PNHP

New arrival in the single payer camp: Max Baucus!

New arrival in the single payer camp: Max Baucus!

Baucus backs single-payer health system

By Gail Schontzler
Bozeman Daily Chronicle, September 8, 2017

It’s time for America to consider seriously a single-payer, government-run health system, says Max Baucus, Montana’s longest serving U.S. senator, former ambassador to China and one of the chief architects of Obamacare.

“My personal view is we’ve got to start looking at single-payer,” Baucus said Thursday night at Montana State University. “I think we should have hearings…. We’re getting there. It’s going to happen.”

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 wouldn’t pass a government-run system like Canada’s. So it was the one alternative he refused to put “on the table” 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 can’t 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…

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Comment:

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. “It’s going to happen,” 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 Baucus’ epiphany, we such give special thanks to the Baucus 8.

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

The Scandalous State of our Healthcare System

Why the Time is Now to Finally Make Healthcare a Right and Not a Privilege

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 Sanders’ 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, workers’ 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:

“We 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.”

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 Sanders’ 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 Harris’ lead and put their constituents’ 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.

http://www.huffingtonpost.com…

Breakthrough editorial in The San Diego Union-Tribune

Medicare for all? Let's copy what works with health care in other nations instead

By The Editorial Board
The San Diego Union-Tribune, September 5, 2017

It’s 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, didn’t explain how to cover its estimated $400 billion annual cost — triple the state’s 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 “Medicare for All” bill that Sen. Bernie Sanders, I-Vermont, plans to introduce this month is picking up support, including from Sen. Kamala Harris, D-California. It’s hard to imagine any Democrat winning the party’s presidential nomination in 2020 without backing single-payer.

But it’s time that Republicans started thinking big about health care as well — 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, “At $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.”

It’s a stunning statistic. Here’s 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 — 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 — or gutting — 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 “marketing, underwriting, administration and profit,” compared with 4 percent in France and 2 percent in Taiwan. This bloat is created both by the profit motive in insurers’ provision of essential care — which Reid says is unique in the developed world — and the vast complexity of U.S. health care, with dozens of government systems and hundreds of private systems. Simple is better.

“Given our remarkable medical assets … the United States could be, and should be, the best [at health care] in the world,” Reid argues. “To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.”

Amen. This is why Democrats who want universal health care should look for inspiration from the rest of the world, not embrace “Medicare for all.” The same holds for Republicans who don’t like how much U.S. health care costs and who think Obamacare is a clunky mess. Americans’ national pride shouldn’t include reverence for a flawed, costly and eminently improvable health care system.

http://www.sandiegouniontribune.com…

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Comment:

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, “Medicare for all,” 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 Americans’ national pride shouldn’t include reverence for a flawed and costly system with the vast complexity of the dozens of government systems and hundreds of private systems. “Simple is better,” 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 Physicians’ Proposal for Single-Payer Health Care Reform. We’re willing to negotiate changing the single-payer Medicare for all label; we just won’t negotiate exchanging beneficial policies for detrimental ones.

The Physicians’ Proposal:
https://pnhp.org/nhi

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

Which emergency department visits are avoidable?

Avoidable emergency department visits: a starting point

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 ‘avoidable’ 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 ‘avoidable’ 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 18–64 years who were seen in the ED and discharged home.

Main outcome measures
We defined ‘avoidable’ 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 ‘avoidable.’ 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 ‘avoidable’ 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 ‘avoidable’ 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 ‘avoidable’ ED visits.

https://academic.oup.com…

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Comment:

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.

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

Anthem drops ACA coverage in only 17 Missouri counties

Anthem cuts back Obamacare coverage in Missouri to 68 counties

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.

https://www.reuters.com…

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Comment:

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. It’s 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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Don’t call it universal without including abortion coverage

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.

It’s 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 women’s 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 women’s 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 state’s 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 “is not truly universal” 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 women’s 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…

Medicare for all is the only health care proposal that meets Trump’s standards

Tweaks won't do what Trump wants: cover everyone, improve care and lower costs. Their fatal flaw is they rely on the profit-driven insurance industry.

By Carol Paris, M.D.
USA Today, September 1, 2017

The Senate’s 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, Americans’ support for a comprehensive national health plan grows even stronger.

As a physician and longtime advocate for Medicare for all, I’m ready for an honest, bipartisan dialogue about the shortcomings of the ACA.

However, in the last few weeks, I’ve read proposals to “fix” the ACA by funneling even more money to private insurers, or to lower premiums by stripping out patient protections. I’ve 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 “band-aid” 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 don’t like would be free to move on, or to start the business of their dreams.

Instead of grading a health proposal on how “not disruptive” 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. “Fixing” 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 Physicians’ 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. We’re just not spending it on actual care.

Crying “It’s too hard!” is not a solution. Fear-mongers have compared our health care system to a barge — too big and heavy to turn around. If health care is a barge, it’s 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

https://www.usatoday.com…

Oregon expels half of Medicaid patients from their program

Oregon removes nearly 55,000 people from Medicaid after they failed eligibility checks

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…

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Comment:

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. Isn’t that the opposite of one of the major goals of reform?

The reasons were entirely legitimate under our current system (which demonstrates, of course, what’s 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 isn’t that precisely the kind of disruption that our highly dysfunctional system cries out for?

Correction of “Oregon expels half of Medicaid patients from their program”

The article used as the source included the following paragraph:

“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.”

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: “it 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.”

Though single payer might be disruptive, “isn’t that precisely the kind of disruption that our highly dysfunctional system cries out for?”

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

Dr. Carol Paris on ‘Forum @360’

PNHP president Dr. Carol Paris participated in a single-payer forum at 360 North in Juneau, Alaska as part of her four-city tour of the state. The Sept. 1, 2017 program attracted a full house, plus a sizable overflow crowd that watched from the lobby. It aired as part of “Forum @360” on 360 North, Alaska’s public affairs channel, on Sept. 22, 2017.

Iowa would slash retroactive Medicaid benefits

Proposed Iowa Medicaid change would eliminate months of retroactive benefits

By Clark Kauffman
The Des Moines Register, August 30, 2017

Currently, Medicaid has a retroactive-eligibility provision that provides payment for health care services that were delivered in the three months leading up to a person being formally declared eligible for Medicaid.

It’s intended to ensure that health care providers accept patients even when those individuals have yet to apply for Medicaid. It often comes into play when people are hit with an unexpected health crisis and need immediate admission to a care facility. With retroactive payment, the facilities have some assurance that Medicaid will eventually pay for the care that pre-dates the decision on eligibility.

The Iowa Department of Human Services has asked the federal Centers for Medicare and Medicaid Services for permission to eliminate the three-month time-frame and have Medicaid pay only for the care that’s delivered from the first day of the month in which the patient applies for eligibility. The state says the move would save Iowa Medicaid, which serves more than 600,000 people and is funded by both the state and federal government, $36.7 million. The state’s share of the savings would be $9.7 million.

If approved, Iowa would become one of the first states in the nation to deny Medicaid beneficiaries three months of retroactive coverage. With more than 3,300 individuals enrolling in Iowa Medicaid each month, 40,000 Iowans would be affected by the change, which DHS hopes to implement in just four weeks, on Oct. 1.

The proposal is the result of actions taken by the Iowa Legislature during the 2017 session. Lawmakers approved a Human Services appropriations bill that specified several mandated cost-containment measures, one of which directed DHS to eliminate retroactive benefits for all Iowa Medicaid applicants. To do that, Iowa first needs the approval of CMS.

In its formal request to the federal agency, DHS says the change would “encourage individuals to obtain and maintain health insurance coverage, even when healthy.” It also says the change would make Medicaid more “closely aligned with the commercial market,” which doesn’t provide retroactive coverage to its customers.

http://www.desmoinesregister.com…

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Comment:

By Don McCanne, M.D.

The need for retroactive qualification for Medicaid is obvious. Healthy individuals who otherwise would qualify for Medicaid on an income basis frequently do not want to bother signing up when they think they would have little use for the program. But unexpected, serious medical problems do occur, and retroactive qualification would cover care provided before enrollment could be completed.

It is not clear why the Iowa state government would want to deny that coverage when, in fact, it does fulfill the intent of the Medicaid program to cover health care for those individuals who otherwise cannot afford it. It seems to represent just plain meanness on the part of the legislators and state administrators who are pushing for denial of this important coverage. The savings to the Iowa government would be less than $10 million – a pittance relative to the importance of this program.

This perverse behavior on the part of Iowa’s stewards reinforces some important principles:

* Above all, lifelong coverage for everyone should be automatic. Coverage should not be dependent on ever-changing personal circumstances.

* Coverage should not be based on ability to pay, but rather should always be automatic. Each individual’s contribution to the national health program should be based on ability to pay, but that is entirely separate from the principle that each person receives health care based on need for that care, regardless of what has been paid.

* Payment to the providers of health care should not depend on whether or not the patient has the resources or coverage to pay for that care, but rather it should be made automatic through public administration of the funds in a universal risk pool.

* The Iowa state administrators say that slashing retroactive coverage would align the state more closely with the commercial insurance market. Our outrageous costs in an underperforming system are due in a large part to reliance on the commercial market. Using the private insurers as a model is the opposite of what we should be doing.

* Perhaps the most important lesson is that we should reject the calls to turn over the health care financing of federal health programs to the states since too many of them are proving to us that their preferred policies are heartless. The federal government has a duty to ensure that every individual receives the health care that he or she needs. We cannot turn that responsibility over to state bureaucrats who have already proven to us that they do not care about the health and welfare of their people.

We all should care, and an improved Medicare for all would make it automatic so that we do not have to give another thought about administrative excesses designed to interfere with care, like the denial of retroactive authorization – a concept totally foreign to a financing system specifically designed to advance health care justice.

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Our next health care debate

By Andy Slavitt
JAMA Forum, August 30, 2017

This current debate isn’t over as long as the administration clings to talk of repealing the ACA. Still, the movement toward a single-payer system or another variant is beginning. There will be much written about the ideas that will shape our future. Whatever those ideas are, if we want them to succeed, we must begin now to create the ingredients for successful legislation finally worthy of our country.

https://newsatjama.jama.com…

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Democrats Should Negotiate with the GOP on Health Care

By James C. Capretta
RealClear Health, August 30, 2017

While in office, President Obama often remarked that the ACA relies, at least in theory and to a degree, on the Republican principles of markets and private insurance. He was right, even if he failed to note that the ACA also includes levels of governmental control and federal spending that Republicans were never going to support. If Democrats are willing to abandon dreams of single-payer and stick with a framework that features competition and consumer choice, it should be possible to find common ground with Republicans while moving even closer to the enrollment of all Americans in a health insurance plan.

http://www.realclearhealth.com…

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Comment:

By Don McCanne, M.D.

Andy Slavitt and James Capretta both support moving forward with health care reform, though one might be considered center-left and the other center-right. So where are we headed?

Republicans support less government and more markets and competition. In contrast, there has been a surge of Democrats voicing support for a government single payer program. But what is the actual record of Democrats?

Since the neoliberals assumed control of the Democratic Party, they have supported market solutions – first with the failed Clinton effort, and then with the Affordable Care Act and their marketplace insurance exchanges of private plans. Even well established government programs are shifting to the private sector with an expansion of private Medicare Advantage plans in the Medicare program, a massive transfer of Medicaid to private Medicaid managed care organizations, and even transferring care of VA patients into the private sector through the Veterans Choice Program.

In his full article (link above), Slavitt states, “Our goal should be to develop policies that we have real-world experience with, so we can avoid think-tank fantasies that either overstate the power of free markets or fail to see the unintended consequences of government intervention.” That’s very neoliberal of him.

Capretta states, “If Democrats are willing to abandon dreams of single-payer and stick with a framework that features competition and consumer choice, it should be possible to find common ground with Republicans while moving even closer to the enrollment of all Americans in a health insurance plan.” That’s very conservative of him.

The pro-market, pro-corporate views of the neoliberals place them in the same camp as the conservatives in regard to financing health care. Many Democratic politicians have given token tribute to single payer, even to the extent of signing on as co-sponsors of Conyers’ single payer bill – HR 676. But several of them qualify their support by describing single payer as being merely an “aspiration” but not a practical consideration at this time when we need to be supportive of the Affordable Care Act. More private Medicaid managed care. More private Medicare Advantage plans. More private VA care. More private plans in the ACA marketplaces. Introducing a public option that is public in name only since it would be designed along the model of private plans while being prohibited from competing “unfairly” and would be financed without government funds – crapola insurance.

There is a night and day difference between financing health care in the marketplace through private insurance and financing it through a government national health program. One is framed around businesses and the other is framed around patients. Today the conservatives and neoliberals are offering us only the business approach supervised by the medical-industrial complex.

Harold Pollack is a highly respected health policy expert from the University of Chicago who sometimes drives us at PNHP a little bit crazy with the legitimate concerns he expresses about the politics and logistics of single payer, even if none of it is insurmountable. But he said something interesting the other day: “Republicans’ failed repeal-and-replace effort has solidified the consensus around universal coverage and provided an exemplar process for radical policy change. A lot of Democrats are saying: ‘If they can try doing this with something so unpopular that would hurt tens of millions of people, why can’t we do something on that order that would be popular and help tens of millions of people?’”

Yes, why can’t we? Not just the Democrats, but all of us. Like maybe single payer.

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