Maine lawmakers to consider single-payer health care system
Supporters of the bill want to adopt a government-run program, but a critic calls that unwise and expensive.
Jim Miller, president of WoodenBoat Publications in Brooklin, wants the decisions about how to provide health insurance for his employees taken out of his hands.
“I hate playing God,” he said. “Every spring I am forced into that position.”
Spring is when his company’s health insurance policies come up for renewal and he has to balance rising costs against being fair to his 30 employees.
Miller supports a legislative proposal for Maine to adopt a system that would replace employer-sponsored health insurance with a government-run program.
Starting in 2017, states can adopt such single-payer systems under the Affordable Care Act, using federal funding that now goes to states for programs such as the health insurance marketplace.
Maine’s bill will be discussed by a legislative committee Thursday in Augusta.
“The ACA is the first step toward a single-payer system,” said Rep. Charles Priest, D-Brunswick, the bill’s sponsor.
Priest concedes that it will be hard to get the bill passed this year, with opposition from Republican Gov. Paul LePage.
“Obviously, it’s a new concept for Maine,” Priest said. “I look at now as a time to educate people about single-payer.”
While there are many ways to create a single-payer system, a simple analogy is that Medicare would be expanded to everyone. Other countries, including Canada and the United Kingdom, operate single-payer health care systems.
Law’s Expanded Medicaid Coverage Brings a Surge in Sign-Ups
WELCH, W.Va. — Sharon Mills, a disabled nurse, long depended on other people’s kindness to manage her diabetes. She scrounged free samples from doctors’ offices, signed up for drug company discounts and asked for money from her parents and friends. Her church often helped, but last month used its charitable funds to help repair other members’ furnaces.
Ms. Mills, 54, who suffered renal failure last year after having irregular access to medication, said her dependence on others left her feeling helpless and depressed. “I got to the point when I decided I just didn’t want to be here anymore,” she said.
So when a blue slip of paper arrived in the mail this month with a new Medicaid number on it — part of the expanded coverage offered under the Affordable Care Act — Ms. Mills said she felt as if she could breathe again for the first time in years. “The heavy thing that was pressing on me is gone,” she said.
As health care coverage under the new law sputters to life, it is already having a profound effect on the lives of poor Americans. Enrollment in private insurance plans has been sluggish, but sign-ups for Medicaid, the federal insurance program for the poor, have surged in many states. Here in West Virginia, which has some of the shortest life spans and highest poverty rates in the country, the strength of the demand has surprised officials, with more than 75,000 people enrolling in Medicaid.
While many people who have signed up so far for private insurance through the new insurance exchanges had some kind of health care coverage before, recent studies have found, most of the people getting coverage under the Medicaid expansion were previously uninsured. In West Virginia, where the Democratic governor agreed to expand Medicaid eligibility, the number of uninsured people in the state has been reduced by about a third.
America ranks near the bottom of developed countries in health and longevity, and many public health experts believe that improving that ranking will be impossible without paying more attention to poor Americans. It is still an open question whether access to health insurance will improve the health of the disadvantaged in the long run, experts say, but the men and women getting the coverage here say the mere fact of having it has drastically improved their mental health.
A national health-care analyst is questioning the findings of a study of Medicaid expansion commissioned by the LePage administration, including what she says is a miscalculation that produced a $575 million error.Kathy Gifford, a Medicaid analyst for Indianapolis-based Health Management Associates, reviewed the study by the Alexander Group, part of a $925,000, taxpayer-funded review of Maine’s public welfare system.
The LePage administration has touted the study’s recommendation that lawmakers reject expansion of MaineCare – the state’s Medicaid program – because it would add 124,000 recipients and increase the program’s cost by $807 million over 10 years. Opponents of expansion have cited the report extensively since it was released Jan. 10.
But Gifford said the report has several shortcomings, including a miscalculation that could significantly overstate the cost of the program and expansion. Gifford reviewed the study for AARP, which favors Medicaid expansion.
She said Monday that the Alexander Group apparently used a lower federal reimbursement rate for its calculations than it cited in the text, effectively inflating Maine’s share of the cost.
Gifford’s comments raise new questions about the report, which had already been assailed as a taxpayer-funded document to validate the LePage administration’s policy positions on welfare and its refusal to expand MaineCare to an estimated 60,000 to 70,000 Mainers.
Mothers in ‘survival mode’ as U.S. trails world on paid leave
Papua New Guinea is the only other nation that doesn’t provide or require a paid maternity leave, according to information on 185 countries.
By KASIA KLIMASINSKA and SANDRINE RASELLO
Bloomberg News
Bloomberg News
WASHINGTON — Roxanne Vivanco just returned to her banking job in Ramsey, N.J., after spending 12 weeks with her newborn daughter without having to deplete her savings.
The 36-year-old community development manager at Toronto- Dominion Bank was able to tap a state-administered benefit that finances family leave through employee payroll contributions. “It was a blessing,” said the mother of three. The money “helped with taking care of our house bills as well as food for the newborn and my other kids.”
Vivanco considers herself fortunate in a nation where only 12 percent of workers get paid time off to care for a baby or a sick parent, according to the U.S. Labor Department. Rhode Island this month became the third state to start a paid family leave insurance program, which was initiated by California in 2004 and by New Jersey in 2009.
A bill introduced last month in Congress would create a similar model nationally. That would make more women eligible for a benefit usually offered in the United States only at large companies such as Bank of America or Goldman Sachs.
Papua New Guinea is the only other nation that doesn’t provide or require a paid maternity leave, according to information on 185 countries compiled by the United Nations’ International Labor Organization. It recommends 14 weeks off at a level no lower than two-thirds of previous earnings.
Posted Jan. 20, 2014, at 5:59 p.m.
AUGUSTA, Maine – A state-funded study on the impact of Medicaid expansion was modified from its first to final draft, according to a Bangor Daily News and Sun Journal review of multiple revised documents.
Late on Friday, the Maine Department of Health and Human Services released three earlier versions of the Rhode Island-based Alexander Group’s feasibility study on Medicaid expansion. The release followed requests for the documents from the Sun Journal and Bangor Daily News under Maine’s Freedom of Access Act.
While the draft reports were produced, neither the governor’s office nor DHHS has fulfilled a secondary request for communications between the state and the Alexander Group regarding the three revisions to the study that took place between Dec. 16, when the first draft was submitted to the state, and Jan. 10, when the final report was released to the public.
A subsequent request seeking that data was sent to state officials again on Monday.
The first and final drafts of the report show that changes were made — some cosmetic, some substantial — that saw the report grow from 95 to 131 pages. While the edits were being made, reporters made several unsuccessful attempts to obtain the documents.
Efforts to contact Gov. Paul LePage’s office and DHHS Monday were unsuccessful. State offices were closed in observance of Martin Luther King Jr. Day.
Much of the report’s growth from first to last draft can be explained by the addition of several expansion scenarios, which outline a spectrum of possibilities if Maine expands.
While the numbers in the report and its final projections and conclusions remain relatively similar, changes included subtle revisions in political rhetoric and small formulaic changes that may have yielded larger changes in conclusions.
For example, the original version of the report said MaineCare enrollment — even without expansion — would grow from 285,416 today to more than 370,000 in 2014. The final version added about 35,000 to that figure, saying enrollment would grow to 406,100 in 10 years.
That may be because the Alexander Group did not originally include in its analysis roughly 45,000 Mainers who receive partial benefits under MaineCare. Subsequent versions of the report did, which may explain why enrollment growth predictions in the final draft were higher than in the original.
The document appears to have been edited to present a more seemingly detached analysis of the Medicaid expansion equations. The most politically sensitive passages were softened or removed outright: Sections outlining poor health care outcomes for those enrolled in Medicaid were trimmed or stricken, as were segments and a related appendix outlining the political breakdown of Medicaid expansion, noting “there appears to be a partisan pattern on how states are deciding to expand.”
Does the Alexander Medicaid report have a $575 million error and misstate what it did?
Maine Politics, Nationalhealth care
By Amy Fried
Gary Alexander’s report on Medicaid expansion has been roundly criticized for its omissions and assumptions.
Now an expert on Medicaid has identified what looks like a big calculation error — $575 million.
Moreover, it looks like Alexander wrote one thing about the figure while using another. If so, that is a grave error, for it means the write-up of the report was not honest and transparent.
Here’s what is being claimed and by whom:
Kathy Gifford, a Medicaid analyst for Indianapolis-based Health Management Associates, reviewed the study by the Alexander Group, part of a $925,000, taxpayer-funded review of Maine’s public welfare system. . .Gifford said the report has several shortcomings, including a miscalculation that could significantly overstate the cost of the program and expansion. Gifford reviewed the study for AARP, which favors Medicaid expansion.She said Monday that the Alexander Group apparently used a lower federal reimbursement rate for its calculations than it cited in the text, effectively inflating Maine’s share of the cost.[source]
The difference between the rate Alexander claimed and the one Gifford found he used may sound small. Alexander said he used a reimbursement rate of 61.55 percent but Gifford’s calculation reveals he used a rate of 60 percent.
The thing is, this seemingly small difference between the two rates adds up to a big difference in what Maine would pay.
And, as already noted, using one rate and claiming one’s used another is dishonest. In my world, this sort of thing would cause a paper to be withdrawn and would have significant consequences for the person who prepared the report and released it to the public.
We recently learned that Alexander’s report wasn’t an independent product submitted to the state. Rather, it underwent multiple revisions by staff in Maine’s Department of Health and Human Services.
We already knew many assumptions were flawed. Also, by leaving out economic impacts and federal payments for programs the state now pays, it overstated costs of expansion and understated the revenues and job gains for the state.
If we assess this report by normal standards — how well it evaluates the likely impacts of a proposed program — this report is highly flawed. And if this error exists and Alexander stated one percentage was used but used another, the report should be withdrawn.
PPACA lessons from developing countries
BY GREG DONAHUE
January 17, 2014
The inclusion of a tax on medical devices has opponents of the Patient Protection and Affordable Care Act arguing that manufacturers will be less inclined to pursue new life-saving and cost-cutting technologies. In response, some health professionals are looking to developing nations — where expensive treatments remain financially unrealistic — for inspiration.
It is known as “reverse innovation” — the idea that doctors who assist in providing care in developing countries often return with fresh approaches to treatment — and it’s becoming more common as costs in the United States continue to rise.
A recent series profiling Bangladesh’s creative approach to care, published in The Lancetmedical journal, attributes that country’s health advances to a continued focus on mobilizing community health workers, as well as a government commitment to partnerships with not-for-profit organizations.
It may be one of the poorest — and most populated — countries in the world, but Bangladesh now has the longest life expectancy, lowest number of births per family and lowest infant and under-5 mortality rates in south Asia. It also spends less on health care than most of its neighbors.
Wyden Plan May Be Vision For Future Medicare Reforms
By Mary Agnes Carey
JANUARY 21ST, 2014, 7:56 AM
Key members of both parties and both chambers of Congress stand before the podium to introduce their bipartisan Medicare proposal. Insurers and health care providers welcome it. Seniors’ groups are on board, too.
If Congress is ever going to overhaul Medicare, it will almost certainly have to happen this way. Sen. Ron Wyden, the Oregon Democrat widely expected to be the next Senate Finance Committee chairman, last week led a bipartisan group of lawmakers, health care experts and seniors’ advocates backing a plan to better coordinate care given to Medicare beneficiaries.
The proposal is part of the ongoing health policy conversation over shifting Medicare away from paying per service provided to paying for the quality of that care. Sponsors say their measure would modify existing law to make it easier for providers to seek out those patients who have multiple chronic conditions like high blood pressure, high cholesterol, heart disease and diabetes and tailor care to their needs.
Health insurers and providers who want to specialize in chronic care would receive a set amount of money to care for patients and would be responsible for the cost, care and outcomes of their enrolled patients. Doctors and nurses would lead those care teams.
An Obamacare “Horror Story” That Just Isn’t True: How Did This Happen? Part 2
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For months, health reform’s opponents have been trumpeting tales of Obamacare’s innocent victims - Americans who lost their insurance because it doesn’t comply with the ACA’s regulations, and now have to shell out more than they can afford – or go without coverage.
Trouble is, many of those stories just aren’t true.
Below I posted about a Fort Worth Star Telegram article that leads with the tale of Whitney Johnson, a 26-year-old new mother who suffers from multiple sclerosis (MS). Her insurer just cancelled her policy, and according to Johnson, new insurance would cost her over $1,000 a month.
That claim stopped me in my tracks. Under the ACA, no 26-year-old could be charged $1,000 monthly – even if she has MS.
Obamacare prohibits insurers from charging more because a customer suffers from a pre-existing condition. This rule applies to all new policies, whether they are sold inside or outside the exchanges.
At that point, I knew that something was wrong.
When I checked the exchange – plugging in Johnson’s county and her age – I soon found a Blue Choice Gold PPO plan priced at $332 monthly (just $7 more than she had been paying for the plan that was cancelled). Co-pays to see a primary care doctor would run just $10 ($50 to visit a specialist) and she would not have to pay down the $1,500 deductible before the insurance kicked in.
My radar went up: Recently, I have been reading more and more reports regarding “fake Obamacare victims.”
Now I couldn’t help but wonder: Who are these folks in the Start-Telegram story? The paper profiled four people who supposedly had been hurt by Obamacare. When I Googled their names I soon discovered that three (including Johnson) wereTea Party members.
The paper describes them as among Obamacare’s “losers,” but the truth is that they didn’t want to be winners. Two hadn’t even attempted to check prices in the exchanges.
Meanwhile, it appeared no one at the Star-Telegram even attempted to run a background check on the sources, or fact-check their stories. I couldn’t help but wonder: “Why?”
The answer will surprise you.
