Maine advocates push for single-payer care systemBy ALANNA DURKIN, Associated PressUpdated 3:33 pm, Thursday, January 9, 2014
AUGUSTA, Maine (AP) — A government-run health care system in Maine would provide universal coverage to residents, cut down on administrative costs and free businesses from the complexities of providing insurance for their employees, supporters of a single-payer model said Thursday.
Advocates of a single-payer system have long been trying to implement the model in Maine with little success, but said they are hopeful that the steps Vermont officials have recently made to spearhead the effort there can help make it a reality in Maine.
"Our current health care system is complicated, is inefficient, unfair and pretty much broken," said Julie Pease, president of Maine AllCare, the group behind the measure, which she said will "return our system to one where ... our medical profession treats our patients based on their health care needs not on their ability to pay or what kind of insurance they have."
The bill, sponsored by Democratic Rep. Charlie Priest of Brunswick, aims to create a single-payer health care system in Maine by 2017, as officials are trying to do in Vermont. Beginning in 2017, Vermont will offer a set package of coverage benefits to every resident under the program.
But the idea in Maine faces fierce opposition from insurance companies and questions remain about how the state could afford such an endeavor.
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| By: Kay Tillow Monday January 6, 2014 9:03 pm
Buried deep in the health reform law is Section 10323. It amends the Social Security Act toextend Medicare coverage to individuals exposed to environmental health hazards in the region defined by the Emergency Declaration of June 17, 2009. That declaration limits this benefit to the area around Libby, Montana.
Section 10323 of the Affordable Care Act (ACA) calls it “deeming of Individuals as eligible for Medicare benefits.” People do not have to be age 65, or wait two years following disability, or to have paid into the Medicare system. The victims of asbestos in Libby were simply “deemed” to be eligible for Medicare. It was described as “discretionary deeming.”
Senator Max Baucus, Chair of the powerful Senate Finance Committee, who hired insurance executive Liz Fowler to write the health reform act, slipped Section 10323 into the law assuring that all those with asbestos-related conditions in the community around Libby, Montana get into Medicare, our single payer program for all those over 65. Further, for this designated group of Montanans, Baucus arranged additional special benefits not normally available to Medicare patients.
Baucus “deemed” single payer off the table
It’s true. Senator Baucus “deemed” single payer off the table during the 2009 health care debate. He had physicians and others arrested for insisting that single payer be included in the nation’s discussion. Baucus effectively locked out any consideration of such a plan. But he gave our country’s single payer program, Medicare, to the people of Libby. And they got free drugs, too.
Bridging the Compassion Gap
Thomas Edsall, NYT
JAN. 7, 2014
What’s going on with John Boehner, the speaker of the House?
On Dec. 12, Boehner broke with hard-line conservative groups, accusing them of “misleading their followers” and charging that “they have lost all credibility." It was evident from the context that Boehner was referring to right- wing powerhouses like Freedom Works, Heritage Action and the Club for Growth. At a news conference a week earlier, on Dec. 5, Boehner declared that if the president “has a plan for extending unemployment benefits I’d truly entertain taking a look at it.” More strikingly, Boehner has signaled that he now supports incremental immigration reform. He recently hired Rebecca Tallent, a former chief of staff for Senator John McCain, a strong backer of immigration reform, and he has encouraged aides to tell reporters that he is prepared to challenge the anti- immigration wing of his party. There are several theories about Boehner’s unexpected turn. One explanation sees Boehner and centrist Republicans generally backing away from some of their more controversial stands in preparation for the 2014 election. Steve Rosenthal, the political director of the AFL-CIO from 1995 to
2002 and now president of the Organizing Group, a Democratic political
consulting firm, noted in an email exchange:
“The ground is shifting on a whole range of issues, and the Republicans know that their hard-liners are way out of step with America. Some of these issues – extending unemployment benefits, increasing the minimum wage – are values issues as much as economic ones. That is, they tell voters whose side a candidate is on.” Boehner, who has primary responsibility for retaining the Republican majority in the House, is less cowed by the Tea Party forces both within his caucus and out in the states. David Brady, a political scientist at Stanford and deputy director of the Hoover Institution, said in an email: “Tea Party threats to run their candidates against incumbents voting against them have lost credibility.”
In close contests, the long-term unemployed, along with their families and
their friends, have the power to determine the outcome in those 2014 elections in
which a percentage point gained or lost can be decisive. On Dec. 28 Congress
allowed unemployment benefits to expire for an estimated 1.3 million out of
work men and women. A vote against restoring the benefits would create “a
political vulnerability,” said John Feehery, a public relations executive who was
once a top aide to Dennis Hastert, the former House speaker. “A lot of those folks
on unemployment are swing voters. They dislike Obama but will vote their
economic interests if they have to.”
US marks 4 straight years of slowing health costsIn a rarity, the U.S. economy grew faster in 2011 and 2012 than did national health care spending.
The Associated Press
WASHINGTON — Even as his health care law divided the nation, President Barack Obama’s first term produced historically low growth in health costs, government experts said in a new report Monday.
While the White House sees hard-won vindication, it’s too early to say if the four-year trend that continued through 2012 is a lasting turnaround that Obama can claim as part of his legacy.
For the second year in a row, the U.S. economy grew faster in 2012 than did national health care spending, according to nonpartisan economic experts at the Centers for Medicare and Medicaid Services.
That’s an important statistic. In most years, health care spending grows more rapidly than the economy, like bills that rise faster than your paycheck. That cost pressure steadily undermines employer insurance as well as government programs like Medicare and Medicaid. But the pattern slowed starting in 2009, and then appears to have reversed ever so slightly and tenuously.
“Have we turned the corner in a sustainable way? That’s still an open question,” said economist Robert Reischauer, who serves as a public trustee overseeing Medicare and Social Security financing. “But I am more optimistic than I have ever been that fundamental changes are under way.” For example, even though baby boomers are joining Medicare in record numbers, that program’s costs are basically stable when measured on a per-patient basis, Reischauer noted.
Nonetheless, America still spends a whole lot. Monday’s report found that the nation’s health care tab reached $2.8 trillion in 2012, the latest year available. Health care accounted for 17.2 percent of the economy, down from 17.3 percent in 2011.
Bounced From HospiceBy PAULA SPAN
It didn’t come as a complete surprise when a Pennsylvania hospice told Phyllis Fine’s family last year that she was no longer eligible to receive care.
Mrs. Fine, 84, enrolled in hospice in June 2012. After supposedly routine heart valve surgery, she suffered a major stroke, leaving her unable to walk, speak much or feed herself.
For months, hospice staffers cared for her in her nursing home. “They were awesome people,” said her daughter, Audrey Marsh. “They bathed and changed her and kept her company. They fed her.”
The hospice had admitted Mrs. Fine for 90 days, then another 90. After that, Medicare rules required re-certification every 60 days, meaning that a physician or nurse-practitioner must attest she is likely to die within six months if her disease runs its normal course. In May, when Mrs. Fine was no longer losing weight or showing other signs of decline, the hospice apologetically said she no longer qualified.
Ms. Marsh understands the rationale: “She’s not getting any better, but she’s not wasting away.”
Carol Willette, on the other hand, is seething. Her family had debated for months about calling hospice. Her mother Earlene Willette, 90, a nursing home resident in Mill Valley, Calif., had been ailing for several years — falling, battling infections, eventually losing mobility.
“Mom was trying to tell people she didn’t want anyone prolonging her life,” Carol said. “I was talking about hospice, but my siblings were in an uproar about it.”
It took a diagnosis of amyotrophic lateral sclerosis, or ALS, to make everyone understand that Earlene Willette’s condition was terminal and meant increasing disability. In mid-November, a local hospice enrolled her, and the usual team — aides, nurses, a social worker, a chaplain — began visiting. “They all said they were there for her and for us,” Carol told me.
Less than a month later, the hospice discharged Mrs. Willette, saying she was not losing ground. “I told them how cruel it was to do this,” Carol said.
Mrs. Willette can return to hospice care as her condition worsens (so can Mrs. Fine), but Carol worries that her mother will feel on probation, at risk of losing care she will come to depend on.
Hospices have always had the ability — and under Medicare rules, the obligation — to discharge some patients. The Medicare Payment Advisory Commission, relying on 2009 and 2010 data, has reported that 20 percent of hospice patients are discharged alive each year; the National Hospice and Palliative Care Organization says its surveys show that a third of discharges are initiated by patients themselves, and two-thirds by hospices.
But discharges are climbing. Gilchrist Hospice, the largest in Maryland, now discharges of about 20 percent of patients, and “we’re on the low side,” said its clinical director, Regina Bodnar. Indeed, a Washington Post investigation, analyzing a million records of California hospice patients, found that the proportion discharged aliverose 50 percent between 2002 and 2012.
It’s Obamacare all the time for RepublicansBy Dana Milbank,
Republican National Committee Chairman Reince Priebus on Tuesday outlined his party’s priorities for 2014. They are, in ascending order of importance:
●Obamacare.
●Obamacare! Obamacare!
●OBAMACARE! OBAMACARE! OBAMACARE! OBAMACARE! OBAMACARE!!!
“We’ve promised that in 2014 we’d continue to pound away at Democrats and Obamacare and that’s how we’re starting the year,” the chairman told reporters on a conference call. “Democrats are eager to change the subject, but Republicans aren’t going to let that happen,” he added. “That’s why, I guess, we’re starting up the year in this fashion talking about Obamacare.”
A reporter from the Cedar Rapids (Iowa) Gazette asked Priebus if “Obamacare is going to be the Johnny-one-note campaign for Republicans” in which “every issue that comes up, you’re going to respond with Obamacare.” Or, he inquired, “is there more to what Republicans want in 2014?”
“The answer is Obamacare,” Priebus said, before adding a “just kidding.” But he wasn’t really kidding. He went on to say that “it’s not possible for this not to be the No. 1 issue going into the 2014 elections. It’s just not. . . . So the answer to your question is, it is going to be the No. 1 issue in 2014.”
The American public has a different view. A Gallup poll last month found that 47 percent cited economic issues as their top concern, including 31 percent who listed the overall economy and jobs. After that, 21 percent named dissatisfaction with government, followed by 17 percent who ranked health care. A CBS News poll a month earlier found much the same: Thirty-one percent cited the economy or jobs, compared to 15 percent listing health care.
But Priebus does seem to be in sync with Republicans in Congress. At the end of the House’s long holiday recess, Majority Leader Eric Cantor (Va.) wrote to Republicans on Thursday to once again take up — you guessed it — Obamacare in the new session of Congress. This time he’s seeking to raise doubts about the privacy protections on HealthCare.gov. “American families have enough to worry about as we enter the new year without having to wonder if they can trust the government to inform them when their personal information — entered into a government mandated website — has been compromised,” he wrote.
Gov. Shumlin Urges Lawmakers To Keep Eyes On Single Payer Prize
In a rare appearance by a sitting governor before a legislative committee, Gov. Peter Shumlin Tuesday took responsibility for problems on the new health insurance exchange, but said the shortcomings only reinforce his case for a publicly financed, universal health care system.
“No one is more disappointed than I am that we fell short of our rollout in the exchange, and I take responsibility for those failures,” Shumlin said. “I know that we have work to do to restore Vermonters confidence in our ability to get health care right.”
Shumlin, however, said the glitch-filled opening of the new website shouldn’t detract from the urgency for a more complete overhaul of the health care system.
“So let me be very clear: I have never been more convinced of the need to keep moving forward. I have never been more certain that we’re on the right path. And I’ve never been more committed to ushering in America’s first universal affordable publicly financed health care system right here in Vermont,” Shumlin said.
But opponents of single-payer say issues on the exchange don’t bode well for the governor’s big picture plans. Darcie Johnston, co-founder of Vermonters for Health Care Freedom, said that if the state can’t get the exchange right, then it has little hope of succeeding in single-payer.
“Because the big story here is that we couldn’t do the easy part at all successfully, which was the exchange. So now we’re moving onto the hard part with no safety net underneath us. It’s a tough, tough road economically, and I don’t see how we get there.”
Shumlin’s testimony before the House and Senate health care committees comes as lawmakers prepare to scrutinize an insurance exchange that has fallen well short of consumer expectations.
Shumlin asked legislative leaders last week for permission to address the committees, in an attempt to preemptively address many of the hard questions his top cabinet officials are likely to face this year.
“Like the rest of the country and the federal government, we’ve had our struggles,” Shumlin said. “I said at the beginning of this process that for those who wanted to focus on the negative, there would be no shortage of material. The website limped out of the gate and it’s only now beginning to hit its stride… The contractors we hired to build it have under-performed at every turn.”
But Shumlin said lawmakers can’t let disappointment in the exchange discourage them from pursuing the longer-term quest for the most dramatic state-level reform of the health care system in the nation’s history. The plan aims not only to eliminate the private insurance market in favor of a publicly financed system, but would also the change the manner in which health care is paid for.
Treatment of medically uninsured Americans shameful
By C.V. Allen, M.D.
The Modesto Bee, Jan. 6, 2014 They are one American in six. They range in age from newborn to 65. They might be anyone – even your neighbor. They are America’s problem and America’s shame. They are America’s 47 million medically uninsured. Contrary to public perception, the uninsured are, for the most part, not the lowest on the economic ladder. They are more likely to be one step up – too well off to qualify for Medicaid, too young for Medicare and too financially stretched to cover even moderate costs of illness. According to the California HealthCare Foundation, here’s what the uninsured look like: • 62 percent of the uninsured are employed. • 32 percent of the uninsured have incomes below the poverty rate ($22,000 for a family of four) • 28 percent have incomes greater than $50,000 • 10 percent are eligible for Medicaid (for minors the rate is 75 percent) • 7 percent have incomes greater than $75,000 • 1 percent of elderly over 65 are uninsured (thanks to Medicare). Large companies of over 500 employees have a 14 percent uninsured rate. That rate rises to 36 percent for companies with fewer than 10 employees and is at 30 percent for the self-employed. This is changing. The number of employers providing medical insurance is declining while employee co-pays and deductibles are rising. About half of America’s annual 1.5 million personal bankruptcies are due to an inability to pay medical costs. It is well documented that care of the uninsured is most often late, less than adequate and lacks follow-up. The results are predictable, including a higher death rate than for the insured. The great perversity here is that the uninsured are confronted with charges well in excess of real costs, charges paid by no one else since Medicare, Medicaid and private insurers all contract for services at far lower rates. The results are nonpayments, which shift the costs to the rest of us, or financial destruction of the individual whose only crime was getting sick. http://www.pnhp.org/print/news/2014/january/treatment-of-medically-uninsured-americans-shameful
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| 01/10/2014 Reported By: Patty B. Wight | |||||||||
The Maine Center for Disease Control and Prevention was scrutinized at a public hearing today for allegedly ordering the shredding public documents to evade a Freedom of Information request. The incident has raised questions about government transparency. And as Patty Wight reports, the Legislature's Government Oversight Committee is trying to decide what final actions to take.
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| The paperwork in question documented how the CDC determined funding levels for 27 different organizations that promote health under the Healthy Maine Partnerships program. The incident was investigated by the government accountability office, OPEGA, which issued a report in December. It found that in 2012, a CDC deputy director ordered two staff members to only retain the final documents and destroy the rest. Former CDC staffer Sharon Leahy-Lind testified before the Government Oversight Committee. "In June 2012, I was ordered to shred public documents related to the entire Healthy Maine Partnerships process by the Maine CDC deputy director," she said. "And the stated reason was because she anticpated there would be a FOIA request for these documents." Leahy-Lind says she refused to destroy the documents and suffered harrassment and discrimination as a result. She has a pending lawsuit over the matter. The CDC falls under the authority of DHHS, and Chief Operating Officer William Boeschenstein says the department is always looking to improve its practices, and is seeking guidance from the state archive office to determine which documents to retain. http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/31696/Default.aspx Maine whistleblower: Boss ordered shredding of documentsThe former state official says the order was prompted by a newspaper's impending request for records on how grant funds had been reallocated.
AUGUSTA — A former Maine Department of Health and Human Services employee told lawmakers Friday that her boss ordered her to destroy public records because a newspaper planned to request them under the Freedom of Access Act.
Sharon Leahy-Lind, who was director of local public health for the state Center for Disease Control and Prevention, stepped down from her job in July and filed a federal lawsuit in October under the Whistleblower Protection Act.
She testified before the Legislature’s Government Oversight Committee on Friday during a public hearing on a report released last month that was highly critical of the CDC for its role in the alleged document shredding.
Committee members deferred action on the report by the Office of Program Evaluation and Government Accountability until their next meeting, on Jan. 24, but talked at length about what the state’s responsibility is to keep certain records and whether those responsibilities are being met.
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Legislative panel delays action on probe that affirmed rampant problems at Maine CDC
Posted Jan. 10, 2014, at 5:25 p.m.
AUGUSTA, Maine — The Government Oversight Committee heard from the public Friday about a recent state investigation into the destruction of documents and possible grant funding manipulation by workers at the Maine Centers for Disease Control.
The Office of Program Evaluation and Government Accountability completed its review of the CDC this fall and presented its report to the Government Oversight Committee on Dec. 12.
OPEGA found a host of problems with the way the CDC distributed millions of dollars to Healthy Maine Partnerships programs last year, including supervisors who ordered the destruction of public documents, funding criteria that was changed during the selection process, Healthy Maine Partnerships funding scores that were changed just before the final selection, a $500,000 tribal contract that seemed to appear out of nowhere and a critical Healthy Maine Partnerships scoring sheet that has vanished.
About half a dozen people spoke to the Government Oversight Committee on Friday morning. Some were outraged by the investigation’s findings. Others said they had good dealings with the CDC and couldn’t believe the investigation’s findings were true.
The committee was scheduled to vote on the report and consider possible actions in light of the investigation’s findings. But members said they had too many questions and too many issues left to consider. They agreed to take up the report again at the next committee meeting on Jan. 24.
At that meeting, the committee could decide to introduce legislation to fix some of the problems OPEGA found, such as the lack of guidance around which public documents should be kept. It could also make its own recommendations to the CDC and the Department of Health and Human Services, which oversees the CDC, though those recommendations would not have the force of law.http://bangordailynews.com/2014/01/10/health/legislative-panel-delays-action-on-probe-that-affirmed-rampant-problems-at-maine-
cdc/print/
cdc/print/
DHHS releases reasoning behind denial of medical marijuana use for Tourette’s syndrome
Posted Jan. 09, 2014, at 4:11 p.m.
AUGUSTA, Maine — The Department of Health and Human Services denied the use of medical marijuana to treat Tourette’s syndrome last month because of a dearth of large-scale studies into its effectiveness and side effects, according to a document provided to the Bangor Daily News on Thursday.
A panel of doctors who advise the department’s Bureau of Licensing and Regulatory Services said in the written decision that they wanted to see the use of marijuana to treat Tourette’s syndrome studied under standards used by the Food and Drug Administration.
Dr. Dustin Sulak, one of the state’s leading medical marijuana proponents who led the failed effort to add Tourette’s syndrome to Maine’s list of ailments legally treatable by medical marijuana, criticized the state’s reasoning. He said Thursday that many of the medications already prescribed to Tourette’s syndrome patients are not approved for that purpose by the FDA and that because of federal laws prohibiting the use of marijuana for any reason, the FDA rarely if ever studies the medical use of cannabis.
The four-doctor Medical Marijuana Advisory Committee is made up of Sheila Pinette, director of the Maine Center for Disease Control; Kevin Flanigan, medical director for the Office of MaineCare Services; Lindsey Tweed, medical director for the Office of Child and Family Services; and Christopher Pezzullo, medical director of population health at the Maine Center for Disease Control.
The panel met to discuss the issue on Dec. 11, 2013, and rendered its written decision two days later. The Bangor Daily News has been requesting the document since late December. Sulak said he also had not seen the document until recently.
Federal judge denies DHHS appeal on 50 percent funding cut at Riverview hospital
Posted Jan. 07, 2014, at 9:47 p.m.
AUGUSTA, Maine — A state appeal of a federal government decision to cut about $20 million in funding from the state-run Riverview Psychiatric Center has been denied by a federal judge.
That means state lawmakers will now have to wrestle with filling the gap as they head into the second half of the 126th legislative session on Wednesday. That gap amounts to about 50 percent of the 92-bed forensic hospital’s budget.
Riverview houses some of the state’s most violent mental health patients, and has been in the spotlight in recent months after attacks by patients against staff and each other prompted an unannounced federal inspection of the facility in March 2013.
That audit determined the state was not compliant with federal rules it must follow to receive Medicare and Medicaid funding for patients at the facility and prompted the cut.
Meanwhile, DHHS officials are also reapplying for the federal funding in hopes it will be restored.
The ruling by an administrative law judge will be appealed, according to Maine Attorney General Janet Mills, who voiced disappointment in a memo to lawmakers this week and noted the ruling was based on a “technicality.”
Mills told lawmakers the decision will be appealed but it still punches an immediate hole into the state’s two-year budget that is already expected to be out of balance by nearly $100 million.
In August, lawmakers passed an emergency law, signed by Republican Gov. Paul LePage, that was meant to satisfy the federal government’s concerns over staff and patient safety, but a subsequent inspection of the facility by auditors from the federal Centers for Medicare and Medicaid Services determined the underlying concerns had not be addressed.
That law created the framework for expanding a mental health unit at the state prison in Warren, which was meant to alleviate Riverview of some of its most dangerous patients.
At the time of the change, lawmakers were assured by Maine DHHS Commissioner Mary Mayhew that the change would at least temporarily allay the federal government’s concerns about Riverview.
That failed to be the case.
On Tuesday, John Martins, a spokesman for DHHS, said the department was working closely with the attorney general’s office on the appeal.
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