Health Care Reform Articles - March 26, 2019

Democrats Pivot Hard to Health Care After Trump Moves to Strike Down Affordable Care Act

by Robert Pear and Sheryl Gay Stolberg - NYT - March 26, 2019

WASHINGTON — A new fight over the future of the Affordable Care Act burst onto the Capitol Hill agenda on Tuesday morning, as Democrats tried to move past the Mueller report and pounce on the Trump administration’s legal motion to have President Barack Obama’s signature health care law invalidated by the federal courts.
“The Republicans did say during the campaign that they weren’t there to undermine the pre-existing condition benefit, and here they are, right now, saying they’re going to strip the whole Affordable Care Act as the law of the land,” Speaker Nancy Pelosi of California told reporters, just hours before Democrats were to unveil their own plan to lower costs and protect people with pre-existing conditions.
“This is actually an opportunity for us to speak to the American people with clarity,” Ms. Pelosi went on. “They say one thing and they do another. They say they’re going to protect pre-existing conditions as a benefit, and then they go to court to strip it and strip the whole bill.”
For Democrats, the Justice Department motion to invalidate the health law could not have come at a more opportune time. With the special counsel’s report failing to find a criminal conspiracy between President Trump’s campaign and Russia’s efforts to influence the election, Ms. Pelosi — who was celebrating her birthday on Tuesday — was already pressing to move her party back to the kitchen-table issues that they believe will shape the 2020 campaign.

In 2018, Democrats campaigned — and won — on their pledge to keep the law’s protections for pre-existing medical conditions, and are planning to roll out their own health care agenda with much fanfare at a news conference on Tuesday afternoon. Representative Hakeem Jeffries of New York, chairman of the House Democratic Caucus, promoted the plan on Tuesday morning, while also accusing Republicans of “launching an assault on health care in the United States of America.”
Ken Paxton, the attorney general of Texas who led the group of Republican state officials who challenged the Affordable Care Act, said he welcomed the Trump administration’s latest expression of support for a lawsuit that had already prompted a district court judge in Texas to strike down the health law. That judge’s December ruling has been on hold as the matter winds its way through the court system.
“We have always been confident that the district court’s extremely well-reasoned opinion was correct on the law, just as we have also always been confident that this administration takes its obligation to uphold the Constitution seriously,” Marc Rylander, a spokesman for Mr. Paxton, said Tuesday. “We applaud the Department of Justice’s faithful execution of that duty.”
Mr. Trump cryptically tweeted what may have been his support as well:

But House Republicans — who also campaigned on a pledge to protect people with pre-existing conditions — were far more eager on Tuesday to take an extended victory lap on the Mueller report than field thorny questions about an issue that helped cost them the majority.

“I haven’t read through what they — was it last night?” Representative Kevin McCarthy of California, the House Republican leader, said during his weekly news conference dominated by a series of long statements about the report. He added, “I think the president has always been very clear that he wanted to repeal Obamacare, and to put a system in that actually lowers the cost and protects individuals’ pre-existing conditions.”
The Democratic offensive came the morning after the Justice Department asked a federal court to strike down the law in its entirety. The administration had previously said that the law’s protections for people with pre-existing conditions should be struck down, but that the rest of the law, including the expansion of Medicaid, should survive.
If the appeals court accepts the Trump administration’s new arguments, millions of people could lose health insurance, including those who gained coverage through the expansion of Medicaid and those who have private coverage subsidized by the federal government.
“The Justice Department is no longer asking for partial invalidation of the Affordable Care Act, but says the whole law should be struck down,” Abbe R. Gluck, a law professor at Yale who has closely followed the litigation, said Monday. “Not just some of the insurance provisions, but all of it, including the Medicaid expansion and hundreds of other reforms. That’s a total bombshell, which could have dire consequences for millions of people.”
In addition to inciting a furor on Capitol Hill, the administration’s new position is also certain to take center stage as an issue in the 2020 elections. Democrats have been saying that Mr. Trump still wants to abolish the law, and they can now point to the Justice Department’s filing to support that contention.
The Justice Department disclosed its new stance in a two-sentence letter to the United States Court of Appeals for the Fifth Circuit, in New Orleans, and will elaborate on its position in a brief to be filed later.
In the letter, the Justice Department said the court should affirm a judgment issued in December by Judge Reed O’Connor of the Federal District Court in Fort Worth.

Judge O’Connor, in a sweeping opinion, said that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power” because Congress had eliminated the tax penalty for people who go without health insurance.
Accordingly, Judge O’Connor said, “the individual mandate is unconstitutional” and the remaining provisions of the Affordable Care Act are also invalid.
In its letter to the appeals court, the Justice Department said Monday that it was “not urging that any portion of the district court’s judgment be reversed.” In other words, it agrees with Judge O’Connor’s ruling.
But on Tuesday, after a closed-door meeting, Democrats were piling on. Representative Cheri Bustos of Illinois, who leads the Democrats’ campaign committee, was quick to note Republicans’ vote in January to back a lawsuit repealing the Affordable Care Act, saying “their actions speak much louder than their lies.”
“Millions of hardworking families across America could see their health care costs explode because Washington Republicans sided with big insurance companies instead of everyday Americans,” Ms. Bustos added. “They simply cannot say they support protections for people with pre-existing conditions, lowering health care costs, or expanding access to care for more Americans, because they voted to destroy all of these things.
In the nine years since it was signed by Mr. Obama, the Affordable Care Act has become embedded in the nation’s health care system. It changed the way Medicare pays doctors, hospitals and other health care providers. It has unleashed a tidal wave of innovation in the delivery of health care. The health insurance industry has invented a new business model selling coverage to anyone who applies, regardless of any pre-existing conditions.
The law also includes dozens of provisions that are not as well known and not related to the individual mandate. It requires nutrition labeling and calorie counts on menu items at chain restaurants. It requires certain employers to provide “reasonable break time” and a private space for nursing mothers to pump breast milk. It improved prescription drug coverage for Medicare beneficiaries, and it created a new pathway for the approval of less expensive versions of biologic medicines made from living cells.

Lawyers said invalidation of the entire law would raise numerous legal and practical questions. It is, they said, difficult to imagine what the health care world would look like without the Affordable Care Act.
The Trump administration’s new position was harshly criticized by the insurance industry and by consumer advocates.
The government’s position “puts coverage at risk for more than 100 million Americans,” said Matt Eyles, the president and chief executive of America’s Health Insurance Plans, the industry lobbying.
Leslie Dach, the chairman of Protect Our Care, a consumer advocacy group, said: “In November, voters overwhelmingly rejected President Trump’s health care repeal and sabotage agenda. But he remains dead set on accomplishing through the courts what he and his allies in Congress could not do legislatively: fully repeal the law, devastate American health care and leave millions of Americans at risk.”
The Trump administration’s new stance appears to put Republicans in Congress in an awkward position. They have repeatedly tried to repeal the health law. But in the last year, they said over and over that they wanted to protect coverage for people with pre-existing conditions, and those protections are among the law’s most popular provisions.
The lawsuit challenging the Affordable Care Act, Texas v. United States, was filed last year by a group of Republican governors and state attorneys general. Officials from California and more than a dozen other states have intervened to defend the law.
The Texas lawsuit “is as dangerous as it is reckless,” Xavier Becerra, the attorney general of California, said Monday as he filed a brief urging the appeals court to uphold the law.
https://www.nytimes.com/2019/03/26/us/politics/democrats-trump-affordable-care-act.html

House Democrats to unveil Affordable Care Act rescue package

by Ricardo Alonzo-Zaldivar - Associated Press - March 26, 2019

WASHINGTON  — Leading House Democrats, backed by Speaker Nancy Pelosi, are unveiling broad legislation to shore up the Affordable Care Act. It’s an attempt to deliver on campaign promises about health care and to — just maybe— change the conversation.
In a capital city consumed with the political storm over special counsel Robert Mueller’s Russia report , Democrats are trying to show they also care about policy by falling back on an issue that worked well for them in last year’s midterm elections .
According to Pelosi’s office, the bill being unveiled Tuesday would make more middle-class people eligible for subsidized health insurance through former President Barack Obama’s health law, often called “Obamacare,” while increasing aid for those with lower incomes who already qualify. And it would fix a longstanding affordability problem for some consumers, known as the “family glitch.”
The legislation would provide money to help insurers pay the bills of their costliest patients and restore advertising and outreach budgets slashed by President Donald Trump’s administration, helping to stabilize health insurance markets.
It also would block the Trump administration from loosening “Obamacare” rules through waivers that allow states to undermine protections for people with pre-existing medical conditions or to scale back so-called “essential” benefits like coverage for mental health and addiction treatment.
The bill will get a vote in the House, but as a package it has no chance of passing the Republican-controlled Senate. However, some elements have bipartisan support and may make it into law.
Trump swept into office promising to “repeal and replace” the Obama health law but was unable to do so, even with a Congress fully under Republican control.
Trump remains committed to overturning the ACA, but with the House in Democratic hands his last hope seems to be a court challenge to the law by Texas and other Republican-led states, now before a federal appeals panel.
The Trump administration said in its most recent appellate court filing in the case that the entire law should be struck down as unconstitutional, a bolder position than it previously held. It’s rare for the Justice Department to decline to defend a federal law.
Meanwhile, millions of people continue to benefit from the ACA’s taxpayer-subsidized private insurance plans, but enrollment is slowly declining and experts fear stagnation.
The government said Monday that 11.4 million people have signed up for coverage this year, just a slight dip from 2018. The Centers for Medicare and Medicaid Services found remarkably steady enrollment, down only about 300,000 consumers. Premiums stabilized, and more insurers came into the market.
Still, the number of new customers fell by more than 500,000. That’s a worrisome sign for backers of the ACA, who say the Trump administration’s cuts to the ad budget and congressional repeal of a requirement that people get insured will gradually eat away at program enrollment. Unless younger, healthier people sign up, already-high premiums will march upward again.
Since Trump took office, the federal health insurance market, HealthCare.gov, has lost more than 1 million customers. State-run markets are holding their own.
The House Democrats’ legislation is being introduced by three major committee leaders: Ways and Means Chairman Richard Neal, D-Mass., Energy and Commerce Chairman Frank Pallone, D-N.J., and Education and Labor Chairman Bobby Scott, D-Va.

https://www.pressherald.com/2019/03/26/house-democrats-to-unveil-affordable-care-act-rescue-package/

Trump administration asks court to totally repeal Obama’s Affordable Care Act

by Isaac Stanley Becker - Portland Press Herald - March 26, 2019

In a significant shift, the Justice Department now says it backs a full repeal of the Affordable Care Act, the signature Obama-era health law.
It divulged its position in a legal filing Monday with the U.S. Court of Appeals for the 5th Circuit in New Orleans, where an appeal is pending in a case challenging the measure’s constitutionality. A federal judge in Texas ruled in December that the law’s individual mandate “can no longer be sustained as an exercise of Congress’s tax power” and further found that the remaining portions of the law are invalid.
Previously, the Trump administration had not gone as far, arguing in a June brief that the penalty for not buying insurance could be distinguished from other provisions of the law, which could still stand.
Officials said there were legal grounds only to strike down the law’s consumer protections, including those for people with pre-existing health conditions.
But in the new filing, signed by three Justice Department attorneys, the administration said that the decision of U.S. District Judge Reed O’Connor should be affirmed and that the entirety of the ACA should be invalidated.
“Because the United States is not urging that any portion of the district court’s judgment be reversed, the government intends to file a brief on the appellees’ schedule,” the filing stated.
If it were successful, the Justice Department’s position supporting the judge’s ruling would potentially eliminate health care for millions of people and create widespread disruption across the U.S. health care system – from removing no-charge preventive services for older Americans on Medicare to voiding the expansion of Medicaid in most states. The change comes as newly empowered Democrats in the House have vowed to protect the ACA from Republican attacks.
House Speaker Nancy Pelosi, D-Calif., pledged in a tweet Monday night that Democrats would “fight relentlessly” to preserve “affordable, dependable health care.”
Timothy Jost, an emeritus professor at the Washington and Lee University law school, called the Justice Department’s new position “crazy” and “legally untenable.”
“I can’t believe that even the 5th Circuit would take that position,” he said in an interview, suggesting that arguably the nation’s most conservative appeals court would still be reluctant to accept the reasoning backed by the administration. “It would be like invalidating the Interstate Highway System, causing chaos on an unimaginable scale. It’s conceivable that the entire Medicare payment system would collapse.”
The filing reflected “a strictly political decision, not a legal decision,” Jost said. “Trump has wanted to get rid of the ACA, and I guess he sees an opportunity here.”
https://www.pressherald.com/2019/03/26/trump-administration-asks-court-to-totally-repeal-obamas-affordable-care-act/

  This woman’s polite request may have saved her $12,000 in surgery costs

by Sean Murphy - The Boston Globe - March 25, 2019

Linda Lane had a lot on her mind when she arrived at MetroWest Medical Center with her 19-year-old son to have his swollen tonsils removed.
At 6 foot 4 inches, Drew is a sturdy lad. But eight months earlier, as a college freshman, he had been knocked off his feet by a nasty bout of both mononucleosis and pneumonia.
On Jan. 3, Lane did her best to steel her nerves as Drew was prepared for surgery that, while usually uncomplicated, is not without risk.
Then MetroWest gave Lane something new to worry about: The hospital wouldn’t take her insurance.

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For the next several months, Lane was caught in the middle of a nightmarish experience with the hospital and her family’s medical insurer, CIGNA.
Through it all, Lane remained undeterred. And at one point, she did something absolutely brilliant as a consumer: She asked for and received a copy of the hospital’s case notes.
“I call it my smoking gun,” she said, passing me a single page at her home in Hopkinton.
That one page may have saved her more than $12,000.
Here’s what happened:
Last spring, after her son got sick, Lane asked CIGNA for a list of ear, nose, and throat specialists in the insurer’s network. She knew the drill: In network, she had generous insurance coverage; out of network, she had none.
Lane booked an appointment with Dr. Yushan Wilson, who examined Drew and determined she would have to take out his tonsils.
Lane asked for — and got — assurances from Wilson’s office that the surgery on Jan. 3 at MetroWest, where Wilson practiced, would be covered by her insurance.
“They said, ‘You’re all set,’ ” Lane said.
But on Jan. 2, Lane received a disconcerting call from an administrator in the “authorizations” department at the Framingham hospital. “You’re out of network,” she said.
Lane called Wilson’s office in a near-panic.
“It’s probably a mistake,” one of the assistants said. “I’ll look into it.”

Jonathan Wiggs/Globe Staff
Linda Lane with a screenshot of the memo written by the MetroWest Medical Center administrator.

Lane next called CIGNA. While she was on the phone with CIGNA, Wilson’s office called back: They had checked with MetroWest, and in fact she was covered.
A relieved Lane shared her “good news” with the CIGNA representative, who wondered aloud why MetroWest wasn’t on her list of in-network hospitals. Maybe it’s under a different corporate name, the CIGNA rep said.
The CIGNA rep volunteered to call Wilson’s office to double check. The rep implied she would call Lane back if there was a problem.
There was no call back.
As Lane arrived at MetroWest on Jan. 3, an administrator beckoned her.
“We have to set up a payment plan,” she said.
For a $100 copay? Lane asked.
“You’re out-of-network,” the administrator said.
Lane had come prepared with names and numbers. She asked the administrator to check with her colleague in “authorizations,” the one Lane had spoken with the day before. She was prepared to cancel the surgery.
After a conversation between the two hospital administrators, Lane was told she was indeed covered.
The administrator began typing notes: “Spoke with [administrator] in authorizations and as of today” Lane’s insurance “is in network and [Wilson’s] office is contracted with this insurance so the surgery will be covered.”
This is when Lane got her “smoking gun.”
“Can I have a copy of that?” she asked politely, looking over the administrator’s shoulder at the notes on the screen.
The administrator looked perplexed. But, yes, she said, you can. She printed it, added a hand-written note, and signed it.
Three weeks later, Lane’s husband discovered online that CIGNA had denied coverage because the surgery — after all that — had again been deemed out-of-network. (Lane emphasized to me that Drew got excellent care from Wilson and MetroWest.)
An exasperated Lane called MetroWest and reached an administrator who expressed surprise that CIGNA had rejected the claim because the hospital listed Drew’s surgery as in-network. She promised to submit the claim again.
Within days, however, Lane received a bill from MetroWest for $12,076.
Lane got back on the phone with CIGNA. And the run-around began again. Turns out that the first CIGNA rep — remember the one who was going to call Wilson’s office to check whether MetroWest was listed under another corporate name? — had determined the surgery wouldn’t be covered but had not called Lane back to share the news with her.
She had instead asked Wilson’s office to call Lane with the bad news.
That filled Lane with anger. First, the CIGNA rep should have called her back directly, instead of delegating it to Wilson’s office. And second, Wilson’s office apparently didn’t get the message or didn’t understand it because it confirmed coverage on the morning of the surgery — Lane’s “smoking gun” says so.
The folks at the MetroWest at first were sympathetic to Lane’s plight, but later took on a clipped, just-the-facts tone. She would have to pay the $12,000. Then they stopped returning Lane’s calls.
At times, Lane said, she felt like screaming.
“I’ve shed a lot of tears and lost a lot of sleep,” Lane said. “I think I did everything right. But the system broke down, and they’re trying to stick me with the bill.”
I made my first call on Lane’s behalf to MetroWest earlier this month. Within two hours, Lane received a call for the first time from a high-ranking manager at the hospital.
Two days later, MetroWest apologized to Lane and ripped up the bill. CIGNA also later apologized. I know my intervention played a role, but credit goes to Lane. She persisted.
Of course, none of this should have happened. The health care system is complex and sometimes baffling. Watch out for yourself.
How, exactly? Do like Lane did: Document everything.
https://www.bostonglobe.com/business/2019/03/25/post-surgery-complications-thanks-breakdown-billing/Di2Q8H7ER0xPDfMkHe7fbO/story.html?

Opinion - Message from Democratic supermajority and health care foundations on reform: No. Relief. Coming. 

by Keith McCallin - Elk Grove News.com - March 19, 2019

Bad news for the single payer/Medicare for All movement in California, and so the
country:

Daniel Zingale, former executive vice president of policy with The
California Endowment, has been brought on board Governor Newsom’s
health care team as “Senior Advisor and Communications Strategist.”

As head of policy of the California Endowment, Dan Zingale oversaw a billion dollar campaign
that effectively argued, don’t fix health care.
In order to appreciate the significance of the Zingale appointment, one must know about the
California Endowment and other California health care foundations.
Health care foundations in California came into existence when non profit health insurance
companies saw the profit potential and decided to go private. They, of course, wanted to steal
away with the mountains of billions in profits captured from their non profiting ways. But, our
state regulatory agency, with help from the courts, said no and told them that those billions in
profits must be placed in foundations and the foundations will then spend those monies to benefit
the health of the California citizenry.
The California Endowment is but one of those foundations. The California Health Care
Foundation and The California Wellness Foundation are others.
They are called “conversion foundations, ” or “health legacy foundations”:
Health conversion foundations [] are formed when a nonprofit hospital,
health care system or health plan is either acquired by a for-profit firm or
converted to for-profit status.

A leading and reliable health care policy voice in California and the U.S. said:
“...the foundations will never grant money to anything that will challenge
the for-profit insurance system...”

Health care foundations hamstring the single payer/Medicare For All movement in four
fundamental ways:
1. Foundations have created a barrier to getting the Single Payer/Medicare For All
message out to the underserved communities for whom the foundations claim (as do we) to
advocate.
The California Endowment is in the last year of a 10 year, one billion dollar campaign called
“Building Healthy Communities,” aka, BHC. South Sacramento is one such community.
Salinas, CA is another such community.
An urban sociologist who has studied the health care needs of South Sacramento, among other

underserved Sacramento area communities, tells of a stark and systemic neglect. In maps and
data, he reveals South Sacramento for the health care desert that it is. Meanwhile:
The California Endowment, which is mandated to promote the health of the California citizenry,
spent a billion dollars to push this narrative:

Don’t Fix Health Care, spend more money on the social determinants of
health.

Social determinants of health are. more. than. real. But, placing don’t fix health care, prior to
those words makes for a deeply flawed but very effective public relations move:
- Health care costs, i.e., the near to trillion dollars in health care waste, consumes the monies
necessary to even begin to attend to the social determinants of health. And fund public school
systems. And pay for infrastructure repairs...
- There are a myriad of issues that fall under “social determinants of health.”
Does it make sense to put off fixing health care until we solve the problem of obesity? Shall we
await until fast food is no longer a staple in the daily American diet?
Shall we wait until we transition our prison system from its current concentration camp design to
something other than that?
Shall we wait until the percent of Americans voting goes from 40% to above 90%?
Shall we wait until a medical transportation system is in place that will transport those living in
health care deserts to deliver those citizens to distant hospitals and clinics so as to get their half
and tiered care?
South Sacramento as well as Salinas, CA, and all the other BHC sites, as well as our middle
class, as well as our younger generations, are actively being cemented into a permanent health
care underclass while the California Endowment sells well the idea of not fixing health care.
2. Foundations grant billions to a myriad of individuals and organizations and so a myriad
of individuals and organizations are not interested in fixing health care once and for all.
Many grantee websites post mission statements that speak of determined advocacy while doing
nothing to fix the root problem that creates the need for their advocacy in the first place.
Medical advocacy is a cottage industry that is fueled=funded by grants from foundations, and
those medical and health advocacy organizations compete fiercely for those grants. It’s a
Hunger Games competition.
Foundations fund many of the so-called health care policy experts and policy organizations who
are featured in our major media.

Foundations fund health care journalism, which we must begin to see as no type of journalism at
all. Courtiers-in-journalist-clothes are a very real thing and they deliver the vast majority of that
which is called health care journalism.
3. The foundations are just another driver of the public relations machine that controls
public opinion.
Is your public radio station, as Capital Public Radio is here in Sacramento, underwritten by the
California health care foundations, and national health care foundations, and local hospitals and
hospital systems?
Here in Sacramento, Capital Public Radio tag-teams with the Sacramento Bee, CalMatters and
the California health care foundations, among others. See public opinion be turned so easily, by
such mediums, away from fixing health care.
4. Foundation monies drain away talented, influential and often affluential, individuals
and keep them focused on not fixing health care.
This talent loss/brain drain refers to individuals in the general public as much as it does
foundation grantees.

Many grantees are mere marketers. For them, the health care issue is just a widget and faux-
advocacy is their game. For them, fixing health care would prove very bad for business.

Many grantees are dedicated professionals with a social worker’s determination, but they can
only find work in the “Billions-For-Band-Aids” approach to fixing health care, which is no fix.
This is an unfortunate reality that profoundly hampers genuine advocacy and reform efforts.
Conclusion:
Our California governor has brought into his office and placed on his health care team a person
who has a curriculum vitae that features an undeniable success championing the idea:

Don’t fix health care.

What is happening here in California is that the powers that be, who have supermajority strength
and pie all over their faces and fingers, are working diligently to protect the for-profit insurance
industry and the profits of the medical corporations. In so doing, our leaders work to:
- Maintain the health care deserts
- Keep GoFundMe as the go-to supplemental plan for all
- Push public schools systems toward insolvency
- Keep our health care system first in the world for its ability to extract cash from consumers and
communities while keeping us last in measures of health system equity, access, administrative
efficiency, care delivery, and health care outcomes.

Meanwhile the underinsured - which is most of us, only learn how painfully unbeneficial our
health care benefits are when we are most desperately in need of those benefits.
Shot by a lunatic then mugged by the health care system, is an All American thing.
There is not any health care policy debate happening in California, nor is there even a political
fight. In California, politicians represent well the health care profiteers while never-ending
public relations campaigns run cover for them.
The greater public relations game began back in 1917 with the creation of the Creel Committee
on Public Information prior to WWI. But, regarding health care, the ability to control well
public opinion came in 1944 when the California Medical Association hired the public relations
team of Whitaker & Baxter to kill California Governor Earl Warren’s single payer bill. So
successful was the public relations campaign, Whitaker & Baxter were then hired by the
American Medical Association to kill Truman's national single payer bill in 1952.
It was a public relations campaign that killed SB562, California’s single payer bill, in 2017.
The health care foundations stand in the way of fixing our health care system. Appealing to our
courts, given the mandate, is not an unreasonable plan, but it is likely to prove a citizen-fool’s
errand given that Citizens United is the law of our land.
Alternatively, since health care foundations fly under our radars yet operate right in front of our
faces, it might take nothing more than informing the uninsured and the underinsured of the
contributions of the health care foundations toward keeping our health care system broken.
Acknowledgment of this health care foundation problem, which is not just a California concern,
could very well prove diagnostic and therapeutic.

http://www.elkgrovenews.net/2019/03/opinion-message-from-democratic.html

Rural America Needs Medicare for All, and Fast

by Barb Kalbach - Common Dreams - March 25, 2019

We’ve got a rural health care emergency on the horizon.
Rural hospitals are closing or teetering on the brink of closure at an alarming rate. More than a hundred have closed since 2005 and hundreds more are on life support. Long-term care facilities are vanishing across rural America or being bought up by large corporations who care about profit, not the care of our loved ones.
Most rural hospitals have even stopped delivering babies — you’ll need to go to the city for that, so plan ahead.
I know firsthand. I’m a registered nurse and lifelong Iowan from the country. I’ve kept a close eye on where we’ve been with health care, and where it appears we’re headed. It’s not looking too good for my community and others if we stay on our current failed path.
Medicaid expansion was supposed to help here in Iowa. It sure didn’t — because we handed the program over to private, for-profit “managed care organizations.” What we got in return was less care — and more services denied, facilities shuttered, and lives lost to corporate greed.
Hospitals that were already struggling now have to submit and re-submit claims to these private companies and wait months, if not years, to get paid. Even without privatized Medicaid, we’d still be facing an impending rural healthcare emergency. Privatization merely hastened what was already happening.
Americans spend about twice as much on health care than any other developed country, but we live shorter lives — even as we create “health care billionaires” that get profiles in magazines like Forbes.
Americans spend about twice as much on health care than any other developed country, but we live shorter lives — even as we create “health care billionaires” that get profiles in magazines like Forbes.
The for-profit healthcare system is an extractive industry, helping to suck the wealth and life out of communities, especially in rural areas. We’re being left behind because the for-profit insurance industry doesn’t see us as worth their time.
Rural hospitals, local nursing homes, and care facilities are the lifeblood of our small towns across the heartland. We’re watching our farms and small towns wither away as the countryside empties out and our health declines.
But it doesn’t have to be this way. A system that puts the wellbeing of our community ahead of the bottom line of a select few can and will deliver the care we need, where and when we need it, and keep our rural communities alive and vibrant.
Which brings us to the Medicare for All Act of 2019 introduced by Rep. Pramila Jayapal of Washington state. Instead of allowing private corporations to decide who pays for health care and how much, we would put our financing back into public hands — and our health care decisions back into the hands of patients and their care provider.
Under Medicare for All, virtually all aspects of our health care will be covered. This includes, but isn’t limited to, medical, dental, vision, hearing, prescription drugs, mental health, addiction treatment, and much more.
Medicare for All also covers long-term and in-home care as well. What a gift to our families, especially those that often go unseen by an industry dominated by profit: the elderly and people with disabilities. Long-term and in-home care allows people to stay near their families or in their homes, rooted in the communities we call home.
Perhaps most importantly for Iowa and other rural communities, Jayapal’s bill includes a special projects budget for capital expenditures and staffing needs of providers in rural or medically underserved areas.
Will this cost money? Of course it will. But we’ll actually spend less overall than we’re currently spending in our broken health care system, and we’ll get better and more comprehensive coverage.
For all these reasons, Medicare for All is the prescription America and our rural communities need.
https://www.commondreams.org/views/2019/03/25/rural-america-needs-medicare-all-and-fast?

Medicare for America

by Michael Lighty - Common Dreams - March 25, 2019

With so much written about the politics and some about the policy of Medicare for All, it seems we’re having a real debate about the key issues.
But appearances deceive.
Instead, it’s more of a struggle over the semantics of “Medicare” – #M4A - is it for America or is it for All? Proponents of “Medicare for America,” the latest talking point elevated to policy – “you can keep your private insurance!”  - claim that it provides universal coverage, and thus insures everyone has healthcare.
But is universal coverage guaranteed healthcare?
To address that question means actually debating the role of US based private insurance, it’s business model, relationship to the healthcare industry and finance sector. This approach reveals much more about the bi-partisan politics and policy choices of healthcare reform.
If proponents of Medicare for America had to honestly address the primary elements of the health insurers’ business model, it would be tough to defend:

• unnecessary insurance company profits ($5.8 billion in 3rd quarter, 2018)
• huge executive salaries ($81 million for UnitedHealth CEO in 2018);
• reliance on high tax subsidies ($262 billion for employer plans in fiscal 2017-18);
• regular denials of care (1 in 5 claims denied in ACA plans per KFF study, 2019);
• escalating premiums to generate enormous revenues invested on Wall Street, benefiting shareholders;
• largest lobbying operation on Capitol Hill ($3.5 bil in lobbying, $710 million in campaign contributions during ACA period) - healthcare financing is the worst example of “crony capitalism” (Angus Deaton, 2015 Nobel Laureate in Economics).

So then, do you continue to enrich the insurance companies by promoting the growth of for-profit Medicare Advantage plans (as the Medicare for America proposal calls for), and subsidize their revenue model with unregulated premiums and high out of pocket costs (a $5,000 “limit” as proposed is a lot to the 78% of people living paycheck to paycheck, and the 40% who don’t have more than $400 in the bank).
A real debate would be about regulating the insurers vs eliminating their role as profit-making intermediaries. Either defend the commercial health insurance business model, or explain how your M4A changes it.
If the real goal of Medicare for America is to unwind these practices, the incremental approach undermines the prospects for success. As we saw during the four year roll-out of the Affordable Care Act vs the efficient, ten month transition to Medicare, lots of lies can be told, the industry can game the system, and opposition can organize. Rather than contort policy into some hybrid, multi-payer regulatory scheme that generates complexity, fragmentation and waste, as it enshrines profit-making and high out of pocket costs, let’s stop the care denials and the insurance company dictates to doctors and patients.
Medicare for All represents the best M4A way: lead and be swift. Don’t tell show. Yes, your premiums are gone, your co-pay to see the doctor is eliminated, you don’t have to worry about your deductible or wait for insurance company approval to get that test.
Very quickly, peace of mind will overwhelm that forgotten desire to keep your private insurance.
Ahhh, freedom.
https://www.commondreams.org/views/2019/03/25/medicare-america?c

Not All Medicare Cuts Are Bad

by The Editorial Board - NYT - March 25, 2019

Senate Democrats, including several of the party’s presidential candidates, have savaged President Trump for proposing to reduce Medicare spending by several hundred billion dollars over the next decade.
Senator Kamala Harris of California said the proposed changes in Medicare “would hurt our seniors.”
Senator Elizabeth Warren of Massachusetts tweeted, “The Trump administration wants to cut hundreds of billions of dollars from the #Medicare budget, all while giving billionaires and giant corporations huge tax breaks.”
The Hawaii senator Brian Schatz, the rare Democrat who is not running for president, offered the following summary: “One party wants to expand Medicare and Medicaid, and the other wants to cut them.”
But some cuts to Medicare make sense. Several sought by Mr. Trump closely resemble cuts that had been proposed by President Barack Obama. And the indiscriminate attacks by Senate Democrats are a reminder of how hard it has become for Congress to perform even the most basic kinds of prudent housekeeping in the public interest.

When Americans with Medicare visit a doctor’s office, the federal government pays a higher fee if that office happens to be owned by a hospital. This bonus payment serves no obvious purpose. A federal advisory board created to monitor Medicare spending has called for its elimination. And this month, the Trump administration proposed the change in its 2020 budget, along with several other measures recommended by nonpartisan experts to reduce payments to service providers without directly affecting the cost or availability of care.
In total, Mr. Trump’s budget would cut proposed Medicare spending by $845 billion over the next decade. About a third of that money would come from moving funding for certain programs to other parts of the federal budget, and pruning, so the actual reduction in spending would be in the neighborhood of $600 billion. The largest chunk of those cuts would come at the expense of hospitals that are paid more than independent doctors’ offices to treat patients.
The two-rate system has its roots in the real differences between a hospital and a doctor’s office. Hospitals tend to treat less-healthy patients; they provide a safety net of related services if something goes wrong; and they must comply with more stringent rules. But that line was warped as hospitals acquired physicians’ offices, taking advantage of their eligibility to collect larger payments from Medicare. Also, advances in medical technology have increased the range of services that can be provided outside a traditional hospital.
In 2015, Congress sought to stem the trend by barring higher payments to any new offices acquired or established by hospitals — but existing practices were grandfathered in.
The Medicare Payment Advisory Commission, a federal panel created in 1997 to provide advice on Medicare spending, has recommended the end of that exemption. The White House budget estimates the change would save $28.7 billion between 2020 and 2029. A pair of more complex but related changes intended to equalize billing for procedures including medical imaging and drug management would save $240 billion more over the same period.

Hospitals understandably dislike these proposals, and there may well be a better dividing line. It’s also possible that in some cases, the federal government should pay higher fees to private practices rather than pay lower fees to hospital affiliates. The administration’s budget contains only a thumbnail sketch of its own ideas, and the details clearly matter.
But Democrats are not debating the details. Instead, a proposal to improve the efficiency of health care spending is being treated as an attack on the availability of health care.
This is not a new phenomenon, of course. The Affordable Care Act included substantial reductions in Medicare spending. Those cuts, like Mr. Trump’s proposals, came mostly at the expense of providers rather than patients. But Republicans chose to attack the changes in language strikingly similar to the language Democrats have used in recent weeks.
Both parties have fallen into the unfortunate habit of characterizing every proposal to reduce Medicare spending as an attack on the program’s beneficiaries. In fact, careful stewardship of spending is necessary to ensure the program can help as many people as possible.
Mr. Trump is guilty of contradicting his campaign promise that he would not seek to cut Medicare spending. But it is the promise that was irresponsible, not the budget proposal.
Some items on Mr. Trump’s list of proposed savings have obvious downsides. For example, he has proposed to cut federal spending by increasing the annual amount that several hundred thousand Medicare beneficiaries are required to pay for needed medications. The budget also proposes large cuts in Medicaid that would reduce the availability of health care for many lower-income and disabled Americans.
But a president’s budget is just a list of ideas. It's up to Congress to pick the good ones.
Support for past cuts in Medicare spending was driven in part by concerns about the growth of the federal debt. Both parties lately have taken a more relaxed view of the government’s borrowing capacity, in part because apocalyptic predictions about the current level of federal debt look rather silly in retrospect. But the government’s ability to borrow money is not a justification for the wasteful spending of tax dollars.

Maintaining tight control of Medicare spending is good government in its own right. Congress ought to feel a sufficient urgency about eliminating unnecessary spending even if the federal government were running an annual budget surplus.
Ms. Harris, Ms. Warren and other Democratic presidential candidates — including Senator Kirsten Gillibrand of New York, Senator Cory Booker of New Jersey and Senator Bernie Sanders of Vermont — have become vocal proponents of expanding Medicare eligibility.
The case for such an expansion would be strengthened if proponents showed greater concern not just for broadening the availability of health care, but also for managing the cost of care.
https://www.nytimes.com/2019/03/25/opinion/trump-medicare-cuts.html?smid=nytcore-ios-share