexcusable,” but will note, as one adviser said, that the health care law is “more than a Web site.”
Sick in America: What Today’s Reactionaries Don’t Want You to Know
By Thomas Magstadt
Much of what we hear about health care is pure propaganda with no basis whatsoever in fact. The purpose of propaganda is to manipulate, not to enlighten or inform, so it's no surprise that the partisan fight over health care in Congress has generated more heat than light. The baleful effect is to deceive and thereby perpetuate the status quo—and an ever-greater inequality that threatens to destroy the fabric of our society.
Among the false impressions created by libertarians, FOX news, and reactionaries of all stripes is that Americans far more freedom to choose physicians, hospitals and treatments than people in Europe and other advanced societies with single payer systems. Most anyone who has lived abroad and experienced a single-payer system in operation knows that's simply not true. Nor is it true that people in these countries get less personalized attention from doctors than we do. (Ask anybody who's spent a few days in a hospital lately how much time the doctor spent with them.) It's what the Corporatocracy tells us, and many of us are only too eager to believe, but it's not true.
The U.S. is NOT the leader in health care in the modern world.
Obama Admits Web Site Flaws on Health Law
By MICHAEL D. SHEAR and ROBERT PEAR
WASHINGTON — President Obama offered an impassioned defense of the Affordable Care Act on Monday, acknowledging the technical failures of the HealthCare.gov Web site, but providing little new information about the problems with the online portal or the efforts by government contractors to fix it.
With Republican critics seizing on the Web site’s issues as evidence of deeper flaws in the health care law, Mr. Obama sought to deflect attention from the continuing problems by focusing on ways to get coverage without going online. Like a TV pitchman, the president urged viewers to call the government’s toll-free number for health insurance, acknowledging that “the wait times probably might go up a little bit now.”
In remarks in the Rose Garden, Mr. Obama acknowledged serious technical issues with the Web site, declaring that “no one is madder than me.” He offered no new information about how many people have managed to enroll since the online exchanges opened on Oct. 1. And he did not address questions about who, if anyone, might be held responsible for the failure.
The president and his top aides played down the importance of the online marketplace that his administration once heralded as the key to the law’s success. Mr. Obama promised that officials are working to fix the Web site, but said that Republican critics should “stop rooting” for the failure of a law that provides health insurance to people who do not have it.
“We did not wage this long and contentious battle just around a Web site,” Mr. Obama told supporters. “That’s not what this was about. We waged this battle to make sure that millions of Americans in the wealthiest nation on earth finally have the same chance to get the same security of affordable, quality health care as anybody else.”
Speaker John A. Boehner said in a statement after the president’s event that the administration is “not prepared to be straight” with the American people about the issues involving the health care Web site and the insurance program behind it.
“Every day, new questions about the president’s health care law arise, but candid explanations are nowhere to be found,” said Mr. Boehner, of Ohio. “This decision continues a troubling pattern of this administration seeking to avoid accountability and stonewall the public.”
The Health Site’s Chaotic Debut
By THE EDITORIAL BOARD
President Obama rightly acknowledged on Monday that there is “no excuse” for the horrendously botched opening of the federal Web site consumers are supposed to use to sign up for health insurance policies under the Affordable Care Act. Unless the problems can be fixed soon, they threaten to undermine the ability of the health care exchanges to help enroll some seven million uninsured Americans in 2014.
The administration created the Web site so the buck necessarily stops with high officials — Kathleen Sebelius, the secretary of health and human services, and President Obama himself — who allowed this to happen. The administration attributes the problems partly to unexpectedly high demand from people eager to compare insurance policies available in their states and partly to technical glitches that blocked or slowed people from submitting applications and erroneous data being sent to insurers. Why the administration failed to anticipate the high demand has never been explained. Nor has it clearly explained the nature of the technical problems — or who in government or among the private contractors is primarily responsible for them.
The problems with the site have frustrated millions of people trying to get information and coverage. In response, the administration has put forward a two-part approach to coping with Web site failures. It has added information technology experts from inside and outside the government to work 24 hours a day, seven days a week to try to overcome the technical glitches. Second, it has expanded and publicized alternative ways to find out about health plans and costs — like increased staffing at call centers that will help people enroll by phone at all hours of day and night, counselors (called navigators) in each state who will help people enroll in person, and applications that can be downloaded and mailed in.
Mr. Obama also made this important pledge to all consumers who tried to apply through the federal Web site and got stuck somewhere in the process: “In the coming weeks, we will contact you directly, personally” to recommend how to complete the application, shop for coverage and pick a suitable plan.
It’s now up to his office to make good on these promises, and there is no reason to believe it can’t be done. The health exchanges in several states appear to be working better than the federal site. And even with the federal site’s problems, some half-million Americans have successfully submitted applications through state and federal exchanges, the first step in the enrollment process.
Obama promises to iron out glitches on healthcare website
'Nobody is madder than me,' he says of technical problems that have given Republicans fresh ammunition. A House panel plans a hearing this week.
By Christi Parsons, Noam N. Levey and Chad Terhune8:52 PM PDT, October 21, 2013
| advertisement |
WASHINGTON — President Obama conceded Monday that technical "kinks" had bedeviled the rollout of the federal healthcare website, but said the administration had launched a "tech surge" to fix it and emphasized that the law would give uninsured Americans access to reasonably priced, quality insurance.
"Nobody is madder than me about the fact that the website isn't working as well as it should, which means it's going to get fixed," Obama told supporters in the Rose Garden. But he insisted: "The product, the health insurance, is good. The prices are good. It is a good deal. People don't just want it; they're showing up to buy it."
With the shutdown and debt limit crisis past, Washington's attention has turned to persistent problems with the website, which processes enrollments for insurance under the Affordable Care Act. But the site — healthcare.gov — has been plagued since it opened Oct. 1 by glitches that threaten to overshadow Obama's signature domestic accomplishment.
The president relaunched his campaign to sell the law as Republicans announced plans for hearings on the balky website. A Gallup poll last week found that 7 out of 10 uninsured Americans were "not too familiar" or "not familiar at all" with the online marketplaces.
Administration officials initially claimed the problems were caused by the unexpectedly high volume of visitors to the federal portal, which serves consumers in 36 states. Obama acknowledged that the website needed to work "better, faster, sooner," but did not explain what went wrong or when it would work properly. He said "some of the best IT talent in the entire country" was part of a "tech surge" to fix it.
Residents in the other states, including California, Connecticut and Kentucky, shop on state-run marketplaces, which have fared better. But even the Covered California website has endured technical glitches. Many consumers in the state have expressed concern about signing up before the exchange fixes its online directory of doctors and hospitals for the health plans. The provider search tool has been offline since Oct. 9 while the state tries to resolve its problems.
Medicaid Expansion Is Set for Ohioans
By TRIP GABRIEL
COLUMBUS, Ohio — As a Republican chairman of the House Budget Committee in the 1990s, John R. Kasich wielded a ferocious budget ax. On Monday, as Ohio’s governor, Mr. Kasich defied his party’s majorities in the state legislature to push through a multibillion dollar expansion of Medicaid under President Obama’s health care law.
By a 5-2 vote, an obscure committee, the Controlling Board, which normally oversees relatively small adjustments to the state budget, accepted $2.5 billion in extra Medicaid funds from the federal government. The money, recently approved by Medicaid administrators in Washington, will provide coverage for 275,000 Ohioans who have not been eligible for the program, the Kasich administration said.
The vote was an extraordinary — and possibly illegal, critics in Mr. Kasich’s own party said — end run by the governor around the General Assembly. Mr. Kasich, who initially declared himself an opponent of the Affordable Care Act and who has declined to set up a state online health insurance marketplace, has argued all year that his sense of Christian compassion, not to mention cool economic practicality, favored extending Medicaid to poor adults and those with disabilities who do not currently qualify.
But Republican majorities in both houses of the General Assembly blocked expansion. Opponents expressed disbelief that Washington would keep its promises under the health care law to pay almost all of the costs of expanding Medicaid, the joint federal-state health insurance program for the poor, and worried that Ohio taxpayers would have to pay.
A budget sent to the governor by the General Assembly forbade Medicaid expansion without lawmakers’ approval. Mr. Kasich vetoed that item. At least three bills to expand Medicaid have failed.
Mr. Kasich, who has championed job creation as he prepares for a re-election campaign next year in his swing state, has argued that expanding Medicaid eligibility will be an economic booster shot, because companies will be lured to Ohio by a healthier work force. Expansion is supported by state hospitals, the County Commissioners Association of Ohio and the Ohio Chamber of Commerce.
A better way to tackle health law
In 1958, four years after the Supreme Court ruled segregation unconstitutional, the state of Virginia opted to shut down its public school system rather than integrate it. Virginia’s plan to stop integration by starving its own schools of funding was framed as heroic resistance to the federal government’s intrusion into the lives of ordinary Americans. The architects of Virginia’s partial government shutdown claimed the fight was about freedom. About halting creeping communism. And saving the country from certain doom.
Sound familiar?
Just like the leaders of our recent partial government shutdown, Virginian politicians magnified the greatest fears of their constituents and captured national attention. Virginia’s Governor J. Lindsay Almond Jr., made the cover of Time magazine. And just like the leaders of the 2013 shutdown, he failed. Within months, he reopened the schools.
The tragedy then, as now, was that the hysteria surrounding integration shifted focus away from serious thinking about the very real challenges integration would bring. Instead of preparing their people for what would come — and brainstorming ways to minimize the disruption of the new system — Virginia politicians hardened opposition to a policy they would one day be forced to implement.
Today, the politicians fighting the Affordable Care Act are making the same mistake.
Instead of pointing out the very real and serious flaws in the new health care law, they repeat hyperbolic dubious claims: That the act is in the “realm of socialism.” (Representative Steve King of Iowa.) That “individual liberty is gone.” (Representative Louie Gohmert of Texas.) That Obamacare “is going to destroy America and everything in America.” (Representative Paul Broun of Georgia.)
MaineCare complaint log: Serious consequences for ride glitches
There's also a discrepancy between the official written log, which shows 266 complaints, and the thousands of complaint calls actually made.
An Aroostook County man who relies on MaineCare for transportation to his medical appointments suffered a burst gallbladder and was hospitalized for three days in August after a transportation broker failed to arrange the ride he needed for a surgical procedure.
Elderly residents elsewhere in Maine were left standing at the curb, and cancer patients missed their treatments.
Those were among the 266 complaints reported to the Department of Health and Human Services for the month of August by the transportation brokers at the heart of Maine’s troubled program to provide non-emergency medical transportation for low-income residents.
But the written log, obtained by the Portland Press Herald under the Freedom of Access Act, falls far below the number of people who complained, DHHS officials said Monday.
The officials said they will soon offer a more detailed explanation of the discrepancy between the 266 complaints reported by the brokers and the thousands of calls received on complaint lines to the companies and the DHHS.
Maine kept in dark on health care sign-up data
Posted: October 21Updated: Today at 12:02 AM
U.S. officials won’t provide numbers until November, leaving a state panel unsure if more public-awareness efforts are needed.
U.S. officials won’t provide numbers until November, leaving a state panel unsure if awareness efforts are needed.
Maine lawmakers expressed frustration Monday that the Obama administration has not released data on how many of the state’s residents are signing up for health insurance on the federal exchange that opened Oct. 1.
Members of a panel that is monitoring implementation of the Affordable Care Act said that without enrollment numbers, the state doesn’t know whether it needs to step up public awareness campaigns to tell residents about the exchange and the availability of subsidized coverage.
Suffocating from the high cost of meds in Maine
Posted Oct. 22, 2013, at 6:24 a.m.
An asthma attack feels like breathing through a pillow that is being held to your face. No matter how hard you work to draw in breath, you can’t get enough air. Panic sets in, and it becomes even harder to breathe.
In this country, nine people die of this chronic disease every day.
Nine. Every day.
Maine has an unusually high rate of asthma in adults and children. And, of the people who struggle with asthma, half of them suffer an asthma attack every year.
Fortunately, with the right care and the right combination of medications, chronic asthma can be well controlled.
The only thing needed is money. And plenty of it.
Last week, The New York Times published a startling report titled “The Soaring Cost of a Simple Breath” looking at the manufacturing and cost of prescription drugs used to treat asthma.
According to that report, albuterol — a commonly prescribed emergency inhaler used to open airways and ease an asthma attack — generally retails for between $50 and $100 in the United States. It wasn’t always that expensive, though.
About a decade ago, it cost less than $15, but when it was repatented to remove chlorofluorocarbon propellants, that required a redesign of dispensers and the price shot up even though the medicine is the same.
In Canada, albuterol is available for $24.95 in the updated dispenser. In Europe, it is free to asthma patients.
Here’s another example of uneven pricing here versus elsewhere:
In the United States, ProAir HFA — another emergency inhaler — retails for $60. In Europe and Canada, it’s about $40.
The price difference is quite a bit more stark for maintenance drugs prescribed to asthmatics.
For instance, Advair Diskus — available only as a brand name drug — retails for more than $300 for a month’s supply in the United States. In Canada, the same dosage costs $42.95.
Singular, another maintenance drug, retails for about $100 for a month’s supply here. In Europe, it costs $36 for the same amount.
A QVAR inhaler, which reduces airway inflammation and has no generic substitute, retails for around $200 here; in Europe it’s $40.
Asmanex Twisthaler, often prescribed to children to control their symptoms, retails for $200 here. In Europe, it’s half that, at $100.
For many patients, multiple asthma drugs are prescribed to best manage their symptoms, which means they’re buying a combination of all of the above. For those who have insurance, they are dishing out the maximum co-pay for each prescription, and for those who don’t have insurance, they’re paying the highest price in the world for these medications.
http://bangordailynews.com/2013/10/22/opinion/suffocating-from-the-high-cost-of-meds-in-maine/print/
Misleading marketing helps rise of robotic surgery
Posted Oct. 21, 2013, at 7:12 a.m.
Last year, Denver’s Porter Adventist Hospital announced that Warren Kortz, a general surgeon on staff, was the first in the Rocky Mountain region to use a technique known as robotic surgery to remove gall bladders through one incision in the belly button.
The operation, performed while the doctor sits at a videogame-like console, was “taking advantage of another breakthrough in robotic surgery” and is “easier on the patient,” the hospital said in a press release.
“It’s Star Wars stuff,” Kortz was quoted as saying in another article put out by the hospital touting a 2010 robot-assisted parathyroid surgery. “My prediction is it will eventually replace everything else.”
What the hospital and Kortz didn’t reveal was the risk. Even as Kortz promoted robotic surgery, 10 patients he treated suffered injuries or complications between 2008 and 2011, according to an April complaint by the Colorado Medical Board. Five had arteries punctured or torn. Objects were temporarily left inside two, and others had nerve damage. One died and another needed cardiopulmonary resuscitation. The complaint charges Kortz with 14 counts of unprofessional conduct, including sometimes not advising patients on alternatives to the robot.
Robotic surgeries are on the rise, fueled by aggressive marketing by doctors, hospitals and Intuitive Surgical Inc., which makes the $1.5 million robot. Advertising on hospital and doctor websites, YouTube videos, billboards, and on radio and television has hyped robotic surgeries, often claimed fewer complications without proof, and sometimes ignored contradictory studies finding no advantage.
Robot operations haven’t been proven in randomized trials to offer significant health benefits compared to standard, less-invasive surgery and multiple studies show they can cost thousands of dollars more.
Last year, U.S. hospitals used robot-assisted surgery in more than 350,000 operations — a 60 percent jump since 2010.
Robotic surgery is used to perform hysterectomies, gall bladder removals, prostate cancer treatment, heart valve operations and many other soft tissue operations. Half of general surgeons plan to add robotic systems within two years in response to general demand, according to a JPMorgan Chase & Co. survey reported Oct. 3.
The rise of Intuitive’s robot surgery highlights flaws in FDA regulation of the marketing of medical devices. Only two full-time employees evaluate ads for such devices, which include radiation therapy machines, implanted devices such as artificial hips and cardiac defibrillators, drug infusion pumps, surgical instruments and surgical robots.
By comparison, the FDA has more than 60 people watching over prescription drug promotion.
The complexity of medical devices makes it hard to evaluate safety and efficacy claims, said Robert Steinbuch, a law professor at the University of Arkansas at Little Rock.
“Hospital advertising is essentially a free-for- all,” Steinbuch said.
Panel: Maine Paying Price for Opting Out of ACA Exchange
Democratic leaders on a special legislative committee say the state is paying a price for the LePage administration's decision to opt out of creating its own health insurance exchange. Instead, the state is allowing the federal government to run the exchange. As A.J. Higgins reports, panelists on the Maine Health Exchange Advisory Committee say the missed money could have helped more Mainers access health care.
Although Mainers are expressing growing interest in health insurance options under the Affordable Care Act, state Sen. Margaret Craven says the state missed the boat by not creating its own exchange to help residents access their health insurance options.
Craven is the Senate chair of the Maine Health Exchange Advisory Committee. She says part of the problem is getting information out about the program. But states that have chosen to run their own exchanges are in better shape. "Other states took it, and they have media outreach, they have individuals on the ground to do outreach," Craven says.
Maine Gov. Paul LePage sided with other Republican governors to oppose the ACA - also known as Obamacare - and said he would not lift a finger to set up a state exchange that serves as a marketplace for companies wanting to sell insurance products in Maine.
After hearing from Christie Hager, the top federal Department of Health and Human Services official for New England, on Monday, Craven says she's confident the state still will still have options to create its own exchange - or marketplace -- after 2014.
Craven is the Senate chair of the Maine Health Exchange Advisory Committee. She says part of the problem is getting information out about the program. But states that have chosen to run their own exchanges are in better shape. "Other states took it, and they have media outreach, they have individuals on the ground to do outreach," Craven says.
Maine Gov. Paul LePage sided with other Republican governors to oppose the ACA - also known as Obamacare - and said he would not lift a finger to set up a state exchange that serves as a marketplace for companies wanting to sell insurance products in Maine.
After hearing from Christie Hager, the top federal Department of Health and Human Services official for New England, on Monday, Craven says she's confident the state still will still have options to create its own exchange - or marketplace -- after 2014.
| Thousands of Mainers Caught in ACA 'Coverage Gap' | |||
| 10/21/2013 Reported By: Patty B. Wight | |||
The Affordable Care Act originally sought make health insurance more accessible in two ways: through a new online markplace that offers federal subsidies, and with a federally-subsidized Medicaid expansion. A Supreme Court ruling allowed states to choose whether or not to expand Medicaid, and Maine is one of 26 states that has opted out. It's creating a coverage gap, where an estimated 25,000 Mainers earn too much to be on Medicaid, but too little to qualify for a subsidy under the Affordable Care Act. Patty Wight has more.
Jerry Robichaud is a book seller. He's 62, and his income is less than the federal poverty level of $11,400 dollars. For a little more than 10 years, Robichaud has received health coverage through MaineCare, the state Medicaid program.
Because of state cuts to the program, that's about to change. "I got the notice a couple weeks ago that it was going to shut off December 31st," he says. Robichaud says what also hurts is that he doesn't qualify for subsidies under the Affordable Care Act. So, he can't afford coverage. "If anything happens and you need medical help, what am I supposed to do, you know?" he says.
It's situations like Robichaud's that highlight the need for Medicaid expansion, says Jessa Barnard of the Maine Medical Association. For the past decade, her organization has supported across-the-board access to health care.
"We know that, currently in the United States, you need health insurance or health coverage of some sort to access health care in a meaningful way," she says. "And so we support everybody having coverage so that they can access health care, and especially so they can access preventative benefits and primary care services, and get the care that they need when they need it." The ACA is the Wrong Direction, Time for Medicare for All
By Margaret Flowers, M.D.
Green Shadow Cabinet, Oct. 21, 2013 In what is perhaps the greatest corporate scam ever, not only did the health insurance corporations write the federal health law, called the Affordable Care Act (ACA), to enhance their profits, but now they also have the government and non-profit groups doing the work of marketing their shoddy products. The foundation of the ACA, the mandate that uninsured individuals purchase private insurance if they do not qualify for public insurance, begins in 2014 and the state health insurance exchanges where people can purchase that insurance opened on October 1. A new non-profit organization called Enroll America was created to organize and train grassroots activists to seek out the uninsured (they even provide maps) and assist them in using the exchanges. Billions of public dollars and tremendous efforts are being spent to create new health insurance markets, advertise them, subsidize their products and actively solicit buyers for them. But the United States, as the only industrialized nation to use a market-based health care system, has already proven over the past 40 years, that this system doesn’t work. It is the most expensive, leaves the most out and leads to poor health outcomes. It means that people only receive the health care they can afford, not what they need. Market competition does not improve health outcomes because it consists of health insurance corporations competing for profit by selling policies to those who are the healthiest and denying and restricting payment for care. And regulation of insurers doesn’t work either. Although rules in the ACA give the appearance of changing insurance company behavior, insurers are already working around them. Defense of the ACA ignores the long history of private insurance influence and domination and is based on the hope that this time things will be different. But the ACA has not changed the fact that private insurance companies view their plans as products and have no more allegiance to human health than does Big Energy which will stop at nothing to drill, frack and blow-up the planet for profits. Experience at the state level with previous similar reforms and a look at current health trends show that the ACA will leave tens of millions without insurance, will increase the percentage of people who are underinsured, will increase financial barriers to necessary care and will further privatize health care. Cutting out the multitudes of insurers and creating a single publicly-financed universal health care system, Medicare for all, is the only way to solve our health care crisis. The ACA fails to solve our health care crisis http://www.pnhp.org/print/news/2013/october/the-aca-is-the-wrong-direction-time-for-medicare-for-all Obamacare vs. Canada: Five key differences
By Antonia Maioni
The Globe and Mail (Toronto), Oct. 3, 2013 Despite the partisan war in Washington that shut down the federal government this week, President Barack Obama has succeeded in implementing the first major health reform in the United States in nearly 50 years, as the Patient Protection and Affordable Care Act goes into effect. Even though its most virulent critics raise the spectre of “Canadian-style” health care, “Obamacare” does little to change the enduring differences between the two health care system. What, exactly, does “Obamacare” look like compared to Canada? Not single-payer: Canadian critics tend to rail against “two-tiered” medicine, but in fact, the U.S. has a multi-tiered system. And despite the hype on both sides of the Congressional aisles, Obamacare keeps the same complex structure in place, while adding another layer through the introduction of health care “exchanges” for uninsured Americans. But the majority of Americans will continue to access care through a variety of health insurance plans made available or subsidized by their employer; nearly 50 million elderly and disabled through the federal Medicare program; another 60 million lowest-income through state-federal Medicaid arrangements. Not universal coverage: Health care in Canada is based on a simple proposition: every legal resident is covered through a publicly-financed provincial or territorial plan. The individual mandate, derived from a Republican precedent in Massachusetts, stands in stark contrast to Canada’s universality principle. Even though Obamacare broadens coverage, the individual mandate relies on a fundamental insurance principle – care depends on type of coverage – and compels Americans to purchase insurance to access care. Americans now have more affordable insurance options and subsidies to cover their costs, and the lowest-income may be eligible for public coverage through the expansion of Medicaid. Still, despite the crush of online traffic as enrolment began Tuesday, only half of the estimated 40-plus million uninsured will be affected by Obamacare. Not “national” health insurance: One of the hallmarks of health care in Canada is that, although each province and territory administers a health plan, everyone can expect to be covered for a comprehensive range of services, no matter where they live. And the federal government is expected to chip in to provincial coffers to make this happen. There’s plenty of intergovernmental friction as a result, but nothing like the fractured federalism of the United States. The implementation of Obamacare will further exacerbate regional and state differences, mainly as a result of the Supreme Court decision to curtail the federal government’s obligation for states to expand their Medicaid coverage. As a result, only about half of the states have chosen to sign on to the new Medicaid program. On the lighter side: Nation That Waited Decades to Pass Health Care Infuriated by Slow Web Site
WASHINGTON (The Borowitz Report)—A nation that waited several decades for health insurance is becoming increasingly infuriated by a Web site that is wasting minutes of its time, reports from across the United States confirm.
The official Web site of Obamacare, HealthCare.gov, has been plagued by glitches, crashes, and sluggishly loading pages, say millions of angry Americans attempting to log on to the site at exactly the same time.
“Look, I know that we had to wait longer for health care than virtually every other industrialized nation on earth,” said Tracy Klugian, a muffler salesman from Akron, Ohio. “But the time I spent on that Web site is thirty-five minutes I’ll never get back.”
Sharing what he called his “Obamacare horror story,” Mr. Klugian said, “Being on that Web site slowed down our wi-fi so much that my kids couldn’t stream videos. For a so-called health-care program, it’s causing a lot of stress that’s the opposite of healthy, if you ask me.”
Harland Dorrinson, a gym manager from Knoxville, Tennessee, had an Obamacare nightmare of his own, having to log on to the site “two completely different times” before getting health insurance for the first time in his life.
“President Obama said he was going to make health care affordable and available to millions of Americans,” he said, bitterly. “He didn’t tell us it would take more than an hour.”
http://www.newyorker.com/online/blogs/borowitzreport/2013/10/nation-that-waited-decades-for-health-care-infuriated-by-slow-web-site.html?printable=true¤tPage=all
SNOWDEN OFFERS TO FIX HEALTHCARE.GOV
MOSCOW (The Borowitz Report)—The N.S.A. leaker Edward Snowden today reached out to the United States government, offering to fix its troubled healthcare.gov Web site in exchange for immunity from prosecution.
Speaking from an undisclosed location in Russia, Mr. Snowden said he hacked the Web site over the weekend and thinks he is “pretty sure what the problem is.”
“Look, this thing was built terribly,” he said. “It’s a government Web site, O.K.?”
Mr. Snowden said that if an immunity deal can be worked out, “I can get to work on this thing right away—I don’t need a password.”
In addition to full immunity, Mr. Snowden said he is requesting that he be allowed to work from home.
At the White House, President Obama offered a muted response to Mr. Snowden’s proposal: “Edward Snowden is a traitor who has compromised our national security. Having said that, if he knows why we keep getting those error messages, that could be a conversation.”
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