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Friday, December 26, 2014

Health Care Reform Articles - December 26, 2014

Governor Stops Vermont’s Move Towards Single-Payer

By Pat Bradley
WAMC Northeast Public Radio, Dec. 23, 2014
Last week Vermont Governor Peter Shumlin told Vermonters he would stop his efforts to implement single-payer health care in the state.  The decision has upset supporters, but they say it won’t stop efforts at the state or national level to implement single-payer. 
A long anticipated and delayed health care reform financing report was due to be issued at the end of this month spelling out the costs of Vermont’s transition to a single-payer health care system.  The report, obtained in advance by VTDigger.org, showed that businesses would face a payroll tax of 11.5f percent and individuals would be charged up to 9.5 percent on their state income tax to pay for the system.
Vermont Governor Peter Shumlin stunned Vermonters last week when he retreated from implementation of single-payer, explaining that converting to such a system isn’t affordable.  “Pushing for single-payer health care financing when the time isn’t right and it would likely hurt our economy is not good for Vermont and it would not be good for health care reform.”
Shumlin said he asked his team to find alternatives, but none met service criteria or they were unaffordable.  “This is the greatest disappointment of my political life so far. That we couldn’t advance this ball as quickly as we’d wished.”
Vermonters for Health Care Freedom has advocated for the state to switch from the state run to the federal healthcare exchange and to back off from its single-payer plans.  Founder and President Darcie Johnston embraces the governor’s decision.  “We knew that the financing wasn’t going to work. If you look at the state’s economy, the state is really struggling from an economic point of view and we can see that a $2.6 billion new tax is not going to help jump-start the economy anytime soon.”
Shumlin gained his office, in part, due to his advocacy for universal health care.  Many advocates of the system feel betrayed. The Vermont Workers Center, which coordinates the Health Care is a Human Right campaign, organized a rally the day after the governor’s announcement. 
Executive Director James Haslam believes Shumlin’s decision was political, not economic.  “This is a guy who’s been championing moving forward with universal health care ever since he started running for governor. He’s been trying to use it as a way to advance his political career and a lot of people voted for him for this. So it’s definitely something that has not gone over well. But the way that he was pushing for health care was really essentially, primarily so it’s pro-business. That’s for us not the goal of a health care system.”
Vermont’s efforts to become the first state with a single-payer health care system are being scrutinized nationally.  In the wake of Governor Shumlin’s announcement Physicians for a National Health Program President Dr. Andrew Coates - who practices in the Albany, NY region - and has contributed commentaries on WAMC - disagreed with his decision.  “Single-payer has enormous efficiencies by cutting out profiteering, cutting out layers and layers of middlemen. Cutting out many duplicative efforts to count the money. And without a proposal to cut out all those middlemen, which Governor Shumlin didn’t have, and then to turn around and say that single-payer isn’t feasible in Vermont was disingenuous.”
Coates adds that while this is similar to setbacks in other states, the movement toward single-payer hasn’t stopped.  “We could think about the California Democratic party while they had Governor Schwarzenegger in the statehouse. They passed single-payer and he vetoed it.  Then when they got Governor Brown in the Statehouse they decided that they wouldn’t table the bill. People were very upset. I don’t think it stopped the movement in California. I think it just means a little bit of a reality check about what we’re really up against.”  
Supporters of single-payer are planning a rally  the Vermont statehouse in January as the new legislative session begins.

Vermont ends single payer bid

Feds now left to confront the issue

BY: JOHN E. MCDONOUGH
December 23, 2014

Feds now left to confront the issue

December 23, 2014
Many American dislike the Affordable Care Act not because it goes too far but because it does not go far enough, as observed in the chart below from the Kaiser Family Foundation and the dark blue.  About 24 percent of Americans believe the ACA should be expanded, and by that, many mean a Medicare-for-All single payer financing scheme that takes insurance companies out of the equation. 
Since the ACA is nothing like single payer, for four years now, the candle in the window for single payer advocates has stood in the governor’s office in the Vermont State House.  Gov. Peter Shumlin got elected in 2010 promising to bring a single payer health financing scheme to Vermont, and various people in his administration have been hard at work figuring how to make it happen.  Last Wednesday, though, Shumlin snuffed out the candle, admitting that he couldn’t make the numbers work.
Two stories are important here.  First, what happened in Vermont, and second what does this mean for the future of single payer health care in the US?

Medicare Patient Skips Mortgage to Cope With $20,000 Bill


  Dec 22, 2014 

Each month, William Piorun has to choose between paying his mortgage or buying medicine that keeps his pituitary-gland tumor in check. 
This month and last, the 65-year-old Medicare patient paid the mortgage, and stopped taking a drug that his doctor says he needs to ward off the risk of premature death. 
Once, hard choices like these were commonly forced only on those without health insurance. Now more patients who have insurance or Medicare must confront them as drug bills for those with chronic and life-threatening decisions soar. 
Related: Gilead Drops After Drug Manager Blocks $1,000 Hepatitis C Pill
Earlier this year, Piorun faced out-of-pocket bills of $1,000 a month for medicines. That -- together with $2,000 in monthly mortgage and home-equity payments, other bills and living expenses -- was too much for him. 
“The average worker can’t pay these prices,” said the self-employed auto-parts supplier, who makes $45,000 a year. He said he was “appalled” when he discovered his medicines cost $20,000 a month, including the share that Medicare picks up. 
“You know your life is going to be shortened if you don’t take your medicines,” he said. “What do you do? Do you cut down on your food, your electricity, or your mortgage?”
More than 300,000 Americans are now taking combinations of prescription drugs that cost $50,000 or more a year, based on Medicare data and estimates by Milliman Inc., a Seattle-based actuarial firm. Many new cancer treatments cost $10,000 a month or more. 

Cost Shifting 

Prices like that have prompted one in every six employer-based plans to make patients pay a percentage share, typically about 20 percent, of the bill for high-cost specialty drugs used to treat serious conditions, according to a survey by the Pharmacy Benefit Management Institute. Meanwhile, the specialty drugs have made the cost-sharing provisions in Medicare more expensive for the elderly. 
“More and more patients are finding they can’t afford these out-of-pocket costs,” said Daniel Klein, chief executive officer of the Patient Access Network Foundation, a Washington nonprofit that provides financial aid to pay drug bills. “It is a growing issue because of the way insurance companies now are shifting costs.” 
“Now you have people who are insured but can’t afford the drug,” said Richard Evans, an analyst at SSR LLC in Stamford, Connecticut. 
Under the federal Medicare drug plan for the elderly, 85,000 Americans received prescriptions costing more than $50,000 in 2012, the latest year of federal data. 

Affordable Care Act’s Tax Effects Now Loom for Filers

If you decided to skip health insurance this year, consider this: Unless you can prove you have a valid excuse, you will be liable for a penalty during the coming tax season — and the time to start making your case is now.
That’s not all. People who bought subsidized insurancethrough one of the marketplaces may have new tax forms to complete, while paying the penalty itself may demand some serious number-crunching.
The Internal Revenue Service is gearing up to answer questions, but it warns that only half of the callers may get through — and those who succeed may have to wait a half-hour or more.
“There are quite a number of moving parts that taxpayers have not had to deal with,” said Kristin Esposito, technical tax manager for the American Institute of Certified Public Accountants.
The Obama administration’s Affordable Care Act — including its penalty provision — is in effect for the first time this year and will be reconciled through a person’s tax return.
For most taxpayers, this will simply mean checking a box on a tax return indicating they had insurance for the full year. But millions of others will have to grapple with new tax forms and calculations that may generate unexpected results.
For instance, most of the 6.7 million people who bought insurance through the exchanges received subsidies, which reduced their monthly premiums. But those subsidies were based on previous years’ income — so people whose incomes have changed will inevitably have to pay some of that money back, while others may receive fatter refunds.
Paying the penalty may also deliver some surprises. People who were uninsured for more than three consecutive months may owe something. (And since the penalty will double next year, now is the time to determine how much that might cost, before it is too late to buy a health policy through a federal or state-run marketplace for 2015.)
“This is a learning experience for everyone involved,” said Roberton Williams, a senior fellow at the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution. “When you combine that with all of the problems with the exchanges, there will be a lot of confusion and people will be sorting it out. I am sure the I.R.S. will be inundated with calls.”



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