PNHP

Connecticut Medicaid Prospers Post Capitated Managed Care

Connecticut Medicaid Prospers Post Capitated Managed Care

Summary: In 2012, advocates in Connecticut won a battle to switch from the predominant implementation model for Medicaid – capitated managed care organizations owned by usually for-profit private insurers – to fee-for-service care payments to providers with added resources to coordinate care. Removing profit-seeking intermediaries both lowered costs and raised quality of care.

How Connecticut Eliminated Capitated Managed Care in Medicaid, February 2019 talk (just released)

[W]hen the capitated managed care model rolled out, there were eleven MCOs, Managed Care Organizations. We were told that the state was going to save money by paying them 95% of what we would otherwise have paid for the same health services under Medicaid. You won’t be surprised that the managed care industry managed to convince the state not to reduce its fees, but to pay it 100% of current spending. And you’ll not be surprised to hear the industry said that actually it’s not getting enough, so it needs more money, even though the whole premise was that it’s going to save money. …

MCOs would say they’re going to coordinate care so that the state saves money, improves access to care, and thus improves the quality of care.

However, in practice, what we saw constantly was routine lack of access to services. It was horrendous in the case of behavioral health, where kids who had been abused would be told they get a limited number of sessions and, if their provider was willing, they could beg for more. …

The federal Medicaid statute offers an alternative type of managed care that doesn’t involve capitation [of health care services] at all. It’s called Primary Care Case Management. What this means is the state pays primary care providers extra to manage care. …

[I]n early 2011, Governor Malloy announced that he was going to show the door to the MCOs and adopt some form of Primary Care Case Management, using primary care providers to coordinate care, and also contract with a non-risk Administrative Service Organization (ASO) … Connecticut chose a non-profit entity, Community Health Network of Connecticut, to take on that role …. [Specialized ASOs were contracted with for dental and behavioral health services.]

[F]ast forward to where we are today. … Connecticut Medicaid member per month costs are down 14% from $706 in the first quarter of 2012 to $610 in the first quarter of 2018. So, that’s six years, and the costs went down. As a result, Connecticut, which is one of the highest health care cost states in the country — our per-enrollment costs had been the 9th highest, now they’re 22nd. …

The other question is, how much of those total costs are actually going to health care? As we all know, there are huge administrative costs that go into the private risk-based insurance system. When we had managed care companies, it was hard to get the data, but we found routinely 20%, even 25% or higher administrative overhead. We actually saw about 40% at one point for administrative costs for one of the plans, under the CHIP program. Based upon the data that has been available now for a few years, we have done really well on both the total costs and the medical loss ratio, which is now about 96.5% [97% as of 2021]. Only 3.5 cents on the dollar goes to administrative costs, paying for the ASO and the state’s own administrative costs. The rest is all going to health care. So it’s a win-win in terms of the cost and where the money goes.

We really care about quality, about access to care. The data there is pretty good as well. Some really basic stuff like significant increases in preventive care, 16.3% from 2015 to 2017, hospital admissions per thousand down 6.29%, readmissions down 3.52%.

There are several reasons, but one of them is the use of patient-centered medical homes. Close to half of our Medicaid population is now attributed to accredited patient-centered medical homes. They have the infrastructure for adequately coordinating care so people don’t end up in the hospital, and they provide routine care and the child visits and screenings and so on. Under the new system, the state has the data on what is being done and doesn’t have to beg an insurance company to give them the data.

Comment:

By Jim Kahn, M.D., M.P.H.

The transformation of Connecticut Medicaid from the main implementation model (capitated for-profit managed care plans) to fee-for-service with enhanced support for care coordination is incredibly important. It demonstrates the greater efficiency (14% drop in per-person costs 2012-18 while Medicaid as a whole rose 10%) and higher quality of care achieved with payment directly to providers. Strong performance continued through the latest data (FY 2020).

This experience demolishes the myth that commercial insurers can magically reduce costs and raise quality while extracting huge profits. And it serves as an object lesson in how committed and resourceful advocates can overcome the influence of corporate money in order to advance the proper purposes of public funds for health care.

Two evaluations favorably review this experience – from Harvard Law School and the Connecticut Health Policy Project. For more information, contact Sheldon Toubman, sheldon.toubman@gmail.com.

Recently I complained about “Medicaid News Noise.” This isn’t more noise – it’s revelatory. The truly impressive Connecticut Medicaid story should inspire similar broad reforms in other states, and ultimately inform provider payment under single payer.

http://healthjusticemonitor.org…

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It’s time to surgically remove the middle man

By Jay D. Brock, M.D.
Fredericksburg (Va.) Free Lance Star, March 24, 2022

“It is well known what a middleman is: he is a man who bamboozles one party and plunders the other.”

Benjamin Disraeli’s remark from the 19th century nails it when it comes to describing the American for-profit health insurance industry and the broken multiple-payer health insurance system that is based on that industry. The system plunders the people, who face continually skyrocketing health care costs and restrictive insurance company rules when they try to get their health care; and, with its immense financial power the industry bamboozles the politicians who make the rules that favor the industry rather than our health care and health.

Defined as “intermediaries between two parties”—in this instance the entity standing between patients and their health care—middlemen have long been the target of much scorn because they charge a price for services that frequently add no significant value for what they do.

And with the for-profit American health insurance industry, what a price it is that we all pay—not just to the industry, with its yearly profits in the tens of billions of health care dollars—but in the overall costs of what it takes to accommodate a health insurance system based on that industry.

What are those costs? Start with this gem. According to a 2020 paper in The Annals of Internal Medicine, we waste 600 billion health care dollars each year just on administrative costs compared with what it would cost to run a Canadian-style single-payer system. Those 600 billion health care dollars are spent on building a bigger medical bureaucracy rather than on our health care. That figure does not include the untold other tens of billions of health care dollars wasted on marketing, overhead, excessive pharmaceutical costs, and profit (nearly $36 billion for the health insurance industry alone in 2019), costs that are essential to our current system at the expense of our health care.

To further highlight the scale of wasted dollars built into our current system, a 2020 Yale School of Public Health study published in The Lancet projects that under a government-funded, privately delivered single-payer system of health insurance, we could cover everyone with “first dollar coverage” (i.e., without those detested copays, deductibles, and other out-of-pocket costs that plague our current system) and save $450 billion (of the $4 trillion health care dollars we currently spend yearly). That study also states such a system would save 68,000 lives lost each year because, in the world’s wealthiest nation, so many of us are unable to afford timely medical care. If that doesn’t describe a failed system, nothing does.

That is a lot of waste, but waste that would be ended under an American single-payer system—where healthcare would be funded by public dollars and provided by the same privately based health care delivery system we have now. Polls show that 7 out of 10 Americans support such a system. So do 6 in 10 physicians.

The response of most Washington politicians? Full speed ahead—with our current system. Despite its costs. Despite its huge gaps in coverage, including 40+ million underinsured—they can’t afford to use their insurance—and 30 million who have no insurance.

Rather than transitioning to a new system such as one based on the single-payer concept, which even some reluctant politicians admit would be the right thing to do if we were starting from scratch, the intent of most politicians in Washington now is either to do no reform at all, or just incremental change. That means perpetuating the current system despite all its weaknesses.

Some politicians want a public option, which would just add one more layer to an onion that already has too many, and without eliminating any of the waste. Others say, let’s build on Obamacare—but subsidizing its costly premiums is already taking too many health care dollars, and its out-of-pocket costs are still unaffordable for too many. Ditto for too many folks on commercial insurance: “What good is insurance one can’t afford to use?” is a question many politicians apparently don’t bother to ask. Similarly, others are loathe to change a system where they say their constituents like their plans—but how popular can those plans really be where last year two-thirds of Americans said they worried how they could afford to pay medical bills?

Given the growing support of Americans—and their physicians—for a publicly funded, privately delivered single-payer system, people are clearly fed up with a health insurance system that has failed to make health care both universal and affordable. Americans are tired of being plundered by a system that doesn’t work for them. Now it’s time for our elected officials to stop being bamboozled and vote for real reform that puts people first: a single-payer system that works.

https://fredericksburg.com…

Seniors’ Medicare Benefits Are Being Privatized Without Consent

The Biden administration is expanding a Trump scheme that is forcing hundreds of thousands of seniors onto for-profit health plans.

By Matthew Cunningham-Cook
The Lever, March 24, 2022

A new Medicare privatization scheme developed under President Donald Trump and now being expanded under President Joe Biden is forcing hundreds of thousands of seniors onto new private Medicare plans without their consent.

The development represents a troubling new dimension in the fight by corporate interests to privatize Medicare, the federal health insurance program for people 65 or older. Medicare Advantage, which allows for-profit health insurers to offer privatized benefits through Medicare, already results in unexpected costs for routine procedures and wrongful denials of care. Private plans have cost Medicare an astonishing $143 billion since 2008, and are now driving some health insurers’ record profits.

The new Direct Contracting Entity (DCE) program similarly adds a private-sector third party between patients and Medicare services. Medicare allows these intermediary companies to offer unique benefits, like gym membership coverage. But as for-profit operations ranging from private insurers to publicly traded companies to private equity firms, these intermediaries are incentivized to limit the care that patients receive, especially when they are very sick.

While Medicare Advantage patients choose to sign up for private insurance plans, patients are being enrolled in these DCE health care plans without their informed consent. As Rep. Pramila Jayapal (D-Wash.) noted in a January op-ed, “Seniors in traditional Medicare may be ‘auto-aligned’ to a DCE if any primary care physician they’ve visited in the past two years is affiliated with that DCE. That means Medicare automatically searches two years of seniors’ claims history without their full consent to find any visits with a participating DCE provider as the basis for enrollment.”

Among those who unexpectedly found themselves caught up in one of these new DCE plans is Suzanne Gordon, a policy analyst based in Richmond, California. Gordon spent her entire professional career studying the U.S. health care system and advocating for Medicare for All. As a firm opponent of privatization in Medicare, she has never signed up for a for-profit Medicare Advantage plan.

That’s why she was so surprised when she got an email in January from her doctor at One Medical, a for-profit primary care practice on the West Coast backed by the private equity giant Carlyle Group. While the email message wasn’t particularly clear, she eventually realized that she was being enrolled without her informed consent in a new private DCE plan run by Iora Health, a primary care provider One Medical purchased last year.

“I got the email, I clicked on it and began a signing process that didn’t tell me what I was signing,” said Gordon. “You sign, you click in, and they tell you that they want you to sign up for a DCE with Iora Health. I wrote back to my doc and said I won’t do this… I felt that a line had been crossed.”

Gordon, a health policy expert, was able to get out of the plan — but others have not been so lucky. Rep. Pramila Jayapal’s (D-Wash.) office told The Lever that 350,000 seniors were in DCE plans as of January 2022 — none of whom elected to sign up voluntarily.

This latest Medicare privatization scheme was started under the leadership of a Trump official who has since launched his own “entrepreneurial firm focused on building and growing transformational health care companies,” with support from private equity firms. Now, the effort is quietly being expanded by the Biden administration through its new ACO REACH program, under the direction of two former Obama administration officials who have revolved between jobs in government and the corporate health care industry.

The development means that even more of the country’s most vulnerable will be at the mercy of corporate arbiters that they know little or nothing about.

“Seniors and people with disabilities are, without their consent or full knowledge, being put into a program that has as its center the profit of the investment community rather than the health of Medicare members,” said Ed Weisbart, a physician who chairs the Missouri chapter of Physicians for a National Health Program (PNHP), a doctors organization that advocates for single-payer health care. “The investment community has proven that they know how to work around the guardrails of any program that has been set up. They know how to do it.”

Privatizing Medicare

The DCE program was originally launched in April 2019 by Trump’s Centers for Medicare and Medicaid Services (CMS), under the auspices of the CMS Innovation Center, known as CMMI.

CMMI was created under President Barack Obama’s signature health care law, the Affordable Care Act (ACA), to pilot new payment models in Medicare and Medicaid without going through the formal rulemaking process that requires public comment. As a result, the new DCE program, which assigns seniors to a privatized model without their consent, has never been subject to any public scrutiny whatsoever.

“All that DCEs do is privatize traditional Medicare,” said Diane Archer, the CEO of Just Care USA, which works to fight Medicare privatization.

Meanwhile, Adam Boehler, who Trump tapped to run CMS’ Innovation Center, has since formed his own firm, Rubicon Founders. The firm’s website claims it will “architect transformational companies and are deliberate in creating the foundation necessary to lead an industry,” but provides few details on how it will do so. Rubicon did not respond to a request for comment.

Boehler’s firm launched with the backing of longtime private equity executive Annie Lamont, who is married to Connecticut Gov. Ned Lamont (D), as well as support from the health care-focused private equity firm Welsh, Carson, Anderson & Stowe (WCAS). WCAS is developing a series of primary care centers for Medicare Advantage patients with the help of Humana, a private health insurer that has also launched a DCE program.

For Archer, the evidence is clear: “Adam Boehler… launched this [DCE] program to enrich his friends in the private equity world.”

“We Needed To Make Sure That CMS Continues This Journey”

Late last month, critics of DCEs say the Biden administration effectively expanded the DCE effort under a new name — the “ACO REACH” program.

The new program — which stands for Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model — allows hospital-led managed care organizations to access the new Medicare privatization scheme, too. ACO REACH similarly assigns patients with little informed consent to for-profit plans that benefit health care profiteers and creates incentives to deny care.

The DCE and ACO REACH programs are being spearheaded in part by CMMI head Liz Fowler, a former Obama administration official who helped write Obama’s signature health care act as the chief health counsel to former U.S. Senate Finance Committee Chairman Max Baucus (D-Mont.). Earlier, she helped write the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, legislation that barred the government from negotiating lower prescription drug prices.

Fowler served as vice president of public policy for the health insurer Wellpoint, now part of Anthem, before moving to Baucus’ office. She later became a health care aide in the Obama administration, before spending nearly seven years as a vice president for pharmaceutical giant Johnson & Johnson.

Neither Anthem nor Johnson & Johnson are currently active in the DCE market. But considering other major insurers like Humana are pursuing DCE contracts, and that Anthem already offers Medicare Advantage plans, it is conceivable that these insurance giants could get into the business at some point in the future.

In a February 24 press call announcing ACO REACH, CMS Administrator Jonathan Blum said that the Biden administration had always been committed to continuing with the DCE program.

“We want to make sure that we see these programs as continuing to grow… we have had many conversations with the public and with stakeholders that started with the new CMS team coming on board,” said Blum. “We have felt from the start that we needed to make sure that CMS continues this journey.”

Blum served as the deputy administrator and later principal deputy administrator of CMS under Obama, before joining CareFirst BlueCross BlueShield as an executive vice president, according to Legistorm.

Fowler and Blum’s boss, CMS administrator Chiquita Brooks-Lasure, is a former health care partner at Manatt, Phelps & Phillips, a lobbying firm that worked to launch Medicare Advantage plans as recently as 2020.

Manatt, Phelps & Phillips also played an integral role in reducing fines for nursing home violations in California by as much as 99.9 percent in the middle of the COVID-19 pandemic.

The agency declined requests for comment.

A Dangerous New Stage Of Medicare Privatization

Kip Sullivan, an attorney who is active with Physicians for a National Healthcare Program, said that the DCE program relies on ensuring that elderly or disabled patients don’t have an informed choice about enrolling in the private health care plans.

“Seniors have been swept into DCEs without their knowledge,” he said. “Many — probably most — beneficiaries are in traditional Medicare as opposed to Medicare Advantage because they did not want to be in a plan run by an insurer.”

Sullivan pointed out that the publicly traded DCEs, like Oak Street Health, brag in investor filings that between 13 and 30 percent of the money they get from Medicare goes into profits. By comparison, according to Sullivan, traditional Medicare plans have overhead of just 2 percent.

“When Medicare passed in 1965, there was never an intention to enrich the insurance industry,” he said. “But that’s exactly what’s happening.”

Weisbart, from the Missouri chapter of PNHP, is especially concerned that the Medicare and Medicaid agency “does not need to get congressional consent, discussion or approval for any of these programs. They’re able to do it on their own.”

Under Trump, the agency even issued a waiver that exempts DCE programs from anti-kickback rules that normally prohibit doctors from entering their patients into such for-profit plans. As a result, doctors can be compensated for involuntarily entering their patients into DCE programs.

In recent months, advocates have been waging a full-court campaign against the DCE scheme. In January, 54 members of the House submitted a letter voicing similar concerns to Health and Human Services Secretary Xavier Becerra and CMS Administrator Brooks-Lasure.

What then, explains the Biden administration’s recent decision to expand the program?

As always in our campaign finance system, money could play a role. In 2020, the leadership of DCE contractor Clover Health donated $500,000 to the main super PAC for Senate Democrats, while the company’s financier Chamath Palihapitiya donated $750,000 to the same super PAC plus $250,000 to the Biden Victory Fund.

One Medical — which employed Suzanne Gordon’s doctor and owns Iora Health, the company that tried to enroll her in a DCE -— is backed by the Carlyle Group, a prodigious donor to both parties. Biden enjoyed Thanksgiving dinner last year at the $30 million Nantucket home of Carlyle co-founder David Rubenstein.

Bill Kadereit, the President of the National Retiree Legislative Network, said that the DCE program could usher in a dangerous new stage of Medicare privatization.

“Medicare Advantage plans have failed,” he said. “Privatization has failed. The cost of Medicare is doubling every ten years because of the health care sector campaign contributions. We’re seeing the disassembly and destruction of our precious public health system. Every place where the profiteers have stepped in costs have gone up and health outcomes have gone down.”

https://www.levernews.com…

Medicaid News Noise

Summary: Scanning the Google news feed about Medicaid on any random day reveals scores of articles on a wide range of topics: from fraud to waitlists, from eligibility to funding, and on and on. This is complex, overwhelming, and unjust. It would disappear with single payer.

Google News search “Medicaid” 21Mar2022:

  • TennCare prepares to expand dental benefits, but only 1 in 3 dentists accepts reduced payments
  • Missouri struggles with Medicaid coverage
  • Lawmakers need to know the difference Medicaid makes for Idaho families and our communities
  • Telehealth Utilization Increasing Medicaid Provider Reimbursement
  • California to eliminate Medicaid waitlists through assisted living waiver
  • Obamacare Medicaid Expansion Is Boosting Economic Health
  • Jury acquits men of all counts in Medicaid fraud case
  • Medicaid and Racial Health Equity
  • Op-ed: Medicaid budget proposal would jeopardize care for New York’s most vulnerable
  • Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey
  • Illinois Sets Aside $66 Million for Medicaid Innovation Collaborative
  • Mississippi could renew push to extend Medicaid for new moms
  • Analysis: A health care problem too big for the Texas Legislature
  • Kentucky House quickly advances bill putting tighter rules on food benefits, Medicaid
  • Political Notebook: Medicaid expansion looks promising in North Carolina, Rep. Sasser says –
  • CMS Releases Updated Guidance on Medicaid Eligibility and Redeterminations
  • Johnson County Mental Health Center highlights Medicaid expansion during advocacy day in
  • Physician venture investor talks telehealth, digital therapeutics, Medicaid tech
  • Counselor Sentenced to Federal Prison for Wide-Ranging Medicaid Fraud Scheme
  • CMS releases Medicaid DSH allotments
  • Ohio Medicaid preaches transparency, withholds watchdog reports
  • Congress Includes Medicare, Medicaid, Other Health Policies in Omnibus FY 2022 Spending Bill
  • Amid a renewed push, vaccine uptake is still lagging among Virginia Medicaid members
  • Arizona to resume disenrolling people from Medicaid program
  • When parents get Medicaid, it can benefit the health of their kids too
  • MACPAC releases Medicaid, CHIP report: 3 things to know
  • Expand Medicaid Now – Henry County Times
  • Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency
  • How Medicaid enrollment in Missouri can disrupt the cycle of incarceration
  • Medicaid funds mired in red tape for people with disabilities
  • Using Medicaid to Fund More Mental Health Supports for Schools
  • Fact-checking Nikki Fried’s claim about Florida’s Medicaid funding
  • Stacey Abrams makes a personal case for Medicaid expansion
  • Oregon embarks on ‘bridge’ health insurance plan for people facing Medicaid expansion sunset
  • Lawmaker Takes Aim at 1960s Law That Blocks Medicaid Funds for Psych Care
  • 4 Ways That 1115 Medicaid Demonstrations Can Address Health Equity
  • A New Era In The Fight Over Medicaid Premiums
  • Oregon Medicaid proposal includes kids-under-6 rule change, services for some inmates
  • Diagnosis for 3.21.22: Checking the pulse of Florida health care news and policy
  • Anthem sues former executive, alleging he divulged Medicaid secret
  • Medicaid Income Limits and Spending By State
  • Top Benefits, Challenges of NC Medicaid Managed Care Model
  • CMS seeks feedback on addressing access, equity in Medicaid and CHIP
  • Is Medicaid a state and federal partnership?
  • Stable and Continuous Coverage Provisions in Medicaid Gain Momentum Through Build Back Better Act
  • Improper Medicaid payments expand after ObamaCare and pandemic, studies find
  • Bradley Ledgerwood might lose vital Medicaid insurance to manage his cerebral palsy
  • Florida lawmakers pass Medicaid plan
  • State Lawmakers Formed a New Committee to Explore Medicaid Expansion
  • Schapiro’s Medicaid dental bill continues to advance
  • Missouri takes months to process Medicaid applications—longer than law allows
  • End of Public Health Emergency Triggers End to Medicare, Medicaid Flexibilities
  • Illinois lawmakers propose expanding Medicaid
  • Medicaid work requirements proposed
  • Hospital leaders concerned as Florida lawmakers plan to cut Medicaid funding
  • Florida group targets Kansas welfare reform for food stamps, Medicaid

Comment:

By Jim Kahn, M.D., M.P.H.

It’s stunning how much energy we put into managing, modifying, and monitoring Medicaid, our largest health insurance program for the poor, which operates separately and differently in each state, with limited finances and ambivalent attitudes. And how much reporting there is on all this commotion.

For those who exploit health care for profit and resist real reform, this complexity isn’t a bug, it’s a feature. It’s confusing and overwhelming, distracting from serious discussion of how to replace our fundamentally flawed financing system.

With single payer, the word “Medicaid” would disappear into the archives of history. The blizzard of press coverage about it would disappear too.

Indeed, the expression “health insurance program for the poor” would no longer have a meaning.

That’s what I call “equity.”

http://healthjusticemonitor.org…

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Why doctors have stood against universal health care — and why that could be changing

Call-in program with Dr. Clifford Marks

WDET, Detroit Today, March 22, 2022

Many in this country struggle to understand their health care plan, and feel they don’t have much agency in choosing it. The United States has a patchwork of plans that contributes to more spending on health care than any other developed nation. And yet, many influential and powerful people advocate against single-payer health care.

For many years, the American Medical Association has been that kind of institution as it helped wreck former President Harry Truman’s 1950s universal health care bill that otherwise had majority support from Americans. But in recent years, the association has been showing signs that it may be changing its tune.

Dr. Clifford Marks is an emergency-medicine resident at Mount Sinai Hospital in New York. He recently wrote a piece in The New Yorker about a younger generation of doctors that are advocating for universal health care coverage.

He says younger physicians have to contest with large industries, including pharmaceutical companies, hospital systems and insurance systems, which are all difficult to navigate.

“When you have to slog through pre-authorizations, suddenly single-payer health care, I think, seems a lot more appealing,” says Marks.

Longtime PNHP member Dr. Peter Orris calls in to the program at 13:43, and a graduating fourth-year medical student named Ryan calls in to the program at 34:07.

https://wdet.org…

Do Super PACs Pack a Punch for Single Payer?

Summary: Despite majority support, single payer faces huge political obstacles. In response, Joseph Q. Jarvis, a longstanding family and public health physician, proposes a political tool: a Super PAC, a political action committee which raises money from varied donors to advocate on an issue, without coordinating with parties or candidates.

American Health Security Project, Website for Super PAC

No matter who you are, where you are from, what you believe, how old you are, or what your work status is, if you live in the United States you and your family should be guaranteed to receive medically necessary care when sick or injured, without worrying about how to pay for it. …

We pay twice as much as any other developed nation for health care, yet we have the worst health of them all. And while we pay the highest taxes for health care in the world, tens of thousands of Americans die each year from treatable illness merely because they can’t afford medical care.

FAQs:

What are the goals of the American Health Security Project?

  • The AHSP is determined to get legislation passed that is Universal and removes all financial barriers from seeking care.
  • This legislation must create a system that is non-profit, publicly-funded healthcare.
  • The system must include comprehensive coverage with essential benefits such as dental, vision, audiology, and mental health services.

Does the American Health Security Project support Medicare for All?

Absolutely. Medicare for All, a single payer system, is the goal of the AHSP.

Why a Super PAC?

For too long healthcare advocates have been at a disadvantage. For-profit insurers and pharmaceutical companies have the ability through Super PACs to pour millions into fighting against Medicare for All and State-Based universal healthcare bills. It is overdue that we level the playing field.

Tell Sec Becerra to Support Granting Federal Waivers to Streamline State Healthcare Expansion, Sponsored by American Health Security Project, The Action Network. March 19, 2022

Sign this petition to Xavier Becerra (Secretary of the Department of Health and Human Services) asking him to publicly state his support of federal funding for state-based single payer healthcare and commit to approving the waivers that would streamline state healthcare expansion. While states can fund these programs via taxes, the federal government’s assistance would ensure success, even in states with limited revenue.

While we push for Medicare for All, we also encourage states to expand coverage to their residents via legislation and ballot measures. Throughout our nation’s history, our states have served as the incubators of democratic ideas. Our neighbors in Canada established their own successful national health program by allowing the province of Saskatchewan to lead with a universal hospital care program in 1947, a decade before the plan took hold nationwide.

The American Health Security Project and our allied sponsors of this action, ask you to sign this petition to Xavier Becerra asking him commit to approving waivers in states like California, Maine, Washington, New York and the many other states with active single payer legislation!

Comment:

By Jim Kahn, M.D., M.P.H.

Let’s be honest: the electoral / legislative politics of the US are stacked against single payer. Too many dollars flow to politicians from those who benefit from the current profit-extracting non-system of paying for and delivering healthcare. Our fight for single payer takes many forms, including grassroots organizing, education, writing (to wit, HJM), and research. We retain popular support for single payer, but lose critical battles. Meanwhile, health insurance and providers are increasingly controlled by private for-profit entities. The short-term political prospects are daunting.

Would a meet-fire-with-fire approach help break the logjam? Joseph Q. Jarvis (physician and author of “The Purple World: Healing the Harm in American Health Care”) believes so. He has launched the “American Health Security Project” (AHSP) in order to use a within-the-system political organizing tool (a Super PAC) in support of a replace-the-system solution (single payer).

You can read about AHSP in his op-ed in The Salt Lake Tribune, Support the American Health Security Project. I didn’t excerpt this above because it elides mention of the single payer goal of AHSP. Jarvis takes inspiration from John McCain, for whom the ACA owes its survival, but not a single payer proponent. Jarvis wrote in the op-ed, “Those of us who are trying to change how Americans do health care business must recognize that health system reform is about politics. No amount of education or marching to the draw attention to the plight of American patients will change the grip of the medical industrial complex on business as usual in American health care. Health system reform … is a power grab …”

The unambiguous support of AHSP for single payer is expressed on its website and in the letter to Sec. Becerra. I welcome that clarity.

I’m not a political tactician, but don’t believe that anyone has figured out the surefire political path to single payer (more on state vs. national efforts in a few days). I hope that AHSP gains traction as one piece of the puzzle, growing the breadth and strength of the single payer movement.

http://healthjusticemonitor.org…

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Medical Debt Multi-Generational Affliction

Summary: Medical debt is common and iatrogenic*, induced by un- and under-insurance. A new survey confirms that it has serious consequences, most of all for mid-life and younger demographics: Gen X (born 1965-80), Millennials (1981-96), and Gen Z (1997-2012). Boomers and the Silent Generation also feel its effects.

* Iatrogenic: Illness caused by medical interventions.

See Update below.

One in Four Gen Z, Millennials Skip Rent or Mortgage Due to Medical Debt: Survey, HealthCare.com, March 15, 2022, by Dan Grunebaum

HealthCare.com’s 2022 Medical Debt Survey shows about one in four Gen Zers and Millennials with medical debt skipped rent or mortgage payments because of their debt.

Close to half of Millennials and Gen Xers with medical debt say the debt harmed their credit score.

Two in three Gen Zers who have health insurance but still incurred medical debt say their health insurance plan didn’t cover the service they received.

More than half of U.S. adults with incomes below $25,000 and medical debt had their bills sent to debt collectors.

Comment:

By Don McCanne, M.D.

Because of the nation’s refusal to replace our fragmented, inequitable system of health care financing with a universal, comprehensive, equitable single payer system, it is inevitable that many individuals will face problems when they are unable to pay their medical bills. This survey describes some of those problems.

Perhaps one of the more alarming is the need to skip rent or mortgage payments thereby threatening their housing. This is a major consequence when you consider that a well-designed, universal, single payer system would totally remove the threat to housing caused by medical debt.

Some of the other risks are the obvious: damaged credit score decreasing flexibility in the marketplace, being hounded by debt collectors, decreased ability to build capital reserves for purposes such as retirement. In other words, screwed up credit merely because of the misfortune of having medical problems in a nation that has still declined to adopt a truly universal, comprehensive, equitable, progressively funded, health care financing system that we all could afford.

How can we tolerate seeing people evicted from their homes merely because of having faced medical misfortune for which our current health care financing system will not guarantee coverage? We can fix that.

Update:

By Jim Kahn, M.D., M.P.H.

This just in: credit agencies have agreed to remove paid medical debt from credit reports, thus not using it to lower credit ratings. But that doesn’t prevent the problems described in today’s post. Indeed, unpaid medical debt, and rent and credit card bills not paid due to paying off medical debts, *will* hurt credit scores. We can’t fix this broken system with band-aids.

http://healthjusticemonitor.org…

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Medicaid Coverage Turmoil as COVID Pandemic Eases

Summary: With federal protections for Medicaid coverage during the public health emergency winding down, states are aiming for an orderly “redetermination” process. Translation: orderly ousting from public insurance. About 1 in 8 individuals with Medicaid coverage will lose it, up to 1 in 3 in some states, often due to process problems. This is a double whammy – administrative burden that worsens access to care. Instead, we need lifelong, universal, equitable coverage.

Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey, Kaiser Family Foundation, March 16, 2022, by Tricia Brooks et al.

Executive Summary: Enrollment in Medicaid has grown significantly during the coronavirus pandemic. Provisions in the Families First Coronavirus Response Act (FFCRA) require states to provide continuous coverage for Medicaid enrollees until the end of the month in which the public health emergency (PHE) ends in order to receive enhanced federal funding. Continuous enrollment has helped to preserve coverage and halted Medicaid churn. However, when the PHE ends, states will begin processing redeterminations and millions of people could lose coverage if they are no longer eligible or face administrative barriers despite remaining eligible. Existing state enrollment and renewal procedures, as well as their approaches to the unwinding of the continuous enrollment requirement, will have major implications for Medicaid enrollment and broader coverage. …

In 20 states able to report, it is estimated that about 13% of Medicaid enrollees will be disenrolled when the continuous enrollment requirement ends. However, the estimates range widely across reporting states from about 8% to over 30% of total enrollees. Based on available data, most states report that an increase in income will be the primary reason for the disenrollments, but several states also expect incomplete renewals or missing documentation to be a primary reason for disenrollment. If these estimates hold true, millions of people will lose Medicaid coverage in the months following the end of the PHE; however, many children will likely be eligible for CHIP and many adults will likely be eligible for Marketplace or other coverage. Successfully transitioning these individuals into those other coverage options could reduce the number who lose coverage altogether and become uninsured.

Comment:

By Jim Kahn, M.D., M.P.H.

One thing we did right on health insurance during the COVID pandemic is to provide continuous coverage for Medicaid participants. That is, don’t remove the poor and near-poor from public health insurance during a public health emergency.

Now that the crisis is easing, we can return to business as usual. Which means:

— Spend a huge amount of effort and money to review eligibility, so if someone is again working (often at a low paying job without health insurance), take away their Medicaid.

— In the process, many people who still do qualify for Medicaid will lose coverage for bureaucratic reasons – missed process steps, not lack of eligibility.

— Net effect: reduced access to care and resulting illness, bankruptcies, and deaths.

Why do we torture ourselves with these burdensome and inhumane systems, when we could cover everyone with high quality insurance for their full lifetimes, while saving money?

Our system is operating with cumbersome rules and indefensible values.

The solution is … yes, you guessed it … single payer. Generous, simple, affordable.

http://healthjusticemonitor.org…

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Medicare for All Explained Podcast: Episode 73

Some Survey Results on Why Having Health Insurance Doesn’t Mean Squat

March 15, 2022

Podcast host Joe Sparks discusses a recent survey on medical debt in the United States, which is a totally foreign concept to people in every other industrialized country. He describes the sacrifices that Americans make to pay for medically necessary care, adding that “the important thing to remember is that all of this economic pain and suffering is unnecessary.”

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Pharmacy Carve-Outs: How to Make Privatized Medicaid Even Worse

Summary: California recently inserted a private pharmacy benefits plan into Medi-Cal, despite evidence from other states that it adds costs. Thousands of patients have suffered medication gaps. All this makes no sense, if the goal is efficient, equitable, effective medical care.

Opinion: New Medi-Cal Rx Is Riddled with Problems, Hurting Those Who Need it Most, California Health Report, March 10, 2022, by Hector De La Torre

Despite warnings that the health of the state’s 14 million Medi-Cal beneficiaries would be threatened, on Jan. 1, the California Department of Health Care Services (DHCS) implemented Medi-Cal Rx, the questionable fee-for-service program that stripped pharmacy benefits from health plans and handed Medi-Cal prescription drug purchasing and distribution to a private, for-profit company. Now, a month into the new program, there are reports that thousands of Medi-Cal patients have been left without their medications for days or even weeks. Physicians are concerned that someone is going to die as a result of this flawed system. Remember, these are individuals in an already underfunded Medi-Cal system, and they are the same people who were disproportionately impacted by the COVID-19 pandemic.

As a former State Assembly member, I am appalled that DHCS moved forward with Medi-Cal Rx. Last November, I offered public comment expressing concerns about the system, versions of which had already failed in 10 other states. Those states expected cost savings, like those promised with Medi-Cal Rx, but they did not materialize. And in 2019, the Menges Group released a report that showed Medi-Cal pharmacy expenditures would jump more than 19 percent if California adopted a carve-out model.

Comment:

By Jim Kahn, M.D., M.P.H.

This policy looks like a classic but especially heinous example of corporate profit over all other considerations — notably health of public beneficiaries, and responsibly managing public funds.

Private Medi-Cal plans have their own serious problems. But adding a private medication plan is remarkable for insane counterproductive complexity layered on top of underlying dysfunction. It boggles the mind, after evidence from other states of serious problems with this strategy.

What could be the motivation? Here are some ideas:

  1. Brainwashed faith in the magic of privatization.
  2. Financial conflicts of interest, via campaign contributions and/or promises of jobs or other major monetary benefits.
  3. Advice from analysts or advisors who are brainwashed and/or financially conflicted.
  4. All of the above.

Time to switch cognitive and moral framework, to a “public good” approach – single payer.

Additional Comment:

By Don McCanne, M.D.

Our editor Jim has appropriately reinforced the outrage demonstrated by former State Assembly Member Hector De La Torre. When we have a severely malfunctioning health care financing system in dire need of replacement, society is resorting to a patchwork approach that not only is inadequate, but is moving us backwards from where we need to be as far as privatization is concerned. Serving private corporate interests at the cost of patient care is outrageous. Dare I say that it is time to consider judicious citizen action to redirect our public representatives in the direction of health justice for all?

http://healthjusticemonitor.org…

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