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Saturday, March 1, 2014

Health Care Reform Articles - March 1, 2014






Bill Nemitz: MaineCare cannibals on the loose. Run for it!

Gov. LePage fights expansion of health care for the poor with scare tactics worthy of Alfred Hitchcock.

Dear Governor LePage,
Can we talk about cannibalism for a minute?
No doubt about it, it’s a word that’s guaranteed to make people cringe. In fact, I just looked up the “Top 10 Cases of Human Cannibalism” on the Internet and could make it only to No. 5 – the notoriously full-of-themselves Mauerova family in the Czech Republic – before I hit the “close” button in horror.
Which makes me a total wimp compared to you, right, Big Guy? In your never-ending quest to demonize Maine’s poor, you’ve transformed our entire Medicaid program, known as MaineCare, into the cannibal that is eating state government!
“Maine Agencies Cannibalized by Welfare Spending,” shrieked the headline of a news release put out twice in the past two weeks by Adrienne Bennett, your intrepid press secretary. For those with weak stomachs, Bennett linked to her release a slightly tamer litany of warnings, headlined “Medicaid Consumes the General Fund,” from other spokespeople throughout state government.
(As the old scaremonger Alfred Hitchcock himself once advised, “Always make the audience suffer as much as possible.”)
Better yet, Governor, on Wednesday you dispatched top officials from the state’s natural resources agencies to warn the citizenry that it’s only a matter of time before MaineCare swallows Augusta whole.
“We represent what Maine is widely known for, its iconic image,” observed Commissioner Walter Whitcomb of the Department of Agriculture, Conservation and Forestry. “But the natural resource agencies have taken it on the chin, financially.”
(Note to Commissioner Whitcomb: When the topic for the day is cannibalism, it borders on overkill to start citing specific body parts.)
Nothing subtle about this horror show of a news conference, was there, Governor? It represented your latest – and hands-down most creative – attempt to prevent as many as 70,000 Mainers from gaining much-needed access to health care under the Affordable Care Act.
More specifically, it was your response to a MaineCare expansion plan developed by two of your fellow Republicans – Sen. Roger Katz of Augusta and Sen. Tom Saviello of Wilton – that is fast attracting legislative support on both sides of the aisle.
Katz and Saviello stopped by the newsroom this week and laid out a clear, compelling and perfectly rational argument behind their proposal:

Medicine for Medicaid: Will Maine reform health care for low-income residents?


Over the last several decades, most states across the country have shifted how they manage the health care of their low-income residents. Instead of coordinating directly with providers and paying for each medical procedure, states have, more and more, handed over that administrative responsibility to outside entities. The trend has not hit Maine until now.
A compromise bill proposed this week by Maine Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton would expand Medicaid coverage to 70,000 residents under the Affordable Care Act and start Maine on a years-long path of converting to a managed care system where the state’s Medicaid program, MaineCare, would be contracted out to private companies or nonprofits.
By all accounts, it would be the largest change to hit MaineCare in years, possibly decades. The goal, Katz and Saviello said, is to ensure all Maine residents have access to quality health care within a system that is ready for them and able to deliver medical care in a cost-effective way.
“The status quo in MaineCare, even if we don’t expand, is unacceptable,” Katz said.
Whether you have ever held a MaineCare card or not, switching to a managed care model would affect you. You might work in the health care or social assistance industry now, or you might in the future; employment in the field grew by 22.6 percent between 2000 and 2012. You might have an elderly parent facing a need for long-term care. Or perhaps you are a taxpayer; MaineCare will comprise about 23 percent of the state general fund in fiscal year 2014.

Concierge Medicine - Time Magazine
t's not like I've never been dumped before. Still, I was ill prepared to be dumped by my GP. For 12 years I thought we got along O.K. Now I continually ask myself, "Was I not sick enough for her?"
The first warning sign was the single-serve coffee machine in the waiting room, featuring festive flavored international coffees and chai.
I eyed it nervously. Had there been an article in an AMA journal offering hints on transforming your drab, predictable reception area into an upscale medi-café? At my next Pap smear, would I meet a barista and be offered a selection of croissants?
"No, no," I said to myself. "Current wisdom dictates that when her practice becomes successful, she must personalize her brand."
If this were a movie, the tone of the music cues would begin to get darker as we arrived at the day the glass display cases containing lovingly arranged bottles of moisturizer were installed. "I guess pricey moisturizers are considered medicine now," I rationalized, wondering about the ever more porous boundaries between beauty and health.
The music cues would grow darker yet as we cut to a scene where I had the flu and found myself waiting for an appointment, surrounded by pamphlets for "facial fillers" and "injectables" like Juvéderm. If she writes me a prescription for a spray tan, I am going to walk, I thought.
But I remained loyal. She was my doctor. Her office still called to remind me about getting my checkups. She was entitled to branch out.
Then, about a month ago, I got The Letter.
"I'd like to wish you and your family a happy holiday season and a prosperous new year," it began.
Interesting word choice, I thought. Prosperous rather than healthy.
Her reasoning became clearer as the letter went on to explain that we were all being dropped as patients--unless we paid a $5,000- or $10,000-a-year retainer for her services, depending on the plan.
"Our nation is faced with the most difficult time in the history of our health care system," the letter went on. "As a result, I will now be transitioning my practice to a concierge medical service."

New Health Fix Offers Subsidies for Insurance Policies Bought Outside Exchanges

By 
WASHINGTON — The Obama administration said Friday that it would allow some people to receive federal subsidies for health insurance purchased in the private market outside of health insurance exchanges. The sudden shift was the latest in a series of policy changes, extensions and clarifications by federal officials trying to help beneficiaries and minimize political damage to Democrats in this election year.
Federal officials said they had agreed to provide such assistance retroactively because technical problems had prevented consumers from using online exchanges to obtain insurance and financial aid in some states.
Gov. John Kitzhaber of Oregon, a Democrat, had specifically asked the federal government to allow financial assistance, in the form of tax credits, for people buying insurance outside the state’s troubled exchange. Other states running their own exchanges, including Hawaii, Maryland, Massachusetts and Minnesota, have also experienced technical difficulties, creating political problems for their governors.
The Obama administration’s decision came as a surprise because the Affordable Care Act is clear: Federal subsidies are available only to people who enroll in a “qualified health plan” through an exchange.
But some of the online state exchanges have not been working well enough to determine if people are eligible for coverage, one of the basic functions of an exchange. The exchanges are competitive marketplaces where consumers are supposed to be able to shop for insurance, enroll and get financial assistance to help pay premiums.

California says 14,500 must redo Obamacare applications after glitch
California's health insurance exchange said about 14,500 people have to redo their online applications for Obamacare coverage because of a software error.
The state's announcement late Friday comes shortly after a five-day outage of the Covered California enrollment website.
About 14,500 people who partially completed applications or updated them Feb. 17-19 -- just before the website went down -- have to either start over or resubmit any changes they made, the exchange said.
Covered California said it will contact the affected consumers and help them complete the sign-up process by March 15 for coverage that takes effect April 1.
“We regret any inconvenience this has caused,” Peter Lee, executive director of Covered California, said in a statement. “Our enrollment website has been up and running this week, and we look forward to helping consumers get the health coverage they want.”
The lost information and website glitches come at a tough time for the exchange, which is in the midst of a final enrollment blitz before the March 31 sign-up deadline. The state had been signing up more than 7,000 people per day, on average, in February.
Covered California said completed applications for an additional 6,500 people were also affected by the software troubles. But the state said that it is restoring the data and that those people don't need to take any additional steps.
The exchange is also working to restore information on 16,000 people who were deemed eligible for Medi-Cal, the state's Medicaid program for the poor. They are to be contacted by the exchange as needed.
Covered California attributed the website problems to a "software malfunction during a planned maintenance outage" this month. 
Through mid-February, Covered California had enrolled 828,638 people in private health plans as part of the Affordable Care Act.

Alan Grayson Offers a Progressive Fix for the ACA: Medicare Buy-In

Over the past month, with the healthcare.gov website malfunctioning and the bad press around plan cancellations, we've seen Democrats run scared as they so often do.
Four Democrats have co-sponsored Republican Rep. Fred Upton's bill: John Barrow (GA-12), Mike McIntyre (NC-07), Patrick Murphy (FL-18), and Kysrten Sinema (AZ-09).
A group of mostly red/purple state senators (many of whom are up for re-election) have jumped on another "fix" bill with Sen. Mary Landrieu (D-LA): Joe Manchin (WV), Joe Donnelly (IN), Kay Hagan (NC), Mark Pryor (AR), Dianne Feinstein (CA), Jeff Merkley (OR), and Tom Udall (NM).
Neither improves the bill, and the former is trying to undermine it.
I've been waiting to hear progressive Democrats start offering progressive "fixes" to the Affordable Care Act because if they don't, they effectively concede the terms of debate over the ACA to the Republicans. The "keep it, but improve it" line resonates well with the public.
Bernie Sanders (I-VT) has been a reliable voice for single payer and has spoken on the issue numerous times over the past month. However, I haven't heard much in the way of "progressive fixes" from other progressive legislators.
I was happy to see Rep. Alan Grayson (FL-09) change that. Back in February, Graysonintroduced the Medicare You Can Buy Into Act:
(WASHINGTON, D.C.) – Congressman Alan Grayson (FL-09) has introduced his first piece of legislation in the 113th Congress, the Medicare You Can Buy Into Act (H.R. 500). The bill would allow any legal resident of the United States to buy into Medicare at cost.
At only four pages long, H.R. 500 is simple: allow Americans to enroll in Medicare, where they would be eligible for coverage under Parts A and B, as well as Part D’s prescription drug access. Because premiums would be equal to cost, the program would pay for itself.
“In many states, a few private insurance companies control the market, restricting consumer choice and driving up the cost of care.  Although the Patient Protection and Affordable Health Care Act attempts to address this problem, more could be done,” Grayson explained. “Why should the insurance companies get all of the options, while we get none? The people deserve a choice. The people deserve a public option. Opening up the Medicare system increases competition and provides more options to consumers.”


Did MaineCare’s crackdown on opiates fuel our state’s heroin problem?


By 

Not long after MaineCare cracked down on the availability of narcotic prescriptions early last year, police reported a spike in heroin abuse.
Maine addiction specialists agree: They say the restrictions, while working to prevent some Mainers from getting hooked on painkillers, also squeeze the drug supply to fuel addiction elsewhere.
Enter Maine’s growing heroin problem, and the state’s ongoing distinction as one of the worst in the country for drug addiction.
State officials view the MaineCare changes as a positive step, leading to a 30 percent drop in the number of opiate prescriptions since 2011. Patients with chronic pain are benefitting from alternative approaches, such as physical and occupational therapy, and MaineCare’s also saving money, they say.
To Dr. Mark Publicker of Mercy Hospital Recovery Center in Portland, however, such prevention efforts amount are small victories in Maine’s existing drug crisis.
“At this point, focusing on prevention is like having a family sitting in their living room and teaching them fire prevention when their house is burning down,” he said. ”It really is important that the family know in the future how to prevent fires, but first they’ve got to put the fire out.”
As doctors prescribe opiates more cautiously, the street supply dwindles, driving up prices and spurring some addicts to turn to cheaper and potentially much more potent heroin, said Dr. Andrew Kolodny, a psychiatrist, public health advocate, and spokesman for the group Physicians for Responsible Opioid Prescribing.
Restricting prescription practices can help in the short term, but “the answer is to do something about the many people who are already addicted,” he said. “If you only curtail the overprescribing, without seeing that the people who are already addicted have access to treatment, then you’ll just see people turning to heroin. You have to do both.”
Emerging from the country’s opioid addiction epidemic are two groups, Kolodny said.
One is young adults who use the medications recreationally, often getting hooked on drugs they found in their parents’ medicine cabinet or scored through friends and family. Those addicts, who tend to be young and otherwise healthy, always faced obstacles convincing a doctor to prescribe the drugs and turned to the black market, he said. Now that prescription opiates are drying up on the street, they’re switching to heroin.
Alarmingly, younger addicts appear to be first experimenting with heroin by shooting up, Publicker said. Most don’t know about the dangers of sharing needles or where to get clean ones. “We’re going to see [HIV],” as a result, he said.
The second group Kolodny describes is middle-aged and older adults, more often prescribed opioids for medical treatment and less likely to turn to heroin in desperation.
“Believe it or not it’s that second group that’s much more likely to die of an overdose death,” he said.
Fatal heroin overdoses in Maine jumped from seven in 2011 to 28 in 2012.
http://vitalsigns.bangordailynews.com/2014/03/01/home/did-mainecares-crackdown-on-opiates-fuel-our-states-heroin-problem/


Glut of ACA Sign-Ups Inundates Maine Insurers
02/28/2014   Reported By: Tom Porter

When David and Robin Millward moved to Ogunquit, Maine, in November from London, England, they knew that getting health insurance coverage was a priority - perhaps even more of a priority for them because David has an hereditary heart condition. And so, like thousands of others residents of the Pine Tree State, they enrolled with Maine Community Health Options - one of the two health insurance companies available under the state's online marketplace. (The other one is Anthem Blue Cross and Blue Shield.) But the Millwards say their experience so far leaves a lot to be desired - and the company acknowledges that an unexpectedly high number of enrollees caught them off guard. Tom Porter has more.
Related Media
Glut of ACA Sign-Ups Inundates Maine InsurersListen
 Duration:
3:49

Everything went OK, says Robin, until the last week in February, when they tried to contact Maine Community Health Options - which describes itself as "Maine's first nonprofit, consumer-operated and oriented health insurance plan." All they wanted to do, she says, was pay their monthly premium over the phone, because the company's online pay system isn't yet working.

"Well, both my husband and I, on separate days, rang the number which was on the invoice," Robin Millward says. "It's not, apparently, a dedicated line for paying your bill. It goes through just to a general 'wait-and-see' line."

And 'wait-and-see' is just what they did, spending more than an hour on hold one day, and a further 45 minutes on hold the next - both times unable to reach a human voice.

Robin, who is a native Mainer but lived in England for 38 years before moving back, says she ended up having to mail in a check for their monthly premium, which is more than $1,500. Because she wanted the check sent guaranteed overnight delivery, this cost a further $16.

"So I've had the inconvenience, the expense, all to make sure that we're not left without cover in a country where failure to have insurance cover can bankrupt you," she says. "I find dealing with this company, this month in particular, to be a complete shambles. I think that they're disorganized, their phone system doesn't work, they're inaccessible and their website is pretty poor as well, just for good measure."

The urgency for health reform returns


By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, Feb. 28, 2014
This week New York State of Health, also named The Official Health Plan Marketplace, put out a press release to celebrate a milestone.
“800,333 New Yorkers have completed their applications and 501,205 have enrolled for coverage since the launch of the Marketplace on October 1, 2013,” the statement read, adding, “Seventy percent who have enrolled to date were uninsured at the time of application.”
The press release went on to report that “New York is on track to meet or exceed its enrollment goal of 1.1 million people by the end of 2016.”
The New York State of Health is the state-run insurance exchange established by the Affordable Care Act, President Obama’s signature social reform.
An arm of the state health department, the Marketplace is a public agency. Its public servants help private insurance companies sell their product and help those eligible receive government subsidies toward the cost of the insurance. (The Affordable Care Act also aims to lower the number of uninsured by expanding Medicaid enrollment, thus the exchange also helps identify those who qualify for Medicaid.)
The cost of private health insurance with comprehensive coverage has, for many years in a row, risen much faster than wages. Private health insurance premiums have become simply unaffordable. Recognizing this, the Affordable Care Act did two things.
First, it put in place a system of tax credit subsidies for people not eligible for Medicaid, Medicare or employer-sponsored insurance. For those eligible (for example if your employer doesn’t offer health insurance) and whose incomes are below 400 percent of the poverty level (about $45,000 in annual income for a single-person household), the Official Health Plan Marketplace is the official way to obtain subsidies toward insurance premiums.
Second, it established minimum coverage at 60 percent of expected costs of care, while planning to tax plans deemed to provide “too much” coverage – for example, truly comprehensive coverage earned through union struggles with large employers.
When people shop for health insurance on the exchanges they can choose among plans that cover 60 percent, 70 percent or 80 percent of anticipated costs. The most affordable premiums come with high deductibles and other large out-of-pocket costs. Because employer-sponsored plans in general covered about 87 percent of expected costs, underinsurance will become the new normal.
The Albany Times Union reported that “Of the total 501,205 people enrolled, the state said 276,681 chose private insurance plans, while 224,524 qualified for coverage under Medicaid, the government-sponsored health insurance program for low-income Americans.” We should note here that about 150,000 of the 500,000 people who enrolled through the marketplace already had some kind of health insurance.
New York state has about 2,270,000 people who lack health insurance. The goal of the state marketplace is to reduce this to nearly half as many by 2017.
So far, establishing the N.Y. State of Health, The Official Health Plan Marketplace, has cost $429,065,407. That’s about $536 per user thus far — or about $856 per newly insured person.
If the exchanges are something of a rescue plan for an industry peddling an unaffordable product, they come at a significant cost. Curiously, the insurance marketplace idea has become a profoundly bipartisan one. It not only that the Democratic president took the idea from the Republican governor’s health reform. Prominent Republican legislators would like to see vouchers for the purchase of Medicare — on an official insurance marketplace.
Most striking is the fact that selling insurance by itself does little to change our health system. For some individuals obtaining coverage, including Medicaid, will prove to be a godsend.
Yet getting insurance or Medicaid does not guarantee access to necessary or comprehensive care. Not only are our health outcomes mediocre, but the experience of going to the doctor, the emergency room, the hospital is too often undignified.
The Affordable Care Act is reducing the number of uninsured, yet at the end of the day it is not a program of universal access to care. Because the major failings of the U.S. system still persist — avoidable death and bankruptcy, racial and socioeconomic disparities, the perverse incentives of profiteering, burgeoning costs — the urgency for thoroughgoing health reform has returned.
http://www.pnhp.org/print/news/2014/february/the-urgency-for-health-reform-returns



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