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Behind the scenes, much of HealthCare.gov is still under construction
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| The Obamacare website may work for people buying insurance, but beneath the surface, HealthCare.gov is still missing massive, critical pieces — and the deadline for finishing them keeps slipping. As a result, the system’s “back end” is a tangle of technical workarounds moving billions of taxpayer dollars and consumer-paid premiums between the government and insurers. The parts under construction are essential for key functions such as accurately paying insurers. The longer they lag, experts say, the likelier they’ll trigger accounting problems that could leave the public on the hook for higher premium subsidies or health care costs. It’s an overlooked chapter in the health care law’s story that has largely escaped scrutiny because consumers aren’t directly affected. Yet it bolsters the Republican narrative that the government has mishandled the implementation of Obamacare. (Also on POLITICO: Full health care policy coverage) “It seems like the insurers’ experience with Obamacare is a lot like that of far too many Americans: broken promises, frequent delays and constantly shifting rules of the road,” said Don Stewart, a spokesman for Senate Minority Leader Mitch McConnell. “It seems like there’s a lot more to the story than what the administration says in their pep rallies.” Without a fully built and operational system, federal officials can’t determine how many of the 8 million Obamacare sign-ups announced last week will have actually paid their premiums. They won’t even know how many enrollment attempts were never completed. That, in turn, could affect the amount of money the government spends on premium subsidies. And once the system finally does all come on-line, the data delays could force a sharp revision in that celebrated 8 million figure. Obama administration officials originally intended to have the major back-end components of HealthCare.gov working by the website’s launch in October. But the deadline slipped as officials focused their energy on the part of the website that consumers would use to enroll in coverage. When that front end failed disastrously on Oct. 1, the administration diverted every resource to fix it, further delaying the behind-the-scenes technical functions. The deadline for completing those pieces gave way to January and then to mid-March. Senior officials said early last month that they hoped to have the entire system ready by the summer. Now, even summer appears to be a question mark. (Also on POLITICO: Democrats race to embrace Obamacare in Pennsylvania primary) Officials at CMS — the federal agency overseeing HealthCare.gov and new insurance exchanges — refused to provide an update on just how much of the back end remains incomplete, the current issues they face and their latest timetable. The site was envisioned as an easy-to-use portal for insurers as well as their customers. It still needs to be that and more. It’s supposed to automatically calculate exact premium subsidies for enrollees and match them with government records to ensure accuracy. It’s also expected to trigger payments from the U.S. Treasury to insurers and measure whether an insurance company’s customers are sicker or healthier than expected — a determination that could affect future premiums. The Obama administration posted a document earlier this month indicating that insurers will continue to be paid through an “interim” accounting process — pretty much a spreadsheet and some informed estimates — until at least September. When the permanent system eventually goes live, it could lead to a massive correction that either exposes taxpayers to more costs or puts pressure on insurance companies to raise prices. “We have the mother of all reconciliations coming,” said insurance industry consultant Robsert Laszewski, using the official term for the correction. “It may be that the administration will not be able to give us a credible enrollment number until then because we really need a reconciliation to accomplish that.” |
Oregon dumps its broken healthcare exchange for federal website
By Maria L. La Ganga
12:39 PM PDT, April 25, 2014
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DURHAM, Ore. — Oregon officials voted unanimously Friday to jettison the state’s disastrous health insurance exchange and instead switch to the federal website, admitting both disappointment and defeat in an arena where the state had been a trailblazer.
With its 7-0 vote, the board of directors for Cover Oregon acknowledged that the state exchange was too expensive and too troubled to fix. Although the state has spent an estimated $248 million to get its exchange up and running, it never enrolled a single private insurance customer online.
Alex Pettit, the state’s new chief information officer, insisted after the vote that the state’s vision did not fail, but that Oregon tried to do too much too quickly.
“It wasn’t anything wrong with the vision,” Pettit said. “The vision the state has is a very valuable, very lofty vision and should not be discounted. This was not a failure of policy. The failure was in the build …. My job is to improve the way the state of Oregon builds things.”
That vision was referred to here as “no wrong door.” The hope was that insurance customers could sign on to coveroregon.com and in one place shop for a private plan, find out if they were eligible for tax credits or Medicaid and enroll online in whatever insurance product was appropriate for them.
But the website where Oregonians were supposed to enroll in private plans, built by Cover Oregon's main contractor, Oracle, was troubled from the start.
After discovering a series of technical problems before the Oct. 1 launch -- including inaccurate calculations of the tax subsidies for which consumers would be eligible -- Cover Oregon decided to scratch its plans to go live along with the rest of the country and never managed to get online enrollment started.
The state turned instead to paper applications, bringing on some 400 workers -- some from other state agencies -- to help process each one. As of this week, about 70,192 individuals have selected private plans through Oregon's marketplace, according to a spokeswoman for Covered Oregon.
Oracle spokeswoman Deborah Hellinger said in a statement before the vote that the firm "looks forward to providing any assistance the state needs in moving parts of Oregon's healthcare exchange to the federal system if it ultimately decides to do so."
One option considered in the last month was to fix the technology using a new vendor. But an outside analysis revealed that such action would take too much time and cost an estimated $78 million, which the state cannot afford.
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DURHAM, Ore. — Oregon officials voted unanimously Friday to jettison the state’s disastrous health insurance exchange and instead switch to the federal website, admitting both disappointment and defeat in an arena where the state had been a trailblazer.
With its 7-0 vote, the board of directors for Cover Oregon acknowledged that the state exchange was too expensive and too troubled to fix. Although the state has spent an estimated $248 million to get its exchange up and running, it never enrolled a single private insurance customer online.
Alex Pettit, the state’s new chief information officer, insisted after the vote that the state’s vision did not fail, but that Oregon tried to do too much too quickly.
“It wasn’t anything wrong with the vision,” Pettit said. “The vision the state has is a very valuable, very lofty vision and should not be discounted. This was not a failure of policy. The failure was in the build …. My job is to improve the way the state of Oregon builds things.”
That vision was referred to here as “no wrong door.” The hope was that insurance customers could sign on to coveroregon.com and in one place shop for a private plan, find out if they were eligible for tax credits or Medicaid and enroll online in whatever insurance product was appropriate for them.
But the website where Oregonians were supposed to enroll in private plans, built by Cover Oregon's main contractor, Oracle, was troubled from the start.
After discovering a series of technical problems before the Oct. 1 launch -- including inaccurate calculations of the tax subsidies for which consumers would be eligible -- Cover Oregon decided to scratch its plans to go live along with the rest of the country and never managed to get online enrollment started.
The state turned instead to paper applications, bringing on some 400 workers -- some from other state agencies -- to help process each one. As of this week, about 70,192 individuals have selected private plans through Oregon's marketplace, according to a spokeswoman for Covered Oregon.
Oracle spokeswoman Deborah Hellinger said in a statement before the vote that the firm "looks forward to providing any assistance the state needs in moving parts of Oregon's healthcare exchange to the federal system if it ultimately decides to do so."
One option considered in the last month was to fix the technology using a new vendor. But an outside analysis revealed that such action would take too much time and cost an estimated $78 million, which the state cannot afford.
Health reform’s problems run deeper than a glitchy website
Posted Nov. 14, 2013, at 11:49 a.m.
Serious problems with the websites created by the Affordable Care Act continue, and probably will for a long time. Although frantic efforts at incrementally improving them are being made by the Obama administration, and some sites are working better than others, they are a long way from working well.
As I’ve written before, the causes of the website’s problems are far more serious than poor software design. They are baked into the law by its extreme complexity.
There is growing frustration and anger at the administration in Congress from both Democrats and Republicans. Much of it is being expressed by the same people whose hypocrisy and obstructionism is responsible for a failure to do the right thing in the first place. Calls from members of Congress to delay the ACA’s implementation or to repeal it entirely will intensify.
Instead of expanding our existing Medicare program, which has been working well for almost 50 years and is our country’s most efficient and least intrusive health care financing program, the ACA creates complex new law that perpetuates and reinforces the chaos and confusion of our hodgepodge of public and private insurance programs. Coverage and financial assistance continue to depend on an individual’s employment status, income, place of residence, age, conjectures about future health status, and many other factors, some of them subject to change with little or no warning and many impossible to predict.
Smooth implementation of the ACA depends upon the ability of many parts of government and thousands of insurance companies to seamlessly communicate with one another and agree on data drawn from myriad different public and private sources. Some in the health insurance field believe such a task will be difficult or impossible to achieve.
We have to ask ourselves, who are the winners from requiring us to go through the expense and confusion inherent in trying to implement a law of over 2,000 pages? The answer is clear. It’s a health insurance industry that profits from complexity and confusion, and providers of pharmaceuticals, medical supplies, devices and services who benefit excessively from the very weak cost controls inherent in our fragmented system of paying for services.
The losers are all the rest of us. The ACA’s objective, access to health care for all Americans, could have been accomplished much more easily with far less confusion, expense and complexity.
I talk to a lot of people from across the political spectrum about health care reform. There is a growing consensus that improved Medicare for all is the necessary first step in repairing our badly broken health care system.
During a trip to California last week, I ran into House Minority Leader Nancy Pelosi. When I explained to her that while I admired her efforts to reform our health care system, I remain an advocate for “Improved Medicare for All,” she responded, “Yes, we should have done single payer.”
Perhaps there’s still hope. Between Harry Reid’s recent comments and Pelosi’s epiphany, there seems to be a growing understanding of the problem, and its solution, in some parts of Congress.
But first, we will have to get rid of the obstructionist politicians whose only interest seems to be in preserving a health insurance industry that has become one of the most destructive forces in American society.
That task is up to us.
Serious problems with the websites created by the Affordable Care Act continue, and probably will for a long time. Although frantic efforts at incrementally improving them are being made by the Obama administration, and some sites are working better than others, they are a long way from working well.
As I’ve written before, the causes of the website’s problems are far more serious than poor software design. They are baked into the law by its extreme complexity.
There is growing frustration and anger at the administration in Congress from both Democrats and Republicans. Much of it is being expressed by the same people whose hypocrisy and obstructionism is responsible for a failure to do the right thing in the first place. Calls from members of Congress to delay the ACA’s implementation or to repeal it entirely will intensify.
Instead of expanding our existing Medicare program, which has been working well for almost 50 years and is our country’s most efficient and least intrusive health care financing program, the ACA creates complex new law that perpetuates and reinforces the chaos and confusion of our hodgepodge of public and private insurance programs. Coverage and financial assistance continue to depend on an individual’s employment status, income, place of residence, age, conjectures about future health status, and many other factors, some of them subject to change with little or no warning and many impossible to predict.
Smooth implementation of the ACA depends upon the ability of many parts of government and thousands of insurance companies to seamlessly communicate with one another and agree on data drawn from myriad different public and private sources. Some in the health insurance field believe such a task will be difficult or impossible to achieve.
We have to ask ourselves, who are the winners from requiring us to go through the expense and confusion inherent in trying to implement a law of over 2,000 pages? The answer is clear. It’s a health insurance industry that profits from complexity and confusion, and providers of pharmaceuticals, medical supplies, devices and services who benefit excessively from the very weak cost controls inherent in our fragmented system of paying for services.
The losers are all the rest of us. The ACA’s objective, access to health care for all Americans, could have been accomplished much more easily with far less confusion, expense and complexity.
I talk to a lot of people from across the political spectrum about health care reform. There is a growing consensus that improved Medicare for all is the necessary first step in repairing our badly broken health care system.
During a trip to California last week, I ran into House Minority Leader Nancy Pelosi. When I explained to her that while I admired her efforts to reform our health care system, I remain an advocate for “Improved Medicare for All,” she responded, “Yes, we should have done single payer.”
Perhaps there’s still hope. Between Harry Reid’s recent comments and Pelosi’s epiphany, there seems to be a growing understanding of the problem, and its solution, in some parts of Congress.
But first, we will have to get rid of the obstructionist politicians whose only interest seems to be in preserving a health insurance industry that has become one of the most destructive forces in American society.
That task is up to us.
Southerners in Poll Oppose Health Law, and Its Repeal
Despite strong dislike of President Obama’s handling of health care, a majority of people in three Southern states – Kentucky, Louisiana and North Carolina – would rather that Congress improve his signature health care law than repeal and replace it, according to a New York Times Upshot/Kaiser Family Foundation poll.
The poll also found that a majority of Kentucky residents – and a plurality in a fourth state, Arkansas — said they thought the health care marketplace in their state was working well, even as they expressed strong disapproval of the health care law. More than twice as many Kentuckians say their state exchange is working well than say it is not.
Most people still loathe the law. Questions about it may evoke associations with an unpopular president, the remoteness of Washington from ordinary Americans and extra costs in family budgets. But majorities say they do not want it taken away, even in states that lean Republican in presidential elections.
And when it comes to how the law is working, people give it much higher marks in the state that runs its own exchange — Kentucky. Arkansas, which has a partnership exchange with the federal government, is also ranked more positively.
One of the poll respondents, Bonnie Broome, who works as a project manager for AT&T in New Orleans, said that the law was “cumbersome,” but that it seemed here to stay. “I’m a Republican, but I’m tired of them saying ‘Repeal, repeal, repeal,' ” Ms. Broome, 53, said in a follow-up interview. “They need to make it better.”
The Real Reason Red States Won’t Expand Medicaid
By now it’s pretty clear that the states refusing to expand health coverage under Medicaid aren’t really worried about the expense. They’re motivated entirely by ideological stubbornness — “for no other reason than political spite,” as President Obama said last week.
New figures, in fact, show that the cost to the states of expanding Medicaid is less than previously thought. In February, the Congressional Budget Office estimated that the expansion would cost the states $70 billion through 2024. This morning, the Center on Budget and Policy Priorities noticed a figure in the April updateto the C.B.O. report that said the state costs have dropped by a third, to $46 billion. (The price tag is so low over a ten-year period because the federal government will pick up 95 percent of the total amount.)
The real costs to the states will be even less, though, because if they expand Medicaid, they will no longer have to pay for much of the emergency care of uninsured people that now takes place at hospitals and clinics. Estimates of this savings, according to the CBPP, range from $26 billion to $101 billion through 2019.
The real costs to the states will be even less, though, because if they expand Medicaid, they will no longer have to pay for much of the emergency care of uninsured people that now takes place at hospitals and clinics. Estimates of this savings, according to the CBPP, range from $26 billion to $101 billion through 2019.
The 19 states that have flatly refused to expand the program are ignoring these facts. (The issue is under debate in another five reluctant states.) Gov. Bobby Jindal of Louisiana, one of the loudest in the “hell, no” chorus of anti-Medicaid Republican governors, claims the state cannot afford even the small fraction of the cost it would have to bear. But the expansion would actually save the state as much as $78 million this year in uninsured costs and $134 million next year, according to the state’s own budgetary analysis. Expanding Medicaid would also add about 15,000 new health care jobs in Louisiana.
Obamacare Observations From the Marketplace
A few observations from my travels and conversations in the marketplace:
About half of the enrollments are coming from people who were previously insured and half are not. When I try to gauge this, I go to carriers who had high market share before Obamacare and have maintained that through the first open enrollment. Some carriers have said only a small percentage of their enrollments had coverage before but health plans only would know who they insured before. By sticking to the high market share carriers who have maintained a stable market share and knowing how many of their customers are repeat buyers, it's possible to get a better sense for the overall market. Other conventional polls have suggested the repeat buyers are closer to two-thirds of the exchange enrollees.
The number of those in the key 18-34 demographic group improved only slightly during the last month of open enrollment so the average age is still high. The actuaries I talk to think this issue of average age is made to be far more important than it should be. It is better to have a young group than an old group. But remember, the youngest people pay one-third of the premium that older people pay. The real issue is are we getting a large enough group to get the proper cross section of healthy and sick?
The bigger concern continues to be the relatively small number of previously uninsured people who have signed up compared to the size of the eligible group.
The recent report released by Express Scripts reporting on very costly pharmacy claim experience from January and February enrollees is far more concerning than the average age.
About 15% to 20% of new enrollees are not completing their first month's enrollment by not paying their premium, according to my marketplace discussions.
I note that the California exchange just reported their non-pay number was 13%. That makes sense to me because California did not have the information technology difficulties the feds did––many of the non-pays were caused by system related problems like duplicate enrollments and "834" transactions that weren't able to be processed. California also appears to have a population more amenable to the new health law and therefore more likely to pay than the national average.
On the other hand, the Georgia insurance commissioner reported that only about half of those who enrolled had paid their premiums by March 31––although any enrollments between March 15th and April 15th have until April 30th to pay.
About half of the enrollments are coming from people who were previously insured and half are not. When I try to gauge this, I go to carriers who had high market share before Obamacare and have maintained that through the first open enrollment. Some carriers have said only a small percentage of their enrollments had coverage before but health plans only would know who they insured before. By sticking to the high market share carriers who have maintained a stable market share and knowing how many of their customers are repeat buyers, it's possible to get a better sense for the overall market. Other conventional polls have suggested the repeat buyers are closer to two-thirds of the exchange enrollees.
The number of those in the key 18-34 demographic group improved only slightly during the last month of open enrollment so the average age is still high. The actuaries I talk to think this issue of average age is made to be far more important than it should be. It is better to have a young group than an old group. But remember, the youngest people pay one-third of the premium that older people pay. The real issue is are we getting a large enough group to get the proper cross section of healthy and sick?
The bigger concern continues to be the relatively small number of previously uninsured people who have signed up compared to the size of the eligible group.
The recent report released by Express Scripts reporting on very costly pharmacy claim experience from January and February enrollees is far more concerning than the average age.
About 15% to 20% of new enrollees are not completing their first month's enrollment by not paying their premium, according to my marketplace discussions.
I note that the California exchange just reported their non-pay number was 13%. That makes sense to me because California did not have the information technology difficulties the feds did––many of the non-pays were caused by system related problems like duplicate enrollments and "834" transactions that weren't able to be processed. California also appears to have a population more amenable to the new health law and therefore more likely to pay than the national average.
On the other hand, the Georgia insurance commissioner reported that only about half of those who enrolled had paid their premiums by March 31––although any enrollments between March 15th and April 15th have until April 30th to pay.
The Global Diabetes Epidemic
Twelve years ago, my husband and I packed up all of our belongings and moved to Trivandrum — a steamy, tropical town at the southern tip of India in Kerala. At the time, I was a medical student interested in studying stroke. For the next six months I dressed in a sari and walked to work on jungle roads. At the hospital, I immediately began seeing a steady stream of young patients affected by strokes, many of whom were so severely disabled that they were unable to work. I initially suspected the cause was tuberculosis or dengue fever — after all, this was the developing world, where infections have long been primary culprits for disease. But I soon learned that my hunch was wrong.
One of my first patients was a woman in her mid-30s who came in with a headache, vomiting and an unsteady gait. Her scan showed a brainstem stroke. Her blood sugars were very high. The underlying cause of her stroke was most likely untreated Type 2 diabetes. Here I was, halfway around the globe, in a vastly foreign culture, but I was looking at a disease — and the lifestyle that fostered it — that was startlingly familiar.
Today, I am an endocrinologist, and diabetes has become a full-blown epidemic in India, China, and throughout many emerging economies.
In the United States, diabetes tends to be a disease that, while certainly not benign, is eminently manageable. Just this month, federal researchers reported that health risks for the approximately 25 million Americans with diabetes had fallen sharply over the last two decades. Elsewhere on the globe, however, diabetes plays out in a dramatically different fashion. Patients often lack access to care and can’t get insulin, blood pressure pills and other medicines that diminish the risk of complications. As more and more people develop the disease, hospitals may soon be overrun with patients experiencing all of its worst outcomes: blindness, limb amputation, kidney failure (necessitating dialysis), coma and death.
Within the last few decades, South Asia has experienced a rapid economic transition paralleled by an epidemiological shift in disease patterns. Recently, when I returned to India for a yearlong fellowship, I saw this for myself. Indians are now living more sedentary lives, working in banks, labs and call centers; all the while, their diet is changing, as they eat out more and consume foods higher in calories and saturated fats.
What’s more, evidence suggests that Indians may be especially predisposed to diabetes, so even those who are slightly overweight are more likely to be at risk. India also has a high malnutrition rate among children, and poor nutrition in early life appears to trigger metabolic changes that lead to diabetes in adulthood. The result is a perfect storm of commerce, lifestyle and genetics.
Health Law Fund-Raising Is Detailed
WASHINGTON — The Government Accountability Office provided new details on Sunday of how the Obama administration raised money from outside organizations to promote enrollment in health insurance under thehealth care law.
Republicans said such solicitations were meant to circumvent limits on government spending imposed by Congress. But in a report to Congress, the accountability office did not give a legal opinion on the propriety of the fund-raising. Administration officials said it was legal. Under federal law, they said, the secretary of health and human services can encourage support for nonprofits that promote public health.
Kathleen Sebelius, the health and human services secretary, “contacted the chief executive officers of five organizations to solicit support for one outside entity, Enroll America,” which ran a national campaign to help people sign up for insurance, the report said. Ms. Sebelius has announcedthat she plans to leave her post.
Specifically, the report said, Ms. Sebelius “requested financial support for Enroll America from the Robert Wood Johnson Foundation and H&R Block.” She also requested “nonfinancial support, such as technical assistance, from Ascension Health, Johnson & Johnson and Kaiser, which consists of the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals.”
More scrutiny for UCLA's School of Medicine
In the wake of a whistleblower lawsuit, a new study raises a red flag about universities' financial ties to industry.
By Chad Terhune
6:18 PM PDT, April 25, 2014
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In the wake of a $10-million payout to a whistleblower, UCLA's School of Medicine is drawing more scrutiny over its financial ties to industry and the possibility that they compromised patient care.
A new study in this month's Journal of the American Medical Assn. raised a red flag generally about university officials such as Eugene Washington, the dean of UCLA's medical school who also serves on the board of healthcare giant Johnson & Johnson. The world's biggest medical-products maker paid Washington more than $260,000 in cash and stock last year as a company director.
"There are real risks here," said Walid Gellad, assistant professor of medicine at the University of Pittsburgh and co-author of the JAMA study. "Are the policies in place enough to govern these potential conflicts among the leadership of academic medical centers?"
Meanwhile, the $10-million, mid-trial settlement this week between the UC system and the former head of orthopedic surgery at UCLA has prompted a consumer group to seek an independent investigation by California Atty. Gen. Kamala Harris or Gov. Jerry Brown.
In a 2012 lawsuit against UCLA and UC regents, Dr. Robert Pedowitz, 54, alleged that they failed to act on his complaints about widespread conflicts of interest among the medical school faculty and that they later retaliated against him for raising those concerns as a whistleblower.
As department chairman, Pedowitz testified, he became concerned about colleagues who had financial ties to medical-device makers or other companies that could unduly influence their care of patients or research into new treatments.
University officials said they thoroughly investigated Pedowitz's claims and found no wrongdoing and no evidence that patient care was jeopardized. UC regents said they agreed to settle to avoid the time and expense of further litigation.
In a statement Friday, UCLA said Washington's work as a J&J director did not compromise the "integrity of operations" at UCLA, and that his outside activities complied with university policies.
"Dr. Washington has absolutely no oversight of purchasing decisions involving devices or supplies," UCLA said. "Dr. Washington's board service provides significant benefits to both UCLA and the wider field of medicine. As the only physician on the board, Dr. Washington provides a frontline perspective on patient care and the needs of doctors."
Such ties between healthcare companies and physicians have drawn increasing attention from government officials and patient advocates. Taking effect this fall is a provision of the federal Affordable Care Act that requires public disclosure of financial relationships between medical companies and doctors.
Consumer Watchdog, a Santa Monica advocacy group that asked for the state investigation, said the troubling nature of Pedowitz's allegations and the large settlement amount warrant further inquiry.
"It is apparent that UCLA's policies governing financial conflicts are either inadequate or unenforced," Jamie Court, president of Consumer Watchdog, wrote in a letter sent to state officials Thursday.
"Are the same failures happening at other hospitals in the UC system? Your independent investigation is needed to ensure that patients are not harmed," he wrote.
Consumer Watchdog said the investigation also should determine whether oversight of UC's relationships with medical companies should be taken away from university administrators such as Washington and given instead to an independent monitor.
A spokesman for the attorney general said Harris is reviewing the consumer group's request. He would not comment further.
Responding to the letter, UCLA said its "current policies and procedures represent best practices that have continued to become stronger and more rigorous in recent years.... We are always looking for ways to improve further."
In an interview last week, the chief compliance officer of the UCLA Health System said Washington encouraged her to investigate Pedowitz's claims fully. Washington testified at Pedowitz's trial, and his handling of the surgeon's allegations came up regularly.
http://www.latimes.com/business/healthcare/#axzz2zzsBElZe
Maine’s own tale of ‘The Emperor’s New Clothes’: LePage’s cloak of rhetoric is wearing thin
Posted April 26, 2014, at 8:21 a.m.
If a known benefactor stepped forward and volunteered to pay your mortgage for three years while you improved your home (or, in my case, my rent, while I saved for a downpayment on a house), would you say no? If the money was offered with goodwill, I’d like to think not. Three years is ample time to make considerable home and financial improvements and to prepare for a potential loss of funds after the third year.
It seems simple, but not for Gov. Paul LePage and his supporters in the Legislature. By insisting on sayingno to federally financed MaineCare expansion, they are sayingno to making Mainers healthier. They are sayingno to improving our health care infrastructure andno to job creation in that diverse field. They are saying they are not capable of accepting money, making improvements and contingency planning.
This irrational thought process has me thinking about Hans Christian Andersen’s“The Emperor’s New Clothes.” When I read the story as a child, I felt bad for the emperor. He gets duped by weavers into believing the fabric of his new clothes is so fine that only the most refined people can even see it. Fearing he’ll be perceived as unrefined, the emperor convinces himself to walk around naked.
LePage and his allies have cloaked themselves in the garb of rhetoric woven by the extreme right-wing. When exposed to the light of day, the fabric is a little thin, especially when it comes to the MaineCare expansion issue. For the second legislative session in a row, fellow Republican Sen. Roger Katz of Augusta gently tried to suggest so by offering compromising legislation, but to no avail. It’s too bad. A majority of members of this legislature were ready to move Maine forward, but they were forced to squander time dealing with outrageous stances taken by the “fabric challenged.”
Who knows what they could have achieved if they hadn’t wasted time on proposals such as LD 1820 and LD 1822, the accomplish-nothing EBT card bills. These unsuccessful bills are like default pantsuits on the right-wing runway and will probably reappear in some slightly modified form next season. They are a part of the governor’s signature line designed to be worn while chasing a pot of welfare-abuse gold.
| Maine 2nd District Democratic Contenders Show Different Styles | |||||||||
| 04/25/2014 Reported By: Jay Field | |||||||||
The two Democrats vying for their party's nomination in Maine's 2nd Congressional district held their first primary debate last night at the University of Southern Maine's Lewiston campus. State Senators Troy Jackson and Emily Cain agree on most of the major issues. But when it comes to talking about their ideas and positions, the personal styles of the two candidates couldn't be more different. Jay Field reports.
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Troy Jackson and Emily Cain are two of the top Democrats in the state Legislature. Both command respect in the party and are viewed as up and comers with bright futures. But the two have taken very different paths to elected office, and this current moment of political opportunity. The candidates touched on these differences in last night's opening statements. Here's Troy Jackson: "You know, where I am - I'm actually from Allagash. I've lived in that area my entire life. I'm a logger by trade. And, quite honestly, I got into politics back in '98 because I felt that things weren't going well for the people in my area." Cain wasn't born in Maine, but told the audience she'd had plenty of her own experience with economic hardship. Her father, she noted, worked in the shoe business, so the family moved around a lot. ………………………….A handful of politicians, university professors and activists were tapped to question the candidates. Heidi Brooks, a physician and Democratic activist, kicked off the debate with a question on health care. "The question is, 'Do you feel that health care is a human right and would you support a universal single-payer system?" Yes and yes, both candidates answered, in ways that highlighted the contrasting styles that are likely to define this campaign. Cain thanked Brooks for her tireless work in Augusta, lobbying for Medicaid expansion, then flexed her policy knowledge. "I absolutely support a universal, single-payer health care system," she said. "I think the way we do that is, it starts by putting everybody in it. We have great models. Whether it's in veterans benefits in health care or in Medicare itself. We have models that show us, when more people are covered, costs are lower. We can afford it and everybody is healthier. And that lowers costs all around." Health care, Jackson noted, was a major reason he first ran for elected office. "You know, I am someone that, for all of my life in the logging industry, I didn't have health insurance," Jackson said. "I wasn't allowed to bargain for it. And many of the people that I knew went without and had a lot of problems and actually had financial problems because of health problems that they had no control over." This is how much of the evening went. Folksy, sometimes personal responses from Jackson and more polished, detailed, policy-oriented answers from Cain. http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/33436/Default.aspx Patients paying more upfront for careProviders say delays in collection threaten viability of hospitalsBy David MarkiewiczAtlanta Journal-Constitution, April 15, 2014 Doctors and hospitals increasingly are asking insured patients to pay more of their bills for elective procedures at the time of the service, rather than collecting a small fee upfront and waiting until later to get the rest of what’s owed. A fundamental shift in coverage is prompting the change: the rise of high-deductible insurance plans. Earlier collection helps avoid payment delays and bad debt, experts say, but also raises concerns. “I think the new aggression on the part of providers to collect payments reflects the growing cost of health care and their need to stay financially viable,” said Sara Collins, vice president at the Commonwealth Fund, an independent foundation that supports research on improving the U.S. health care system. “From a consumer standpoint,” she added, “I think it’s a very ominous development for patients. The trends in employer-based coverage, and most people have that, is towards ever-increasing levels of out-of-pocket exposure.” Hospitals and physician practices say they are under greater financial pressure to get payment for the services they provide, and can’t easily do what they have historically done: collect a token copay upfront, perform the procedure, then sit back and wait for insurers to run the numbers and for patients to pay their share. Insurance is covering less, and if patients don’t pick up the rest, providers are stuck holding the debt. With unpaid medical debt in the tens of billions of dollars and rising, and with the number of high deductible plans increasing, the issue is stressing everyone, and potentially affecting care. “Even people with six-figure salaries can have trouble paying a $5,000 deductible,” said Dr. Douglas Lundy, the co-president for Resurgens Orthopaedics. “People are choosing not to do tests or surgery. The high deductibles are hurting things.” The growth in high-deductible plans and increasing bad debt are closely related, said Michael Mascolo, North Region Employee Benefits Practice Leader for Wells Fargo Insurance. Providers used to have very few people in these plans, but that has changed. More employers are offering high-deductible plans, and workers are signing up for them because they offer lower premiums. The high-deductible plans save employers money and can mean lower premiums for employees. The number of workers with high-deductible plans that included a health savings account option jumped to 20 percent of all covered workers last year, from 5 percent in 2007, according to the Kaiser Family Foundation. ‘Explosion’ of bad debt Kaiser said one in three Americans has had problems paying medical bills in the last year, is paying old bills over time, or has bills that can’t be paid at all. As a result, Mascolo said, there is “an explosion of bad debt.” American hospitals provided $41 billion in uncompensated care in 2011, according to the American Hospital Association. That includes “bad debt” for services that hospitals expected to be paid for but were not, and charity care. “We’re being flooded with patients with little or no ability to pay their portion of the bill,” Greg Hurst, chief operating officer for Piedmont Healthcare said. Approximately 50 percent of its patients are on a high-deductible plan with some form of co-insurance, he said. “For elective procedures, we’re going to have to be disciplined about collecting the patient’s financial obligation at time of service,” Hurst said. http://www.pnhp.org/print/news/2014/april/patients-paying-more-upfront-for-care | |||||||||
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