PNHP

Recent Articles of Interest

7 Questions to Ask to Protect Yourself From Medicare Advantage Scams

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By Diane Archer
Common Dreams, November 21, 2023

During this Medicare Open Enrollment period, ask yourself these seven questions. And, please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP—State Health Insurance Assistance Program—for free, unbiased advice on any of your Medicare questions.

Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. In traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all doctors and hospitals in the United States with no incentive to stint on your care. In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often second-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care. Regardless of whether you stay in traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.

Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to steer you away from traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare. For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.

Q. Why can’t I rely on my friends or the government’s star-rating system to pick a good Medicare Advantage plan? Unlike traditional Medicare, which gives you easy access to the physicians and hospitals you use from everywhere in the U.S. and allows for continuity of care, you can’t count on a Medicare Advantage plan to cover your care from the healthcare providers listed in their network or to cover the medically necessary care that traditional Medicare covers. Even if your friends say they are happy with their Medicare Advantage plan right now, they are gambling with their healthcare. The government’s five-star rating system does not consider that some Medicare Advantage plans engage in widespread inappropriate delays and denials of care, and other Medicare Advantage plans engage in different bad acts that can endanger your health. So, while you should never sign up for a Medicare Advantage plan with a one, two, or three-star rating, Medicare Advantage plans with four and five-star ratings can have very high denial and delay rates.

Q. If I’m enrolled in a Medicare Advantage plan, can I count on seeing the physicians listed in the network and lower costs? Unfortunately, provider networks in Medicare Advantage plans can change at any time and your out-of-pocket costs can be as high as $8,300 this year for in-network care alone. You can study the MA plan literature, and you can know your total out-of-pocket costs for in-network care. But, you cannot know whether the MA plan will refuse to cover the care you need or delay needed care for an extended period. This year alone, dozens of health systems have canceled their Medicare Advantage contracts, further restricting access to care for their patients in MA, because MA plans make it hard for them to give people needed care.

Q. Doesn’t the government make sure that Medicare Advantage plans deliver the same benefits as traditional Medicare? No. The government cannot protect you from Medicare Advantage bad actors. The insurers offering Medicare Advantage plans can decide you don’t need care when you clearly do, and there’s no one stopping them; they are largely unaccountable for their bad acts. In the last few years there have been multiple government and independent reports on insurance company bad acts in Medicare Advantage plans.

Q. If I join a Medicare Advantage plan, can I disenroll and switch to traditional Medicare? You can switch to traditional Medicare each annual open enrollment period. However, depending upon your situation, where you live, your income, your age, and more, you might not be able to get supplemental coverage to pick up your out-of-pocket costs and protect you from high costs. What’s worse, you could incur thousands of dollars in out-of-pocket costs in Medicare Advantage.

Q. If I have traditional Medicare and Medicaid, what should I do? If you have both Medicare and Medicaid, traditional Medicare covers virtually all your out-of-pocket costs. You will get much easier access to physicians and inpatient services in traditional Medicare than in a Medicare Advantage plan if you need costly healthcare services or have a complex condition.

Again, for free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP.

Diane Archer is president of Just Care USA, an independent digital hub covering health and financial issues facing boomers and their families and promoting policy solutions. Ms. Archer began her career in health advocacy in 1989 as founder and president of the Medicare Rights Center, a national organization dedicated to ensuring that older and disabled Americans get the health care they need.

https://www.commondreams.org…

Medicare Advantage is giving away billions to corporate insurers. It’s time we put a stop to it.

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By Rep. Pramila Jayapal (D-Wash.) and Dr. Diljeet Singh
The Hill, November 17, 2023

Physicians and policymakers are, in different ways, both responsible for the health and well-being of patients. While physicians care for patients to the best of their ability, policymakers ensure that the structures that make up the health care system are effective and equitable. Whenever and wherever there is a threat to these goals, both groups have a role to play in recognizing and combating it. That is why we are speaking out on the need to make fundamental changes to the Medicare Advantage (MA) program.

MA as it exists today is a threat to patient care, to health equity, and indeed to the integrity of our public health infrastructure. A new report from Physicians for a National Health Program, an organization of doctors working to reform the health care system, shows that for-profit, corporate MA insurers are overpaid anywhere from $88 to $140 billion a year. That’s money coming out of patients’ and taxpayers’ pockets.

MA is the privately-run version of the traditional government-administered Medicare program. Instead of paying directly for care, the government instead pays insurers to “manage” patients’ needs. Enrollment in this program has grown significantly over the past two decades, with over 50 percent of eligible beneficiaries opting for an MA plan in 2023. Unfortunately, growth in the program has not led to better care for beneficiaries or a better deal for taxpayers — just the opposite, in fact. Tens of billions of taxpayer dollars are being siphoned off as profit by insurance companies that don’t even provide necessary care. That money doesn’t just cost our government, it costs seniors. For example, premiums paid for Medicare Part B, which covers most medical services outside of hospitalization, totaled $131 billion in 2022. With the amount of extra money that corporate insurers get from the government, we could totally eliminate Part B premiums and still have money left over.

Where is all this money coming from? It’s complicated, the result of a tangled web of loopholes, policies, and practices that are difficult for an individual beneficiary or physician to see. Even so, scholars and regulators have identified a few major factors that lead to overpayments. For example, insurance companies in MA tend to enroll patients that are healthier and therefore cost less than average but still get paid as if their patients were much sicker. This is called favorable selection, and by some estimates, it could cost as much as $75 billion a year in extra payments.

Because Medicare gives additional money to MA insurers for patients with more severe or more numerous diagnoses, another source of overpayments are all the irrelevant or old conditions that insurers record on patient charts. This practice is known as upcoding; these conditions aren’t being actively treated, so they don’t cost the insurance company anything, but they do lead to as much as $20 billion in extra payments. These methods only scratch the surface of all the ways in which MA insurers take advantage of the system, but the bottom line is clear: these companies are pocketing billions of dollars that belong to Medicare beneficiaries.

Of course, it isn’t just about the money; it’s also about patient care. Medicare Advantage plans tout their low premiums and extra benefits, but often these are only worth it as long as you’re healthy. If you get sick and need complex or significant care, plans start to show their true colors. Difficult authorization processes and narrow networks can make getting treated under an MA plan a nightmare. In fact, high-need patients with chronic conditions and patients in their last year of life are substantially more likely to switch out of MA and back to traditional Medicare, tired of having to justify each and every needed procedure or medication to their insurance company.

In our roles as a member of Congress and a practicing physician, we see different but equally concerning manifestations of these problems. Constituents call in with stories of being lured into an MA plan, and then denied care or prevented from seeing their doctor. Cancer patients, for whom an early diagnosis and treatment plan is imperative to survival, face weeks of delay because of onerous pre-authorization requirements. In fact, some of these patients have ended up needing emergency surgery or aggressive radiation that could’ve been avoided if insurers hadn’t gotten in the way. MA doesn’t just take billions in taxpayer dollars; it makes it harder for doctors to do their jobs, and harder for patients to get well.

With the money that we spend on corporate giveaways, we could entirely fund Medicare’s prescription drug benefit, establish an out-of-pocket maximum in traditional Medicare, or even provide dental, hearing, and vision benefits to everyone on Medicare and everyone on Medicaid. This doesn’t need to be a partisan issue. We should all agree that programs paid for by the people should benefit the people. It’s time to crack down on overpayments in MA and use those resources to improve Medicare for all patients.

Pramila Jayapal represents Washington’s 7th District. Dr. Diljeet K. Singh is a women’s health advocate and an integrative gynecologic oncologist in clinical practice since 1999. She currently serves as vice president for Physicians for a National Health Program.

https://thehill.com…

Physicians gather in Atlanta to march for Medicaid expansion, AMC site

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By Donovan J. Thomas
The Atlanta Journal-Constitution, Nov. 12, 2023

A national group of doctors gathered Sunday for a march in downtown Atlanta, pushing for the expansion of Medicaid, while also urging Wellstar Health System to donate the former Atlanta Medical Center site to the city.

Some carried signs with tombstones of closed hospitals in Georgia, and others of the over 100 people in attendance chanted in support for a single-payer health system, while decrying the actions of Georgia state officials and Wellstar Health System as detrimental to the health of Georgians.

The effort was a collaboration between Physicians for a National Health Program, a group of doctors that advocates for Medicare for All, elected officials, community members, patients and advocacy groups such as the New Georgia Project, Georgians for a Healthy Future and Georgia Equality.

Dr. Anwar Osborne, a member of Physicians for a National Health Program and an emergency medicine physician in Atlanta, spoke to concerns around proximity to care for underserved community members. He also talked about the stress being put on Atlanta’s now sole safety-net hospital and Level 1 trauma center, Grady Memorial Hospital.

“We’re here to say that closing this building, regardless of the forces that allowed that to happen, improve nothing here,” he said. “Those of us who are still left in the health care space are just fighting to make it to the next day.”

Organizers cited Georgia’s high rate of uninsured patients and lack of health care access as drivers for the march. Additionally, the closure of hospitals across the state, including two hospitals in Atlanta by Wellstar in 2022, were cited as a cause for alarm for underserved communities with dwindling health care options.

Georgia is one of 10 states to not expand Medicaid, the state-federal program that pays for health care for the poor, people with disabilities and many elderly patients. Because the state did not expand Medicaid, which was part of the Affordable Care Act, billions of federal dollars that are meant to support the state’s health systems are going unused.

Many doctors, other providers and health policy experts believe the lack of expansion leads to worsening health outcomes and will harm the state’s poor residents for years to come.

“We know that the lack of Medicaid expansion and the governor’s attempt to come up with a contrived system is an opportunity for him to eliminate people, just like attempts at eliminating voters,” said Sandra Lee Williams, president of the Atlanta North Georgia Labor Council.

Of Georgia’s 370,000 poorest uninsured adults, less than 2,000 have been enrolled in Georgia Pathways to Coverage, which has work or activity requirements. Many say the program is costing more than expanding Medicaid would and hurting those most in need.

“The fair thing would be for the governor to fully expand Medicaid,” Dom Kelly, co-founder of the New Disabled South, the first regional group focused on disability rights in the country, said. “It’s really beyond time. People are dying.”

Wellstar’s plans for hospitals in affluent suburbs of Cobb and Columbia counties were also called to question.

“They’ve left a lot of our community behind,” said Dr. Mindy Guo, a family medicine physician in Atlanta and co-chair of the Georgia chapter of Physicians for a National Health Program. ” We want them [Wellstar] to start acting like a nonprofit and actually benefiting the community instead of just not paying taxes.”

Demonstrators marched from Martin Luther King Jr. National Park to the former Atlanta Medical Center site in Old Fourth Ward.

Atlanta City Councilmember Liliana Bakhtiari and Georgia State Senator Nan Orrock spoke at the rally, pushing for the health needs of the community, while also condemning the acts of Wellstar and state officials for not expanding Medicaid.

Physicians for a Nation Health Plan demanded a meeting with Governor Brian Kemp to discuss full Medicaid expansion, for the state legislature to sign a bill fully expanding Medicaid in the next session, for Wellstar to donate the Atlanta Medical site to the city of Atlanta and for Atlanta Mayor Andre Dickens to reclaim the land to provide for the unmet health needs of the community.

“This is not done,” Bakhtiari said. ” We have the ability to turn this around.”

https://www.ajc.com…

Recent Members in the news

Dr. Susan Rogers on “Fixing the System”

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This article includes video

PNHP immediate past president Dr. Susan Rogers was interviewed for “Fixing the System,” an examination of single-payer health care that was awarded third prize in the national C-SPAN StudentCam 2023 competition.

“Getting rid of private insurance companies would help a lot,” said Dr. Rogers while explaining the benefits of single payer. “What they’re doing is they’re shifting the cost to patients.”

“Fixing the System” was produced by Eastern Middle School (Silver Spring, Md.) students Adelaide Keller and Linnea Ericson.

Dr. Phil Verhoef on “The Rick Smith Show”

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This article includes video

PNHP president Dr. Phil Verhoef appeared on “The Rick Smith Show” on January 27, 2023. Dr. Verhoef warned viewers about the rapid privatization of Medicare—started in earnest under the Medicare Advantage program and continuing under the recently launched ACO REACH program.

Commercial insurance companies and other for-profit entities are “looking at REACH as an opportunity to make money,” he said. “The only way you make money as an insurance company is by not covering care.”

Dr. Ed Weisbart on “MRCC Medicaid Minute”

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This article includes video

PNHP national board member Dr. Ed Weisbart appeared on the Missouri Rural Crisis Center’s “Medicaid Minute: Medicare Edition” podcast on December 6, 2022. Dr. Weisbart warned seniors about the false promises of Medicare Advantage plans. He added that many of the insurers that are active in Medicare Advantage are lining up to administer Traditional Medicare benefits through the ACO REACH program.

“They make more money the less health care you get,” he said, referring to the financial incentives that are present in both Medicare Advantage and REACH. “That is a radical transformation of Traditional Medicare [and] it’s rolling forward unless we stop it.”

Recent Quote of the Day

John Geyman: The Medical-Industrial Complex…plus exciting changes at qotd

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“America’s Mighty Medical-Industrial Complex: Negative Impacts and Positive Solutions”

By John Geyman

This book has three goals: (1) to bring an historical perspective to how medicine and health care have evolved over the last 100 years, including the transformation of their original ethic of service with a moral purpose and how that ethic has been compromised by corporate greed; (2) to describe where an engulfing medical-industrial complex has brought us in terms of decreasing access to affordable health care, unacceptable quality of care, profiteering and fraud; and (3) to consider whether and how our unsustainable health care system can be brought into line against this deepening crisis in serving the needs of our people.

Copernicus Healthcare: http://www.copernicus-healthcare.org

Amazon: https://www.amazon.com…

Comment:

By Don McCanne, M.D.

Most of us want a health care system that has a mission to maintain and improve our health, yet we have a system that has lost its way in that its mission places a priority on advancing the interests of the medical-industrial complex at the cost of compromising our health care. John Geyman explains how we got there and how detrimental the impact has been. Although the political barriers to reform seem almost insurmountable, he does show us that there is a path to the essential reform that we need to bring health care justice to all. By understanding the source and nature of the dysfunctions, we can find our way out.

Exciting changes at qotd

As some of you may have heard, the interruption in the Quote of the Day messages was due to a TIA/stroke suffered by the author. Fortunately, the recovery has been dramatic, though incomplete. As a result, after two decades of daily commentaries in his retirement years, it is time for a change.

Future messages will be from noted health policy experts within and outside of PNHP. We will be receiving the latest from the best. With this change in format, we will also be changing the name to “Health Justice Monitor.” Launch is planned for next week.

I hope that you are as excited as I am as I become a consumer rather than a producer of the latest in health policy science. The more we understand, the sooner we will have health care justice for all.

Peace,
Don McCanne

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Quote of the Day interlude

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By Don McCanne, M.D.

Quote of the Day will take a brief interlude. We are refining our approach to communicating information to educate and advocate for single payer and health care justice for all.

See you soon.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

More trouble: Drug industry consolidation

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Over 30 years, dramatic consolidation has meant higher prices, fewer treatment options and less incentive to innovate

By Robin Feldman
The Washington Post, April 6, 2021

In the past few decades, three waves of mergers have substantially increased concentration in the pharmaceutical industry.

All told, between 1995 and 2015, the 60 leading pharmaceutical companies merged to only 10.

As a result, now only a handful of manufacturers are responsible for sourcing the vast majority of prescription drugs: Just four companies, for example, produced more than 50 percent of all generic drugs in 2017.

Drug companies were drawn to merging because of the lure of increased market power, improved synergies, larger economies of scale and more diverse product portfolios.

In the period following merger waves one and two, the industry generated fewer new molecular entities each year compared to pre-merger levels. Merged drug companies also spent proportionally less on research than their non-merged competitors.

Consolidation also enabled drugmakers to directly quell competition through what were known as “killer acquisitions,” in which they acquired innovative peers solely to stop potential competition.

In short, consumers were the losers from the two waves of drug company mergers. They confronted higher prices and fewer choices — and saw companies exploring fewer paths that might produce breakthroughs. To make matters worse, around 2010, another wave of mergers began.

As with the earlier waves, giant drug companies have merged. But in a new twist, in recent years, most consolidation has featured bigger players acquiring smaller start-ups. The difference reflects a dramatic shift in the structure of the pharmaceutical industry. Faced with stagnating research productivity, large drugmakers now rely on outsourcing their new drug research to start-ups and other small pharmaceutical firms.

Increasingly, these smaller players specialize in high-risk research and early drug development, with larger firms then gobbling them up and navigating the FDA’s regulatory process. For example, 63 percent of all new molecular entities in 2018 came from smaller biopharma firms, compared with just 31 percent in 2009.

The end result of now three waves of pharmaceutical consolidation is decreased or diverted new drug innovation, fewer treatment options and higher prices. Consumers have lost as firms fuse together to bolster the bottom line.

Robin Feldman is director of the UC Hastings Center for Innovation.

https://www.washingtonpost.com…

Comment:

By Don McCanne, M.D.

Yesterday we discussed consolidation of UnitedHealth/Optum and how it has become a mega-corporation of the medical-industrial complex. Today’s selection discusses consolidation within the pharmaceutical industry. The article describes how we can expect decreased or diverted drug innovation, fewer treatment options, and above all, higher prices. Works for the industry, but not so well for the people.

We’re just trying to introduce single payer Medicare for All. How much impact can that have on these mega-corporations? Where is our government in all of this? Aren’t they supposed to protect us? Maybe we’re aiming too low by advocating for a social insurance program. Maybe we should be taking over the industry so that we can gear it up to better serve us, the people. International comparisons do rate national health services very high in performance. Maybe if we talk about it a little more we can convince them that Medicare for All is a compromise that they can live with. We think we can too.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Recent State Single Payer News

N.Y. Assembly passes universal health care bill

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By Dan Goldberg
Capital New York, May 27, 2015

The state Assembly on Wednesday voted for a single-payer health bill, the first time in more than two decades the chamber has taken up the measure.

The vote was 89-47, an overwhelming but largely symbolic step toward universal health insurance. The bill now heads to the Republican-controlled Senate where it is not expected to pass.

Assemblyman Richard Gottfried, chair of the health committee, gave an impassioned speech on the floor in support of the New York Health Act, arguing that it was long past time for New Yorkers to rid themselves of the intrusive insurance companies whose goal is to deny claims rather than provide care.

“You do not have to be an Einstein to understand New York Health is the right choice for New York,” Gottfried said.

Gottfried, a Democrat from Manhattan, spent the legislative session barnstorming the state, trying to gain support for his bill, which would be funded through a progressive income tax and payroll assessments. There would be a net savings of $45 billion in health spending by 2019, Gottfried said, based on an analysis from Dr. Gerald Friedman, a professor at the University of Massachusetts at Amherst, though that figure was attacked by Republicans.

The bill, Gottfried said, would lower costs by getting rid of insurance companies. It would lower administrative costs and allow doctors to focus their time on treating patients instead of fighting for reimbursements.

“What will bring down health care costs is taking out of the equation the more than 20 percent we now spend on administrators whose job it is to fight with insurance companies,” he said.

The plan’s benefits, Gottfried said, would be more generous than any plan on the current market, and there would be no co-pays or deductibles. The bill would also require a care coordinator for every member, though that coordinator is not empowered to choose the type of care a patient receives.

For some Republicans, it was all too good to be true.

“This bill promises remarkable things for New York State residents,” said Assemblyman Andy Goodell, a Republican from Chautauqua. “It says providers, ‘you’ll be paid a lot more money,’ and it says to the employees ‘you’ll contribute a lot less money,’ and it says to the patients ‘you’ll have much broader access,’ and to the employers ‘you’ll pay $45 billion less.’ My background is in math and economics and I haven’t been able to figure out how this all works. … There is no free lunch, there is no free health care.”

Leslie Moran, spokeswoman for the New York Health Plan Association, which represents insurers, said the bill “represents an unrealistic, utopian view of a universal health care system where everyone would be covered, everything would be covered and the system would magically pay for it all.”

One problem, pointed out by Republicans, is that the offering, while generous, is the opposite of what public health officials are pushing, including those in the Cuomo administration, who have professed that insurance systems, and high deductibles and co-pays help ensure people use the health system judiciously instead of opting for more, often unnecessary, care.

“There is a role for insurance companies,” state health commissioner Dr. Howard Zucker said Wednesday before the debate.

The last time a universal health care bill was on the Assembly floor was 1992. It passed but the debate was sidelined because of federal efforts to reform health care, which ultimately failed under the Clinton administration.

The passing of the Affordable Care Act, which subsidizes private insurance for people below a certain income level, was a valid effort, Gottfried said, but ultimately served to highlight why the system needs to be entirely scrapped.

“I think the A.C.A. has made it clear to people … there are profound problems in our health care system that cannot be addressed by incremental change in that system,” Gottfried said.

Wiping out an industry — even the insurance industry — was not seen as popular by many Republicans who worried about the loss of jobs and what might happen should this plan fail.

Goodell asked why the state should go down this road when when Medicaid — a government run insurance program for lower-income residents — is expensive, burdensome and not well liked.

“Why would we want to expand that type of approach,” he asked.

Gottfried responded that his bill would improve Medicaid by putting everyone into one pot. He would, he said, eliminate the two-tiered system. There’d be no greater risk of fraud under this law than in the current Medicaid program.

Republicans also pointed out how much was left to be done. The income tax rates have yet to be decided, but would likely cost the highest earners more than they currently pay for health insurance, while subsidizing lower income residents.

The analysis provided by Gottfried estimates no income tax on the first $25,000, an income tax of 9 percent on income between $25,0001 and $50,000, graduating to 16 percent tax for income over $200,000.

The legislation is also not specific on how to deal with residents of New York State who retire to another state.

That would have to be resolved at a later date, Gottfried said.

“Though we have numerous pages on this legislation, we have numerous holes also,” said Al Graf, a Republican from Holbrook. “There is no way I can go back to my constituents and tell them you may have coverage in the future. … This is an exercise in insanity.”

Moran said there is no certainty that providers would accept government set reimbursement, though Gottfried said almost all would receive more for their services than they are currently being paid.

The bill also “completely disregards the economic contribution of health plans — both to the state and to local communities,” Moran said.

Joseph Borelli, a Republican from Staten Island, cited Vermont, which tried and failed to enact a single-payer health system.

Vermont’s collapse has been a cautionary tale for even the most enthusiastic supporters of government sponsored health insurance, but Gottfried was having none of it.

“New York … bears no resemblance to Vermont,” Gottfried said. “The bill bears very little resemblance to Vermont. Their financing system is different. The two have absolutely nothing to do with one another, nothing! Why don’t you ask me whether New York will flood Just like Texas flooded if we enact this plan. The weather in Texas has as much to do with this as Vermont does.”

Read the bill here: http://bit.ly/1JVUg1I

http://www.capitalnewyork.com/article/albany/2015/05/8568890/assembly-pa…

N.Y. Assembly votes for universal health coverage

By Michael Virtanen, Associated Press
Democrat & Chronicle (Rochester, N.Y.), May 27, 2015

ALBANY – The New York Assembly voted 89-47 on Wednesday for legislation to establish publicly funded universal health coverage in a so-called single payer system.

All New Yorkers could enroll. Backers said it would extend coverage to the uninsured and reduce rising costs by taking insurance companies and their costs out of the mix.

With no patient premiums, deductibles or co-payments for hospital and doctor visits, testing, drugs or other care, New York Health would pay providers through collectively negotiated rates. It would be funded through a progressive payroll tax paid 80 percent by employers and 20 percent by employees.

Also, waivers would be sought so federal funds now received for New Yorkers in Medicare, Medicaid and Child Health Plus would apply.

“Employers are shifting more and more health care costs to workers or are dropping it entirely,” said Assemblyman Richard Gottfried, chief sponsor. “The only ones who benefit are the insurance companies.”

The Manhattan Democrat estimated universal care would save New Yorkers more than $45 billion annually, cutting the statewide total cost for health care to about $255 billion in 2019.

Assembly Republicans doubted Gottfried’s estimate and questioned what would happen to everyone now employed by insurance companies.

“All I can say right now I think this is the last think New York state needs as far as an additional cost,” said Assemblywoman Jane Corwin, an Erie County Republican. She said they’re still trying to grapple now with the cost of the federal Affordable Care Act. That extended health care coverage to about 1 million New Yorkers, more than half in Medicaid and the others in private insurance with possible tax subsidies to offset costs.

An identical bill hasn’t advanced in the state Senate and isn’t expected to before the legislative session ends in June. Senate Health Committee Chairman Kemp Hannon said Wednesday that Gottfried’s bill faces two major hurdles, resistance from senior citizens to giving up Medicare for a new state program and obtaining federal waivers to apply Medicaid and Medicare funding to support it.

http://www.democratandchronicle.com/story/news/local/2015/05/27/assembly…

Single-Payer Health-Care Bill to be Introduced in Pa.

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Berks Community Television (Reading, Pa.), Oct. 25, 2015

HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.

The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.

“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.

The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.

The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.

“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”

Similar legislation has been introduced in each legislative session since 2007.

Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.

“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”

Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.

http://www.bctv.org/special_reports/health/pa-legislature-introduces-sin…

Single-Payer Health-Care Bill to be Introduced in Pa.

Posted

Berks Community Television (Reading, Pa.), Oct. 25, 2015

HARRISBURG, Pa. – A bill to create a single-payer health-care system in Pennsylvania will be introduced in the state Legislature by the end of the month.

The legislation is being introduced by Representative Pamela DeLissio of Philadelphia and was crafted with the assistance of HealthCare 4 ALL PA, a not-for-profit advocacy group. David Steil, past president of that organization, says the bill is simply called the Pennsylvania Health Care Plan.

“What it does is create a health-care system that includes every resident of Pennsylvania, that is publicly funded and privately delivered,” says Steil.

The cost of the program would be covered by increased taxes, which Steil acknowledges may present a significant obstacle to passage by the state Legislature.

The plan would increase the state personal income tax by an additional three percent, substantially less than most pay for private insurance. It would also add a 10 percent payroll tax on businesses which, as Steil points out, is much less than what businesses spend on health insurance now.

“The average cost for health care benefits for companies that provide health care is about 17 percent of payroll,” he says. “So at 10 percent of payroll, the saving is significant.”

Similar legislation has been introduced in each legislative session since 2007.

Most recently it was introduced as Senate Bill S-400. None of the earlier versions have not gotten very far. Raising taxes is a hard sell, especially to conservative lawmakers. But Steil insists they’re asking the wrong question.

“The question each one has to ask is not just ‘look at the taxes’ because there are taxes to it, it’s not free,” he says. “The question is, ‘How much less than you’re currently paying is this plan to you?'”

Steil says the bill would also eliminate health-insurance costs on pension plans and vehicle insurance, making the potential savings even larger.

http://www.bctv.org/special_reports/health/pa-legislature-introduces-single-payer-health-care-bill/article_a41a6da0-7996-11e5-b8a4-2ba3ba19b536.html