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Newsletter, "What's going On...", July 20, 2010

July 20, 2010


Drew Altman, President and CEO of the Kaiser Family Foundation, has a post this week reading in part “…..the fact of the matter is that they (conservatives) are winning more than even they may realize in the current health care equation. That's because the nature of health insurance itself is being redefined and moving gradually but seemingly inexorably in the direction conservatives have long advocated: more consumer "skin in the game" through higher patient deductibles. 

Item: In our recent survey of people in the non-group insurance market, we found that the average deductible for an individual policy is now $2,498, and for families it's $5,149. These are very high thresholds by any standard. Consider, for example, that a family with median income facing such a deductible would be spending almost 10% of their annual income just for their deductible before their insurance kicked in.”


In Great Britain, the new Conservative government, in office for three months, has undertaken a major restructuring of the National Health Service.  Its proponents believe the change is necessary to control cost, add efficiency and to improve quality.  Labor and unions see it as the first step toward privatization of the NHS.  In Britain ‘privatization’ of the National Health Service is as much of a political cuss word as ‘socialized medicine’ is in this country.


The Kaiser Health News: Federal Task Force On Preventive Care Faces New Challenge Under Health Law. For years, an obscure federal task force sifted through medical literature ranging from colonoscopies to fluoride treatment, ferreting out the best evidence for doctors to use in caring for their patients. But now its recommendations have new financial implications, raising the stakes for patients, physicians and others in the health care industry.  Under the new health care overhaul law, insurers will be required to pay fully for services that get an "A" or "B" recommendation from the U.S. Preventive Services Task Force, a volunteer group made up of primary care and public health experts. That's good news for patients, who will no longer face cost-sharing for these services, but it puts the group in the crosshairs of lobbyists and disease advocates eager to see their top priorities – including routine screening for Alzheimer’s disease, domestic violence, diabetes or HIV – become covered service.  The lobbying effort to influence the Task Force has already begun, is already intense.  More…


Sunday, the New York Times published an article: Insurers Push Plans Limiting Patient Choice of Doctors.


Wonkbook reports: “Massachusetts' hasn't managed to truly control health-care costs, writes Robert Samuelson: "State leaders have proved powerless to control these costs. Facing a tough reelection campaign, Gov. Deval Patrick effectively ordered his insurance commissioner to reject premium increases for small employers (50 workers or fewer) and individuals -- an unprecedented step. Commissioner Joseph Murphy then disallowed premium increases ranging from 7 percent to 34 percent. The insurers appealed; hearing examiners ruled Murphy's action illegal. Murphy has now settled with one insurer allowing premium increases, he says, of 7 to 11 percent."  It is no coincidence that Patrick is presenting himself as tough on insurance companies and that his major opponent is a former health insurance company CEO.


By contrast, Ezra Klein has what reads like a fair and balanced (I know, I know) assessment of the Massachusetts experience.  He concludes: “What we can say about Massachusetts now is pretty much what we've been able to say about Massachusetts since the early days of its implementation: It's been a successful attempt to expand coverage and reform the non-group market, and it was never an attempt to control costs. As such, costs in Massachusetts, much like costs nationally, are rising. Insofar as that contains lessons for the national effort, it's that we should stick to the law and make sure to implement the cost controls and delivery-system reforms.


Klein also has an interesting analysis of “Cost control and the ACA”


The New York Times reports: Health Plans Must Provide Some Tests at No Cost.   WASHINGTON — The White House on Wednesday issued new rules requiring health insurance companies to provide free coverage for dozens of screenings, laboratory tests and other types of preventive care.  The new requirements promise significant benefits for consumers — if they take advantage of the services that should now be more readily available and affordable.  In general, the government said, Americans use preventive services at about half the rate recommended by doctors and public health experts.  The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children. Other services that must be offered at no charge include counseling to help people stop smoking; screening and counseling for obesity; and tests for infection with the virus that causes AIDS.


Colorado made significant progress this past legislative session.  While there’s regret and sorrow that single payer legislation didn’t pass, Coloradans point to:


Encouraging health care providers to work in rural and medically underserved areas.  HB 1138 creates a Health Care Jobs for Colorado Program, a loan repayment system for those who choose to work in underserved communities.


HB 1021 requires insurance carriers to provide coverage for maternity care and contraception.  Group policies cannot exclude coverage on the grounds that pregnancy was a pre-existing condition, while individual policies can only exclude a current pregnancy at the time coverage is obtained.


Under HB 1008, insurance carriers are prohibited from charging women more than men solely on the basis of gender.  It also declares any varying of premium rates by gender as unfairly discriminatory.


HB 1166 makes insurance policy details easier to understand, mandating that all auto, dental, long term care, and health insurance policies sold in the state be written at no more than a 10th grade reading level.


An All-Payer Claims Database is created under HB 1330, which will make public information regarding safety, quality, cost, and efficiency, increasing transparency within the health care system.


HB 1332, the Medical Clean Claims Act, streamlines and standardizes insurance claims, saving time and money.


The Medicaid Efficiencies Act helps cut down on fraud and abuse and increases Medicaid's efficiency, providing health care for more people at a lower cost.


HB 1228 will hold agents and insurance companies responsible for every plan they sell, and allows the commissioner of insurance to collect damages from an insurance company when deceptive policies are sold.


SB 153 creates a comprehensive approach to behavioral health issues, including mental health and substance use disorders.  Aside from creating a mechanism for the state and stakeholders to address cross department behavioral health concerns, it creates standard elements for behavioral health screening in the criminal justice system and facilitates the transformation of the behavioral health system in Colorado.


Might be interesting to see if there’d be need and interest in similar legislation in this state.


The bipartisan National Commission on Fiscal Responsibility and Reform, also known as the deficit reduction commission, is understood to be preparing recommendations for cuts in Medicare and Social Security for its report due this fall.  Should our coalition, Health Care for Everyone – Alabama, get involved in that controversy?  We are, after all, a single issue organization, advocating (only) the same, high quality, affordable health care for everyone.  On the Healthcare-NOW conference call Sunday night someone made the point that if we don’t defend against cuts in Medicare today, we can’t expect to expand an improved ‘Medicare for Everyone’ to cover everyone tomorrow.  The argument was persuasive.  We’ll join that fight.  Wally Retan


Who else would be interested in planning a Birthday Bash for Medicare when it turns 45 this July?  Maybe in the Birmingham area?  Montgomery?  Tuscaloosa?  Mobile?  We ought to be able to get some cake, serve it with candles to some elected officials, local TV and newspapers.  Let me know if you’re interested. 

*     *     *

Thursday, July 22.  8 PM Central.  PNHP Conference Call.  Call me for the number and the Conference Code.  Agenda heavy on plans for Medicare’s birthday.


Friday, July 30.  Medicare Birthday Bash, Huntsville Public Library, 12-1.  Birthday cake, speakers.  Details to follow.


Friday, July 30.  Medicare Birthday. Healthcare-NOW is “looking to July 30th this year as a major day of action to protest the cuts and privatization of our hard-won entitlement programs. These cuts are simply, ‘off the table.’  We hope you will consider activating your network on July 30th to demonstrate at your local Congress person's office, your state capitol, a private insurance company, or another target that you think will bring awareness, media attention, and pressure on our elected officials. Healthcare NOW will help to support your efforts with sample press releases, media kits, post cards, petitions, staff support, and email blasts. We need you on the ground to make the noise, and collectively, our work to protect these important programs will build our networks in advocating for what we know can help alleviate so much of the unnecessary suffering in this country: expanded and improved Medicare for All.  Please let Healthcare-NOW staff know if you are interested in planning actions for July 30th at info@healthcare-now.org.”


Sunday, August 1. Healthcare-NOW! will be hosting it's standing activist conference call at 7pm (CDT). Please use this Dial-in Number: 1-218-862-1300 and Conference Code: 441086.


Monday, August 2, 2010  @ 5:30 PM.  North Alabama Healthcare for All Monthly Meeting —Huntsville/Madison County Public Library, 901 Monroe Street  (downtown).  The meeting is in Room AB, on the first floor. After you enter the library’s front door, turn right towards the auditorium.  The July meeting is CANCELLED


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