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Newsletter, 'What's Going On...", August 17, 2010

August 17, 2010


“Medical Homes” are the current vogue in health policy.  They are encouraged under the Affordable Care Act and endorsed by the major medical societies (Family Physicians, Pediatricians, Internists and Osteopaths) that represent first-line doctors.  It’s fun to read a well-reasoned healthy skeptic., particularly when I agree with him.


I know this paragraph isn’t about health care.  But it really is.  Read Gail Collins: “The story in American history I most like to tell is the one about how women got the right to vote 90 years ago this month. It has everything. Adventure! Suspense! Treachery! Drunken legislators!                 But, first, there was a 70-year slog.              Which is really the important part. We always need to remember that behind almost every great moment in history, there are heroic people doing really boring and frustrating things for a very prolonged period of time.”  More….


Monday, Healthcare.gov published an analysis of the capacity of each state to deal with insurance premiums, broken down by state.  “On August 16, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced the award of $46 million to enhance States’ current processes for reviewing health insurance premium increases.  Forty-five States and the District of Columbia applied for grants, and each will receive $1 million in grant funds to help improve the review of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes, and ensure consumers receive value for their premium dollars.  A list of States’ current health insurance rate review practices and a summary of their intended use of these new resources is below.

States have proposed to use this funding in a variety of ways.

The chart below provides a detailed summary of how each State intends to overhaul its health insurance premium review process.”  This is the situation in Alabama.




Current Authority


      Individual Market: Individual: Alabama has limited rate review authority.  Blue Cross Blue Shield rates are approved if they do not alter the expense formula (Ala. Code § 10-4-109).  HMOs must file rates before use.  HMOs and Blue Cross Blue Shield must file actuarial justifications and can use any rating trait.  Commercial carriers are encouraged to file rates but do not have any requirement to do so.


      Small Group Market: Small Group Market: HIPAA rating restrictions only (Ala. Admin. Code r. 482-1-116-.01 (2010)).


Additional Legislative Authority: Currently the department has very limited health insurance premium review authority - restricted to reviewing premiums proposed by Blue Cross Blue Shield and HMOs They will develop legislative language to expand review authority and add approval authority in 2011 session.


Expand the Scope of Health Insurance Premium Review: The State will expand the scope to include additional health insurance carriers, markets and lines of business.


Improve the Health Insurance Premium Review Process: With the current limitations in review authority, the State plans significant improvements.  The State proposes to develop a new review unit.  They will develop and implement regulations as well as establishing a standardized filing and review process.


Make More Information Publicly Available: The State does not currently publish rate filings that are considered proprietary.  They will seek authority to post consumer friendly summaries, develop toolkits for consumers, conduct town hall meetings for consumer education.


This is important.  We have a law, the Affordable Care Act.  Many of the regulations that put it into effect depend on action on the state level, action by state legislatures.  You can bet that insurance company lobbyists will be all over the legislature, seeking regulations just as favorable to insurance companies as possible.  Ordinary people will have to scream to make their voices heard.  Talk with your state legislator, your state senator, your local newspaper contacts, be sure they’re aware of what’s going on.


Everywhere you look, Medicaid seems to be in jeopardy. The program provides health insurance for the very poor, but depends on state funding and, right now, the states don’t have any to spare. Last week, President Barack Obama signed a law that will give the states additional money, enough to avoid the worst cuts, but when that money runs out, in the middle of 2011, those cuts could be back on the agenda.  Cutting Medicaid during a recession is terrible economics, since it takes money out of the economy at precisely the moment when we should be putting more into it. It’s also cruel. The Medicaid population includes some of the country’s most economically and medically vulnerable residents. Without Medicaid coverage, these people become even more vulnerable.  A little outrage, then, is in order. But what kind of outrage?  From Jonathan Cohn, writing for the New Republic and for the Kaiser Health News.


POLITICO Pulse: AN ESSENTIAL PROBLEM - Paring back Massachusetts' mandatory benefits package, cutting services like chiropractors and infertility treatment, could help alleviate the state's cost crisis, Harvard's Robert C. Pozen argued in a Boston Globe piece (last) Tuesday. He understands that changing the mandatory benefits package is a politically heavy lift: "There is a real tension between how big the core service package is and whether that's going to be affordable," Pozen, a Democrat who served under Romney as Secretary of Economic Affairs, tells PULSE. His argument is particularly relevant, as federal reform will create an "essential benefits package." Building a package both affordable and comprehensive, is "absolutely crucial in the beginning," says Pozen. "It's very tough to cut what's already considered essential." Case in point: Pozen has already received a flurry of emails from chiropractors, making a case for their services. Pozen's column http://bit.ly/bn789wHis piece also calls for a higher co-payment for services at the highest cost medical centers.


Study Showcases Community Health Centers as Remedy for Woes of Economy, Health Care System.  The Commonwealth Fund finds that Community Health Centers are going to be a significant answer to the question of where all the newly insured people, especially those on Medicaid, are going to be able to find care.  They’ll also contribute about 450,000 new jobs with the funding currently authorized.  The centers are a remarkably good idea; remarkable, too, for the bipartisan support they receive in Congress.  Alabama centers are listed here.


California One Care’s daily TV commercial: (From the California campaign for state single-payer insurance)  Eunice Grigsby says that too many of us are stuck because we don't want to lose our health care coverage. We're stuck in dead end jobs, stuck in unhealthy relationships, or stuck with our spouse's inadequate health care plan. Single payer, California OneCare would get us unstuck with comprehensive coverage for all.  Their campaign includes a new TV commercial daily for 365 days, featuring ordinary Californians. 


Downside of Rural Medicine: Slow Internet, No iPhone, Dating Woes.”  Wall Street Journal Health blog.  (Years ago I read that isolation…absence of a colleague to talk to, to get consultative advice from, is a major deterrent to rural practice.) 


If you’ve ever wondered about the difference between Healthcare-NOW and Health Care for America Now (HCAN), this post should clarify.  And if you ever made the mistake of believing that they’re both pushing for single payer, think again.  (not a calm, dispassionate, analytic piece, but then….)


Dr. Pippa Abston’s blog points out positions advanced by the Republican Candidate for Governor that are seriously worrisome to those physicians who treat adolescent children.  A Must Read for those physicians. 


A new study released (last week) by Health Affairs focuses on an often-neglected segment of Medicare enrollees: people ages 18–64 with permanent disabilities, a group that currently numbers eight million, or roughly one-sixth of the total number of Americans on Medicare.  Just one of the findings from the study: “Half of the nonelderly beneficiaries reported problems paying for health care services in the previous twelve months, versus 18 percent of the elderly population. Similarly, 46 percent of the nonelderly group reported delaying or not getting health care services because of cost, compared to 16 percent of senior enrollees.”  From the Health Affairs Blog.


Republican complain that the Affordable Care Act costs too much.  But, curiously, they’re attacking the Affordable Care Act at the point where it controls cost.  Ezra Klein notes: “On July 27, Sen. Jon Cornyn (R-Tex.) introduced the Health Care Bureaucrats Elimination Act, co-sponsored by Sens. Orrin G. Hatch (R-Utah), Jon Kyl (R-Ariz.), Pat Roberts (R-Kan.) and Tom Coburn (R-Okla.). The legislation doesn't seek to repeal health-care reform (though many Republicans would also like to do that). Instead, it takes aim at perhaps its most promising cost control: the Independent Payment Advisory Board. "In true fashion of Obama- Reid-Pelosi hubris," Cornyn said, "the IPAB is the definition of a government takeover." A government takeover of . . . Medicare?”


The National Association of (state) Insurance Commissioners has been meeting in Seattle, struggling to come up with rules that insurance companies will have to follow in classifying some of their expenditures.  That’s because the Affordable Care Act requires insurance companies to pay out at least 85% of premium income to offset the costs of medical care.  It won’t surprise that companies are trying to get everything they can classified as ‘medical care.’  There’s something like 1000 insurance company lobbyists for the 65 insurance commissioners.  One article about what’s going on…from the Wonkroom.


President Obama’s commitment to Social Security.


Paul Krugman basically collects the blog posts of the past few days to make a fully formed argument against Social Security benefit cuts or increases in the retirement age. He basically says that the expected increase in the percentage of GDP needed for Social Security in the next 20 years is less than the increase in the military budget since 9/11, and that those with their knives out for the program are using accounting tricks.  From Firedoglake.


Paul Ryan has put forward a proposal for major change in Medicare.  Here’s his proposal in a nutshell.


Ezra Klein notices Republican critics of health care reform's costs targeting its cost-control measures: "The board's first recommendations will be for 2015, but it'll take until 2018, when its purview expands to cover hospitals, for it to really start swinging its weight around. If the board makes it that far, it'll be the most aggressive effort lawmakers have ever made to control Medicare's costs. That's a big if. Republicans have zeroed in on the board as a soft target in their campaign to gut the health-care reform bill. 'In true fashion of Obama- Reid-Pelosi hubris,' Cornyn said, 'the IPAB is the definition of a government takeover.' A government takeover of . . . Medicare?"  From the Wonkbook


Health News Florida: "The Florida Medical Association decided Sunday after two days of heated debate not to break off relations with the American Medical Association, officials and delegates said at the conclusion of the event. Instead, FMA will send AMA a letter describing just how unhappy it is with the national group's actions on health reform" (Gentry, 8/16).


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Thursday, August 26, 8 PM CDT.  PNHP’s monthly activist phone call.  Please call me for the phone number and access code. 


Sunday, September 5,  7PM CDT.  Healthcare-NOW monthly activist phone call. Please use this Dial-in Number 1-218-862-1300 and Conference Code 441086. To mute and unmute the line, please hit *4.

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