Health Care Reform Articles - January 18, 2016

Medicare-for-All Plan Detailed by Sanders: Improves Health Care, Cuts Costs

JANUARY 17, 2016

CHARLESTON, S.C. – U.S. Sen. Bernie Sanders on Sunday detailed a Medicare-for-all plan to provide better health care for all Americans at less cost.

“Universal health care is an idea that has been supported in the United States by Democratic presidents going back to Franklin Roosevelt and Harry Truman,” Sanders said. “It is time for our country to join every other major industrialized nation on earth and guarantee health care to all citizens as a right, not a privilege.”

The proposal would expand Medicare, the popular and successful health care program for seniors, and build on the success of the Affordable Care Act, which Sanders helped craft. Patients would be able to choose their own doctors and receive comprehensive care for everything from hospital stays to emergency room visits to primary and specialty care.

Sanders’ Medicare-for-all plan would save $6 trillion over the next 10 years compared to the current system, according to a detailed analysis by Gerald Friedman, an economist at University of Massachusetts at Amherst who is a leading expert on health care costs.

In a nation that now spends $3 trillion a year on health care – nearly $10,000 per person – Sanders’ plan would save consumers money by eliminating expensive and wasteful private health insurance. The plan would save taxpayers money by dramatically reducing overall health care costs and bringing down skyrocketing prescription drug prices which are far greater in the United States than in any other country.

The typical family earning $50,000 a year would save nearly $6,000 annually in health care costs, Friedman calculated. The average working family now pays $4,955 in premiums for private insurance and spends another $1,318 on deductibles for care that isn’t covered. Under Sanders’ plan, a family of four earning $50,000 would pay just $466 per year to the Medicare-for-all program.

Businesses would save more than $9,400 a year in health care costs under Sanders’ plan. The average annual cost to the employer for a worker with a family who makes $50,000 a year would go from $12,591 to just $3,100.

The shift to universal health care would be paid for with a 2.2 percent health care premium (calculated under the rules for federal income taxes); a 6.2 percent health care payroll tax paid by employers; an estate tax on the wealthiest Americans and changes in the tax code to make federal income tax rates more progressive.

Under the plan, individuals making $250,000 to $500,000 a year would be taxed at a rate of 37 percent. The top rate, 52 percent, would apply to those earning $10 million or more a year, a category that in 2013 included only the 13,000 wealthiest households in the United States.

Additional savings would be achieved from reducing outlays for taxpayer-supported health care expenditures.

Sanders laid out his health care plan and progressive tax reform proposals here in South Carolina where he and former Secretary of State Hillary Clinton and former Maryland Gov. Martin O’Malley were to take part on Sunday night in a nationally televised debate in their contest for the Democratic Party presidential nomination.

To read more about Sanders’ Medicare-for-all plan and his progressive tax proposals, click here.
To read Professor Gerald Friedman’s analysis of Sanders’ plan, click here.

https://berniesanders.com/press-release/medicare-plan-detailed-sanders-improves-health-care-cuts-costs/

Bernie Sanders’s single-payer plan isn’t a plan at all

Sanders's long-awaited health care plan is, by turns, vague and unrealistic. 

Updated by Ezra Klein on January 17, 2016

Hillary Clinton has made a lot of bad arguments about Bernie Sanders's support for single-payer. But her best argument was her simplest: With mere weeks to go before the Iowa caucuses, Sanders still hadn't released any details about his plan. And absent a real plan no one could really say what he was proposing, or whether it was a good idea. As Clinton said in an interview with MSNBC's Rachel Maddow, "the devil's in the details when it comes to health care."

On Sunday night, mere hours before the fourth Democratic debate, Sanders tried to head off Clinton's attacks by releasing his plan. Only what he released isn't a plan. It is, to be generous, a gesture towards a future plan.

To be less generous — but perhaps more accurate — this is a document that lets Sanders say he has a plan, but doesn't answer the most important questions about how his plan would work, or what it would mean for most Americans. Sanders is detailed and specific in response to the three main attacks Clinton has launched, but is vague or unrealistic on virtually every other issue. The result is that he answers Clinton's criticisms while raising much more profound questions about his own ideas.

Sanders promises his health-care system will cover pretty much everything while costing the average American almost nothing, and he relies mainly on vague "administrative" savings and massive taxes on the rich to make up the difference. It's everything critics fear a single-payer plan would be, and it lacks the kind of engagement with the problems of single-payer health systems necessary to win over skeptics.

What Sanders's plan tells us that we didn't know before

Clinton's first attack was that Sanders hadn't released a plan. Now he has.

Clinton's second attack was that Sanders would rely on states to manage and partially finance his health-care system, as he's proposed in the past. His plan puts that criticism completely to rest, clarifying that the system will be "federally administered." As far as this document goes, there is no role for states at all.

Clinton's third attack was that Sanders's plan would raise taxes on the middle class. In response, Sanders gets very detailed on the financing of his plan. It would raise taxes on the middle class — in part through a 2.2 percent tax increase on all income, and in part by a 6.2 percent "income-based premium" on employers (which would, in turn, get passed onto workers through lower wages and higher prices).

The rest of the financing would come through a raft of new taxes on the rich. Sanders would raise marginal rates on income over $250,000, he would raise the tax rate on capital gains and dividend income, he would hike the estate tax, and he would close sundry deductions and loopholes.

In general, I'm comfortable with higher taxes on the rich — though they've risen substantially in the Obama era already — but tax increases of the scale Sanders proposes here would begin to have real economic drawbacks. European countries tend to pay for their health-care systems through more broad-based, economically efficient taxes like VATs; Sanders's effort to fund a universal health-care system so heavily on the backs of the wealthy would be unprecedented.

All in all, Sanders wants to raise taxes by a bit over a trillion dollars per year — which may not sound like much to those who remember the Obamacare debate, but remember that the numbers that got thrown around for Obamacare were 10-year estimates. Adding inflation, Sanders will be raising taxes by close to $15 trillion when the Congressional Budget Office applies its normal scoring window.

Of course, these new taxes replace the premiums Americans pay now. Here, Sanders promises that between shifting health-care financing to the rich and cutting costs through single-payer's efficiencies, his plan will only cost the average American family around $450 — a savings of more than $5,800 over what they're paying in premiums now.

Those benefits are big. To get them, Sanders is assuming some immense cost savings. And that's where the problems start.

http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-payer-health-care

Here's why creating single-payer health care in America is so hard

To become politically feasible, an American single-payer system would necessarily replicate our current system’s most glaring defects.

Updated by Harold Pollack on January 16, 2016

The Hillary Clinton campaign is taking some hard knocks from liberals over its maladroit attacks on Bernie Sanders’ single-payer proposal. In one sense, the knocks are well-deserved. Even if single-payer markedly lowers medical expenditures, proponents such as Larry Seidman estimate that a tax increase of at least 8 percent of GDP would likely be required to finance it. That’s a heavy political lift. It’s about as much as the entire federal income tax on individuals.

Yet as proponents rightly observe, these taxes would replace many visible and invisible ways we now provide to support a health sector that consume more than 17 percent of our economy. The experience of peer industrial democracies suggests that a well-designed single-payer system would be more humane and markedly less expensive than what we have right now.

Such a system would certainly be less convoluted and bureaucratically hidebound. Aggressively deploying government power to rein in prices, a well-designed single-payer system would be more fiscally disciplined, and would probably be more effective in targeting resources to best promote public health. Sanders deserves credit for noting the real virtues of a well-executed single-payer system.

In another way, though, the Clintons’ critique raises uncomfortable questions that deserve greater attention. It’s commonplace (though true) to note that single-payer is beyond the current boundaries of American politics. But what if, by some miracle, liberal Democrats won comprehensive victories that created a window of opportunity in which single-payer becomes realistically possible?

Designing a single-payer system in America

Imagine what would happen were President Bernie Sanders swept into office backed by a Democratic congressional majority similar to what President Obama enjoyed in 2008. Imagine further that President Sanders were sufficiently fortunate and skilled after that victory to enact a single-payer system. I wonder how different our policy dilemmas would really be from what we now face in implementing the Affordable Care Act.

As I have  written at-length in the Journal of Health Politics, Policy, and Law (and draw upon here), an American single-payer system would be more complex and kludgy than many proponents have considered or admitted. The source of these problems resides in American politics rather than the technocratic or ideological premises of our health care system. A different system operating through the same political mechanisms would produce  similar complexity and kludge.

The pitch for single-payer is admirably simple: We cover every (legal) resident. We mail a Medicare card to everyone. Everyone is covered. That’s a lot easier to explain and market than it is to explain the convoluted structures of Medicaid and state marketplace plans.

http://www.vox.com/2016/1/16/10779270/pollack-single-payer-in-america

Health Reform Realities

by Paul Krugman

Health reform is the signature achievement of the Obama presidency. It was the biggest expansion of the social safety net since Medicare was established in the 1960s. It more or less achieves a goal — access to health insurance for all Americans — that progressives have been trying to reach for three generations. And it is already producing dramatic results, with the percentage of uninsured Americans falling to record lows.

Obamacare is, however, what engineers would call a kludge: a somewhat awkward, clumsy device with lots of moving parts. This makes it more expensive than it should be, and will probably always cause a significant number of people to fall through the cracks.

The question for progressives — a question that is now central to the Democratic primary — is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better.

My answer, as you might guess, is that they shouldn’t, that they should seek incremental change on health care (Bring back the public option!) and focus their main efforts on other issues — that is, that Bernie Sanders is wrong about this and Hillary Clinton is right. But the main point is that we should think clearly about why health reform looks the way it does.

If we could start from scratch, many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone. But single-payer wasn’t a politically feasible goal in America, for three big reasons that aren’t going away.

First, like it or not, incumbent players have a lot of power. Private insurers played a major part in killing health reform in the early 1990s, so this time around reformers went for a system that preserved their role and gave them plenty of new business.

Second, single-payer would require a lot of additional tax revenue — and we would be talking about taxes on the middle class, not just the wealthy. It’s true that higher taxes would be offset by a sharp reduction or even elimination of private insurance premiums, but it would be difficult to make that case to the broad public, especially given the chorus of misinformation you know would dominate the airwaves.

Finally, and I suspect most important, switching to single-payer would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers. You might say that they would end up just as well off, and it might well be true for most people — although not those with especially good policies. But getting voters to believe that would be a very steep climb.

What this means, as the health policy expert Harold Pollack points out, is that a simple, straightforward single-payer system just isn’t going to happen. Even if you imagine a political earthquake that eliminated the power of the insurance industry and objections to higher taxes, you’d still have to protect the interests of workers with better-than-average coverage, so that in practice single-payer, American style, would be almost as kludgy as Obamacare.

http://www.nytimes.com/2016/01/18/opinion/health-reform-realities.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region&region=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region

Tightening Democratic Race Revives Party's Old Debate Over Health Care

by Chris Megerian and Noam Levey - LA Times

When Hillary Clinton was working on healthcare reform as first lady more than two decades ago, she disappointed some left-wing Democrats by refusing to push a system that would offer government health coverage to all Americans.

Instead, like many top Democrats and liberal leaders, Clinton advocated a centrist approach that would guarantee health coverage while preserving the current system of commercial insurance. That political strategy later became the foundation of President Obama’s successful push to enact the Affordable Care Act.

Now, Clinton finds herself replaying some of the same battles over how to achieve universal healthcare as she runs for president and tries to beat back a challenge for the Democratic nomination from Vermont Sen. Bernie Sanders.

Sanders, a self-described democratic socialist, is exciting liberal activists by championing a proposal where the government supplies healthcare in what’s known as a single-payer system, an elusive ideal that many on the left have demanded for more than half a century.

Clinton argues that Obama’s hard-fought healthcare law, often called Obamacare, should be defended and improved. She has called for new consumer protections to lower the cost of prescription drugs and safeguard patients from surprise medical bills and limited insurance networks.

Now is not the moment to plunge the country back into a divisive battle.  - Jake Sullivan, a senior advisor to Clinton

The divergent views epitomize the differences between the candidates – Clinton as a battle-hardened realist, with Sanders the uncompromising crusader – and the healthcare debate has become one of the most rancorous parts of an increasingly competitive primary. Polls show Sanders closing the gap with Clinton in Iowa and leading her in New Hampshire, the states that hold the country’s first two nominating contests.

Sanders, who has repeatedly introduced single-payer legislation in his 2 1/2 decades in Congress, wants to use new taxes to expand Medicare to everyone. He says it would save patients money by reducing insurance premiums.

The Clinton campaign has fired back. Clinton’s daughter, Chelsea, claimed during a campaign stop in New Hampshire this week that Sanders would “dismantle Obamacare” and “strip millions and millions and millions of people off their health insurance.” The Sanders campaign rejected the charge, saying its plan would expand coverage.

Clinton has also called Sanders’ proposal financially unrealistic, arguing that it would require raising taxes on the middle class.

And her campaign criticized the senator for potentially delaying details on how he wants to fund the plan until after the Iowa caucuses on Feb. 1, which would backtrack on an earlier pledge.

Sanders wants to “basically start all over again, start a contentious debate to try to get to a single-payer system,” Clinton told MSNBC’s Rachel Maddow on Thursday. “But he’s not telling us what it will look like and what it will cost.”

After some mixed signals from his campaign, Sanders said Thursday that he would provide new information before the caucuses.

This intra-party battle over single-payer healthcare dates back decades, as many Democrats have long hoped the federal government would assume responsibility for providing health insurance for all Americans, just as Medicare now covers the elderly.

But after years of failed efforts to provide “Medicare for all,” as the idea has been called, many Democrats – including liberal lions such as former Sen. Edward M. Kennedy (D-Mass) – concluded they would have to compromise first if they were ever to get to universal coverage.

“Even President Obama said he would support a single-payer system, if he could do anything he wanted,” former Rep. Henry A. Waxman (D-Los Angeles), a liberal Democrat who helped craft the Affordable Care Act, said in an interview Thursday. “But he and we chose a moderate alternative that we felt would accomplish the goals of getting people insurance coverage. And even this more moderate approach was extremely hard to pass."

http://www.latimes.com/politics/la-na-democrats-universal-healthcare-20160115-story.html

Tell the Truth about Bernie’s Health Care Stand

By Bill Moyers, Michael Windhip

The Clinton campaign just made a serious mistake.

They sent Hillary and Bill Clinton’s daughter Chelsea out on behalf of her mother to bash Senator Bernie Sanders on the issue of health care.

What’s so wrong with that? Don’t all candidates use family surrogates when and where they can? The Kennedys, for example, deployed a horde of kinfolk for Jack’s campaign for president, then Bobby’s, then Teddy’s.

But when it’s the first time (as this was for Clinton the younger), the surrogate should be sure whereof she speaks, and had better stick to talking about her candidate, not the opponent. Unfortunately, Chelsea Clinton misrepresented Senator Sanders’ position, and her premiere performance on the stump backfired, producing a flood of political donations to Sanders.

Here’s what she said: “Senator Sanders wants to dismantle Obamacare, dismantle the [Children’s Health Insurance Program], dismantle Medicare, and dismantle private insurance.” Whew! She would have us believe that the Vermont senator is a one-man wrecking crew, an enraged King Kong – or, to be modern about it, a mendacious Darth Vader – proposing “to go back to an era – before we had the Affordable Care Act – that would strip millions and millions and millions of people off their health insurance.”

Uh, not exactly. In fact, not even close. As Karen Tumulty noted in The Washington Post, Bernie Sanders has long been a champion of a single-payer health care system as the only way to assure that all Americans receive medical coverage. Rather than “strip” millions and millions of people of their health insurance, he wants to be sure millions and millions of people actually get health insurance.

This was Sanders’ position as far back as 1993 when newly-elected President Bill Clinton put First Lady Hillary Clinton in charge of reforming our disheveled and unjust health care system. Her task force huffed and puffed in secret for months, calling in legions of experts and academics, ultimately producing a plan so complicated and impenetrable – not to mention unexplainable – that it would have collapsed of its own ponderous weight even if the Republicans had not propagandized it into a laughing stock of pretensions and inefficiencies that could only make matters worse.

And here’s an ironic note: During that 1993 quest for a health care plan, Secretary Clinton sent Sanders an autographed picture of the two of them, wishing him the best and thanking the senator “for your commitment to real health care access for all Americans.”

http://www.commondreams.org/views/2016/01/16/tell-truth-about-bernies-health-care-stand

Clinton’s Pre-Iowa Assault On Sanders’ Medicare-For-All Plan

by David Johnson

As the Iowa caucuses draw near and as Bernie Sanders closes in on Hillary Clinton in the polls, Clinton has started “attacking” (media word) Sanders’ proposals for providing universal health care through a Medicare-for-All plan.

The corporate media largely covers the horse-race aspect of this as an entertainment item. Here is a look at the substance of Clinton’s assertions.

Medicare For All

Sanders has proposed replacing “Obamacare,” the Affordable Care Act mandate to purchase insurance from private companies, with a Medicare-for-All, “single-payer,” “universal heath care” plan. In other words, he proposes to extend (and expand) the current Medicare system to cover every American so they can stop having to locate and purchase private insurance policies. Sanders’ plan would also end the need for other government health programs, including Medicaid and the Children’s Health Insurance Program (CHIP).

Medicare for All is very popular, especially among Democrats. The December 2015 Kaiser Health Tracking poll found that 58 percent of Americans support it (34 percent strongly), with 81 percent of Democrats and 6 in 10 independents saying they favor the idea. “This is compared to 34 percent who say they oppose it, including 25 percent who strongly oppose it,” the poll said. Among Republicans, 63 percent say they oppose it.

Proposing Medicare for All is not just the right policy for the country, it is very smart politics.

Clinton Attacks

Clinton claims that Sanders’ plan would require a big tax hike. Politico reports this claim, in “Clinton hits Sanders on middle class tax hikes“:

“Bernie Sanders has called for a roughly 9-percent tax hike on middle-class families just to cover his health-care plan,” said Clinton spokesman Brian Fallon, referring to legislation Sanders introduced in 2013, “and simple math dictates he’ll need to tax workers even more to pay for the rest of his at least $18-20 trillion agenda. If you are truly concerned about raising incomes for middle-class families, the last thing you should do is cut their take-home pay right off the bat by raising their taxes.”

More recently, Clinton’s daughter Chelsea claimed that Sanders’ Medicare-for-All plan would “dismantle Medicare” and “strip millions and millions and millions of people off their health insurance.” (Clinton later stood by her daughter’s statement.) The Huffington Post reported:

“Sen. Sanders wants to dismantle Obamacare, dismantle the [Children’s Health Insurance Program], dismantle Medicare, and dismantle private insurance,” she said, according to an account from NBC News. “I worry if we give Republicans Democratic permission to do that, we’ll go back to an era – before we had the Affordable Care Act – that would strip millions and millions and millions of people off their health insurance.”

The Clinton campaign also said that Sanders’ plan would “send health insurance to the states, turning over your and my health insurance to governors” including Republican governors like Iowa’s Terry Branstad. “I don’t believe number one we should be starting over. We had enough of a fight to get to the Affordable Care Act. So I don’t want to rip it up and start over,” Clinton said.

Sanders Campaign’s Response

Sanders campaign spokeswoman Ariana Jones responded:

“It is time for the United States to join the rest of the industrialized world and provide health care as a right to every man, woman, and child. A Medicare-For-All plan will save the average middle-class family $5,000 a year. Further, the Clinton campaign is wrong. Our plan will be implemented in every state in the union regardless of who is governor.”

Sanders himself explained his health care plan and his strategic thinking behind it in an interview Wednesday with MSNBC’s Chris Hayes. The claim of $5,000 a year in savings for average middle-class families refers to the plan’s elimination of ever-increasing private insurance premiums, co-pays and deductibles that people currently have to pay under Obamacare. People would end up paying less and in many cases much less – an average of $5,000 each year. Companies would also no longer have to provide health insurance coverage for employees.

On the claim that Sanders’ has a “$18-20 trillion agenda,” switching to Medicare for All would replace the current costs of Medicaid, CHIP, Obamacare and other healthcare programs. Sanders’ plan would actually cost fewer trillions in the future than continuing the current system. The large “trillions” figure is misleading because it does not take into account the cost of the current system of Medicare for people over 65, Medicaid, CHIP, current Obamacare subsidies and other government health programs that would be replaced by Sanders’ plan. Left alone these would add up to more than Sanders’ plan.

Since Sanders’ plan also removes private-company profits from the system, this “Sanders agenda” amount is actually lower than the cost of continuing with the current system. (It also includes Sanders’ plans to repair the country’s infrastructure, cut college costs, and the rest of his proposals. Note that Sanders has outlined specific revenue sources to cover the costs of the proposals.)

The claim that Sanders’ plan would “strip millions and millions and millions of people off their health insurance” is perhaps the most misleading and disingenuous claim of all. People would not be “stripped” of their insurance; everyone would get Medicare instead so people would not need “insurance.” Clinton’s “strip” wording here implies that millions of people would lose health care, when in fact they would only lose the need to pay insurance premiums, co-pays and deductibles.

http://www.commondreams.org/views/2016/01/14/clintons-pre-iowa-assault-sanders-medicare-all-plan

'Fighting Dirty,' Clinton's 'Inflammatory Distortion' of Sanders' Single-Payer Plan

by Deirdre Fulton

At campaign stops in Iowa and New Hampshire on Monday and Tuesday, both Hillary and Chelsea Clinton directly criticized Sanders on healthcare policy.

"His plan would take Medicare and Medicaid and the Children's Health Insurance Program [CHIP] and the Affordable Care Act health-care insurance and private employer health insurance and he would take that all together and send health insurance to the states, turning over your and my health insurance to governors," Hillary Clinton said Monday. "I don't believe number one we should be starting over. We had enough of a fight to get to the Affordable Care Act. So I don’t want to rip it up and start over."

She echoed the argument on Tuesday, the same day a Quinnapiac poll showed Sanders overtaking her in Iowa, 49 percent to 44 percent. Reiterating her claim that Sanders' plan would jeopardize the Affordable Care Act and effectively turn over health coverage programs to the states, many of them led by Republican governors, she said: "If that’s the kind of 'revolution' he's talking about, I'm worried, folks."

Since his campaign launched last year, Sanders has repeatedly called for a political revolution "to transform our country economically, politically, socially and environmentally." The Sanders campaign told The Week on Tuesday that it would come out with an official campaign plan on healthcare "quite soon."

Meanwhile, serving as a campaign surrogate in New Hampshire on Tuesday, Chelsea Clinton declared:

Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance. I worry if we give Republicans Democratic permission to do that, we'll go back to an era—before we had the Affordable Care Act—that would strip millions and millions and millions of people off their health insurance."

This isn't the first time that Hillary Clinton has attacked single-payer healthcare, having done so in November and December of last year.

In a statement on Monday, Sanders spokesman Michael Briggs hit back: "Secretary Clinton is inaccurate in suggesting that Republican governors would be able to circumvent the law and deny implementation in their states." Referring to a single-payer proposal he put forth in 2013, Briggs added: "The bill Sen. Sanders introduced was very clear. It is national legislation for all states."

National Nurses United added its voice to those defending Sanders' proposal, accusing Clinton of deliberately distorting the facts.

http://www.commondreams.org/news/2016/01/12/fighting-dirty-clintons-inflammatory-distortion-sanders-single-payer-plan

Can Obama persuade reluctant states to expand Medicaid? New aid plan aims to do so

by Noam Levey

President Obama, in a bid to keep up momentum behind the Affordable Care Act in his final year in office, plans to propose new federal aid to persuade more states to expand their Medicaid programs through the 2010 law.

The proposal, to be included in the president’s 2017 budget blueprint, comes as Obama visits Louisiana, which is poised to become the 31st state to offer Medicaid coverage to all its residents.

The newly elected governor, Democrat John Bel Edwards, signed an executive order this week that will allow low-income adults in the state to begin signing up for Medicaid starting July 1, making the state the first in the Deep South to undertake the expansion.

Elected officials in several other traditionally conservative states, including South Dakota and Wyoming, are also pushing for expansion.

Medicaid, along with new insurance marketplaces created by the health law commonly called Obamacare, has helped expand coverage to about 17 million Americans since 2013, driving the largest reduction in the nation’s uninsured in half a century.

Medicaid now provides coverage to nearly 1 in 4 Americans at an annual cost to taxpayers of more than $500 billion. And the program is growing rapidly, thanks largely to the law, which provides hundreds of billions of dollars of federal aid to states to expand Medicaid eligibility to low-income, working-age adults. (Medicaid historically has served poor children, their mothers and the disabled.)

But the expansion has been rejected by many Republican governors and state lawmakers, who, despite growing evidence about the benefit to patients, have argued that Medicaid is ineffective and too costly to states.

Though the law provided federal funding to fully pay for the expansion in 2014, 2015 and 2016, the aid is gradually phased down so that states will ultimately foot 10% of the cost in 2020, a prospect many state lawmakers find worrisome, given doubts about the price tag.

That means that if a state such as Florida, which has opposed the law, decides in 2017 to expand Medicaid, the state would never get the full federal support.

Obama’s new proposal would change that, allowing any state that decides to expand Medicaid eligibility under the law to get three years of full federal funding, no matter when the expansion starts.

“This common-sense proposal makes the expansion as good a deal for states that expand now as it is for the states that have already done so,” Shaun Donovan, director of the Office of Management and Budget, and Cecilia Muñoz, head of the Domestic Policy Council, wrote in a blog posted Thursday morning by the White House.

“It is further evidence of the Administration’s willingness to work with states to build on recent progress in improving health coverage and making Medicaid affordable to states and taxpayers alike," they wrote. "We hope Congress will act to provide this extra incentive to states that haven’t yet expanded, encouraging them not to miss out on the benefits other states are already enjoying.”

Providing this additional assistance would probably be expensive. The White House did not provide a cost estimate.

It also would require congressional approval, which is likely to be difficult, given persistent GOP antipathy to the health law. Congressional Republicans this month passed legislation, which Obama vetoed, that would have repealed large sections of the law, including the Medicaid expansion.

http://www.latimes.com/nation/la-na-obama-medicaid-20160113-story.html

How Measurement Fails Doctors and Teachers

By ROBERT M. WACHTERJAN. 16, 2016

TWO of our most vital industries, health care and education, have become increasingly subjected to metrics and measurements. Of course, we need to hold professionals accountable. But the focus on numbers has gone too far. We’re hitting the targets, but missing the point.

Through the 20th century, we adopted a hands-off approach, assuming that the pros knew best. Most experts believed that the ideal “products” — healthy patients and well-educated kids — were too strongly influenced by uncontrollable variables (the sickness of the patient, the intellectual capacity of the student) and were too complex to be judged by the measures we use for other industries.

By the early 2000s, as evidence mounted that both fields were producing mediocre outcomes at unsustainable costs, the pressure for measurement became irresistible. In health care, we saw hundreds of thousands of deaths from medical errors, poor coordination of care and backbreaking costs. In education, it became clear that our schools were lagging behind those in other countries.

So in came the consultants and out came the yardsticks. In health care, we applied metrics to outcomes and processes. Did the doctor document that she gave the patient a flu shot? That she counseled the patient about smoking? In education, of course, the preoccupation became student test scores.

All of this began innocently enough. But the measurement fad has spun out of control. There are so many different hospital ratings that more than 1,600 medical centers can now lay claim to being included on a “top 100,” “honor roll,” grade “A” or “best” hospitals list. Burnout rates for doctors top 50 percent, far higher than other professions. A 2013 study found that the electronic health record was a dominant culprit. Another 2013 study found that emergency room doctors clicked a mouse 4,000 times during a 10-hour shift. The computer systems have become the dark force behind quality measures.

http://www.nytimes.com/2016/01/17/opinion/sunday/how-measurement-fails-doctors-and-teachers.html?action=click&pgtype=Homepage&region=CColumn&module=MostEmailed&version=Full&src=me&WT.nav=MostEmailed

Critics say ACA ‘risk’ strategies are having reverse Robin Hood effect
By Amy Goldstein January 13 at 9:56 PM

In early summer, a small, nonprofit HMO in Birmingham, Ala., got a surprise from the federal government: a bill for $1.7 million.

The charge, which amounted to a startling two-fifths of the premium money that Viva Health had collected from 1,100 customers, stemmed from an obscure part of the Affordable Care Act designed to support health plans with lots of sick, expensive customers by giving them money from plans with healthier customers.

The goal is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices — the basic principles of the law.

Yet the way the Obama administration has carried out this strategy shows another unexpected consequence of the 2010 health-care law. The administration defends its approach, but critics say the “risk adjustment” program is having a reverse Robin Hood effect — taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players.

Indeed, Blue Cross and Blue Shield of Alabama, which dominates the market in which Viva sells, is getting more than $2.5 million.

“It’s completely backwards,” said New Mexico Insurance Superintendent John Franchini, one of several state insurance regulators concerned about the way this aspect of the ACA has been handled and the impact it is having on competition.

Some insurers hit with big bills have already raised rates; others intend to limit what or where they sell. New health plans have been particularly vulnerable: For 2014, 27 of 35 such plans were told to write checks to the program, according to an analysis by a fledgling coalition of small insurers in the ACA insurance exchanges.

Unless the government changes the way it figures out risk, more plans “of all kinds” are certain to depart, Richard Foster, the retired chief actuary for the Centers for Medicare and Medicaid Services, warned in a critique commissioned by the coalition and sent to Health and Human Services Secretary Sylvia Mathews Burwell.

https://www.washingtonpost.com/national/health-science/critics-say-aca-risk-strategies-are-having-reverse-robinhood-effect/2016/01/13/e41cf574-b48f-11e5-a842-0feb51d1d124_story.html?hpid=hp_hp-more-top-stories_aca-risk-921pm%3Ahomepage%2Fstory

A Republican governor’s move to shutter Kentucky’s Obamacare exchange, explained

By Amber Phillips January 14 

Since it launched its state health-care exchange in 2013, Kentucky has been held up by Obamacare supporters as a model of how to do it right.

Now, Kentucky's newest governor, Republican Matt Bevin, is moving to get rid of it. He argues that the state-run exchange, kynect, will eventually cost the state money to keep running it, and that it's redundant when Kentuckians can just use the federal government's website to shop for health insurance.

Critics and nonpartisan health-care policy analysts question how much money Bevin will actually save in dismantling Kentucky's health-care exchange -- and at what cost to Kentuckians, who have used the popular health-care exchange to get insured in record numbers.

But if and when it happens -- and Bevin officially got the process started in a letter to the feds Dec. 30, which was reported this week -- Kentucky would again make history, becoming the first state to shut down a functioning health-care exchange and hand it over to the feds.

Once again, the eyes of the health-care industry are on Kentucky. Here is everything you need to know about how it's playing out.

https://www.washingtonpost.com/news/the-fix/wp/2016/01/14/a-republican-governors-move-to-shutter-kentuckys-obamacare-exchange-explained/?hpid=hp_hp-cards_hp-card-politics%3Ahomepage%2Fcard

Committee backs advocates on restoring service that helps customers with health insurance

DHHS had ended its contract with a private group and took on the work, but now Mainers are facing delays and struggling to get answers vital to their medical care, critics say.

BY STEVE MISTLER STAFF WRITER

AUGUSTA — A bill that would help low-income Mainers cut through the red tape that can block access to MaineCare health insurance benefits won support at a legislative hearing Wednesday.

Insurance agents, lawmakers and health care organizations urged the Legislature’s Health and Human Services Committee to endorse a measure to reinstate a $300,000 federally funded ombudsman service.

The bill is a response to a state Department of Health and Human Services’ decision last year not to contract out the ombudsman service and instead handle consumer inquiries through its own MaineCare eligibility hotline. The decision has drawn strong opposition.

The former ombudsman contractor, Consumers for Affordable Health Care, a advocacy group that also helps Mainers find insurance coverage through the Affordable Care Act, is suing the LePage administration for not continuing the service.

The advocacy group handled 7,000 consumer requests for help in 2014 before its contract was terminated at the end of the fiscal year in June 2015, said Executive Director Emily Brostek. That’s a four-fold jump from 2006, when it fielded 1,600 inquiries. The jump in inquiries coincides with the implementation of the Affordable Care Act.

On Wednesday, Brostek’s group joined other health care organizations and several Republican legislators in supporting the bill, which compels DHHS to use the federal grant to help Mainers navigate the state bureaucracy and settle eligibility disputes.

LAUNDRY LIST OF PROBLEMS

DHHS has argued that federal law doesn’t require the state to contract with an outside vendor for ombudsman services, and that it can fulfill its outreach and education obligations in-house.

Advocates of the bill disagree. During the public hearing, lawmakers and health organizations told stories of individuals unable to reach DHHS because of long wait times on the agency’s hotline and conflicting written responses about eligibility. The result, proponents of the bill said, was delayed access to coverage, accumulating medical bills and frustration.

Rep. Karen Vachon, a Scarborough Republican and insurance agent, said that she had seen firsthand how badly consumers need an advocate to help them navigate “the complex relationship between private and public health care coverage” and “how to defend themselves when an injustice has occurred.”

http://www.pressherald.com/2016/01/13/advocates-for-mainecare-ombudsman-hope-bill-forces-dhhs-to-reinstate-contract/

Ambitious elder community planned for historic midcoast farm

by Meg Haskell

DAMARISCOTTA, Maine — When dairy farmer David Chapman died five years ago at the age of 94, none of his heirs wanted to take over the rambling 19th century house, the three-story barn and milking parlor, the rolling fields and productive woodland where his family lived for nine generations.

Although the historic property is just a stone’s throw from busy Route 1 and surrounded by small businesses, the family also was unwilling to sell it for commercial development.

“My father-in-law had the chance to sell it once for over a million dollars,” said John Gallagher, 66, who is married to Chapman’s daughter. “It would have been flattened and turned into a big-box development, and no one was willing to see that happen.”

One family member moved in briefly to provide maintenance and general caretaking, but for the most part the old farm — in what may be the nation’s oldest community — sat empty while the family and the community fretted over its future.

But now, with the vision and support of local residents, a grass-roots nonprofit group has purchased the Chapman farm for $500,000 with funds raised over the past year from local donors. Plans are under way to develop the property into an innovative, affordable housing community for older adults and seniors.

Inn Along the Way is a registered 501(c)3 organization founded by a small group of area women with connections to local hospice and other end-of-life services. Board president Sherry Flint, 58, who lives in the village of Pemaquid, said the area needs more housing for aging residents. Existing options range from full-care nursing facilities to assisted living centers and subsidized housing, she said, but she envisions something different.

“We are not here to recreate what is already being done and done well,” she said. “We want to be the missing link.”

Flint’s vision for the project, while still in the free-form stage, includes several clusters — she calls them “pocket neighborhoods” — of small, residential cottages where independent older adults can live long-term, playing an active role in the community and aging safely in their homes with friends and neighbors looking in on them. She also sees a handful of short-term “respite cottages” for seniors who need intensive personal care; a separate inn for visiting families and the traveling public; a teahouse, cafe, gift shop and community center in the old farmhouse; an arts center in the old barn; extensive gardens for produce and flowers; and a network of public walking trails.

Key to the project’s mission is its commitment to attract and serve average-income, local residents. Sliding-scale rents in the residential cottages will help keep the community as affordable and inclusive as possible, Flint said, and more active, physically able residents will be able to further offset costs by working in the revenue-producing cafe, inn and arts center.

“And we know we’ll always have to do some fundraising,” she said. She’s confident local philanthropy, family donations and private foundation money will keep the project in the black.

Flint says she has visited many planned communities around the country, taking lessons and ideas away from each. Inn Along the Way is loosely modeled after the Brookwood Community, a faith-based residential community in Texas for developmentally delayed adults that includes staffed residences, on-site employment opportunities and public attractions such as a high-end cafe, shops, gardens and an elegant wedding venue to attract visitors and their checkbooks.

Many of Inn Along the Way’s supporters are affiliated with religious and spiritual traditions, Flint said, but the project itself is not.

“Though the seeds of Inn Along the Way were certainly sown through my faith — love of God walked out through love of ‘neighbor’ — we are indeed an ecumenical group,” Flint said. “My hope is that we will be a safe place from the storms and a refuge for people to come and rest their weary spirits.”

The oldest town, the oldest county, the oldest state in the nation

As the baby boomer generation approaches retirement and old age, communities across the country are looking for ways to support the social concept known as “aging in place,” defined by the U.S. Centers for Disease Control and Prevention as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.”

According to 2010 U.S. Census data, Maine boasts the oldest population of all the states, with a median age of 42.7 years compared to the national median of 37.2 years. In Lincoln County, the median age is 48.1 years. And in tiny Damariscotta, with a population of about 2,200 souls, the median age is 50.7 years.

These figures, according to Town Planner Tony Dater, give Damariscotta the dubious distinction of having the oldest population of any municipality in the nation.

“Our 2014 comprehensive plan has as the highest priority strategies for aging in place,” Dater said. In preparation for developing additional retiree housing options in the community, he said, the town is reviewing zoning designations to maximize appropriate land use.

“Like most coastal communities in midcoast Maine, there are two income tiers in Damariscotta,” Dater said. “You’ve got your well-heeled retirees along the coast, but the further inland you go, generally, the more rural, native and low-income the population gets.”

That means, he said, that Damariscotta, which also serves as the commercial and professional hub for a wider population of about 20,000, faces a major challenge in providing affordable local housing for aging residents.

http://bangordailynews.com/2016/01/15/next/ambitious-elder-community-planned-for-historic-midcoast-farm/print/

Lower-cost nonprofit insurer continues to struggle

By Priyanka Dayal McCluskey GLOBE STAFF

The executives at Minuteman Health Inc. picked the brightest orange they could find to splash across their advertisements when they launched the company three years ago, hoping to grab the attention of consumers and the broader health care industry.

But despite spending millions on advertising and promising consumers deep discounts on their health insurance, the nonprofit insurer has yet to become a household name or make a significant impact on the state’s health insurance market.

Minuteman’s membership has failed to meet initial projections, while expenses have exceeded them. The company has lost more than $43 million since its 2013 launch.

Minuteman is one of many nonprofit insurers created under a troubled program of the federal Affordable Care Act that was designed to inject more competition into local markets and offer lower-cost insurance for individuals and small businesses. Twenty-three of these insurers were launched two years ago with $2.4 billion in federal funds — including $156 million to launch Minuteman — but more than half of the insurers have since shut down.

Known as CO-OPs — for consumer operated and oriented plan — these insurers have faced a variety of problems. Some could not attract enough members, while others were flooded too quickly with more members than they could manage.

Jonathan Gruber, an economist at the Massachusetts Institute of Technology who was an adviser on the state and federal health care laws, said the CO-OP program was a risky venture from the outset, given how difficult it is for new companies to develop provider networks and compete with established insurance companies. But it was a risk worth taking, Gruber said, since it could pay off by giving consumers access to affordable insurance.

“They’re fighting an uphill battle, even at the start,” Gruber said of Minuteman and the other CO-OP insurers. “It’s a very hard market to break into because creating an appropriate doctors network is all about negotiating power.”

Thomas D. Policelli, the chief executive of Minuteman Health, attributes the insurer’s financial challenges mostly to problems with rolling out federal health care reform. The first year that Minuteman began selling insurance to individuals and small businesses, the state’s Health Connector website broke down, making it all but impossible for consumers to buy health coverage online and depressing Minuteman’s membership.

In addition, Minuteman, which had $23 million in revenue in the first nine months of 2015, was slapped last year with $3 million in payments through a new federal program called risk adjustment. The payments are designed to spread the risk and cost of insuring the sickest patients by requiring insurers with healthier members to pay money to those with sicker members. Minuteman’s coverage has tended to attract relatively healthy members.

In Massachusetts, the state’s largest insurer, Blue Cross Blue Shield, has been the biggest beneficiary of risk adjustment payments. Smaller insurers, including Minuteman, collectively paid more than $51 million to Blue Cross last year.

Minuteman expects its risk adjustment payments will be even higher this year unless the federal program changes. Policelli is among several insurance executives across the country now lobbying federal officials to change the formula used to calculate the payments.

“It’s been a tumultuous period in health care in general,” Policelli said.

http://www.bostonglobe.com/business/2016/01/17/lower-cost-nonprofit-insurer-struggling/87RUe4zEjXm6UeWs7E6AZI/story.html?s_campaign=email_BG_TodaysHeadline&s_campaign=

Maine nurses oppose Pacific trade pact’s gifts to billionaire drug companies

By Cokie Giles, Special to the BDN

Posted Jan. 18, 2016

Nurses are patient advocates — and by extension advocates for our patients’ families and our communities — and today we are sounding an alert on the Trans-Pacific Partnership, an international agreement that puts the public health of Maine, and the nation, at risk.

Maine nurses urge Congress to reject this fatally flawed agreement and strongly encourage the Legislature to speak out in the public interest and against the Trans-Pacific Partnership. While there are many good reasons to reject this trade pact, Maine’s registered nurses are particularly appalled by this agreement’s threat to public health and safety.

Despite the promises and reassurances offered by the Obama administration over the past few months, including during the president’s State of the Union address, the final text of the Trans-Pacific Partnership is even worse than prior reports had predicted.

Monopoly pricing protections for giant pharmaceutical firms in the Trans-Pacific Partnership could be a death sentence for countless patients in need of affordable medications around the world. Pharmaceutical corporations would be given years more of monopoly pricing practices on their patents for high-priced, brand-name drugs to block distribution of competitive, cheaper, lifesaving generic medications. That is especially critical for people suffering from cancer, HIV/AIDS, hepatitis, and other illnesses in developing countries as well as in the United States.

The Trans-Pacific Partnership would allow drug companies the legal authority to challenge and overturn national laws and regulations that permit governments to negotiate lower drug prices through bulk purchases, which cuts costs for everyone. That would hurt the people in the countries signatory to the agreement that already do drug bulk purchasing, and it would hurt the ability of the U.S. government to finally do it here at home.

These gifts to the billionaire drug companies are a cruel and disgraceful threat to the lives of Mainers and people across the country. The pretext of giving the pharmaceutical corporations expanded monopoly control to “repay” them for research and development costs is particularly hollow considering that a substantial percentage of those costs are paid for with public funds with drugs developed at public universities.

Nurses are appalled at the provisions regarding the so-called Investor State Dispute Settlement process that allows global corporations to sue to overturn laws and regulations, including public safety and environmental protections. As has already occurred with prior trade deals, the Investor State Dispute Settlement process allows corporations to challenge domestic laws through extrajudicial tribunals staffed by corporate attorneys who can demand taxpayers reimburse corporations for lost “expected” profits. In prior trade pacts, this provision has forced some countries to drop health, safety, or environmental rules rather than face bankruptcy from billion dollar rulings.

This agreement is an all out assault on not only health and safety but also on the democratic rights of the American people to pass public protections. It’s another reminder that the pharmaceutical industry and other corporate lobbyists, who wrote many of these provisions, continue to dominate and corrupt our political system.

We can understand why these huge multinational corporations want such deals and why they in fact are helping write them: bigger and bigger profits for them. But Congress should reject this outright because it is clearly not in the public interest.

In addition, the Trans-Pacific Partnership would undermine environmental and food safety standards. Maine nurses also share the concerns of workers across the country that the Pacific trade pact will lead to more job loss, lower wages and weakened labor protections in the U.S.

Maine’s members of Congress must now step up and join this fight to defeat the Trans-Pacific Partnership. Nurses and working people will not be silent in working to stop and overturn this dangerous agreement.

http://bangordailynews.com/2016/01/18/opinion/contributors/maine-nurses-oppose-pacific-trade-pacts-gifts-to-billionaire-drug-companies/?ref=OpinionBox

Nearly 80,000 Mainers Sign Up for Coverage on HealthCare.gov 

By ANDREW CATALINA 

PORTLAND, Maine — Nearly 80,000 Maine residents have signed up for health care coverage through the HealthCare.gov platform since open enrollment began in November.

Officials with the U.S. Department of Health & Human Services say 78,891 people from Maine have either signed up or had their coverage automatically renewed as of Jan. 9. The deadline to enroll for coverage starting Feb. 1 passed on Friday.

Federal statistics show that more than 57,000 of the residents were in the Portland-Auburn market and the rest were in the Bangor market area.

http://news.mpbn.net/post/nearly-80000-mainers-sign-coverage-healthcaregov