PNHP

Myths about ED use by Medicaid patients

Myths about ED use by Medicaid patients

Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms

By Anna Sommers, Ellyn R. Boukus, Emily Carrier
Center for Studying Health System Change, July 2012
Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people.
Misconceptions
Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.
Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.
http://www.hschange.com/CONTENT/1302/

In an effort to control health care spending we are seeing efforts to punish Medicaid patients for their excessive use of our Emergency Departments (EDs). This reports adds to the policy literature that confirms that this premise is flat out wrong. Just like privately insured patients, most Medicaid patients use EDs for urgent and emergency conditions.
Rather than penalizing patients for attempting to receive urgent care that they should have, we should direct our efforts to incorporating health system design changes that would improve access to urgent care services, both through EDs and through other community resources such as extended-hour practices and urgent care centers. As an example, EDs could use community physicians during peak hours to provide care for less intensive problems that have been sorted out by triage.
With a single payer system we could adjust incentives to encourage more effective and efficient use of our health care delivery system. Under our current fragmented financing system, dominated by private health plans and perpetuated by the Affordable Care Act, rational coordination of care for urgent conditions is not possible because of conflicting interests, financial and otherwise.
We can do a much better job of getting our priorities straight through a single payer national health program.

Administration expands use of exemption from mandate penalty

Letter
July 10, 2012
From: Kathleen Sebelius, Secretary of Health and Human Services
To: State Governors

Excerpt:

As you know, beginning in 2014, the Affordable Care Act provides for the expansion of Medicaid eligibility to those adults under age 65 with incomes up to 133 percent of the federal poverty level who were not previously eligible for Medicaid. The Supreme Court held that, if a state chooses not to participate in this expansion of Medicaid eligibility for low-income adults, the state may not, as a consequence, lose federal funding for its existing Medicaid program. The Court’s decision did not affect other provisions of the law. For example, the decision did not change the fact that the federal government will completely pay for coverage under the eligibility expansion in 2014-2016, and for at least 90 percent of such costs thereafter, or that states have flexibility to design the benefit package for the individuals covered.

Ultimately, I am hopeful that state leaders will take advantage of the opportunity provided to insure their poorest working families with unusually generous federal resources while dramatically reducing the burden of uncompensated care on their hospitals and other health care providers. If any state were to choose not to do so, the Affordable Care Act exempts individuals who Congress determined cannot afford coverage from the individual responsibility provision. As to the very small number of affected individuals who would not quality for the statutory exemption, Congress provided additional authority, which we intend to exercise as appropriate, to establish any hardship exemption that may be needed.

http://capsules.kaiserhealthnews.org/wp-content/uploads/2012/07/Secretary-Sebelius-Letter-to-the-Governors-071012.pdf

Comment: 

By Don McCanne, MD

It is outrageous that some governors are refusing to provide coverage to low-income adults, even though the Affordable Care Act authorizes the federal government to pay most of the costs of this expansion in the Medicaid program. So what is the Obama administration doing to be sure that these individuals become insured?

Many of these low-income adults who are not yet included in the state Medicaid programs are so poor that they will qualify, under ACA, for an exemption from the “individual responsibility provision” – the penalty or “tax” that must be paid for not being insured. Thus they have the explicit right to remain uninsured without being penalized for being so.

Others are still poor, but fall above the threshold for the exemption from the individual responsibility provision. It is for this sector that the administration is taking action. They are making the generous offer to exercise their authority to provide exemptions for these additional individuals from the penalty or tax that would otherwise be assessed for not being covered by an extension of a Medicaid program that the governors refuse to authorize, or for not purchasing a plan in an insurance exchange that they can’t possibly pay for even with the subsides provided (not to mention that most of these very low-income adults were presumed under ACA to be covered by Medicaid, thus the law seems to lack provisions for them to be allowed to receive subsidies for purchase of plans in the exchanges).

Wow. The most needy population is being left out and all the administration can do is to relieve them of the financial penalties they would owe for being uninsured?

To be fair, this is not simply a response of an uncaring president and his administration. They have an irreparably flawed health care financing system with which to work. But the administration should be lambasted for not just cooperating with but also for leading with the planning and implementation of such an unmerciful system.

This system is beyond repair. We need to replace it with a humane, equitable and efficient single payer national health program that would take care of the health care needs of all of us.

Health care reform needs a do-over

By Arnold Relman, M.D.
USA Today, July 10, 2012

The Affordable Care Act narrowly escaped death at the hands of the Supreme Court, but its troubles are far from over. Stability in how Americans will get their health care in the future is now just as much threatened by the ACA’s internal flaws as it is by Republican opposition and fresh lawsuits.

Republican presidential candidate Mitt Romney’s plan to undermine the Obama administration’s health care reform effort if elected is well-known. But even if President Obama is re-elected and Democrats regain control of both houses of Congress, the ACA’s problems will not disappear.

Although, as it is implemented, the law will expand insurance coverage and make the health care system fairer in many other ways, the financial side of the ACA has serious problems that make it unlikely to survive in anything like its present form.

Reforms fall short

It leaves most private health care in the hands of a for-profit insurance industry that takes a huge share of health care money (15 percent -20 percent of private premiums) for its own business expenses and profits, and adds paperwork and billions in additional administrative expenses to hospitals, physicians and patients who must deal with it.

Although it establishes a committee to propose cost-saving legislation to Congress and supports trials of new payment systems designed to control costs, these measures are not guaranteed to work.

The ACA does not replace fee-for-service payment or the commercialized medical care marketplace, both of which raise costs by encouraging unnecessary services and allow opportunity for fraud.

Compounding these problems is the sheer complexity of the legislation, which requires elaborate and expensive regulations. Neither taxpayers nor health care consumers will get the lower costs they have been promised.

A different solution

For this reason, some Democrats, otherwise supportive of the administration, believe that the ACA was misconceived and will inevitably become unworkable. These critics differ from the anti-ACA Republicans in what they propose to substitute for ObamaCare.

Republicans preach consumer choice and price competition as solutions, favoring high-deductible private insurance with health savings accounts, which they believe would give patients financial incentives to shop for lower medical prices and reduce the demand for services. Unfortunately, none of these policies has ever been shown to control costs without reducing access.

Liberals who consider the ACA to be fatally flawed favor replacing private insurance with a publicly funded single-payer system that provides universal access to care. They point to many advanced countries that rely on such systems to provide less costly, but better, service than the United States. Medicare is, of course, an example of a single-payer program for all citizens 65 and older, but its costs are unsustainable because it largely depends on the fee-for-service payment and a commercialized medical care market that other single-payer systems are designed to replace.

The ultimate solution will prove to be medical care provided by non-profit physicians groups that are compensated on a per-capita basis by a single payer. Such reform will be a long time coming because it will require major political realignments. In the meantime, the ACA will help reduce the misery that would otherwise ensue as we slowly and painfully seek a better system.

Dr. Arnold Relman is professor emeritus of medicine and social medicine at Harvard Medical School and former editor in chief of The New England Journal of Medicine.

http://www.usatoday.com/news/opinion/forum/story/2012-07-11/health-care-single-payer/56135206/1

Administration expands use of exemption from mandate penalty

Letter
July 10, 2012
From: Kathleen Sebelius, Secretary of Health and Human Services
To: State Governors
Excerpt:
As you know, beginning in 2014, the Affordable Care Act provides for the expansion of Medicaid eligibility to those adults under age 65 with incomes up to 133 percent of the federal poverty level who were not previously eligible for Medicaid. The Supreme Court held that, if a state chooses not to participate in this expansion of Medicaid eligibility for low-income adults, the state may not, as a consequence, lose federal funding for its existing Medicaid program. The Court’s decision did not affect other provisions of the law. For example, the decision did not change the fact that the federal government will completely pay for coverage under the eligibility expansion in 2014-2016, and for at least 90 percent of such costs thereafter, or that states have flexibility to design the benefit package for the individuals covered.
Ultimately, I am hopeful that state leaders will take advantage of the opportunity provided to insure their poorest working families with unusually generous federal resources while dramatically reducing the burden of uncompensated care on their hospitals and other health care providers. If any state were to choose not to do so, the Affordable Care Act exempts individuals who Congress determined cannot afford coverage from the individual responsibility provision. As to the very small number of affected individuals who would not quality for the statutory exemption, Congress provided additional authority, which we intend to exercise as appropriate, to establish any hardship exemption that may be needed.
http://capsules.kaiserhealthnews.org/wp-content/uploads/2012/07/Secretary-Sebelius-Letter-to-the-Governors-071012.pdf

It is outrageous that some governors are refusing to provide coverage to low-income adults, even though the Affordable Care Act authorizes the federal government to pay most of the costs of this expansion in the Medicaid program. So what is the Obama administration doing to be sure that these individuals become insured?
Many of these low-income adults who are not yet included in the state Medicaid programs are so poor that they will qualify, under ACA, for an exemption from the “individual responsibility provision” – the penalty or “tax” that must be paid for not being insured. Thus they have the explicit right to remain uninsured without being penalized for being so.
Others are still poor, but fall above the threshold for the exemption from the individual responsibility provision. It is for this sector that the administration is taking action. They are making the generous offer to exercise their authority to provide exemptions for these additional individuals from the penalty or tax that would otherwise be assessed for not being covered by an extension of a Medicaid program that the governors refuse to authorize, or for not purchasing a plan in an insurance exchange that they can’t possibly pay for even with the subsides provided (not to mention that most of these very low-income adults were presumed under ACA to be covered by Medicaid, thus the law seems to lack provisions for them to be allowed to receive subsidies for purchase of plans in the exchanges).
Wow. The most needy population is being left out and all the administration can do is to relieve them of the financial penalties they would owe for being uninsured?
To be fair, this is not simply a response of an uncaring president and his administration. They have an irreparably flawed health care financing system with which to work. But the administration should be lambasted for not just cooperating with but also for leading with the planning and implementation of such an unmerciful system.
This system is beyond repair. We need to replace it with a humane, equitable and efficient single payer national health program that would take care of the health care needs of all of us.

Uninsured seasonal firefighters

Seasonal firefighters face many dangers without health insurance; union seeks federal coverage

By Associated Press
The Washington Post, July 9, 2012

They work the front lines of the nation’s most explosive wildfires, navigating treacherous terrain, dense walls of smoke and tall curtains of flame. Yet thousands of the nation’s seasonal firefighters have no health insurance for themselves or their families.

The National Interagency Fire Center in Boise, Idaho, which coordinates firefighting efforts nationwide, says 15,000 wildland firefighters are on the federal payroll this year. Of that number, some 8,000 are classified as temporary seasonal employees, who work on a season-to-season basis with no guarantee of a job the following year and no access to federal benefits.

In two years, the Affordable Care Act, the new federal health care law, will allow seasonal firefighters the same opportunity to buy health insurance as other uninsured Americans.

http://www.washingtonpost.com/national/health-science/seasonal-firefighters-face-many-dangers-without-health-insurance-union-seeks-federal-coverage/2012/07/09/gJQAUMWHZW_story.html

Comment: 

By Don McCanne, MD

Very few would disagree with the principle that firefighters and their families should be covered with health insurance, even if only seasonally employed. The question then is, should that coverage be provided by the government as the employer?

The issue of health insurance coverage faces all seasonal employees. If coverage is provided, would it be only during the period of employment? Would off-season employment in other occupations be the source of intermittent and therefore fragmented coverage? Would being unemployed off-season qualify the family for Medicaid, again with fragmentation of coverage?

Does the ability to purchase coverage through state exchanges, to be established under the Affordable Care Act, provide adequate opportunities for coverage in these populations with fluctuating incomes, with varying eligibilities for coverage or for subsidies? Are the rules that allow exemptions, based on income, from the mandate to purchase coverage an adequate solution, since it means that the family would remain uninsured?

With variations in the type of coverage and especially in the composition of provider networks between various employer-sponsored plans when there may be more than one employer during the year, or with intermittent coverage under Medicaid, or with individual plans purchased through the exchanges, or with dependency on charity or safety-net institutions during periods while uninsured, is this disruption and fragmentation an acceptable standard for coverage for these families? No.

It would be less expensive and more efficient to provide one single coverage throughout life – coverage that provides choice of health care professionals and institutions. Employment status should no longer be a factor in determining health benefits, choices in health care, and even whether or not one is covered at all. An improved Medicare that covered everyone would finally bring an end to our irrational current and ACA-pending methods of financing health care.

Uninsured seasonal firefighters

Seasonal firefighters face many dangers without health insurance; union seeks federal coverage

By Associated Press
The Washington Post, July 9, 2012
They work the front lines of the nation’s most explosive wildfires, navigating treacherous terrain, dense walls of smoke and tall curtains of flame. Yet thousands of the nation’s seasonal firefighters have no health insurance for themselves or their families.
The National Interagency Fire Center in Boise, Idaho, which coordinates firefighting efforts nationwide, says 15,000 wildland firefighters are on the federal payroll this year. Of that number, some 8,000 are classified as temporary seasonal employees, who work on a season-to-season basis with no guarantee of a job the following year and no access to federal benefits.
In two years, the Affordable Care Act, the new federal health care law, will allow seasonal firefighters the same opportunity to buy health insurance as other uninsured Americans.
http://www.washingtonpost.com/national/health-science/seasonal-firefighters-face-many-dangers-without-health-insurance-union-seeks-federal-coverage/2012/07/09/gJQAUMWHZW_story.html

Very few would disagree with the principle that firefighters and their families should be covered with health insurance, even if only seasonally employed. The question then is, should that coverage be provided by the government as the employer?
The issue of health insurance coverage faces all seasonal employees. If coverage is provided, would it be only during the period of employment? Would off-season employment in other occupations be the source of intermittent and therefore fragmented coverage? Would being unemployed off-season qualify the family for Medicaid, again with fragmentation of coverage?
Does the ability to purchase coverage through state exchanges, to be established under the Affordable Care Act, provide adequate opportunities for coverage in these populations with fluctuating incomes, with varying eligibilities for coverage or for subsidies? Are the rules that allow exemptions, based on income, from the mandate to purchase coverage an adequate solution, since it means that the family would remain uninsured?
With variations in the type of coverage and especially in the composition of provider networks between various employer-sponsored plans when there may be more than one employer during the year, or with intermittent coverage under Medicaid, or with individual plans purchased through the exchanges, or with dependency on charity or safety-net institutions during periods while uninsured, is this disruption and fragmentation an acceptable standard for coverage for these families? No.
It would be less expensive and more efficient to provide one single coverage throughout life – coverage that provides choice of health care professionals and institutions. Employment status should no longer be a factor in determining health benefits, choices in health care, and even whether or not one is covered at all. An improved Medicare that covered everyone would finally bring an end to our irrational current and ACA-pending methods of financing health care.

Health care: What now?

By Jack Bernard
Columbus (Ga.) Ledger-Enquirer, July 6, 2012

Times are hard. Major changes are needed, politically, economically and socially. Statistics show that the U.S. spends much more than other nations and that our mortality and morbidity outcomes are not as good, as anyone who has studied the problem knows. In this vein, more Americans are coming to see the benefits of reforming our health care “non-system.”

Public-spirited Americans have been trying to do this for the past 75 years but have been thwarted by special interests. According to Dr. Robert McElvaine of Milsap College in Mississippi, a 1937 national survey indicated 79 percent of the American public favored the federal government providing free medical care for those unable to pay. The insurance, physician, pharmaceutical and hospital lobbies, which still exist today, were simply too strong for FDR to overcome.

Since then, initiatives have been put forth by several other administrations to establish national health care insurance. The only real legislative successes were Medicaid and Medicare under Johnson and SCHIP for children under Clinton (whose broader reform effort was sunk by the insurance industry and self-interested others).

So you have to hand it to Obama politically for getting the Affordable Care Act passed. But is the ACA the right prescription for the country? Not in my opinion.

The ACA is based on Romneycare, which has increased access but done nothing to restrain cost escalation. Massachusetts has had a dramatic rise in health care expenses since Romneycare’s enactment, something that will occur nationally under the ACA. Insurance companies are still in charge and will make record profits, more so than ever before.

We have a much better solution to the worsening health care access crisis: Expand Medicare to cover all. Polls show that most Americans support Medicare. Why? Because Medicare works. When combined with supplemental private policies, it currently provides a base level of coverage for those over 65, plus more coverage as desired. Why not simply expand it to cover people under 65?

Private providers will continue to deliver health care and physician relationships will be preserved, as they are for Medicare recipients right now. Expanding Medicare is not “socialism” — the outlandish charge made by fanatics when a single-payer system is discussed — any more than the government operating Veterans Administration hospitals is communism. And do you know of any patriotic older Americans who are so unhappy with their “socialistic” Medicare that they want to give it up?

Medicare administrative costs (3 percent) are much lower than the private insurance sector, which spends about one-third of our premium dollars on marketing-related costs. Cost savings will be achieved. Further, if current Medicare efforts regarding determining best medical practices are expanded under a single-payer system, more cost savings can be obtained. This will largely offset any increased systemic costs.

Yes, there will be cost-shifting from businesses to government. This will make our industries more competitive with foreign manufacturing, which does not pay health benefits to its employees. That’s a real stimulus for American car manufacturers and other who export.

And there will be cost shifting from state and local governments, which are now picking up part of the tab for indigents and their employees, to the federal government where it belongs. This may not solve the state budget crisis, but it sure won’t hurt.

As someone who has made his living as an executive in the for-profit health care system, I understand well the dirty little secret of why many health-care-related businesses, professionals and organizations are opposed to expansion of Medicare: It may lower their earnings. For this reason, the extent of lobbying by these groups cannot be underestimated. However, health care providers and political figures must do the right thing to regain the confidence of the public. And that is Medicare coverage for all.

Jack Bernard, a Jasper County commissioner and former chairman of the Jasper County Republican Party, is now a private consultant for small business.

http://www.ledger-enquirer.com/2012/07/06/2112265/health-care-what-now.html

The ACA and a Single-Payer System

By J. David Gaines, M.D.
The Wall Street Journal, Letters, July 9, 2012

Regarding Daniel Henninger’s “The President That Time Forgot” (Wonder Land, June 28): Although the Supreme Court has upheld the Affordable Care Act, the unfortunate reality is that the law, despite its modest benefits, is not a remedy for our health-care crisis. It will not achieve universal coverage, as it leaves at least 26 million individuals uninsured. It will not make health care affordable to Americans with insurance because of high co-pays and gaps in coverage that leave patients vulnerable to financial ruin in the event of serious illness, and it will not control costs.

The reason for this is that the ACA perpetuates a dominant role for the private-insurance industry. Each year, that industry siphons off hundreds of billions of health-care dollars for overhead, profit and the paperwork it demands from doctors and hospitals. It denies care in order to increase insurers’ bottom line, and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved Medicare-for-all system would provide truly universal, comprehensive coverage, health security for our patients and their families, and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration and reins in costs for medications and other supplies through its bargaining clout.

The government need not run the program, only finance it. In the state of Connecticut, where I practiced general medicine for over 35 years, Medicare was administered by a private insurance company at an overhead of only 3%, compared to HMOs’ 20%. Unlike with HMOs, I was paid promptly and rarely questioned about my selection of diagnostic tests or treatments. My patients were satisfied with this type of care, and they never needed a referral to whatever specialist I thought was best to treat their conditions.

J. David Gaines, M.D., resides in New Haven, Conn.

http://online.wsj.com/public/page/letters.html

Presbyterian Church takes step toward divestment from for-profit health insurers

By Johanna W.H.van Wijk-Bos
Healthcare not Wealthcare, July 7, 2012

[PNHP note: Johanna W.H.van Wijk-Bos’ advocacy statement for the Assembly’s action is appended below.]

Today the Presbyterian Church (USA) took a step toward divestment from for-profit health insurance companies in the United States by instructing the appropriate committee of the General Assembly to begin a process of information gathering. The Mission Through Responsible Investing Committee (MRTI) is instructed by the General Assembly of the Presbyterian Church (USA) to request information and explanations of health insurance companies.

This information will focus especially on the insurers’ practices in regard to state and federal lobbying expenditures and political campaign contributions, government subsidies and profit margins, denials of claims, and top executives’ compensation packages. Other directives include a conversation with the Board of Pensions, the overseeing body that works with the health care provider, to ensure that the church’s health plan submits to the same standards that it asks of other insurers. Based on its analysis MRTI will evaluate the variance between church principles of universal access and affordability on the one hand and corporate objectives on the other. It will also assess the likelihood of significant change in corporate behavior.

In addition, the committee is to recommend measures to the appropriate Council of the church, including possible divestment from the health insurance companies, measures that will strengthen the integrity of the church’s practice. The relevant committees and councils are requested to report on their action to the General Assemblies of 2014 and 2016, with an eye to guiding individual Presbyterians, congregations and mid-councils, in relation to their own investment holdings in this major part of the economy.

Finally, all official bodies are encouraged to continue to support cost-effective health coverage for all through the single payer (or expanded Medicare) model common elsewhere in the developed world, and to support making health care affordable and transparent.

The overture for this step originated with the Mid-Kentucky Presbytery, was joined by the Presbyteries of Albany, New York City, Long Island and West Jersey, and was approved overwhelmingly by the Committee on Health Issues of the General Assembly on July 3, 2012.

Johanna W.H.van Wijk-Bos is Dora Pierce Professor of Bible – Louisville Presbyterian Seminary and Minister member of Mid-Kentucky Presbytery. She can be reached at jovanwijk@gmail.com.

21-01On Instructing MRTI to Study and Report Corporate Practices of Health Insurance Companies and Possible Divestment of Same—From the Presbytery of Mid-Kentucky.
Source:Presbytery Sponsor: Mid-Kentucky Presbytery
https://www.pc-biz.org/IOBView.aspx?m=ro&id=3735

ASSEMBLY ACTION
On this Item, the General Assembly, acted as follows:
Approve as Amended

Voice Vote
Final Text:
In response to Item 21-01, that the 220th General Assembly (2012) approve the following alternate recommendation:

“1. The MRTI Committee is instructed to request information and explanations of health insurance company policy and practice on: state and federal lobbying expenditures and political/campaign contributions, government subsidies and profit margins related to provisions of the healthcare ‘reform’ legislation, aggregate data on increases in premiums and deductibles over the past ten years, categories and percentages of claims denied, and percentages of profits used in compensating top executives in comparison with return to shareholders.

“2. The MRTI Committee is instructed to be in conversation with the PC(USA) Board of Pensions to ensure the PC(USA) health plan submits to the same standards that PC(USA), through MRTI, asks of other insurers.

“3. Based on this corporate engagement and analysis, a summary of which shall be posted, MRTI is asked to evaluate the variance between church principles of universal access and affordability and corporate objectives, to assess the likelihood of significant change in corporate behavior, and to recommend to the GAMC and General Assembly measures, including possible divestment, that would strengthen the integrity of the church’s practice.

“4. The GAMC, the Presbyterian Foundation, and the Board of Pensions, in turn, are requested to report on their actions (or request guidance) to the 221st and 222nd General Assembly (2014) and (2016), with an eye to guiding individual Presbyterians, congregations, and mid councils in relation to their own investment holdings in this major part of the economy.

“5. The Office of Public Witness and other Presbyterian bodies are encouraged to continue to support cost-effective health coverage for all through the single payer (or expanded Medicare) model common elsewhere in the developed world, and, to support making health care affordable and transparent.”
http://pc-biz.org/Explorer.aspx?id=3735

http://healthcarenotwealthcare.us/2012/07/07/presbyterian-church-usa-takes-step-toward-divestment-from-for-profit-health-insurance-companies/

Advocacy Statement

By Johanna W.H.van Wijk-Bos

Presented by Johanna W.H.van Wijk-Bos, Overture Advocate on overture 21-01 from Mid-Kentucky Presbytery, before the Health Issues Committee of the 220th General Assembly of the Presbyterian Church (USA), July 3, 2012, Pittsburgh, Pa., David Lawrence Convention Center.

Thank you, Madam Moderator, for providing this opportunity to speak to the overture before us and advocate its passing. My name is Johanna Bos, Teaching Elder member of the Mid-Kentucky Presbytery, the Presbytery that elected me to be the Overture Advocate during its meeting on September 17, 2011.

You are familiar with the overture, for which the background is the 2008 endorsement of Single Payer health care reform by the General Assembly.

Clearly, I am for it, I would not be here otherwise, so in preparing for the meeting today, I thought about what would be the best advocacy. I could recite a great deal of facts, huge profits on the part of the health insurance companies, escalating premiums, declining access, the lamentable state of actual health care in the United States, the maternal death rate rising by 25 percent in the last 10 years while globally maternal death rates are declining, infant mortality rates and so on, racial and gender disparity … the list goes on and on.

There is an overview here on the resource table for your interest and much of it is described in the rationale and background materials of the overture. I lift out only the last sentence of the document: “The only way for the health insurance companies to make a profit for their shareholders is to find ways not to pay for the care of the sick. This is the basic flaw in for-profit health insurance. … They add no social value to justify their profits and the negative effects they inflict on the entire medical system.”

So there are lists and statistics that clearly go against the mandates of our faith and institutions. Then I thought about the Bible, I am a teacher of Bible after all, and how the Bible often teaches through story. Jesus went around as a healer and teacher and taught through stories, stories that people recognized and identified with, stories in which they recognized themselves.

Long before the time of Jesus, when King David had gone off the rails, God sent the prophet Nathan who told the king a story. The story Nathan tells is not one of adultery, or rape or even directly murder, but it is about theft and misuse of privilege by a rich man, a great
benefactor for a guest who comes to visit and who does not ask where the gift he receives came from.

So then I thought the best thing I could do is to tell my story, because it may help us forward. Not that I think of myself as a prophet but I do believe the overture asks our denomination to take on a prophetic task.

The overture that you have before you was written by my husband, whose name was also David, who believed strongly in a Church that calls society and government to its responsibilities of caring for the weakest among us first of all. He would have stood before you today, had his sudden and unexpected death in February of last year not robbed us of his presence.

As he lay in the hospital, struggling with the oxygen mask provided to give his lungs the air they needed, he spoke haltingly what would be his last words on this earth: “How much will this cost?” He died six days later.

Three weeks after his death a representative from our health insurance company informed me in a telephone call that they rejected the claim to pay for my husband’s hospitalization and medical costs because of a “pre-existing condition.”

How much will it cost? The existing problems are clear, our mandate is clear, so how much will it cost our denomination to continue on the path we have started on? It will cost us only the courage to stand up and investigate where the money lavishly earned at times and lavishly spread around, also to us as a denomination, where this money is coming from, and how it is gained.

I can think of few issues going to the core of who we are as a Christian community that are of greater importance. We have the opportunity to let our light shine before the world. Let us take this chance.

Madam Moderator, Madam Vice-Moderator, members and facilitators of the committee, I thank you for your attention and cede the rest of my time to my co-advocate, Bebb Stone from Albany Presbytery.

Private insurers have more administrative services to sell us

How to split the health care dollar (America’s Health Insurance Plans meeting)

By Emily Berry
American Medical News, July 9, 2012

Payers are well aware that physicians and hospitals need the kind of business expertise that insurers have held almost exclusively until now: how to track claims, coordinate care, administer case management and deploy a new records system.

Health insurers are offering physicians and health systems access to that expertise — for a price. UnitedHealth Group’s enormously profitable Optum subsidiary is one example of that business angle. Indeed, Dr. Safavi said, some hospitals and doctors may be in a position of paying Optum for consulting and information technology expertise so they can be prepared for the demands that United and other insurers will make under new payment models. They will have to pay United before they can get paid by United.

http://www.ama-assn.org/amednews/2012/07/09/bisa0709.htm

Comment: 

By Don McCanne, MD

What did you expect? As long as private insurers are left in charge, as they are under the Affordable Care Act, they will always figure out a way to work the system to benefit themselves. We really do need to replace them with a single payer system.

Local physician has mixed feelings on Supreme Court ruling

By George Prentice
Boise Weekly (Idaho), June 28, 2012

In a landmark ruling still being scrutinized by analysts, the U.S. Supreme Court handed down its ruling on the Affordable Care Act this morning, largely letting it stand. According to The New York Times, ” the decision was a striking victory for President Barack Obama and Congressional Democrats.”

The majority of the court, including its Chief Justice John Roberts, affirmed “the central legislative pillar of Obama’s term,” according to the Times. The high court upheld the ACA’s individual mandate in a 5-4 decision, conceding that the mandate was a tax despite the Obama administration’s reluctance to describe it that way during the bill’s passage in 2010.

However, the Supreme Court did restrict one major portion of the law: an expansion of Medicaid. The ruling now allows states the flexibility not to expand their Mediciad programs, without paying the same financial penalties that the law initially called for.

“I’m disappointed with that,” Dr. Greg Thompson, a Boise physician told Citydesk this morning.”That expansion would have help to insure 16 to 17 million more Americans. Unfortunately, by 2019, we may still have as many as 42 million Americans still uninsured.”

Thompson said he knows quite a bit about the uninsured. As a physician in the St. Luke’s Healthcare System, he estimated that more than 80 percent of his patients accessed Medicaid or Medicare. Thompson said he treats everyone from “presidents of corporations to the homeless.”

Idaho joined 25 other states in suing the federal government over the law, arguing that the individual mandate, which requires people to buy health insurance or face a fine starting in 2014, was unconstitutional. But the high court’s majority maintained that the mandate was indeed constitutional.

“I must say that I am still happy about a number of elements of the Affordable Care Act that will still be intact, starting with wellness exams,” said Thompson. “The ACA pays for wellness exams for our Medicare population and that is huge. Plus, we’ll still be allowing young adults, up to the age of 26, to remain on their parents’ insurance, and also the court upheld the rule that keeps insurance carriers from rejecting coverage on pre-existing conditions.”

Thompson said insurance carriers remain the big winners.

“Administration and profit among insurance companies still totals $350 billion. If you think of it, that would pay for insurance coverage for everyone,” he said.

Thompson, co-chair of Idaho Health Care For All, the local chapter of Physicians for a National Health Program, will be sponsoring a ripped-from-the-headlines event on the evening of Wednesday, July 18, when Dr. Jim Girvan, professor emeritus at Boise State, will address today’s SCOTUS ruling. The event is scheduled for 7 p.m. at Boise’s Main Public Library.

http://www.boiseweekly.com/CityDesk/archives/2012/06/28/supreme-court-upholds-most-health-care-reforms-local-physician-has-mixed-feelings

After court ruling, single-payer advocates vow to continue fight

By Scott Harris
Between the Lines, July 4, 2012

Interview with Dr. Steffie Woolhandler, professor of public health at City University of New York, co-founder of Physicians for a National Health Program, conducted by Scott Harris.

In a long-awaited decision from the Supreme Court, the justices handed down a 5-4 ruling on June 28 that upheld the constitutionality of President Obama’s Affordable Care Act, which mandates that all citizens who are financially able purchase private health insurance, or be subject to a tax or penalty. Conservative Chief Justice John Roberts surprised many by siding with the court’s liberal members, providing a majority opinion that will allow the health care reform legislation to be implemented as planned by 2014. However, in writing the court’s opinion, Roberts explained that he upheld the legislation’s individual mandate as a tax, not as a valid exercise of Congress’ commerce clause power.

The court’s decision trimmed back the power of the federal government to impose the Affordable Care Act’s goal of expanding Medicaid eligibility in the states. By a 7-2 vote, the justices prohibited Washington from withdrawing all Medicaid funds to states that refuse to participate in the expansion.

Despite the court’s ruling, public opinion polls find that the nation remains largely split on their support or opposition to the health care reform law. However, the reasons many oppose the bill vary widely. Advocates for a single-payer universal health care system that exists in most other industrialized nations of the world, are critical of the Affordable Care Act for its severe limitations. They point out that once fully implemented, some 26 million Americans will not be covered under the law, and that the measure won’t do much to effectively contain sharply rising health care costs. Between The Lines’ Scott Harris spoke with Dr. Steffie Woolhandler, professor of public health at the City University of New York and co-founder of the group Physicians for a National Health Program. Here, she assesses the Supreme Court ruling on the Affordable Care Act, and the way forward for advocates of a single-payer health care system.

DR. STEFFIE WOOLHANDLER: You know it’s a good thing that the Supreme Court decided to obey the Constitution rather than play politics. I think them playing politics and overturning the law on really bogus grounds would’ve been a very bad thing. The law has some modest benefits, but they are modest indeed, and there are also some very big downsides to the ObamaCare law.

One of the biggest downsides is that when it’s fully implemented, the law will leave 26 million Americans completely uninsured. We know from some prior work we’ve done that when you have 26 million Americans you can expect to have about 26,000 deaths annually caused by lack of health insurance. So, 26 million uninsured Americans is simply unacceptable to me as a physician. And it means that we need to be moving forward to that single-payer, expanded, improved Medicare for all that you were talking about earlier.

BETWEEN THE LINES: Dr. Woolhandler, from your perspective of being an advocate of single-payer, is having the Affordable Care Act in place after the Supreme Court ruling a better place, a better starting point for universal coverage than if the law was struck down by the Supreme Court or repealed in the near future?

DR. STEFFIE WOOLHANDLER: Well, it’s hard to say. At this point, the Obamacare is the law of the land. I doubt it’s going repealed, so I think that’s the base we’re starting from. So, the slogan we’re using is “Forward to Single-payer.” Whether you think Obamacare was a slight step forward, a step backward, a step to the side, is somewhat irrelevant now because this is what we have, and it’s clear that it’s not a solution. That we’re still going to have 26 million uninsured people, that we’re still going to have tens of millions more middle-class people who buy health insurance in good faith only to find that when they get serious illness and their insurance fails them. There’s too many gaps like co-payments, deductibles and uncovered services so that despite having health insurance, they still can’t afford the care. And the health care costs are still going to go through the roof. And, all of those things are going to push us to a new round of reform.

I don’t expect to hear much about that until 2014, when the law goes into effect and people get a chance to look at what it is and say, “Wow, this is in effect? It’s fully implemented and there’s nothing here for my family and there’s nothing for me. My health care’s still too (un)affordable and I can’t get the health care I need and deserve. So we do expect the debate to re-open after full implementation in 2014. Until then, I think a lot of folks will continue to be very confused about what’s in the bill and what isn’t. Some of that confusion is by this crazy talk that the Republicans have been doing. But some of the confusion actually is done by people who support President Obama and feel that they can’t say a word that’s bad about anything he’s doing. I certainly hope Obama beats Romney in the next election, but I don’t think it’s reasonable for people to keep their mouths shut and not tell the truth about the problems in some of these laws that Obama passed.

BETWEEN THE LINES: The political reality in the estimation of many observers is that the giant insurance and pharmaceutical companies call the shots in Washington. The question really is, “How can their power and money be defeated and allow a single-payer or Medicare-for-all system to go forward? What’s the focus of your work going to be in the coming months and years?

DR. STEFFIE WOOLHANDLER: We think we need to build a movement. The way we got civil rights in this country was not a bunch of politicians talking about it, but building a movement to win civil rights. The way we ended the Vietnam War in this country wasn’t persuading politicians; it was a political movement. And the American people are really suffering under the current health care system. They may like the doctors in hospitals, but they’re tormented by the payments, knowing that when they get sick they could be bankrupted, that if they somehow manage to get care, they’re ruining their grandkids’ future by spending all the family assets. So people really suffer under the current health care system and I think it’s really not possible, but probable that we’ll be able to build a movement of the American people to demand a single-payer movement. I’m very unhappy with corporate power in Washington, but we’re not giving up on democracy. We still think we can make democracy work if people get involved.

http://www.btlonline.org/2012/seg/120713af-btl-woolhandler.html