By Harvey Fernbach, M.D.
“I just enrolled in Medicare. It took me 5 minutes. Single payer anyone?”
– John Podesta, Twitter, Nov. 14, 2013
The delays, glitches, complexity and time involved in enrolling in Obamacare is in sharp contrast to a America’s largest and premiere government financed and privately delivered health insurance program — Medicare.
With a reliable track record since 1965, Medicare quietly enrolled over 1.8 million people in 2012 — that’s over 150,000 per month, nearly 5,000 per day.
Medicare enrollment has been increasing as the American population ages.
From the 2012 numbers, Medicare enrolled at least 225,000 in the six weeks since ACA’s health exchanges went live on Oct. 1.
That is more than twice as many as those who enrolled in private insurance through the exchanges, as U.S. Department of Health and Human Services reported this week.
Enrolling all U.S. residents in Medicare — and expanding its benefits as proposed by the “Expanded and Improved Medicare for All Act,” a bill in Congress (HR 676) — would be relatively simple.
Polls report that a majority of people want the kind of program H.R. 676 offers: lifelong comprehensive coverage for outpatient visits, inpatient care, laboratory tests, dental care, mental health services and more (all necessary care).
The idea that people “like their health insurance” is a myth. People want health care, not insurance policies.
An improved Medicare for All would eliminate hundreds of billions of dollars now wasted on insurance company, hospital and clinic overhead. Those billions would be redirected to delivering actual care. It would also be much more effective in controlling rising health costs, using its bargaining clout to negotiate lower prices for drugs and other medical supplies.
Medicare for All would be much easier to administer nationally, would be accessed individually by patients, eliminate hassle for providers as well as employers.
Numerous economic studies comparing this approach to the current health care plan in America demonstrate huge saving and economical advantages for the nation.
No wonder John Podesta, former chief of staff for President Clinton and founder of the Center for American Progress, joyfully tweeted: “I just enrolled in Medicare. It took me 5  minutes. Single payer anyone?”
The answer is a resounding, emphatic, loud “Yes!” We need single payer for the health of everyone!”
Harvey Fernbach, M.D., M.P.H., is a member of Physicians for a National Health Program. He resides in Bethesda, Md.

Officials Were Warned About Health Site Woes

By  and 
WASHINGTON — Senior Obama administration officials, including several in the White House, were warned by an outside management consultant early this year that the effort to build the HealthCare.gov site was falling behind and at risk of failure unless immediate steps were taken to correct the problems, according to documents released by House investigators.
The report, by McKinsey & Company, which was prepared in late March at the request of the Department of Health and Human Services, said that management indecision and a “lack of transparency and alignment on critical issues” were threatening progress, despite the tight deadline.
The McKinsey report found that the effort was at risk because of issues including “significant dependency on external parties/contractors,” as well as “insufficient time and scope of end-to-end testing,” and “parallel stacking of all phases,” all predictions that have turned out to be accurate. Briefings on the report were held in the spring at the White House and at the headquarters of the Health and Human Services Department and for leaders at the Centers for Medicare and Medicaid, congressional investigators said.
“The administration was on track — on track for a disaster — and yet officials refused to be transparent with the Congress and the American people,” said Representative Fred Upton, Republican of Michigan and chairman of the House Energy and Commerce Committee, which released the report. The McKinsey warnings were first reported online by The Washington Post.
The latest evidence detailing the Web site’s troubled startup came amid signs of progress in repairing it. As of mid-November, more than 50,000 people had selected an insurance plan — up from 27,000 in the entire month of October, people working on the project said.
That is still a fraction of the number the administration had hoped for. And specialists plowing through an initial list of more than 600 software and hardware defects remain worried about whether they can meet the administration’s goal of enabling four in five users to enroll through the online federal exchange, HealthCare.gov, by Nov. 30. One person said a more realistic goal was that four out of five people “have a positive experience,” which could include being redirected to customer service agents.
White House officials said on Monday that many of the remaining users would turn to call-in or counseling centers because their insurance situations were complicated. But specialists involved in the repair effort said technical issues may frustrate more users than administration officials suggest. And it is unclear how many fixes remain to be made, because the list keeps changing.
White House officials and some computer experts say much of the criticism is overblown, designed more to scare would-be enrollees away from the insurance exchanges. But the concern is bipartisan. At a closed-door meeting last week, two Democratic senators pressed administration officials on efforts by Chinese hackers to break into the site, according to a Democratic Senate official at the meeting.

A New G.O.P. Excuse for Doing Nothing

By 
With unrestrained glee, Republicans are using the calamitous debut of the Affordable Care Act as their latest justification for undermining all of health care reform. But they’re not stopping there. The Obama administration’s fumbling is apparently a good excuse for them to do nothing on immigration reform, on a budget agreement, and on any other initiative coming out of the White House.
“We don’t want a repeat of what’s going on now with Obamacare,” said Eric Cantor, the House majority leader, explaining last week why party leaders would not allow the Senate’s immigration bill to come to a vote, or even to be the subject of negotiations.
Their opportunistic theme is clear: If you can’t trust President Obama on this issue, how can you trust him on anything else? Unquestionably, the White House handed them this gift through two kinds of incompetence: the technical failure of the health-exchange website, and the political failure of the president in falsely promising that no one would lose an insurance policy they already had.
But just as these blunders are not the end of the health reform, they will also, in the end, not stop the long march to immigration reform, more jobs or desperately needed improvements to education, transportation and other fundamental functions. The House minority leader, Nancy Pelosi, was right to urge Democrats on Sunday not to be “knocked for a loop” by the Republican feeding frenzy. Most people, she said on NBC News’s “Meet the Press,” still support progressive goals like guaranteed health insurance, a humane path to citizenship for immigrants, background checks for gun ownership and ending workplace discrimination.
Republicans want the country to believe that this month’s debacle shows the overall weakness of what Representative Paul Ryan on Sunday called “big government in practice.” In fact, Americans have long been quite happy with big government programs, as long as they work. They don’t like failure, and they hate being misled. But what people really care about is results, and once the health care website is working, millions will realize that what they are being fed by Republicans is largely bunk.

Flawed Gauge for Cholesterol Risk Poses a New Challenge for Cardiologists

By 
This week, cardiologists learned that a new online calculator meant to help them determine a patient’s suitability for cholesterol treatment was flawed, doubling the estimated risk of heart attack or stroke for the average patient. But fixing it would not be easy, because it is based on older data, and heart attack and stroke rates today are much lower than in decades past, meaning that people are at less risk than might be expected from historical extrapolations.
Yet the outdated risk figures are the only ones available for researchers to use as assessment tools, cardiologists say, and that raises real problems for the new risk calculator, which the American Heart Association and the American College of Cardiology posted online last week as part of a radical new set of guidelines for treating high cholesterol. The guidelines, which are supposed to shape the way doctors prescribe cholesterol-lowering statins, recommend looking beyond a patient’s cholesterol readings.
“The disease of atherosclerosis is changing before our eyes,” said Dr. Peter Libby, the chief of cardiovascular medicine at Brigham and Women’s Hospital in Boston. The reasons for the changes, he said, are only partly understood.
The problem of using longitudinal health studies from previous decades to assess health risks today arose unexpectedly last weekend at the annual meeting of the American Heart Association. Two Harvard researchers, Dr. Paul M. Ridker and Dr. Nancy Cook, revealed that the new calculator released with fanfare last week exaggerated the true risk of a heart attack or stroke by an average of 100 percent. Moreover, they said, the committee that developed the calculator knew that the online tool was inaccurate yet told doctors to use it in deciding whom to treat.
The data that was used to build the calculator was 20 years old, the researchers said, and a lot has happened since then. Many fewer people have heart attacks and strokes. Those who have them do so at older ages. Women are now nearly as susceptible as men.
But there also is another issue, said Dr. H. Gilbert Welch, a medical professor at Dartmouth. The calculator, like many others used in medicine, is based on a mathematical model that assumes that risk rises in a straight line. As levels of blood pressure rise, for example, the chances of a heart attack or stroke rise in concert, the calculator assumes. In reality, Dr. Welch said, that line is far from straight.

Healthcare coverage counselor stymied by website problems

Jessie Orozco's efforts to walk people through the process of applying for coverage is hampered by computer glitches. 'It's depressing, it's frustrating and it's disrespectful,' she said.

By Eryn Brown
7:08 PM PST, November 16, 2013
advertisement

Passport and tax records in hand, Nela Barboza fiddled nervously with a plastic folding fan as she approached Jessie Orozco's desk. "Buenas tardes," she said cordially. "I'm here to sign up for Obamacare."
Orozco, a benefits counselor at St. John's Well Child & Family Center in South Los Angeles, was thrilled. Around her neck, she wore a badge certifying that she was a state-trained enrollment counselor for California's new medical insurance marketplace — touted as one of the better-functioning parts of the Obama administration's healthcare overhaul.
With a picture of the president tacked to the wall behind her, Orozco noted that Barboza could be the first person she would walk through the process of signing up. "I'm going to celebrate when I get this lady approved!"
The sense of anticipation quickly dissipated. Orozco encountered problems with the state website created for counselors like her. She couldn't find forms in Spanish, the language Barboza best understands. She had trouble estimating the costs Barboza would pay and confirming details of what would be covered.
Barboza became agitated, complaining at one point that she and her husband would be better off if he didn't work because they would get government-paid medical care.
The state has struggled to put enough trained troops like Orozco on the front lines of the healthcare overhaul. Officials say they are catching up and are poised to help millions of Californians reap the benefits of Obamacare.
From the vantage point of Orozco's desk, that hope was tempered by the reality of continuing obstacles. Computer glitches persisted, misinformation and rumors were in the air, and consumers procrastinated, worried about the unknowns of choosing a health plan and what it could mean for their care and their pocketbooks.
::
Covered California, the state marketplace, got relatively high marks last week when officials released initial enrollment figures under the Affordable Care Act.
More than 30,000 Californians had selected insurance plans during the first month of sign-ups, and about the same number chose plans during the first 12 days of November. An additional 72,000 used the exchange to find out they were probably eligible for expanded coverage under Medi-Cal, the state's healthcare program for the poor.
Nationwide, 106,185 people enrolled in Affordable Care Act plans during October, far short of Obama administration goals.
The mix of patients at community clinics like St. John's underscores the complexity of matching people and medical insurance. Many are undocumented and can't participate in the state insurance exchange or receive full Medi-Cal coverage. Another large group is already enrolled in Medi-Cal or Healthy Way L.A., a low-income county program that will be folded into Medi-Cal on Jan. 1. Orozco and her colleagues at the clinic had been successfully signing up people for those programs for months.
Another smaller group is made up of lower-income workers who will be required to purchase insurance. Those patients now can apply through the state's online marketplace or via enrollment counselors like Orozco. If they qualify, they can obtain government assistance to help pay the premiums.
After a rocky first few days, state officials said last week that 70% of patients using the public enrollment website, at http://www.coveredca.com, reported the application was easy to complete. Some were able to enroll in just 15 minutes, the exchange reported.
On her first day as an enrollment advisor, Orozco logged onto a separate website used by counselors — and the trouble began.
"You can look, but you can't use the website to do the income calculation," Orozco told Barboza and her sister Rosa Aguirre, who was along to apply for her own insurance.
The women waited patiently as Orozco struggled to estimate costs and get descriptions of coverage options. The site froze up repeatedly. Clicking on Spanish-language links led to English pages. A drop-down menu asked how the women learned about Covered California. But the answer options weren't working; they were all blank.
Barboza gradually grew distressed as Orozco sought to explain the insurance plans. She'd hoped to sign up for Medi-Cal. Her sister, whose only income is rent she collects from Barboza and other relatives who live in her South Gate home, was likely to qualify for that program.
But Barboza's husband earns close to $24,000 a year — too much for the couple to qualify for Medi-Cal.
Without access to a fully functioning website, Orozco tried to describe how the insurance plans and pricing would work.
Barboza became alarmed when she saw the full, unsubsidized cost of the plan she was considering: several hundred dollars a month.
Orozco said the couple would receive government assistance with the premium. (According to the state's public website, they would probably pay between $28 and $104 per month).
Barboza and Aguirre didn't appear to understand. Why did they have to pay a high premium? Barboza wondered. Why was Covered California looking at their gross income and not what remained after taxes and expenses?
Illnesses prevented her from holding a job, Barboza said, and her husband's employer would not provide full-time hours or affordable medical benefits.
http://www.latimes.com/local/la-me-obamacare-signup-clinic-20131117,0,4928018,print.story

Healthcare plan enrollment surges in some states after rocky rollout

Healthcare insurance enrollment increases in some states that run their own exchanges, boosting hopes of Obamacare backers.

By Noam N. Levey
7:20 PM PST, November 18, 2013
advertisement

WASHINGTON — Despite the disastrous rollout of the federal government's healthcare website, enrollment is surging in many states as tens of thousands of consumers sign up for insurance plans made available by President Obama's health law.
A number of states that use their own systems, including California, are on track to hit enrollment targets for 2014 because of a sharp increase in November, according to state officials.
"What we are seeing is incredible momentum," said Peter Lee, director of Covered California, the nation's largest state insurance marketplace, which accounted for a third of all enrollments nationally in October. California — which enrolled about 31,000 people in health plans last month — nearly doubled that in the first two weeks of this month.
Several other states, including Connecticut and Kentucky, are outpacing their enrollment estimates, even as states that depend on the federal website lag far behind. In Minnesota, enrollment in the second half of October ran at triple the rate of the first half, officials said. Washington state is also on track to easily exceed its October enrollment figure, officials said.
The growing enrollment in those states is a rare bit of good news for backers of the Affordable Care Act and suggests that the serious problems with the law's rollout may not be fatal, despite critics' renewed calls for repeal.
But the trend also emphasizes how widely experience with the new law varies by location.
Fourteen states and the District of Columbia, covering about one-third of the nation's population, are operating their own Obamacare marketplaces and have their own enrollment websites. The others, including most states with Republican-led governments, have declined to do so, making their residents dependent on the malfunctioning federal site.
In addition to better-functioning websites, many states that are running their own marketplaces also have significantly more resources to help consumers sign up for coverage.
Many of the states that have declined to run their own websites have also refused to expand the joint federal-state Medicaid program, as the new law allows.
Overall enrollment totals in states using the federal site were dismal in October, according to figures released last week by the Health and Human Services Department.
For example, just 2,991 people successfully enrolled in health plans in Texas in October. That was fewer enrollees than in Kentucky, which has a sixth as many residents.
Altogether, 106,000 people enrolled in health coverage nationwide last month, a figure far below administration projections.
Nearly half of those who enrolled in October were in California or New York. Both states have continued to show growth in their numbers. In New York, enrollment has continued at roughly October's rate and stands at 24,509, according to state officials.
Even with the growing consumer interest in health insurance in many states, the new marketplaces created by the health law need millions more enrollees. The Obama administration aims to get 7 million consumers into health insurance plans in 2014 to ensure that the marketplaces have enough people to be sustainable.
With fixes still being made to the federal website, it is unclear whether enrollment will catch up everywhere.

White House tries to pressure LePage on Medicaid expansion

But the governor resists an expansion, saying providing tens of thousands of new Mainers with health care would overburden a system that's always flawed.

By Kevin Miller kmiller@pressherald.com
Washington Bureau Chief
WASHINGTON — The White House made an effort Monday to add pressure on Gov. Paul LePage to expand the state’s Medicaid program, by highlighting the thousands of Mainers who would gain health care coverage.
LePage administration officials replied that although they continue to seek more flexibility from federal officials, expanding Medicaid won’t fix major structural problems in the program.
“Why expand a program that is not adequately serving its citizens now?” LePage’s spokeswoman, Adrienne Bennett, said of MaineCare, the state’s Medicaid program.
In the Obama administration’s latest attempt to sway governors who oppose expanding their states’ Medicaid programs under the Affordable Care Act, White House Deputy Press Secretary Josh Earnest said in a conference call that at least 28,000 uninsured Mainers would benefit. Other estimates have put that figure at as many as 60,000 to 70,000.
Earnest was joined on the call Monday by Portland Mayor Michael Brennan and state Rep. Linda Sanborn, D-Gorham, both of whom have lobbied for Maine to take the offer of additional federal money to open up MaineCare to more of the uninsured.
“We have a moral obligation to provide health care to every person in this state,” Brennan said.
“Thousands of Mainers have been left out because of politics,” said Sanborn.

Michaud slams governor over MaineCare rides program

The response to service chaos has been weak, says the congressman. A LePage aide fires back: Go fix Obamacare problems.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer
U.S. Rep. Mike Michaud waded into the controversy over the state’s MaineCare rides program Monday, blaming Gov. Paul LePage for what he said has been an inadequate response to problems in a system that’s meant to help low-income patients.
Michaud, who is running for governor, urged LePage in a news release to dump a system that’s “beyond repair” and has caused people to miss crucial medical appointments since it started Aug. 1.
“Mainers deserve more than a government driven by dysfunction where disabled Mainers are being left stranded, waiting for a ride. They deserve real leadership and action from Gov. LePage and his administration,” Michaud said.
Michaud, a Democrat who represents Maine’s 2nd Congressional District, is running against the Republican governor and independent Eliot Cutler in the 2014 race for governor.
A spokesman for the LePage campaign said Michaud should focus on problems that have plagued the implementation of the federal Affordable Care Act.
“Michaud needs to work on fixing Obamacare, which he voted for, before criticizing a department of the state,” said Brent Littlefield, LePage’s senior political adviser.
The federal government reported last week that only 271 Maine residents had been able to enroll for insurance through the troubled HealthCare.gov website from Oct. 1 to Nov. 2, although recent reports suggest the site is working better.
Cutler wrote in an email response to a question that problems in the MaineCare transportation program will not be solved by partisan bickering.

Maine hospitals reluctant to play lead role in implementing Obamacare

By Mario Moretto, BDN Staff
Posted Nov. 18, 2013, at 4:55 p.m.
AUGUSTA, Maine — A lobbyist for the Maine Hospital Association says that at least half of the state’s hospitals have specialists on hand to help uninsured visitors sign up for health insurance on theexchanges launched last month as part of the Affordable Care Act.
Still, the hospitals are wary about taking a lead role in implementing the ACA, also known as Obamacare, because they already feel the program is being paid for out of their pockets.
The hospitals stand to lose between $800 million and $900 million in cuts to Medicare reimbursements over a 10-year period, if Medicaid isn’t expanded.
The lobbyist, Jeff Austin, spoke Monday before the state Health Exchange Advisory Committee, charged by the Legislature with monitoring and evaluating the implementation of the health exchanges, also called marketplaces.
Maine is one of several states that has opted to use the federal exchange website — the glitchy and beleagured healthcare.gov — rather than building its own exchange or partnering with the federal government on a hybrid project. President Barack Obama has endured weeks of criticism since the launch of the website, which has been marred by inaccessibility, glitches and user confusion.
Obama has also come under fire in the wake of many Americans — including thousands of Mainers — getting notice from their insurance companies that their plans had been modified or canceled. Obama had previously promised that if someone liked their current insurance plan, they’d be able to keep it under the Affordable Care Act.
So the panel, composed of lawmakers and other stakeholders, was curious to find out what Maine’s hospitals are doing to assist the uninsured in signing up for health insurance. Hospitals, which cover many poor and uninsured patients through charity care, are one group that stands to benefit significantly if more people sign up for health insurance.
Austin said different providers have taken different approaches to ensuring their patients had access to professionals who could help them make their way through the sign-up process. Some simply make referrals to state “navigators,” outside experts who specialize in getting new people signed up for health insurance on the exchange.
Other hospitals have staff on hand called “certified application counselors” who can help uninsured hospital visitors see their options under Obamacare. Austin said it’s similar to what hospitals were already doing when they screened uninsured patients for Medicaid/Medicare eligibility.
Austin said that within the next few weeks, all Maine hospitals would likely have some plan for diverting patients to the exchanges, whether by referral to navigators or to in-house counselors.
Lawmakers on the committee said they want to see Maine’s hospitals actively engage in community outreach programs to sign up people for insurance.
“I would really like to see the hospitals taking a leading role in signing people up,” said Rep. Sharon Treat, D-Hallowell. “It benefits your bottom line, it benefits the health of Maine people in general and it’s going to help make this whole thing work.”
The reduced reimbursements were meant to be offset by a mandatory expansion in Medicaid as predicted by the Affordable Care Act. But the U.S. Supreme Court said that the federal government could not require Medicaid expansion, paving the way for states to opt out. Maine did just that when Gov. Paul LePage vetoed Medicaid expansion bills last session.

By not expanding Medicaid, Maine misses out. But Obamacare still has benefits

Posted Nov. 18, 2013, at 3:10 p.m.
What is Maine missing out on as a result of Gov. Paul LePage’s decision earlier this year to veto a bill that would extend Medicaid coverage to 50,000 low-income adults and preserve it for 25,000 more?
Beyond the primary drawback that some of Maine’s poorest will miss out on the chance to gain access to the health care they deserve, Maine is missing out on a chance to extract maximum benefit from a law meant to make high-quality health care affordable to a broader segment of the population.
A study released Monday puts that reality into perspective, even if it does it in an inexact way. The website WalletHub ranked the states and Washington, D.C., by how much they’re expected to benefit from the Affordable Care Act, the Obama administration’s health care reform law.
Maine came out 16th. If Maine and every other state agreed to expand Medicaid — an optional component of the health care law that many Republican-led states are rejecting — its ranking would jump to No. 2, behind West Virginia.
Although Maine is among those states deciding against a Medicaid expansion, other provisions of the Affordable Care Act — not considering the law’s flubbed and chaotic rollout — stand to benefit the Pine Tree State more than others.
By one measure considered by WalletHub, Maine ranks second for the average expected savings due to the Affordable Care Act’s limits on the amount an insurance plan can allow its subscribers to pay out of pocket through deductibles and copayments. The law limits the amount to $6,350 for an individual and $12,700 for a family. Based on the amount Maine residents pay out of pocket for medical care right now, the average savings would be $2,098.97, according to WalletHub.
In 2011, the organization Families USA estimated Mainers spent nearly $159 million out of pocket on health care beyond the limits Obamacare will apply to insurance plans — with some exceptions — starting next year. The firm Gorman Actuarial, in a 2011 analysis for Maine’s Bureau of Insurance, predicted Maine households — especially low-income households — would see, on average, a $1,010 budget benefit from the Affordable Care Act’s provisions.
Some of the benefit would come from lower deductibles and co-payments; 15 percent of those enrolled in individual market plans in 2011 had deductibles of $15,000, according to Gorman. And the benefit would still accrue despite Gorman’s projections that, due to the health reform law, 57 percent of those who purchase their insurance through the newly deployed online health insurance exchanges will see their premiums rise by an average of 37 percent — even after the law’s tax subsidies are applied.
Maine’s ranking was also helped by the fact that the state is home to a disproportionate number of small businesses — the fourth highest number per capita, according to WalletHub — that could qualify for the Affordable Care Act’s small business tax credit, which is meant to offset health coverage costs for small businesses with fewer than 25 full-time employees who earn, on average, less than $50,000.
Maine ranks fifth in the nation for its rate of emergency room visits per capita, and that’s another reason WalletHub flagged Maine as a state that stood to benefit most from Obamacare.