Health Care Plans Attracting More Older, Less Healthy People
By ROBERT PEAR and MICHAEL D. SHEAR
WASHINGTON — People signing up for health insurance through the Affordable Care Act’s federal and state marketplaces tend to be older and potentially less healthy, officials said Monday, a demographic mix that could cause premiums to rise in the future if the pattern persists.
But officials expressed optimism that more young people will sign up in the months ahead, calling it “solid, solid news” for the health care law. They said demand for insurance through the marketplaces was increasing sharply across all age groups and they said youth outreach will become more aggressive in the months ahead.
“We’re pleased to see such a strong response and heavy demand,” said Kathleen Sebelius, the secretary of health and human services. “Among young adults, the momentum was particularly strong.”
Officials for the first time released basic demographic information about the people signing up for insurance. Of those who signed up in the first three months, 55 percent are age 45 to 64, officials said. Only 24 percent of those choosing a health insurance plan are 18 to 34, a group that is usually healthier and needs fewer costly medical services. People 55 to 64 – just below the age at which people qualify for Medicare -- represented the largest group, at 33 percent.
JANUARY 13, 2014
TWEETING CANCER
POSTED BY MEGHAN O'ROURKE
For good reason, the Internet lit up on Monday with debate over Bill Keller’s strange column “Heroic Measures,” in the Times, which, like a recent Guardian post by his wife, Emma Keller, addresses the ethics of publicly chronicling one’s battles with cancer. (Emma Keller’s post was taken down by the Guardian on Monday.) The occasion for both editorials are the tweets and blog posts of Lisa Bonchek Adams, who is being treated for metastatic breast cancer (Stage IV). Adams, as Emma Keller writes, has tweeted more than a hundred and sixty thousand times, often about her illness. (A recent example: “Another shoutout to the palliative team. Pain management specialists are some of my heroes @sloan_kettering.”)
Both columns betray discomfort with the public nature of Adams’s response to her illness. And both writers veil what appears to be personal distaste for Adams’s public display with high-minded questions about the ethics of prolonged care and of public self-revelation without examining the complexities of their own response. In this way, both columns are a stark and tone-deaf reminder of just how repressed and ahistorical our public relationship to dying and death is today. It’s a shame, as both writers touch on interesting questions about how we think about those issues, questions of the very sort that Adams has been trying to address in her blog posts and tweets.
Other writers have already effectively characterized many of the problems with Bill Keller’s column, which contrasts Adams’s decision to pursue treatment, despite the gravity of her cancer, with his father-in-law’s “calm death.” But perhaps the most salient point is that he used one woman’s story as an occasion for debate about what might be wrong with broader approaches to dying. I’m sympathetic to some of Keller’s larger points, especially those about our collective difficulty with facing dying, our cultural habit of pursuing treatment past the rational point of stopping, and the importance of medical centers that offer alternatives to highly interventional care.
But, as Keller barely pauses to acknowledge, such collective issues break down into millions of complex individual realities—realities that go largely ignored in his Op-Ed, which treats Adams’s personal choices as an occasion for moral legislation about the wisdom of resigning oneself to death. It is very different to be faced with late-stage cancer at seventy-nine (the age that Keller’s father-in-law, Anthony Gilbey, was when he died) than to learn at thirty-seven that you have breast cancer, as Adams did. When Gilbey chose not to pursue life-prolonging treatment, he was nearing the end of life; when Adams learned her cancer had metastasized, she was in her forties with three children at home. A debate about the rationale for extending treatment looks very different when it concerns those who have lived the bulk of their lives rather than those who are halfway through theirs.
Older Pool of Health Care Enrollees Stirs Fears on Costs
By MICHAEL D. SHEAR and ROBERT PEAR
WASHINGTON — People signing up for health insurance through the Affordable Care Act’s federal and state marketplaces tend to be older and potentially less healthy, officials said Monday, a demographic mix that could threaten the law’s economic underpinnings and cause premiums to rise in the future if the pattern persists.
Questions about the law’s financial viability are likely to become the next line of attack from its critics, as lawmakers gear up for the midterm elections this fall. Republicans quickly seized on the government’s progress report on Monday as evidence that the health insurance law would not work.
But administration officials expressed optimism that more young people would sign up in the months ahead, calling the latest enrollment numbers “solid, solid news” for the health care law. They said that interest in obtaining insurance through the marketplaces was increasing sharply across all age groups and that youth outreach efforts would become more aggressive as the March 31 open enrollment deadline approached.
We’re pleased to see such a strong response and heavy demand,” said Kathleen Sebelius, the secretary of health and human services. “Among young adults, the momentum was particularly strong.”
Of those who signed up in the first three months, administration officials said, 55 percent are age 45 to 64. Only 24 percent of those choosing a health insurance plan are 18 to 34, a group that is usually healthier and needs fewer costly medical services. People 55 to 64 — the range just below the age at which people qualify for Medicare — represented the largest group, at 33 percent.
The latest figures about enrollment add pressure on the Obama administration after a disastrous rollout of the HealthCare.gov website in October. Senior officials said they understood the stakes and were working to increase sign-ups. The White House recently hired Marlon Marshall, the deputy national field director for Mr. Obama’s 2012 presidential campaign, to run a campaign-style effort aimed at increasing sign-ups, especially among young people.
LePage’s controversial welfare consultant to present Medicaid expansion findings to lawmakers
By Mario Moretto, BDN Staff
Posted Jan. 14, 2014, at 11:19 a.m.
AUGUSTA, Maine — After releasing an initial 131-page report on a potential Medicaid expansion to reporters last week, a controversial consultant hired by Republican Gov. Paul LePage will present those findings to lawmakers on the Health and Human Services Committee on Tuesday.
The report by the Alexander Group, which says accepting federal Medicaid dollars to expand coverage to roughly 70,000 Mainers who make less than 138 percent of the federal poverty limit wouldcost the state $807 million over 10 years, has bolstered LePage and legislative Republicans’ argument against Medicaid expansion.
The report is the first document generated under a $925,000 contract the state signed with the Rhode Island-based Alexander Group in September. The group is spearheaded by Gary Alexander, a former welfare chief in Rhode Island and Pennsylvania, who now works as a roving consultant. Alexander has delivered similar reports in other states, all of which have argued that welfare services are too generous and Medicaid expansion too costly.
Tuesday marks the first time lawmakers will meet with Alexander since he was contracted by the state. Previous efforts by the Health and Human Services Committee to invite Alexander to meetings in the State House have been unsuccessful.
Democrats on the committee are expected to grill Alexander about the assumptions used in his proprietary financial model, which include a predicted 31.5 percent increase in the number of Mainers living under the poverty line over the next 10 years. That number matters because the more the poverty rate grows, the more Mainers would be eligible for MaineCare, the state’s Medicaid program.
The state’s most recent Consensus Economic Forecast predicts slow but steady economic growth in the coming years.
Alexander is also facing criticism from some advocacy groups for focusing exclusively on the cost of Medicaid expansion while ignoring the health and economic benefits of accepting federal dollars and extending health care services to the poor.
In the report, Alexander states that an “economic impact statement is beyond the scope of this study.” Backers of the report say cost is the most important question facing the state in deciding whether to expand.
Expansion, a keystone of President Barack Obama’s landmark 2010 health care reform law, would be funded 100 percent by the federal for the first three years before annually winnowing down to 90 percent funding thereafter. The expansion effort was defeated last year by gubernatorial veto, but House Speaker Mark Eves, D-North Berwick, and Senate Majority Leader Troy Jackson, D-Allagash, have both introduced measures to put it back on the table this session.
Taxpayers foot the bill for LePage manifesto on Medicaid expansion
Editorial
Posted Jan. 14, 2014, at 10:01 a.m.
Gov. Paul LePage’s administration has orchestrated a purely political move disguised as impartial analysis in advance of Wednesday’s public hearing on a bill that would sign Maine up for an expansion of Medicaid under the federal Affordable Care Act.
Now, when a proponent discusses the merits of expanding coverage to about 75,000 low-income parents and adults without children, LePage and his allies have an easy, one-number retort: $807 million.
That’s the cost of expansion ascribed to state coffers over the next decade by the Alexander Group, the LePage administration’s hand-picked consultant hired to conduct a $925,000, multipart analysis of the state’s Medicaid and public welfare programs.
The Maine Department of Health and Human Services last week released the first installment of the Alexander Group’s work, a feasibility study on Medicaid expansion. Unsurprisingly for a consultant hired by expansion opponent LePage, the Alexander report essentially concludes the cost of expansion isn’t one Maine’s state budget can handle.
“The more pressing needs are restructuring and streamlining to make MaineCare more efficient and to deliver better quality outcomes,” the report reads. “While health care access and improved health outcomes remain an imperative, expansion of Medicaid may not be the best policy choice to achieve those goals.”
A Maine-specific, cost-benefit analysis that is honest and comprehensive would be a valuable addition to the Medicaid expansion debate. Unfortunately, that’s not what the Alexander Group brings to the discussion.
The document reads as a political manifesto that methodically explains each talking point Medicaid expansion opponents have used over the past year to refute calls to extend coverage. In some spots, the report goes beyond the scope of evaluating Medicaid expansion’s costs to make policy judgments on education, public safety and corrections.
At the same time, the Alexander Group claims it’s “beyond the scope of this study” to analyze the economic effect of expanding Medicaid and to make recommendations on a “political decision” over whether the state should opt to continue receiving a type of federal funding meant to help hospitals offset the cost of uncompensated care.
One clear message is that Maine’s Medicaid program is bound to grow regardless of the state’s decision on expansion. The report projects a basically uninterrupted 31 percent increase in Maine’s poverty rate over the next decade that no expert is predicting. With more people falling into poverty, eligibility for Medicaid — expanded or not — would rise, inevitably increasing costs to both the state and federal government.
But even assuming the drastic rise in poverty, Alexander doesn’t appear to consider the fact that the federal government chips in a greater percentage of Medicaid costs for states with low personal income. While these concerns don’t entirely negate the report’s predictions that Medicaid expansion will cost the state, they raise questions about the $807 million figure.
This is a political document that makes the case for one LePage policy position, but the major poverty growth projected by the Alexander Group might get in the way of another point LePage wants to make as he runs for re-election — that Maine’s economy is turning around under his leadership.
The Alexander Group report also falls short in other areas that raise questions about its conclusions. For example, the report applies generic, national spending growth projections to Maine’s Medicaid program to make the case that Medicaid spending will continue to grow and subsume an ever-increasing portion of Maine’s state budget.
Under Commissioner Mary Mayhew, however, Maine’s Health and Human Services Department has begun a number of cost-saving initiatives for which the LePage administration is already claiming savings.
The Alexander document also apparently fails to consider potential savings to the state in the form of mental health services, substance abuse treatment and inmate health care for which Medicaid would start to cover costs as a result of the expansion. Right now, those services are completely state-funded for some residents who would be newly eligible for Medicaid under the expansion. In Michigan, this reality translated into major state budget savings.
Head of Anthem in Maine talks about health care rollout, but mum on enrollments
By Nick McCrea, BDN Staff
Posted Jan. 14, 2014, at 12:08 p.m.
BANGOR, Maine — The head of Maine health insurance giant Anthem Blue Cross Blue Shield of Maine said that in spite of the beleaguered launch of the the online marketplace under the Affordable Care Act, the exchange will continue to stabilize, as will prices.
Daniel Corcoran, president and general manager of Anthem, delivered the keynote address at the Bangor Region Chamber of Commerce’s annual business breakfast Tuesday morning at a packed Morgan Hill Event Center in Hermon.
Corcoran, giving his views on the new system, said the unpopular individual mandate, requiring people to have an insurance plan or face a penalty, was “necessary for the stability of rates.”
“Health care is consuming more and more of our disposable income,” Corcoran said, which is holding back other parts of the economy. He said Maine has the fifth-highest spending per capita on health care in the nation.
Corcoran also trumpeted the launch of Anthem’s Enhanced Personal Health Care Program. The program is aimed at improving communications and the relationship between patients and their doctors in hopes of keeping people out of the hospital whenever possible through preventative care.
Since its launch in July, 800 primary care physicians have signed on, he said. The result has been fewer hospital admissions, readmissions and fewer emergency room visits that will help keep the costs of health care — and insurance — down over the long term.
The one constant in the health care industry is that “things are constantly changing,” Corcoran said, and providers and insurers need to adapt.
Corcoran didn’t mention a recent U.S. Department of Health and Human Services report indicating that startup nonprofit Maine Community Health Options, or MCHO, is outpacing Anthem in the number of signups in the marketplace. Kevin Lewis, who leads MCHO, has said 80 percent of Mainers enrolling have chosen options through his organization. Anthem has yet to provide its figure.
Corcoran took no questions from the audience at the event in Hermon. When asked about the report in the parking lot as he was leaving, Corcoran said he hadn’t reviewed it.
Since the launch of healthcare.gov on Oct. 1 of last year, 13,704 Maine residents selected a health plan through the federal government’s gateway for the marketplaces as of Dec. 28, 2013, according to a report from the U.S. Department of Health and Human Services. That’s an eightfold increase compared to the month of November.
BDN reporter Jackie Farwell contributed to this report.
Maine health insurance signups skyrocket, participants skew older
By Jackie Farwell, BDN Staff
Posted Jan. 13, 2014, at 4:37 p.m.
The number of Mainers signing up for health coverage under the Affordable Care Act skyrocketed last month, and most are middle-aged or older, according to new federal figures released Monday that for the first time include demographic data key to the law’s insurance overhaul.
Since the launch of healthcare.gov on Oct. 1, 2013, through Dec. 28, 2013, 13,704 Maine residents selected a health plan through the federal government’s gateway for the marketplaces in Maine and 35 other states, according to a report from the U.S. Department of Health and Human Services. That’s an eightfold increase compared to the month of November.
Enrollment also shot up nationally, with nearly 2.2 million people choosing plans through both healthcare.gov and state-run health insurance marketplaces. December alone accounted for nearly 1.8 million enrollees.
Also called “exchanges,” the marketplaces are geared toward small businesses and individuals who buy their own health insurance rather than receive coverage through work or government programs such as Medicaid and Medicare. In Maine, about 65,000 to 104,000 people are estimated to be eligible to shop on the marketplaces.
In a press release announcing the figures, HHS touted an eightfold increase in the number of young adults ages 18 to 34 signing up for coverage. The Affordable Care Act’s overhaul of the insurance market for those who buy their own coverage relies on young, healthy Americans signing up to help share the risk with older, sicker consumers and keep costs from skyrocketing.
Americans aged 18 to 34 accounted for nearly a quarter of the 2.2 million people who have selected health plans so far. That’s short of the White House’s target, but administration officials stressed that young people still have plenty of time to enroll.
“We expected older adults to sign up early and we expect more young adults to come in [during] the month of March, by the end of the open enrollment period,” Nancy Delew, HHS’ acting deputy assistant secretary for planning and evaluation, said on a press call Monday.
The White House previously said that if 7 million people ultimately enroll in coverage as projected, 2.7 million, or 40 percent, should be young adults whose premiums would subsidize the costs of older, less healthy enrollees.
In Maine, the oldest state in the country, the proportion was lower, with 18 percent of enrollees under age 35. Only two states, Arizona and West Virginia, posted lower showings at 17 percent. Maine tied with New Mexico and Arkansas. Data was not available for three states.
More than 60 percent of those who had signed up for coverage in Maine were between the ages of 45 and 64.
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