PNHP national board member Dr. Adam Gaffney appeared on “The Real News” on September 11, 2017 to preview Sen. Bernie Sanders’ Medicare for All Act. He discussed the growing movement for single-payer reform, as evidenced by citizen demands and by the number of legislators backing bills in both the House and the Senate.
By John Bowden
The Hill, September 9, 2017
Massachusetts Sen. Elizabeth Warren (D) dismissed conflict inside the Democratic Party on Friday in a new interview, noting that Democrats are rallying around health care and other issues.
Warren told the editorial board of The Republican on Friday that the Democratic Party has found agreement on the idea that health care should be a guaranteed right for all citizens.
She added that the true strength of the Democratic Party doesn’t come from the party elites, but rather the grassroots activists who shifted the party left on health care.
“We don’t live in a world where a handful of insiders get to run the Democratic Party ā we just don’t live in that world,” Warren insisted. “We live in a world where the heart and soul of the Democratic Party is down at the grassroots ā this health care fight has shown the power of the grassroots.
“It’s not only that people have shown it to themselves and to each other, they’ve shown it to the leadership, as well,” she added.
Warren on Thursday announced she would join Sens. Kamala Harris (D-Calif.) and Sheldon Whitehouse (D-R.I.) in co-sponsoring legislation from Sen. Bernie Sanders (I-Vt) establishing a single-payer Medicare-for-all health care system.
“I believe itās time to take a step back and ask: what is the best way to deliver high quality, low-cost health care to all Americans?” Warren said in a statement Thursday.
“Everything should be on the table ā and thatās why Iām co-sponsoring Bernie Sandersā Medicare for All bill that will be introduced later this month.”
By Don McCanne, M.D.
For our purposes, Sen. Elizabeth Warrenās message is not what is happening within the Democratic Party but rather that the recent surge in support for single-payer Medicare for all has originated within the grassroots and not from the political elites.
Yes, the lead taken by Sen. Bernie Sanders certainly has helped to spark the movement. But it is not Bernie Sanders alone who is bringing other politicians on board. When those politicians went to their home districts, it was the demand of the people that woke them up. āHey, this single payer movement is the real thing.ā
The people lead, politicians follow, and that is not a phenomenon limited to the Democratic Party. So gather the grassroots together and lead. Be there, bring others, and do it.
Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.
By Sunny Aslam, M.D.
Syracuse (N.Y.) Post-Standard, September 8, 2017
To the Editor:
Dr. Dennis Nave writes a vital prescription in “Working Americans need affordable health care, quality education,” (Sept. 1, 2017). Those who build our economy should have what all other developed countries have: universal, guaranteed healthcare. We simply need the political will to get there.
Not only workers benefit from universal healthcare; businesses do. The New York Health Act — one state Senate sponsor away from a majority — would save employers billions by providing a simplified plan that covers all medically necessary care. Imagine your business model if all of your employees and customers have health coverage! State Sens. John DeFrancisco, Patty Ritchie and Pam Helming could tip the balance by sponsoring the New York Health Act.
Medicare-for-all (HR 676) in the U.S. House of Representatives has 117 co-sponsors. We need Republicans like Rep. John Katko, who voted against the American Health Care Act and supports Medicare, to sign on to expanded Medicare-for-all.
Let’s build a grassroots movement to fight the special interests that drain profit and burden the system with huge administrative costs. It will be hard work, but it can be done.
I recently spent hours navigating our wasteful healthcare morass: filling out paperwork for denied medications, trying to get people without insurance the care they need. I would love to see the day when we don’t have to ask patients what type of insurance they have because they are all covered. Please join the fight to help us all.
Dr. Sunny Aslam is a member of Physicians for a National Health Program.
http://www.syracuse.com…
By Gail Schontzler
Bozeman Daily Chronicle, September 8, 2017
Itās time for America to consider seriously a single-payer, government-run health system, says Max Baucus, Montanaās longest serving U.S. senator, former ambassador to China and one of the chief architects of Obamacare.
āMy personal view is weāve got to start looking at single-payer,ā Baucus said Thursday night at Montana State University. āI think we should have hearingsā¦. Weāre getting there. Itās going to happen.ā
It was a startling turnaround for Baucus, who eight years ago was chairman of the powerful Senate Finance Committee and a key Democratic leader in the political battles that ultimately passed the Affordable Care Act.
Back then, Baucus said, he felt adamantly that Congress wouldnāt pass a government-run system like Canadaās. So it was the one alternative he refused to put āon the tableā for consideration.
But you can see the difference, Baucus said, when you visit hospitals on either side of the border. In Montana, half a rural hospital will be dedicated to processing medical insurance claims. In Canada, he said, just one small room is needed to verify that patients are residents.
And Americans pay much higher drug prices, he said, because the government canāt negotiate better prices with the drug industry, so U.S. patients end up subsidizing drug prices for the rest of the world.
http://www.bozemandailychronicle.com…
C-SPAN: The Baucus 8:
https://www.youtube.com…
***
By Don McCanne, M.D.
When Max Baucus was leading the legislative process that resulted in the Affordable Care Act, he refused to allow any formal consideration of single payer. In response, a group of notable single payer advocates – the Baucus 8 – protested at the Senate Finance Committee hearing that theoretically represented all views – except single payer, which was specifically excluded. The Baucus 8 got their message out, and Max Baucus got his capitol police to escort them out, one at a time.
The Baucus 8 did not give up. They have continued in their advocacy work for single payer reform, as have we all. As an example, one of them, Dr. Carol Paris, is now president of PNHP. Eight years later, Max Baucus now says that it is time to seriously consider a single-payer, government-run health system. āItās going to happen,ā he says.
It is tempting to celebrate this as a victory for the Baucus 8 over Max Baucus, but actually it is more than that. It is a bittersweet victory for all of us, including Max Baucus. It is tragic that that so many have continued to face unnecessary financial hardship, physical suffering and even death over the past eight years.
But the victory is that the message got through. Single payer is now inevitable. Although we have many to thank for that, at this moment of Max Baucusā epiphany, we such give special thanks to the Baucus 8.
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By Paul Y. Song, M.D.
Huffington Post, September 7, 2017
Last week, Senator Kamala Harris boldly announced that she would co-sponsor Senator Bernie Sandersā upcoming Medicare-for-all legislation and Senator Elizabeth Warren just agreed to do so as well. As the dust settles after yet another failed GOP attempt to repeal the Affordable Care Act (ACA), it is vitally important for everyone to understand why simply preserving the ACA is not good enough.
By now, many of us are aware that despite spending twice as much per capita on healthcare as any industrialized nation, we still have a healthcare system where 29 million Americans are uninsured, tens of thousands of people die each year simply because they lack coverage, and medical illness remains the top cause of bankruptcy.
Even more shocking however, is the 30+ million insured Americans who continue to have such high out-of-pocket costs and deductibles relative to their incomes that they are considered underinsured. Due to this dynamic, one out of three people with insurance will delay seeking care, leading to more advanced disease and poorer outcomes.
Because the ACA was largely written by the private insurance and pharmaceutical industries, it did not regulate insurance rates or address skyrocketing/unaffordable drug prices. As a result, a 2017 Kaiser Family Foundation study revealed that 37% of insured Americans reported difficulty paying their monthly premiums, up from 27% two years ago. For 2018, individuals who purchase coverage without subsidies are expected to get walloped once again with double digit increases in their premiums. And according to a recent study by Prescription Justice, 45 millions Americans did not fill their prescriptions last year because they could not afford to.
Staggering healthcare obligations are also having a negative impact on US business competitiveness. Prior to the bailout, General Motors spent more on healthcare than it did on steel to make cars. Each year, escalating premiums consume more and more of company budgets that could otherwise be used for capital improvements, R&D, and higher wages. With no end in sight, large employers report that health plans will cost more than $14,000 per employee in 2018. And a recent Kaiser Family Foundation study found that companies are shifting more and more of these costs to their employees. Despite stagnant wages, workersā contributions towards their employer sponsored health insurance premiums rose 83 percent from 2005 to 2015, and the amount employees had to pay for deductibles increased 255 percent from 2006 to 2015. All of this leads to far less take home pay and disposable income. Money that could otherwise be used to help families and our economy is instead going into the pockets of insurance and pharmaceutical executives.
And while the Medicaid expansion was transformative in increasing coverage to many of our poorest disadvantaged communities, very low reimbursements have hindered the ability of these patients to find providers willing to treat them in a timely fashion. This lack of access has had a detrimental effect as many curable diseases are often caught too late.
Meanwhile, despite contributing over $12 billion in taxes each year, undocumented immigrants have been mostly excluded from all federal health programs, leading to more uncompensated care. Hospitals have then used this as an excuse to grossly inflate basic costs of good and services leading to higher liabilities that are passed onto all of us one way or another.
In 1972, the late Shirely Chisholm wrote:
āWe have never seen health as a right. It has been conceived as a privilege, available to only those who could afford it. This is the real reason the American healthcare system is in such a scandalous state.ā
Sadly, these words continue to ring true over four decades later, but the time is now to finally fix our broken and immoral healthcare system.
Instead of making drastic inhumane cuts or throwing good money after bad with incremental changes that maintain a broken status quo, we must demand bold action to establish a Medicare-for-all program where we no longer treat healthcare as a commodity.
It is the only comprehensive solution that can adequately address all of the significant issues listed above by removing the gross inefficiencies of a bloated fragmented system while controlling costs of premiums, pharmaceuticals, medical procedures, and medical devices through bulk purchasing and fair cost controls. At the same time, it will strengthen and enhance the current Medicare system by greatly expanding the risk pool with younger and healthier individuals.
Establishing Medicare-for-all is no doubt a daunting and complicated task, but not an impossible one. Every other industrialized country in the world covers all of their people at a much lower cost with better health outcomes.
We can too, but it will take serious time, effort, and commitment coupled with real political will.
Representative John Conyers has introduced H.R. 676 for the past 14 years, but for the first time has 118 sponsors. Along with Senator Sandersā much anticipated Medicare-for-all bill, this will put forward a solid framework from which we can begin to finally have a serious discussion and earnest attempt to bring about the the type of healthcare system we truly deserve, but are just not getting.
Critics will say that we cannot afford this right now. They will point to an earlier Urban Institute study estimating the cost of such a plan at $32 trillion over 10 years. The reality is that we already spent $3.4 trillion on healthcare in 2016, and this is projected to increase an average of 5.6% per year per decade and cost $49 trillion over the next 10 years without addressing any of the serious problems discussed. And besides taxpayers are already paying for two-thirds of every dollar spent on healthcare
Support of Medicare-for-all is at an all-time high and what we cannot afford is to continue the same status quo. We must demand that the rest of our legislators follow Senator Harrisā lead and put their constituentsā health security before corporate interests once and for all.
Paul Y. Song, M.D., is a Board Member of Physicians for a National Health Program and Co-Chair for Campaign for a Healthy California.
By The Editorial Board
The San Diego Union-Tribune, September 5, 2017
Itās now clear that creating a single-payer health care system is the top priority of the Democratic Party and millions of Americans.
In California, Assembly Speaker Anthony Rendon, D-Lakewood, made the right call in June when he pulled the plug on a bill creating a state single-payer system. He did so because the measure, Senate Bill 562, didnāt explain how to cover its estimated $400 billion annual cost ā triple the stateās general-fund budget. This reasonable decision led to national blowback. Now Rendon plans to hold hearings to discuss how to get to universal health care.
In Washington, the āMedicare for Allā bill that Sen. Bernie Sanders, I-Vermont, plans to introduce this month is picking up support, including from Sen. Kamala Harris, D-California. Itās hard to imagine any Democrat winning the partyās presidential nomination in 2020 without backing single-payer.
But itās time that Republicans started thinking big about health care as well ā and stop equating any expanded government role with socialism. According to a study by the American Journal of Public Health, taxes already pay for 64 percent of U.S. health care. The study found that, āAt $5,960 per capita, government spending on health care costs in the U.S. was the highest of any nation in 2013, including countries with universal health programs such as Canada, Sweden and the United Kingdom.ā
Itās a stunning statistic. Hereās another: A 2015 Commonwealth Fund study found the U.S. spent per capita at least 47 percent more of its gross domestic product on health care than 12 other wealthy, First World nations ā yet had among the worst health outcomes, with the exception of treating cancer. The U.S. had the lowest life expectancy.
Any CEO would look at this picture and say the U.S. must do better. Republicans must do the same. Instead of tinkering with ā or gutting ā the Affordable Care Act, the Trump White House and congressional GOP leaders should consider setting up a commission to examine how to emulate other nations which deliver better outcomes at a lower cost.
Some answers are obvious. In 2009, journalist T.R. Reid chronicled how 20 percent of U.S. health spending goes to āmarketing, underwriting, administration and profit,ā compared with 4 percent in France and 2 percent in Taiwan. This bloat is created both by the profit motive in insurersā provision of essential care ā which Reid says is unique in the developed world ā and the vast complexity of U.S. health care, with dozens of government systems and hundreds of private systems. Simple is better.
āGiven our remarkable medical assets … the United States could be, and should be, the best [at health care] in the world,ā Reid argues. āTo get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.ā
Amen. This is why Democrats who want universal health care should look for inspiration from the rest of the world, not embrace āMedicare for all.ā The same holds for Republicans who donāt like how much U.S. health care costs and who think Obamacare is a clunky mess. Americansā national pride shouldnāt include reverence for a flawed, costly and eminently improvable health care system.
http://www.sandiegouniontribune.com…
***
By Don McCanne, M.D.
This is a truly remarkable editorial considering the conservative heritage of The San Diego Union-Tribune. Although the editorial board adheres to its conservative roots by dismissing the label, āMedicare for all,ā it makes the case for abandoning our highly dysfunctional health care financing system and turning to models used successfully in other nations – universal systems in which governments play significant roles.
It is a breakthrough acknowledgment that Americansā national pride shouldnāt include reverence for a flawed and costly system with the vast complexity of the dozens of government systems and hundreds of private systems. āSimple is better,ā they state.
It is time that we quit arguing over labels and get down to seriously considering health policies that actually work. An honest assessment will lead to those policies included in the Physiciansā Proposal for Single-Payer Health Care Reform. Weāre willing to negotiate changing the single-payer Medicare for all label; we just wonāt negotiate exchanging beneficial policies for detrimental ones.
The Physiciansā Proposal:
https://pnhp.org/nhi
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By Renee Y. Hsia and Matthew Niedzwiecki
International Journal for Quality in Health Care, August 31, 2017
Abstract:
Objective
To better characterize and understand the nature of a very conservative definition of āavoidableā emergency department (ED) visits in the United States to provide policymakers insight into what interventions can target non-urgent ED visits.
Design/setting
We performed a retrospective analysis of a very conservative definition of āavoidableā ED visits using data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011.
Participants
We examined a total of 115,081 records, representing 424 million ED visits made by patients aged 18ā64 years who were seen in the ED and discharged home.
Main outcome measures
We defined āavoidableā as ED visits that did not require any diagnostic or screening services, procedures or medications, and were discharged home.
Results
In total, 3.3% of all ED visits were āavoidable.ā The top five chief complaints included toothache, back pain, headache, other symptoms/problems related to psychosis and throat soreness. Alcohol abuse, dental disorders and depressive disorders were among the top three ICD-9 discharge diagnoses. Alcohol-related disorders and mood disorders accounted for 6.8% of avoidable visits, and dental disorders accounted for 3.9% of CCS-grouped discharge diagnoses.
Conclusions
A significant number of āavoidableā ED visits were for mental health and dental conditions, which the ED is not fully equipped to treat. Our findings provide a better understanding of what policy initiatives could potentially reduce these āavoidableā ED visits to address the gaps in our healthcare system, such as increased access to mental health and dental care.
From the Discussion
Our findings serve as a start to addressing gaps in the US healthcare system, rather than penalizing patients for lack of access, and may be a better step to decreasing āavoidableā ED visits.
***
By Don McCanne, M.D.
This study is helpful in that the authors deliberately used a very conservative definition for which emergency department visits were avoidable. Under such a definition, 97% of visits were appropriate. The significance of this is that, instead of establishing often punitive policies to keep patients from supposedly abusing the emergency department, we should instead establish policies that would improve access for patients to more appropriate health care services and facilities.
A health care system designed to benefit the medical-industrial complex, including the private insurance industry, is going to use resources and incentives differently than a public system designed to benefit patients. Single payer supporters should have no difficulty in conceiving what those differences might be regarding urgent and emergency care.
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By Michael Erman
Reuters, September 1, 2017
U.S. health insurer Anthem Inc said on Friday that it will no longer offer Obamacare plans in 17 counties in Missouri but will remain in the bulk of the state, covering 68 counties that would not otherwise have Obamacare coverage for their residents.
***
By Don McCanne, M.D.
Boring. Boring. Boring. So Anthem eliminated coverage in 17 Missouri counties. That is so commonplace that it is a wonder that Reuters even reported it. But this is precisely the problem. We have accepted as routine the fact that Anthem and the other private insurers will take care of themselves first and use patients merely as a tool to achieve their own ends.
Contrast that with what an improved Medicare for all would be like. The public administrators would be making efforts to see that all regions are covered. Itās time that we put patients first rather than the rentier shareholders of the private insurers. Our Security and Exchange Commission protects the rentiers with the complicity of Health and Human Services – an agency that should be serving patients instead.
The voters can change that, but we keep hearing that the politics are too difficult. Really?
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By Vidya Visvabharathy
KevinMD.com, September 4, 2017
As Sen. Bernie Sanders prepares to introduce a universal health care bill in the next few weeks, many progressives who support a universal single-payer program worry about its effects on abortion access. Can we win Medicare-for-all while protecting hard-won reproductive rights? As a woman of color, a reproductive rights advocate, and graduate student of public health, I recognize the importance for marginalized groups to stand in solidarity for progress to happen. I urge single-payer advocates to push to repeal the Hyde Amendment as part of our fight for truly universal health care.
Itās no surprise that the majority of Americans support a national health program. Although the U.S. spends twice as much on health care than other industrialized nations, key health outcomes such as life expectancy and infant mortality fare much worse as compared to our international counterparts. Most of this difference in spending can be traced to our fractured, profit-based insurance industry, which wastes nearly a quarter of our health care dollars on billing, advertising, and profits, none of which contribute to quality of care. In contrast, a single-payer health program is a universal health care model that is publicly financed and covers all Americans for medically-necessary care, such as doctor visits, hospital stays, long-term care, and drugs.
Single-payer has been a long-standing progressive cause, and would seem to have no problem gaining support from all progressive groups. However, many womenās advocacy groups are hesitant to back a single-payer system because it could restrict access to abortion. The Hyde Amendment, passed in 1976 after the landmark Roe v. Wade case legalized abortion, bans all federal funding for abortion services except in the cases of rape, incest, and life endangerment to the mother. Therefore, a single-payer program could not fund abortion, unless explicitly stating that reproductive and abortion services would also be covered. Single-payer advocates should ally with womenās advocates and work to repeal the Hyde Amendment to increase support for both causes.
Progressives can learn a lot from efforts to enact single-payer programs at the state level. For example, in November 2016, Colorado lawmakers tried to enact a health care system similar to single-payer, known as ColoradoCare. However, NARAL (National Abortion and Reproductive Rights Action League) opposed the plan because it would leave more than 550,000 women without access to abortion services due to the stateās constitutional ban on funding for abortions except for life-threatening circumstances. Many women who have access to abortion services through private insurance plans would have lost this coverage under ColoradoCare. According to a statement by NARAL, the bill āis not truly universalā since it does not guarantee abortion services. Ignoring reproductive health caused ColoradoCare to lose key supporters necessary to win universal care.
The statewide single-payer legislation in New York serves as a promising model that explicitly incorporates reproductive services in the health system. The program, known as New York Health, covers all medically-necessary services that are currently covered by the state Medicaid program, including abortions. Diverse health organizations such as New York State Family Physicians and the Reproductive Health Access Project were heavily involved in crafting the bill from the start, underscoring the need for single-payer and womenās health groups to build legislation together.
In order to avoid the mistakes of ColoradoCare at both the state and national level, single-payer groups must explicitly advocate for coverage of abortion services, and work with reproductive health advocates to repeal the Hyde Amendment. While it is laudable that the single-payer advocacy organization Physicians for a National Health Program recently released a statement supporting abortion coverage, supporting causes ideologically is not enough. Reproductive health services, including abortion, must be explicitly written into any single-payer bill. If we want a universal health care system, it must be a system that covers comprehensive reproductive services as well.
Vidya Visvabharathy is a graduate student in public health with a concentration in maternal and child health epidemiology.
http://www.kevinmd.com…
By Carol Paris, M.D.
USA Today, September 1, 2017
The Senateās chaotic attempts to dismantle the Affordable Care Act prove that Republicans who campaigned for years against the ACA never had a plan to replace it. In the meantime, Americansā support for a comprehensive national health plan grows even stronger.
As a physician and longtime advocate for Medicare for all, Iām ready for an honest, bipartisan dialogue about the shortcomings of the ACA.
However, in the last few weeks, Iāve read proposals to āfixā the ACA by funneling even more money to private insurers, or to lower premiums by stripping out patient protections. Iāve seen plans to let patients buy into Medicaid or Medicare, or to establish a public option to compete with private plans.
But unlike a comprehensive single-payer program, these āband-aidā proposals are merely tweaks disguised as solutions. They are sold as easy, politically achievable, and best of all, NOT disruptive.
What exactly are we afraid of disrupting? Under Medicare for all, the only people worse off would be insurance and pharmaceutical company executives like Mark Bertolini of Aetna, who made $41 million last year, or John Martin of Gilead Sciences who took home nearly $900 million. Crowdfunding sites like GoFundMe would have to rethink a business model fueled by desperate families facing catastrophic illness and bankruptcy.
Under Medicare for all, doctors would continue to care for their patients, but would have to decide how to spend the extra nine hours they used to waste each week on administrative tasks like billing. Patients could visit the doctors and hospitals they like, but the average family would have to plan how to spend the countless hours they wasted haggling with private insurers and negotiating medical debt. Businesses would have to decide what to do with the time they spent shopping for small group policies and sweating over outrageous annual cost increases. The millions of Americans tied to jobs they donāt like would be free to move on, or to start the business of their dreams.
Instead of grading a health proposal on how ānot disruptiveā it is, use the standards set by President Trump: Does it cover everyone? Does it improve care? Does it lower costs, both for patients and the federal government? For incremental plans like increased subsidies, buy-ins and the public option, the answer is no.
The fatal flaw in these plans is their reliance on the profit-driven insurance industry to finance care. āFixingā the ACA means dumping more cash into the pockets of private insurers, that, despite record profits and billions in subsidies, regularly threaten to abandon the marketplace, treating patients like hostages and leaving millions more uninsured. The public option would do little for those squeezed by the skyrocketing costs of employer plans, and has no power to eliminate the waste inherent in a fractured, multi-payer system.
The only bill that meets all three of Trump’s standards is H.R. 676, the Expanded and Improved Medicare for All Act. But we have to get it right. My colleagues at Physicians for a National Health Program have studied health systems around the globe, measured costs and outcomes and answered tough questions about provider payments, cost containment and even job retraining for insurance workers.
In our Physiciansā Proposal for Single-Payer Health Care Reform, we conclude that a slight increase in government spending would be offset by massive administrative and personal savings under Medicare for all. The U.S. spends more than $3 trillion per year on health care, and the vast majority is already financed by your tax dollars. The money is there. Weāre just not spending it on actual care.
Crying āItās too hard!ā is not a solution. Fear-mongers have compared our health care system to a barge ā too big and heavy to turn around. If health care is a barge, itās time to lose the dead weight of private insurers with their layers of administrative waste and profit, and start moving in the right direction: Medicare for all.
Dr. Carol Paris, president of Physicians for a National Health Program, is a retired psychiatrist who worked for more than 25 years in private practice, community mental health, prison psychiatry and academia. Follow her on Twitter: @CarolParis7
By Hillary Borrud
The Oregonian, September 1, 2017
Oregon has kicked nearly 55,000 people off its Medicaid program, after the state found they no longer qualified or failed to respond to an eligibility check.
The state made the announcement Thursday, after workers finally cleared a backlog of eligibility checks that built up due to technology troubles and a massive increase in Medicaid enrollment under the Affordable Care Act.
Historically, around 28 percent of Oregonians on Medicaid were found to no longer qualify at annual eligibility reviews. But when the state finished working through its backlog of 115,000 Medicaid enrollees, it took the free insurance away from nearly 48 percent of them.
The Oregonian/OregonLive has reported the state had to process hundreds of thousands of Medicaid applications by hand because an automated eligibility system failed along with the rest of the $300 million Cover Oregon project. More than 500 temporary workers were assigned to the project.
Medicaid is supposed to provide care for people with low incomes. To qualify in Oregon, single people can earn no more than $17,000 a year and a family of four no more than $33,000.
Historically, around 28 percent of Oregonians on Medicaid were found to no longer qualify at annual eligibility reviews. But when the state finished working through its backlog of 115,000 Medicaid enrollees, it took the free insurance away from nearly 48 percent of them.
http://www.oregonlive.com…
***
By Don McCanne, M.D.
The Affordable Care Act supposedly was designed to expand health care coverage, including an expansion of the Medicaid program. Yet in Oregon almost half of Medicaid beneficiaries were kicked off the program. Isnāt that the opposite of one of the major goals of reform?
The reasons were entirely legitimate under our current system (which demonstrates, of course, whatās wrong with the system). Since Medicaid is a program for low-income individuals and families, those with incomes above the qualifying thresholds ($17,000 for individuals and $33,000 for a family of four) were removed. It is ironic that with a program that is designed to expand coverage, Oregon had to hire an additional 500 employees just to kick out those who were no longer qualified.
We have stated repeatedly that it is the highly flawed financing infrastructure that has created extensive administrative inefficiencies while frequently running counter the the stated goals of reform – in this example an increase in administrative activities merely for the purpose of taking coverage away from people.
The pressure is on to move forward in reform by tweaking ACA. Yet no number of tweaks will stabilize the Medicaid population. Not only does eligibility vary based on changing levels of income, other factors such as a change in employment, eligibility for Medicare, eligibility for ACA subsidies, veteran status and the like, perpetuate instability in health care coverage.
A single payer national health program – an improved Medicare for all – eliminates that instability. Coverage is for life. There is no necessity to hire a brigade of employees whose job it is is to see who should be expelled from their programs solely for reasons related to the defective design of the health care financing system rather than for any logical reason.
So the progressive commentators are telling us now that enacting and implementing a single payer system would be too disruptive. Maybe getting rid of those 500 employees who are taking health benefits away from people would be disruptive, but isnāt that precisely the kind of disruption that our highly dysfunctional system cries out for?
Correction of āOregon expels half of Medicaid patients from their programā
The article used as the source included the following paragraph:
āHistorically, around 28 percent of Oregonians on Medicaid were found to no longer qualify at annual eligibility reviews. But when the state finished working through its backlog of 115,000 Medicaid enrollees, it took the free insurance away from nearly 48 percent of them.ā
It has been pointed out to me by Beth Capell and by Christopher Lowe that Oregon has over 900,000 enrollees in their Medicaid program (992,000 in May 2017, per KFF). Thus the 55,000 removed from coverage was not half of all enrollees but rather nearly half of the subset of a backlog of 115,000 enrollees.
Although it is a relief to know that only about 6% lost their coverage rather than 48%, unfortunately that does not change the absolute number that did – 55,000 people still lost their coverage.
The conclusion remains the same: āit is the highly flawed financing infrastructure that has created extensive administrative inefficiencies while frequently running counter to the the stated goals of reform – in this example an increase in administrative activities merely for the purpose of taking coverage away from people.ā
Though single payer might be disruptive, āisnāt that precisely the kind of disruption that our highly dysfunctional system cries out for?ā
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