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Tuesday, April 28, 2015

Health Care Reform Articles - April 28, 2015

Britain’s National Health Service, Creaking but Revered, Looms Over Elections

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LONDON — The room was bare and crowded, and as patients waited impassively to see a doctor, workmen labored noisily around them installing seating while one man vomited discreetly into a bucket.
Sometimes, when visiting a hospital here, it is hard to see why Britain’s National Health Service is held in such high esteem that competing claims to be its protector could help decide the national elections next month.
Yet as much as ever, the health system, now creaking under the strain of an aging population and tight budgets, remains a touchstone of British life, an institution that has, to a remarkable degree, escaped the ideological conflicts that have characterized the debate over health care in the United States. With the governing Conservatives and the opposition Labour Party locked in a tight race, the political jousting over health care essentially boils down to one question: Who would spend more on it?
Largely untouched by the conservative revolution unleashed by Prime Minister Margaret Thatcher in the 1980s or by Britain’s continued drift toward a more market-based society, the National Health Service still mostly provides what it promised when it was established by a Labour government in the 1940s: free treatment for all.
Ahead of elections on May 7, Labour has pledged to find an additional 2.5 billion pounds, or $3.76 billion, for health care, a sum it describes as a “down payment.” The Conservatives — whom, according to opinion polls, voters trust less on health care — have trumped that by promising an extra £8 billion a year, but without explaining where the money would come from.
Despite the system’s many shortcomings and failures, regularly documented in newspapers and on television, there is no serious debate in Britain about moving away from universal health care. Indeed, the right-wing, populist U.K. Independence Party, the one British party to flirt with the idea of shifting to a private insurance system, has retreated on the issue.
In an era when Britons disdain their politicians and detest their bankers, government officials see the National Health Service as “the most revered public institution in this country,” said Chris Ham, chief executive of the King’s Fund, an independent health care charity.
“No government would want to seriously entertain changing the basic principles on which health care is funded and provided,” Mr. Ham said. “It would be electoral suicide to move away from that model, even though clearly it’s under huge strain.”


The Demise of Vermont's Single-Payer Plan

John E. McDonough, Dr.P.H., M.P.A.
On December 17, 2014, Vermont Governor Peter Shumlin publicly ended his administration's 4-year initiative to develop, enact, and implement a single-payer health care system in his state. The effort would have established a government-financed system, called Green Mountain Care, to provide universal coverage, replacing most private health insurance in Vermont. For Americans who prefer more ambitious health care reform than that offered by the Affordable Care Act (ACA), Shumlin's announcement was a major disappointment. Was his decision based on economic or political considerations? Will it damage the viability of a single-payer approach in other states or at the federal level?
Shumlin's exploration of a single-payer health care system, which included three assessments by different expert groups, was among the most exhaustive ever conducted in the United States. A 2011 study led by Harvard health economist William Hsiao provided optimistic projections: immediate systemwide savings of 8 to 12% and an additional 12 to 14% over time, or more than $2 billion over 10 years, and requirements for new payroll taxes of 9.4% for employers and new income taxes of 3.1% for individuals to replace health insurance premiums 
Two years later, a study by the University of Massachusetts Medical School and Wakely Consulting projected savings of just 1.5% over 3 years.Finally, a 2014 study by Shumlin's staff and consultants predicted 1.6% savings over 5 years and foresaw required new taxes of 11.5% for employers and up to 9.5% for individuals. The governor cited these last projections in withdrawing his plan: “I have learned that the limitations of state-based financing, the limitations of federal law, the limitations of our tax capacity, and the sensitivity of our economy make that unwise and untenable at this time . . . . The risk of economic shock is too high,” Shumlin concluded.
Two factors explain most of the decline in the plan's financial prospects. First, the anticipated federal revenues from Medicaid and the ACA declined dramatically. Second, Shumlin's policy choices significantly increased the total projected cost of Green Mountain Care: raising the actuarial value of coverage — the expected portion of medical costs covered by a plan rather than by out-of-pocket spending — from 87% to 94%, providing coverage to nonresidents working in Vermont, and eliminating current state taxes on medical providers. Still, even Shumlin's projections indicated that the plan would reduce Vermont's overall health spending and lower costs for the 90% of Vermont families with household incomes under $150,000. Despite differing projections, all three studies showed that single payer was economically feasible.
In reality, the Vermont plan was abandoned because of legitimate political considerations. Shumlin was first elected governor in 2010 promising a single-payer system. But in the 2014 election, his Republican opponent campaigned against single payer. Shumlin won the popular vote by a single-percentage-point margin, 46% to 45%, which sent the election to the Democratic-controlled House of Representatives; though the House reelected him easily in January, a clear public mandate for his health care agenda was nowhere in evidence.
Public disagreement over single payer was clear in an April 2014 survey showing 40% public support, 39% opposition, and 21% undecided. Though Shumlin's team had worked hard on policy development between 2011 and 2014, they had neglected to launch a serious and sustained effort to educate the public — a crucial missed opportunity. Indecision was evident in the Vermont legislature, where strong support for single payer was hard to find. Also, the administration's disastrous launch of its ACA health insurance exchange website, Vermont Health Connect, created doubts about the state's capacity to assume management and administrative responsibilities for the entire health care system.
Asking the legislature to approve a new 11.5% payroll tax on employers and income taxes on households as high as 9.5% to finance Green Mountain Care would have increased the size of Vermont's 2015 state budget, set at $5.6 billion, by 45%. Even though the taxes would have replaced private insurance premiums that employers and individuals currently pay, and even though the Internal Revenue Service had agreed that the taxes would be federally deductible, in political terms it would have been a mammoth increase that would have been glaringly evident on every Vermonter's tax bill, unlike employer-based health insurance premiums, which most workers fail to notice. According to research in behavioral economics, people pay more attention to hypothetical losses than to hypothetical gains. The political furor that would certainly have erupted over Shumlin's tax plan — as foreshadowed by the political uproar over the ACA — would have left most Vermonters believing they would be losers. Shumlin's decision to withdraw the plan represented a failure of political will — but sometimes making decisions because of likely political consequences is the necessary, albeit regrettable, thing to do.
In many states, legislators continue filing bills to establish state single-payer systems. Because of Vermont's failure, their path is both clearer and more difficult. Any other state considering this path will find obstacles similar to Vermont's.
For example, Section 1332 of the ACA permits state governments, beginning in 2017, to obtain federal waivers to develop alternative health coverage systems and to claim federal revenues that would otherwise flow into the state under the ACA. The three reports on Vermont's single-payer plan offered widely varying and rapidly descending revenue estimates: $420 million in the 2011 report, $267 million in 2013, and $106 million in 2014.
In the early 1990s, I served as a Massachusetts legislator who took a turn as the state's leading single-payer advocate. After years of failure, I reluctantly concluded that single payer is too heavy a political lift for a state. Though the economic case is compelling, our body politic cares about more than just economics. In 2011, many observers thought that Vermont, a small and progressive state, was the ideal locale in which to try single payer. No more. Even in deeply blue Massachusetts, Donald Berwick, former acting administrator of the Centers for Medicare and Medicaid Services, came in last in the 2014 Democratic gubernatorial primary in a campaign where his single-payer platform represented a compelling difference between him and his two opponents.
At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states — and no time soon.


UNE official: Better teamwork could reduce medical errors

By Scott Mitchell Johnson, Presque Isle Star-Herald
Posted April 24, 2015, at 4:25 p.m.

RESQUE ISLE, Maine — Teamwork among health care professionals can lead to better patient outcomes, according to Dr. Dora Anne Mills, vice president for clinical affairs at the University of New England.

Mills shared some of the university’s research on team-based care during a summit on interprofessional collaborative practice held earlier this month at Northern Maine Community College. She also extended an invitation to Aroostook County hospitals and health centers to host teams of UNE health profession students.

“About 210,000-440,000 Americans die every year in hospitals due to medical errors, mostly health care associated infections and medication mistakes,” Mills said. “When you do a root cause analysis of those errors, what you find out is that 80 percent of them are due to poor teamwork — that is the health care professionals, especially with professionals from other health professions, have ineffective communication, coordination and/or collaboration.
“The Institute of Medicine recommends that health professionals learn how to be effective team members, especially with students from different professions and with patients through strategies called interprofessional education,” Mills, who was Maine’s public health director for 15 years, said.
Mills said she spent four years in medical school and three years in residency and “never once during those seven years was intentionally placed with a nursing student or a dental student or anybody else.”
“I only trained with other medical students. It’s sort of like training the first baseman together with just other first basemen, training the outfielders together with just other outfielders, and so on and so forth, and then on opening day say, ‘OK, now you guys get on the field and play together.’ They don’t really know the language that each other uses, they don’t know the strategies each other uses; they’re all hanging onto a different part of the elephant,” she said.
“Health professionals generally are very dedicated to their patients,” Mills continued, “but because we are traditionally educated and trained in the silos of our separate professions, working in a team with those from other professions is not necessarily easy.”
For about 15 years, Mills said, UNE has been educating health profession students from the 13 degree programs — including medical, dental, pharmacy, nursing, physician assistant, dental hygiene, occupational therapy, physical therapy and social work — together on campus.
“The students learn from each other how a doctor approaches a patient versus how a nurse might or a pharmacist might, differences in their scope of practice, differences in language, etc.,” she said.
Thanks to a Josiah Macy Jr. Foundation grant, UNE is expanding the efforts that were initiated on campus, now fully integrating them into clinical settings by implementing clerkships in which students from different professions work together in the same clinical settings, Mills said.

Democratic lawmakers reject switching their health coverage to Obamacare

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Democratic state lawmakers on Thursday shot down a proposal that would have required all California state legislators to get their health insurance from Covered California, the benefits exchange set up to implement Obamacare in the state.
The Assembly Rules Committee split along party lines, with seven Democrats opposing AB 1109 and three Republicans in support of the bill by Assemblyman Scott Wilk (R-Santa Clarita). The measure would have forced lawmakers to give up the taxpayer-subsidized health plans provided by the Legislature and individually sign up for Covered California.
Wilk introduced the measure after hearing complaints from several constituents about difficulties in signing up on the Covered California website and limitations on what is covered.
“I believe the Legislature would be more pro-active in addressing these concerns if we were enrolled in the program,” Wilk said.
However, some Assembly members said the legislation violates a provision of the federal Affordable Care Act (ACA) that prohibits large employers from shifting their workers to Obamacare.
Wilk does not believe the ACA provision on large employers would prevent lawmakers from switching to Covered California, according to his spokeswoman, Lisa Johnson.
“Legislators are not employees of the Assembly in any traditional sense,” she said. “They aren’t hired or fired by the Assembly.  They have immunity from many things.  Legislators are representatives to their respective districts and are elected by the people. If anything, they are employees of those voters and individual districts.”

18,000 Californians use extended Obamacare sign-up to avoid tax penalty

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California officials said about 18,000 people have taken advantage of an extended Obamacare enrollment period that was created as a final opportunity to escape the health law's tax penalties.
The special enrollment window runs until April 30 for people who claim they were unaware of the Affordable Care Act's financial penalties for being uninsured.
Peter Lee, executive director of the Covered California exchange, said Tuesday that since Feb. 23 more than 18,000 people have signed up for a private health plan and cited that reason for enrolling during the extended period.
Normally, obtaining a policy outside regular open enrollment, which closed Feb. 20, is reserved for people who experience a qualifying event such as divorce, having a child or losing employer coverage. That type of special enrollment is available year round.
Overall, 1.4 million Californians get their health coverage through the state marketplace.
Uninsured people can't avoid a health-law penalty for lacking coverage in 2014. But there's still time to do something for the 2015 tax year.

Decades-long Franklin County health initiative praised in national medical journal

By Judith Meyer, Sun Journal
Posted Jan. 14, 2015, at 1:07 p.m.
FARMINGTON, Maine — Forty years ago, the concept that the health of an entire community could be improved if everyone worked together for their shared benefit was launched by a handful of doctors and nurses at Franklin Memorial Hospital.
That concept is earning high praise from the Journal of the American Medical Association, along with the Journal of the American Medical Association’s recommendation that the accomplishments in Franklin County deserve international study.
In the 1970s, recognizing that low-income residents were not getting the health care they needed, Dr. Burgess Record and his wife, Sandra Record, R.N., solicited the help of co-workers and volunteers who teamed up and went to churches, town halls, schools and businesses to talk to people about high blood pressure and do health screenings, combining social outreach and individual medical care.
At the suggestion of Dr. David Dixon of Franklin Memorial Hospital, they tracked their efforts and patient outcomes and have since proven this community-based health care model works to help prevent chronic disease.
According to their data, this team approach reduces hospitalizations, reduces deaths, increases quit-smoking rates, improves the lives of people suffering from chronic diseases and increases workplace productivity.
The community-based health care model — The Franklin Model — is the subject of what is being called a tremendously important Journal of the American Medical Association study titled “ Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County 1970-2010.”
The study was released Tuesday.
Included in the Journal of the American Medical Association report is an editorial recommending the Franklin approach be studied for possible replication in rural areas of the United States and other parts of the world.
In fact, Franklin Memorial Hospital Chief Operating Officer Gerald Cayer, one of 10 study co-authors, said the proof of improved health under the Franklin approach is so clear and the process so well-documented in the Journal of the American Medical Association study that it supports the idea “that this approach is replicable and may be a piece of the surprising solution for fixing our health care system.”
At a news conference announcing details of the Journal of the American Medical Association study Tuesday at Franklin Memorial Hospital, Dixon said the idea of teams reaching out to their neighbors to improve health care seemed straightforward and attainable in the 1970s, but “it was a deceptively difficult task” to document the work and prove that their approach works. And in the early years, not everyone in the county supported their efforts.
Less comprehensive efforts in other communities failed, including in Minnesota and Rhode Island, but Dixon attributes the success in Franklin County to its community base.
Dr. Daniel Onion of the Maine-Dartmouth Family Medicine Residency and another co-author of the Journal of the American Medical Association study said he moved to Franklin County “in the 1970s with a 1960s zeal to help the community.”
That zeal propelled, Dixon, Onion, the Records, Dr. Roderick Prior and Fenwick Fowler of Western Maine Community Action, among others, to come up with a plan to improve access and document patient outcomes. They describe it as a frugal, efficient and effective plan.
Due in great part to a federal grant, Franklin Memorial Hospital increased staff and established three satellite clinics, creating a nurse-directed communitywide effort to reach people where they shopped, worked, worshipped and their children attended school.
After years of continued outreach, including finding and reaching out to patients who didn’t attend appointments, Prior said the result was that Franklin County started to produce good health statistics, better than elsewhere in Maine. That is despite its low-income population, which is generally a statistical indicator of poor health.
In time, and after then-Gov. Angus King and then-Public Health Director Dr. Dora Anne Mills designated tobacco settlement funds for quit-smoking programs, the quit-smoking rate in Franklin County was higher than anywhere in Maine and higher than the U.S. average. The hospitalization and mortality rates for those living in Franklin County were lower than in Maine and elsewhere in the country, and those successes have since continued.
According to Onion, health care workers and volunteers “created peer support for a community culture change,” demonstrating that, by working together, “low-income counties may not be doomed to low health outcomes.”
Angus King, a U.S. senator, joined the news conference by video and said the Journal of the American Medical Association study “is a big deal. This is a big national deal. It verifies what some of us have known for years,” and that is “community health can be improved.”
King’s wife, Mary Herman, joined him in the videoconference. A nurse, she praised the study participants for their work and said her favorite part of the Franklin story was how volunteers worked in the community among their friends and neighbors “to bring about behavioral changes.”
King, who said he hoped other communities will look to the Franklin model to improve their health, said he has faith it can be done if people remain committed.
“This is a national model that can be replicated and can save money,” King said, a combination “that is a good thing for Maine, for Franklin County, but really for the entire United States.”
He called the Franklin results “an important direction for health care.”
Franklin’s success, according to Sandra Record, was to go where people are rather than expect everyone, particularly those who don’t have insurance or can’t pay for health care, to seek medical attention.
“We go to where the people are, was our motto,” she said, including outreach at the University of Maine at Farmington, five school districts and 60 community and civic groups across Franklin County. And in an effort to lead by example, Franklin Memorial Hospital became the first smoke-free hospital in Maine.
Dr. Thomas Pearson, executive vice president for research and education at the University of Florida Health Services Center and a co-author of the Journal of the American Medical Association study, called the 40-year commitment in Franklin County “just amazing.” He described it as a group of people “who decided to do the right thing and then stuck with it.”

Former Rep. Allyson Schwartz's new group, The Better Medicare Alliance, is not what it appears

Commentary: Fronting for a phony front group

By 

 

 Updated: 

Admitted to Your Bedroom: Some Hospitals Try Treating Patients at Home

When Martin Fernandez came into Mount Sinai Hospital’s emergency room one recent afternoon, with high fever and excruciating abdominal pain, he and his family were asked an unexpected question.
Mr. Fernandez, 82, would have to be officially admitted to receive intravenous antibiotics for his urinary tract infection. But he could stay at Mount Sinai, or he could receive treatment at home.
If he chose to be hospitalized at home, doctors and nurses would visit daily. He would receive lab draws and intravenous medications, even X-rays or ultrasound scans if he needed them. The costs to him would be no greater than if he were physically in the hospital. In three or four days, he would be discharged — and he would not have to go anywhere.
For Mr. Fernandez, a retired house painter from Venezuela who lives with his wife on Manhattan’s Upper West Side, the choice was clear. He was hospitalized at his daughter’s apartment, just a couple blocks away, a few hours later.
He had a urinary catheter, but Mr. Fernandez could still wear his own clothes during the day and his pajamas at night. His wife and his daughter cooked him meals of arepas, vegetables and black beans, and served them to him in bed.
“Hospitals help you, but there’s so much noise that you can’t sleep and you’re lonely,” said Mr. Fernandez’s daughter, Ana Vanessa Fernandez. “Here, there was no timing for visitors. There was no curfew. It’s like being at home, but the hospital is home with you.”


Health Care Policy and Marketplace Review

A Health Care Reform Blog––Bob Laszewski's review of the latest developments in federal health policy, health care reform, and marketplace activities in the health care financing business.
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The Republicans should offer an unconditional subsidy extension if the Supreme Court strikes them down


Wisconsin Senator Ron Johnson (R) has offered a plan to extend the Obamacare state exchange subsidies into 2017 if the Supreme Court strikes them down this summer. The Republican Senate leadership is supporting his bill.

But Johnson has some pretty big conditions:
  • Existing subsidies in the federally run exchanges would continue until September 1, 2017. 
  • The individual mandate would be struck down.
  • The employer mandate would also be repealed.
  • Obamacare's benefit mandates––the essential health package requirements––would be struck down enabling insurance companies to market any health insurance plans that complied under state law. 
  • Consumers could keep any pre-Obamacare policies still in effect. 
  • The subsidy extension would not apply to new enrollees––just those individuals and families getting subsidies at the time the Senator's bill became law. 
On the face of it, Republicans are smart to demand the most unpopular parts of Obamacare should be immediately scrapped.

But, Democrats just aren't going to go for this. They will point out that while the individual mandate was being struck down the guarantee issue provisions of Obamacare would still be intact leading to significant anti-selection and problems for the health insurance markets without at least a viable alternative to the individual mandate.

They will also point out that all subsidized enrollments in the federally-run states would be frozen resulting in people who would otherwise be eligible for coverage being prohibited from signing up for subsidized Obamacare insurance, including during the scheduled open-enrollments starting in late 2015 and late 2016. 

In other words, this Republican strategy just takes us into another partisan pissing contest while regular people worry about the status of the insurance subsidies.
http://healthpolicyandmarket.blogspot.com

Vermont Activists Battle Democratic Governor for Single-Payer Health Care 

April 27, 2015
Steve Early, Workers Power Administration
Liz Nikazmerad is a rarity in American labor: a local union president under the age of 30, displaying both youth and militancy. For the last two year years, she has led the 180-member Local 203 of the United Electrical Workers (UE), while working in the produce department of City Market in Burlington, Vermont. Thanks to their contract bargaining, full-time and part-time employees of this bustling community-owned food cooperative currently enjoy good medical benefits.
But that wasn’t always the case in Nikazmerad’s past non-union jobs, nor is it any assurance that UE members won’t be forced to pay more for their health care in the future. To curb medical cost inflation and related cost-shifting to workers, the UE has long advocated that private insurance plans be replaced with publicly funded universal coverage.
Four years ago, a newly elected Vermont governor, Peter Shumlin, took a promising first step in that direction at the state level. His Democrat-dominated legislature passed Act 48, which laid the groundwork for creating a comprehensive public insurance plan called Green Mountain Care (GMC).
Not all activists deemed GMC to be truly “single-payer,” because of potential legal or political obstacles to the inclusion of Vermonters currently covered through Medicare, the Veterans’ Administration, and even some “self-insured” plans offered by local employers. However, Act 48’s blueprint for getting everyone else into a more rational, cost-effective healthcare system, financed by taxes, was generally hailed as a great breakthrough.
Unfortunately, the Affordable Care Act (ACA) first required Vermont to operate a private insurance exchange until 2017, when a federal waiver permitting further experimentation might be granted. Despite this delay, Shumlin was still reassuring Vermonters, as recently as last fall, that a brighter health care future lay just a few years ahead.
By January 8, when the governor began his third term, that promise had dimmed so much that Liz Nikazmerad and several hundred others weren’t there to applaud his inauguration in Montpelier. Instead, frustrated advocates of health care reform staged a sit-in at the state capitol, chanting and singing, unfurling banners and refused to leave in protest against the governor’s abrupt abandonment of universal health care six weeks after his re-election.
“People had fought for this a long time,” Nikazmerad says. “It was a huge win and to have the rug yanked out like that was very upsetting. People were very emotional about it.”


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Thursday, April 23, 2015

Health Care Reform Articles - April 23, 2015

Obamacare, Hands Off My Medicare




A number of factors underpin the anti-redistributionist shift in public opinion that I wrote about last week.
First, and perhaps most important, is the emergence of significant resistance to downward redistribution among the elderly, a major voting bloc.
The views of older voters deserve scrutiny. They “worry that redistribution will come at their expense, in particular via cuts to Medicare,” Vivekinan Ashok, a Ph.D. candidate in political science at Yale; Ilyana Kuziemko, a professor of economics at Princeton; and Ebonya Washington, a professor of economics at Yale, write in a March 2015 Brookings Institution essay, “Support for Redistribution in an Age of Rising Inequality”— an essay my Times colleague Neil Irwin also discussed in a recent column that asked why Americans don’t want to soak the rich.
In the end, Ashok, Kuziemko and Washington conclude that
the elderly have grown increasingly opposed to government provision of health insurance and that controlling for this tendency explains roughly half of their declining relative support of redistribution.

What the Brookings essay neglects to explore are the material circumstances of over-65 voters that might affect their views on redistribution. Over a third of retirees depend on Social Security for 90 percent or more of their annual income, according to the Social Security Administration. In the zero-sum competition for federal dollars, the cost of major spending programs like the Affordable Care Act has to be made up by spending cuts elsewhere.

http://www.nytimes.com/2015/04/22/opinion/obamacare-hands-off-my-medicare.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region&_r=0



It’s time for Maine to reconsider Medicaid expansion


Gov. Paul LePage and his administration have claimed repeatedly over the past few years that Maine can’t afford to expand Medicaid to about 70,000 low-income parents and adults without children.
But policymakers in Maine can now inform their decisions with the experience so far of states where Medicaid coverage expanded on Jan. 1, 2014. Drawing on that experience, a new analysis of Medicaid expansion’s potential impact on Maine’s state budget complicates the narrative that extending health coverage would be prohibitively expensive.
The analysis, released Wednesday by the Maine Health Access Foundation, projects a $26.7 million budget benefit in 2016 if Maine expands Medicaid due to a combination of savings from shifting expenses elsewhere in the state budget to Medicaid and new revenues the state would take in from hospitals treating newly covered patients. Those $43.9 million in projected savings and new revenues for 2016 would more than offset the $17.2 million projected in new costs.
The organization that conducted the analysis, Manatt Health Solutions, drew on its examination of the expansion-related costs and savings experienced by eight states that extended Medicaid coverage. Those states all faced costs due to the expansion — to be sure, Maine would see higher initial costs than many — but the savings more than offset them.
Those savings came in part from enrolling newly eligible residents in Medicaid who would otherwise qualify for services funded entirely or mostly with state funds. By shifting state spending for mental health services, breast and cervical cancer screening, and prescription drug assistance for older residents to Medicaid, the federal government effectively takes over the responsibility of paying for them.

What It Means For Your Health When Your State Refuses to Expand Medicaid

Nearly 60 percent of African Americans and 40 percent of Latinos live in states that have not expanded the program.




Even though the Affordable Care Act (ACA) has helped millions of people get health insurance, quality health care is still out of reach for a large number of people of color, low-income families and those with language barriers. The high cost of insurance premiums and co-pays was the main reason cited for those who remain uninsured. The complexity of the enrollment process was also a deterrent.

Those were some of the findings in a report released Thursday by the Alliance for a Just Society (AJS) that interviewed 1,200 low-income people in 10 states, including California.

The report indicated that people who were hurting the most were those living in states that had not expanded Medicaid.

As the ACA was being rolled out, states were given the option of whether or not to expand their Medicaid program. Twenty-two states have chosen not to. The expansion allowed people whose income fell below 138 percent of the federal poverty level (about $16,000 for an individual and $33,000 for a family of four) -- up from the earlier requirement of 133 percent -- to enroll. It also removed the asset cap and the requirement that individuals had to have a child in order to qualify for Medicaid.

Nearly 60 percent of African Americans and 40 percent of Latinos live in states that have not expanded Medicaid.
http://www.alternet.org/personal-health/what-it-means-your-health-when-your-state-refuses-expand-medicaid?akid=13023.109750.ogXP4F&rd=1&src=newsletter1035128&t=19


$1 billion in Federal Tax Dollars and a One Star Rating on Yelp––Quite an Expose––Behind the Scenes at Covered California


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What a difference a year makes.

Last year the California Obamacare insurance exchange, Covered California, was touted as the poster child for the Obamacare launch. Supporters said it worked well, enrolled lots of people, and was off to the kind of start that proved how successful Obamacare could be.

But after the second open enrollment new sign-ups have hit a wall, customer renewal rates are among the worst in the country, and consumer complaints are growing:
In a March 2013 post on this blog, I pointed out that Covered California was, at that time, getting $930 million in federal government money, including $250 million for marketing, to build and launch its services. Almost all of the other states building an exchange got less than a third of California's budget. Also by comparison, I pointed out that the privately funded national web insurance broker Esurance.com received a total of $40 million in the late 1990s to launch its insurance website enrollment business.

So, what's really been going on behind the scenes at Covered California?

Former CBS News Emmy winning investigative journalist, Sharyl Attkisson, has a two part expose, "Incompetence, Mismanagement Plague California's Obamacare Insurance Exchange" and "Insider's Detail Culture of Secrecy at California's Obamacare Exchange" on The Daily Signal, that fills in the details behind all of the high expense, poor consumer service, and now dismal enrollment results.

Among her findings:
  • Shortly after the October 2013 launch, Covered California's systems ran into trouble that took months to fix and cost another $155 million putting the total federal investment in Covered California at $1.06 billion.
  • Last fall, Covered California hoped to increase enrollment by 500,000 in the recent second open enrollment. But only an additional 7,098 selected a plan for 2015.
  • Only 65% of Covered California's 2014 customers reenrolled for 2015. The rest dropped off the rolls.
  • One leading Covered California insurance agent is quoted as saying, "I've got one family...their Covered California account shows three different effective dates." Attkisson goes on to quote him, "I've found out a woman's plan had been terminated, but they couldn't tell me why...I know their [Covered California's] enrollment numbers aren't right. They're marketing themselves [to generate] fees." Attkisson concluded, "[The agent's] once cheerful blog has turned into a consumer chronicle of Covered California's tribulations." 
But in California, the spin continues. From Attkisson's report:
"New enrollment for 2015 coverage is strong and has brought in consumers who our marketing and outreach targeted,' said Covered California Executive Director Peter Lee, overlooking the fact that his organization's retention of last year's customers was among the lowest in the country."
Now, I want to reiterate something: $1 billion for a website and insurance marketing organization––and a one-star rating. Folks, you also need to see those Yelp reviews.
http://healthpolicyandmarket.blogspot.com/2015/04/1-billion-in-federal-tax-dollars-and.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

Why are Obamacare’s polling numbers so low?

By Stephen Stromberg April 22 

The Kaiser Family Foundation released a poll Tuesday showing that public opinion is divided on the Affordable Care Act, also known as Obamacare. Forty-three percent of respondents reported that they approve of the health-care law, and 42 percent said they disapprove. That’s a marked improvement from much of the last year. But those of us who believe that the ACA is decent policy that’s working fairly well still need to ask: Why do its polling numbers remain so low?
At least part of the answer is that the ACA’s primary purpose was to cover people who had severe trouble affording insurance, and most Americans didn’t have this problem.
The ACA is at its core a coverage-expansion policy. It enlarged Medicaid and designed special marketplaces to give people who had limited or no access to private health coverage the ability to get quality insurance. That class of people included low-income Americans and uninsured or under-insured Americans with expensive preexisting conditions. Most people weren’t in those categories. According to polling numbers Gallup reported in January, the rate of uninsured peaked in 2013 at 18 percent, meaning 82 percent of Americans had coverage before the law fully phased in, and most got it in fairly stable “large group” plans, often from their employers, or in preexisting federal health-care programs.
Yes, the ACA has a variety of provisions meant to help people who had insurance before the law. It requires insurers to allow children to stay on their parents’ insurance plans until age 26. It is supposed to promote competition and price control among insurers in new, well-functioning health-care markets that can’t turn people away. Among other things, that will make people feel more comfortable buying insurance on their own, which enables them to leave jobs they kept merely for the health-care benefits. The law also requires a minimum level of quality among health-care plans, which helps some of the previously insured as well as the newly insured. Programs that punish preventable hospital re-admissions and promote better hospital care, meanwhile, are showing promise driving down medical mistakes.
But many of these benefits either aren’t clear to most Americans or aren’t associated with Obamacare in people’s minds. Fifty-six percent of Americans polled by Kaiser said the law has had no direct impact on them or their families. This number might change as the law phases in, but that’s where it stands now.
The ACA’s most spectacular success so far has been the plummeting rate of uninsured Americans. For the moment, that will have to stand as a moral victory, if not an obvious political one.

Morning Plum: Battle over Florida Medicaid expansion goes wild

By Greg Sargent April 22 

Your humble blogger has been tracking the battle over the Medicaid expansion in Florida, because it’s a really big deal. If the administration can get Governor Rick Scott and state House Republicans to accept the expansion, it could help weaken the blockade against it that conservatives have built in other states, which has slowed down Obamacare’s health coverage expansion after a number of states accepted it last year.
Now things are getting truly crazy in Florida. Legislators who oppose the Medicaid expansion are locking reporters out of meetings about the issue. And Republicans who support it are saying this episode is now reflecting badly on the national GOP.
Background: State Senate Republicans support a “conservative” version of the expansion.  The administration may withhold federal money for the Low Income Pool — which pays hospitals to treat the uninsured — that Scott and Republicans prefer, and instead wants Florida to take the expansion money, which would cover at least 800,000 Floridians. But that’s Obamacare, so Americans for Prosperity, Governor Scott and state House Republicans are dug in against it. Result: A budget impasse that’s imperiling, among other things, the tax cuts Republicans want.
Fox 13 News in Florida captures the latest developments:
Florida House Republicans just discussed the showdown over health care in a secret meeting in Tallahassee. But they may not have realized a veteran Associated Press reporter was listening through the door. AP reporter Gary Fineout held his ear to the closed door, because House leaders would not let the public see or hear what they’re doing.
State law bans three or more lawmakers from discussing pending legislation behind closed doors. But the House Republicans walked right past the journalists, then locked out the media, in order to privately discuss the legislative battle over health care. Representative John Wood chanted ‘liberty’ as he walked past reporters camped in the hallway…
“It’s important for our members to ask questions and that’s what they did,” said House Speaker Steve Crisafulli. He said they did not discuss pending legislation. But when Crisafulli was told that [he] was overheard telling members to ‘stand like a rock on the issue,’ he justified his remarks by saying there is no legislation in the house on Medicaid expansion.
About Representative Wood chanting “liberty” at the assembled reporters: It’s worth noting that state House Republicans and Scott want federal money to cover health care in the form of LIP; they just don’t want it if it’s part of “Obamacare.” Their ostensible reason is that the feds can’t be trusted to keep their end of the Medicaid bargain, leaving the state on the hook. But state Senate Republicans reject that argument.
Florida reporter Marc Caputo notes that the impasse could result in a government shutdown, which could hurt the state’s economy. And one Senate Republican is now arguing that the whole mess could be a “problem” for “the image of the Republican Party in America.”









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