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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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