Local aid, student hunger bill, Medicaid: LePage opposes all that helps people
Posted Feb. 24, 2014, at 12:54 p.m.
State Sen. Geoff Gratwick of Bangor hit the nail on the head in his Feb. 9 BDN OpEd about the importance of keeping a promise to local governments — the promise of revenue sharing with every community in the state. By returning a portion of sales and income taxes collected back to municipalities, the Legislature provides direct help to hard-pressed towns. This money is spent on a myriad of needed services locally, allowing communities to survive, even in trying times.
By contrast, Gov. Paul LePage, who loves to talk about cutting taxes, eliminated revenue sharing in his last year’s budget plan, thereby clobbering towns and shifting the tax burden back to local property owners. As an example, my hometown of Brooklin, population 824, would have lost $12,759 this year thanks to the governor’s refusal to continue revenue sharing. After all, it’s “welfare for municipalities.” While Brooklin’s $12,759 is a minuscule amount compared to the $2.3 million Bangor would lose, every dollar counts.
In the governor’s world, looking out for everyone’s welfare is, apparently, a bad thing. He seems not to realize that revenue sharing is equal to a tax cut to the towns, something that’s supposed to be near and dear to his heart. Fortunately, most of our state legislators live in the real world, and they voted to continue revenue sharing.
Another theme for the governor is “compassion,” which he addressed extensively earlier this month in his State of the State address. Apparently, it is out of compassion that he wants to lower the legal working age to 12, and generally loosen child labor laws. After all, he started work when he was 11! “It’s not a big deal. Work doesn’t hurt anybody,” he is quoted as saying. Why else would he promote a “training wage” of $5.25 for working children? This, at a time when when poverty is increasing, and 200,000 children and adults in Maine face “food insecurity.”
A partial solution, LD 1353, which aimed to make summer food programs more common for the 84,000 kids who qualify for free or reduced-cost lunches at their local schools, was vetoed by the governor. He called it another “irresponsible unfunded mandate.” Our legislators took a different tack. With bipartisan support they overrode the governor’s veto, and in doing so, encouraged more school districts to accept federal funds that pay for the summer lunch program.
An equally far-reaching issue facing the Legislature is the expansion of Medicaid to about 70,000 qualified, low-income Mainers who do not currently have health insurance. These are folks whose income is under 138 percent of the federal poverty level; many do not qualify for subsidies. The federal government would pick up 100 percent of the cost for the first three years, and ratchet down funding to 90 percent thereafter. Imagine the newly found peace of mind and improved health these families would experience if they had reliable health care, including a primary care provider who can guide them toward preventive care.
It seems that LePage is against virtually everything that is designed to help individuals. Worse, he demeans people in need. He, along with a chorus of his political supporters continue to refer to potential beneficiaries of the Medicaid expansion as “able-bodied,” implying, in other words, lazy and undeserving, and MaineCare as “welfare.”
What is the governor thinking? He says he is for job creation, but apparently not if the government initiates it. However, handing out millions of dollars in tax breaks — corporate welfare by any other name — to some imaginary big business is just fine with him.
Expanding Medicaid would create thousands of new jobs that cannot be outsourced. It is a good business decision, as well as an ethical one. Refusing hundreds of millions of dollars in federal funds — more than a quarter of a billion in new funds in 2016 and $82 million annually — makes no sense and punishes people who need our help most.
Governors: ‘Obamacare’ here to stay
Governors of both parties shared a more pragmatic outlook on the controversial program known as “Obamacare” as millions of their constituents begin to be covered.
By Steve Peoples and Ken Thomas
The Associated Press
The Associated Press
WASHINGTON – The explosive politics of health care have divided the nation, but America’s governors, Republicans and Democrats alike, suggest that President Barack Obama’s health care overhaul is here to stay.
While governors from Connecticut to Louisiana sparred on Sunday over how best to improve the nation’s economy, governors of both parties shared a far more pragmatic outlook on the controversial program known as “Obamacare” as millions of their constituents begin to be covered.
“We’re just trying to make the best of a bad situation,” said Republican Gov. Terry Branstad of Iowa, who calls the health care law “unaffordable and unsustainable,” yet something he has to implement by law. “We’re trying to make it work as best we can for the people of Iowa.”
As governors gathered in Washington this weekend, Democratic governors such as Maryland’s Martin O’Malley and Connecticut’s Dannel Malloy made pitches to raise the minimum wage, while Republican governors such as Louisiana’s Bobby Jindal and Indiana’s Mike Pence called for more freedom from federal regulations, particularly those related to the health insurance overhaul. But governors from both parties report that a full repeal of the law would be complicated at best, if not impossible, as states move forward with implementation and begin covering millions of people – both by expanding Medicaid rolls for lower-income resident or through state or federal exchanges that offer federal subsidies to those who qualify.
Republican opposition to the law is the centerpiece of the GOP’s political strategy ahead of the midterm elections. And to be sure, not every GOP leader embraced the inevitability of the law’s implementation.
“I don’t think that it’s so deeply entrenched that it can’t be repealed,” Louisiana Gov. Bobby Jindal said. “But I do think, as we argue for repeal, we have to show folks what you replace it with.”
Maine bills seek clarity on hospitals left out of insurance networks
The sponsors want patients who sign up for Obamacare and the providers to be fully informed of exclusions like those not in Anthem’s network.
By Alanna Durkin
The Associated Press
The Associated Press
AUGUSTA — When Roberta Lane went to her local hospital emergency room, where the doctors she’s seen for years practice, she was shocked to find out her insurance wouldn’t cover treatment.
The Auburn resident had bought a plan on the Affordable Care Act exchange through Anthem Blue Cross and Blue Shield, unaware that Central Maine Medical Center was one of the six excluded in the insurer’s “narrow network,” Lane wrote to lawmakers last month. Unable to immediately transfer to another hospital, she spent several days at the medical center in Lewiston worrying about how she’d pay the mounting costs.
“I was quite irritated and angry and obviously had some anxiety because I was like, this is a $15,000 bill,” said Lane, who declined to say why she was receiving treatment. “To have to worry about that on top of dealing with a serious illness ... that’s really the last thing I need to worry about.”
Lane said it appears that Anthem will cover the costs after all, thanks to a built-in grace period, but Maine lawmakers hope they can help others avoid that headache.
Two bills that the Insurance and Financial Services Committee will examine again on Tuesday aim to bring more transparency to these narrow provider networks – both for the consumers and the hospitals that are being excluded.
Rep. Paul McGowan, D-York, wants to require insurers to clearly show in their marketing and informational materials what hospitals aren’t included in plans. He also wants insurers to explain publicly how their plans provide reasonable access to care for their members. Under another measure the committee is examining, introduced by Sen. Dawn Hill, D-Cape Neddick, insurers would have to disclose to providers why the providers weren’t included in the network.
TODAY IN 1965: LBJ SIGNS MEDICARE INTO LAW
July 30, 2010
- See more at: http://blog.legalsolutions.thomsonreuters.com/legal-research/today-in-1965-lbj-signs-medicare-into-law/#sthash.TrDSxrtY.dpuf
It was 45 years ago today that President Lyndon Johnson enacted national health insurance for millions of elderly Americans with the stroke of a pen – a pen handed to him by Harry Truman.
Immediately afterward, Johnson signed the paperwork that would make Truman and his wife, Bess, the very first Medicare enrollees.
“They told me, President Truman, that if you wish to get the voluntary medical insurance you will have to sign this application form, and they asked me to sign as your witness,” Johnson told the former president. “You’re getting special treatment, since cards won’t go out to the other folks until the end of this month – but we wanted you to know, and we wanted the whole world to know, who is the real daddy of Medicare.”
While Teddy Roosevelt was the first president to publicly endorse national health insurance, Truman did more than any other to advance the concept that would become Medicare. During World War II, Truman was troubled by the number of draftees who failed their induction physicals due to untreated medical conditions. Truman saw this as evidence that too many ordinary Americans couldn’t afford adequate care. “That is all wrong in my book,” he said. “I am trying to fix it so the people in the middle-income bracket can live as long as the very rich and the very poor.”
With the war’s end in 1945, Truman proposed the first national health care plan to Congress. Originally conceived to cover most Americans, the proposal was gradually scaled back until, by the end of his presidency in 1953, it was roughly equivalent to Medicare.
President John F. Kennedy resurrected the Medicare concept in a 1962 speech, but it continued to face formidable opposition from most Republicans and from the American Medical Association, which regarded any government involvement in health care as “socialized medicine.” At the height of its campaign against Medicare in 1963, the AMA hired actor-turned-pitchman Ronald Reagan as its spokesperson, just a year before Reagan launched his political career with an energetic pitch for Barry Goldwater at the Republican National Convention.
In 1964, Johnson defeated Goldwater in a landslide – and with large Democratic majorities riding Johnson’s coattails into both houses of Congress, the stage was set for Medicare’s passage.
- See more at: http://blog.legalsolutions.thomsonreuters.com/legal-research/today-in-1965-lbj-signs-medicare-into-law/#sthash.TrDSxrtY.dpuf
How Health Care Costs Affect Small Town Living
By the time people feel the effects of reduced city services, it's hard to tell that medical spending is a part of the problem.
By Susan Brink
A half century of rapidly escalating health care costs has taken a toll on every village, town and city in America, including China, Maine. The town in the far northeast corner of the country has a population of about 4,500 in the off-season, 5,500 when the fish are biting in China Lake. Town officials face the same economic challenges in maintaining roads and infrastructure and in providing education, library, recreation and emergency services as any other place in America.
Spending $2.8 trillion on healthcare in America has ripple effects that spread far and wide. And the town manager of China, Maine, Dan L’Heureux, who is also a member of Maine Quality Counts, an independent healthcare collaborative focused on improving health and health care in the state, has spent a lot of time thinking about the trade-offs in his town’s budget decisions forced by rising health care costs.
Health insurance premiums have grown nationally by 138 percent between 1999 and 2010, while wages have gone up 42 percent in that same period. Of the estimated $765 billion in wasteful healthcare spending in the U.S. in 2009, $210 billion was attributed to overuse of medical services. Health care spending has roughly doubled between 2000 and 2010 while simultaneously citizens and governments have struggled with recession, unemployment and a slow economy. Everyone feels the pain.
It’s nearly impossible to connect the dots to show a direct line between the high cost of medical services and cutbacks in everyday needs like schools, fire departments, public safety, roads, parks and public transportation. There are countless other variables—national, regional and local--in a struggling economy. By the time most people feel the effects of stagnant or diminished paychecks and reduced city services, they are scarcely aware that medical spending is a big part of the problem.
Yet it’s more than just instinctive to feel that rising medical costs have far-reaching consequences. L’Heureux and Rosemary Gibson, a senior advisor at the Hastings Center and author of “The Treatment Trap,” about the overuse of unnecessary medical services, met at a meeting of Maine Quality Counts last year, and L’Heureux opened the meeting with some remarks about his picturesque but struggling town. “Dan said that in his small town in rural Maine, there were 11 municipal employees,” Gibson says. “And the cost of providing health insurance was close to $200,000.”
To put in another way, L’Heureux says, the cost of health insurance for one individual with dependents is equal to the town’s entire annual parks and recreation budget or the operation’s budget for one of the town’s three volunteer fire departments.
New MaineGeneral hospital ‘doing its best’ amid bed shortage
CEO Chuck Hays says the hospital in north Augusta, which opened in November, is at full capacity 26 percent of the time.
By Amy Calder
Kennebec Journal
Kennebec Journal
AUGUSTA — In the four months MaineGeneral Medical Center’s new hospital in north Augusta has been in operation, all of its patient beds have been full a quarter of the time.
That bed shortage has created a challenge for staff when people come into the emergency room and need to be admitted to the hospital, officials said.
Those patients are placed on hospital beds in emergency department rooms until beds open up on the floors, according to Chuck Hays, chief executive officer of MaineGeneral Health, the parent organization of MaineGeneral Medical Center.
“We move stretchers out into the hall (in the emergency department) and we move an inpatient bed into the room,” Hays said.
The $312 million, 192-bed hospital opened Nov. 9 and replaced inpatient care at MaineGeneral hospitals in Augusta and Waterville, which together had a total of 226 beds. MaineGeneral officials initially had asked the state for 226 beds in the new hospital, but were denied the request in 2010 and it was instead OK’d for 192.
Hays said MaineGeneral officials wanted the higher number of beds because that’s what they expected the hospital’s need to be.
The bed number was set in a certificate of need MaineGeneral received for the hospital project in 2009, a review that was handled by the Licensing and Regulatory division of the Department of Health & Human Services. DHHS spokesman John Martins did not respond to requests for comment Monday on the number of beds authorized by the state.
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On Friday, the Obama administration announced that it plans to cut funding to the Medicare Advantage program in 2015. The cuts are part of the Affordable Care Act. And while some say the move will take money away from some effective health programs, others say it's needed to bring overall health care costs down. Patty Wight reports.
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Medicare Advantage is a private version of Medicare, through which insurance companies contract with the government to provide Medicare benefits. Portland-based Martins Point Health Care is one of those contractors, with their Generations Advantage program. And COO Larry Henry gives a thumbs down to the proposed 2 percent cut to the program.
"Well, as a health plan that covers nearly one out of 10 Medicare beneficiaries here in the state of Maine, these cuts are troubling," Henry says. Troubling because they will likely result in higher premiums for consumers, says Henry. But health advocates like Wendy Wolf, of the Maine Health Access Foundation, say the cuts are warranted. "When the Affordable Care Act was passed, one of the things that the legislation intended to do is bring down health care spending. And one of the ways that it was aiming to do this, was to look for areas where we're overpaying," Wolf says. One of those places, says Mitchell Stein of Consumers for Affordable Health Care, is Medicare Advantage. If the program had lived up to its original intent, says Stein, it would never have faced the chopping block, because the whole idea behind it was to give private insurance companies a chance to do things more efficiently than the U.S. government. How can the physician workforce be diversified?
By Lyndonna Marrast, M.D., and Danny McCormick, M.D., M.P.H.
KevinMD.com, Feb. 22, 2014
The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be.
While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state program that the ACA will expand), these incentives are likely to be too small to dramatically boost physicians’ willingness to care for disadvantaged patients or to affect the underlying national shortage of primary care physicians.
How then can we help ensure that the health care needs of disadvantaged patients are better met as ACA implementation proceeds? In the February 1st, 2014 print issue of JAMA Internal Medicine we reported the results of a study that may provide part of the answer: train more minority physicians.
Our study analyzed data from a federal survey of 7,070 patients and found that compared to other patients, the disadvantaged were more likely to be cared for by a minority physician. This was true regardless of how “disadvantaged” was defined, i.e. by low income, minority race/ethnicity, having Medicaid, being uninsured, being non-English speaking, or being in less-than-good health. For instance, patients with Medicaid were one and a half to two times more likely to be cared for by a minority physician than a white physician. Black, Hispanic and Asian patients were 19-26 times more likely to be cared for by a minority physician of the same race. And patients in fair to poor health were 20-44 percent more likely to see a minority physician.
We hope to one day live in a fully integrated society where everyone has the same, comprehensive health coverage, race and ethnicity matter less, and everyone has access to high quality health care professionals. However, until that day comes, we need to recognize the disproportionate role of minority physicians in meeting the health care needs of the poorest and sickest Americans.
Organizations such as the Institute of Medicine, the American Medical Association and the Association of American Medical Colleges have affirmed a need to train more minority physicians. In spite of this, African-Americans, who represent 12 percent of the population, only account for 6.3 percent of U.S. physicians. Hispanics make up 16 percent of the population but account for just 5.5 percent of physicians. These proportions have changed little in 20 years.
How can the physician workforce be diversified? Increased efforts to identify talented minority students and help prepare them for medical careers are needed. In addition, decreasing the exorbitant tuition costs of medical schools would disproportionately benefit minority students.
However, the change that would have the most direct impact is a revamping of medical school admissions priorities. Although a recent Supreme Court decision requires admissions committees to show that diversity could not be achieved by other means before resorting to race-conscious selection criteria, it nonetheless affirmed a compelling government interest in achieving diversity. All medical schools should set diversity as an explicit institutional priority and adopt admissions criteria that give preference to students (of any race/ethnicity) who bring diversity to the profession. Such policies might also favor students with a history of volunteering or working in underserved communities and those who seek careers serving disadvantaged patients.
On Obamacare: a med student's view
By Jawad Husain
The Daily Free Press (Boston University), Feb. 23, 2014 I voted for Barack Obama in 2008 because he promised to sign a universal health care law. This aligned with my ambitions to become a doctor who treats patients based on their medical need, not their ability to pay. Finally, the time had come for us to fix our inequitable system and offer our citizens the human right to health. Six years later, most of the provisions of the Patient Protection and Affordable Care Act have been implemented. However, it’s apparent that political pressure from the private insurance industry and the big drug companies has thwarted the goal of the universal health care. Obamacare is expected to help an additional 20 million Americans obtain health insurance, mostly through Medicaid expansion and subsidized private insurance, but about 30 million Americans will remain uninsured. According to the American Journal of Public Health, this translates to approximately 30,000 preventable deaths a year. Mandating Americans who don’t qualify for Medicaid and who don’t have employer-based coverage to buy private insurance policies benefits insurance companies, but does little to make health care affordable. For example, those enrolling in an exchange-based Bronze Plan will have only 60 percent of their actual health care costs covered by insurance. According to a report by the Kaiser Family Foundation, even after paying premiums, a family may have to spend up to $12,700 out of pocket. When patients have “more skin in the game,” e.g. higher co-pays and deductibles, they often forgo necessary medical care. Medical costs caused 37 percent of Americans to forgo seeing a doctor or skip filling a prescription in 2013, according to findings by The Commonwealth Fund. The private insurance industry’s profit-making incentive makes health care a commodity that is unaffordable for the poor. However, there are promising solutions currently being proposed at the state level. Vermont is already in the process of setting up a statewide single-payer health insurance system. Vermont’s legislature has declared health care a “public good” and assumes the responsibility to, “ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters.” This is not “socialized medicine;” doctors and hospitals will remain independent. All medical needs are covered for everyone, and patients are free to choose their doctor. Canada’s single-payer system has resulted in high-quality universal coverage at a cost that is about half of what the United States spends on health care. Risk is shared across the entire population, administrative costs drop and zero profits go to insurance companies. If Vermont’s approach succeeds, we can expect other states to follow. Massachusetts gubernatorial candidate Dr. Donald Berwick intends to establish a single-payer system if elected. Congressional Representative John Conyers, Jr. has sponsored a single-payer bill in the House and Senator Bernie Sanders has as similar bill in the Senate. Single-payer national health insurance is not impossible. Canadians did not always have a single-payer health care system — they demanded it. Their single-payer movement started with a single province. http://www.pnhp.org/print/news/2014/february/on-obamacare-a-med-students-view Rep. John Dingell, Long-Time Champion Of Health Legislation, Will Not Seek Re-Election
Rep. John D. Dingell, a Michigan Democrat who was a key player in many health care battles in Congress, including enactment of the 2010 health care law and his push for a “Patient’s Bill of Rights” in the late 1990s and early 2000s, said Monday he will retire at the end of his current term.
“I’m not going to be carried out feet first,” Dingell told the Detroit News in a story published Monday morning. “I don’t want people to say I stayed too long.”
The 87-year-old, who has served in the House for nearly 60 years, is known in the health care world for championing a variety of issues, including Medicare (hepresided over the House when it passed the bill), children’s health care and the quality and safety of the nation’s drug supply.
Every year since he joined Congress in 1955, Dingell has sponsored universal health insurance legislation first introduced by his late father, John Dingell Sr., whom he succeeded in the House. A former chairman of the Energy and Commerce Committee, Dingell also worked with the late Rep. Charlie Norwood, R-Ga., and former Rep. Greg Ganske, R-Iowa, to find a compromise to move a Patients’ Bill of Rights. Many of the elements of that bill eventually were incorporated into the health care law.
New ACA Insurance Causes Headaches In Some Doctors' Offices
Sheila Lawless is the office manager at a small rheumatology practice in Wichita Falls, Texas, about two hours outside of Dallas. She makes sure everything in the office runs smoothly – scheduling patients, collecting payments, keeping the lights on. Recently she added another duty--incorporating the trickle of patients with insurance plans purchased on the new Affordable Care Act exchanges.
Open enrollment doesn’t end until March 31, but people who have already bought Obamacare plans are beginning to use them. “We had a spattering in January—maybe once a week. But I think we’re averaging two to three a day now,” says Lawless.
That doesn’t sound like many new customers, but it’s presented a major challenge: verifying that these patients have insurance. Each exchange patient has required the practice to spend an hour or more on the phone with the insurance company. “We’ve been on hold for an hour, an hour and 20, an hour and 45, been disconnected, have to call back again and repeat the process,” she explains. Those sorts of hold times add up fast.
In the past, offices have been able to make sure patients are insured quickly, by using an online verification system. But for exchange patients, practices also have to call the insurer to make sure the patient has paid his premium. If he hasn’t, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made.
That’s because of a provision of the law that gives exchange patients who neglect to pay their premium a “grace period” of up to 90 days. During the first 30 days, insurers have to pay any claims incurred by the patient. But for the next 60 days, nothing is guaranteed. If the patient visits the doctor, the insurer can “pend” the claim – that is, wait to pay the doctor until the patient pays his premium. At the end of the 90-day grace period, if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup the payments it’s already made. And that puts the doctor’s office at risk.
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