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Friday, November 14, 2014

Health Care Reform Articles - November 14, 2014

I include the following article by Roger Cohen of the NYT because it reminded me of the huge problem of apathy on the part of a large segment of the American population, including many of my colleagues in academia, regarding the confusing complexity, cruelty and unfairness of our health care system. After all, "I've got mine".

- SPC

Mere Human Behavior


When I was a correspondent in Germany 15 years ago, I attended a ceremony at a military base renamed for a soldier in Hitler’s army who disobeyed orders. His name was Anton Schmid. He was a sergeant whose conscience was moved by the suffering of Jews in the Vilnius ghetto.
Thousands were being shot by the Germans, with help from Lithuanian collaborators, every day. It was the same story throughout Lithuania in the fall of 1941. In my grandmother’s home town of Zagaré, more than 2,200 Jews, by the Nazi count, were shot on a single day, Oct. 2, 1941.
In a letter to his wife, Stefi, Schmid described his horror at the sight of this mass murder and of “children being beaten on the way.” He wrote: “You know how it is with my soft heart. I could not think and had to help them.”
Schmid, forging papers for the Jewish underground and hiding children, managed to save more than 250 Jews before he was arrested in 1942 and summarily executed. In his last letter to his wife he wrote, “I merely behaved as a human being.”
But the human beings had all vanished, swept up in the Nazi death trance. “Merely” had become the wrong adverb; “exceptionally” would have been closer. Schmid’s resistance was almost unknown. It can be singular just to be human. It can be very lonely. It can cost your human life.

Estimates lowered of how many people will sign up for Obamacare in 2015
The Obama administration has substantially scaled back estimates of how many people will sign up for insurance in 2015 through the federal healthcare law, projecting that millions fewer Americans will use marketplaces created by the Affordable Care Act.
Instead of 13 million customers in the second year of the marketplaces, as had been predicted, the Department of Health and Human Services now says 9 million to 9.9 million people probably will get coverage by the end of next year.
About 7.1 million people have health plans through the marketplaces today, according to the federal agency.
Administration officials said the downward adjustment reflected a more realistic assessment of how quickly a new program like the marketplaces can ramp up. Officials continue to sound upbeat about the marketplaces, which are scheduled to open Saturday for a second enrollment period.
“We are confident we’re going to have a successful open enrollment,” Health and Human Services Secretary Sylvia Mathews Burwell said Monday.
Nevertheless, the lower expectations drew criticism from Obamacare’s opponents and supporters.
“The administration is again trying to rewrite its definition of success,” Rep. Marsha Blackburn (R-Tenn.) said.
The new numbers also suggest that the administration is not prepared to reach more uninsured Americans, which administration officials have said is the most important metric, said Jon Kingsdale, who ran Massachusetts’ insurance marketplace from 2006 to 2010. That program was the model for the federal marketplaces.
“I am concerned that there is not a sufficiently sophisticated outreach effort to get people covered,” he said.

Woman taken to 'wrong' hospital faces bankruptcy

By Adam Schrager
Channel3000.com (WISC-TV, Madison, WI), November 10, 2014
MADISON, Wis. - Megan Rothbauer would rather be discussing an impending engagement, her future marriage and eventually, children. However, the 30-year-old Madison resident is instead scouring the Internet looking for solutions to stave off bankruptcy.
A project manager for a manufacturing company, she is one year removed from a cardiac arrest and the subsequent physical recovery is being dwarfed by a near-impossible fiscal recovery. She was sent last Sept. 9 to the emergency room at St. Mary's Hospital, which was out of her insurance network, instead of to Meriter Hospital, three blocks away, which was covered by her insurance. It's the difference between a $1,500 maximum out-of-pocket expense and the now-$50,000-plus she's facing in bills.
"I was unconscious when I was taken to the hospital," she said. "Unfortunately, I was taken to the wrong hospital for my insurance.
"I was in a coma. I couldn't very well wake up and say, 'Hey, take me to the next hospital.' It was the closet hospital to where I had my event, so naturally the ambulance took me there. No fault to them. It's unfortunate that Meriter is in network and was only three blocks away from St. Mary's," Rothbauer said.
A News 3 investigation revealed Rothbauer's situation -- what's called "balance billing," where patients receive the balance between the hospital charge and what insurance companies will cover -- is not unique. While the local insurance companies that represent roughly 80 percent of those who have insurance in our area will offer out-of-network patients in-network rates during emergency room visits, there remains no guarantee they won't face hefty bills on the back end depending on the treatment they receive.
"My strong suspicion is this happens more frequently than you think," said Meg Gaines, who runs the Center for Patient Partnerships, a consumer health care advocacy group at the University of Wisconsin-Madison Law School. "I mean every time someone goes down, they don't have someone around who knows what their insurance is."
In Rothbauer's case, her insurer, Blue Cross Blue Shield, said it paid St. Mary's 100 percent of its in-network rate or $156,000 to cover part of the original $254,000 bill that she incurred during 10 days in a medically-induced coma and another six days in the cardiac unit. St. Mary's negotiated with Rothbauer to reduce the remainder of her $98,000 bill by 90 percent. This is separate from the bills she received from the doctors, the ambulance, the therapist and others.
Gaines said consumers have little chance to negotiate against the parties in the health care industry as they don't have the necessary tools.

Obama officials work on health site contingency plans as enrollment nears

by Amy Goldstein
With the next time to buy health plans under the Affordable Care Act starting in less than a week, the Obama administration is expressing confidence that HealthCare.gov is no longer the rickety online insurance marketplace that exasperated consumers a year ago.
Behind the scenes, however, federal health officials and government contractors are scrambling, according to confidential documents and federal and outside experts familiar with this work. They have been making contingency plans in case the information technology or other aspects prove less sturdy than the administration predicts. And some preparations are coming down to the wire.
As the Nov. 15 beginning of open enrollment nears, administration officials have been eager to draw public attention to the fact that parts of the computer system have been rebuilt, online insurance applications will be easier to use and new federal managers are in charge.
“We’re really making sure that that Web site works super well,” President Obama said at a news conference a few days ago. “We’re double- and triple-checking it.”
Despite such efforts, the confidential documents written in recent weeks hint at elaborate backup planning that undercuts the administration’s predictions that an improved HealthCare.gov will be able to handle everyone who wants to sign up. More broadly, they reflect the high stakes confronting the administration as it tries to avoid last year’s mistakes and deal with new threats to the Affordable Care Act: the Republican gains in the midterm elections and the Supreme Court’s decision to review the government insurance subsidies that are a linchpin of the law.

GOP’s anti-Obamacare push gains new momentum in wake of Gruber video

By Robert Costa and Jose A. DelReal
The Republican Party’s ardent campaign against President Obama’s health-care law gained new momentum Wednesday as lawmakers reacted angrily to assertions by an architect of the policy that it was crafted in a deliberately deceptive way in order to pass Congress.
On both sides of the Capitol, leading conservatives said they may call economist Jonathan Gruber to testify about his remarks, which were made last year and surfaced this week in a video on social media. In the video, Gruber suggests that the administration’s signature health-care legislation passed in part because of the “stupidity of the American voter” and a “lack of transparency” over its funding mechanisms.
“The strategy was to hide the truth from the American people,” said Sen. Jeff Sessions (R-Ala.), who is slated to chair the Senate Budget Committee next year. “That is a threat to the American republic.” 
Gruber has been a complicated figure in the history of the health-care law. He helped the Obama administration craft the measure and has been a leading advocate of it, but he has also made sporadic comments sparking political brush fires that have been problematic for the law’s supporters.
The White House sought Wednesday to distance itself from Gruber and his comments. 
House Speaker John Boehner (R-Ohio) outlined his priorities at a news conference following the midterm elections that swept many Republicans into Congress. He said the president "needs to put politics aside" in dealing with Republican lawmakers. (AP)
“The Affordable Care Act was publicly debated over the course of 14 months, with dozens of Congressional hearings, and countless town halls, speeches, and debates,” White House spokeswoman Jessica Santillo said in a statement. “The tax credits in the law that help millions of middle class Americans afford coverage were no secret, and in fact were central to the legislation. Not only do weMargot Sanger-Katz disagree with [Gruber’s] comments, they’re simply not true.”
http://www.washingtonpost.com/politics/gops-anti-obamacare-push-gains-new-momentum-in-wake-of-gruber-video/2014/11/12/e0d6b4d2-6aa7-11e4-9fb4-a622dae742a2_story.html?hpid=z1

The Gruber Confession

by Charles Krauthammer

It’s not exactly the Ems Dispatch (the diplomatic cable Bismarck doctored to provoke the 1870 Franco-Prussian War). But what the just-resurfaced Gruber Confession lacks in world-historical consequence, it makes up for in world-class cynicism. This October 2013 video shows MIT Professor Jonathan Gruber, a principal architect of Obamacare, admitting that, in order to get it passed, the law was made deliberately obscure and deceptive. It constitutes the ultimate vindication of the charge that Obamacare was sold on a pack of lies.
“Lack of transparency is a huge political advantage,” said Gruber. “Basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical to getting the thing to pass.” This was no open-mic gaffe. It was a clear, indeed enthusiastic, admission to an academic conference of the mendacity underlying Obamacare.
First, Gruber said, the bill’s authors manipulated the nonpartisan Congressional Budget Office, which issues gold-standard cost estimates of any legislative proposal: “This bill was written in a tortured way to make sure CBO did not score the mandate as taxes.” Why? Because “if CBO scored the mandate as taxes, the bill dies.” And yet, the president himself openly insisted that the individual mandate — what you must pay the government if you fail to buy health insurance — was nota tax.
Worse was the pretense that Obamacare wouldn’t cost anyone anything. On the contrary, it’s a win-win, insisted President Obama, promising that the “typical family” would save $2,500 on premiums every year.
Skeptics like me pointed out the obvious: You can’t subsidize 30 million uninsured without someone paying something. Indeed, Gruber admits, Obamacare was a huge transfer of wealth — which had to be hidden from the American people, because “if you had a law which . . .made explicit that healthy people pay in and sick people get money, it would not have passed.” 
Remember: The whole premise of Obamacare was that it would help the needy, but if you were not in need, if you liked what you had, you would be left alone. Which is why Obama kept repeating — PolitiFact counted 31 times — that “if you like your plan, you can keep your plan.”



First Look at Health Insurance Rates for Next Year Is Encouraging

Early evidence suggests that competition in the new Affordable Care Act marketplaces is working. Health insurance premiums in major cities around the country are barely rising.
That’s the conclusion of two studies of data about newly public insurance rates. One, from the Kaiser Family Foundation, a health research group, looked at 49 cities and found that prices for a popular type of plan are actually going down, on average. A second, from the actuarial firm Wakely Consulting Group, looked at the largest county in each of the 34 states with marketplaces run by the federal government and found an average rate increase of zero.
Decreases in the price of health insurance are basically unheard-of. The individual insurance market that these new marketplaces replaced experienced annual increases of 10 percent in recent years. In the employer market, premiums went up by a record-low rate of 3 percent this year, but even that increase can’t compare with what’s happening in many exchange markets.
“Usually, health insurance premiums have gone in one direction, and that is up,” said Cynthia Cox, a senior analyst at Kaiser who was a co-author on its paper. She said that the widespread premium decreases really stood out when she ran the numbers.
The studies suggest that, in large cities, at least, the new health insurance marketplaces are working as intended: Health insurers, competing for business, are keeping prices low. That’s great news for the federal budget, since the government is paying subsidies to help some 85 percent of people on the market pay their bills. It’s also good for consumers who will be coming to the market for the first time during open enrollment, which begins Saturday.

How Many People Have Enrolled So Far in Obamacare's Second Open Enrollment?

by Bob Laszewski

Undoubtedly I will hear that question many times in the coming weeks.

The answer is that this enrollment process is so screwed up we will have no earthly idea how many new people have enrolled and how many 2014 enrollees remained on the program until at least April 2015.

Let me try to illustrate.

Let's say George is now enrolled in Obamacare. He is happy to have subsidized and guaranteed health insurance for the first time. He was even been happier to read in the media that the second year Obamacare rate increases would be small.

He was also happy to get a letter just before the Election Day telling him he will be automatically renewed in his current plan. 

Then on December 6th George gets his January premium statement. He is paying a lot more! What happened? His insurance company phone lines are suddenly jammed. Seems like a lot of other people got a surprise.

Turns out all of those expert analysts and reporters writing stories about "average rate increases" never heard of the term loaded average––that's when the plan that got 70% market share increased their rates 15% and the rest cut their rates or gave tiny increases.

That is happening a lot in Obamacare this renewal season. Here is a sample list of the rate increases the biggest market share carriers are asking for:

Too High a Price: Out-of-Pocket Health
Care Costs in the United States
Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, September–October 2014
Sara R. Collins, Petra W. Rasmussen, Michelle M. Doty, and Sophie Beutel
Abstract Whether they have health insurance through an employer or buy it on their own, Americans are paying more out-of-pocket for health care now than they did in the past decade. A Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More than one of five 19-to-64-year- old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or more. Adults with low incomes had the highest rates of steep out-of-pocket costs. About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible.
http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/nov/1784_collins_too_high_a_price_out_of_pocket_tb_v2.pdf

Obamacare’s ‘death panel’

By Dana Milbank, The Washington Post
Posted Nov. 13, 2014, at 8:42 a.m.
So it turns out there is an Obamacare death panel after all.
It has nine members and it operates out of a marble building directly across the street from the Capitol.
When the Supreme Court on Friday announced that it would take up another challenge to the Affordable Care Act in March, it delivered the threat of two mortal blows to the signature achievement of the Obama presidency.
First, it raised the possibility that the justices, who narrowly spared the law in 2012, will in June come out with a new ruling that would dismantle the law on different grounds. But even if the justices make no such ruling, the very act of taking up the challenge will itself undermine the law. The justices announced their decision just a week before the open-enrollment period for 2015 begins — and the looming possibility that the high court will strike down the law will probably deter those who are considering signing up for its coverage.
Thus did Sylvia Mathews Burwell, the new secretary of health and human services, find herself in a defensive posture Monday afternoon, even though she was in the friendly environs of the liberal Center for American Progress. An event had been scheduled to generate enthusiasm for the new open-enrollment season, but the host, former Ohio Gov. Ted Strickland, had little choice but to acknowledge the elephant in the room.
“What do you want consumers to know and should they be concerned, as we head into this open-enrollment period, about this Supreme Court decision?” he asked gingerly.
Burwell’s practiced reply: Nothing to see here.
“The most important thing for consumers to know is that nothing has changed,” she said, assuring all that the law’s tax credits would continue. “And so as we go into open enrollment, nothing has changed,” she repeated. She kept her face determinedly in a smile, though nothing about the gesture indicated pleasure.
Strickland coached her further, asking whether she expects that “the court will ultimately make the correct decision and this will no longer be a problem?”
“That’s correct,” the secretary replied. “And I think what’s most important is that nothing has changed. And as we go into this open enrollment, which we’ll be starting this Saturday … nothing has changed.”
For those keeping score, Burwell managed to say “nothing has changed” four times in 90 seconds.
And she’s right, technically. Nothing has changed, and nothing will, at least until the Supreme Court rules. The trouble is the doubt among potential enrollees the Supreme Court has created by raising the possibility that the law will be eliminated — just like the doubt created when HealthCare.gov flopped a year ago, and the doubt Republicans have tried to create with incessant talk of repealing the law.
Further complicating Burwell’s don’t-worry message to the liberal think tank: The administration had just cut its forecasts for Obamacare enrollment in 2015 — an effort to lower expectations. Previously, the Congressional Budget Office had forecast enrollment of 13 million by the end of the year.

Obamacare and manufactured outrage: What keeps a good law from working better

Posted Nov. 12, 2014, at 2:15 p.m.
About 28 million Americans today have health insurance because of the provisions of the hyper-controversial Affordable Care Act. That’s the federal health care reform law that introduced online health insurance exchanges that have signed up more than 7 million people, allowed young adults up to age 26 to stay on their parents’ insurance and funded the expansion of Medicaid to nearly 7 million low-income people in 28 states.
It’s the law that has barred insurers from declining to cover someone because he or she has a pre-existing health condition — a provision made possible by the law’s unpopular individual coverage mandate.
It’s also the law that instantly invites outrage from those who oppose it. And now, the law’s opponents in the Republican Party and their allies who have repeatedly advocated for its repeal are newly emboldened by GOP victories in last week’s election.
Republicans will take control of the Senate, meaning repeated Obamacare repeal votes in the House might have life in more than one chamber. At the same time, the Supreme Court will consider a challenge to the law that could render a major part of it unworkable.
Add to that the release last week of year-old footage of MIT economist Jonathan Gruber discussing at an academic conference the “tortured way” in which the Affordable Care Act was written so it had a chance of passing a Congress resistant to voting for a bill designated a new tax.
“Lack of transparency is a huge political advantage,” said Gruber, who designed core components of Massachusetts’ health care reform law and the federal law that followed the Massachusetts model. “And basically, call it the stupidity of the American voter, or whatever, but basically that was really, really critical for the thing to pass.”
The outrage from Obamacare opponents that followed was predictable — and manufactured.
“Your reaction to that? Are you as outraged as most of America?” Fox & Friends host Brian Kilmeade asked Maine Sen. Angus King, an Obamacare proponent, on Tuesday.
King didn’t come out of the confrontational interview looking so good, but he didn’t give in to the manufactured outrage. And he brought up the point that needs to be the focus of any discussion about the future of Obamacare.
“We’ve got 8 million people that have insurance now that didn’t before, and don’t lecture me about this, because 40 years ago, I had insurance. If I hadn’t had it, it caught a cancer that saved my life. If I hadn’t had insurance I’d be dead,” he told his interviewers.
“And if you guys are saying people shouldn’t have health insurance, I don’t know where you’re coming from,” he said later in the segment. “Are you that cruel? That is what you’re saying.”
In March, the Affordable Care Act will be five years old. In a few days, the law’s second open enrollment period will begin, allowing newly insured people to change their coverage plans and uninsured people to gain coverage and potentially qualify for subsidies.
Since the law’s major provisions took effect, the percentage of Americans without insurance has dropped to 13.4 percent from a high of 18 percent in 2013. More insurers are participating in the second year of Obamacare’s online insurance exchanges. And those benefiting from the new coverage provisions are paying premiums that are, on average, substantially lower than the pre-Obamacare cost of individual insurance plans.
The Affordable Care Act isn’t perfect, and there are tweaks that could make the law more workable and, potentially, more popular. But as long as Obamacare is under existential threat, the law’s positive impact on millions of people’s lives will remain overlooked and the potential for it to work for even more people will be sacrificed.

The right economic message can get the Democrats back on track

By Harold Meyerson Opinion writer
A bit belatedly, Democrats have detected a deficiency in their 2014 midterm campaigns: They didn’t really have an economic message.
Economic messages are serious business for Democrats. Republicans tend to win elections not when their own economic messages are plausible (such instances are too few to be statistically significant) but when the Democrats’ economic pitch fails to persuade many voters. Such was surely the case last week. Turnout collapsed among the voters who typically benefit from Democrats’ successes at boosting the economy — so much so that the Republicans’ share of the big-city vote grew by 10 percentage points from 2012, according to the exit polls (though Democrats still won 61 percent of that vote). What that means is that minority and working-class voters in cities such as Chicago, Boston and Baltimore simply didn’t go to the polls, enabling Republicans to win the governorships of Illinois, Massachusetts and Maryland. Overall national turnout was the lowest since 1942 — another banner Republican year.
The Democrats’ problem wasn’t that the Obama administration had failed to get the economy growing again; it’s been growing since late 2009. It’s that the economy doesn’t grow like it used to. In particular, it no longer rewards labor at almost any point on the economic spectrum. The significance of IRS data showing 95 percent of post-recession income growth going to the wealthiest 1 percent is that the economy rewards investment rather than work, capital rather than labor. Maximizing shareholder value has meant minimizing employee hours and pay, which explains how many large companies can boast of rising profits even as their sales stagnate or decline. 
What, then, are the Democrats to do in an economy where merely engendering growth no longer benefits the vast majority of Americans, and their voting base least of all? It’s clear from last week’s elections in Arkansas, Nebraska and South Dakota that Americans even in the reddest of states will vote to raise the minimum wage. But how do the Democrats propose to jump-start the stalled incomes of Americans who make more than the minimum? Improving our education system is a necessity, but the dividing line in our economy isn’t between the well educated and the poorly educated; it’s between those who derive their income from their investments and those who get it from their work.

 Op-Ed 

History gives clues to Chief Justice Roberts' thinking on new Obamacare case

By RICHARD L. HASEN

The Supreme Court's surprising decision last week to hear a new challenge to the Affordable Care Act has once again focused attention on Chief Justice John Roberts, who cast the deciding vote in a 2012 decision that saved Obamacare from being declared unconstitutional. Many court watchers expect that he will once again be the swing vote in deciding a case crucial to the healthcare law, this one involving questions about who qualifies for subsidies under the law.  But Roberts' vote in a recent voting rights case suggests he might not step in to save the health law this time.

At issue in King vs. Burwell is a provision of the Affordable Care Act that authorizes subsidies in the form of tax credits for qualifying individuals who buy their insurance from exchanges "established by the state." But 34 states did not set up their own healthcare exchanges, opting instead, as the law allows, to send state residents to a federal exchange to buy insurance. The challengers argue that because this exchange was not created by a state, but rather by the federal government, people obtaining insurance through it are not entitled to subsidies.

There are strong reasons to reject this argument. First, the intent of the Affordable Care Act's drafters is clear. The text as a whole makes sense only if the provision in question is interpreted to include federal exchanges. At worst, the wording of the law might be considered ambiguous, and in ambiguous circumstances the court has said that it should defer to reasonable interpretations by the agency in charge of administering it. In this case, the IRS has interpreted the law to allow subsidies for those on federal exchanges. Finally, the court has a well-established tradition of looking to interpret laws so that they work and are coherent, a practice that long predates a recent tendency on the part of some justices to fixate on narrow snippets of statutory text.

Still, it seems entirely possible that Roberts might focus narrowly this time on the snippet of the act extending subsidies only to those insured by exchanges "established by the state." One argument he might make in defense of that position is that Congress has the ability to go back and fix any unclear language through a revised statute.

Roberts telegraphed his willingness to take such an approach in the 2013 Shelby County vs. Holder case, which struck down a key provision of the Voting Rights Act. The provision the Supreme Court declared unconstitutional defined which states had to get federal approval (or pre-clearance) before making changes to their voting laws. Roberts' opinion for the majority ordered the provision struck because it was based on old data. Congress, he reasoned, could simply update the formula to respond to "current conditions" if it wished to.
When Roberts wrote his Shelby County opinion, he knew full well that Congress would not update the coverage formula. Congress is polarized, and the issue was a political hot potato. Indeed, in the period since the opinion, a bill introduced to update the Voting Rights Act has gone nowhere. It is supported by Democrats and a sole Republican, Jim Sensenbrenner (R-Wis.).

http://www.latimes.com/opinion/op-ed/la-oe-hasen-roberts-supreme-court-obamacare-20141113-story.html


Will Obamacare separate Scalia from his principles?

Republican leaders in the House and Senate have made clear that they’ll deploy every weapon in the legislative arsenal to repeal the Affordable Care Act. They’ll try to chip away at the taxes that support it and abolish the mandates that make its insurance markets work. 
They might even stand on their heads and stop breathing if that would do the trick.
It’s a shame they are approaching matters this way. Various provisions of the Affordable Care Act have helped well over 100 million Americans, including about 20 million who gained coverage or got new insurance under the law. 
In a rational republic, both parties might try to figure out how to improve the law. Why wreck it? But elections have consequences. So if Republicans invest a lot of energy in attempting to kill the thing — well, this is exactly what they told the voters they’d do.
It’s something else again if another part of the conservative power structure does a lot of the dirty work in undermining the law before Congress has to. I refer here to the hyper-activist conservative justices on our Supreme Court. 
To the shock of many neutral legal analysts, four justices decided to take up an absurd legal challenge to the health-care law even before a lower court can rehear the case and before there is a conflict that typically triggers the high court’s involvement. 
At issue is one phrase in the law that, in the worst possible construction, is a drafting error. It declares that subsidies to help people buy insurance will be available to those who were enrolled “through an exchange established by the State under [section] 1311.”

Teamwork can help Maine achieve health care’s Triple Aim

By Andrew Webber, Special to the BDN
According to most national estimates, per-capita health care expenditures in Maine are among the top five in the United States. These high health care costs — nearly 20 percent of the state’s gross domestic product — have a crippling downstream impact on the economy and hurt the ability of businesses large and small to thrive, expand and move forward. High health care costs also squeeze needed investments in education, infrastructure and economic development and largely explain stagnant wage growth over decades.
While the reasons for this are fairly well known — we’re older, we consume a lot of health care services, we have a high rate of residents on some form of government assistance, some parts of the state lack medical infrastructure and we have increasing rates of chronic diseases like heart disease, diabetes and lung disease — solutions have been hard to come by.
Until now.
Recently, hundreds of experts from across Maine and the United States gathered in Portland for the annual symposium hosted by the Maine Health Management Coalition. The title of the event was “Finding Value: How to Improve Cost and Lower Health.” Attendees included local employers, health care providers, consumers and community leaders, and those assembled heard from national authorities on the issue of heath care costs and how to contain them. Closer to home — and more importantly — they learned about innovative approaches happening right here in the Pine Tree State. A common theme quickly emerged, and the news was refreshing indeed.
In the not too distant past, discussions in Maine about the cost of health care sometimes devolved into fingerpointing among various entities. But today’s climate is decidedly more collaborative. That is wonderful news for those who live and work in our state. Insurance carriers are teaming up with providers to better align reimbursement with the quality of health care services provided and improved outcomes as opposed to the quantity of services. Health care providers are developing more integrated and team-based systems of care built on a strong foundation of primary care and capable of managing patient populations to better health outcomes while restraining total costs. Employers also are making a contribution by using their worksites to promote healthier behaviors. Bath Iron Works, along with its insurance carrier, is providing special support to employees with diabetes, helping them lead healthier lifestyles, decreasing the need for costly medications and increasing workplace productivity.
These elements and others are why Maine is well on the way to achieving the so-called Triple Aim of health care. Developed by the Institute for Healthcare Improvement, the initiative outlines an approach to optimizing health care delivery through three parallel tracks:
— Improving the patient experience of care, including quality and satisfaction
— Improving the health of populations
— Reducing the per-capita cost of health care
Prop. 45's resounding defeat is a boon for health insurers
Already a financial bonanza for health insurers, Obamacare paid off for the industry again at the ballot box as Californians soundly rejected a bid to rein in health insurance rates.
Even so, the companies still face heat over their ever-increasing health insurance premiums, and pressure will build on California's Obamacare exchange to hold the line on rates.
California's biggest health plans, led by Anthem Blue Cross and Kaiser Permanente, spent millions of dollars on ads portraying Proposition 45's rate regulation as a threat to implementation of the health law. In a lopsided result, 60% of voters joined the industry in opposition.
Proposition 45 would have granted the state insurance commissioner veto power over rate increases for about 6 million Californians with individual and small-business policies. California regulators, unlike 35 other states, don't have authority to block rate hikes that are deemed excessive.
Despite the stinging loss, supporters of rate regulation vowed to keep fighting on behalf of consumers in the courts, state Legislature and possibly again at the ballot box.
In 2010, Anthem tried to raise rates by up to 39% in California. That move sparked national outrage and helped propel the Affordable Care Act into law.
"It's incredible that an industry that's so unpopular could do so well in this election," said Robert Laszewski, a healthcare consultant who has closely tracked California's implementation of the health law. "Pro-Obamacare forces and anti-regulation folks formed a 60% coalition. It was a strange set of bedfellows."
Both sides agreed the outcome could have been far different had the vote been held two years ago as intended.
The ballot measure came up short in 2012 on a state tally of petition signatures. Since then, the Covered California exchange has twice negotiated lower-than-expected rates and more than 1 million Californians signed up under the Affordable Care Act.
Nationwide, health insurers have gained millions of new customers through state exchanges and an expansion of Medicaid. Shares of health insurers have soared on Wall Street.




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