Pages

Thursday, March 27, 2014

Health Care Reform Articles - March 27, 2014


Guest Editorial: It's Time for Massachusetts to lead again with single-payer health care

By DON BERWICK
Massachusetts was the first state to make health care a human right. Now it’s time to lead again – toward single-payer health care – “Medicare-for-all.”
Patients, families, workers, businesses, health care providers, and the public treasury would all be winners. They would benefit from lower health care costs and better health outcomes. That’s because the current many-payer system adds complexity for everyone with little benefit for anyone. Doctors, nurses, hospitals, and patients have to navigate through a maze of bureaucracy and approval processes that drain energy and money from care itself.
The current financing system is opaque, unaccountable, and overly complex. We have all experienced how frustrating this can be: just try to read your hospital bill or ask your insurer to explain why a procedure your doctor says you need isn’t covered. When patients aren’t getting the quality of care they need, a single payer system can offer a unified voice on behalf of the patient that the multi-payer system has difficulty organizing.
To be fair, some private payers have made progress toward better care and more rational coverage. Blue Cross Blue Shield of Massachusetts, for example, has pioneered its “Alternative Quality Contract (AQC)” to encourage hospitals and doctors to focus on outcomes of care, not volume; and the AQC has become a model for similar efforts around the nation. Thanks to this and other innovations, the upward curve of this state’s health care costs is bending – a little.
But, the progress toward better care at lower cost is agonizingly – and unacceptably – slow, and the consequences for both public and private enterprise are toxic. In the Commonwealth’s budget, just about every single line item has 
fallen by double-digit percentages in the past decade: local aid down 40%, higher education down 30%, parks and recreation down 25%. Only one has gone up substantially: health care – 59% up in a decade and now accounting for 42% of the entire state budget. Meanwhile, three independent assessments of the levels of waste in health care, including one focused specifically on Massachusetts, have determined that 30% to 40% of our health care costs are pure waste – activities that help no one. According to Harvard economist David Cutler, the largest single factor in that waste is administrative costs.
http://www.masslive.com/opinion/index.ssf/2014/03/guest_viewpoint_time_for_massa.html
















Health Law’s Small Co-ops Have Had a Mixed Success So Far

By ,  and 
The rented offices of HealthyCT, a new insurer in Connecticut, bustle with the energy of a start-up. The sales force takes pride in noting that HealthyCT is a truly local outfit, governed by members, rather than a for-profit behemoth like Anthem, the state’s dominant insurer whose offices are a 10-minute drive away.
Lawmakers were hoping for that newcomer’s zeal when they added a provision to the federal health care law setting up 23 nonprofit cooperatives intended to shake up the insurance market.
“We’ve got a great story to tell,” Ken Lalime, the chief executive ofHealthyCT, said recently from his office in Wallingford, Conn.
But so far, few in Connecticut are listening. Just 1,700 customers have signed up for plans through the co-op, about 3 percent of those who have bought coverage in the state’s new insurance marketplace, where other carriers, Anthem and ConnectiCare, have outpaced it. “Our goal was five times that, by this point,” Mr. Lalime said.
The story of HealthyCT and its disappointing enrollment figures illustrates how uneven the co-ops’ performance has been more than halfway through the sign-up period in the first year of the new insurance exchanges, an analysis by The New York Times shows. In contrast to Connecticut, the co-op in Maine, Maine Community Health Options, has grabbed the majority of enrollment, outpacing Anthem, its sole competitor, which is owned by one of the nation’s largest insurers, WellPoint.
How the co-ops fare will be a key indicator of the success of President Obama’s highly charged health care law because they are crucial in determining whether the law can inject more competition into the nation’s entrenched insurance market.
The co-ops were a late addition to the Affordable Care Act, proposed as an alternative to the so-called public option, a plan that would have been offered directly by the federal government and that was met with political resistance. The idea was to offer consumers more choice in areas then dominated by just one or two insurers. The co-ops received federal loans, and must be largely governed by their members.
The program is being heatedly debated in Washington, where congressional Republicans recently warned that many of the co-ops could fail, putting at risk the nearly $2 billion in government loans that helped create them. Democrats point to the co-ops as agents of change, saying they have driven down prices in areas where there was little competition.

Six Senators, Fearing Political Cost, Urge Changes to Health Act

By 


WASHINGTON — Six senator, five Democratic and one independent, on Thursday rolled out a series of policy proposals they said were intended to fix and improve President Obama’s signature health care law.
Three of the Democrats — Senators Mark Begich of Alaska, Mary L. Landrieu of Louisiana and Mark Warner of Virginia — are up for re-election in 2014. Their unveiling of the policy prescriptions comes as vulnerable Democratic candidates in both the House and Senate are under increasing pressure to distance themselves from the Affordable Care Act.
The other Democratic senators, Heidi Heitkamp of North Dakota and Joe Manchin III of West Virginia, as well as Senator Angus King, independent of Maine, rounded out the group of centrists who laid out their plans in anop-ed article in Politico Magazine Thursday.
The move reflects part of a broader strategy by Democrats, who are grappling with the awkward reality of how to escape the embrace of the health care law — which passed with no Republican votes and has become a political liability — while not going as far as their Republican counterparts who are trying to repeal it.
http://www.nytimes.com/2014/03/28/us/politics/six-senators-fearing-political-cost-urge-changes-to-health-act.html?hpw&rref=politics&_r=0

U.S. Announces Further Exemptions for Insurance Enrollment Deadline

By 

WASHINGTON — The Obama administration on Wednesday expanded the list of people who could sign up for health insurance after the deadline, announcing “special enrollment periods” for legal immigrants, victims of domestic violence and tens of thousands of people who experienced various problems trying to complete their applications for coverage.
Administration officials said that the expected surge in applications ahead of next week’s deadline to sign up for coverage had led to high traffic on the federal insurance website, which “could potentially keep consumers from completing the enrollment process despite their efforts to meet the deadline” at 11:59 p.m. Monday.
“Any consumer who comes in after April 1 will have to attest to the fact that they were in line and eligible to continue their enrollment,” said Julie Bataille, a spokeswoman at the Centers for Medicare and Medicaid Services, which is running the federal insurance exchange. “We are not going to shut the door on those people who want coverage and have come in and tried to get it.”
The White House outlined the new policy in informal guidance that appears to give federal officials and caseworkers vast discretion to grant or deny requests for special enrollment periods.
On Tuesday, Ms. Bataille said, there were more than 1.2 million visits to HealthCare.gov and more than 390,000 telephone calls to the federal insurance marketplace.
In guidance sent to insurance companies Wednesday, the administration said that “C.M.S. will provide consumers who tried to enroll during the open enrollment period, but did not complete the process by March 31, a limited amount of additional time to finish the application and enrollment process.”
In most cases, if consumers are granted a special enrollment period, they will have 60 days to select a health plan, officials said. Those who finish their applications by April 15 and pay their initial premiums will be eligible for coverage starting May 1.
In a separate bulletin, the administration listed 10 types of special enrollment periods for people with “complex cases.” These will be available to people who were “enrolled in the wrong plan against their wishes”; victims of domestic abuse; indigent legal immigrants who were improperly denied coverage or subsidies; families with twins who were not allowed to sign up together; and people whose applications for Medicaid were not properly transferred between federal and state agencies.

Survey: Mainers struggle to pay medical bills — even those with insurance

By Jackie Farwell, BDN Staff
Posted March 26, 2014, at 5:12 p.m.
Many Maine residents, even those with health insurance, struggle to afford their medical bills, a new statewide survey has found.
While the poorest Mainers reported the most difficulty affording health services, more than a quarter of residents with health coverage ran into trouble paying medical bills, according to the survey released Wednesday by the Maine Health Access Foundation.
Designed to track the impact of the Affordable Care Act in Maine, the survey polled nearly 1,000 residents in December 2013, just before new private policies purchased on Healthcare.gov took effect on Jan. 1, 2014. The research will provide a snapshot of the burden of health costs in Maine to serve as a benchmark in future years, said Dr. Wendy Wolf, president and CEO of the private nonprofit foundation.
“One of the most important questions that policymakers are going to want to know is what is happening in the wake of the Affordable Care Act with actually lowering the rate of uninsurance, and also helping people with the issue of both affordability and the types of benefits that are offered in insurance plans,” she said.
The foundation, which is leading the effort to sign Mainers up for health insurance under the ACA, partnered with market research firm GfK to conduct the survey. The poll piggybacked on a national health reform survey developed by the Urban Institute and funded by the Robert Wood Johnson Foundation and the Ford Foundation.
Bucking the national trend, Maine adults in the middle income range actually struggled more than their low-income counterparts to pay medical bills. About 35 percent of mid-range earners — with incomes between about $33,000 and $93,000 a year for a family of four — faced problems or were unable to afford their bills during the prior year, compared to 32 percent of those earning less. Many middle-income Mainers receive no government aid and don’t earn enough to buy a health policy with sufficient coverage, the survey results noted.
The Maine survey polled 992 adults between the ages of 18 and 64 across a range of incomes. Included were the uninsured; people who buy their own coverage in the individual market; those who get coverage through work; and Mainers with government-sponsored insurance, with the exception of Medicare.
The growth of bare bones, high-deductible health plans in the individual market likely contributed to many Mainers’ difficulty affording medical bills, Wolf said. Those plans will be phased out under the Affordable Care Act, except for those under age 30.
A chief goal of the law, also known as Obamacare, is to expand access to more robust and affordable health insurance, with free preventive care and a cap on out-of-pocket costs. Healthcare.gov, the federal government’s gateway for insurance marketplaces in Maine and 35 other states, targets private policies for individuals and small businesses, but also allows users to determine if they’re eligible for Medicaid.
In Maine, budget cuts led to thousands of residents dropping from Medicaid rolls as of Jan. 1. Gov. Paul LePage also opted out of expanding the low-income health insurance program, known as MaineCare, under the ACA. Earlier this month, the Maine Senate passed a bill to expand the program, but fell short of enough votes to overcome a veto from the governor.

Hospital Mergers Raise Concerns Over Patient Costs

By: | 

Hospital administrators in Connecticut who have been involved in the unprecedented streak of mergers and consolidations often tout the financial benefits and efficiencies of such moves.
But as the number of independent hospitals in the state dwindles – with more than half of the 29 acute-care hospitals now operating in networks with other hospitals or out-of-state partners – experts and advocates worry that the consolidations will reduce competition in the market and give hospitals more leverage to raise prices.  Adding to their concerns is a proposal by a private company to convert four non-profit hospitals to for-profit entities.
Several studies, as well as data from the federal Medicare program, suggest that mergers and for-profit conversions may lead to higher prices. But the state has yet to study the impact of mergers on patient pricing, and has no requirement that hospitals try to hold patient charges steady after a merger or conversion. The state also has no comprehensive blueprint guiding hospital configuration or limiting the number of takeovers or networks it will allow.




Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)