Number of Americans Without Health Insurance Falls, Survey Shows
Federal researchers reported on Tuesday that the number of Americans without health insurance had declined substantially in the first quarter of this year, the first federal measure of the number of uninsured Americans since the Affordable Care Act extended coverage to millions of people in January.
The number of uninsured Americans fell by about 8 percent to 41 million people in the first quarter of this year, compared with 2013, a drop that represented about 3.8 million people and that roughly matched what experts were expecting based on polling by private groups, like Gallup. The survey also measured physical health but found little evidence of change.
The findings were part of the National Health Interview Survey, a nationally representative examination that is considered a gold standard by researchers. It interviewed about 27,000 people in the first quarter, fewer than Gallup, which interviewed 45,000 people in the second quarter alone. But researchers say it is considered particularly trustworthy because federal interviewers conduct the survey in Americans’ homes. It also sets a federal level that others can use as a benchmark.
Larry Levitt, a director at the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, a health research organization, said the first-quarter findings “dramatically understate the effect” of the law, as almost half of the people who signed up for insurance during the open enrollment period did so in March and did not get their insurance cards until later. Private surveys have shown that there were eight million to 10 million fewer uninsured by the second quarter, he said.
“Regardless of what you think of the A.C.A., there should be no doubt at this point that the law is increasing the number of people insured,” he said.
U.S. to End Coverage Under Health Care Law for Tens of Thousands
By ROBERT PEAR
WASHINGTON — The Obama administration said on Monday that it planned to terminate health insurance for 115,000 people on Oct. 1 because they had failed to prove that they were United States citizens or legal immigrants eligible for coverage under the Affordable Care Act. It also told 363,000 people that they could lose financial aid because their incomes could not be verified.
The 115,000 people “will lose their coverage as of Sept. 30,” said Andrew M. Slavitt, the No. 2 official at the Centers for Medicare and Medicaid Services, which runs the federal insurance marketplace.
Some of them may be able to have their coverage reinstated retroactively if they produce the documents that they were repeatedly asked to provide in recent months, Mr. Slavitt said.
At the end of May, the administration said, 966,000 people were found to have discrepancies in their immigration and citizenship records. Most sent in documents as requested. In mid-August, the administration sent letters to about 310,000 people who had failed to respond. They were supposed to submit documents by Sept. 5, but the 115,000 consumers failed to do so, Mr. Slavitt said.
Many consumers and lawyers who work with them said that they had tried to submit immigration and citizenship papers, but that they experienced problems transmitting documents through HealthCare.gov. Other people said they sent the documents by mail to a federal contractor in Kentucky but never heard back from the contractor or the government.
“We heard from lots of consumers who told us they sent in their documents multiple times or tried to upload them through HealthCare.gov,” said Mara Youdelman, a lawyer at the National Health Law Program, an advocacy group for low-income people.
Jenny Rejeske, a health policy analyst at the National Immigration Law Center, which represents immigrants, said: “It is unduly harsh to terminate coverage while there are still technical problems with the federal system for verifying citizenship and immigration status. And there has not been adequate notice to people who speak languages other than English and Spanish.”
Florida leads the list of states whose residents are losing coverage because of immigration and citizenship issues, with 35,100. Federal officials said they were ending coverage for 19,600 people in Texas, 6,300 in Georgia, 5,300 in North Carolina, 5,200 in Pennsylvania, 4,000 in Illinois and 2,400 in New Jersey. The numbers released on Monday are for 36 states using the federal insurance marketplace. They do not include terminations in California, New York and other states running their own insurance exchanges.
Conservative columnist bemoans the absence of public health infrastructure -
-SPC:
Goodbye, Organization Man
Imagine two cities. In City A, town leaders notice that every few weeks a house catches on fire. So they create a fire department — a group of professionals with prepositioned firefighting equipment and special expertise. In City B, town leaders don’t create a fire department. When there’s a fire, they hurriedly cobble together some people and equipment to fight it.
We are City B. We are particularly slow to build institutions to combat long-running problems.
The most obvious example is the fight against jihadism. We’ve been facing Islamist terror for several decades, now, but every time it erupts — in Lebanon, Nigeria, Sudan, Syria and beyond — leaders start from scratch and build some new ad hoc coalition to fight it.
The most egregious example is global health emergencies. Every few years, some significant epidemic strikes, and somebody suggests that we form a Medical Expeditionary Corps, a specialized organization that would help coordinate and execute the global response. Several years ago, then-Senator Bill Frist went so far as to prepare a bill proposing such a force. But, as always, nothing came of it.
The result, right now, is unnecessary deaths from the Ebola virus in Africa. Ebola is a recurring problem, yet the world seems unprepared. The response has been slow and uncoordinated.
The virus’s spread, once linear, is now exponential. As Michael Gerson pointed out in The Washington Post, the normal countermeasures — isolation, contact tracing — are rendered increasingly irrelevant by the rate of increase. Treatment centers open and are immediately filled to twice capacity as people die on the streets outside. An Oxford University forecast warns as many as 15 more countries are vulnerable to outbreaks. The president of Liberia, Ellen Johnson Sirleaf, warned: “At this rate, we will never break the transmission chain, and the virus will overwhelm us.”
The catastrophe extends beyond the disease. Economies are rocked as flights are canceled and outsiders flee. Ray Chambers, a philanthropist and U.N. special envoy focused on global health, points out the impact on health more broadly. For example, people in the early stages of malaria show similar symptoms to Ebola and other diseases. Many hesitate to seek treatment fearing they’ll get sent to an Ebola isolation center. So death rates from malaria, pneumonia and other common diseases could rise, as further Ebola cases fail to be diagnosed.
The World Health Organization has recently come out with an action plan but lacks logistical capabilities. President Obama asked for a strategy, but that was two months ago and the government is only now coming up with a strong comprehensive plan. Up until now, aid has been scattershot. The Pentagon opened a 25-bed field hospital in Liberia. The U.S. donated five ambulances to Sierra Leone. Coordination has just not been there.
At root, this is a governance failure. The disease spreads fastest in places where the health care infrastructure is lacking or nonexistent. Liberia, for example, is being overrun while Ivory Coast has put in a series of policies to prevent an outbreak. The few doctors and nurses in the affected places have trouble acquiring the safety basics: gloves and body bags. More than 100, so far, have died fighting the outbreak.
But it’s not just a failure of governance in Africa. It’s a failure of governance around the world. I wonder if we are looking at the results of a cultural shift.
California health insurance exchange unveils ad campaign and outreach
By CHAD TERHUNE
Preparing for the second year of Obamacare enrollment, California unveiled new television ads and handed out $14.6 million to community groups for consumer outreach.
The state-run insurance exchange, Covered California, said the new grant funds are in addition to $33.4 million that has already been given to clinics, unions, schools and nonprofit groups helping with enrollment.
State officials said the new grant money will support more than 220 organizations statewide working on consumer education and enrollment assistance as part of the Affordable Care Act.
Among the grants were $750,000 for AltaMed Health Services Corp. in Los Angeles and Orange counties, $300,000 for Crenshaw Health Partners in L.A. and $225,267 for the city of Long Beach.
The next open-enrollment period begins Nov. 15, and Covered California has two major tasks ahead. It wants to help about 1.2 million enrollees renew their coverage or find a better deal. It also wants to reach more of the state's uninsured population and expand enrollment to 1.7 million people by mid-February.
But the exchange will have to pull that off in three months — half the time it had during the first six-month enrollment period.
Peter Lee, executive director of Covered California, said this next round of outreach will be harder in many ways because so many potential applicants have learned to live without health coverage. He pointed out that 56% of people eligible for federal premium subsidies have gone without health insurance for more than two years and 15% have never had health coverage.
EMHS to eliminate more than 40 jobs in IT department
By Jackie Farwell, BDN Staff
Posted Sept. 15, 2014, at 5:37 p.m.
BREWER, Maine — Eastern Maine Healthcare Systems plans to eliminate more than 40 positions in its information systems department as part of a long-term effort to overhaul operations and avoid a $100 million shortfall in 2019, according to information obtained by the Bangor Daily News.
The Brewer-based health care system, parent to Eastern Maine Medical Center in Bangor, expects to eliminate 43 positions in the department, according to a July PowerPoint presentation EMHS prepared for employees. Of those, 15 are vacant positions that would be left unfilled and five represent jobs that would become obsolete, according to the presentation.
Employees in several of the remaining positions targeted for elimination may be reassigned to other jobs within the system, according to EMHS spokeswoman Suzanne Spruce. She noted the job figures haven’t yet been finalized with strategic planning still in progress.
“Forty-three positions may change, but that doesn’t mean 43 people are without a job,” she said.
The targeted positions represent about 12 percent of the workforce in the department, which employs 360 people with a wide range of technology duties, from overseeing electronic medical record and clinical information systems to an employee help desk. The majority of the department’s staff work in the Bangor-Brewer area, though several are employed at member hospitals throughout the state, Spruce said.
Better aligning the department’s functions would slash operating costs by $4.5 million through fiscal year 2015, according to the presentation.
The structural changes are part of a broader effort EMHS announced in November 2013 to “reinvent” how the system provides health care and improve its services and business functions. Without the changes, the system could face a $100 million financial gap by the end of fiscal year 2019, according to EMHS.
The system began re-examining its departments two years ago, work its top executive described as necessary to meet the health care needs of EMHS communities while saving costs.
In March, the system’s flagship hospital EMMC announced it faced a $7 million shortfall as a result of shrinking government reimbursements, fewer patients than expected and a surge in unpaid care.
The parent system already has reworked operations in its human resources and credentialing departments, Spruce said.
Several jobs may be redesigned or relocated.
‘We need to think about people not as a collection of ailments’: Michaud unveils his health care plan
By Christopher Cousins, BDN Staff
Posted Sept. 15, 2014, at 12:25 p.m.
PORTLAND, Maine — As part of a wide-ranging 10-point health care plan he unveiled Monday, Democratic candidate for governor Mike Michaud reiterated his support for expanding Medicaid to 70,000 uninsured Mainers and making investments in preventative health care programs.
The plan earned positive responses from health care advocates, though they said there is little in it that has not been discussed before.
“It’s not Earth-shattering,” said Gordon Smith, executive vice president of the Maine Medical Association, which does not endorse political candidates. “It’s all good stuff. It’s not particularly innovative, but it’s thoughtful, and there are a lot of positive things in it.”
Michaud has long said one of his first goals as governor would be to accept federal dollars offered under the Affordable Care Act, something that Gov. Paul LePage has refused to do — vetoing five such proposals sent to him by Democratic legislators in the past two years. LePage, Republican lawmakers and their supporters have argued that past expansions of Medicaid eligibility caused major debts to Maine’s hospitals and funneled money away from other health care programs.
“Michaud’s health care plan is centered around the expansion of welfare, just like the one he pushed while in the Maine Senate that caused our massive, welfare hospital debt,” said LePage campaign spokesman Alex Willette, repeating a claim the LePage campaign has been making for months.
Michaud fired back by calling LePage “fiscally irresponsible” for both the way he paid back the hospital debt — by borrowing — and for opposing Medicaid expansion, which Michaud said puts more financial pressure on hospitals to deal with uncompensated care.
“Yes, the hospitals got paid back, but [LePage] borrowed money from Wall Street to pay the hospitals back, and he’s paying interest,” said Michaud. “I would have paid that back with money. I would not have borrowed the money.”
LePage, backed by bipartisan support in the Legislature, paid past Medicaid debt to the state’s hospitals by renegotiating the state liquor contract and using the increased state profits to repay a 10-year revenue bond. The $220 million bond was taken with an interest rate of about 3.8 percent.
LePage has talked about health care very little on the campaign trail, and his campaign website makes virtually no mention of it, other than his opposition to Medicaid expansion. Willette said the governor and Republicans took a major step in 2011 with the passage of PL 90, which among other things created a high-risk insurance pool funded by a monthly fee on insurance premiums and eliminated the requirement that insurance rate hikes of less than 10 percent be reviewed by the Bureau of Insurance. Asked how LePage would cover the state’s uninsured poor, Willette said many of them are eligible to buy government-subsidized policies through the Affordable Care Act.
“The reality is that the governor has already pushed through reforms with PL 90,” said Willette. “Unfortunately, the Affordable Care Act has really taken over health care and insurance and made it a national issue to the point that the state can do less and less to impact the price of health insurance.”
Fate of Children’s Insurance Program Is Called Into Question at Senate Hearing
WASHINGTON — A Senate hearing on Tuesday set the stage for a coming debate over whether the federal government should continue financing a popular health insuranceprogram for lower-income children who are now eligible for new coverage options under the Affordable Care Act.
The Children’s Health Insurance Program, known as CHIP, has helped cut in half the uninsured rate for children, to about 7 percent in 2013 from 14 percent in 1997, when it was enacted. It provides coverage for about eight million children in families that earn too much to qualify for Medicaid, the government health care program for the poor, but cannot afford private coverage.
The federal government gives matching funds to states to provide the coverage, but that funding is set to end in September 2015, on the assumption that most beneficiaries will be able to get subsidized private coverage through the insurance exchanges created under the health care law. The federal government pays most of the $13 billion annual cost for CHIP.
But advocacy groups are warning that exchange plans will prove unaffordable for many households with children, partly because a quirk in the law prevents families from getting subsidies if a parent is offered “affordable” coverage at work. The law considers premiums on employer-based plans unaffordable if they exceed 9.5 percent of household income, but in what has become known as the “family glitch,” that standard applies only to premium costs for individual plans — not to family plans.
Another concern is that families will face more out-of-pocket costs for exchange plans, and that such plans will offer a narrower set of benefits for children. A recent analysis by the Wakely Consulting Group found that many families would need to spend substantially more out of pocket to get the same care through an exchange plan that they get through CHIP.
In Kentucky, Health Law Helps Voters but Saps Votes
LOUISVILLE, Ky. — The Affordable Care Act allowed Robin Evans, an eBay warehouse packer earning $9 an hour, to sign up for Medicaid this year. She is being treated for high blood pressure and Graves’ disease, an autoimmune disorder, after years of going uninsured and rarely seeing doctors.
“I’m tickled to death with it,” Ms. Evans, 49, said of her new coverage as she walked around the Kentucky State Fair recently with her daughter, who also qualified for Medicaid under the law. “It’s helped me out a bunch.”
But Ms. Evans scowled at the mention of President Obama — “Nobody don’t care for nobody no more, and I think he’s got a lot to do with that,” she explained — and said she would vote this fall for Senator Mitch McConnell, the Kentucky Republican and minority leader, who is fond of saying the health care law should be “pulled out root and branch.”
Ms. Evans said she did not want the law repealed but had too many overall reservations about Democrats to switch her vote. “Born and raised Republican,” she said of herself. “I ain’t planning on changing now.”
Kentucky is arguably one of the health law’s biggest early successes, with about 10 percent of the population getting coverage through the state’s online insurance marketplace — albeit mostly through Medicaid, not private plans — and none of the technology failures that plagued other enrollment websites. The uninsured rate here has fallen to 11.9 percent from 20.4 percent, according to a recent Gallup poll that found only Arkansas had experienced a steeper decline.
But there is little evidence that the expansion of health coverage will help Kentucky Democrats in this fall’s midterm elections. Republicans hold all of the state’s congressional seats except for one, in a district centered in Louisville, and none are considered vulnerable this year. Republicans, who already control the State Senate, have a chance of taking the State House of Representatives, where Democrats hold an eight-seat majority. And several recent polls have put Mr. McConnell ahead of his Democratic opponent, Alison Lundergan Grimes, even though his approval ratings are tepid.
Mr. McConnell and other Republicans here, while more focused on other issues, like protecting Kentucky’s coal industry, continue to attack the health law as a symbol of government overreach and Democratic bungling. And far from flaunting Kentucky’s strong enrollment numbers, Democratic candidates — most notably Ms. Grimes — have remained reticent about the law, even its successes.
By Jackie Farwell, BDN Staff
Posted Sept. 16, 2014, at 3:20 p.m.
The share of Mainers without health insurance rose from 2012 to 2013, making the state one of just two nationally to record an increase, according to new U.S. Census data.
The data was included in one of three health insurance surveys the federal government released Tuesday.
Maine’s uninsured population rose from 135,000 individuals in 2012 to 147,000 in 2013, an increase of 12,000 people, according to the U.S. Census Bureau’s American Community Survey. Last year, 11.2 percent of Mainers lacked health insurance, up from 10.2 percent in 2012.
Going without coverage puts Mainers’ health at risk and threatens their economic security when high medical bills hit, said Emily Brostek of Consumers for Affordable Health Care, an Augusta-based advocacy group.
“We know that people who don’t have health insurance are more likely to have a number of negative health outcomes … There have been some recent studies that show a higher death rate even, ultimately, for people and communities with high uninsurance rates,” she said.
New Jersey was the only other state to record an increase in its uninsured population, which ticked up by 47,000 people.
While Maine’s uninsured rate increased, it remained lower than rates in many other states. The national average was 14.5 percent, dipping by 0.2 percentage points.
The American Community Survey included a margin of error in Maine of 10,000 people. With a sample of 3 million households, it asks whether families are covered at the time of the survey.
Experts noted that the results reflected little about the impact of the Affordable Care Act, which aims to bring health insurance to millions more Americans. The survey was administered prior to the law’s broad expansion of health insurance coverage through private insurance marketplaces and largely before states began expanding their Medicaid programs under the ACA.
Private health insurance policies available through Healthcare.gov and state-run insurance marketplaces took effect on Jan. 1 of this year.
While Maine was one of 21 states that opted against expanding Medicaid, the health insurance program for the poor, the effect of that decision on uninsured rates won’t play out until 2014 data is available next year, said Genevieve Kenney, co-director and senior fellow in health policy at the Urban Institute in Washington, D.C.
“I don’t think this is being driven by state decisions with respect to the Medicaid expansion,” she said. “It’s a question of timing.”
But in addition to refusing to expand Medicaid, Maine Gov. Paul LePage and the 125th Maine Legislature, led by Republicans, also tightened eligibility criteria for the program in 2011 and 2012. Those changes prevented many low-income adults from qualifying or keeping their coverage.
A long-term payoff for a Medicaid expansion in Maine: Significantly better health
By Joe Feinglass, Special to the BDN
Posted Sept. 16, 2014, at 1:26 p.m.
Gov. Paul LePage’s vetoes of the Affordable Care Act’s federal subsidies for Medicaid expansion have already cost Maine thousands of jobs and hundreds of millions of dollars. Yet partisan critics of Obamacare continue to argue that expanded Medicaid coverage will have no effect on health and may actually harm the poor.
Over 40 years of research has documented that the uninsured have fewer doctor visits and fail to receive basic preventive services like blood pressure screening, pap tests, cholesterol testing and influenza vaccinations. As a result, the uninsured are diagnosed at more advanced stages of cancer, especially for cancers detectable by screening. The uninsured are much more likely to have undiagnosed high blood pressure and high cholesterol, more severe strokes and poorer control of diabetes.
A recent study of preventable leg amputations describes an uninsured 53-year-old woman with undiagnosed diabetes who was regularly drinking six-packs of ginger ale. She reported that she “felt like a junkie just looking for something just to quench my thirst.” She suffered a diabetic coma, woke up in the hospital with infected toes and required a leg amputation. Another study of unconscious patients hospitalized after severe motor vehicle crashes found that the uninsured received less care and had a 40 percent higher mortality rate than insured patients, even after controlling for type of vehicle, injury, auto insurance, income, neighborhood and hospital characteristics.
So do Obamacare critics deny the value of Medicaid coverage? Most of the uninsured are young and healthy, they might argue. They cycle in and out of employer-based insurance, and when major health declines do occur, previously uninsured individuals then qualify for disability and Medicaid.
But a study of expanding Medicaid for the uninsured in Oregon shows clearly that gaining insurance had a significant positive effect on the health of the newly insured — and that those newly covered had gone a long time without care they needed.
In 2008, Oregon conducted a lottery to fill 10,000 additional Medicaid slots for low-income, uninsured residents. Researchers compared health and financial outcomes of Medicaid lottery winners with lottery losers over the next two years. Individuals who won the lottery had a greater chance of having a physician visit, getting blood cholesterol or blood sugar tests, receiving a diagnosis of diabetes and, thus, obtaining diabetes medications. There was a 30 percent reduction in depression among insurance lottery winners, a 25 percent lower rate of unpaid bills sent to collection agencies, and catastrophic medical expenditures were reduced by more than 80 percent.
Critics of Obamacare focused on the Oregon results showing that, two years after receiving coverage, blood pressure, cholesterol and diabetes were not significantly different among those who won the Medicaid lottery. They dismissed as “perceptions” the fact that many more of the lottery winners reported their health as the same or better than the previous year, despite the fact that such questions are highly predictive of future health. Critics also decried the increase in emergency room visits for lottery winners.
Yet increased use of health care is typical of the initial transition to insured care. Older uninsured patients who transition to Medicare at age 65 receive an expensive “backlog” of tests and treatments but also experience disproportionately greater gains in health than their continuously insured peers, while their use of health care ultimately stabilizes.
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