PNHP

Record Level of Americans Not Insured on Health

Record Level of Americans Not Insured on Health

Record Level of Americans Not Insured on Health
By MILT FREUDENHEIM

Published: August 27, 2004

Rising costs for health coverage and a continuing fall-off in the number of workers in employer-sponsored health plans are among the reasons that a greater number of people did not have health insurance last year, experts say.

The increase in uninsured people last year, as reported by the United States Census Bureau yesterday, was 1.4 million, to a record 45 million.

More than 10 million of those without insurance were young people, 25 to 34 years old, government officials said, an increase of 576,000 from 2002. “Young adults got hammered,” said John F. Holahan, a health economist at the Urban Institute, a nonprofit research center in Washington.

In 2002, there were 43.6 million people without insurance, or 15.2 percent of the census estimate of 288.3 million Americans. The proportion of people who were uninsured grew only slightly last year, to 15.6 percent. That reflected growth in the total population and 3.2 million more people added to government health programs including Medicare, Medicaid and state coverage for children. More than one in four Americans is in a public program.

As the population grew, the number of people who had insurance also increased, by one million, to 243.3 million last year, also a record, the Census Bureau said.

Health insurance is a hotly debated campaign issue. Senator John Kerry has promised new subsidies to extend coverage to more people. The Bush campaign points to a feature of the new Medicare law that provides tax breaks for special savings accounts to help people pay for care.

Senator Judd Gregg of New Hampshire, who led a recent Republican panel that studied health insurance issues, said the “uptick” in the number of uninsured “reflects the still sluggish economy” in 2003. He said one million new jobs had been added since then.

Bill Frist of Tennessee, the Senate majority leader, said the numbers also reflected “a decade-long downward trend in the proportion of Americans who receive health insurance through their employers.”

Len M. Nichols, vice president of the nonprofit Center for Studying Health Systems Change in Washington, said, “The question is whether the recovery will be strong enough to generate good jobs with health insurance to counter the fact that health insurance is more costly now.”

Surveys by research groups show that health costs continue to rise much faster than wages and other costs borne by employers. Economists say the employment trend is still moving away from jobs that provide generous coverage.

Employers are already planning for steep increases in health costs for 2005. A separate survey of 916 employers released yesterday by Mercer Human Resource Consulting, a benefits consulting firm, said costs of current coverage would rise about 13 percent next year. Many employers plan to cut back on benefits and shift more of the costs to their workers to slow the increase to 9.6 percent, on average, Mercer said.

The cuts will “increase the pressure on small employers to discontinue coverage or increase their employees’ share of premiums,” said Blaine Bos, a Mercer survey spokesman. The upshot will be “more employees saying, ‘I don’t see the value of that’ and going without insurance,” he said.

There were 20.6 million uninsured full-time workers last year, the Census Bureau said, an increase of 1.6 million over the last two years.

The Census Bureau said that 12.1 million people without insurance were members of families with annual incomes of $50,000 or more, including 6 million in families that made at least $75,000 a year. Some conservative economists contend that these people could afford to pay for insurance.

“Households that earn $50,000 per year or more account for about 90 percent of the increase in the number of uninsured over the past 10 years,” according to the National Center for Policy Analysis, a research center based in Dallas that says it opposes government solutions to public policy problems.

Health policy experts who advocate a greater government role say a family with $50,000 in total income has trouble affording family coverage, which typically costs more than $9,000 annually, unless it obtains help from an employer or the government. They say many of these people are self-employed or work for small businesses that find health costs daunting.

This year the number of uninsured people in families with incomes of $50,000 or more increased by 704,000, the census report said. It also said there were 619,000 people without insurance in families with incomes of less than $25,000.

Although a number of states, including Texas, have cut back on children’s health programs, the number of uninsured children declined slightly, to 8.4 million, but remained at 11.4 percent of all children, last year. The proportion of poor children without insurance was 19.2 percent.

The proportion of uninsured people held steady among Hispanic, Asian and black Americans. About 18.5 percent of blacks, 18.7 percent of Asian-Americans and 32.7 percent of Hispanics did not have insurance.

With large numbers of Hispanic residents, Texas and New Mexico have the highest proportions of uninsured people, the Census Bureau said. Both had average uninsured rates of more than 20 percent over the three years from 2001 to 2003. The three-year average was 19.4 percent in Louisiana, 18.7 percent each in California and Oklahoma, and 17.8 percent in Alaska.

The states with the lowest three-year averages were Minnesota, at 8.2 percent; Rhode Island, at 9.3 percent; and Iowa and Wisconsin, at 9.5 percent each. Massachusetts, New Hampshire and Vermont were also at the low end, with 9.9 percent.

The uninsured rate was 15.5 percent in New York, 13.7 percent in New Jersey and 10.4 percent in Connecticut.

The true colors of the partisan divide on health care

The true colors of the partisan divide on health care

Background for today’s Quote of the Day: California has served as a unique laboratory for the application of health care policies in the reform movement. The process is handicapped by the fact that a two-thirds vote is required in both the Assembly and the Senate if a measure would result in a tax increase. Since the Republicans control over one-third of each chamber, and they vote as a block against any tax increase, reform measures have been limited to those that do not require significant additional state spending.

Although in this environment it would be almost impossible to enact a state-funded system of universal coverage, it is truly remarkable what the legislators have been able to accomplish with the support of dedicated advocates such as the leadership of California’s Health Access.

Today’s message discusses one small but important issue: the excessive fees charged uninsured patients who have no choice when they must access the health care system on an emergency basis. The debate over this legislation
is very instructive because it reveals the true colors of those on each side of the partisan divide.

I am especially indebted to Anthony Wright, Executive Director of Health Access, who granted me permission to distribute excerpts from his message for today.

Quote of the Day:

HEALTH ACCESS UPDATE
Tuesday, August 24, 2004

CA ASSEMBLY VOTES TO PROHIBIT HOSPITAL OVERCHARGING OF UNINSURED

On Monday, August 23rd, the California Assembly passed SB379 (Ortiz) to
prohibit hospitals from overcharging uninsured patients, and provide other consumer protections. Both SB379, and a similar bill, AB232 (Chan) are expected to be voted on in the Senate and, if successful, be sent to Governor Schwarzenegger’s desk by the end of the week. Both bills would provide first-in-the-nation consumer protections for self-pay hospital patients.

SPECIFIC PROTECTIONS FOR HOSPITAL PATIENTS: The bills that address aggressive hospital billing and collections, SB 379 and AB232, are similar. They address an issue raised by dozens of “uninsured and overcharged” patients that have been sent to collections, court, or bankruptcy for the simple act of seeking needed care. Both bills ensure that self-pay hospital patients:

Are informed of their consumer rights and financial options; Have at least 120 days before being sent to collections; If they are under 400% of the federal poverty level (under $60,000 for a family of three), don’t pay more than the Medicare, Medi-Cal or worker’s compensation rate for treatment.

A fact sheet on the bill is available at:
http://www.health-access.org/ab232_fact_sheet.htm

The text for AB232 (Chan) is at: http://www.leginfo.ca.gov/pub/bill/asm/ab_0201-0250/ab_232_bill_20040817_amended_sen.html

The text for SB379 (Ortiz) is at: http://www.leginfo.ca.gov/pub/bill/sen/sb_0351-0400/sb_379_bill_20040817_amended_asm.html

ASSEMBLY DEBATE: Assemblywoman Wilma Chan, the author of AB232 (sponsored by Health Access California), served as the floor manager on the debate on SB379, by Senator Deborah Ortiz. She started the discussion by talking about a specific patient who, when her health insurance ran out, was forced to pay four times the amount that her insurance had paid for a similar treatment. Chan made the point that hospital debt is a leading cause of personal bankruptcy.

REPUBLICAN OPPOSITION: Several Republicans rose to argue against the bill,including Assemblymen Tim Leslie, Tom Harman, Dennis Mountjoy, Ray Haynes, and at the end of the discussion, Tony Strickland.

Leslie questioned why “Democrats want to attack hospitals, and they are continuing to make hospital operations more difficult.”

Harman made several points in his objections. “Hospitals are businesses.They are run like any other business, whether it is a manufacturing business, a service business, a barber shop, a beauty salon.” He mistakenly stated that, “this bill simply says, well, you’ve got to provide free medical care to certain types of patients… that you can’t use wage garnishment or a collections agency…. Well, how else are they going to collect it if they don’t pay it?” He admitted that “we need to have a plan where everyone can get the necessary medical treatment that they need.

I support that in some fashion, I don’t know exactly what it would be.” Finally, he referenced the individual story that Chan cited in her opening: “I’m sorry, but maybe that person should have had better health coverage, maybe that person should have thought about this problem. That’s what we have bankruptcy court for…. Is it any different than a contract debt? How is it different from any other kind of debt? I submit to you that it is not.”

Mountjoy also misrepresented the bill, stating that it said that “if you are a hospital that is serving a patient, and if they are low-income, you gotta give it to them. Well, why don’t we do that for plumbers?… And the electrician, he ought to give you a break, too. Where in the Constitution does it say that we owe folks health care?… We don’t own them health care.” He continued, “why should we put the burden on a business like hospitals?… They are a business not unlike any other. They are there to make a profit, they have a board of directors that looks for that every month.”

Haynes decried the “Orwellian state” he was in. “When you order somebody to give stuff away for free, or you order somebody to work for free, that is what is known in the parlance as slavery. We are basically ordering hospitals to be our slaves.”

Later, Strickland stated that “part of the reason why costs have gone up in the hospital is that the hospitals are providing a lot of charity care. The uninsured are not paying their hospital bills…. The hospitals are shutting down their emergency rooms because they are providing too much charity care.”

DEMOCRATIC REBUTTALS:. Democrats that rebutted these claims include Assemblymembers Lloyd Levine, Hannah-Beth Jackson, and Jackie Goldberg. Levine responded, “more and more people are going without health care in California. And frankly, I actually… resent the implication that they should have had thought of this sooner, and gee, they should have had health insurance. The cost of health insurance is continuing to skyrocket…, many families cannot afford health insurance, and to say ‘oh, it is their fault,’ really misses the point…. We need to pass this bill and do everything we can to make sure people have access to health care when they need it.”

Jackson brought the discussion back to the question that the bill addresses:
“Is it correct that many hospitals charge uninsured people higher rates than what they charge and are willing to receive from insurance companies and Medicare?” She continued: “This is a bill that tells hospitals that you can’t take advantage of poor people who don’t have insurance… Let’s be fair to the people that are least able to pay by not forcing them to pay more than you and I who have the benefit of having health insurance. It is a sad state of affairs when anybody takes a predatory practice to charge the least able to pay more money for any service because they can… The goal is to give everybody, whether they are rich or poor, a chance to have quality health care at a fair and reasonable price.”

Goldberg also clarified that the bill “asks that the hospitals require nothing more than the higher of Medi-Cal, Medicare, or worker’s comp.So it is not free. And why is this business different than any other business? Well, this business you can’t live without, in some cases.” She also cited statistics that showed that while the uninsured are a small percentage of the patients in many hospital chains, they account for a disproportionate share of the profits. “The only way that could be true is to be gouging those folks as compared to people who have insurance…”

Chan closed by rebutting the arguments: “This does not in any way call for free care. Back in the 80s, I believe, there were strict limits on what a hospital could charge. This does not even go that far… It just says,if you go to the hospital, there should be some ceiling on what you can be charged. Collection agencies can be called in, but this bill gives the person a chance.” She concluded: “We are not talking about something free here, we are talking about basic fairness.”

The bill passed with an unofficial vote of 41-31, along party lines.

Health Access California:

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Comment: Although there is certainly a partisan divide over concepts of the appropriate roles of government and the marketplace in addressing problematic social issues, in general many Americans believe market forces must be allowed the freedom to address these issues without significant government intervention. But most also believe that when the market is unable correct significant social injustices then the government should enter to provide policies that will satisfy our quest for simple fairness.

I find it difficult to believe that most politically conservative individuals personally identify with the comments made by the Republican legislators in this debate on price gouging of the insured for emergency care. I believe that if Republicans knew what their own elected legislators were doing they would replace them with conservatives who were, in fact, truly compassionate. They need to prove that Compassionate Conservatism is not the Big Lie.

Mike Luff on Canada's vacillating solidarity

Mike Luff on Canada’s vacillating solidarity

In the last Quote of the Day message, a Globe and Mail article on Canadian solidarity and the right to health care ended with: “When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.”

My comment following the quote posed the question: “Whether in the United States or Canada, is it solidarity that is vacillating, or is it merely due to our all too feeble efforts to involve ourselves in the political process?”

Mike Luff, National Representative for Canada’s National Union of Public and General Employees (NUPGE) responds:

With respect to your question (above), I would submit the following response: it’s not an “either/or” issue. The problem is both diminishing solidarity and confidence in the political process. But I believe we can change this. By honestly answering two deceptively simple questions: If not us, who? If not now, when? Allow me to elaborate, please.

Conviction and courage are almost nonexistent in politics in Canada and the US. It’s so bad we even tell jokes about it. One I heard goes like this.

Question: Why is a politician like a banana?
Answer: Because he starts out green, turns yellow and then goes rotten. But it is no laughing matter. The problem is not that politicians don’t live up to our expectations – the problem is that they too often do live up to our expectations and behave like politicians. They too often show no conviction and courage. They too often play us for suckers. This is what we’ve come to expect from the “people’s representatives” in Ottawa and Washington. It’s very dangerous. Because it pushes most people to give up on politics. To throw our hands up and follow the famous bumper sticker advice: “Don’t vote. It only encourages ’em.” That’s the real danger. Because the more people give up on politics the closer we edge to giving up on democracy itself.

But we do have the power to stop the drift to democratic despair. To do this we must come on strong. Remind people that to give up on politics is to give up on ourselves – and that we are not about to do that. We must rally regular, everyday people with the conviction they can hold out for themselves and we must give them the courage to use their ballots to finally do it. We must state and restate our conviction that it is regular, everyday folks who make history every day when we shut off the alarm clock, get the kids off to school and go into work. We must have the courage to say this is our world and we are not about to throw up our hands and lose it by default to the fools in Ottawa and Washington – elections will be won and lost until we get what we want.

The example of how we got Medicare in Canada in the first place should give us strength. The people that thought up and fought for Canada’s Medicare didn’t put their faith in politics or politicians. They put their faith in people, in each other. There were 105 people at the founding meeting of the movement to fight for Canada’s Medicare. There were 20 construction workers; 19 unemployed men and women; 15 farmers; 12 members of Parliament; six housewives; six teachers; six railway workers; six nurses; three journalists; two lawyers; two union leaders; two steam engineers; one miner; one professor; one hotel keeper; one retired minister; one merchant; and one motion picture operator. And not one stuffed shirt in the lot. They were all regular folks. They had nothing much going for them except their belief in themselves, their common desire to make the world into a better place and their faith in the power of ordinary people to do extraordinary things.

It is what made them strong then. It is what makes us strong now. It is what will keep us strong in the future.

It’s just a fact that civilization doesn’t happen because we leave it to other people. We have to stand up and fight for it – as if the cause depends on each one of us, because it really does! We must make it plain that we are going to hold out for what is right and just and ours. We must do this because we owe it to ourselves and to all the other women and men of good will who came before us and all those who will follow. We must be, as they were and will be, the change we wish to see in the world. Let us together openly declare that we are the ones who will lead by example, with conviction and courage, and we will do it now!

Mike Luff
National Representative
National Union of Public and General Employees (NUPGE)
NUPGE is Canada’s second largest union.)

HMO workers strike over health benefits

HMO workers strike over health benefits

SEATTLE (AP) — About 1,700 nurses and other health care workers formed picket lines to start a five-day strike against Group Health Cooperative — one of the nation’s oldest HMOs — over the cost of their own health benefits. Nurses, medical assistants, therapists and others represented by Service Employees International Union Local 1199 began striking at 18 clinics in western Washington, union spokesman Carter Wright said Monday. Negotiations between the two sides ended last week.

Before the walkout began, Group Health transferred an undisclosed number of maternity patients, rescheduled outpatient surgery and postponed back-to-school physical exams. Nonstriking employees and outside replacement workers filled in for the union members. The walkout is scheduled to end at midnight Friday. Group Health, a nonprofit health maintenance organization begun in 1947, says it needs its employees to pay more for health benefits to save money and prevent the HMO from passing on costs to members in the form of higher premiums.

Union workers now get benefits with no premiums or deductibles. They make $5 co-payments for office visits and prescriptions. Group Health wants to raise co-payments to $15, institute deductibles and charge premiums on a sliding scale. Union members say they are willing to contribute more but not as much as Group Health has sought, adding that some employees could not afford health coverage under the cooperative’s proposal. Union members range from nurses making $70,000 a year to custodians making $24,000. Group Health is the second largest consumer-governed HMO in the nation

Mike Luff on Canada’s vacillating solidarity

Mike Luff on Canada’s vacillating solidarity

In the last Quote of the Day message, a Globe and Mail article on Canadian solidarity and the right to health care ended with: “When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.”

My comment following the quote posed the question: “Whether in the United States or Canada, is it solidarity that is vacillating, or is it merely due to our all too feeble efforts to involve ourselves in the political process?”

Mike Luff, National Representative for Canada’s National Union of Public and General Employees (NUPGE) responds:

With respect to your question (above), I would submit the following response: it’s not an “either/or” issue. The problem is both diminishing solidarity and confidence in the political process. But I believe we can change this. By honestly answering two deceptively simple questions: If not us, who? If not now, when? Allow me to elaborate, please.

Conviction and courage are almost nonexistent in politics in Canada and the US. It’s so bad we even tell jokes about it. One I heard goes like this.

Question: Why is a politician like a banana?
Answer: Because he starts out green, turns yellow and then goes rotten. But it is no laughing matter. The problem is not that politicians don’t live up to our expectations – the problem is that they too often do live up to our expectations and behave like politicians. They too often show no conviction and courage. They too often play us for suckers. This is what we’ve come to expect from the “people’s representatives” in Ottawa and Washington. It’s very dangerous. Because it pushes most people to give up on politics. To throw our hands up and follow the famous bumper sticker advice: “Don’t vote. It only encourages ’em.” That’s the real danger. Because the more people give up on politics the closer we edge to giving up on democracy itself.

But we do have the power to stop the drift to democratic despair. To do this we must come on strong. Remind people that to give up on politics is to give up on ourselves – and that we are not about to do that. We must rally regular, everyday people with the conviction they can hold out for themselves and we must give them the courage to use their ballots to finally do it. We must state and restate our conviction that it is regular, everyday folks who make history every day when we shut off the alarm clock, get the kids off to school and go into work. We must have the courage to say this is our world and we are not about to throw up our hands and lose it by default to the fools in Ottawa and Washington – elections will be won and lost until we get what we want.

The example of how we got Medicare in Canada in the first place should give us strength. The people that thought up and fought for Canada’s Medicare didn’t put their faith in politics or politicians. They put their faith in people, in each other. There were 105 people at the founding meeting of the movement to fight for Canada’s Medicare. There were 20 construction workers; 19 unemployed men and women; 15 farmers; 12 members of Parliament; six housewives; six teachers; six railway workers; six nurses; three journalists; two lawyers; two union leaders; two steam engineers; one miner; one professor; one hotel keeper; one retired minister; one merchant; and one motion picture operator. And not one stuffed shirt in the lot. They were all regular folks. They had nothing much going for them except their belief in themselves, their common desire to make the world into a better place and their faith in the power of ordinary people to do extraordinary things.

It is what made them strong then. It is what makes us strong now. It is what will keep us strong in the future.

It’s just a fact that civilization doesn’t happen because we leave it to other people. We have to stand up and fight for it – as if the cause depends on each one of us, because it really does! We must make it plain that we are going to hold out for what is right and just and ours. We must do this because we owe it to ourselves and to all the other women and men of good will who came before us and all those who will follow. We must be, as they were and will be, the change we wish to see in the world. Let us together openly declare that we are the ones who will lead by example, with conviction and courage, and we will do it now!

Mike Luff
National Representative
National Union of Public and General Employees (NUPGE)
NUPGE is Canada’s second largest union.)

New book attacks attempt to privatize the British NHS

Allyson Pollock. NHS plc. The privatisation of our health care. London: Verso September 2004

It’s here at last. In this eagerly-awaited book, Allyson Pollock draws together the many strands of her research and experience, and that of her colleagues in the Public Health Policy Unit. Using historical detail, financial analysis, and personal anecdote, she paints the big picture of how the National Health Service, once offering the population “freedom from fear” “from cradle to grave”, has been delivered, under cover of “diversity”, “local ownership”, and “the right to choose” into the hands of private providers.

James Lancaster
Public Health Policy Unit t: 44 (0)20 7679 4985 (UCL: 24985)
School of Public Policy f: 44 (0)20 7916 8536

Bush's Health Proposal Would Fall Short of Estimates for Expanded Coverage

Experts Say President Bush’s Health Proposal Would Fall Short of Estimates for Expanded Coverage, Washington Post Reports

Several independent analyses of President Bush’s proposal to extend health care to 10 million uninsured U.S. residents at a cost of $102 billion over 10 years found that the “hard data fell far short of the claims,” the Washington Post reports. The Congressional Budget Office, the Treasury Department, academics and the Bush campaign Web site “suggest that under the best circumstances, Bush’s plans for health care would extend coverage to no more than six million people over the next decade,” according to the Post. It is possible that the proposal would only result in two million additional insured people, the Post reports. Henry Aaron, health policy expert at the Brookings Institution, said, “There’s little reason to expect that there would be any reduction in the overall numbers of Americans without health insurance. We’re swimming against a rather swift current in our efforts to reduce the number of uninsured, and the power of President Bush’s proposals to move against that current is, it seems to me, very, very limited.” Megan Hauck, deputy policy director for health care in the Bush campaign, “generally touts” that the proposal would expand coverage to 10 million uninsured through tax credits, association health plans and health savings accounts, the Post reports. However, she agreed that it could expand coverage to as few as six million.

Tax Credits

Based on testimony by a Treasury Department official, the Bush campaign estimates that about five million people would use a $1,000 tax credit to purchase health insurance. However, Jonathan Gruber, an economist at the Massachusetts Institute of Technology, said that some businesses could drop coverage as a result and that his analysis shows the Bush policy could result in 1.8 million newly insured.

Association Health Plans

Hauck said that the Bush campaign’s plan to allow the formation of association health plans would result in an increase of two million insured residents. The figure comes from a January 2000 CBO report that estimated the plans would attract 10,000 to two million members; however, a July 2003 CBO analysis of such plans found that about 600,000 U.S. residents would join health plans. Mercer Risk, Finance and Insurance Consulting estimated that association health plans could lead to an increase of one million uninsured U.S. residents because of an increase in small business insurance premiums.

Health Savings Accounts

The Bush campaign also has said it could expand health coverage to three million people through health savings accounts. Hauck said an internal campaign estimate found the accounts would extend coverage to 1.1 million people, and that an additional 1.9 million would receive coverage through a Bush proposal to make premiums for such coverage tax-deductible. Gruber and Paul Ginsburg, president of the Center for Studying Health System Change, said HSAs would have a minimal impact on the rate of uninsured because some people who are likely to open such accounts are already insured. Gruber said that expanding use of health savings accounts by making premiums tax-deductible would increase the number of uninsured by about 350,000 when combined with Bush’s tax credit policy.

Past Proposals

According to the Post, the “assertions Bush makes about his first-term health care record” are exaggerated. For instance, he speaks about more than four million seniors who previously lacked prescription drug coverage as enrolling in the new Medicare drug discount card program. However, he fails to note that 2.9 million of those seniors were signed up automatically as a result of their participation in a Medicare managed care plan. Further, the Bush campaign Web site states that the administration has expanded eligibility under Medicaid and SCHIP to more than 2.6 million people. Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, said that the statement “is not really true,” adding, “In reality only 200,000 of them got coverage” because of policies enacted by the Bush administration. Rowland said, “Part of the reason more people were covered is the economy got so bad that people lost income. There were more low-income people under Bush than previously, so they became eligible for public programs.” Hauck said the figures cited by Rowland are “awfully low” (Connolly, Washington Post, 8/22).

Bush’s Domestic Agenda

In related news, the Los Angeles Times on Monday examined Bush’s domestic agenda — including his plan to expand use of health savings accounts, which the paper says “may not appear that weighty or new” but “still add[s] up to something big.” Articulating his vision for an “ownership society,” Bush said, “During the next four years, we’ll help more citizens to own their health plan, to own a piece of their retirement, to own their own home or their own small business” (Vieth, Los Angeles Times, 8/23).

Bush’s Health Proposal Would Fall Short of Estimates for Expanded Coverage

Experts Say President Bush’s Health Proposal Would Fall Short of Estimates for Expanded Coverage, Washington Post Reports

Several independent analyses of President Bush’s proposal to extend health care to 10 million uninsured U.S. residents at a cost of $102 billion over 10 years found that the “hard data fell far short of the claims,” the Washington Post reports. The Congressional Budget Office, the Treasury Department, academics and the Bush campaign Web site “suggest that under the best circumstances, Bush’s plans for health care would extend coverage to no more than six million people over the next decade,” according to the Post. It is possible that the proposal would only result in two million additional insured people, the Post reports. Henry Aaron, health policy expert at the Brookings Institution, said, “There’s little reason to expect that there would be any reduction in the overall numbers of Americans without health insurance. We’re swimming against a rather swift current in our efforts to reduce the number of uninsured, and the power of President Bush’s proposals to move against that current is, it seems to me, very, very limited.” Megan Hauck, deputy policy director for health care in the Bush campaign, “generally touts” that the proposal would expand coverage to 10 million uninsured through tax credits, association health plans and health savings accounts, the Post reports. However, she agreed that it could expand coverage to as few as six million.

Tax Credits

Based on testimony by a Treasury Department official, the Bush campaign estimates that about five million people would use a $1,000 tax credit to purchase health insurance. However, Jonathan Gruber, an economist at the Massachusetts Institute of Technology, said that some businesses could drop coverage as a result and that his analysis shows the Bush policy could result in 1.8 million newly insured.

Association Health Plans

Hauck said that the Bush campaign’s plan to allow the formation of association health plans would result in an increase of two million insured residents. The figure comes from a January 2000 CBO report that estimated the plans would attract 10,000 to two million members; however, a July 2003 CBO analysis of such plans found that about 600,000 U.S. residents would join health plans. Mercer Risk, Finance and Insurance Consulting estimated that association health plans could lead to an increase of one million uninsured U.S. residents because of an increase in small business insurance premiums.

Health Savings Accounts

The Bush campaign also has said it could expand health coverage to three million people through health savings accounts. Hauck said an internal campaign estimate found the accounts would extend coverage to 1.1 million people, and that an additional 1.9 million would receive coverage through a Bush proposal to make premiums for such coverage tax-deductible. Gruber and Paul Ginsburg, president of the Center for Studying Health System Change, said HSAs would have a minimal impact on the rate of uninsured because some people who are likely to open such accounts are already insured. Gruber said that expanding use of health savings accounts by making premiums tax-deductible would increase the number of uninsured by about 350,000 when combined with Bush’s tax credit policy.

Past Proposals

According to the Post, the “assertions Bush makes about his first-term health care record” are exaggerated. For instance, he speaks about more than four million seniors who previously lacked prescription drug coverage as enrolling in the new Medicare drug discount card program. However, he fails to note that 2.9 million of those seniors were signed up automatically as a result of their participation in a Medicare managed care plan. Further, the Bush campaign Web site states that the administration has expanded eligibility under Medicaid and SCHIP to more than 2.6 million people. Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, said that the statement “is not really true,” adding, “In reality only 200,000 of them got coverage” because of policies enacted by the Bush administration. Rowland said, “Part of the reason more people were covered is the economy got so bad that people lost income. There were more low-income people under Bush than previously, so they became eligible for public programs.” Hauck said the figures cited by Rowland are “awfully low” (Connolly, Washington Post, 8/22).

Bush’s Domestic Agenda

In related news, the Los Angeles Times on Monday examined Bush’s domestic agenda — including his plan to expand use of health savings accounts, which the paper says “may not appear that weighty or new” but “still add[s] up to something big.” Articulating his vision for an “ownership society,” Bush said, “During the next four years, we’ll help more citizens to own their health plan, to own a piece of their retirement, to own their own home or their own small business” (Vieth, Los Angeles Times, 8/23).

Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care

Annals of Internal Medicine
August 17, 2004
Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study
By Eve A. Kerr, MD, MPH, et al

We believe that this is the first study to use equivalent instruments and methods to compare quality of diabetes care for patients treated in the VA system with quality for those in commercial managed care systems. We should note that the average results for diabetes quality among the commercial managed care plans participating in this study are at or near the top of diabetes performance when compared with national results for commercial plans participating in the National Committee for Quality Assurance accreditation process. Despite this relatively high level of performance in the commercial plans, we found that the processes of care and 2 intermediate outcomes for VA study participants were better than or as good as those for commercial managed care participants. In many cases, the observed differences in quality of care between VA and commercial managed care were large.

…as an integrated health care system, the VA system has implemented several simultaneous, national-level strategies, such as an integrated electronic medical record, unified nationwide guidelines, service integration, alignment of payment incentives, and effective performance monitoring. While almost all commercial managed care plans also had established diabetes quality improvement and monitoring systems, the Chronic Care Model suggests that changes in several domains of care and investment in quality by organizational leaders are necessary to move the quality needle effectively.

Our results suggest that a federally sponsored national health care organization can provide care that is equivalent to or better than that provided by high-performing commercial managed care plans.

http://www.annals.org/cgi/content/full/141/4/272

Comment: So much for “the government can’t do anything right.”

Canada's vacillating solidarity

The Globe and Mail
August 20, 2004
Then they came for health care
By Rick Salutin

It has been a summer of dire warning about eroding health care, leading doomfully toward a health summit in September. This is not new. For a decade, virtually the entire political class and opinion elites have said our health care is not “sustainable,” as if it is a coastline faced by a weather system. The sole public voice (aside from the public) to reject this fatalism has been Roy Romanow. This week, he noted that tax cuts have cost $250-billion in revenue since 1996 while health costs have risen just $108-billion. In other words, the decline in health care is a result of free human choice.

The reason public opinion has resisted elite wisdom about our hopeless health care is not that people adore those “free” doctor visits, but that they have come to see it as a basic right. It may not have begun that way,but it soon took on that air. This sense of health care as a right makes it resistant to fiscal fear-mongering. What would you say if you were told we cannot afford free speech, or democracy, due to current economic conditions? Health care is different and similar. But rights can be lost, as well as gained. To shed light on how that happens, let me take another case: the right to be free of destitution, known disparagingly as welfare.(Welfare is not just about being poor but being destitute. Welfare incomes are often about 15 per cent of average income and miles below the poverty line.)

The sense of welfare as a human right emerged in the 1960s, like health care. It, too, occurred by stealth. Till then, welfare had been akin to charity, bestowed by their betters on the poor, who were seen as partially or wholly responsible for their plight. But during the Depression, the destitute started being seen as victims of market forces largely outside of their control. The token of this change was the 1966 Canada Assistance Plan (CAP), which offered federal funding for welfare as long as the provinces made it universally available, provided a decent living standard and removed distinctions between the worthy and unworthy poor. It was a kind of informal acceptance of the right not to be destitute.

The retraction of this right — one of the “givebacks” of the 1990s — was the work of then-finance minister Paul Martin. His 1995 budget abolished the CAP, replacing it with the Canada Health and Social Transfer, a pot of money the provinces were handed with far fewer conditions attached. Ontario and B.C. swiftly brought in the old divisions between the worthy and unworthy poor, plus programs such as workfare. The right of Canadians not to be destitute was effectively repealed. It’s striking that this did not extend to the health component of federal funding. There, standards stayed in place and the right to health care stood. The ill as a class were now treated as more fully human, as mirrored by their rights, than the poor — surely due to calculating the votes involved.

This was bad news for the poor. But I’d say it was also bad news for the rest of us. The loss of the right not to be destitute makes the poor less fully human. The non-poor, meanwhile, become more fully human, and they get to show it by lording it over the poor, deciding their fate by giving or withholding welfare. This kind of social breakup is the essence of charity,which was defined in 1825, for instance, as something that exists “to signify the promoting of the happiness of our inferiors.” Welcome to the 19th century. Less human solidarity, more division and strife.

The accumulation of human rights is a social, historical process. It isn’t handed down once and for all. It can move ahead and fall back. If you can find a reason to deny the rights of the destitute, you can do the same for those of the ill. Why not give health care only to those who deserve it, who exercise, don’t smoke etc. It is not inherently illogical. The same for free speech. You can find reasons to withdraw it: terror, moral decay . . . The right to vote? At one time, it went only to those with property or other virtues.

When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040820/COSALU20/TPHealth/

Comment: Whether in the United States or Canada, is it solidarity that is vacillating? Or is it merely due to our all too feeble efforts to involve ourselves in the political process?

Canada’s vacillating solidarity

The Globe and Mail
August 20, 2004
Then they came for health care
By Rick Salutin

It has been a summer of dire warning about eroding health care, leading doomfully toward a health summit in September. This is not new. For a decade, virtually the entire political class and opinion elites have said our health care is not “sustainable,” as if it is a coastline faced by a weather system. The sole public voice (aside from the public) to reject this fatalism has been Roy Romanow. This week, he noted that tax cuts have cost $250-billion in revenue since 1996 while health costs have risen just $108-billion. In other words, the decline in health care is a result of free human choice.

The reason public opinion has resisted elite wisdom about our hopeless health care is not that people adore those “free” doctor visits, but that they have come to see it as a basic right. It may not have begun that way,but it soon took on that air. This sense of health care as a right makes it resistant to fiscal fear-mongering. What would you say if you were told we cannot afford free speech, or democracy, due to current economic conditions? Health care is different and similar. But rights can be lost, as well as gained. To shed light on how that happens, let me take another case: the right to be free of destitution, known disparagingly as welfare.(Welfare is not just about being poor but being destitute. Welfare incomes are often about 15 per cent of average income and miles below the poverty line.)

The sense of welfare as a human right emerged in the 1960s, like health care. It, too, occurred by stealth. Till then, welfare had been akin to charity, bestowed by their betters on the poor, who were seen as partially or wholly responsible for their plight. But during the Depression, the destitute started being seen as victims of market forces largely outside of their control. The token of this change was the 1966 Canada Assistance Plan (CAP), which offered federal funding for welfare as long as the provinces made it universally available, provided a decent living standard and removed distinctions between the worthy and unworthy poor. It was a kind of informal acceptance of the right not to be destitute.

The retraction of this right — one of the “givebacks” of the 1990s — was the work of then-finance minister Paul Martin. His 1995 budget abolished the CAP, replacing it with the Canada Health and Social Transfer, a pot of money the provinces were handed with far fewer conditions attached. Ontario and B.C. swiftly brought in the old divisions between the worthy and unworthy poor, plus programs such as workfare. The right of Canadians not to be destitute was effectively repealed. It’s striking that this did not extend to the health component of federal funding. There, standards stayed in place and the right to health care stood. The ill as a class were now treated as more fully human, as mirrored by their rights, than the poor — surely due to calculating the votes involved.

This was bad news for the poor. But I’d say it was also bad news for the rest of us. The loss of the right not to be destitute makes the poor less fully human. The non-poor, meanwhile, become more fully human, and they get to show it by lording it over the poor, deciding their fate by giving or withholding welfare. This kind of social breakup is the essence of charity,which was defined in 1825, for instance, as something that exists “to signify the promoting of the happiness of our inferiors.” Welcome to the 19th century. Less human solidarity, more division and strife.

The accumulation of human rights is a social, historical process. It isn’t handed down once and for all. It can move ahead and fall back. If you can find a reason to deny the rights of the destitute, you can do the same for those of the ill. Why not give health care only to those who deserve it, who exercise, don’t smoke etc. It is not inherently illogical. The same for free speech. You can find reasons to withdraw it: terror, moral decay . . . The right to vote? At one time, it went only to those with property or other virtues.

When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040820/COSALU20/TPHealth/

Comment: Whether in the United States or Canada, is it solidarity that is vacillating? Or is it merely due to our all too feeble efforts to involve ourselves in the political process?

New Hampshire uses market reform to cover the healthy

New Hampshire uses market reform to cover the healthy

The Union Leader
August 18, 2004
State health insurance ‘reform’ is making matters worse
By Burt Cohen

I know I’m not the only one whose health insurance premium has long since surpassed my mortgage. This is crazy.

But hang on to your seat. Thanks to a bill sponsored by Sen. Russell Prescott, R-Kingston, it’s going to get much worse. Prescott’s infamous Senate Bill 110, with Gov. Craig Benson’s active support, became law despite overwhelming evidence it would do great harm.

The simple premise of SB 110 was that, by allowing market forces free rein,more health insurance companies would be drawn to New Hampshire, and health insurance costs would drop. My goodness, it didn’t turn out that way.The actual results are that insurance will now be cheaper for the young and healthy (who generally don’t even buy health insurance), but more expensive for the old and sick. Premiums are skyrocketing from 25 percent to 75 percent, or more, for small businesses and families across New Hampshire.

It was obvious at the time that SB 110 was about cherry picking. It enables insurance companies to make more money by being more selective in who they underwrite. They can now charge higher rates for small groups according to
geographic region, as well as age or health.

The public good is served when the healthy help pay the costs of caring for the sick. And it’s not like we have a choice in getting sick. While it is certainly fair to have bad drivers pay more for insurance, is it fair to charge the sick more for their unchosen predicament? Yet that’s exactly how SB 110 works.

It’s hard to imagine, but thanks to Sen. Prescott’s bill, today our New Hampshire government is prying deep into private personal information.You must list every health problem, and every medication taken by anyone in your family during the past five years. So here we have it: The state of New Hampshire, through SB 110, is now serving the interests of the health insurance industry against the interests of the citizens.

Yes, we have to do something. More and more health care providers are coming to the conclusion that it’s time to create a national solution,something like an expanded Medicare system.

http://www.theunionleader.com/articles_showfast.html?article=42473

New Hampshire’s Chapter 420-G: Portability, Availability, and Renewability of Health Coverage:
http://www.gencourt.state.nh.us/rsa/html/indexes/420-G.html

Comment: The splitting of insurance coverage into high risk and low risk pools is not some theoretical policy proposal by advocates of “consumer directed” health coverage. It is already here. Health coverage is being made affordable for the larger sector of our population that is relatively healthy. Those with higher health care needs are being shoved into unaffordable high cost pools.

We desperately need to establish one single universal risk pool that spreads the costs equitably. Is this concept really so complex that we should remain frozen in inaction?