Health Care Reform Articles - July 26, 2021

 

We got the bill for having a baby – $37,000. Welcome to life in America

by Arwa Mahdawi - The Guardian - July 22, 2021

Baby got bills

For the last couple of months my wife and I have been playing a quintessentially American game of Guess the Baby Bill. The rules are simple: try to guess exactly how much we would be charged for the birth of our daughter earlier this year. Last week the hospital bill finally came, putting an end to the guessing game. The cost of an uncomplicated vaginal birth? $37,617.69.

I won’t repeat what I said when we got this bill, because it is unprintable. My language became particularly colourful when, scrutinizing the bill, I noticed that the bulk of the charge was for three nights’ “room and board” in a semi-private room (containing two beds separated by a curtain) which was $10,350 a night. That’s five times more expensive than a completely private suite at the Ritz-Carlton by Central Park. The post-delivery hospital room, by the way, was more budget motel than the Ritz. It was barely big enough to swing a baby, and I had to sleep in an office chair squeezed by my wife’s bed. To add insult to economic injury, the hospital also marked me down as “male” on the baby’s birth certificate and we’ve spent the last two months trying – and failing – to get this changed.

Anyway, the good news is that we don’t have to pay the entire bill: our health insurance covers about $31,000 – leaving us with a balance of around $6,000. Although, of course, that doesn’t make the ridiculously high prices OK. We’re still covering the costs indirectly via our enormous insurance premiums. Which, we were recently informed by Oxford Health, part of UnitedHealth Group, are going to go up by 16% next year. But it’s understandable, I guess. They need that money to do the things health companies are supposed to do: maximise profits, boost the share price and pay their executives huge amounts of money. The UnitedHealth Group’s chief executive made over $50m in salary, bonus and stock option compensation in 2019.

It’s not just the extortionate prices in America’s health system that are problematic. It’s the lack of transparency. My partner called our insurance company multiple times before the birth to try to find out how much we would expect to pay. We were told on each occasion that we wouldn’t have to pay anything. Which was obviously baloney as nothing in the US healthcare system is free. Then again, nothing in the US healthcare system seems to have a fixed price. It seems like medical providers come up with the largest number they think they can get away with, charge you that, and then wait for you to spend three months of your life haggling about the bill. I’m not sure Franz Kafka himself could have envisaged a bureaucratic system as nightmarishly opaque and absurd as American healthcare.

America’s healthcare system isn’t just a nightmare to navigate – it’s inefficient and inequitable. The US may spend more on healthcare as a share of the economy than any other developed country, but it also has the highest maternal mortality rate in the developed world and maternal deaths have been increasing since 2000. And Black women are three times more likely to die from a pregnancy-related cause than white women.

Sadly, while there’s a growing desire among Americans for a single-payer system, it doesn’t look like healthcare in America is going to grow more affordable or equitable any time soon. Joe Biden campaigned on the idea of creating a public insurance option but plans for that seem to have fizzled out. Meanwhile, across the Atlantic, things are not looking much better: Britain’s NHS is slowly and stealthily being privatized.

Do you know what the saddest thing about my hospital bill is? In the grand scheme of American healthcare, the $6,000 we have to pay really isn’t so bad. Lauren Bard, an ER nurse from California, for example, got hit with a bill for $898,984.57 when her daughter arrived at just 26 weeks. You’d think a nurse would get pretty good health insurance from her employer but Dignity Health, whose motto is “Hello humankindness” refused to cover the costs until the media company ProPublica got involved. $6,000 is a lot of money but it could have been a lot worse.

Still, if we lose our minds and decide to have another kid in the US, then I’m hiring a midwife and popping the kid out at the Ritz.

https://www.theguardian.com/commentisfree/2021/jul/17/baby-got-bills-week-in-patriarchy-arwa-mahdawi 

 

Americans’ Medical Debts Are Bigger Than Was Known, Totaling $140 Billion

A new study finds that health care has become the country’s largest source of debt in collections. Those debts are largest where Medicaid wasn’t expanded.

by Sarah Kliff and Margot Sanger-Katz - July 20, 2021

Americans owe nearly twice as much medical debt as was previously known, and the amount owed has become increasingly concentrated in states that do not participate in the Affordable Care Act’s Medicaid expansion program.

New research published Tuesday in JAMA finds that collection agencies held $140 billion in unpaid medical bills last year,. An earlier study, examining debts in 2016, estimated that Americans held $81 billion in medical debt.

This new paper took a more complete look at which patients have outstanding medical debts, including individuals who do not have credit cards or bank accounts. Using 10 percent of all credit reports from the credit rating agency TransUnion, the paper finds that about 18 percent of Americans hold medical debt that is in collections.

The researchers found that, between 2009 and 2020, unpaid medical bills became the largest source of debt that Americans owe collections agencies. Overall debt, both from medical bills and other sources, declined during that period as the economy recovered from the Great Recession.

“If you think about Americans getting phone calls, letters and knocks on the door from debt collectors, more often than not it’s because of the U.S. health care system,” said Neale Mahoney, a health economist at Stanford University and the paper’s lead author.

The $140 billion in debt does not count all medical bills owed to health care providers, because it measures only debts that have been sold to collections agencies. The increasing number of lawsuits that hospitals file against patients to collect debt, which can lead to legal fees or wage garnishments, are not included in the figure. Nor are the medical bills that patients pay with credit cards or have on long-term payment plans. Some of the difference between the new estimate and the older, smaller one may reflect differences in how different credit rating agencies categorize debts.

The new paper does not include data during the coronavirus pandemic, which is not yet available.

The ameliorating effects of Medicaid expansion were not a big surprise to the paper’s authors. Previous research demonstrated how Medicaid coverage can reduce medical debts. In states that have expanded, most low-income adults can get coverage without paying premiums, and with minimal cost sharing. Mechanically, Medicaid tends to eliminate the kinds of medical bills that result in outstanding debts.

But Mr. Mahoney said he was shocked to see the widening inequality in medical debt that disparate state decisions appear to have caused. The states that have declined to expand Medicaid — particularly in the South — started out having more medical debt before Obamacare passed, and since other states have expanded Medicaid, the chasm has grown wider. In 2020, Americans living in states that did not expand Medicaid owed an average of $375 more than those in states that participated in the program, roughly a 30 percent increase from the gap that existed the year before enactment.

Amy Finkelstein, a professor of economics at M.I.T., was a co-author of an influential study that showed how Medicaid coverage could improve Americans’ financial health. She studied what happened when Oregon used a lottery to randomly offer Medicaid coverage to a share of low-income adults seeking coverage.

The study found substantial improvements in measures of financial health for people who received coverage. It also found improvements in those people’s mental health — increases too large to be explained by new medical treatments alone.

Professor Finkelstein said the new paper was a reminder that health insurance often acts as a strong buffer against financial adversity.

“It’s a misnomer — it’s not just to insure your health,” she said. “It’s actually to protect you economically in the event of poor health.”

Medical debt is unlike other kinds of debts because people often cannot choose whether to incur it. A poorer person may choose to buy a less expensive car than her richer neighbor, but if she has a heart attack and needs surgery, she will get a bill just as big as her neighbor.

The new paper finds that medical debts are higher in poorer neighborhoods. In the lowest-income ZIP codes that researchers studied, people owed an average of $677. Those in the highest-income ZIP codes owed an average of $126. Those figures represent the general population, not just debt holders.

But medical debts are different in another way, too: They are much less likely to be repaid. Prior research suggests that many people with medical debts have other kinds of debt that may be a bigger priority. Failing to pay your utility bills could result in shut-offs, and failing to pay your auto loan could cause your car to be repossessed. Medical debts, in contrast, tend mostly to harm people’s credit reports and peace of mind.

“Debt collections agencies place very low odds on recovering these debts,” said Benedic Ippolito, a senior fellow at the American Enterprise Institute, and a co-author of an earlier paper examining medical debt in America. “If you had to choose between keeping the lights on and paying your mortgage and paying some doctor you’re never going to see again, I think a lot of us would make the same decision.”

Democrats in Congress have recently shown strong interest in providing coverage to millions of low-income Americans who live in the 12 states that do not participate in the Medicaid expansion.

Democrats included the idea in last week’s $3.5 trillion reconciliation package. Legislators are still debating the right policy to fill the coverage gap — if they should provide the uninsured with subsidies to buy private coverage, for example, or work with cities that want to expand coverage locally — as well as how to pay for it.

The most recent proposal comes from Senators Raphael Warnock and Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin, who represent states without the expansion. Last week, they introduced legislation that would allow the federal government to provide Medicaid coverage in states that decline to do so.

“Expanding Medicaid is the single most effective solution to closing our state’s coverage gap,” Mr. Warnock said in a recent call with reporters.

Others see a need for bigger change. In his presidential campaign last year, Senator Bernie Sanders of Vermont proposed eliminating medical debt altogether — part of a plan to move the country to a single-payer system in which no one pays for medical care directly.

Some have also proposed smaller ways to make medical debt less painful.

Senator Chris Murphy of Connecticut introduced legislation last year that would require hospitals to publicly report how they collect debt, and cap the interest rates that patients could owe. The law would also require clear communication from hospitals of what debts are owed before they could turn to a collection agency.

“I understand that hospitals have pressures to squeeze every dollar out of their consumers,” Mr. Murphy said in a recent interview, “but I think they should refrain from the most aggressive debt collection practices.”

https://www.nytimes.com/2021/07/20/upshot/medical-debt-americans-

medicaid.html?referringSource=articleShare

 

 Editor's Note -

 "Price Transparency" has been promoted by many politicians as a politically attractive way to allow "consumers" to more effectively shop for medical care, and reduce healthcare costs as a result - thereby avoiding the politically risky idea of "price controls". What could be more American? 

 

The following articles explain why this idea has not, will not and cannot ever work.  Painful as it may be, these articles should be read and understood by proponents of "price transparency" as a policy tool in health care,

 

- SPC

 

The Health 202: Biden says he'll enforce Trump-era rules requiring hospitals to post their prices

By Alexandra Ellerbeck - The Washington Post - July 12, 2021

 

President Biden is putting his foot down on a price transparency rule that many hospitals have skirted over the past seven months.

On Friday, Biden released an executive order instructing the Secretary of Health and Human Services to “support” price transparency regulations issued by the Trump administration.

Starting on Jan. 1, hospitals were required to post the prices they charge cash-paying customers and the rates they negotiate with insurers — figures that were largely obscured from public scrutiny. Proponents of greater hospital transparency championed the change, saying it would help patients shop for better deals and drive down health care prices. Until now, it was unclear exactly how the Biden administration would approach the Trump-era rules, even as advocates and some lawmakers urged stronger enforcement amid signs of widespread noncompliance. 

Friday’s executive order still didn’t provide many details, but it signaled that the new administration views the transparency rules as valuable, even if they ultimately don’t pack as much of a punch as former president Donald Trump had claimed.

Recent studies have found that many hospitals aren’t complying with the rule.

• A study published in the American Journal of Managed Care last month looked at 20 prominent U.S. hospitals and found that only 60 percent listed their cash prices on their websites, as of February. Only 5 percent displayed the minimum charges that they negotiated with insurers.
• Another study published in the journal JAMA Internal Medicine found that some 83 percent of hospitals are not fully complying with the price transparency rules.

Many hospitals provided a price estimator tool for patients, the JAMA study found, but far fewer provided an easy-to-use file with the prices the hospital negotiated with different insurers.

“Because patient-oriented price estimator tools make prices visible only for a given patient and insurance plan and not to payers or the public, selective compliance may fail to expose abuses of market power, affect price negotiations, or support broad analysis of price variation to the extent intended by the transparency initiative,” the study authors write.

Biden’s executive order is sparse on details, saying that the health secretary should “support existing price transparency initiatives for hospitals” along with any future transparency requirements. But the Department of Health and Human Services began in April to send letters to hospitals that weren’t complying with the rule and indicated it plans to audit a sample of hospitals. 

Transparency advocates, who’d been disappointed by hospitals’ lack of compliance, are hoping the fresh attention from the Biden administration could signal stronger enforcement.

“Biden’s executive order hands the torch to both [Health and Human Services Secretary Xavier] Becerra and Health and Human Services to boldly enforce the rules. It gives them the power to do what they need to do even if it means they need harsher penalties and stricter enforcement,” said Cynthia Fisher, the founder of Patient Rights Advocate, a nonprofit that pushes for price transparency.

The response from hospitals themselves was muted, but Molly Smith, vice president for public policy at the American Hospital Association, told Health 202 that the organization “strongly encourage[s]” hospitals to follow federal guidelines on transparency. 

Still, even with enforcement, the effects of greater price transparency may be modest.

Experts in health care finance have said that the new transparency rules are unlikely to be a silver bullet when it comes to driving down health care costs. 

Many Americans are insulated from the direct cost of treatment because their insurance picks up the tab, and even those patients who pay directly may have a hard time wading through hundreds of pages of complex pricing documents. 

Even when hospitals do post their prices, many Americans don’t know to look for them. Fewer than 1 in 10 Americans say they are aware that hospitals are required to post their prices, according to a recent Kaiser Family Foundation poll.

“Healthcare goods are very complex. We care a lot about quality, and we in essence listen to what our doctor recommends,” said Zack Cooper, a professor of health policy and economics at Yale University. “I think the idea somebody is going to be out there with a price transparency tool figuring out where to go in this market is just not realistic.”

President Biden signed a sweeping executive order on July 9. The order outlines 72 initiatives to rein in the corporate powerhouses that control markets. (Reuters)

Biden’s executive order also called for action on drug pricing and hospital consolidation. 

The health care provisions come in a sweeping executive order that has 72 initiatives aimed at scaling back monopolies and offering consumers more options in technology, finance, and health care.

The order encourages Federal Trade Commission to crack down on hospital mergers that are harmful to patients and to ban “pay-for-delay” tactics that allow brand name drug manufacturers to pay generic manufacturers to keep their products off the market.

It also directs the Food and Drug Administration to work with states on importing drugs from Canada, another initiative started during Trump’s time in office, as our colleague Amy Goldstein reports.

“Just a handful of companies control the market for many vital medicines, giving them leverage over everyone else to charge whatever they want,” the president said before a signing ceremony at the White House. “As a result, Americans pay two and a half times more for prescription drugs than any other leading country.”

https://www.washingtonpost.com/politics/2021/07/12/health-202-biden-says-he-enforce-trump-era-rules-requiring-hospitals-post-their-prices/ 

 

Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess.

 by Julie Appleby - Kaiser Health News - July 2, 2021

A colonoscopy might cost you or your insurer a few hundred dollars — or several thousand, depending on which hospital or insurer you use.

Long hidden, such price variations are supposed to be available in stark black and white under a Trump administration price transparency rule that took effect at the start of this year. It requires hospitals to post a range of actual prices — everything from the rates they offer cash-paying customers to costs negotiated with insurers.

Many have complied.

But some hospitals bury the data deep on their websites or have not included all the categories of prices required, according to industry analysts. A sizable minority of hospitals have not disclosed the information at all.

While imperfect and potentially of limited use right now to the average consumer, this trove is, nonetheless, eye-opening as an illustration of the huge differences in prices — nationally, regionally and within the same hospital. It’s challenging for consumers and employers to use, giving a boost to a cottage industry that analyzes the data, which in turn could be weaponized for use in negotiations among hospitals, employers and insurers. Ultimately, the unanswered question is whether price transparency will lead to overall lower prices.

In theory, releasing prices may prompt consumers to shop around, weighing cost and quality. Perhaps they could save a few hundred dollars by getting their surgery or imaging test across town instead of at the nearby clinic or hospital. But, typically, consumers don’t comparison-shop, preferring to choose convenience or the provider their doctor recommends. A recent Peterson-KFF Health System Tracker brief, for instance, found that 85% of adults said they had not researched online the price of a hospital treatment.

And hospitals say the transparency push alone won’t help consumers much, because each patient is different — and individual deductibles and insurance plans complicate matters.

Under the Trump-era rule, hospitals must post what they accept from all insurers for thousands of line items, including each drug, procedure or treatment they provide. In addition, hospitals must present this in a format easily readable by computers and include a consumer-friendly separate listing of 300 “shoppable” services, bundling the full price a hospital accepts for a given treatment, such as having a baby or getting a hip replacement.

The negotiated rates now being posted publicly often show an individual hospital accepting a wide range of prices for the same service, depending on the insurer, often based on how much negotiating power each has in a market.

In some cases, the cash-only price is less than what insurers pay. And prices may vary widely within the same city or region.

In Virginia, for example, the average price of a diagnostic colonoscopy is $2,763, but the range across the state is from $208 to $10,563, according to a database aggregated by San Diego-based Turquoise Health, one of the new firms looking to market the data to businesses while offering some information free of charge to patients. Another is Health Cost Labs, which will have pricing information for 2,300 hospitals in its database when it goes live this month.

Patients can try to find the price information themselves by searching hospital websites, but even locating the correct tab on a hospital’s website is tricky.

Here’s one tip: “You can Google the hospital name and the words ‘price transparency’ and see where that takes you,” said Caitlin Sheetz, director and head of analytics at the consulting firm ADVI Health in the Washington, D.C., area.

Typing in “MedStar Health hospital transparency,” for example, likely points to MedStar Washington Hospital Center’s “price transparency disclosure” page, with a link to its full list of prices, as well as its separate list of 300 shoppable services.

By clicking on the list of shoppable services, consumers can download an Excel file. Searching it for “colonoscopy” pulls up several variations of the procedure, along with prices for different insurers, such as Aetna and Cigna, but a “not available” designation for the cash-only price. The file explains that MedStar does not have a standard cash price but makes determinations case by case.

Performing the same Google search for the nearby Inova health system results in less useful information.

Inova’s website links to a long list of thousands of charges, which are not the discounts negotiated by insurers, and the list is not easily searchable. The website advises those who are not Inova patients or who would like to create their own estimate to log into the hospitals’ “My Chart” system, but a search on that for “colonoscopy” failed to produce any data.

Because of the difficulty of navigating these websites — or locating the negotiated prices once there — some consumers may turn to sites like Turquoise. Doing a similar search on that site shows the prices of a colonoscopy at MedStar by insurer, but the process is still complicated. First, a consumer must select the “health system” button from the website’s menu of options, click on “surgical procedures,” then click again on “digestive” to get to it.

There is no similar information for Inova because the hospital system has not yet made its data accessible in a computer-friendly format, said Chris Severn, CEO of Turquoise.

Inova spokesperson Tracy Connell said in a written statement that the health system will create personalized estimates for patients and is “currently working to post information on negotiated prices and discounts on services.”

For consumers who go the distance and can find price data from their hospitals, it may prove helpful in certain situations:

• Patients who are paying cash or who have unmet deductibles may want to compare prices among hospitals to see if driving farther could save them money.
• Uninsured patients could ask the hospital for the cash price or attempt to negotiate for the lowest amount the facility accepts from insurers.
• Insured patients who get a bill for out-of-network care may find the information helpful because it could empower them to negotiate a discount off the hospitals’ gross charges for that care.

While there’s no guarantee of success, “if you are uninsured or out of network, you could point to some of those prices and say, ‘That’s what I want,’” said Barak Richman, a contract law expert and professor of law at Duke University School of Law.

But the data may not help insured patients who notice their prices are higher than those negotiated by other insurers.

In those cases, legal experts said, the insured patients are unlikely to get a bill changed because they have a contract with that insurer, which has negotiated the price with their contracted hospitals.

“Legally, a contract is a contract,” said Mark Hall, a health law professor at Wake Forest University.

Richman agrees.

“You can’t say, ‘Well, you charged that person less,’” he noted, but neither can they say they’ll charge you more.

Getting the data, however, relies on the hospital having posted it.

As for compliance, “we’re seeing the range of the spectrum,” said Jeffrey Leibach, a partner at the consulting firm Guidehouse, which found earlier this year that about 60% of 1,000 hospitals surveyed had posted at least some data, but 30% had reported nothing at all.

Many in the hospital industry have long fought transparency efforts, even filing a lawsuit seeking to block the new rule. The suit was dismissed by a federal judge last year.

They argue the rule is unclear and overly burdensome. Additionally, hospitals haven’t wanted their prices exposed, knowing that competitors might then adjust theirs, or health plans could demand lower rates. Conversely, lower-cost hospitals might decide to raise prices to match competitors.

The rule stems from requirements in the Affordable Care Act. The Obama administration required hospitals to post their chargemaster rates, which are less useful because they are generally inflated, hospital-set amounts that are almost never what is actually paid.

Insurers and hospitals are also bracing for next year, when even more data is set to come online. Insurers will be required to post negotiated prices for medical care across a broader range of facilities, including clinics and doctors’ offices.

In May, the Centers for Medicare & Medicaid Services sent letters to some of the hospitals that have not complied, giving them 90 days to do so or potentially face penalties, including a $300-a-day fine.

“A lot of members say until hospitals are fully compliant, our ability to use the data is limited,” said Shawn Gremminger, director of health policy at the Purchaser Business Group on Health, a coalition of large employers.

His group and others have called for increasing the penalty for noncomplying hospitals from $300 a day to $300 a bed per day, so “the fine would be bigger as the hospital gets bigger,” Gremminger said. “That’s the kind of thing they take seriously.”

Already, though, employers or insurers are eyeing the hospital data as leverage in negotiations, said Severn, Turquoise’s CEO. Conversely, some employers may use it to fire their insurers if the rates they’re paying are substantially more than those agreed to by other carriers.

“It will piss off anyone who is overpaying for health care, which happens for various reasons,” he said.

https://khn.org/news/article/hospital-prices-must-now-be-transparent-for-many-consumers-theyre-still-anyones-guess/

Comment by Hannah Leibson and Allison K. Hoffman
 
Efforts to increase price transparency in health care have become a policy obsession of academics and policymakers alike, despite little evidence it provides any benefit to patients.
 
On January 1, 2021, the Trump Administration finalized the Transparency in Coverage final rule and drank the Kool-Aid. This rule requires hospitals to disclose publicly what they charge uninsured patients for items and services as well as the rates they negotiate with insurers. The Administration hoped that the rule would force insurers to compete with each for lower priced items and services, driving down the overall cost of health care.
 
The rule’s roll out has not gone as anticipated. Up to 83 percent of hospitals are not fully complying with the rule. For hospitals that have disclosed prices, they are often hidden deep on their websites – shielded from patients’ view. This week, the Biden Administration urged the Department of Health and Human Services to boost their enforcement of the rule.
 
But as Appleby and Ellerback have highlighted, the rule overlooks a key reality. Even when consumers have greater access to information, they generally do not use it to shop medical care as policymakers imagine. Empirical research has shown that consumers are unwilling to price compare, and even when they do, it does not drive their choices.
 
Instead, the role of referring physicians plays a far greater role in patient choice and decisionmaking. This is unsurprising. Price data says little about quality, which is just as or more important to people, and assessing quality and making price/quality tradeoffs is a herculean task for most of us. Various studies have shown that giving people price information, even in a fairly digestible form and even with regard to reasonably fungible services, does little. Consider just two:
 
One study examined the consumer choices of people with easy access to price shopping for lower-leg MRIs, where quality does not vary wildly. The researchers concluded that only 14 percent of consumers went to the lowest-cost MRI provider within thirty minutes of their home, often bypassing six lower-priced providers between their home and location of their chosen scan. They went to the location their doctor suggested.
 
Another recent study assessed whether consumers changed their behavior after a transparency tool was introduced in the California Public Employees’ Retirement System (CalPERS). The interface showed consumers the prices for lab tests, office visits, and imaging services. The researchers found that only 12 percent of people used the interface in the first fifteen months after it was introduced, and most did not choose a lower-priced service after use.
 
Given this reality, it is likely that the Transparency in Coverage final rule will have a trivial effect on lowering the overall cost of health care through consumer-driven behavior. Regulations like the Transparency in Coverage rule are rooted in a fallacy that when we make the market work better, patients can navigate in the front seat. And they perpetuate that fallacy.
 
More direct price regulation or central budgeting, like what occurs under the Medicare program, is the only way to rein in escalating prices going forward. Without such measures, we will continue to face rapidly rising health care costs. 

(This comment was published in the newsletter "Health Justice Monitor Blog" on July 20, 2021)

 

Missouri’s Medicaid Expansion Is On Again

But the tortuous path it’s taken highlights the obstacles to expanding the low-income health program in other states where it has not been welcomed.

by Sarah Kliff - NYT - July 23, 2021

 

The Missouri Supreme Court has cleared the way for the Medicaid expansion to go forward there, ruling unanimously Thursday that the state legislature must fund the new program. The Obamacare program is expected to bring coverage to approximately 275,000 low-income people.

Missouri’s difficult and winding path to Medicaid expansion — voters approved the program last summer, but Republicans in state government refused to proceed with it — demonstrates the challenge Democrats face in bringing the program to the dozen states that do not yet participate.

Most states led by Democrats adopted the program as soon as it began in 2014, and some states with Republican leadership have joined since then. Still, a dozen states, primarily in the South, do not participate, with Republican officials citing concerns about the cost of expanding coverage and worries that free public insurance could create a disincentive to work. That has shut about 4 million low-income Americans out of the public coverage program.

Missouri is among a half-dozen states that have used voter referendums to join the program, circumventing opposition by state lawmakers or governors by going straight to the ballot box.

Most of the states that do not have Medicaid expansion also lack a ballot initiative process that would allow voters to decide on the issue, shutting off one of the Democrats’ most successful tactics for growing enrollment in the program.

Democrats in Congress have increasingly begun discussing how to bring coverage to that population. They plan to address the issue in the new reconciliation package, which was released last week, but have not yet agreed on a policy to do so.

Some Democrats have suggested building a federal program identical to Medicaid that could step in and cover people in the nonparticipating states. Others have proposed working with cities and counties that do want to expand, rather than trying to bring entire states on board.

Missouri’s Medicaid expansion ballot initiative passed by a six-point margin last summer. The measure directed the state to begin expanding Medicaid this July, but this spring the Republican-controlled state legislature declined to appropriate funds for the program.

Gov. Mike Parson, a Republican, then said he was unable to implement it.

Groups supporting the Medicaid expansion turned to the courts for relief. A lower court ruled in the state’s favor, finding that the legislature was not required to appropriate funds for Medicaid expansion. But the ruling from the Missouri Supreme Court now reverses that decision.

The court said that the state Medicaid program was now bound by the ballot initiative “concerning which individuals are eligible to enroll,” regardless of any appropriation decisions made in the legislature.

The new ruling directs the lower court to work out the details of getting the new program underway, but it is unclear when exactly Missouri will begin enrolling patients. Kelli Jones, a spokeswoman for Governor Parson, said in an emailed statement that the governor did not think he had the “necessary budget authority” to implement the expansion, and was “looking at what options may be available.”

Because of its timing, Missouri’s participation in Medicaid expansion is actually likely to leave the state better off financially, at least for the next two years. That’s because new federal stimulus funds, available to states that expand Medicaid this year, will cover the state’s 10 percent share of the program — and then some.

The state will receive about $1 billion over two years in additional funds for expanding Medicaid, according to a Kaiser Family Foundation estimate. Last summer, before those funds existed, Missouri’s state auditor had estimated that the Medicaid expansion would cost the state a maximum of $200 million.

Missouri is the second state to receive the new stimulus funds from the American Rescue Program, after Oklahoma, which opened its Medicaid expansion on July 1 after it also passed a ballot initiative in 2020. Both states passed their ballot initiatives before those stimulus funds were created.

The Fairness Project, a national nonprofit that helped organize the Medicaid ballot initiative in Missouri and in other states, is now aiming to put the issue to a vote in South Dakota in 2022. Groups there are gathering signatures ahead of a September deadline.

It had to abandon a similar effort in Mississippi after that state made significant revisions to its voter referendum process earlier this year.

But the ballot initiative strategy may soon reach its limit. Two more states that have not expanded Medicaid, Wyoming and Florida, do allow the issue to be brought to a vote, but each presents unique challenges. Florida, as a large state, would be an expensive place to run a campaign, and Wyoming does not provide strong protections for the initiatives its voters pass.

The other states that have not expanded have no statewide ballot initiative process at all.

“We have no way of helping the folks in Texas,” said Kelly Hall, executive director of the Fairness Project.

Ms. Hall said those other states may need the federal intervention that Democrats in Washington are currently discussing.

“Everybody has to row in the same direction to solve this problem,” she said. “We’ve done our part of the work. I’m always hopeful there will be even bigger and better solutions coming out of D.C.”

https://www.nytimes.com/2021/07/23/upshot/missouris-medicaid-expansion-is-on-again.html?action=click&module=Well&pgtype=Homepage&section=The%20Upshot 

 

Universal Healthcare: The Surprising Conservative Case

by Ira Dember - Medium - July 25, 2021

Many people view single-payer universal healthcare, aka Medicare for All (M4A), as a “progressive” issue. But M4A looks remarkably solid from a conservative standpoint. For instance:

1. FREE MARKETS. Private health insurers take away our free choice of doctors by imposing artificial networks. M4A guarantees free markets. At last we’ll choose doctors in a true free-enterprise system with real competition.

2. LIBERTY. “Healthcare shackles me to a job — and to my employer’s health-plan choices, out of my control.” Let’s repeal and replace this straitjacket system. M4A guarantees comprehensive coverage including medical, dental, vision, hearing, long term care and more…plus access without stress, paperwork, bills. That’s liberty!

3. BUSINESS FREEDOM. Healthcare management has nothing to do with most businesses. It doesn’t help us make or sell things. So why burden employers with this responsibility? M4A gets healthcare off business owners’ backs, and at lower cost. Now owners can focus on what they do best, without HR hassles.

4. PRO-GROWTH ECONOMICS. M4A will save our nation as much as $650 billion a year. (Source: 200-page CBO analysis, Dec 2020.) In Congressional District TX-2 where I live, it will be like $3.1 billion injected into our local economy during our Rep’s next two-year term — on average, an $11,000 boon to every TX-2 household.

5. RESPONSIBILITY. Conservatives respect responsible behavior. M4A takes responsibility for helping workers transition out of meaningless, parasitic paperwork jobs — part of massive new cost-saving healthcare efficiencies. Even with transition costs, M4A will still save hundreds of billions a year.

6. DISRUPTION! Entrepreneurs and investors thrive on disruption. Harvard even teaches “disruption” to C-suite executives. Like our most successful capitalists, M4A disrupts a broken healthcare system. But unlike Wall Street raiders, it doesn’t leave honest hardworking people in the lurch. (See #5.) Celebrate disruption!

7. HONOR TRADITION. Pure conservatism is extremely popular. Misguided conservatives fought traditional Medicare (“socialized medicine!”) and Social Security (“communist!”), today America’s most popular programs. Similarly, once enacted no one would dream of trying to take away cost-saving, life-saving universal healthcare.

There are other conservative arguments for M4A — some economic, others ideological — but these seven offer starting points.

For millions of American families, universal healthcare will deliver a gift of life. It needs and deserves a political reassessment. Let’s drag M4A out of its old, tired, tribal dichotomy between “left” and “right.”

Defining M4A from a conservative standpoint could help reframe the national conversation. I sure hope so.

*********

Is your Congress member co-sponsoring HR 1976, the Medicare for All Act of 2021? If yes, thank them! If no, they need to get on board now.

https://medium.com/@idember/universal-healthcare-the-surprising-conservative-case-656d23617a3a 

 

Advocates in Portland demand Medicare for all

Saturday's rally in Lincoln Park was one of many held around the country to pressure lawmakers to expand health care benefits. 

by Rob Wolfe - Portland Press Herald - July 24, 2021

A crowd of about 60 gathered in Portland’s Lincoln Park on Saturday to call for federal action on legislation extending Medicare benefits for all Americans.

Saturday morning’s event was one of many rallies around the country to push for universal health care coverage. Patty Kidder, a Maine People’s Alliance volunteer from Springvale, led the group in chants demanding “Medicare For All.” She applauded recent successes, including the Maine Legislature’s approval of dental coverage for MaineCare recipients this summer, but said much more needed to be done.

“These successes at the state and federal level are huge, and vital for so many Mainers,” she said. “But they are still just Band-Aids on our hemorrhaging, broken health care system. We need more. We all need 100 percent coverage, with no deductibles and no co-pays, no matter our age.”

To cheers from the crowd, she added, “We need improved Medicare for all, now!”

Organizers from Mainers for Accountable Leadership, Maine AllCare, Southern Maine Workers’ Center and the Maine People’s Housing Coalition urged the crowd to contact their state and federal legislators. And a few state legislators were present on Saturday, including Sen. Ben Chipman, D-Portland; Rep. Heidi Brooks, D-Lewiston; and Poppy Arford, D-Brunswick.

“Literally, it’s about life or death,” said Chipman, who co-sponsored a bill to give MaineCare to all residents of the state. “And that’s why I’m so passionate about it.”

Chipman and others promoting Medicare for all argued that, if everyone joined the program, questions about cost would solve themselves. The “collective bargaining power” of the united American people would drive down prices, they predicted.

Otherwise, advocates said, society will continue to reap the untold costs of inadequate coverage. That includes the economic toll of mental illness and homelessness brought about by insufficient coverage or overwhelming bills.

Delene Perley, a Portland resident who works at the Woodfords-area food pantry Project Feed, said she had recently encountered a client who said he had lost his savings and been forced to move his immediate family in with relatives because of health bills he couldn’t pay. Other patrons ask Perley not to give them food that’s hard to chew because they have had inadequate dental care, she said.

“How many people in other First World countries go bankrupt because of medical bills?” Perley asked.

The crowd answered: “None!”

While “none” may be an exaggeration, it’s true that Americans pay far more for health care, and are far more likely to go bankrupt facing overwhelming medical bills, than residents of many other wealthy countries. A Los Angeles Times review in 2019 found that “nearly all of America’s global competitors — whether they have government health plans, such as Britain and Canada, or rely on private insurers, such as Germany and the Netherlands — strictly limit out-of-pocket costs.”

This past session, the Maine Legislature passed L.D. 1045, “An Act To Support Universal Health Care,” which directs state officials to create a “Maine Health Care Plan” available for all. But the bill only takes effect if the federal government acts first to authorize universal health care. Brooks and Arford, who attended Saturday’s rally, were sponsors.

Arford passionately urged those present to “work, work, work” to help pass a federal version of the legislation.

“This is real, folks,” she said. “We are on the path. It can happen.”

https://www.pressherald.com/2021/07/24/advocates-in-portland-demand-medicare-for-all/ 

 

Editor's Note -

This is overall a positive article. But it contains one small but important error.  LD 1045, which recently became Public Law 2021, chapter 391, does not require the federal government to authorize universal health care, but rather to pass legislation that facilitates support from the federal government for the enactment of universal health care by states, such as Maine, that wish to do so absent action on universal health care by the federal government  - a much lower bar.  The legislature also passed an accompanying Joint Resolution urging the Maine congressional delegation to support legislation that does that. The statement, as written, doesn't make sense.
 

 Perhaps a correction is in order.

 - SPC

 

Dozens rally for universal healthcare in Maine on Saturday

by Taylor Cairns - WGME-TV - July 24, 2021

((PORTLAND)) -- On the grounds of Lincoln Park in Portland on Saturday, Mainers from around the state came together to show their support for universal healthcare.

"The state should provide universal, hopefully publicly funded and privately provided, healthcare for all Mainers," MaineAllCare board member Thomas Sterne said. "We spend an amazing amount of money unnecessarily on things that don't directly contribute to care. About a quarter of every dollar goes to administrative overhead."

Organizers led chants and speeches in support of providing healthcare to everyone. Similar rallies took place in about 50 cities nationwide.

"We are losing dozens of Maine people every year, who are dying because they cannot afford healthcare," a Topham based psychiatrist Dr. Julie Pease said. "I have seen insurance companies come between me and my patients to get the healthcare that they need, and that makes me angry." 

This year, Maine took a step towards universal healthcare by passing a bill in the 2021 legislative session that shows support for an all encompassing healthcare approach. The bill doesn't actually change any of Maine's current health systems, but instead, states that the Maine Health Care Plan will provide universal health care coverage to all residents.

Organizers at the Portland rally say they want to see changes on the federal level.

"Why should corporations be profiting off of our healthcare? The money is in the system. It's how we choose to allocate the money," Mainers for Accountable Leadership director Marie Follayttar said.

"Maine would probably get the expanded benefits at about 1.8 to 2.0 billion dollars a year less than what it currently costs now.," Sterne said. 

https://wgme.com/news/local/dozens-rally-for-universal-healthcare-in-maine-on-saturday