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eridani

Profile Information

Gender: Female
Hometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 02:52 AM
Number of posts: 44,442

About Me

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity

Journal Archives

If the Fire Department Were Run Like Healthcare…


https://www.healthcare-now.org/blog/if-the-fire-department-were-run-like-healthcare/

During a press conference prior to the first of six public hearings held by the New York Assembly across the state, Assemblyman Richard Gottfried, Chair of the Assembly Health Committee since 1987, was asked by a reporter whether his legislation for universal, public health coverage for all of New York would limit patients’ choice of providers… Watch as Assemblyman Gottfried flips the script on the reporter, and paints a picture of how inhumane and dysfunctional our fire services would be if they worked like the U.S. healthcare system!

Insight 11. Medicare Helps Low Income People

Of the 54 million people with Medicare, a staggering 25% have annual incomes below $14,400. For these people living in retirement, or coping with a disability in poverty, Medicare coverage offers a lifeline, a chance to get needed health care. That precious red white and blue Medicare card means that a doctor will see you, a physical therapist will help you recover from a stroke and much more. But that lifeline disappears if you can’t afford to pay your $105 monthly Medicare Part B premium, or your $1260 hospital deductible, or if you have 10 prescriptions that need filling, each with a co-pay of $20 or $30.

Fortunately, the Medicare lifeline does work for many people in poverty, but only because safety net programs work together with Medicare to plug coverage gaps and make the Medicare benefit affordable. The Medicaid program covers Medicare premiums, deductibles and co-payments. Enrollees in full-scope Medicaid receive Medicaid long-term services along with coverage of their Medicare costs; those who qualify only for Medicare Savings Programs – operated by state Medicaid agencies and generally offered to people with incomes slightly higher than full Medicaid cut-offs – get help with their Medicare costs but do not get other Medicaid services. Today fully twenty percent of Medicare beneficiaries rely on Medicaid-funded programs for Medicare premium or cost-sharing assistance. In addition, the Low Income Subsidy, known as “extra help,” provides relief to about 11 million beneficiaries who otherwise could not afford Medicare prescription drug program premiums, deductibles and co-pays. That subsidy also protects low income beneficiaries from falling into the infamous donut hole.

Dual eligibles, people who qualify for both Medicare and Medicaid, need these safety net programs to remain strong and to grow. When states seek instead to narrow Medicaid eligibility standards, they not only are cutting off people from needed Medicaid services, like long-term services and supports, but also are effectively making it impossible for dual eligibles to use their Medicare. Medicare is a benefit that many earned working their whole lives at low-paying difficult jobs. Like other workers, they saw their Medicare contributions deducted from each and every paycheck. We at Justice in Aging are committed to working with the Center for Medicare Advocacy and other advocates to ensure that all Medicare beneficiaries, especially those who most need what Medicare can provide, can afford to use the benefits to which they are entitled.

You can read more about Justice in Aging, Medicare and low income beneficiaries at http://justiceinaging.org/our-work/healthcare/dual-eligibles-california-and-federal/.

You can read all of the Center for Medicare Advocacy's Medicare Insights at: http://www.medicareadvocacy.org/medicares-50th-anniversary/#Insights.


“Doc Fix” Package Passed by House Takes Too Much from Beneficiaries with Too Little In Return

Today, March 26, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). While the Center for Medicare Advocacy believes it’s in the best interest of Medicare beneficiaries to find a permanent solution to the broken physician payment formula called the “Sustainable Growth Rate” (SGR), this Bill is not the answer. Unfortunately, the SGR replacement package passed by the House is not sufficiently balanced; it asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It furthers Medicare’s march toward privatization by increasing costs for beneficiaries for traditional Medicare and Medigap plans.

Of the portion of the SGR package that will be offset, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:

Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
Further means-testing premiums for higher-income beneficiaries; and
Overall increases in Part B premiums.

While the SGR package would make the Qualified Individual (QI) program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for low-income education and outreach, it does not address other issues that serve as barriers to care for beneficiaries. For example, instead of repealing the annual outpatient therapy caps, the anemic exceptions process is merely extended for another two years, and instead of addressing hospital observation status, the bill simply further extends enforcement of the so-called “two-midnight” rule.

In short, Medicare beneficiaries would pay too much, with too little in return. Major industries pay nothing, and stand to gain a great deal. As the SGR bill now moves to the Senate, we hope further balance and improvements for beneficiaries can be made.

For more information, see the Center’s March 24th Press Release here: http://www.medicareadvocacy.org/analysis-of-sgr-legislation-from-the-center-for-medicare-advocacy/.

With billions in the bank, Blue Shield of California loses its state tax-exempt status

Score another one for CA!

http://www.latimes.com/business/la-fi-blue-shield-california-20150318-story.html

Authorities have revoked the tax-exempt status of nonprofit Blue Shield of California, potentially putting it on the hook for tens of millions of dollars in state taxes each year.

The move by the California Franchise Tax Board comes as the state's third-largest health insurer faces fresh criticism over its rate hikes, executive pay and $4.2 billion in financial reserves.

The highly unusual action comes after a lengthy state audit that looked at the justification for Blue Shield's taxpayer subsidy.

Now, a company insider has sided with critics. Michael Johnson, who resigned as public policy director last week after 12 years at the company, said the insurer has been "shortchanging the public" for years by shirking its responsibility to Californians and operating too much like its for-profit competitors.


Comment by Don McCanne of PNHP: Many of us in California were very upset when Blue Cross of California converted to a for-profit (WellPoint, then Anthem) and immediately changed its behavior to fulfill its responsibilities to its shareholders as a profit-making business. We immediately saw “insurance innovations” that redirected its business goals from taking care of patients to taking care of shareholders.

It was particularly disappointing to see non-profit Blue Shield of California adopt similar insurance innovations in order to remain competitive in the California insurance market. From the perspective of health care “consumers,” Blue Shield and Blue Cross remained virtually indistinguishable.

Blue Shield of California has annihilated the dream of those who believed that the United States could adopt a universal system of private, non-profit insurance companies like they have in Switzerland. There are many serious problems with the Swiss model, but some believed that a market of well-regulated, non-profit insurers would make optimal patient care a priority. Blue Shield of California has now demonstrated to us that this pipe dream would only become another nightmare in the saga of private insurance markets in the U.S.

Economists Throw Weight Behind Universal Health Care in Vermont

http://www.commondreams.org/news/2015/02/26/economists-throw-weight-behind-universal-health-care-vermont

It is not only possible, but financially and economically advantageous to implement a publicly financed healthcare system in Vermont, according to an open letter signed by more than 100 economists and delivered Thursday to lawmakers at the Vermont State House.

"As economists, we understand that universal, publicly financed health care is not only economically feasible but highly preferable to a fragmented market-based insurance system," reads the letter, whose signatories include Dean Baker of the Center for Economic and Policy Research; Richard Wolff of New School University; and Julie Nelson of the University of Massachusetts-Boston.

It continues: "Health care is not a service that follows standard market rules; it should be provided as a public good. Evidence from around the world demonstrates that publicly financed health care systems result in improved health outcomes, lower costs and greater equity."

In December, Vermont Gov. Peter Shumlin abruptly abandoned his much-lauded plan to create a single-payer healthcare system in the state, saying moving forward with the proposal would be too costly.

But the economists' letter, presented in tandem with a report (pdf) from the the Vermont Workers' Center and the New York-based National Economic and Social Rights Initiative (NESRI), shows that that universal health care can be implemented—affordably—in Vermont within the next few years.

"By moving from private, market-based insurance to public financing of universal care," said Anja Rudiger of NESRI, "we flip the way we pay for care: people contribute based on their ability, so that low- and middle-income people pay a small

With Private Health Insurance, Waste Is Revenue

http://www.counterpunch.org/2015/03/02/five-years-in-hows-the-affordable-care-act-doing/

In addition, the complexity of plans, each with its own marketing, paperwork, enrollment, premiums, rules and regulations, also contributes to an enormous administrative cost overhead.

I spoke about this with James G. Kahn, M.D., MPH, who is a researcher at the Philip R. Lee Institute of Health Policy at the Univ. of Cal., SF, and senior author of a recent study analyzing grotesquely excessive administrative costs of insurance companies and how it diverts several hundred billions of dollars annually from actual hands-on medical treatment.

What appears as wasteful to the normal person such as the enormous resources devoted to complicated billing and other insurance related activities (BIR), as documented by Dr. Kahn, is considered as income and revenue by insurance companies because they charge for these excesses.

Thus, extravagant squandering of funds and resources is endemic to the business model of insurance companies and precisely because it adds to their bottom line, there is no incentive to eliminate the bureaucratic discombobulation.

Healthcare economics scholar Uwe Reinhardt expressed his exasperation even before ACA in his Nov. 19, 2008 testimony to U.S. Senate Finance Committee: “900 billing clerks at Duke with 900 beds. Not sure we have a nurse for each hospital bed but we have a billing clerk. It’s obscene.”

This chronic problem has grown with ACA.

Blue Shield of CA refusing to sell health insurance in many zip codes

http://www.capradio.org/articles/2014/12/17/after-blue-shield-pulls-out-of-zip-codes,-consumers-see-limited-insurance-options/

Blue Shield of California used to sell policies to individuals in every county in the state, according to the Department of Managed Health Care, one of California’s two teams of health insurance regulators. But by 2014’s open enrollment period, Blue Shield had pulled out of 250 zip codes throughout the state, including four entire counties: Alpine, Monterey, Sutter, and Yuba.

The gaps are particularly felt in the top third of the state, where thousands of residents now have only one choice of insurer if they want to buy a health plan on the exchange.

Blue Shield of California declined an interview with NPR. But in a written statement, the company reported that it’s not selling in certain areas of California because it could not find enough health providers willing to accept a level of payment that would keep premiums low. According to the statement, the company also is not selling in areas where there is no contracted hospital within 15 miles.



Comment by Don McCanne of PNHP: Blue Shield of California has pulled out of 250 California zip codes in the Covered California program (California’s insurance exchange under the Affordable Care Act), citing inability to negotiate low prices with the local health care providers.

Nonprofit Blue Shield of California and for-profit Anthem Blue Cross were the only Covered California insurers in many zip codes in the state. It is ironic that the for-profit Blues plan - Anthem Blue Cross - has continued to serve areas where coverage is more difficult, whereas the nonprofit Blues plan - Blue Shield - has pulled out. So much for the theory that nonprofit Blues plans are public service models while for-profit Blues are primarily profit-making business models. They have become the same animal, with the for-profits leading the way.

Blue Shield blames regulatory guidelines requiring that patients have access to care. By refusing to contract with the local providers, patients would have been required to travel long distances for care - a violation of the Affordable Care Act.

Some might blame Blue Shield for demanding rates that were too low to adequately cover costs, whereas others might blame the providers for demanding rates that provided excessive profits, but the primary blame does not lie with either party. It is the model that uses private insurers as financial intermediaries that is defective and should be blamed.

Contrast that with Medicare, which is a public insurer that administers the rates to be paid. Medicare is not setting rates to ensure that the government is profiting off of the program. Rather it is setting rates to be sure that the health care delivery system is adequately funded so that it will be there when patients need it.

It is true that Medicare rates are not always optimal, but that is because it is only one payer in a dysfunctional, multi-payer system which makes rate setting much more difficult. If Medicare were the only payer for the entire nation, it could set rates with much greater precision, paying legitimate costs and fair margins.

Although the Blues had their day as health insurers serving in the public interest, those days are long gone. It is time for a single payer, improved Medicare for all.

Why High Risk Pools (Still) Won't Work

Why High Risk Pools (Still) Won't Work

http://www.commonwealthfund.org/publications/blog/2015/feb/why-high-risk-pools-still-will-not-work

http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2014/dec/1792_hall_highrisk_pools.pdf

As the new Congress convenes and the Supreme Court prepares to hear arguments in the King v. Burwell case challenging tax subsidies for insurance purchased through the federally facilitated marketplaces, proposals to repeal and replace the Affordable Care Act (ACA) are resurfacing. Many of these rely on high-risk health insurance pools to cover people with preexisting health conditions.

In fact, the risk pools are suggested as a viable alternative to the ACA's ban on preexisting condition exclusions in the individual market and the marketplaces. My recent analysis of high-risk pools, however, explains why these entities simply are not a realistic alternative to coverage requirements under the ACA. In a nutshell, high-risk pools:

1. are prohibitively expensive to administer,

2. are prohibitively expensive for consumers to purchase, and

3. offer much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.



Comment by Don McCanne of PNHP: Those who wish to repeal or at least drastically reduce the provisions of the Affordable Care Act realize that they must come up with a replacement.

Most of the proposals would grant much greater flexibility to insurance products while reducing regulatory oversight. The problem that creates is that individuals with high medical expenses tend to be shut out of the insurance market. To ensure coverage for these individuals, high-risk insurance pools have been proposed.

This article and the brief that it is based on explain why high-risk pools are not a satisfactory solution. The premiums are unaffordable, and the pared-down benefits are unsatisfactory. These over-priced plans do not provide the financial protection that patients with chronic disorders need.

Even with the Affordable Care Act, enrollment in the temporary high-risk pools had to be closed early because they proved to be too expensive, threatening depletion of the allotted funds. They provide poor coverage at a very high cost.

With a single payer system this problem disappears. Funding is based on ability to pay, through the tax system, and not on the basis of anticipated medical expenses. Everyone receives the care they need, regardless of their health status. The fragmented plans supported by the repeal and replace people cannot do that.

Why do Canadians so strongly support their single payer system?

By Don McCanne, PNHP

This week the Forum Club of Sun City Palm Desert (a California retirement community) held a forum on single payer health care. Forum Club Secretary Mike Wedekind, a Canadian, spoke on Canada’s single payer system, and I spoke on the problems with the U.S. system that would be amenable to enactment of a single payer system.

Since it was an after-dinner meeting, I expected the usual laid-back audience with a few partaking of postprandial snoozes. On the contrary, we received great feedback from the attendees. Many attending were snowbirds - relatively affluent and generally politically conservative Canadians who maintain a winter residence in this desert community.

After we each spoke for twenty minutes, the attendees met at round tables to discuss various aspects of U.S. and Canadian health policies. Then a moderator from each table presented their quite astute observations.

I spoke individually with several of the attendees. Even though the Forum Club is explicitly non-partisan, I received no negative comments about a single payer system for the United States. In fact, the reason that I decided to write this commentary was the response of the Canadians. Though most seemed to be politically conservative, there was absolutely no indication that they thought that somehow their single payer system was deficient, especially compared to ours, except for a problem with queues for some elective services such as joint replacement. There was no mention of the need to privatize health care since they already have a private health care delivery system. They certainly see no need for intrusive, wasteful private insurers, other than to provide supplementary benefits outside of their Medicare.

It made me wish that it was as easy to converse on this topic with conservatives here in the United States. A poll last month revealed that 23 percent of Republicans already support “an expanded, universal form of Medicare” (as do 79 percent of Democrats and 45 percent of Independents).

Everyone should give some thought as to what the message might be that resonates with the Independents and Republicans who are supportive, but, above all, what is it that causes Canadians across the political spectrum to be so supportive of their Medicare? We have to deliver that message here in the United States.
Quote-of-the-day@mccanne.org

President’s Proposed 2016 Budget: The Impact on Medicare

Email from Medicare advocates--

This week, the White House released the President’s proposed fiscal year (FY) 2016 budget. Similar to years past, there are proposals that the Center endorses and proposals that cause us concern.

On the positive side, proposals we support include several that would yield savings on prescription drugs, including a new proposal that would give the Secretary of Health and Human Services (HHS) the authority to negotiate drug prices for biologics and high cost drugs in the Part D prescription drug program. The budget would also close the Part D Donut Hole three years earlier (by 2017) than is currently planned under the Affordable Care Act. In another new proposal, the current 190-day lifetime limit on inpatient psychiatric hospital days would be eliminated, reducing a long-time barrier to true mental health parity in the Medicare program.

Among the proposals we oppose are many provisions that would shift additional costs to Medicare beneficiaries, including adding a copayment for certain home health visits, increasing the Part B deductible, further income-relating (“means testing”) Part B and D premiums, and adding a surcharge to Medicare supplemental (Medigap) policies that offer cover all or most out-of-pocket expenses. We are also concerned about proposed changes to the Medicare administrative appeals process.

For more analysis by the Center, see http://www.medicareadvocacy.org/the-presidents-proposed-fy-2016-budget-the-impact-on-medicare/.
On February 3rd, the Kaiser Family Foundation published a summary of the Medicare-related provisions in the President’s budget, available at http://kff.org/medicare/issue-brief/summary-of-medicare-provisions-in-the-presidents-budget-for-fiscal-year-2016/.
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