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eridani's Journal
eridani's Journal
December 1, 2015

Instability in Marketplaces Draws Concern on Both Sides of Health Law


In applying for rate increases in 2016, many insurers filed data showing that they had lost money on their exchange business in 2014. To stop the losses and control costs, many have increased premiums and deductibles and other out-of-pocket costs, while reducing the number of doctors and hospitals available to consumers through their provider networks.

Conservatives want to let consumers buy policies with fewer mandated benefits, on the theory that such coverage would be more affordable. Some lawmakers say that insurers should be allowed to sell cheaper “copper” plans alongside the bronze, silver, gold and platinum plans available in the marketplaces.

Harvey J. Rosenfield, the founder of Consumer Watchdog, an advocacy group based in California, suggested that “maybe the government should step in and run the system as Medicare for all.”

“People are sticking their heads in the sand if they say there are not serious problems with the Affordable Care Act,” Mr. Rosenfield said, adding: “People who were previously uninsured are indisputably better off, but many people in the middle class are struggling. They are entitled to buy health insurance, but that is an empty promise if the number of doctors and hospitals in your network has shrunk and deductibles have soared.

Comment by Don McCanne of PNHP: Instability. Shrinking networks. Soaring deductibles. These are characteristics of plans offered in the Obamacare insurance exchanges - features that are now contaminating employer-sponsored health benefit programs. What can be done?

We can stabilize choice in physicians and hospitals by eliminating the networks, providing patients with free choice of their health care professionals and institutions. We can eliminate instability in access caused by financial barriers to care by eliminating deductibles, copays and coinsurance. We can stabilize insurance coverage by mandating it while making premiums truly affordable for everyone.

The problem is that under the current model of financing care, the insurers cannot offer plans with affordable premiums without reducing patient access to care - precisely what networks and deductibles are designed to do.

As it turns out, even with these perverse measures most insurers are still losing money. Mounting losses only perpetuate and intensify instability since the insurers must make additional changes to ensure the success of their business model. Quite clearly, additional changes based on business decisions will benefit only the insurers while serving to the further detriment of patients.

Suppose we did reverse course and eliminated networks, excessive cost sharing, tiering of benefits, and other detrimental features of today’s health plans. The variable that would have to give is affordability of the insurance premiums. They would skyrocket. If we really want people to have affordable access to decent health care by correcting these problems, that means that the government subsidies would have to be greatly expanded - both in the amount and in the size of the population that would be eligible. Basically, the government would be covering much of our care, except for the wealthy.

If we were to spend that much in taxes to support such a system, why would we perpetuate this very wasteful and dysfunctional model that we have? If we had any sense, we would demand an efficient, effective system that would ensure access for everyone - a single payer national health program (an improved Medicare for all). Until we do, learn to enjoy the torment of increasing instability in our health care.
November 20, 2015

UnitedHealth May Quit Obamacare in Blow to Health Law


The biggest U.S. health insurer is considering pulling out of Obamacare as it loses hundreds of millions of dollars on the program, casting a pall over President Barack Obama’s signature domestic policy achievement.

UnitedHealth Group Inc. has scaled back marketing efforts for plans sold to individuals this year and may quit the business entirely in 2017.

While millions of Americans have gained coverage under Obamacare since new government-run marketplaces for the plans opened in late 2013, in UnitedHealth’s case they haven’t been the most profitable. Customers the company has added have tended to use more medical care. UnitedHealth also said today that some people are signing up for coverage, getting care and then dropping their policies.

“We cannot sustain these losses,” Chief Executive Officer Stephen Hemsley told analysts on a conference call. “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”

UnitedHealth said it expects as much as $500 million in losses on the Obamacare plans in 2016.

Comment by Don McCanne of PNHP: The Affordable Care Act was designed by the nation’s largest insurers to serve the interests of the nation’s largest insurers. It was almost as if the patients were not much more than a necessary nuisance, required only because an insurance market requires patients to purchase their plans. How is it working out for the insurers?

The largest insurer in the nation - UnitedHealth - has scaled back their marketing of ACA exchange plans and is considering totally exiting the exchanges by the end of next year. Two of the other largest insurers - Anthem and Aetna - have yet to profit from the exchanges and are waiting to see if the exchange business will improve before they decide about the future.

It is no secret what happened. The insurers had to agree to crucial reforms in the insurance market. They had to accept higher cost individuals with preexisting disorders; they had to cover ten categories of health care benefits; they had to limit excess administrative costs and profits by agreeing to minimum medical loss ratios, and they had to submit higher premium increases to insurance regulators for greater public scrutiny.

In other words, they had to agree to market basic insurance products to anyone who was eligible for them. With these requirements, premiums would be unaffordable for all but the wealthy. Thus ACA was crafted to keep premiums down by making lower actuarial value plans the standard - requiring greater cost sharing by patients, though with government subsidies for lower-income individuals. ACA also was crafted to provide government subsidies for the premiums to assist lower-income individuals with the purchase of these plans. That still was not enough so they used the leverage of narrow provider networks to contract for cheaper medical services, and they increased the deductibles, shifting more of their costs to patients.

Guess what. It isn’t working - for the insurers or the patients. Congress dumped on us an administratively complex system that has made it almost impossible for the insurers to offer a product with affordable premiums that still meets the basic plan elements required by the legislation. For the patients, the premiums and deductibles are not affordable for the average family, and they have had to give up their health care choices because of the narrow networks selected by the insurers.

Congress and the Obama administration did this one for the insurers. Yet the insurers are beginning to back out now. That’s just fine because it will allow us to replace them with a financing plan that is designed for patients instead. A well designed single payer national health program would make health care affordable for everyone while returning to them their choices in health care delivery.

November 17, 2015

Many Say High Deductibles Make Their Health Law Insurance All but Useless


But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

Sara Rosenbaum, a professor of health law and policy at George Washington University who supports the health law, said the rising deductibles were part of a trend that she described as the “degradation of health insurance.”

Insurers, she said, “designed plans with a hefty use of deductibles and cost-sharing in order to hold down premiums” for low- and moderate-income consumers shopping in the public marketplaces.

Comment by Don McCanne of PNHP: The deductibles are out of control. The anecdotes in the full article (link above) demonstrate that many people find that their insurance is “all but useless” simply because they cannot afford to pay the deductibles. Anecdotes do not constitute a scientifically valid study, but they certainly do tell us what is happening to individuals out in the real world.

Insurers needed to keep premiums affordable in order to maintain a viable market of private plans. They do that by shifting costs to patients through ever higher deductibles. This was inevitable through the reform model selected for the misnamed Patent Protection and Affordable Care Act. Because of the large deductibles, actual health care is not affordable for individuals with modest incomes and thus patients do not have the protection that they need.

The three trillion dollars that we are already spending on health care is enough to provide all essential health care services for everyone. With a properly designed financing system there is no need to erect financial barriers to care since cost containment can be achieved through patient-friendly policies such as those of a single payer national health program.

Without proper reform, “degradation of health insurance” will progress. People will face greater financial hardship because of medical bills. People will suffer more because of forgone health care. People will die.

This isn’t right. We need an improved Medicare that includes everyone.

November 14, 2015

Medicaid coverage improves access to health care and chronic disease control:

American Journal of Public Health study


Low-income Americans with Medicaid insurance have more awareness and better treatment of chronic diseases, such as high blood pressure, than their uninsured counterparts, a group of Harvard researchers said today. People with Medicaid are also five times more likely to see a doctor than those with no health insurance.

These are among the chief findings of a new study by a team of researchers led by Dr. Andrea Christopher, a fellow at Harvard Medical School, published today in the American Journal of Public Health. The study is based on data gathered from 4,460 poor Americans in national surveys conducted by the Centers for Disease Control and Prevention.


From the Discussion

Our findings suggest that, nationally, Medicaid was associated with improved access to outpatient medical care, as well as awareness and control of important chronic conditions. Medicaid recipients visited health care providers much more frequently than comparable uninsured individuals, and were more likely to be aware of their hypertension and overweight. In addition, Medicaid recipients were more likely to have their blood pressure controlled, a clinical goal known to reduce all-cause mortality by as much as 17%. However, we found no differences in the diagnosis or control of diabetes, and only nonsignificant differences among those with hypercholesterolemia. We theorize that the lack of findings for diabetes may be because control requires more significant diet and lifestyle changes compared with other chronic conditions, and these changes may not be easily remedied through access to medical care.

Comment by Don McCanne of PNHP: Opponents of the Affordable Care Act have been using the Oregon Health Insurance Experiment (OHIE) to supposedly show that Medicaid does not improve health outcomes even though the study was not powered to demonstrate such. Thus this new study is important because it does show that Medicaid improves access, improves awareness of important chronic conditions, and improves control of hypertension. The OHIE trial did show that “Medicaid coverage increased health care use, improved patients’ financial security and self-reported health, lowered depression rates, and raised diabetes diagnosis rates.”

Clearly Medicaid is of benefit. However, as a chronically underfunded welfare program, Medicaid does have significant deficiencies. Last week, a UC Davis study reported that cancer care is worse for Medicaid patients than for other insured patients. The question is, what should we do about it?

Some conservatives would convert Medicaid into a block grant to the states, limiting federal contributions, likely compounding the problem of underfunding. Other conservatives would eliminate Medicaid and place everyone in high-deductible private plans, perhaps with some federal contributions to health savings accounts for low-income individuals. Narrow networks and cost sharing would surely limit access for this population.

A much better solution would be to replace our fragmented health care financing system with a single payer national health program, eliminating cost sharing and network barriers. Since the program would cover all of us, chronic underfunding for a sector of us would not be tolerated.

November 10, 2015

91-year-old veteran brings audience to tears as he explains the importance of National Health Care

Go NHS!! Maybe one day we'll get universal health care.


No one in our community was safe from poor health, sickness and disease. In our home, TB came for my oldest sister, Marion, who was the apple of my dad’s eye. Her sickness and his inability to pay for medicine broke his heart.

Tuberculosis tortured my sister and left her an invalid that had to be restrained with ropes tied to her bed. My parents did everything in their power to keep Marion alive and comfortable but they just didn’t have the dosh to get her to the best clinics, doctors or medicines.

Instead she wasted away before our eyes until my mother could no longer handle her care and she was dispatched to our workhouse infirmary where she died 87 years ago. Mum and dad couldn’t afford to bury their darling daughter. So like the rest of our country’s indigent, she was dumped nameless into a pauper’s pit.

My family’s story isn’t unique. Rampant poverty and no health care were the norm for the Britain of my youth. That injustice galvanized my generation to become, after the Second World War, the tide that raised all boats.

In 1945, at the age of 22, still in the RAF after a long hard Great Depression and a savage and brutal war, I voted for the first time.

Election Day 1945 was one of the proudest days in my life. I felt that I was finally getting a chance to grab destiny by the shirt collar and that is why I voted for Labour and for the creation of the NHS.

Today my heart is with all of those people from my generation who didn’t make it past childhood, didn’t get an education, didn’t grow as individuals, didn’t marry, didn’t raise a family and didn’t enjoy the fruits of retirement. They died needlessly and too early. But my heart is also with the people of the present, who are struggling once more to make ends meet, and whose futures I fear for.

Today, we must be vigilant. We must be vocal. We must demand that the NHS will always remain an
nstitution for the people and by the people.

November 5, 2015

The Corporate Case for Single Payer


Mingling among the doctors, nurses and activists at the single payer conferences in Chicago this weekend was one Richard Master.

Master is the owner and CEO of MCS Industries Inc., the nation’s leading supplier of wall and poster frames — a $200 million a year company based in Easton, Pennsylvania.

Master has just produced a movie — Fix It: Healthcare at the Tipping Point.

He was in Chicago to show it to the single payer advocates gathered there attending two conferences — the Physicians for a National Health Program annual meeting and the Single Payer Strategy Conference put on by nurses and other labor unions.

In a way, Master was a fish out of water — a businessman among activists.

But he had reached the same conclusion.

“My company now pays $1.5 million a year to provide access to healthcare for our workers and their dependents,” Master said. “When I investigated where all the money goes, I was shocked.”

What he found was that fully 33 cents of every health care premium dollar “has nothing to do with the delivery of health care.” Thirty-three percent of the healthcare budget was being spent on administrative costs.

That’s why he reached out to a couple of award winning filmmakers to produce Fix It — which makes the corporate case for scrapping the current multi-payer system for a single payer.

November 5, 2015

The Co-ops Collapse: How GOP & HMOs Undercut Obamacare's Nonprofit Option, Leaving 500K Uninsured

Yep--the co-ops really cannot compete if they want to be good guys. ANY for profit insurance allowed to exist at all will guarantee that the good guys are going to finish last. And the Repukes can't wait to help make that happen.


We welcome you all to Democracy Now! Steffie Woolhandler, let’s begin with you. In New York, there are well over 200,000 people who are—have insurance under what’s called Health Republic, one of these healthcare co-ops. Suddenly, last Friday, to the shock of many—even people working within the system—they were told that this healthcare co-op will close by the end of the month. That’s November. That’s before you can even get coverage in this open enrollment period. The next time is January 1st. So they have to sign up twice—right now, to fill the gap to the end of December, and then, because of IT issues—they can’t just sign up now and get that insurance from now on in another company—they have to sign up now ’til the end of December, and sign up within the open enrollment period, like a day later, for getting insurance in January. Over 200,000 people are out of insurance.


AMY GOODMAN: Just in New York alone.

DR. STEFFIE WOOLHANDLER: Just in New York. And 10 of the 23 co-ops have closed, and several more are expected to close soon. These nonprofit co-ops, many of us felt they were never going to be viable. These tiny insurance co-ops was like the peewee football going against the NFL. They just didn’t have the size to make it in the marketplace.

But also, they weren’t cheaters. And the way the health insurance market works is good guys finish last, and cheaters win. The way you make a killing in the health insurance market is by signing up lots of healthy people, collecting as high premiums as possible and giving them as little care as possible—and, if they get sick, figuring out ways to force them out of the insurance. That’s the way the U.S. insurance market works. And these small nonprofit co-ops were not very good at playing the game. Many of them didn’t want to play that game.

So, we’re not surprised they went under. You know, the only way to insure a population, that has worked, is through some form of nonprofit national health insurance. That’s what every other developed nation uses. And then you have everybody in what we call the same risk pool—everyone in, nobody out.

November 3, 2015

Our Nation Needs This Balm as Single-Payer Action Surges Forward


Over the past few days, more than 700 people from all over the country came together for the annual single-payer strategy conference. This year, we were in Chicago, my hometown, Of course we shared ideas, successes, concerns, and knowledge about the kind of healthcare reform that might truly give us the best healthcare system in the world through an improved Medicare for all for life model.

The convening groups represented Healthcare-NOW, the Labor Campaign for Single-Payer Health Care, One Payer States, and Physicians for a National Health Program.Leaders from this movement get precious little time to gather face-to-face during the year. There were scores of nurses from all over the country -- New York, Massachusetts, Illinois, Texas, California, Minnesota, Pennsylvania and beyond. There were doctors from all over the place. And there were those of us who are patients who have been injured (or might be injured) by our aggressively greedy healthcare system. Labor leaders brought the hopes of their rank and file membership that someday we will actually allow contract bargaining to surround much more than healthcare benefits and costs that have squeezed out other issues like wages, vacation and other leave benefits and so on.

The conference opened with a joint protest at the Blue Cross/Blue Shield building in Chicago. One of the great moments for me was seeing the medical students passionately calling for changes to their chosen profession. It gave me hope for the future and the potential for real change.

But the highlight of the conference for me came in something much less quantifiable but much more powerful -- the balm of knowing that this wonderful nation is filled with compassionate, decent people who believe in the promise of our Declaration of Independence in which we read that all men are endowed by their creator of certain unalienable rights, and that among these rights are life, liberty and the pursuit of happiness. There can be none of those dearly held rights for Americans when our healthcare system snuffs out any chance for equality and the opportunity to live life to its fullest extent.

A special shout out to National Nurses United for their support of the conference and continued support of the movement to advance single-payer in our states.

We missed those of you who were not with us.

If you would like to check out the conference materials, there is a wiki page at: http://singlepayer2015.wikidot.com/

Ben and Stephanie at Healthcare-NOW will be adding PowerPoints and other documents over the next few days, so even if you missed being with us this time, you will be able to take advantage of a great deal of our work.

If you would like to get a feel for the conference, I have written a blog that you may wish to read and/or share. And if others have photos or other writings, I urge you to share them on the Wiki page or send them to Ben and Stephanie (emails above) so that they may post them


or if you wish to read this on Common Dreams: http://www.commondreams.org/views/2015/11/02/our-nation-needs-balm-single-payer-action-surges-forward

Finally, we screened the terrific new documentary film, Fix It: Healthcare at the Tipping Point (.
http://fixithealthcare.com/) Most of those who attended left with a DVD and/or thumb drive with a trailer, a shortened 38-minute version of the film, and the full 58-minute film ready to be used to do outreach to your business community. The demand for the film was so high that all of the copies the Fix It team brought (more than 500) were handed out in Chicago, and we took down the names and contact information for many, many more to be sent along.

If you did not get a copy, you did not leave your information with us or if you need assistance with your outreach plan, please let us know. We will also be spending some time on the November OPS call with strategies and suggestions for connecting with the business community using this great new tool.

Thank you to all who attended and all who continue to make OPS a great way to connect with other state single-payer activists.
November 3, 2015

The CPI-E A Better Option for Calculating Social Security COLAs


President Obama’s 2014 budget proposal includes a plan to change the way Social Security cost-of-living adjustments, or COLAs, are calculated by adopting the “chained” consumer price index (CPI). The National Committee has been vocal in its opposition to the chained CPI because it does not accurately measure the purchasing patterns of our elderly population. We urge the adoption of a CPI for the elderly, or CPI-E, as a more accurate means of calculating Social Security COLAs. An in-depth examination of the CPI-E follows.

The CPI-E uses the same formulas and prices as the CPI-W, but their importance is determined, or weighted, differently. The CPI-E uses expenditure weights for households with individuals age 62 or older. This sample size is 26 percent of the size used for the other BLS indices, so is subject to a greater sampling error than the other indices. This is one reason the CPI-E continues to be classified as “experimental”.

From December 1982 to December 2011, the experimental CPI-E has tended to rise more rapidly than the CPI-W. Using the CPI-E to determine the Social Security COLA would increase the expected average COLA by about 0.2 percentage points per year. In contrast, using the chained CPI would result in COLAs lower than under current law. COLAs using the chained CPI are estimated to reduce expected average COLAs by 0.3 percentage points per year. That means a typical 65 year-old would see a decrease of about $130 in

Social Security benefits using the chained CPI after the change has been effective for three years. At age 95, the same senior would face a 9.2 percent reduction—almost $1,400 per year. The BLS acknowledges the current CPI does not “produce official estimates for the rate of inflation experienced by subgroups of the population, such as the elderly or the poor.” Neither the current CPI-W nor the proposed chained CPI takes into account the spending patterns of America’s seniors. This is why we need an elderly index.

According to the BLS, in order to move to an “official” CPI-E, it would need to conduct additional research including where elderly households are located, where the elderly actually shop, and what mix of products the elderly purchase. The CPI-E has been under review for nearly three decades. It is time for the federal government to provide the resources for BLS to conduct this research and to expand the sample size of individuals age 62 and older, to conclude its analysis, and adopt a more accurate consumer price index for the elderly.
November 3, 2015

Obamacare Premiums Climb, But Insurers Struggle for Profit


Many people shopping for health coverage this weekend on the websites created by Obamacare are going to see double-digit percentage increases in their premiums. That’s still not enough for some insurers.

Anthem Inc. says there remain competitors in the government-run marketplace offering premiums that aren’t enough to profitably provide the coverage patients will require. Prices in some areas probably will have to climb in 2017 and even 2018 to reach levels that make sense, according to Chief Financial

Officer Wayne Deveydt. Meantime, Anthem will sacrifice market share to keep its plans profitable, he said.


Aetna hasn’t been turning a profit in Obamacare plans, the company has said. Guertin said its price hikes range from high single digits to the mid-teens, depending on the market. UnitedHealth Group Inc., the largest U.S. health insurer, has said its premium increases are in the double digits as well.

Comment by Don McCanne of PNHP: The performance of competing private insurance plans within the ACA exchanges is not much different from the performance of the pre-ACA private plans in the individual market. Trends in higher insurance costs, greater cost sharing, and narrower choices were already occurring, and they continue to grow progressively worse. Access and affordability can only suffer.

Higher premium credits and out-of-pocket subsidies are helping individuals with incomes near poverty levels, but, for middle-income families, they are inadequate to provide much benefit.

Higher premiums and more cost-shifting to patients are adequate to maintain profits for most larger insurers, but where even these measures are inadequate, insurers are pulling out of the exchanges, and some of the smaller insurers are even folding. Market manipulations create instability.

The insurers show their true colors through statements such as that of Anthem’s Chief Financial Officer Wayne Deveydt. Reporting to Wall Street analysts, Deveydt said about the market, “When you have fewer national enrollees and you have price points that we don’t believe are sustainable, we’ve just made a
conscious decision we’re not going to chase it.”

Higher premiums, greater cost-sharing, narrower networks - the behavior of the private insurers is not changing in spite of the promise of higher value and lower costs through the ACA Marketplaces. The ACA
exchanges are a creeping failure that is growing worse. Congress enacted the wrong model of reform. We
need single payer.

My comment: Health insurance should never be allowed to make a profit, any more than fire departments.

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: 51,907

About eridani

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