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Saturday, May 24, 2014

Health Care Reform Articles - May 24, 2014

A progressive alternative to Obamacare

By Geoffrey Cowley
MSNBC, May 23, 2014
BURLINGTON, Vermont—Al Gobeille is not your garden-variety health advocate. For the past two decades, he and his wife have hawked fried clams, liquor and ice cream on the Lake Champlain waterfront. He’s a big man with an impish grin and a can-do spirit rooted in an earlier career as a military officer. “Running a restaurant is a lot like being an army lieutenant,” he observes as locals queue up for Maple Creemees at the Burlington Bay Market & Café, one of his company’s four venues. “You stay alive by staying alert, and you lead by getting people to believe you care about them.”
It’s an apt description of the new job Gobeille stumbled into last fall. As the chair of Vermont’s Green Mountain Care Board, this plainspoken entrepreneur is overseeing one of the boldest social experiments in Vermont’s history, or the nation’s for that matter. Under his board’s guidance, the state is creating a health care system that will insure every Vermonter—regardless of income or employment—through a public entity that defines benefits, sets uniform prices for medical services, and covers patients’ bills.
That’s the dream anyway. President Obama’s Affordable Care Act gives private insurers control of the market through 2016, but Vermont lawmakers have voted to adopt a single-payer system as soon as that federal mandate expires. If state officials can devise a viable financing plan—and keep all the critical stakeholders onboard—the transformation could come as soon as 2017.
“We’ve already agreed we want universal health care,” Gobeille says. “The challenge is to fund and deliver it in ways that everyone can live with. Some groups will benefit more than others, but we can’t leave anyone feeling ripped off. The winner-loser issue is the place where the alligators live.”
A bold alternative to Obamacare
Vermont’s plan is a radical departure from Obamacare, but it embodies the bolder vision the president once embraced as a candidate. “I see no reason why the United States of America, the wealthiest country in the history of the world, is spending 14 percent—14 percent!—of its gross national product on health care and cannot provide basic health insurance to everybody,” Obama told an AFL-CIO audience in 2008. “A single-payer health care plan, a universal health care plan—that’s what I’d like to see.”
By the time he signed the Affordable Care Act in March 2010, Obama had ditched that idea—along with the more modest one of letting consumers choose between public and private insurance plans. The advent of Obamacare was an epochal achievement, to be sure, but it leaves commercial insurers a dominant role, bets on market forces to control spiraling costs, and keeps large employers in charge of most people’s health care. Beyond the small subset of Americans (about 7% of those under 65) who buy insurance on the individual market, Obamacare simply preserves the status quo.
So four years ago, Vermont elected Democratic Gov. Peter Shumlin to pursue a bolder alternative. The legislature hopped on board, and in 2011 Shumlin signed Act 48, a law that defines health care as a basic public good, like roads, schools or potable water. It gets employers out of the insurance business by sponsoring coverage for everyone. And instead of making consumers choose among four levels of coverage with different premiums and cost-sharing formulas, as Obamacare does, Act 48 seeks to cover at least 80% of people’s essential health care costs. Under the ACA, only those who can afford gold or platinum plans get that level of security.
“I don’t think we can nibble around the edges to fix our health care system,” the governor declared again last winter, as the state scrambled to launch its private insurance exchange. “We should look at how regressive and unfair the current system is. And we should embark on the path of designing a new system that is built upon equity, fairness and common sense.”
Act 48 grew out of a report by William Hsiao, a Harvard health economist who has helped remodel health care systems in a dozen countries. Four years ago, state officials asked Hsiao’s team to assess several routes to universal care. The object of the game was to cover all Vermonters without (a) raising overall health spending, (b) cutting providers’ earnings, (c) forfeiting any federal support, or (d) increasing burdens on workers or employers.
Hsiao’s analysis, detailed in a 130-page report and summarized in a 2011 statement and journal article, make a compelling case for a single-payer system. In keeping with past national studies, his team found that if doctors and hospitals could submit claims to one central payer instead of dozens, the administrative savings alone would cut health care costs by 7% over 10 years. If the new system also took proven steps to promote wellness, curb fraud and reduce waste and duplication by medical providers, the cost of care would fall by a quarter.
Hsiao showed that by reinvesting those savings in its health system, Vermont could cover the 32,000 residents who remain uninsured under Obamacare, boost everyone’s benefits, and expand the clinical workforce—all while reducing the total amount that businesses and employees spend on care.
Taxpayers could balk
The initiative will count as a victory if it works even half that well, but alligators lurk at every turn.
The state’s first challenge is to coordinate its plans with federal agencies that administer Medicare and Medicaid and subsidize private health coverage for people without job-based plans. Medicare will remain separate from Green Mountain Care. But if the feds grant the necessary waivers, the state will pour all its other federal disbursements into one pot, starting in 2017. Those negotiations are underway and reportedly going well.
The state also needs to raise a staggering $2 billion in new taxes.  While it’s not really a tax increase—just a different way to amass the same money individuals and employers now spend on private insurance—$2 billion is still a staggering sum for a state whose entire tax base is now just $2.7 billion.
Hsiao suggested that the state levy a new payroll tax and earmark the proceeds for health care, but no one expects Shumlin to do that. “It’s too blunt,” says Gobeille. “If you suddenly started taxing every employer at 7% to finance health care, the shock would tip a lot little companies over.”
The financing plan will be a hard sell no matter how deftly Shumlin spreads the burden. But proponents believe resistance will fade if they can show people the true cost of employer-sponsored coverage.
http://www.pnhp.org/print/news/2014/may/a-progressive-alternative-to-obamacare

New Augusta hospital to lay off 16 workers

Chief Executive Officer Chuck Hays says the hospital that opened in November is overstaffed.

By Susan McMillan
Kennebec Journal
AUGUSTA — MaineGeneral Health will lay off 16 employees in July because of lower patient volumes and overstaffing at the new regional hospital.
Chief Executive Officer Chuck Hays said the fiscal year 2015 budget, which starts in July, eliminates 128 full-time jobs, most of which are vacant. Sixteen people will lose their jobs, however.
Hays said only two of the positions involve direct interaction with patients, and most are in management. Some departments will be consolidated under the supervision of one manager.
MaineGeneral has about 4,300 employees and a budget of $456 million for this year. The organization opened its $312 million north Augusta hospital, the Alfond Center for Health, in November and is making $10 million in improvements at the Thayer Center for Health in Waterville, which will consist of outpatient care offices.
Hays said the new hospital is overstaffed.
“The new hospital is more efficient, so as you get used to the building and give people time to acclimate, now it’s time to go back and right-size the staffing,” he said.
MaineGeneral also anticipates lower inpatient volumes because MaineCare – the state’s Medicaid program – is not being expanded, and the organization’s providers are managing the care of high-cost patients in new ways. Changes to a diabetic’s care, for example, may mean they need less health care overall because they don’t have to go to an emergency room or be admitted to a hospital.
The occupancy rate for beds at the Alfond Center for Health is still high, at 88 percent. It was 86 percent in December, a month after the hospital opened.
The patients being admitted have more acute needs and are staying longer, Hays said, but reimbursements are per patient.
“So whether you stay here three days or you stay here nine days, we get the same reimbursement,” Hays said.

Remarks of PNHP President Dr. Andrew Coates at single-payer summit

The following is an unofficial transcript of the remarks of Dr. Andrew D. Coates, president of Physicians for a National Health Program, at a summit on single-payer health care convened by Sen. Bernie Sanders, I-Vt., on May 21, 2014, at the Dirksen Senate Office Building in Washington.
Sen. Bernie Sanders: Dr. Andrew Coates is president of Physicians for a National Health Program. He is assistant professor of medicine and psychiatry at Albany Medical College, and practices hospital medicine at a community hospital in Upstate New York. Dr. Coates, thanks for being with us.
Dr. Andrew D. Coates: Thank you, Senator Sanders. It’s a great honor.
I’m representing Physicians for a National Health Program, 19,000 physicians who have been advocating for national health insurance for over 25 years.
Physicians have a special relationship with society. As the profession has evolved, our relationship with society has become profound, but also tangled with business. And what I has happened is almost bewildering to my colleagues many times.
We know from studies, very good research, that the majority of American physicians want national health insurance. And we know that from our daily practice because patients should have access to all necessary care when they need it. I think that question is absolutely settled in this country.
Right now there’s a scandal in the Veterans Administration, and there’s a scandal because those patients should have everything they need. And the entire country knows it. And we should all make it our responsibility to make that happen. That’s the starting point for the dialogue in our nation, and it’s the same starting point among the physicians.
What’s happened lately is that costs have been completely out of control in terms of aggregate, but the plan about what to do about those costs has been to shift them onto individuals.
So in our hospital I understand that emergency room visits are down, they’re falling. The administrators think it’s because of the co-pays, the co-insurance, the deductibles – the new forms of insurance that the patients have. But as the visits to the emergency room are going down, the number of admissions to the hospital are climbing. So the patients who are coming to the hospital are much sicker.
We practice near the southern Vermont border. Many of staff and some of our patients come from Vermont. We know this community well. It’s a community with a heroin epidemic. The needs are colossal. The poverty is severe. And we see the presentation of very advanced disease from people who have not had access to adequate primary care every day.
Patients don’t have the choice of where they can go. This system shunts them and schleps them wherever. My own doctor, several years ago, cancelled my health insurance, wouldn’t take my health insurance, because she couldn’t come to terms with the company that my employer had chosen.
And so, when you lay out the evidence, like Rob [Weissman] did, the system actually indicts itself. It doesn’t make any sense at all. If the goal were to provide all necessary care for everyone in the United States, the system we have is a failure. Way too many people are left out, there are hideous disparities, African Americans do not get the same care that white patients get, immigrants are actually left out in all kinds of different ways -- the most hideous violations of human rights in our country are the medical deportations of undocumented patients who are sick and who are sent back by air ambulance to their home country by the hospital.
And through this, it’s clear to me that physicians want to do their best as caregivers. We want to do what we learned to do. We want to apply the medical science and the human arts at the bedside in the best and exemplary way, and yet our society doesn’t organize to give us those resources.
The farther I go in this advocacy for national health insurance, I think, Why is it that the mainstream of our society is so interested in single payer? Why is it that we’re in The New York Times every week, or The Washington Post, or the U.S. Senate? And I know that the wonderful educational efforts of senators like yourself and representatives are crucial to keep the discussion going, but it’s also the simple fact that this would work.
Single payer would work. We could do this. It would be completely feasible. It could happen rather quickly. We have what it takes. We have the excellent caregivers, we have the infrastructure, and we have the know-how. So it’s something we could do.

Public Citizen’s president speaks at Sanders’ panel on single payer

Insurance News Net, May 21, 2014
Public Citizen issued the following statement by Robert Weissman, the organization’s president, on May 21:
WASHINGTON – Thank you, Senator Sanders, for your leadership in paving the way so that our country finally receives the health care it deserves, through a single-payer, Medicare-for-All system.
Today’s panel discussion is important because we know that single-payer wins the health care argument on the merits. We know that it wins with the American people, and the more they learn about single-payer, the stronger will be their support.
The problem in Washington is that we haven’t had a merits argument on single-payer. Policymakers have decreed it “off the table,” because it’s not “realistic.” By realistic, they mean, it will be too hard to defeat the health insurance industry. That can’t be the way we do policymaking, especially when the stakes are so high.
No other industrialized country follows the U.S. insurance-driven model of high-pay, bad-results. Although the details of their systems vary in important ways, every other industrialized country provides guaranteed coverage to its citizens.
As a result, those countries have far better health outcomes. The Commonwealth Fund finds that the United States performs last among industrialized countries in the rate of mortality amenable to health care -- deaths that might have been prevented with timely and effective care with a rate 68 percent higher than the rate in the leading countries. Infant mortality is so high in the United States that the best-performing U.S. states have rates twice as high as those in some industrialized countries.1
These countries get better results at far lower costs. As a proportion of GDP, we spend at least 50 percent more on health care than every other rich nation. Per person costs in the United States, by World Bank figures, are $8,608. In Germany, it’s $4,875. In neighboring Canada, $5,630.
There are many ways that our health care payment system can be improved. Indeed, the list is seemingly endless, precisely because there are so many problems. But fixing particular problems will only get us so far, because that long list of problems is a direct outgrowth of the multi-payer, private insurance system, with all of its complexities and profit-driven irrationalities.
Here are three illustrative problems that will be fixed when we move to a single-payer, Medicare-for-All system.
First, balance billing.2 This widespread problem refers to bills for the difference between the amount that an insurance company is willing to pay for treatment and a provider’s total charges. Providers who are not members of a patient’s insurance network have charged patients as much as 9,000 percent of what Medicare would have paid for the same procedure.
Patients can be subjected to balance bills despite making their best efforts to avoid them. For instance, they might receive care at an in-network facility, only to find out later that an out-of-network doctor -- even a pathologist with whom the patient never interacted -- was involved in their treatment.
This problem is a direct result of the multi-payer system, and the complicated and multiple pricing schemes between providers and insurers. Medicare and Medicaid have both essentially banned balance billing for their beneficiaries. The problem goes away with a rational payment system.
Second, executive compensation. The New York Times reported earlier this month on executive compensation at insurance companies and hospitals, noting that “the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.”
Asked about extraordinary compensation for insurance company and hospital executives, the New York Times reported, “Hospitals and insurers maintain that large pay packages are necessary to attract top executives who have the expertise needed to cope with the complex structure of American health care, where hospitals and insurers undertake hundreds of negotiations to set prices.”3
One might dispute whether this really justifies the need for exorbitant compensation of hospital and insurance administrators and executives, but we know this: With a single-payer system, that “complex structure” and “the need to undertake hundreds of negotiations to set prices,” is eliminated.
And, indeed, it is the case that hospital administrators are much more modestly compensated in other countries.
Third, drug prices. The company Gilead has a new hepatitis C drug (brand name: Sovaldi) that may dramatically improve care and health outcomes for hepatitis C patients. The company is charging roughly $90,000 for a course of treatment. An estimated 3 million people in the United States have hepatitis C. The math is jaw-dropping: the country cannot afford to provide Gilead’s hepatitis C treatment at this price level. Gilead’s price is so outrageous that insurers are revolting - but with what final result, we do not know. What we do know is that it won’t be a rational result; the final price will be too high, and some people -- maybe very many people -- will very likely be denied treatment.
This example is exemplary of drug pricing trends. As drug prices, especially for biologics, skyrocket, insurers are aiming to reduce pharmaceutical use by imposing huge co-pays,4 which is certainly the wrong way to stop excessive prescribing and deliver appropriate care.5 Drug companies are circumventing these co-pays by providing coupons and direct reimbursements to patients. And so the irrational system goes.
A single-payer system would eliminate these problems by providing a fair and rational system for compensating drug makers and incentivizing new research. At minimum, it would involve a single negotiation over price where negotiating power rested with the single-payer; ideally, it would involve replacing the system of compensation via patent monopolies with something that better pays and incentivizes innovators, while avoiding the unjustified consumer rip-offs of the patent monopoly system.6
These problems, and many more, are endemic to our current health care system.
We have a cure: It is called a single-payer, Medicare-for-All system.
With a single-payer, Medicare-for-All system, we would eliminate all of this wasteful and deadly irrationality. We would - we will - finally recognize that health care is a human right, and that no one should be denied needed care because they can’t afford it.

Remarks of Dr. Margaret Flowers at single-payer summit

By Margaret Flowers, M.D.
May 21, 2014 
Thank you for inviting me to participate in this important discussion today.
The first step in the work to move to a single payer plan must be to take stock of where we are and where we are headed. We must do what we can to prevent further damage while we organize for the real solution to our healthcare crisis: a national single payer health system.
We are continuing a trend that began in the 1980s of privatization of every facet of our healthcare system. This is the opposite direction from where we need to go. If we viewed the U.S. healthcare system as an experiment, which it largely is – one that defies sound health policy – we would see that it has failed. If we treated our system as an experiment, we would be required to stop it because of the high number of preventable deaths, wide health disparities and financial ruin caused by illness and medical costs. These are our outcomes despite the fact that the U.S. spends the most per capita each year on health care, two and a half times more than the average OECD nation.
There is no affordable market solution to the healthcare crisis even though the public is being steeped in market rhetoric as we speak. The private health insurance industry has proven for decades that it defies regulation. Our market-based system will continue to increase healthcare spending, leave people out and result in poor health outcomes because the bottom line is profit, not health.  Until we change this fundamental dynamic, we will continue to fail to significantly improve the health of our population.
It is time for an honest national conversation about our healthcare system. We must ask ourselves whether we want to continue to treat health care as a commodity so that people receive only what they can afford or whether we want to join the rest of the industrialized world and create a healthcare system that treats health care as a public good so that people receive the health care they need.
The primary obstacle to a national single payer health system is political will. But we know from past experience that political will can change through public pressure. To effectively create this pressure we must recognize that the U.S. is not a legitimate democracy. It is an oligarchy, or more accurately a plutocracy. Health spending is almost one fifth of U.S. GDP. The medical industrial complex wields tremendous political influence. Therefore, single payer will only be on the table when the public puts it there. There is no easy way to do this, no secret back door. A national single payer health system will come from steadfast determination and strategic organizing and action.
As we are educating, organizing and mobilizing the public to demand a single payer health system, we need to take steps to challenge further privatization of our health system. I have three major areas of concern: the privatization of our public insurances, the trend towards more people being required to purchase inadequate insurance through the exchanges and increasing subsidies to private insurers that will be used as justification to cut social programs.
One harmful trend that should be addressed immediately is the privatization of our public insurances, Medicaid and Medicare. Currently at least 75 percent of Medicaid enrollees are in Managed Care Organizations, private administrators that act like private insurers by keeping a high percentage of their payment for administration, profits and salaries and cherry picking the healthiest patients. This percentage is expected to grow. It is no coincidence that WellPoint moved to buy AmeriGroup after the ACA was passed. They saw a huge profit opportunity in the Medicaid expansion.


Tax dollars are paying Gary Alexander to recommend cutting aid to Maine’s poorest

If Maine residents needed another reason to discredit the Alexander Group’s work for the LePage administration, they need look no further than the consulting firm’s recommendations for “reforming” the municipal-state General Assistance program.
The recently released second installment of the group’s five-part analysis of Maine government assistance programs suggests several ideas for cutting costs within the statewide General Assistance system. General Assistance is an option of last resort for people in emergency situations often facing destitution or homelessness; it’s administered by municipalities, and it’s paid for jointly by municipalities and the state.
People must apply for the aid — such as for food, medication prescriptions or housing — and the payment is made directly to the vendor. Many municipalities require people to work, often doing odd jobs for the town or city, in order to receive the assistance.
Because General Assistance is reserved for people in dire circumstances who may not qualify for other aid, it is irresponsible to lightly suggest eliminating it, without any discussion about alternative approaches or the effects on Maine people and its economy. But that is what the Alexander Group does. It suggests several “options,” as the report puts them, for cutting costs. One is to “eliminate the GA program altogether.”
We don’t think Gov. Paul LePage needed to pay the Alexander Group $925,000 as part of a no-bid contract to suggest ideas like that. Need to cut costs in a certain program? Well, just get rid of it!
Never mind what would happen to Maine’s neediest or how long-term costs would transfer to municipalities. Don’t think too hard about the fact that consultant Gary Alexander is being paid with Maine tax dollars and federal funds to recommend an idea that required no creativity or skill and would take assistance away from Maine residents.
The report suggests other “options” as well, several of which were proposed by the LePage administration in the past but didn’t gain support. One would turn General Assistance into a block grant where the state would allocate a specific amount of money to municipalities based on their previous spending. Once the towns spent the grant, they would be ineligible for more state money. So, basically, Maine residents would want to have their emergencies early in the year, before their town ran out of funds.




Le

Page suspends payments as more plagiarism found in Maine welfare study

An expert finds uncredited information from five other sources in the Alexander Group’s welfare report, as the consultant admits ‘anomalies.’

By Eric Russell erussell@pressherald.com
Staff Writer
Gov. Paul LePage has suspended all payments to a consultant group after revelations surfaced that the group lifted information from other sources without attribution.
According to a plagiarism expert who studied the Alexander Group’s report on Maine’s public assistance programs this week, the authors took information from as many as five other sources, without attribution or with improper citations of the original source.
The new examples, revealed Friday, come on the heels of revelations this week that the report used extended passages from a 2011 report by the Center on Budget and Policy Priorities without proper attribution.
Asked to comment on those additional instances Friday afternoon, Gary Alexander said his agency already had conducted an internal investigation this week after the initial reports of plagiarism surfaced. He said he was aware of other “anomalies” and attributed them to one employee who has been disciplined and removed from the project.
“We are disappointed in our own efforts,” he said. “We have high standards and, in this particular case, we failed.”
LePage was not satisfied by that explanation and acted swiftly. Within an hour of being told about the allegations, the governor released a statement announcing that he was suspending payments totaling more than $400,000. He did not address the $500,000 that the Alexander Group has already been paid.
Adrienne Bennett, LePage’s spokeswoman, said the governor takes the latest allegations seriously and plans to contact the plagiarism expert cited by the Press Herald to learn more.
Shortly after the statement came out, Bennett said in a follow-up phone call that LePage had actually suspended payments to the Alexander Group on Wednesday, after the initial plagiarism reports, even though his health and human services commissioner Mary Mayhew downplayed those allegations the same day, saying that “the media and Democrats have chosen to politicize punctuation over policy.”

LePage stops payment to Alexander Group amid plagiarism scandal, says contract may be canceled

By BDN staff, Special to the BDN
Posted May 23, 2014, at 4:03 p.m.
AUGUSTA, Maine — Concerned about accusations of plagiarism by the controversial Alexander Group, Republican Gov. Paul LePage said Friday he would take immediate action against the company, if warranted, after getting a full report of the facts.
LePage said in an interview Friday that payments had already been suspended to the Alexander Group on Wednesday, after the Bangor Daily News reported sections of the group’s latest report had been lifted from a liberal Washington, D.C., think tank, verbatim, without proper attribution.
The Alexander Group was awarded a $925,000 sole-source contract last year to study the state’s welfare system and make recommendations toward its improvement. A scheduled monthly payment of $61,680 was ordered to be held by LePage as a result of the plagiarism allegations. More than $501,000 has been paid on the contract to date.
Gary Alexander, owner of the Alexander Group, did not respond to a request for comment Friday from the Bangor Daily News.
On Friday afternoon, Mike Tipping — spokesman for the liberal Maine People’s Alliance and columnist for the BDN and the Portland Press Herald — reported in a column published by the Portland newspaper that there were even more instances of plagiarism than originally reported.
Tipping cited original research conducted by a Mike Smit, a professor and plagiarism expert at Dalhousie University, who studied the report with anti-plagiarism software.
“I will take every action we can. I am not happy about this,” LePage told reporters Friday. “I’m saying I will withhold part to all of what’s left over, and maybe go back after what we paid. It’s all a matter of the extent of what the damage is.”
After the first round of plagiarism accusations, the consulting firm’s chief, Gary Alexander, said the error was one of scale: The report did cite the source of the material at one point, but failed to indicate that the following two pages all originated in someone else’s work.
But on Friday, Tipping said that in some cases, there was no attribution at all.
“This is true of portions of the reports copied wholesale from policy papers published by the Kaiser Family Foundation, the Commonwealth Fund and the University of Southern Maine’s Muskie School of Public Service, as well as text taken from a number of Maine government documents,” Tipping wrote.
LePage said Friday that he would speak with Smit, and promised “severe” penalties against the Alexander Group if the accusations are true, including the possibility of canceling the contract altogether. He also said he intends to have the state purchase plagiarism detection software, and run its own analysis of Alexander’s work.
LePage also stressed that he was upset that Alexander had communicated with a reporter from the Portland Press Herald about the latest plagiarism accusations without contacting the state to inform his administration that another round of concerns had been raised.
The plagiarism allegations may have surfaced just this week, but controversy over the Alexander Group goes back much further: Democrats and advocates for welfare recipients have said for months that Alexander’s outfit is highly partisan, and that the consultant was contracted to provide seemingly objective political fodder for the governor.



Arkansas officials call Maine GOP’s claims about Medicaid expansion in their state ‘misinformation’

By Scott Thistle, Sun Journal
Posted May 24, 2014, at 6:10 a.m.
AUGUSTA, Maine — Officials in the state of Arkansas are saying “not so fast” to claims being made by leaders in Maine’s Republican Party that an expansion of Arkansas’s Medicaid program has led that state to fiscal crisis and Maine was wise not to expand its low-income health care program.
Amy Webb, communications director for the Arkansas Department of Human Services, said claims made in a guest column by Maine House Minority Leader Ken Fredette, R-Newport, were incorrect and misleading.
Webb characterized the claims as “misinformation” and said the implication that Arkansas’s Medicaid director recently resigned as a result of problems from the expansion was not true.
Fredette, in a guest column in the Bangor Daily News, published earlier this month, wrote Arkansas’s experience with expanding Medicaid was evidence that Maine made the right decision by not expanding its Medicaid program.
The Arkansas expansion of Medicaid, Fredette wrote, was over budget by $8 million and “the costly disaster has led their Medicaid director to resign, the state government to seek a federal bailout and former champions of the expansion to backtrack and disavow their support.”
Not so, said Webb.
“It’s not over budget at all,” she said. “It’s a three-year cumulative demonstration project, and we won’t know what the actual costs are for a full year. Folks who are saying we are over budget are simply making predictions that we would be over budget. At this time, we are not.”
Webb also said Arkansas’s Medicaid expansion, funded by the federal government, allows the state to use federal block grant funding to buy private health insurance for Medicaid-eligible residents on the state’s private insurance exchange.
The result of a compromise in the Arkansas State Assembly, lawmakers agreed to expand health insurance coverage without directly adding to the state’s Medicaid rolls.
Known as the “private option,” the Arkansas model is one method states with divided governments are using to reach legislative compromise that allows them to accept millions in new federal funds meant to expand the number of people with health care coverage. Maine’s neighbor, New Hampshire, enacted similar legislation this year, and Utah is in the process of debating it.
The Maine Legislature this spring approved a bill that would set up a private-option waiver with the federal government, but the bill was vetoed by Republican Gov. Paul LePage.
In his veto message, LePage noted the measure was modeled on the New Hampshire expansion, which was modeled on the Arkansas private-option program.
Most of Maine’s GOP lawmakers and LePage have rejected expanding Medicaid to about 70,000 uninsured people under the Affordable Care Act, saying it will be too costly for the state in the long term.
One estimate from a private consultant hired by LePage’s administration to analyze the impact of expansion pegged the cost at more than $800 million over a 10-year period.
Republicans say predictions of how many people the state will eventually cover with Medicaid are underestimated. They have suggested the growth in the program could reach an additional 100,000, not the 70,000 forecast by supporters.
Health policy experts say Fredette and other Republican opponents of expansion are not painting a full picture of what a Medicaid expansion would mean to the state.
The biggest flaw in the opponents’ approach, according to Joan Alker, executive director of the Georgetown University Health Policy Institute’s Center for Children and Families, is only looking at one side of the financial equation.
“Most analysis of Medicaid expansion has shown it actually saves states money,” Alker said. “Because the federal match is generous and because states are already spending money on these people — one way or another, they are spending some money on these uninsured folks — either in the mental health system, your substance abuse systems and with your uninsured in the ERs and uncompensated care.”
Maine, which already provides some of the best health care access for low-income people, only stands to benefit by accepting the federal funds, Alker said.
“I can see no reason at all why Maine would not want to accept these funds,” she said.
http://bangordailynews.com/2014/05/24/politics/arkansas-officials-call-maine-gops-claims-about-medicaid-expansion-in-their-state-misinformation/print/

Obamacare Buried By Avalanche Of Negative Ads, Study Finds

by 
It's been obvious ever since 2010 that Republicans and conservatives were spending a lot more slamming the Affordable Care Act than the Obama administration and Democrats were spending to defend it.
But 15 to 1?
Yes. That's the ratio calculated by Kantar Media's campaign media analysis group — CMAG to political junkies. Kantar estimates that national advertising against the ACA cost $418 million, compared with $27 million for ads supporting the law. Kantar calls the anti-ACA spending "unprecedented [and] largely unanswered."
Even in general election-focused ads this year, 76 percent of Republican ads airing from January through April attacked the health care law. In Senate campaigns in New Hampshire and North Carolina and in 13 House races, Kantar found that every GOP broadcast ad brought up the anti-ACA messages.
Kantar's Elizabeth Wilner, a co-author of the analysis, said, "Positive ads about the ACA are still so rare that whenever one appears, it gets a national news story."
This massively lopsided spending is also a complete reversal from 2008, when then-candidate Barack Obama's campaign aired one contrast ad on health care policy 24,000 times. Kantar says that's a record for the past 10 years — at least. But in 2012, the Obama re-election campaign ran just one ad on the ACA.
Yet in 2013, when millions of Americans had to sign up for coverage, industry spending spotlighted the differences of magnitude between American politics and American commerce. In just six months, insurance companies ran ads costing an estimated $381 million, not far behind what the law's critics spent over four years. The industry ads were neutral, neither attacking nor defending the law — "Switzerland," as Wilner put it.
Overall, she said, three factors — Republican intensity against the law, the new federal role and insurers' new activity selling insurance to consumers — came together to produce "a confluence of political and product advertising never seen before."
http://www.npr.org/blogs/itsallpolitics/2014/05/20/314366027/study-obamacare-buried-by-avalanche-of-negative-ads?wpisrc=nl_wonk

Poll finds Americans' disapproval of Affordable Care Act continues

But most who signed up for coverage say they found premiums in line with what they expected, or even lower, and are happy with the law.

The Associated Press
WASHINGTON — President Obama celebrated when sign-ups for his health care law topped 8 million, far exceeding expectations after a slipshod launch. Most Americans, however, remain unimpressed.
A new Associated Press-GfK poll finds that public opinion continues to run deeply negative on the Affordable Care Act, Obama’s signature effort to cover the uninsured. Forty-three percent oppose the law, compared with just 28 percent in support.
The pattern illustrates why the health care law remains a favored target for Republicans seeking a Senate majority in the midterm elections.
The poll does have a bright spot for the administration: Those who signed up for coverage aren’t reeling from sticker shock. Most said they found premiums in line with what they expected, or even lower.
But even that was diminished by another finding: More than one-third of those who said they or someone in their household tried to enroll, were ultimately unable to do so. For the White House, it’s an uncomfortable reminder of the technical problems that paralyzed theHealthCare.gov website for weeks after it went live last fall.
The example of business owner Henry Kulik shows some of the cross-currents of public opinion.
Kulik is disabled as a result of Lou Gehrig’s disease, a condition that destroys the brain’s ability to control muscle movement. His family runs several stores that sell ice cream and other summer refreshments in the Philadelphia area.
Kulik says he doesn’t believe the federal government should require people to carry health insurance, as the law does. And he can understand worries about the cost to taxpayers. On the other hand, he’s been able to slash what his family pays for health insurance by purchasing coverage through the law’s new insurance markets and by taking advantage of tax credits to lower the premiums.




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