PNHP

New Hampshire AFL-CIO endorses H.R. 676

New Hampshire AFL-CIO endorses H.R. 676

By Kay Tillow
Single Payer News, May 29, 2013

“On Saturday, May 4, the New Hampshire AFL-CIO unanimously passed a resolution supporting H.R. 676 and the adoption of a national single-payer health care system that covers all Americans for all necessary medical care including prescription drugs and dental,” reports President Mark MacKenzie.

New Hampshire is the 42nd state AFL-CIO federation to endorse H.R. 676, Expanded and Improved Medicare for All, sponsored by Congressman John Conyers Jr., D-Mich.

“H.R. 676 will save hundreds of billions of dollars by eliminating the private health insurance industry with its high overhead and profits,” said MacKenzie.

“As president of the New Hampshire AFL-CIO I am proud to have our members actively participate in the movement to win passage of H.R. 676 and to make health care a human right.”

In a separate development, on May 21, H.R. 676 gained another co-sponsor in Congress with the addition of Rep. Danny Davis (Ill.-7). H.R. 676 now has 42 co-sponsors.

***

More on the Expanded and Improved Medicare for All Act

H.R. 676 would institute a single-payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S.

H.R. 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long-term care.

H.R. 676 ends deductibles and co-payments. H.R. 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

In the current Congress, H.R. 676 has 42 co-sponsors in addition to Conyers.

H.R. 676 has been endorsed by 601 union organizations including 145 Central Labor Councils/Area Labor Federations and 42 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA, RI, & NH).

For further information, a list of union endorsers, or a sample endorsement resolution, contact: Kay Tillow, All Unions Committee for Single Payer Health Care—H.R. 676, c/o Nurses Professional Organization (NPO) 1169 Eastern Parkway, Suite 2218, Louisville, KY 40217. Phone: (502) 636-1551. E-mail: nursenpo@aol.com Website: unionsforsinglepayer.org

Millions of the poorest will remain uninsured

States’ Policies on Health Care Exclude Some of the Poorest

By Robert Pear
The New York Times, May 24, 2013

The refusal by about half the states to expand Medicaid will leave millions of poor people ineligible for government-subsidized health insurance under President Obama’s health care law even as many others with higher incomes receive federal subsidies to buy insurance.

More than half of all people without health insurance live in states that are not planning to expand Medicaid.

People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance.

http://www.nytimes.com/2013/05/25/us/states-policies-on-health-care-exclude-poorest.html?hp&_r=0&pagewanted=all

Comment:

By Don McCanne, M.D.

The poorest of the poor, those living below the federal poverty level, are ineligible for subsidies for the exchange plans, and they will not be able to enroll in Medicaid in those states that have refused to expand eligibility beyond those who are already qualified.

For those living in poverty, the Affordable Care Act (ACA) could have provided plans through the state exchanges with subsidies for 100 percent of the premiums and 100 percent of the out-of-pocket costs. Instead, it was decided to cover those in poverty with Medicaid, while limiting the income-indexed exchange subsidies to those living above 100 percent of the federal poverty level.

That was before the Supreme Court ruled that state participation in the Medicaid expansion could not be made mandatory. Since so many states opted out, millions of the very poor will not be eligible for Medicaid nor for the exchange plan subsidies. They will simply remain uninsured.

Because of the obstructionists in Congress, no legislative remedy is possible at this time. Too many members of Congress want to prove that ACA won’t work. Of course, they do not advance any program that will.

Even if all glitches were eliminated, the fundamental structure of ACA is irreparably flawed. It will leave 31 million uninsured, establish under-insurance as the new standard, and fail to control costs. So let’s replace it with a system that covers not only the poorest of the poor, but covers all of us – an improved Medicare for all.

Economist: North Carolina could save $18.7B by adopting single-payer model for health care

The U.S. health-care payment system is unsustainable, Gerald Friedman, a professor of economics at the University of Massachusetts at Amherst, said Thursday night in Charlotte

By Jennifer Thomas
Charlotte (N.C.) Business Journal, May 24, 2013

North Carolina could save as much as $18.7 billion next year on health-care costs if it changed the way it finances health care.

The catch? That change would require a switch to a single-payer system in which one entity collects all health-care fees and pay related costs, says Gerald Friedman, a professor of economics at the University of Massachusetts at Amherst.

“We have a system that was broken 10 years ago, and it’s getting worse,” he says. “You can’t fix it unless you change its fundamental basis.”

Friedman spoke Thursday night in Charlotte at the Health Care Justice meeting. That organization wants everyone in the community to have access to health care. It is a chapter of the Physicians for a National Health Program, which supports single-payer national health insurance.

Friedman has drafted financing plans for single-payer health systems for Maryland, Massachusetts and the United States. If adopted, he estimates such a payment model could result in $2 trillion in savings nationwide over the next decade mainly by cutting administrative costs and controlling prescription drug prices.

On Thursday night at the Midwood International and Cultural Center, he touted the need for universal-comprehensive coverage, in which everyone would have access to care. Individuals, businesses and the government stand to benefit, Friedman said.

Universal coverage would minimize billing expenses, avoid wasteful competition among insurers and eliminate adverse selection against people who are sickest, he said.

Friedman estimates that nationwide there is $1.5 trillion in waste annually when it comes to health-care spending. Such spending now accounts for roughly 18 percent of the gross domestic product. And it is expected to rise to 22 percent of the GDP within five years.

In North Carolina, health-care spending has risen more than 400 percent in North Carolina since 1990, Friedman said.

At the same time, per capita income has barely doubled, which puts increased pressure on a family’s income. In 1960, health-care spending accounted for just 7 percent of a family’s take home pay. That rose to 39 percent in 2010.

“More and more money is going to health care,” he said.

The current health-care payment system is unsustainable because it is focused on making profits, Friedman said. That results in waste, fragmented care delivery and significant administrative costs and monopolistic pricing, he added.

For example, he said drug prices are 60 percent higher in the U.S. than elsewhere.

Health insurers will spend nearly $200 billion on administrative costs in 2013, he noted.

Friedman expects the current payment system will collapse. He notes expanded access through federal health-care reform will fall short of providing universal coverage and does not do enough to stem rising health-care costs.

That means health insurance premiums will continue to rise, making it unaffordable for more individuals.

“Right now health-care is a lump-sum tax on individuals, especially sick individuals,” he said.

Jennifer Thomas covers health care, biotech, education and retail for the Charlotte Business Journal.

http://www.bizjournals.com/charlotte/news/2013/05/24/economist-nc-could-save-187b-by.html?page=all

Health care CEOs have highest pay

Health care tops other industries for highest median CEO pay

The Washington Post, May 23, 2013

Here’s a look at median CEO pay by industry last year, as calculated by executive pay research firm Equilar. For the fourth time in five years, health care CEOs got the most pay and utilities CEOs got the least.

—Health care: $11.1 million

—Industrial goods: $11 million

—Services: $10.9 million

—Financial: $9.8 million

—All companies: $9.7 million

—Consumer goods: $9.5 million

—Basic materials: $9.3 million

—Technology: $9.2 million

—Utilities: $7.5 million

http://www.washingtonpost.com/business/health-care-tops-other-industries-for-highest-median-ceo-pay/2013/05/23/8003ef12-c3be-11e2-9642-a56177f1cdf7_story.html

Comment:

By Don McCanne, M.D.

So health care CEOs have the highest median pay of all industries in the United States. But notice that their pay is not much higher than the median CEO pay in all industries. That brings up a couple of questions.

What do CEOs do?

Does their “contribution” to society warrant that level of pay?

Considering what CEOs do, do we really even want them in our health care system since it is an “industry” apart from all the rest?

Cruelty or Care? The Choice is Yours

By Pippa Abston, M.D.
Pippa Abston’s blog, May 22, 2013

Well. From the beginning, I have been telling you all that the so called “Patient Protection and Affordable Care Act” is neither protective nor affordable to patients. We can keep the same PPACA abbreviation and call it what it is: The Profiteering Protection and Affordable Cruelty Act. Although I read the whole darn thing, I lack a background in law or politics. As the specific corporate protections emerge from this convoluted mess, I have to say I didn’t foresee some of them. I knew it would be bad, just not all the details of said badness.

The latest in our story of woe? Insurers and some employers have discovered an irresistible loophole that allows skimpy policies covering only a few outpatient services. The key phrase is “minimal essential coverage,” previously defined in federal law under the IRS Act of 1986. I noticed some folks had conflated that term with “essential health benefits,” but EHB are mandated items on state Exchange policies starting in 2014. No plan will be allowed to put lifetime or annual dollar limits on coverage, but outside of the Exchanges, other details of minimal essential coverage are minimally described.

I think I was fooled by the ACA’s opening paragraphs allowing insurers to temporarily restrict annual limits on essential health benefits until 2014. I missed the absence of any requirement to offer those benefits at all, at any date, except on the Exchanges. Insurer can’t restrict annual dollar amounts of those benefits if they are offered. In a stunning twist on catastrophic coverage, it is possible for insurers to cover only the required preventive services and omit the catastrophes. You can get your colonoscopy “free” if you have a non-grandfathered plan, but any follow-up surgery is entirely on you.

The most minor effect is that employers who offer bare-bones policies and employees who get them are exempt from the ACA penalties. I see some reference to this loophole only applying to large employers, but I don’t know how that was determined. I don’t see it in the IRS code that I found, which includes as minimal essential coverage “B) any other plan or coverage offered in the small or large group market within a State” —it may be elsewhere. It seems to me it would apply to any size group policy offered outside of the Exchanges. If one of you can find me the relevant law making this only applicable to large employers, I’d be grateful.

The worst effect is that employees who have minimal essential coverage are not eligible for premium subsidies on the Exchanges, as far as I can tell. This also seems to be the IRS’s interpretation: “A month is not a coverage month for an individual, and thus no premium tax credit is allowable for the individual’s coverage, if the individual is eligible for minimum essential coverage other than coverage offered in the individual market for that month.” If you can show me in the law itself or in administrative policy how it can be read otherwise, please post a link. Maybe the IRS can do some creative adjusting. Generally their creativity seems to apply only to corporations.

How many employers will use these plans to avoid penalties and thus apply this affordable cruelty to their employees in the process? You know it will start with those who already pay poor wages. As health care costs rise, don’t be surprised if you get this offer you can’t refuse in your own benefits package.

Do I have grounds to put the word “cruelty” in place of “care” in the ACA? The law is no longer new. It is now part of our health care system. I don’t know what else to call a system that not only allows but entrenches the abuses I see in my office. Children who desperately need skilled child psychiatrists but whose insurance does not have a single child psychiatrist, skilled or unskilled, on the panel. Children who don’t get the care they need because their parents delay over co-pays and deductibles. Parents who work long, hard hours at low pay, producing goods and services we use without gratitude or notice, whose “non-emergency” pain goes untreated because of money. Who try to smile at me in front of their kids, as if it doesn’t hurt, but cry when I take them in another room. I refuse to make excuses for this awfulness or play around with euphemisms. Cruelty, brutality, callousness — many words apply, and none of them is “care.”

I can hear the defensive talk already, from people who won’t be able to believe their beloved party would intentionally expose us to this treatment. It was an oversight, right? The law is complicated. We missed this problem, and they did too. We have a bumbling, well-meaning but hapless government, like a dog that’s so ugly it’s almost cute. Don’t buy it. Somebody had better ask what the President and insurers knew and when they knew it. Remember the industry was mighty cozy with our Executive Branch during construction of the law. Is it just now that this minimalist option has been discovered? Or is this a convenient time for discovery, well into the second term? Will we allow the President to wash his hands of the disaster and pretend he never imagined anyone would behave so?

What will it be, folks? Do you want to keep trying to pass legislation to close loopholes, even though the insurers are always one step ahead? How long will you continue to support and vote for people who cater to them? When will you finally say “don’t let the door hit your butt on the way out” — and insist on real insurance and real representation?

Improved, expanded Medicare for All is a simple, achievable, affordable, practical next step. It doesn’t require revolution, utopia or socialism. Even conservatives can embrace it. We have the structure in place. We are only waiting for you. Will you speak up?

Pippa Abston, M.D., Ph.D., F.A.A.P., is a pediatrician. She resides in Huntsville, Ala.

http://pippaabston.wordpress.com/2013/05/22/cruelty-or-care-the-choice-is-yours/

Important: Milliman Medical Index now $22,030

2013 Milliman Medical Index (MMI)

Milliman, May 2013

The MMI represents the projected total cost of medical care for a hypothetical American family of four (two adults and two children) covered under an employer-sponsored PPO health benefit program.

Key findings

*  As measured by the 2013 MMI, the total annual cost of healthcare for a typical family of four covered by an employer-sponsored preferred provider plan (PPO) is $22,030.
 
*  The 6.3% increase over 2012 is the fourth consecutive year of decreasing trends, but the total dollar increase of $1,302 is the fourth year in a row of increases over $1,300.

*  Of the $22,030 healthcare cost for a family of four, the employer pays about $12,886 in employer subsidy while the employee pays the remaining $9,144, which is a combination of $5,544 in payroll deductions and $3,600 in employee out-of-pocket costs. For employees, this represents a cost increase of 6.5% over last year’s total employee cost of $8,584.

*  We expect that the emerging reforms required by the Patient Protection and Affordable Care Act (ACA) will have little impact on the cost of care for our family of four in 2013 because this family tends to be insured through a large group health plan. Some of the most far-reaching reforms will not become effective until 2014, and they are focused primarily on the individual and small employer markets. Additionally, while those reforms will likely have immediate impacts on premium rates in those markets, it is unclear whether they will have any near-term effects on growth in the cost of healthcare services for a given person.

http://publications.milliman.com/periodicals/mmi/pdfs/mmi-2013.pdf

Comment:

By Don McCanne, M.D.

According to the Milliman Medical Index (MMI), the average projected cost for health care today for the typical family of four with an employer-sponsored preferred provider plan (PPO) is $22,030. That includes an employee contribution to the premium of $5,544, out-of-pocket expenses of $3,600, both totaling $9,144, plus an employer contribution of $12,886 which is actually paid by the employee through forgone wage increases.

Median annual household income is now $51,404 (February 2013). Although that does not represent the same demographic group as working families with four members, it does give you a general perspective of the burden of today’s health care costs on families and households.

An important point made in the MMI report: “the Patient Protection and Affordable Care Act (ACA) will have little impact on the cost of care for our family of four in 2013 because this family tends to be insured through a large group health plan,” and ACA is “focused primarily on the individual and small employer markets.” Since employment remains the primary source of health care coverage, the majority of families can anticipate little relief from these health care cost burdens.

A fundamental flaw in employer-sponsored coverage is that the entire burden of health care costs is placed on the employee (when considering forgone wages), yet it is clearly not affordable for low- or middle-income families. Progressive financing of health care is an imperative.

ACA provides at least modest income-indexed public subsidies which extend into the middle-income ranges, though they are still inadequate. Premiums for employer-sponsored plans are tax deductible, which is a form of public subsidy (tax expenditure), but since the premiums represent forgone wages, this tax subsidy benefits higher-income individuals much more than those with lower incomes. Thus the financing of health care through employer-sponsored coverage is terribly regressive (lower-income families pay a much larger percentage of their income for health care than do higher-income families).

This outrageous $22,000 burden on typical working families should be enough to provide us with an incentive to fix our health care financing system. A single payer national health program that includes everyone and is financed with progressive taxes is precisely what we need. Keep in mind this $22,000 burden when you discuss health care reform with others. ACA is not going to make that go away.

Insurers dump debt on physicians

Loophole in health care law could stick doctors with tab

By Jim Sanders
The Sacramento Bee, May 22, 2013

A loophole in California’s upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills.

A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.

Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation – but insurers are responsible only for the first month.

The U.S. Department of Health and Human Services, in written comments, conceded that nonpayment of premiums would “increase uncertainty for providers and increase the burden of uncompensated care.” But it rejected a handful of proposals for cracking down on families whose policies lapse.

During the three-month grace period, insurers are required to pay claims for the first month, after which policyholders would be asked to pay their doctor’s bill or their insurance premium. If they pay neither, doctors get stuck with the tab.

http://www.sacbee.com/2013/05/21/5438115/loophole-in-health-care-law-could.html

Comment:

By Don McCanne, M.D.

This looks like another provision of the Affordable Care Act (ACA) designed specifically to protect insurers, at least partially, from untoward losses.

To protect patients who have financial hardships that prevent them from paying their premiums on time, ACA requires that their insurance remain in force for three months before it can be cancelled for non-payment. Physicians contracted with the insurers providing plans through the exchanges will have to continue to provide services for three months after non-payment begins. The insurers, on the other hand, are required to pay the bills for only the first month. After that, the physicians bear the losses.

This is one more example of the role played by the private insurers in both creating ACA and then in implementing it, taking care of their own interests first.

This particular defect is directly related to the fact that Congress, with the support of the Obama administration, selected a highly flawed model of reform – expanding our fragmented, dysfunctional system of private and public plans.

A much greater problem than this transitional coverage issue for non-payment is what then follows. After three months, the patient may remain uninsured, especially if not eligible for Medicaid. The financial hardship that caused the lapse of insurance in many instances will prevent the person from obtaining any other coverage.

Although we can be angry with the insurers for dumping on the physicians, we should hold greater contempt for the politicians and policy makers who brought us this highly flawed financing system. They know that we could have prevented these problems by enacting an improved Medicare that automatically includes everyone, forever, but they didn’t do it.

We still can, you know.

Health Care for All Colorado will try for 2014 ballot with universal, single-payer plan

By Michael Booth
The Denver Post, Daily Dose blog, May 21, 2013

Health Care for All Colorado will shoot for a 2014 statewide ballot vote rather than 2013, supporters have decided.

The progressive cause has launched an education effort across the state, but decided to take the extra year to gather support and earn enough of the tens of thousands of signatures it would need to make the ballot, said director Donna Smith.

One of the group’s slogans is that health care is a right, not a commodity. Most supporters are backers of “Obamacare” reforms passed by Congress in 2010, but argue they don’t go far enough to guarantee health care to all citizens. In Colorado alone, hundreds of thousands of people will remain without health insurance because of gaps left in undocumented residents, workers changing jobs, and those who risk a penalty in refusing to buy insurance.

Health Care for All would put a payroll tax on all residents according to their income and asset levels. It would also ask Medicare and Medicaid, which use federal and state dollars to pay for more than a million state residents, to issue waivers allowing their funds to be pooled with the health care tax. A single administration would then make payments to health care providers like doctors and hospitals, on a common set of benefits.

A separate effort for a somewhat similar system was dropped in this past Legislature by Sen. Irene Aguilar of south Denver, a Democrat who also believes Obamacare did not go far enough. Because she wanted the Legislature to refer the issue to voters, Aguilar would have needed a two-thirds vote, including highly reluctant Republicans. She apparently was not able to win that extra support.

http://blogs.denverpost.com/health/2013/05/21/health-care-for-all-colorado-will-try-for-2014-ballot-with-universal-single-payer-plan/3249/

10,000 signatures for universal health care

By Tanique Williams
Legislative Gazette (Albany, N.Y.), May 21, 2013
   
New Yorkers from across the state — including hundreds of doctors, nurses, patients, labor unions, community organizations, faith groups, and seniors — delivered 10,000 signatures supporting a single-payer health care bill sponsored by Assemblyman Richard Gottfried, D-Manhattan, and Sen. Bill Perkins, D-Harlem.

The press conference was coordinated with Healthcare-NOW NYC, Hunger Action Network of New York State, Physicians for a National Health Program (New York Metro chapter), Single Payer New York, and Statewide Senior Action.

“These signatures are a testament to the dedication of New Yorker all across this great state to reach out to members of their communities and help build the grassroots movement it will take to make healthcare a human right in New York,” said Katie Robbins, an organizer with Healthcare-Now.

The New York Health bill (A.5389-a/S.2078-a) —”an act to amend the public health law and the state finance law”— would expand health coverage to all New Yorkers regardless of age, income, or employment status, and would control costs by implementing a single-payer, universal healthcare system, its supporters say.

The bill has 74 co-sponsors in Assembly and 17 in the Senate.

“The affordable care act has made some important improvements in how we organize and pay for health care in this country but it still leaves us and our health care, and our wallets, in the hands of insurance companies—with their premiums, and their administrative costs, and deductibles, and co-pays, and limited network, and denials of payment for the care we need. We can do better and New York can do better,” said Gottfried, chair of the Assembly Health Committee.

“President Obama during [his] campaign said that no American should have to spend their golden years at the mercy of insurance companies, and I agree with that, but I want to know why that is only for golden years. We can get better health care, more affordable health care, more fairly paid for, for every single New Yorker if we enact the New York Health bill to provide universal, publicly sponsored, publicly funded, single-payer health coverage. We want to get this bill to the floor of the Assembly this year for a vote,” he said.

Under the legislation, there would be no premiums, co-payments, or deductibles, and coverage would be publicly funded. Advocates said they would like to see the bill passed in the Assembly, in the Senate, and signed by the governor.

Perkins began his speech with a call and response of “you’re heath is your wealth.”

“We not only want to get [the New York Health bill] passed in the Assembly, we also want to get it passed in the Senate, and most importantly, we want the governor to sign the bill. In fact if we could, we would ask the governor to advocate [and] make sure it gets passed in the Assembly; to advocate [and] make sure it gets passed in the Senate; to be standing there with us so that our wealth, our health, is not compromised,” Perkins said.

New York Hunger Action Network Executive Director Mark Dunlea said health care costs are “one of the three big bills” that send people to emergency food programs.

“When Massachusetts enacted their insurance mandate, many low-income residents found they had less access to health care services. It is immoral that the rich country in the world still refuses to treat health care as a basic human right, even while we spend far more money on health care per capita than countries with universal access,” Dunlea said.

The 10,000 signatures were delivered to the offices of Gov. Andrew Cuomo, Senate Republican Leader Dean Skelos, R-Rockville Centre, Independent Democratic Conference head Sen. Jeff Klein, D- Bronx, and Assembly Speaker Sheldon Silver, D-Manhattan.

http://www.legislativegazette.com/Articles-Top-Stories-c-2013-05-21-83855.113122-10000-signatures-for-universal-health-care.html

Some unions protest Obamacare’s impact on multiemployer health plans

By Kay Tillow
Firedoglake, May 21, 2013

The Affordable Care Act (ACA) of 2010, also known as Obamacare, presents challenges to the  multiemployer plans through which some unions bargain collectively to provide health care insurance for their members. These plans, often called Taft-Hartley plans, currently cover about 26 million workers, families, and retirees. Unless there is a major regulatory change made by Health and Human Services, these union negotiated plans will be struck a harsh blow once the exchanges go into effect in 2014.

A quiet effort by many unions to persuade the Obama administration to make this change is now becoming very public.

In an op-ed published in The Hill, Joseph T. Hansen, president of the United Food and Commercial Workers (UFCW), said:

“But as currently interpreted, the ACA would block these plans from the law’s benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law’s penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers. In other words, they will be forced to change their coverage and quite possibly their doctor. Others will be channeled into Medicaid, where taxpayers must pick up the tab.

“In addition, the ACA includes a fine for failing to cover full-time workers but includes no such penalty for part-timers (defined as working less than 30 hours a week). As a result, many employers are either reducing hours below 30 or discontinuing part-time health coverage altogether. This is a cut in pay and benefits workers simply cannot afford. For example, a worker making $10 an hour that has his or her schedule cut by six hours a week would lose $3,100 a year in income. With millions of workers impacted, this would have a devastating effect on our economy.”

The effort of unions to persuade the Obama administration to change the regulations in order to resolve the problems was reported in the Jan. 30 edition of The Wall Street Journal.

“Top officers at the International Brotherhood of Teamsters, the AFL-CIO and other large labor groups plan to keep pressing the Obama administration to expand the federal subsidies to these jointly run plans, warning that unionized employers may otherwise drop coverage.”

“We are going back to the administration to say that this is not acceptable,” said Ken Hall, general secretary-treasurer for the Teamsters, according to the WSJ article.

Many unions have been working through the National Coordinating Committee for Multiemployer Plans (NCCMP) to find a solution. In a memorandum to the Department of Health and Human Services, the NCCMP stated:

“If subsidies are available only for plans purchased through Exchanges, employers contributing to multiemployer plans will face tremendous economic pressure to stop contributing to multiemployer plans. … Many employers will feel the need to drop coverage and access the subsidies to remain competitive.”

On April 16, the United Union of Roofers, Waterproofers and Allied Workers International President Kinsey M. Robinson issued a statement calling for a repeal or complete reform of President Obama’s Affordable Care Act. He stated that the union has supported President Obama for both terms in office but that the union’s concerns “over certain provisions in the ACA have not been addressed, or in some instances, totally ignored.

“In the rush to achieve its passage,” Robinson continued, “many of the Act’s provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer sponsored coverage could keep it. These provisions jeopardize our  multiemployer health plans, have the potential to cause a loss of work for our members, create an unfair bidding advantage for those contractors who do not provide health coverage to their workers, and in the worst case, may cause our members and their families to lose the benefits they currently enjoy as participants in  multiemployer health plans.”

The Cornell University Industrial and Labor Relations School recently held a special workshop on “The Affordable Care Act: Impact on Multiemployer Plans.” The materials from that educational event are available here.

So far there is no adequate answer from the Obama administration to the efforts of unions to resolve the issues. The state exchanges must be in place by October of 2013 so that they are ready to go by Jan. 1, 2014.

Many of the unions involved contend that regulations for the ACA could be written to allow the employers that pay into these union negotiated plans to receive the same subsidies that employers will receive in the exchanges. So far, that has not happened.

This is one of many conundrums that face unions as the costs of health care in our corporate-controlled, profit-oriented system make the maintenance of health benefits increasingly difficult to achieve.

This growing crisis underlines the need for unions to press for passage of H.R. 676, Expanded and Improved Medicare for All, national single-payer health insurance. H.R. 676 has been reintroduced by Congressman John Conyers, D-Mich., into the 113th Congress and has 42 co-sponsors. This real solution awaits a dynamic, massive, in-the-streets movement that makes sound health policy also politically feasible.

Such a solution would improve the lives of all workers by assuring that everyone has all medically necessary care with no co-pays and no deductibles. Even dental care and long-term care are covered.

Private for-profit health insurance companies and the massive waste they cause would be removed. Unions would free their health care from corporate control as labor has done in other industrialized countries where some form of publicly funded single-payer care is guaranteed. Care would be expanded and costs brought under control. By leading this fight for universal care, unions would once again prove that social justice can be achieved through the leadership of the nation’s organized workers.

With all of labor harmed by the attacks in Wisconsin, the “right to work for less” in Michigan and Indiana, a host of Koch-sponsored legislation in states across the country, and the brutal assault on pensions, what better way to fight back than to use labor’s vast grassroots mobilizing clout to promote H.R. 676?

The union movement will grow as it leads this vital struggle. Labor has always led progress for workers, and that progress also lifts up the nation.

http://my.firedoglake.com/kaytillow/2013/05/21/some-unions-protest-obamacares-impact-on-multiemployer-health-plans/

Does Medicare Overpay Private Plans? The Debate Heats Up

By John Wasik
Medicare NewsGroup, May 21, 2013

The debate on whether Medicare Advantage (MA) is reducing health care costs is intensifying.

A recently released analysis of government data by America’s Health Insurance Plans (AHIP), the main health insurance lobby, found that seniors enrolled in MA plans in California and Nevada had better health outcomes than patients enrolled in Traditional Medicare.

The group, in examining data from the Agency for Healthcare Research and Quality (AHRQ), claims that MA patients had fewer readmissions and overall days in the hospital and better control of diabetes and dehydration than Traditional Medicare patients. AHIP said their study revealed that, as compared to Traditional Medicare:

* Hospital days were reduced by 30 percent in California and 23 percent in Nevada for Medicare Advantage beneficiaries;
* MA readmissions in the same quarter for the same condition were 15 percent less in California and 33 percent less in Nevada;
* In both states, MA seniors were 6 percent less likely to be admitted to the hospital for conditions described by AHRQ as “potentially avoidable,” such as dehydration, urinary tract infection, or uncontrolled diabetes;
* MA patients spent an average of 18 percent fewer days in the hospital and had an average of 27 percent fewer visits to the emergency room;
* MA beneficiaries experienced a 42 percent lower rate of hospital readmissions; and
* MA beneficiaries had 13 percent fewer avoidable admissions.

The AHIP study comes on the heels of several government findings that MA is actually proving to be more expensive than Congress intended. In March, a MedPAC report stated that MA cost about 14 percent more person than Traditional Medicare. The Congressional Budget Office has estimated that Medicare will spend more than $54 billion more for MA payments than what it spends for fee-for-service care.

Private insurers currently serve about 27 percent of Medicare recipients. Instead of running a fee-for-service model, they employ managed care and often offer more covered services than Traditional Medicare. The current MA program started in 2003 with the Medicare Modernization Act; before that law, there were Medicare HMOs. The theory behind introducing managed care to Medicare was that closer attention to patients with chronic diseases and a capping of provider expenses would lower overall costs.

GAO Report Found Overpayments

Earlier this year, Bloomberg reported that Medicare was considering an $11 billion cut in MA payments but that it was rebuffed after an intense, faux grassroots lobbying effort by the health insurance industry. That was after the Government Accountability Office (GAO) discovered that MA providers were overpaid by up to $5 billion from 2010 to 2012. The GAO, criticizing Medicare’s “risk scores” for calculating payments, presented the findings to the Centers for Medicare & Medicaid (CMS), which did not comment.

The health insurance industry, represented by AHIP, welcomed the rate-cut rescission. In a statement, Karen Ignani, AHIP president, said:

“By being responsive to the more than 160 members of Congress from both parties who raised concerns about the impact of the proposed payment rate on seniors, CMS has taken an important step to help stabilize Medicare Advantage at a time when the program is facing significant challenges. We are currently reviewing the final rate announcement and will continue to work with policymakers in both parties to strengthen this critically important part of Medicare that provides high-quality, affordable coverage to more than 14 million   seniors and people with disabilities.”

AHIP had argued that trimming MA subsidies would have hurt beneficiaries by cutting benefits and raising premiums from $50 to $90 per month. In mounting a multistate, multimedia campaign, AHIP persuaded more than 40,000 MA recipients to call Congress to oppose the cuts.

New Study Charges Overbilling

On the other side of the MA debate, a physicians’ group is charging that MA providers are overbilling. According to a recent study by Physicians for a National Health Program (PNHP), a Chicago-based group advocating for a single-payer health system, Medicare overpaid private carriers $282 billion between 1985 and 2012. The group studied payments to Medicare Advantage insurers and predecessors.

The PNHP study claims that managed care has resulted in excessive billing to Medicare that pays private insurers based on estimated annual costs per patient, which was around $10,000 in 2012. But the study’s authors assert that the insurers have consistently found ways to game the system, including:

* The selective enrollment of healthier beneficiaries before 2004, or what PNHP calls “old cherry-picking.” Under the previous payment formula that was in effect until 2004, Medicare paid private plans a premium that was risk-adjusted only for a few demographic factors, such as age, gender, disability, Medicaid eligibility (a proxy for poverty), and whether an enrollee resided in a nursing home. Hence a healthy 70-year-old man would be charged the same premium as his sicker 70-year-old neighbor. Private plans used marketing, benefit design, enrollment office location, and other techniques to recruit the healthier and discourage  the sicker seniors from enrolling.
* Gaming of Medicare’s more complex risk-adjustment scheme, known as Hierarchical Condition Categories (HCCs). Since 2004, private plans have been selectively enrolling beneficiaries with very mild cases of the medical conditions included in the HCC risk-adjustment formula. Such patients have, on average, substantially lower costs than the risk-adjusted premium payment that Traditional Medicare pays the private plan on their behalf. PNHP refers to this as “new cherry-picking.”
* Congressionally mandated overpayments included in the 2003 Medicare Modernization Act (MMA), such as duplicate payments for indirect medical education. The provisions that generated these overpayments were tacked onto the MMA after heavy lobbying by the private insurance industry.
* Bonus payments from the $8.3 billion CMS Medicare Advantage Quality Bonus Payment Demonstration, an expansion of the $3 billion in quality bonuses contained in the Affordable Care Act (ACA). This demonstration awards bonuses to plans covering more than 90 percent of MA beneficiaries and offsets more than one-third of the cuts to MA overpayments mandated by the ACA between 2012 and 2014. According to the GAO, the demonstration is so poorly designed that it will generate almost no useful findings to improve quality.
* Duplicate payments for private plan members who receive all or part of their care at Veterans Health Administration facilities. Medicare pays the private plan a full premium payment no matter how much of a patient’s care is delivered (and paid for) by the Veterans Affairs (VA). In an extreme case, a senior might receive all care at a VA, making the premium given to the private plan pure profit. In 2009, 8.3 percent of all MA enrollees were enrolled in the VA.

How will the CMS act on the GAO and PNHP reports? Will it seek a further revision in its MA payment program? Or will it defer action indefinitely? At the very least, the Department of Health and Human Services Office of Inspector General should examine the payments and provide another level of oversight.

If government auditors verify the PNHP’s claims, it may undermine calls to further privatize the system. What if insurers are deliberately recruiting younger, healthier recipients into their plans? How then do MA beneficiaries compare to the general Medicare population? What do these MA plans spend on marketing?

Given the growing toxic environment in Washington and the fact that MA has become a political football, it’s unlikely t
hat the CMS or Congress will act before the 2014 elections, delaying a closer look.

John Wasik writes for The Medicare NewsGroup.

http://medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/05/21/does-medicare-overpay-private-plans-the-debate-heats-up

Evolving Role of Emergency Departments

The Evolving Role of Emergency Departments in the United States

By Kristy Gonzalez Morganti, Sebastian Bauhoff, Janice C. Blanchard, Mahshid Abir, Neema Iyer, Alexandria Smith, Joseph V. Vesely, Edward Okeke, Arthur L. Kellermann
RAND Health, May 20, 2013

To develop a more complete picture of how EDs (emergency departments) contribute to our modern health care system, the Emergency Medicine Action Fund asked RAND to conduct this mixed-methods study.

Key findings include the following:

• Between 2003 and 2009, inpatient admissions to U.S. hospitals grew at a slower rate than the population overall. However, nearly all of the growth in admissions was due to a 17 percent increase in unscheduled inpatient admissions from EDs. This growth in ED admissions more than offset a 10 percent decrease in admissions from doctors’ offices and other outpatient settings. This pattern suggests that office-based physicians are directing to EDs some of the patients they previously admitted to the hospital.

• In addition to serving as an increasingly important portal of hospital admissions, EDs support primary care practices by performing complex diagnostic workups and handling overflow, after-hours, and weekend demand for care. Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves.

• As a result of these shifts in practice, emergency physicians are increasingly serving as the major decisionmaker for approximately half of all hospital admissions in the United States. This role has important financial implications, not only because admissions generate the bulk of facility revenue for hospitals, but also because inpatient care accounts for 31 percent of national health care spending.

• Although the core role of EDs is to evaluate and stabilize seriously ill and injured patients, the vast majority of patients who seek care in an ED walk in the front door and leave the same way. Data from the Community Tracking Study indicate that most ambulatory patients do not use EDs for the sake of convenience. Rather, they seek care in EDs because they perceive no viable alternative exists, or because a health care provider sent them there.

• Medicare accounts for more inpatient admissions from EDs than any other payer. To gain insight into whether care coordination makes a difference in the likelihood of hospital admission from an ED, we compared ED admission rates among Medicare beneficiaries enrolled in a Medicare Choice plan versus beneficiaries enrolled in Medicare fee-for-service (FFS). We found no clear effect on inpatient admissions overall, or on a subset of admissions involving conditions that might be considered “judgment calls.”

• Irrespective of the impact of care coordination, EDs may be playing a constructive role in constraining the growth of inpatient admissions. Although the number of non-elective ED admissions has increased substantially over the past decade, inpatient admissions of ED patients with “potentially preventable admissions” (as defined by the Agency for Healthcare Research and Quality) are flat over this time interval.

Our study indicates that: (1) EDs have become an important source of admissions for American hospitals; (2) EDs are being used with increasing frequency to conduct complex diagnostic workups of patients with worrisome symptoms; (3) Despite recent efforts to strengthen primary care, the principal reason patients visit EDs for non-emergent outpatient care is lack of timely options elsewhere; and (4) EDs may be playing a constructive role in preventing some hospital admissions, particularly those involving patients with an ambulatory care sensitive condition. Policymakers, third party payers, and the public should be aware of the various ways EDs meet the health care needs of the communities they serve and support the efforts of ED providers to more effectively integrate ED operations into both inpatient and outpatient care.

http://www.rand.org/pubs/research_reports/RR280.html

Comment:

By Don McCanne, M.D.

This RAND Health report provides an excellent perspective on how emergency departments (EDs) have evolved into institutions providing a greater central role in health care delivery. It is a particularly valuable report because it sets aside many misperceptions about ED functions – misperceptions that can lead to flawed policy recommendations.

It is crucial that we continue to assess and recommend improvements in the health care delivery system. This report reflects the benefit of such an approach since EDs have expanded their roles in very beneficial ways. As they continue to evolve, integration with both inpatient and outpatient care should become more efficient, especially from the perspective of benefiting patients.

The current focus of policy reform seems to be not so much on the improvement of health care delivery, but rather on mechanisms that supposedly would slow the growth in health care spending. Accountable care organizations, bundling of payments, innovative insurance designs such as those that erect financial barriers to care, are the types of policy approaches that will have very little impact on overall costs while inappropriately expanding the administrative excesses of our dysfunctional system.

This report is well worth downloading. As you read it, you can see many opportunities to further expand the progress that we have seen through the evolving improvements in the role of EDs in our health care system. Thinking about how further improvement in integrating their role with both inpatient and various community outpatient services can help us envision further opportunities to achieve the goals of a high-performance system.

An example of the misguided and misdirected emphasis on innovative payment reform is the failure to find any clear effect on inpatient admissions when comparing the public Medicare program with the much more expensive private Medicare Advantage plans. Payment innovation is simply not where it’s at.

We need to get this right. Let’s continue to work on fixing the health care delivery system so that it works best for patients. That is the key to improving value in health care. It will work as long as we adopt a financing system that is designed exclusively to fund a high-performance health care system (single payer), as opposed to one that is designed to keep policy wonks and insurance administrators employed in bringing us ever-expanding payment innovations that we don’t want (Obamacare).