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Sunday, February 2, 2014

Health Care Reform Articles - February 2, 2014

Rep. Henry Waxman: The reason I’m leaving Congress

By Rep. Henry A. Waxman, Published: January 31

Rep. Henry A. Waxman is a Democrat from California.
I announced this past week that I will be retiring after having the honor of serving my Los Angeles constituents in Congress for 40 years.
Immediately, speculation began that I am leaving because I am frustrated with a broken institution. But the exact opposite is true: I am leaving Congress with my conviction intact that the legislative branch can be a powerful force for good.
Of course there are aspects of the current Congress that I abhor. This past week, every Republican on the Energy and Commerce Committee, where I have served most of my career, voted to limit the Environmental Protection Agency’s ability to regulate carbon pollution that is causing climate change. When my colleague Rep. Jan Schakowsky (D-Ill.) offered a simple amendment affirming that climate change is real, they voted against that, too.
That kind of mindless denial of science is an embarrassment.
Voting over and over to repeal the Affordable Care Act, shutting down the government and threatening default are other deplorable examples of the extremism of tea party Republicans.
But even in this polarized environment, there are important opportunities to advance the public interest. Two years ago, I worked with Rep. Fred Upton (R-Mich.), chairman of the Energy and Commerce Committee, and our Senate colleagues to write a landmark telecommunications law that will ease the looming shortage of wireless spectrum, create new Super WiFi technologies and fund the long-overdue construction of a nationwide broadband network for police and firefighters. Last year, we negotiated a law that will create an electronic tracking system to protect consumers from counterfeit drugs. And even now, I am working with a bipartisan group from the House and the Senate to fix the Medicare physician payment system that has bedeviled Congress for more than a decade.
These efforts may not garner headlines, but they make our country stronger and are deeply gratifying.
No question, it is hard to pass legislation in today’s Congress. But it has always been hard. Our system of checks and balances makes it simpler to stop bills than to enact them.
In fact, the story of my career is that Congress can do tremendous good, but it never comes easily.


Health Care Issue is Misunderstood
By Philip Caper, M.D.
Ellsworth-American
January 30, 2014

Dear Editor:

Your editorial in the January 16 Ellsworth-American titled “There’s No Free Health Care” deserves a response. Here’s mine:

I agree with the title. That’s where it stops. 

To seriously suggest that Congressman Michaud is advocating for free health care for everybody in the world is, on its face, absurd. Since he is a candidate for Governor of Maine, not emperor of the world, I think we can safely assume his advocacy of healthcare as a human right is limited to the people of Maine.

I fully understand that many people in our state rankle at the idea that somebody may get something they don’t deserve at their expense. But I also truly think they misunderstand the nature of the problem.

It turns out to be far less expensive to cover everybody than to spend lots of money, energy and political capital figuring out how not to cover the “undeserving”. Just check out the political food-fight now going on in Augusta about expanding MaineCare at federal expense.

 Many people don’t believe you can cover more people for less and probably can’t be persuaded. But it’s still worth trying.

First, it’s a well known fact that people without health insurance often delay seeing a doctor if they think they can’t afford it. This results in many delayed diagnoses that then end up requiring treatments that are far more difficult and expensive. Emergency rooms try to stabilize patients, but cannot prevent illnesses and injuries from happening in the first place, and do not generally provide follow-up care.

Such pent-up demand is most likely what underlies the recent finding that the use of emergency rooms surged among newly insured Medicaid enrollees, who are less likely to have a regular doctor. I expect that it will level off as they begin to receive regular care.

Second, the administrative costs associated with actuarially slicing and dicing people up into ever smaller “risk pools” are very high. Think of the costs of supporting insurance company underwriting (usually their largest departments) and add to it the costs doctors and hospitals incur to accurately bill patients belonging to dozens of different plans with differing benefits packages, deductibles, co-payments and “provider networks”.

It quickly adds up to real money. For example, doctors in Maine spend about three times as much as Canadian doctors on administration. Hospitals spend even more.
Credible estimates of the money wasted on unnecessary administration in Maine alone run to almost $800 million.

Finally, if we were all covered by the same plan it would be much easier to control ongoing costs into the future. Our heavily fragmented ways of financing medical care in the US have made it very difficult to constrain the growth of overall medical costs. It’s like trying to control the flow of a river by building a dam in its delta rather than upstream. Out of control healthcare costs are eroding our ability to do lots of other important things in both public and private sectors.

Many of these efforts and their associated costs are intended to make sure that only the “deserving” (wealthy, employed, elderly, pregnant, children, etc.) get medical care in a dignified way. The costs of doing that are very high. Think of them as a tax on your own healthcare costs.

 Adding it all up, the price of unnecessary administration, avoidable illness and lack of more effective control of costs easily amount to 20% of our total healthcare spending. In Maine alone, that amounts to $1500 for every person in the state. Is it really worth $1500 to you and every member of your family  to make sure some “undeserving” person doesn’t get “free” medical care? 


When Biography Trumps Substance

SPOKANE, Wa. — Only the snarkiest would not be open to the likable life story of Representative Cathy McMorris Rodgers, the Eastern Washington politician who gave the “official” Republican response to the president’s State of the Union speech. She’s a farm girl from a big empty county just north of here, first in her family to attend college, mother of three, a rare woman in the retrograde men’s club of her party’s leadership.
Her district, poorer than the west side of the state, with much of the broken-family, broken-promise poverty of white rural America, is in real trouble. But the policy prescriptions of McMorris Rodgers have nothing to offer these people. Through her, you can see what happens when biography trumps substance in politics.
Consider Stevens County, her home, an area about half the size of Connecticut with fewer than 50,000 people. It’s gorgeous country, hard by the Columbia River, but a hard place to make a decent living. The county’s unemployment rate was 30 percent above the national average last year. One in six people live below the poverty level. One in five are on food stamps. And the leading employer is government, providing 3,023 of the 9,580 nonfarm payroll jobs last year.
Given that picture, it would seem surprising that McMorris Rodgers voted to drastically cut food aid last year, and joined her party in resisting emergency benefits to the unemployed. She has been a leading strategist in the unrelenting Republican attempt to kill the Affordable Care Act.
And yet, in her district, people are flocking to Obamacare — well beyond the national average. Though she has been screening town hall meetings to highlight only critics of the new law, her constituents are doing something entirely different in making their personal health decisions.

Lawmakers criticize hiring of Obamacare enrollers with criminal records

By Chad Terhune
10:34 AM PST, January 30, 2014
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California's health insurance exchange allowed 31 people with criminal records to be enrollment counselors for Obamacare coverage, drawing fire from Republican lawmakers.
Two state legislators are calling for a hearing on the exchange's hiring practices and its efforts to prevent identity theft and fraud.
This move comes as other critics of the Affordable Care Act express concern about the security of people's personal information when they apply for policies through online exchanges or with enrollment workers.
In a letter Wednesday, Assembly Minority leader Connie Conway (R-Tulare) and Assemblyman Brian Nestande (R-Palm Desert) asked the Covered California exchange to explain at a joint legislative hearing why people convicted of forgery, burglary and welfare fraud were permitted to be enrollment counselors.
"We understand that individuals who have paid their debt to society deserve a second chance, but felons convicted of financial crimes should be disqualified from being hired by the state," the lawmakers said in their letter.
"Allowing these individuals to have access to private information, such as Social Security numbers, would be like giving an auto thief a set of car keys," they added.
Covered California defends its background check system. It said it reviewed the age and nature of the offense, the applicant's age when it was committed and the relation of the crime to enrollment duties.
Full coverage: Obamacare rolls out
The approved applicants "demonstrated that they have rehabilitated themselves," said exchange spokesman Larry Hicks. "A zero-tolerance approach for all individuals who have suffered criminal convictions would constitute discrimination" under federal civil-rights law.
The state exchange provided records that show it approved 31 people with criminal convictions as enrollment counselors from June to late November. Four people with convictions were disqualified.
The National Review reported on the documents Wednesday.
Overall, California has certified 3,729 enrollment counselors statewide so those with criminal records represent less than 1% by this count.
The convictions involved felonies and misdemeanors and many date back to the 1980s and 1990s. The crimes included the sale and possession of drugs, petty theft, perjury, driving under the influence, shoplifting and battery.
One certified counselor had two convictions for forgery in 1988 and a 1998 conviction for domestic violence, state records show. Another counselor had a 1982 conviction for forgery, burglary in 1992 and forgery again in 1994.
These enrollment counselors aren't government employees. Rather, they typically work at nonprofit groups, clinics and other community organizations that help sign people up through the state marketplace.During the application process, these workers often deal with sensitive information such as Social Security numbers, income tax returns and a person's medical needs.
Covered California said it is still reviewing the lawmakers' request and it declined to comment further.
http://www.latimes.com/business/money/la-fi-mo-california-exchange-background-checks-20140129,0,3332746,print.story

Canadian Health Care: Separating Opinion From Fact

Trudy Lieberman - Canadian Huffington Post
Posted: 01/29/2014 9:20 am

One thing Americans and Canadians can agree on is that we don't want each other's health care systems. In truth, most Americans don't know how Canada's system works and Canadians don't know much about the U.S. system.
What Americans know has come mainly from the negative talking points of politicians and others who have argued for years against national health insurance. Two decades ago, The New York Times reported that Canadian women had to wait for Pap smears, a point vigorously refuted by the Canadian ambassador who shot back in a letter to the Times editor: "You, and Americans generally, are free to decide whatever health care system to choose, avoid or adapt, but the choice is not assisted by opinions unrelated to fact."
Yes, there are waiting lists for some services -- but, no, Canadians are not coming across the border in droves to get American care.
There's misinformation among Canadians, too. Wherever I went, Canadians told me they thought, mostly based on what they said they heard on CNN and Fox, that Obamacare meant America was getting universal health coverage like their country has.
When I explained the law was simply another patch on a patchwork quilt of coverage, and the Congressional Budget Office had estimated last year there would still be some 30 million people without insurance, the reaction was "the news media didn't tell us that." A former deputy health minister in New Brunswick said to me, "After all that, you will still have 30 million people without coverage!"

Joining GOP Trend, U.S. Chamber Of Commerce Urges Fix, Not Repeal, Of Obamacare

TOPICS: HEALTH REFORM, POLITICS, MEDICAID, INSURANCE
By ERIC WHITNEY
JAN 31, 2014
Some influential conservatives are now saying the health care law is too entrenched to repeal. Take the U.S. Chamber of Commerce, the powerful business lobbying group. When the Affordable Care Act Passed in 2010, the Chamber got behind a major business lawsuit to fight it at the U.S. Supreme Court. And in January, 2011 during his annual State of American Business address, Chamber President Tom Donohue said, "It's time, in my opinion, to go back to the drawing board...and thus we support legislation in the House to repeal it."
But now, he’s striking a different tone: "We're not going to get rid of that bill, and so we're going to have to devise ways to make it work," he said at a recent press conference.
While some business writers called that "a striking about-face," and a "Nixon Goes to China moment,"Avik Roy, former health policy advisor to Mitt Romney and Forbes opinion editor says, says: Not so fast.
"He didn't say that he opposes repeal," Roy says about Donohue's statement. "He just didn't think repeal was realistic in the next several years."
Roy says business groups like the Chamber have to be pragmatic and deal with the world as it is, not as they'd like it to be, which is why the Chamber is now focusing on changing specific parts of the health care law they don't like, rather than repealing it.
"It's very difficult once a law that transformative has been in effect for seven years to repeal it," Roy says. "I think there are more attractive ways to achieve the goals of conservatives than repeal and replace."
That doesn't sound attractive or pragmatic to conservative talk show host Erick Erikson, who runs the Red State blog. It sounds more like capitulation.
"The lobbying groups that have open access to Republican leaders are abandoning repeal, the wonks the GOP leaders listen to are abandoning repeal. They're laying the groundwork to bail on fighting Obamacare," he says in a recent podcast.
The Chamber of Commerce and Roy say they remain committed to fighting the health law. The Chamber wants specific items thrown out, like the requirement, beginning in 2015, that employers with more than 50 workers provide health insurance or pay a fine.
Three Republican senators — Orrin Hatch of Utah, Tom Coburn of Oklahoma and Richard Burr of North Carolina — have issued an alternative to the health care reforms that they deride as Obamacare. Conservative analysts have hailed their proposals as “an important milestone in the health care debate” and a “reform that has enormous promise.” But the plan, which is hard to parse because it has not been put into precise legislative language, looks inferior in most respects to the existing law.
The plan would repeal the Affordable Care Act and substitute an alternative that would likely cover fewer uninsured people, raise premiums for many older adults, shrink Medicaid, cut back on subsidies for middle class Americans, scale back protections for people with pre-existing conditions, and allow private insurers to escape many of the consumer-friendly requirements now imposed on them.
It is a blueprint for what the Republicans hope to do if they capture the White House in 2016. They say they are relying on market competition to keep costs down; empowering consumers to choose plans they want, not plans whose benefits are set by the federal government; emphasizing private insurance, not government programs; and giving states the primary role in managing the reform effort.
All of these ideas have been debated for decades, and the most important have been incorporated into the existing reforms, which also rely on market competition and give consumers tools to choose among private insurance plans. In fact, the Republican plan keeps some parts of Obamacare that the public has embraced — like guaranteed coverage for pre-existing conditions in some circumstances, allowing children to remain on their parents’ policies until age 26, and barring insurers from imposing lifetime benefit caps. But simply grafting those popular elements onto a package that reduces coverage will not mask the defects in the Republican plan.
The plan claims to guarantee coverage for people with pre-existing conditions, but there is a big catch. It is only guaranteed if they maintain “continuous coverage.” If they lose a job and the insurance that went with it, they must enroll in another plan promptly or they could be locked out of insurance or charged unaffordable rates if they have pre-existing conditions.
Although the Republicans would retain the most popular provisions of the reform law, they would drop consumer protections like a ban on annual benefit limits, free preventive services, equal premiums for men and women, and comprehensive benefits designed to make sure all plans are adequate.
http://www.nytimes.com/2014/02/02/opinion/sunday/what-gop-style-reform-looks-like.html?hp&rref=opinion

Life after Jan. 1: Kentucky clinic offers early glimpse at realities of health-care law

By , Published: February 1

in Breathitt County, Ky. — The envelopes began arriving in December across eastern Kentucky, one of the sickest and poorest corners of the country.
“Dear member . . . We want you to be healthy . . .” read the letter to Mary Combs, and with it came a plastic card representing the first insurance she ever had: a Medicaid plan made possible by the nation’s new health-care law, effective Jan. 1.
Nine days into the new year, the 41-year-old call-center worker headed to the health clinic on Highway 15. She saw a doctor about her chronic stomach ulcers, had her blood drawn for tests and collected referrals for all the specialists she had been told she needed but could never afford.
The next week, she saw a neurologist, who found lesions on her brain and prescribed medicine for the cluster headaches, which are also called “suicide headaches” for pain that is far more intense than a migraine and which Combs had been treating with an alcohol-soaked cloth wrapped around her head. She lined up a gynecologist for abnormal uterine bleeding and a hematologist for anemia and an ophthalmologist for an affliction she called “arthritis of the eye,” which was diagnosed on one of the rare occasions she decided to see a specialist, a $250 visit her husband paid for by selling his lawn mower.
“She got mad at that,” Johnny Combs said now, waiting in an exam room with his wife, who was back at the clinic again, this time for an earache she would normally treat with sweet-oil drops.
“Well, we needed that mower, too,” Mary Combs said, and soon the nurse practitioner arrived, and a new conversation began:
“Okay,” she said. “We are no stranger to these ear complaints.”
“No,” said Combs, who soon had another referral for an ear, nose and throat specialist, as Week 3 in the world of the newly insured carried on.
This is the world that many critics of the new health-care law have worried about, one in which the sick and the poor expand the ranks of Medicaid while other Americans see premiums rise, policies canceled or favorite doctors booted out of networks.
Supporters of the new law argue that another scenario will unfold in places such as eastern Kentucky, in which the sick and the poor get insurance, seek treatment for long-neglected illnesses and prevent other health problems down the line, ultimately saving the health-care system billions in emergency-room visits and other costs.
A week at the Breathitt County Family Health Center provides an early glimpse into how those theories are beginning to play out in a place where people have long worried about having no insurance at all.
“That’s the big question — does getting insurance bend the cost curve or the health outcomes curve?” said Karen Ditsch, the executive director of Juniper Health, which runs the nonprofit Breathitt clinic. “Is it going to make a difference?”
The starting point for any answer begins with life before Jan. 1. Eighteen percent of the county’s population — about 2,500 people — were uninsured, and rates of diabetes, heart disease and other chronic illnesses have remained some of the highest in the country. The rate of adult obesity is 40 percent, for example, while 31 percent of adults smoke. The unemployment rate is 10 percent, and complications of poverty abound.

Maine Voices: Accepting federal funds, containing costs makes sense for MaineCare

Maine can cover more people and reduce the program’s costs without wholesale restructuring.

By Trish Riley 
BRUNSWICK — Rejecting billions of federal dollars available to cover more low-income Mainers because MaineCare is “too expensive” holds the uninsured hostage to program inefficiency. Maine can cover more people and reduce the program’s costs. And we don’t need a wholesale restructuring of the program to do so.
Some say MaineCare should “look more like the national average,” yet from 2007 to 2012, MaineCare’s annual enrollment growth was far below national averages. Adults, the target population for expansion, comprised 28 percent of MaineCare 2010 enrollment but accounted for only 10 percent of costs. There are better ways to lower costs than limiting enrollment.
Maine has higher disability rates among low-income people, and we are older than the nation. Those populations, who are particularly costly to serve, dominate MaineCare enrollment. Persons with disabilities account for 20 percent of MaineCare enrollees but half of spending.
• MaineCare spending per person is 7 percent higher than the national average.
• High health care costs drive spending for both commercial payers and MaineCare. But most MaineCare spending is on long-term care and services for persons with disabilities – services often provided, not by traditional health providers, but by organizations whose primary source of revenue is MaineCare. As the primary payer of those agencies, MaineCare has more capacity to address their costs.

Another View: MaineCare expansion would push costs onto other payers

People with health insurance will end up paying higher rates if the federal program continues to underpay.

By Ronald G. Thurston 
Trish Riley’s Maine Voices column has encouraged me to add my two cents’ worth to the MaineCare debate (“Accepting federal funds, containing costs makes sense for MaineCare,” Jan. 20). I recall fondly that when I served on one of Trish’s planning committees, I brought up the paucity of the Medicare payment system, which resulted in a shift in payment to the private payer and their private health insurance rates.
At the time the Medicare “shortfall” averaged something like $2,000 per Medicare patient per year. The 2012 estimate by the Maine Hospital Association is that Medicare now pays 86 cents of every dollar of costs, and Medicaid (known here as MaineCare) pays 75 cents. Changes in the Affordable Care Act will certainly add to those payment deficits.
Part of the discussion then was on then-Gov. John Baldacci’s economic stimulus program to attract old people to move to Maine. Maine now leads the nation in old people, so it apparently worked. The economic development plan now being promoted is to add thousands of MaineCare recipients to the rolls, with the resultant expanded cost shift to private payers. The government’s continued failure to modernize and simplify its payment systems to rectify these problems is a disgrace.

GOP intransigence accelerates health care crisis

By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, Jan. 31, 2014
The Affordable Care Act, President Obama’s health care law, will reduce the number of uninsured through an expansion of both private health insurance and Medicaid. When fully implemented five years from now, it is estimated the law will leave about 30 million people without any form of health insurance, a number that would have been lower had 25 states not “opted out” of Medicaid expansion.
In the meantime Republican lawmakers have continued to call for repeal of the Affordable Care Act.
The Republican majority in the House of Representatives has symbolically voted to repeal the law dozens of times — 14 times over the last year and 35 times during the previous Congress. The irony of voting to repeal a law that was initially a Republican and Heritage Foundation idea — the compulsory purchase of private health insurance —has been highlighted by the fact that Republicans have not seemed to have a counter-proposal, something with which to replace the Affordable Care Act.
This week, evidently in an effort to show they have an alternative, but implicitly acknowledging the ongoing health care crisis, three Republican senators put forward a legislative proposal they call the Patient Choice, Affordability, Responsibility, and Empowerment Act. The Republican senators’ proposal would still use taxpayer money to subsidize the purchase of private health insurance for those can’t afford it, but to a lesser extent than the Affordable Care Act now does.
Oddly, from the party where Grover Norquist’s “no new taxes” pledge is so popular, the Republican senators propose to tax health insurance benefits as income.  The income tax would be levied upon employees, not employers.  This stems from the erroneous theory that health care costs might be reduced if workers are compelled to choose plans with lower premiums, but higher out-of-pocket costs, like co-pays, co-insurance, deductibles.
Under the current law, Medicaid expansion was intended to help millions of people living at or near the poverty level obtain health coverage.  Yet Republican lawmakers in 25 states “opted out” of the expansion of Medicaid that the Affordable Care Act proposed. Had these 25 states implemented the law, nearly 8 million people, presently uninsured, would have gained coverage. The Republican senators would like to see even fewer people covered by Medicaid than their counterparts have allowed state-by-state.
Yesterday, a third-year Harvard medical student, Samuel Dickman, together with senior researchers from Harvard Medical School and the City University of New York, published a study that highlights the human toll of these political decisions.
If all states had “opted in” to the expansion of Medicaid coverage as the law was designed, 7,780,000 more uninsured would have gained coverage. Dickman and colleagues found that if these millions of people gained Medicaid coverage, at least 7,115 and perhaps as many as 17,100 deaths might be prevented.

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