Is Obamacare Destroying the Democratic Party?
Charles Schumer, the third-ranking Democrat in the Senate, has forced a debate over fundamental party priorities out into the open. Should Democrats focus primarily on the problems of the poor or should they first address the economic struggles of the working and middle classes?
It’s not often that a politician provokes conflict within the ranks of his party’s core supporters. Schumer did just that in a National Press Club speech on Nov. 25, three weeks after devastating Democratic losses in Senate, House, gubernatorial and state legislative elections.
According to Schumer, President Obama and his party suffered defeat last month in large part because of the strategic decision to press for enactment of the Affordable Care Act soon after Obama won the presidency. In 2009, with Democrats in full control of Congress and the White House, Schumer said,
Democrats blew the opportunity the American people gave them. We took their mandate and put all of our focus on the wrong problem – health care reform. The plight of uninsured Americans and the hardships caused by unfair insurance company practices certainly needed to be addressed. But it wasn’t the change we were hired to make; Americans were crying out for an end to the recession, for better wages and more jobs; not for changes in their health care. This makes sense considering that 85 percent of all Americans got their health care from either the government – Medicare or Medicaid – or their employer. And if health care costs were going up, it didn’t really affect them.
Schumer analyzed Obamacare in terms of pure political calculation:
Only a third of the uninsured are even registered to vote. In 2010 only about 40 percent of those registered voted. So even if the uninsured kept with the rate, which they likely did not, we would still only be talking about only 5 percent of the electorate. To aim a huge change in mandate at such a small percentage of the electorate made no political sense. So when Democrats focused on health care, the average middle-class person thought, the Democrats are not paying enough attention to “me.”
There were also adverse political and policy consequences to the emphasis on enactment of Obamacare:
Had we started more broadly, the middle class would have been more receptive to the idea that President Obama wanted to help them. The initial faith they placed in him would have been rewarded. They would have held a more pro-government view and would have given him the permission structure to build a more pro-government coalition. Then Democrats would have been in a better position to tackle our nation’s health care crisis.
Schumer’s remarks set off an explosion.
Nancy Pelosi, the Democratic House leader, responded in a written statement: “We come here to do a job, not keep a job.”
Former Obama administration staffers took to their Twitter accounts to voice their outrage.
A trip to the ‘wrong’ hospital shouldn’t bankrupt you
Sometimes, the best way to identify a problem is to see it through someone else’s eyes. Take, for example, the British media coverage of the plight of a U.S. woman who was taken to the “wrong” hospital when she suffered a heart attack. The Wisconsin woman now faces bankruptcy because of her medical bills.
How is this possible, the incredulous reporter for The Telegraph wonders?
Megan Rothbauer suffered a serious heart attack at work last September. The then-29-year-old was unconscious when an ambulance arrived. It took her to the closest hospital.
But that hospital was not in the network covered by Rothbauer’s insurer.
The result? Rothbauer was left with $52,531.92 in bills for her care, which included 10 days in a medically induced coma, The Telegraph’s David Milward reported. If the ambulance had gone three blocks farther to a hospital in Rothbauer’s insurer’s network, the bill would have been capped at $1,500.
This situation “highlighted the complexity of the American health insurance system,” Milward wrote. In America, you have to stay in your insurance network, even when facing an emergency and, in Rothbauer’s case, unable to speak and tell an ambulance what hospital to go to.
The hospital where Rothbauer was treated, St. Mary’s, was actually very accommodating. Its total bill for her care was $254,000. Her insurance company, Blue Cross-Blue Shield, agreed to pay $156,000, the rate it would pay to an in-network hospital. St. Mary’s then wrote off 90 percent of the remaining hospital charges. Rothbauer still has to pay bills from doctors, therapists and the ambulance — which were outside the Blue Cross network. These charges totaled more than $50,000.
An unnamed spokesperson for the insurance company said the company wouldn’t pay more “since we have no contract with this hospital, we have very little influence over what the hospital is charging in this situation,” The Telegraph reported.
Likewise, Rothbauer had little influence over where she ended up for her medical care. Yet she now bears a heavy financial burden for her care simply because she was taken to a hospital that didn’t have a contract with Blue Cross-Blue Shield. Rothbauer, by the way, doesn’t really blame anyone for what happened. Instead, she is focused on finding ways to pay her bill, including delaying her wedding and considering bankruptcy.
For Meg Gaines, head of the Center for Patient Partnerships, a consumer advocacy group at the University of Wisconsin-Madison Law School, “This brings the health care problems to a pinnacle. The question is, will we tolerate this as a society?”
That is the question. Reform work, like the Affordable Care Act, has eliminated some of the most egregious health insurance discrimination, such as denying policies to people with pre-existing conditions. Steering patients to providers with better outcomes and negotiating lower prices are important steps in reducing America’s high health care expenses.
But cases like Rothbauer’s show that reliance on a system heavy on bureaucracy and inflexible policies leaves people with health insurance vulnerable to falling into unexpected gaps in coverage when an emergency strikes.
Obamacare’s Inertia Problem
BY JAMES SUROWIECKI
Obamacare has had a rough month: it’s being challenged in a Supreme Court case; House Republicans are trying to undermine it with a lawsuit; and its poll numbers are terrible. But on the ground the Affordable Care Act—which is starting its second open-enrollment period—looks robust. Most people in the program say they’re happy with their plans, and new insurers are entering the market. Prices are pretty good, too: estimates suggest that premiums for the second-cheapest of the “silver” plans, which is the benchmark used to set subsidies, have risen by an average of just two to five per cent. Still, one fundamental challenge remains: if Obamacare is to succeed in holding down premiums over the long run, it needs consumers to shop around.
Obamacare has had a rough month: it’s being challenged in a Supreme Court case; House Republicans are trying to undermine it with a lawsuit; and its poll numbers are terrible. But on the ground the Affordable Care Act—which is starting its second open-enrollment period—looks robust. Most people in the program say they’re happy with their plans, and new insurers are entering the market. Prices are pretty good, too: estimates suggest that premiums for the second-cheapest of the “silver” plans, which is the benchmark used to set subsidies, have risen by an average of just two to five per cent. Still, one fundamental challenge remains: if Obamacare is to succeed in holding down premiums over the long run, it needs consumers to shop around.
People have no difficulty comparison-shopping and changing allegiance when it comes to, say, automobiles or consumer electronics. Companies in those markets face huge pressure to keep quality high and prices low. But there are also markets where consumers tend to stick with the same choice forever, even though switching could save them quite a bit of money. Energy bills are a classic example. We’ve long been told we can save money by leaving incumbent providers for newer upstarts, but the vast majority of us haven’t. Economists call it consumer inertia, and you can see it in many fields, including banking, credit cards, and health insurance. “History tells us that people are very sticky about health insurance,” Larry Levitt, a senior vice-president at the Kaiser Foundation, told me. “If you look at federal employees or at Medicare Part D, people generally don’t switch plans from year to year.”
Lincoln Hospital to Stop Delivering Babies
By PATTY WIGHT
LINCOLN, Maine — Starting next spring, the sound of a newborn baby's first cry will be heard a lot less frequently at Penobscot Valley Hospital.
The hospital, in rural, Lincoln is ending nonemergency delivery services on May 1 due to a decline in newborns in the area and the departure of four physicians. The limiting of services is happening at hospitals across the state and the nation, and some health advocates say that's not necessarily a bad thing.
Five years ago, 100 babies were born at Penobscot Valley Hospital, situated between Bangor and Millinocket. So far this year, that number has dropped to 59. That's a steep decline, says hospital spokeswoman Kristie Libby.
"Most facilities our size — we're a small critical access hospital — they use a cut off of about 200 deliveries a year," she says. "Anything less than that, they start to look at the service and analyze whether you can provide great quality with such low numbers of deliveries."
Libby says what finally pushed the decision to end delivery service at the hospital was the impending departure of all four obstetrical service specialists within the next year or so.
Underinsurance Remains Big Problem Under Obama Health Law
By Aaron E. Carroll, MD
The New York Times, December 1, 2014
Before the A.C.A. was passed, underinsurance was prevalent. Of adults age 19-64 in 2010, 16 percent, or 29 million, met the Commonwealth Fund’sdefinition of being underinsured: one’s out-of-pocket health care costs exceeding 10 percent of income (5 percent when income is less than 200 percent of the federal poverty line), or one’s insurance deductible being more than 5 percent of income. The number of underinsured Americans had grown by 80 percent from 2003 to 2010.
This is important, because research shows that those who are underinsured are more likely to go without needed care.
In the most recent update of the Commonwealth Fund survey, conducted in September and October of this year, investigators found that 13 percent of all adults 19-64 spent more than 10 percent of their income on out-of-pocket health care costs. Poor adults were the most likely to spend this amount. More than 30 percent of nonelderly adults earning less than the poverty line spent more than 10 percent of their income on out-of-pocket costs, and 18 percent of those making between 100 percent and 200 percent of the poverty line did so. All of these people were insured.
Deductibles remain high for Americans as well. Over all, 13 percent of people age 19-64 had a deductible that was 5 percent of their income or more. Since Medicaid traditionally doesn’t have deductibles, pretty much all of these people had private insurance. Still, those at the lowest end of the socio-economic spectrum were hit the hardest. A full quarter of nonelderly adults below the poverty line had deductibles this large, and 20 percent of those making between 100 percent and 200 percent of the poverty line did.
This is too much for many to spend. More than 40 percent of people who were surveyed said their deductibles were unaffordable. Almost two-thirds of people making between 100 percent and 200 percent of the poverty line said they were unaffordable.
http://www.pnhp.org/print/news/2014/december/underinsurance-remains-big-problem-under-obama-health-law
The New York Times, December 1, 2014
The Affordable Care Act, like most health care reform efforts, focuses on people without insurance. That’s fine, because those people do face significant problems obtaining health care in the United States.
But underinsurance is a real concern, too, and it’s often ignored.Before the A.C.A. was passed, underinsurance was prevalent. Of adults age 19-64 in 2010, 16 percent, or 29 million, met the Commonwealth Fund’sdefinition of being underinsured: one’s out-of-pocket health care costs exceeding 10 percent of income (5 percent when income is less than 200 percent of the federal poverty line), or one’s insurance deductible being more than 5 percent of income. The number of underinsured Americans had grown by 80 percent from 2003 to 2010.
Some of the A.C.A.'s regulations, such as removing annual or lifetime limits on reimbursements, were aimed at reducing the out-of-pocket spending that people might have to make. When the act went into effect and some people found their policies had been canceled (despite President Obama’s now-infamous assurance that “if you like your health care plan, you can keep it”), it was often because those policies left them underinsured, even if they didn’t realize it.
But the A.C.A. has not done as much as many had hoped it would to reduce underinsurance. In fact, it may be helping to spread it. And proposed modifications to the law, like those that would introduce a new tier of “copper” plans in addition to bronze, silver, gold and platinum, might make underinsurance worse.This is important, because research shows that those who are underinsured are more likely to go without needed care.
In the most recent update of the Commonwealth Fund survey, conducted in September and October of this year, investigators found that 13 percent of all adults 19-64 spent more than 10 percent of their income on out-of-pocket health care costs. Poor adults were the most likely to spend this amount. More than 30 percent of nonelderly adults earning less than the poverty line spent more than 10 percent of their income on out-of-pocket costs, and 18 percent of those making between 100 percent and 200 percent of the poverty line did so. All of these people were insured.
Deductibles remain high for Americans as well. Over all, 13 percent of people age 19-64 had a deductible that was 5 percent of their income or more. Since Medicaid traditionally doesn’t have deductibles, pretty much all of these people had private insurance. Still, those at the lowest end of the socio-economic spectrum were hit the hardest. A full quarter of nonelderly adults below the poverty line had deductibles this large, and 20 percent of those making between 100 percent and 200 percent of the poverty line did.
This is too much for many to spend. More than 40 percent of people who were surveyed said their deductibles were unaffordable. Almost two-thirds of people making between 100 percent and 200 percent of the poverty line said they were unaffordable.
http://www.pnhp.org/print/news/2014/december/underinsurance-remains-big-problem-under-obama-health-law
Medical errors in Mass. still common, study finds
State center resets focus on safety, care
The case of Betsy Lehman, a Boston Globe health reporter who died in 1994 after receiving a massive overdose of chemotherapy at a prestigious Boston cancer center, galvanized health leaders to reduce medical errors.
But two decades later, nearly one-quarter of Massachusetts residents say they, or someone close to them, experienced a mistake in their medical care during the past five years, according to a survey released Tuesday. And about half of those who reported a mistake said the error resulted in serious health consequences.
The poll of 1,224 residents by Harvard School of Public Health researchers found that many people did not report the medical mistakes, often because they did not believe it would do any good, or they did not know how to report it.
The findings are in a trove of new reports commissioned by an agency created in Lehman’s memory, the Betsy Lehman Center for Patient Safety and Medical Error Reduction.
“When you are trying to reduce incidents, and 20 years later you still have a significant number of people who report a significant event, it sets off concerns,” said Robert Blendon, a Harvard professor of health policy and political analysis, and the poll’s director.
Lehman, a 39-year-old wife and mother of two who had been undergoing breast cancer treatment, was given a fourfold overdose of an anticancer drug, despite questions raised by her husband at the time about her horrific symptoms. The mistake was not detected until a routine review months after her death.
In 1999, a landmark report from the Institute of Medicine concluded that as many as 98,000 people were dying in hospitals each year because of preventable medical errors.
A study released Tuesday from the federal government suggests some progress in stemming the tide. An estimated 50,000 fewer hospital patients nationwide died in the past three years, largely from decreases in medication errors and pressure sores, compared with the rates in 2010, the Department of Health and Human Services analysis concluded.
The Lehman center was launched in 2004 as part of the state’s Executive Office of Health and Human Services, and produced guidelines to reduce patient harm in weight-loss surgery and to control infections during treatment in medical facilities. But it struggled for funding, then fell victim to recession budget cuts and went dark in 2010.
It was reestablished last year because of a push by state Senator Richard T. Moore, former chairman of the Joint Committee on Health Care Financing, to improve quality and reduce health care costs. The center is now an independent agency within the state’s Center for Health Information and Analysis, and draws its $970,000 annual budget from a fee assessed on hospitals and insurers.
By Kay LazarGLOBE STAFF
Obama administration announces major decline in medical errors
Infections and other medical errors that harm patients in hospitals have declined significantly, the Obama administration said Tuesday, hailing the progress as a sign that new efforts to improve patients' safety are bearing fruit.
From 2010 to 2013, so-called hospital-acquired conditions declined 17%, according to a new report from the Department of Health and Human Services.
Administration officials said the declines resulted in about 50,000 fewer deaths and savings of some $12 billion.
“Today's results are welcome news for patients and their families,” said Health and Human Services Secretary Sylvia Mathews Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our healthcare dollars more wisely. HHS will work with partners across the country to continue to build on this progress.”
The improvement initiative, which the administration kicked off in 2011 with funding from the Affordable Care Act, was driven by growing concern about widespread quality problems in U.S. healthcare.
Maine Businesses Gear Up for Affordable Care Act's 'Employer Mandate'
By PATTY WIGHT
AUGUSTA, Maine - In 2015, the Affordable Care Act's so-called "employer mandate" kicks in. Companies with 100 or more full-time equivalent workers must offer health insurance to at least 70 percent of their employees.
No comments:
Post a Comment