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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: 51,659

About Me

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

Journal Archives

Establishment Dems Fight to Defeat 'Medicare-for-All' in Colorado


http://www.commondreams.org/news/2016/05/20/establishment-dems-fight-defeat-medicare-all-colorado

Highlighting the divisions in the Democratic party this election, Colorado's ballot measure for a universal, single-payer healthcare plan is facing unexpected resistance from the very same party that has been calling for such a healthcare plan since the 1990s.

"There is a disconnect between the powers that be and the people," said state senator Irene Aguilar, a former doctor and the chief architect of the statewide 'Medicare-for-all,' called ColoradoCare, in an interview with the Guardian. "The powers that be are incrementalists. There hasn't been a courage of conviction to try and deal with ."

<snip>

Clinton's campaign is directly linked to Coloradans for Coloradans, the most prominent organization opposing ColoradoCare. Formed solely to defeat the measure, Coloradans for Coloradans is being funded by the very same consultant firm currently working for the Clinton super PAC Priorities USA, as Lee Fang reported in the Intercept.

While a stance for the ACA and against single payer is the least popular with the public, it is the most popular within a certain sector of the population: pharmaceutical and healthcare companies.

Indeed, in Colorado the "anti-single-payer effort is funded almost entirely by health care industry interests," Fang reported, "including $500,000 from Anthem Inc., the state’s largest health insurance provider; $40,000 from Cigna, another large health insurer that is current in talks to merge with Anthem; $75,000 from Davita, the dialysis company; $25,000 from Delta Dental, the largest dental insurer in the state; and $100,000 from SCL Health, the faith-based hospital chain."

Growing Support for a National Health Program and Health Care as a Human Right

http://www.pnhp.org/news/2016/may/growing-support-for-a-national-health-program-and-health-care-as-a-human-right

This 2016 election season brings us three very different alternatives concerning future health care in this country: (1) continuation of the Affordable Care Act (ACA) with changes as necessary; (2) a Republican “plan” for health care; and (3) single-payer NHI. Despite some expansions of coverage, especially through Medicaid, the ACA has failed to make health care more affordable, has accelerated waste, bureaucracy and profiteering, and is unsustainable. Yet Hillary Clinton calls for expansion of the ACA to 100 percent coverage with no possible way of doing it by retaining some 1,300 private insurers. She also claims disingenuously that NHI will raise our taxes—without acknowledging that Gerald Friedman’s classic 2013 study found that 95 percent of Americans will pay less for insurance premiums, deductibles, co-payments, actual care and out-of-pocket payments, and that only the wealthiest five percent would pay more.6

Although no concrete plan has yet been advanced by the GOP, we can expect that it will repeal the ACA, then “replace” it with long discredited reliance on free markets in health care, consumer directed health care, health savings accounts, selling insurance across state lines, and high-risk pools.

Neither the ACA nor GOP options will make health care more affordable or accessible.

Single-payer NHI is the only alternative that will achieve universal coverage in an affordable and sustainable way. A strong case for it has been made elsewhere on economic, sociopolitical, and moral grounds.7 It will meet conservatives’ principles regardless of party affiliation, including efficiency, maximal choice, minimal waste, value, and everyone contributes in proportion to his or her income.8 Long an iconic guru of free-market economics, Kenneth J. Arrow has recently acknowledged that “a single-payer system is better than any other system,” as long as private practice is preserved (as it would be with NHI).9

We know that powerful forces are aligned against passage of NHI, including private insurers, Big PhRMA, medical device makers, and other members of the medical-industrial complex. They are empowered further by their hundreds of lobbyists and corporate money in our post-Citizens United world. As Bernie Sanders has observed: “the Koch brothers, as the second-wealthiest family in America with $82 billion in wealth, advocate destruction of federal programs that are critical to the financial and personal health of middle-class Americans.”10

Government Auditor Finds Billions in Improper Payments to Medicare Advantage Plans--

--Coupled with Inadequate Oversight by Federal Regulator

http://www.gao.gov/assets/680/676441.pdf

This week the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments. The report states that the Centers for Medicare & Medicaid Services (CMS) estimates that about 9.5% of its annual payments to Medicare Advantage (MA) organizations were improper – totaling $14.1 billion in 2013 alone – “primarily stemming from unsupported diagnoses submitted by MA organizations.” This plan-initiated billing practice is commonly referred to as “upcoding” when an MA plan reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program. The report also highlights the significant flaws in CMS’ current efforts to address and recoup such payments.

The Center is deeply troubled by these ongoing improper payments to MA plans and CMS’ lack of progress in recouping previous payments and deterring future misconduct. In an NPR story about the GAO report, “GAO Audit: Feds Failed To Rein In Medicare Advantage Overbilling” (May 9, 2016) the Center is quoted as stating: "We hope that policymakers who protect MA (Medicare Advantage) profit at all costs, while at the same time often proposing to shift more costs on to the majority of beneficiaries in traditional Medicare, take heed of this GAO report and ensure that the recommendations are implemented."

Kids need healthy mothers

http://www.urban.org/research/publication/how-are-moms-faring-under-affordable-care-act-evidence-through-2014

The number of uninsured mothers fell from 7.5 million in 2013 to 5.9 million in 2014, as the uninsurance rate for mothers reached its lowest point since 1997. The largest declines in uninsurance were found among low- and moderate-income mothers who were targeted by the ACA’s Medicaid expansion and the introduction of subsidized Marketplace coverage, respectively.

Despite these gains in coverage, nearly one in six mothers remained uninsured in 2014, and these mothers were disproportionately young, low-income, Hispanic, noncitizens, less educated, not married, and living in the South. One particularly concerning finding is that about one in five mothers who were likely to have the greatest physical and mental health care needs—those who reported being in less than very good health or having moderate or severe psychological distress—were uninsured.

When asked about the reasons why they do not have health insurance or stopped having coverage, 41.5 percent of uninsured mothers in 2014 said it was because the cost was too high. The next most frequently reported reason was that coverage stopped after pregnancy (18.7 percent). In addition, some mothers identified their inability to get employer-based coverage as a reason for being uninsured, either because they or the person in their family with coverage lost or changed jobs (18.0 percent) or because their current employer does not offer coverage (7.3 percent). Over 5 percent said they had lost Medicaid or other coverage because of a new job or increase in income, and 18.6 percent reported not having coverage for other reasons, such as divorce, separation, or death of a spouse or parent, becoming ineligible because of age or leaving school, denial of coverage from an insurance company, or not needing coverage.



Comment by Don McCanne of PNHP:
Most would agree that having healthy mothers would be of benefit to their children. Suppose 5.9 million mothers were uninsured, wouldn’t it seem that we should enact health care reform that would address this problem? In fact, we did enact the Affordable Care Act, and between 2013 and 2014 the number dropped from 7.5 million to 5.9 million. Rather than celebrating the “success” of ACA reform, shouldn't we be advocating for reform that really does work for everyone?

Yesterday the Physicians' Proposal for Single-Payer Health Care Reform was released. Under that proposal the number of uninsured mothers would drop to zero. At the following link you can read and download the Proposal and its supporting documents, and provide your personal endorsement:

http://www.pnhp.org/beyondaca

You don't want to trouble yourself by providing an endorsement? But Mother's Day is this weekend. Surely you'll reconsider, you know, for Mom.

Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change--

--At Age Sixty-Five

http://content.healthaffairs.org/content/35/5/864.abstract

To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers—including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter — or 32.4 percent — upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare’s purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does.


Comment by Don McCanne of PNHP: This study looked at the changes in spending and volume of services for individuals who, at age 65, transferred from private insurance to the traditional Medicare program. The authors showed that the volume of services remained the same, but spending went down, which reflects the lower provider prices that Medicare pays compared to private insurers.

One suggestion that has been made to “save Medicare” from future federal budget deficits would be to increase the eligibility age from 65 to 67. They showed that this would actually increase our national health expenditures without changing the volume of services, not exactly the health care cost containment that we are seeking.

Conservatives and neoliberals might think that the increase in spending would be worth it just to advance their ideological goal of relying less on government spending and more on the private sector. But a portion of the reduction in federal spending would be offset by increased Medicaid coverage for those eligible, and increased ACA premium tax credits and cost-sharing subsidies, resulting in tax revenue losses and greater outlays. Not a good deal at all.

Others have suggested that we should expand Medicare enrollment, perhaps by reducing the eligibility age in 5 year increments. Although it would be an extrapolation of this study, it is not unreasonable to assume that we could significantly reduce our expenditures without any change in the volume of services for those who otherwise would have been privately insured.

Or go all the way. Replace the private insurers with a Medicare for all program. Not only is Medicare a more efficient purchaser of health care services, the recovery of much of the profound administrative waste of our fragmented financing system would be enough to fully fund a health care system for all without increasing our national health expenditures from the current level.

Remember who the patient is. It is not the government budget. It is the people who need health care.
Establishing a well-designed single payer Medicare-for-all system would take care of the people, and the government budget would perk along just fine.

The Neoliberal Model Comes Home to Roost in the United States — If We Let It

http://monthlyreview.org/2016/05/01/obamacare/

Many countries have rejected the neoliberal model, and have instead constructed health systems based on the goal of “health care for all” (HCA). Such countries strive to provide universal access to care without tiers of differing benefit packages for rich and poor. For instance, Canada prohibits private insurance coverage for services provided by its national health program. Because Canada’s wealthy must participate in the publicly financed system, the presence of the entire population in a unitary system assures a high-quality national program. In Latin America, countries trying to advance the HCA model include Bolivia, Brazil, Cuba, Ecuador, Uruguay, and Venezuela. The inevitable failure of Obamacare may open a space, finally, for even the United States to pursue a national health program that does not follow the neoliberal model.


A Neoliberal’s Manifesto

http://www.washingtonmonthly.com/features/1983/8305_Neoliberalism.pdf

If neoconservatives are liberals who took a critical look at liberalism and decided to become conservatives, we are liberals who took the same look and decided to retain our goals but to abandon some of our prejudices. We still believe in liberty and justice and a fair chance for all, in mercy for the afflicted and help for the down and out. But we no longer automatically favor unions and big government or oppose the military and big business. Indeed, in our search for solutions that work, we have come to distrust all automatic responses, liberal or conservative.

Comment by Don McCanne Of PNHP: The majority of Americans would like to see a high quality health care system that is affordable and accessible for everyone. We do not have that now. Why not?

Progressives/liberals generally recognize that costs and market dysfunctions require a major role of government in financing health care. Conservatives/libertarians believe that free markets can fulfill that role with the exception that those impoverished not by choice need private charity or the helping hand of government. But it is those in the middle - the moderates - who determine policy through the election process. So who are they?

They are both Republicans and Democrats. In health care, they support private financing, primarily through insurance, though they support public tax expenditures to help pay for the most common coverage - employer-sponsored plans. They also support Medicare for seniors and those with disabilities, and most support Medicaid for low-income individuals and families.

In fact, President Obama abandoned single payer in favor of the Heritage Foundation proposal, based on these principles, since it had broad bipartisan support - or so he thought, until the Republicans decided that a political defeat for Obama was more important than improving our health care system.

So what happened to these moderates? The Republicans have retreated toward the right where they would try to tolerate the conservative tea party faction. The moderate Democrats did not move to the left but instead also moved somewhat toward the right into the pro-market neoliberal niche. Following the groundwork laid by President Reagan, President Bill Clinton followed a neoliberal path in which "the era of big government is over" (State of the Union, 1996). The neoliberals then became the establishment force in the Democratic Party. President Obama, whether voluntarily or through political obstructionism, did not change the direction of the party. The likely next president has indicated that she will follow the neoliberal Clintonian path as well and not change direction in health care.

Today’s article describes how neoliberalism and its advocacy of using markets instead of the government to control the financing of health care has resulted in our overpriced and underperforming health care system, as if the neoliberals have failed to see the irony of a health care system that is already 60 percent funded through the tax system and that has failed to conform to free market dynamics.


Whatever labels are used, the majority of Americans support Medicare. If we already had an improved version of Medicare that included everyone, the support would be near unanimous. The neoliberals either need to take a reality check on their ideology, or they need to attend the next local tea party function and listen to the voices extolling the virtues of a society without a functioning government.




Is ACA Coverage Affordable for Low-Income People? Perspectives from Individuals in Six Cities

http://kff.org/health-reform/issue-brief/is-aca-coverage-affordable-for-low-income-people-perspectives-from-individuals-in-six-cities/

Issue Brief:
http://kff.org/report-section/is-aca-coverage-affordable-for-low-income-people-perspectives-from-individuals-in-six-cities-issue-brief-8867/

While people were grateful for coverage, unexpected bills, dealing with insurance companies, and facing known deductibles were sources of stress which made those with Marketplace coverage fearful to use the coverage they had. They were particularly frustrated by the out-of-pocket costs, which were unaffordable to many and wanted insurance that didn’t come with so many hidden costs.


Comment by Don McCanne of PNHP: This report of nine focus groups confirms that real people have found that the Affordable Care Act (ACA) often fails to provide access to affordable care.

Although the leading candidate for president has said that she wants to build on ACA, reducing premiums and deductibles pours yet more tax money into what is the most expensive and least efficient model of health care financing. The model cannot really be fixed if we want true value in health care. It needs to be replaced with a model that does work - a single payer national health program - Improved Medicare for All.

Ryan wants to end Obamacare cost protections for sick consumers

http://www.reuters.com/article/us-usa-health-ryan-idUSKCN0XP00C

U.S. House of Representatives Speaker Paul Ryan called on Wednesday for an end to Obamacare's financial protections for people with serious medical conditions, saying these consumers should be placed in state high-risk pools.

In election-year remarks that could shed light on an expected Republican healthcare alternative, Ryan said existing federal policy that prevents insurers from charging sick people higher rates for health coverage has raised costs for healthy consumers while undermining choice and competition.

The rule, a cornerstone of President Barack Obama's Affordable Care Act, has been praised by patient advocates for providing access to medical care for people who previously could not afford private health insurance. The Affordable Care Act also bars insurers from excluding coverage for pre-existing conditions.


Comment by Don McCanne of PNHP:
House Speaker Paul Ryan has promised to produce the Republican alternative to the Affordable car Act, likely before the Republican convention in July. In his comments at Georgetown University yesterday he discussed what would be the most important policy supposedly designed to control health care spending for the vast majority of Americans: Establish state level risk pools for the 10 percent of people with the greatest health care needs. Let's see what that means.

The top 10 percent of individuals in spending account for 65 percent of health care costs. By removing them from the standard insurance pools that means that the other 90 percent would have to pay insurance premiums that funded only 35 percent of total health care. Ryan says that this would lower insurance premiums through competition, but that is nonsense. Premiums would be much lower because two-thirds of health care costs are pulled out of the insurance plans in the marketplace. Surely most Americans would be happy with private insurance premiums that were one-third of what they would be if everyone were included. It would be a very popular program, and the Republicans would take credit for it.

But what about the 10 percent of people who account for two-thirds of our health care costs. Their premiums would have to be about 7 times what the premium would be if everyone were covered under a common risk pool, or about 20 times what everyone else is paying. As Paul Ryan says, they are “really kind of uninsurable.” So he proposes high-risk pools at the state level, with subsidized premiums. Expecting the states to subsidize two-thirds of our health care costs is a non-starter. Without massive increases in taxes, which are opposed by the Republicans anyway, the states would not be able to fund those pools.

We already have considerable experience with state high-risk pools. In recent decades, thirty-five states established such pools, and overall they were a spectacular failure. Also, the Affordable Care Act authorized temporary Pre-Existing Condition Insurance Plans (PCIP) which were also high-risk pools. These plans proved to be prohibitively expensive to administer, prohibitively expensive for consumers to purchase, and offered much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.

It is so obvious on the face of it. Most of us might be happy with our low premiums, but we would be very unhappy with the massive increases in regressive state taxes that would be enacted to pay for this. Vermont’s reform effort failed once the tax consequences were recognized, and that wasn’t even for high-risk pools.

As I wrote in a previous Quote of the Day, “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.”

Medical loss ratios affect insurance company stock values.

Health insurer Centene's profit beats as medical costs fall

http://www.reuters.com/article/us-centene-results-idUSKCN0XN14E

U.S. health insurer Centene Corp (CNC.N) reported a better-than-expected quarterly profit, helped by lower medical costs in certain patient populations and the acquisition of rival Health Net.

The company's health benefits ratio, or the amount it spends on medical claims compared with its income from premiums, improved to 88.7 percent in the first quarter from 89.9 percent a year earlier


Anthem Falls As Medicaid, Obamacare Results Pressure Margins

http://www.bloomberg.com/news/articles/2016-04-27/anthem-profit-beats-estimates-as-insurer-s-enrollment-increases

Anthem Inc., the No. 2 U.S. health insurer, fell in New York trading as costs tied to its Medicaid and Affordable Care Act businesses pressured margins.

The shares fell 2.8 percent to $142.91 at 11:24 a.m. Wednesday. Anthem spent 81.8 cents of every premium dollar on medical claims in the first quarter, up from a medical-loss ratio of 80.2 percent a year earlier, according to a statement.


Comment by Don McCanne of PNHP
: Today’s message is just a reminder of one of our problems that the Affordable Care Act (ACA) did not fix. A well-functioning health care financing system should be designed to obtain maximum value by spending our funds on health care and not wasting them on excessive administrative services and on profits that add no value to health care. Yet ACA perpetuates policies that turn these priorities upside down, to the pleasure of Wall Street.

Centene is reporting greater profits attributed to a lower percentage of revenues spent on health care compared to the year before - the medical loss ratio decreased from 89.9 percent to 88.7 percent. A comparable medical loss ratio for Medicare would be about 98 percent - only 2 percent is used for administrative services, and there are no profits. Spending less on patient care and retaining more for Centene’s own administrative services and for profits, Wall Street deems to be an improvement.

In contrast, the percent of revenues that Anthem spent on health care increased - the medical loss ratio increased from 80.2 percent to 81.8 percent. For insurers to spend more on health care is considered to be bad news on Wall Street, and thus they punished Anthem by bidding down the price of their shares.

Since these insurers are giving us the opposite of what we want, why are we leaving them in charge of our health care dollars? Let’s fix Medicare and expand it to cover everyone. Yes, we would have a very high medical loss ratio - with 98 percent of our Medicare tax revenues spent on patient care - but it would be a much better deal for all of us - except for the insurance executives and Wall Street rent-seekers.



Health Care Industry Moves Swiftly to Stop Colorado’s “Single Payer” Ballot Measure

https://theintercept.com/2016/04/22/colorad-single-payer/

The campaign in Colorado to create the nation’s first state-based “single payer” health insurance system, providing universal coverage and replacing insurance premiums with higher taxes, has barely begun.

But business interests in Colorado are not taking anything for granted, and many of the largest lobbying groups around the country and in the state are raising funds to defeat Amendment 69, the single-payer ballot question going before voters this November.

The Council of Insurance Agents & Brokers, a national trade group, is mobilizing its member companies to defeat single payer in Colorado. “The council urges Coloradans to protect employer-provided insurance and oppose Proposition 69,” the CIAB warns. The group dispatched Steptoe & Johnson, a lobbying firm it retains, to analyze the bill.


As you know, there's a citizens' initiative on the ballot in Colorado this November to create a state-specific plan that will cover everybody, eliminate deductibles, and let the patient, not the insurance company, choose the doctor, chiropractor, hospital, etc. If "ColoradoCare" passes, it can be a model and an incentive for other states where people like you are working to get health care for all.

I'm happy to report that our early polls show us ahead statewide. I'm unhappy to tell you that our lead is not big enough to withstand the expected onslaught from our opponents. The insurance companies have funded a huge “No" campaign. The Koch Brothers are already running TV ads that say for-profit insurance is the ideal way to pay for health care.

So we need help. We need money…


http://coloradocareyes.co


Comment by Don McCanne of PNHP
: Without additional enabling federal legislation, Colorado is not able to enact a bona fide single payer system. However, their ballot measure - Amendment 69, ColoradoCare - would improve efficiency, equity and coverage through the health care financing system in their state. Strong opposition is expected since ColoradoCare could be disruptive to some of the well-financed stakeholders, especially the private insurance industry.

The advocates of ColoradoCare are now seeking support for their effort (link above). It will be difficult to educate the public on the facts behind their reform proposal. Even when saturated with facts, the public often remains dubious because of the prevailing anti-government and anti-tax rhetoric. It is a massive project to convert the majority of the voters into passionate supporters of such a cause.

In the meantime, the opponents know that their task does not involve educating the public on the facts. They do not have to engage the other side in a information battle over the truth. They merely have to appeal to the passion of the voters. Simple rhetorical soundbites are usually enough to convince the voters that they do not have to waste their time studying some complicated government scheme in order to know how to vote on it. Just look at some of the rhetoric of the opposition group, Coloradans for Coloradans: “doubling the state budget,” “diminishing accessibility and quality,” and “creating an unaccountable, massive bureaucracy.” Who would support that? No need to try to find out the truth.

This is not just theoretical, as single payer activists supporting ballot measures in California and Oregon can attest to. In both cases, early polling was favorable, as it is now in Colorado. But closer to election time, intensive campaigns were launched by the opponents using simplistic sound bites and slogans, and the results were a disaster. California’s Proposition 186 lost by a 3 to 1 margin and Oregon’s Measure 23 lost by 4 to 1.

So what should we do? I have three suggestions.

1. Contribute to their effort in any way you can. (Today I made a donation through their website.)

2. If the effort should fail (and I hate to say that), then be sure that everyone understands that this was not a failure of single payer, especially since it is not even a bona fide single payer proposal. Rather it will have been a failure in mobilizing a social movement.

3. Above all, do not let up in the least in your advocacy for a single payer national health program - an improved Medicare for all. That is the ultimate goal, and it could be accomplished in a single step without having to first enact compromised systems in several states. Difficult? Of course. But, in spite of many attempts, how many states have enacted single payer? In this age of advanced communications, mobilizing a social movement on a national basis makes more sense than trying to do it in selected individual states.



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