House Minority Leader Nancy Pelosi (D., Calif.) told Ezra Klein a single payer healthcare system would be the best fix to Obamacare in an interview posted Tuesday on Vox.com.
Pelosi offered a halfhearted political endorsement of Obamacare, telling Klein Democrats will simultaneously run on Obamacare this November while also emphasizing they stand ready to “improve” the law.
“I have some of my own suggestions I couldn’t get through on the first round,” she said ominously.
“How would you like to see [Obamacare] improved?” Klein asked.
“Well, of course I wanted a single payer, and I wanted a public option,” replied the San Francisco Democrat.
The Department of Veterans Affairs offers healthcare to veterans in a similar fashion to single payer. The V.A. has fallen under scrutiny recently over revelations the department created secret wait lists to mask wait times for veterans seeking care.
Pelosi went on to acknowledge the public option and single payer are not “in the mix” currently. However, her disturbing and reflexive endorsement of single payer further illustrates liberals see Obamacare as a stepping stone to a full government takeover of the American healthcare system.
Locate 1.2 million people. Find even the thousands of them who don’t speak English or don’t have a place to live. Get them to fill out a 26-page application. Process those forms. And get it done by the end of the year.
That is the unprecedented mandate facing state officials this year: to scour the rolls of MassHealth, the state’s Medicaid program for low-income people, and make sure that all the enrollees are still eligible.
Officials stumbled at first with an attempt to reenroll 500,000 people in just three months. There were long waits at the MassHealth call center and long lines at the community health centers. Thousands of other recipients simply failed to do anything. In the end, officials extended deadlines, added staff, and changed policies.
“This was new for us,” said Marylou Sudders, the state’s secretary of health and human services. “We didn’t know what to expect of 1.2 million people.”
The daunting project is a consequence of the 2013 software failure of the Massachusetts Health Connector. The Connector website was supposed to calculate whether people qualified for MassHealth or for another type of coverage, but it was unable to determine anyone’s eligibility. That forced MassHealth to halt its usual process of confirming eligibility, which involves reenrolling recipients monthly on a rolling basis.
As a result, everyone who was on MassHealth stayed on MassHealth, regardless of income increases.
Now the federal government, which pays for half or more of MassHealth costs, is requiring the state to get its house in order. And Governor Charlie Baker is counting on the “redetermination” process to reap big savings — at least $250 million to $300 million in the calendar year — by culling those who no longer qualify.
“I don’t believe any other jurisdiction in the country has had to redetermine so many people in the same period of time,” said Amy Whitcomb Slemmer, executive director of the advocacy group Health Care for All.
“I think the idea that patients can do this on their own is just not realistic,” said Sue Joss, executive director of the Brockton Neighborhood Health Center. “They have to go somewhere for help, and we’re happy to do that. But it’s just overwhelming.” At one point, as many as 70 to 80 walk-ins were streaming into the Brockton health center each day, on top of the 45 with appointments, Joss said.
To help, MassHealth trained 1,300 “certified application counselors” who work in health centers, hospitals, and community groups. The state budget allocated $14 million for all aspects of the redetermination process, with three-quarters of the money coming from the federal government.
The challenges cast into relief the immensity and importance of the state program that provides health coverage for low-income and disabled people.
Forty cents of every state taxpayer dollar goes to MassHealth. The program covers a quarter of Massachusetts residents (including 40 percent of children, half the disabled people, and two-thirds of nursing home residents). MassHealth fuels the economy with payments to hospitals, health centers, physicians, laboratories, health insurers, and more.
The challenge extends from the 11th-floor office of MassHealth director Daniel Tsai to a basement classroom in Brockton, where earlier this month Maria Ribeiro was doggedly scrolling, clicking, and typing her way through a MassHealth application.
The 47-year-old frequently asked for help from Simao Mendes, a worker with the Brockton Neighborhood Health Center, who runs this weekly enrollment class.
Speaking in Cape Verdean Creole, Mendes helped Ribeiro estimate her annual income even though her wages as a cake decorator vary from week to week. He showed her where to click when a red-lettered alert declared a discrepancy in her husband’s income (the box saying he had lost his job). He coached her in identifying her relationship to her husband when the pull-down menu did not include the word “husband” (she located the word “spouse”).
In the end, Ribeiro’s husband and two young sons qualified for MassHealth and were reenrolled, but she was deemed ineligible. Instead, she found a separate plan through the Connector that cost $1 a month after subsidies were applied. Then, she packed away her pay stubs and ID cards, and left — two hours after she arrived.
MassHealth enrolls 1.9 million people. Of them, 700,000 signed up too recently to require reenrollment. The rest need to verify their eligibility, although 200,000 are easily deemed eligible because they qualify for another income-based government program.
Officials decided to first reenroll those who qualified mainly because their income was low. Because income levels can shift, these people were most likely to have changed circumstances that might affect eligibility. The effort started with letters mailed Jan. 15.
But when the April 17 deadline arrived, barely half had taken any action, and many of those who tried to act found they could not get help before their deadline.
Antonia McGuire, president of the Edward M. Kennedy Community Health Center in central Massachusetts, said her centers saw a steady stream of people unable to complete applications on their own.
“The original time frame was ambitious, to put it in a word,” McGuire said.
Several insurers were also raising concerns about possibly losing members and income. About two-thirds of MassHealth members enroll in health insurance plans that receive payments from the state to manage enrollees’ care.
In response, Sudders and Tsai allowed people to file for extensions to June 30. They doubled staff at the MassHealth call center to shorten wait times. And they gave the health insurers lists of members who had not responded, allowing the insurers to contact them and file extensions for them.
“It was a little bumpy in the beginning, but I think it has gotten better,” said Michael Nickey, executive director of MassHealth programs for Fallon Health, a Worcester insurer with about 32,000 MassHealth members statewide.
By early May, the crunch had eased, as thousands filed for extensions.
The number of people responding to the state’s letters steadily increased, reaching 69 percent by Tuesday. The 158,000 who did not respond were disenrolled. But they can get back on the program, with retroactive coverage, if they make contact with MassHealth before June 30.
In July, MassHealth will start reaching out to the next 500,000 enrollees. These include disabled and elderly people and those with complicated family situations. Lessons from the first half-million will shape the approach to the next group. Tsai said he will contact organizations that work with such patients even before the letters go out.
Maine lawmakers endorse bill to protect Obamacare subsidies
Nearly 67,000 Mainers receive premium assistance through the Affordable Care Act that could be eliminated, depending on a U.S. Supreme Court ruling.
BY STEVE MISTLERSTAFF WRITER
AUGUSTA — A bill designed to protect health insurance subsidies for nearly 67,000 Mainers won key support Thursday from a committee of lawmakers.
In a unanimous vote, the Legislature’s Insurance and Financial Services Committee endorsed the effort to maintain the health insurance premium subsidies that are offered as tax credits through the Affordable Care Act. Those credits are being challenged in a federal lawsuit known as King v. Burwell, which the U.S. Supreme Court is expected to decide next month.
The case is a significant threat to the ACA, also known Obamacare, the 2010 health care law vigorously opposed by Republicans.
The plaintiffs in King v. Burwell argue that the wording in the Affordable Care Act precludes consumers in states that did not set up their own health insurance marketplaces from receiving federal subsidies. Attorneys for the Obama administration counter that it was merely a technical glitch in the drafting of the law, and that the intent of Congress was to provide subsidies to consumers in all states.
The law allows states to choose whether to operate their own marketplaces, where consumers can shop for and purchase a health insurance policy, or have the federal government do it. Maine is one of 37 states that opted to let the federal government run their insurance exchanges.
The ACA provides for advance payment of premium tax credits for people with incomes between 100 percent and 400 percent of the federal poverty level, or $11,770 and $47,080 for an individual. Cost-sharing reductions are available for people with incomes between 100 percent and 250 percent of federal poverty level, or $11,770 and $29,425 per year for an individual.
Nearly 90 percent of the 74,792 Mainers who have purchased health insurance during the two enrollment periods since the law went into effect receive some kind of subsidy. According to a national analysis by the Urban Institute, 80 percent of the adults who would lose the subsidies are working, 46.5 percent full time and 33.7 percent part time. If the subsidies through federal exchanges are struck down, the institute estimates that 73 percent of part-time workers would become uninsured.
DURHAM, N.C. — IN virtually every field of medicine, black patients as a group fare the worst. This was one of my first and most painful lessons as a medical student nearly 20 years ago.
The statistics that made my stomach cramp back then are largely the same today: The infant mortality rate in the black population is twice that of whites. Black men are seven times more likely than white men to receive a diagnosis of H.I.V. and more than twice as likely to die of prostate cancer. Black women have nearly double the obesity rate of white women and are 40 percent more likely to die from breast cancer. Black people experience much higher rates of hypertension, diabetes and stroke. The list goes on and on.
The usual explanations for these health disparities — poverty, poor access to medical care and unhealthy lifestyle choices, to name a few — are certainly valid, but the longer I’ve practiced medicine, the more I’ve come to appreciate a factor that is less obvious: the dearth of black doctors. Only around 5 percent of practicing physicians are black, compared with more than 13 percent of Americans overall.
As a general rule, black patients are more likely to feel comfortable with black doctors. Studies have shown that they are more likely to seek them out for treatment, and to report higher satisfaction with their care. In addition, more black doctors practice in high-poverty communities of color, where physicians are relatively scarce.
As a psychiatrist, I’ve seen this up close. I’ve frequently been the only black doctor (or one of very few) in clinics with large black populations. Quite often, patients ask to see a black doctor, but the sheer volume of people seeking help prevents me from accommodating most of their requests.
Black patients, compared with those of other races, tend to be far less trusting of physicians and their medical advice. Much of this is rooted in a dark history of experimentation on black people without their consent (the four-decade-long Tuskegee syphilis study is the most notorious modern-day example). Too often, however, this mistrust is to the patients’ detriment. I’ve met countless black people who have either delayed or refused needed treatments because they were skeptical about their physician’s motives and honesty. Some wound up far sicker than they should have been; others died.
Perhaps the most compelling evidence that black patients are more likely to trust black doctors comes from the mental health field, where a patient’s relationship with his or her provider is especially important. Black people have often fared poorly in their interactions with the mental health care system. For example, they are nearly half as likely as whites to receive treatment for diagnosed mental health disorders of comparable severity. When black patients do receive treatment, it is far more likely to occur in an emergency room or psychiatric hospital than it is for whites, and less likely to be in the calmer office-based setting, where longer-term treatment can take place.
The horrific Amtrak derailment outside Philadelphia this week set off some predictable uncertainty about what exactly had happened—a reckless motorman? An inadequate track? A missing mechanical device? Some combination of them all?—and an even more vibrant set of arguments about the failure of Americans to build any longer for the common good. Everyone agrees that our rail system is frail and accident-prone: one tragedy can end the service up and down the entire path from Boston to Washington, and beyond, for days on end. And everyone knows that American infrastructure—what used to be called our public works, or just our bridges and railways, once the envy of the world—has now been stripped bare, and is being stripped ever barer.
What is less apparent, perhaps, is that the will to abandon the public way is not some failure of understanding, or some nearsighted omission by shortsighted politicians. It is part of a coherent ideological project. As I wrote a few years ago, in a piece on the literature of American declinism, “The reason we don’t have beautiful new airports and efficient bullet trains is not that we have inadvertently stumbled upon stumbling blocks; it’s that there are considerable numbers of Americans for whom these things are simply symbols of a feared central government, and who would, when they travel, rather sweat in squalor than surrender the money to build a better terminal.” The ideological rigor of this idea, as absolute in its way as the ancient Soviet conviction that any entering wedge of free enterprise would lead to the destruction of the Soviet state, is as instructive as it is astonishing. And it is part of the folly of American “centrism” not to recognize that the failure to run trains where we need them is made from conviction, not from ignorance.
There is a popular notion at large, part of a sort of phantom “bi-partisan” centrist conviction, that the degradation of American infrastructure, exemplified by the backwardness of our trains and airports, too, is a failure of the American political system. We all should know that it is bad to have our trains crowded and wildly inefficient—as Michael Tomasky points out, fifty years ago, the train from New York to Washington was much faster than it is now—but we lack the political means or will to cure the problem. In fact, this is a triumph of our political system, for what is politics but a way of enforcing ideological values over merely rational ones? If we all agreed on common economic welfare and pursued it logically, we would not need politics at all: we could outsource our problems to a sort of Saint-Simonian managerial class, which would do the job for us.
What an ideology does is give you reasons not to pursue your own apparent rational interest—and this cuts both ways, including both wealthy people in New York who, out of social conviction, vote for politicians who are more likely to raise their taxes, and poor people in the South who vote for those devoted to cutting taxes on incomes they can never hope to earn. There is no such thing as false consciousness. There are simply beliefs that make us sacrifice one piece of self-evident interest for some other, larger principle.
What we have, uniquely in America, is a political class, and an entire political party, devoted to the idea that any money spent on public goods is money misplaced, not because the state goods might not be good but because they would distract us from the larger principle that no ultimate good can be found in the state. Ride a fast train to Washington today and you’ll start thinking about national health insurance tomorrow.
The ideology of individual autonomy is, for good or ill, so powerful that it demands cars where trains would save lives, just as it places assault weapons in private hands, despite the toll they take in human lives. Trains have to be resisted, even if it means more pollution and massive inefficiency and falling ever further behind in the amenities of life—what Olmsted called our “commonplace civilization.”
The state’s four
largest nonprofit health insurers said Friday that hefty taxes and fees
related to the federal health care law caused them to lose a combined
$124 million on operations in the first three months of the year.
Since
the beginning of 2014, insurers have been required to pay a series of
taxes and fees to underwrite the Affordable Care Act, which expanded
health coverage to millions of new people nationwide.
Blue Cross Blue Shield of Massachusetts, the state’s largest
commercial insurer, had the biggest operating loss, $73 million.
However, that was less than the $91 million it lost in the same quarter
of 2014, the first time new federal taxes and fees went into effect.
Tufts
Health Plan said it lost $24 million, down from a loss of $44 million
last year. Harvard Pilgrim Health Care lost $20 million, up from about
$17 million last year. And at Fallon Health, the losses were about $7
million, up from $3 million.
Insurers are required to record
payment of the taxes and fees in the first quarter of the year. They
don’t expect significant losses to continue for the rest of 2015, but
the first-quarter losses could drag down their overall earnings. Last
year, most of the large insurers reported operating losses and blamed
them largely on the federal taxes and fees. But income from investments
or other sources helped them end 2014 with net gains.
The losses in the first quarter of this year are on track with what
insurers said they were expecting. Their new taxes and fees are
significant; Blue Cross, for example, said it paid $87 million to the
federal government to pay for the health care overhaul.
The
federal government is collecting some $8 billion from health insurers
and using the money to, in part, underwrite coverage for people
receiving subsidized policies.
Although the charges have been in
effect only since last year, insurers warned they could trickle down to
consumers in the form of higher premiums. Blue Cross and Tufts, for
example, said premiums are up about 1 to 2 percent.
“It has to get
passed eventually to customers,” said Tufts’ chief financial officer,
Umesh Kurpad. “This is the reason why health plans are looking for ways
to reduce costs in all other aspects of our business.”
Another
ongoing challenge, insurers said, is the cost of expensive new
medicines. The biggest budget buster among specialty drugs in recent
months has been Sovaldi, a breakthrough drug for hepatitis C that costs
$84,000 for per treatment per person.
In addition to the federal
taxes and fees, “the major story of the quarter, and likely for the
year, is the increasing cost of so-called specialty medications which
continue to rise,” Allen Maltz, chief financial officer at Blue Cross,
said in a statement. http://www.bostonglobe.com/business/2015/05/15/mass-health-insurers-lose-money-federal-taxes/q9b9rPAnbAwgHyppRv1h1M/story.html#
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