Newsletter, What's Going On, December 7, 2010
Governor-elect Robert Bentley says he will implement a key part of the Patient Protection and Affordable Care Act, a health care exchange for Alabama. "We will work within the law," said Bentley, a Republican who will replace Gov. Bob Riley in January. The Alabama Department of Insurance has already accepted a $1 million grant from the U.S. Department of Health and Human Services to begin work on the health exchange, which will allow consumers and small businesses to comparison shop several health insurance plans in a new marketplace. The exchanges -- whether run by the state or the federal government -- must be in place by 2014, but Bentley said he thinks Alabama can beat that deadline.
Last Friday the Incidental Economist wrote:
I’ve had a long week. I won’t bore you with the details, because this blog isn’t about me, nor are my problems worth your time. I tell you this only because as much as I wish I could bring it, I’ve got no snark for this. It’s too much. From the New York Times:
Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.
“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”
I think I’ve built up enough credibility to say you’ll know I’m not posturing when I say that we do need to reduce health care costs. We do. But this is just wrong. You don’t get a transplant to feel better about yourself. You don’t get one to have a slightly better quality of life. You don’t get one because you can’t be bothered to make lifestyle changes.
You get a transplant to save your life.
Evidently, Arizona has decided to discontinue to allow Medicaid to pay for lung transplants, and some liver, bone marrow, and pancreas transplants. Want to know how much they will be saving?
About $4.5 million. Seriously.
But that’s not why I can’t make a joke. It’s because, when confronted with this, the governor of that state couldn’t stop politicking. When asked why Arizona was doing this, she blamed it on “Obamacare”. There’s just one small problem. The Arizona bill was voted on in March, “before President Obama signed [PPACA] into law.”
I really don’t know how to joke. Some people complain about government spending, but can only find a way to cut a few million dollars, and do so by literally depriving life saving treatment to poor people who need it. These same people then dare to utter words like “death panels” when referring to something that is nothing of the sort. And when confronted with the facts of what they’ve done, they blame something else, something that factually could not be the cause, because it occurred after their decision.
I’m done. I hope you have a good weekend. I’m cutting out and heading over to Sun King Brewery to refill my growlers. If something good happens, please do let me know.
NPR: "Of all the scary scenarios predicted for the new health law this is among the scariest: A new survey of doctors predicts the rapid extinction of the private-practice physician. A survey of some 2,400 MDs from around the country found nearly three quarters said they plan to retire, work part-time, stop taking new patients, become an employee, or seek a non-clinical position in the next one to three years" While 34% blamed health reform, 36% said their biggest issue was the failure to fix the Medicare physician payment formula. (Rovner, 11/29). Kaiser Daily Health Policy Report.
The Affordable Care Act carefully safeguards the right of states to make determinations about the fairness of rate increases proposed by health insurers. You will be shocked…shocked!!!...to discover they don’t all do a good job. A Kaiser Health study of state practices is linked here and summarized here.
The Health Affairs Blog: The Republican drive to repeal the Patient Protection and Affordable Care Act nearly got a surprise boost earlier this month from the American Medical Association, which up to now has provided valuable support for President Obama’s health care reform effort. At the AMA’s interim meeting on Nov. 9, conservatives within AMA’s House of Delegates won a close vote to rescind the organization’s support for requiring all Americans to obtain health insurance, a key part of the new reform law. But, following desperate scrambling by AMA leaders, the House, in a second vote, narrowly decided to refer the issue to the AMA Board of Trustees and defer the issue until the annual meeting next June. Conservative doctors, who have formed a Tea Party-type movement they call “Take Back the Profession,” vow to continue their fight to reverse AMA support for the individual mandate and emphasize the AMA’s more market-oriented policy positions. These include high-risk pools, insurance subsidies, and health savings accounts. And they want to make it the AMA’s top legislative priority to allow doctors to charge Medicare patients fees over and above what Medicare pays.
POLITICO Pulse: UP OVERNIGHT: DEDUCTIBLES RISE 77 PERCENT- And premiums in employer-based health insurance plans have increased 41 percent between 2003 and 2009, according to a study being released this morning (last Thursday) by the Commonwealth Fund. Another key finding: if premium costs continue to rise at the pace seen in recent years, annual premiums would average $23,342 per family by 2020. (note: this is premium cost, exclusive of deductible, co-payment and out-of-pocket-for-uncovered services costs.) The analysis assumes that health reform will slow cost growths by 1.5 percent. Those savings, however, are contingent on health reform delivering promised innovations. "A lot will ride on what we learn from the new Center for Medicare Innovation in what we can do to reward quality and efficiency," Commonwealth Fund Senior Vice President Cathy Schoen told reporters Wednesday. And: State Trends in Premiums and Deductibles, 2003–2009: How Building on the Affordable Care Act Will Help Stem the Tide of Rising Costs and Eroding Benefits. The Commonwealth Fund.
While there’s been considerable discussion and dismay generated by the Simpson-Bowles deficit commission report, the daily Kos notes that the commission legally ceased to exist on December 1, before taking a vote on its proposed report. Congress won’t vote on the commission recommendations, for Congress only votes on legislative language and the draft report contains no legislative language. The Herndon Alliance adds: Rep. Paul Ryan (R-Wis.), the incoming House Budget Committee chairman and Rep Jeb Hensarling will not vote for the proposal because it will not privatize Social Security and convert Medicare into a voucher system” and because “the plan accelerates and entrenches ObamaCare,” In the Senate, the Budget committee will be chaired by North Dakota Democrat Kent Conrad, who has endorsed the Simpson-Bowles recommendations. We’re not out of the woods yet.
Text: Fiscal Commission's Recommendations On Health Care Spending.
And what all six of the deficit reduction plans propose to halt or slow the increases in Medicare spending.
Last week, Republicans got a taste of the difficulty of repeal of the Affordable Care Act. At issue was an obscure, but unpopular, provision within the new health law that requires businesses to file 1099 tax forms anytime they purchase goods or services worth more than $600. The idea is to collect income taxes from the vendors producing those goods and services -- taxes many vendors avoid paying now. The change is supposed to produce $19 billion in new revenue. Several repeal proposals reached a vote in the Senate last week but none could get enough votes to pass.
The president of the Catholic Health Association continued her public disagreement with the U.S. bishops over whether the national health care overhaul will allow federal funding of abortion. ‘As far as I was concerned, if I knew in my heart that it did not fund abortion, I could not do anything but stand up for the passage of that bill for the 32 million” people who do not have health insurance,’ .... “We are the only industrialized country that does not provide health care to all,”.... ‘Nine million children are among those without health insurance’.... “What excuse justifies a child not having access to health care?” Sr. Carol Keehan, quoted in Herndon Alliance Quote of the Day.
The New York Times convened an impressive panel of experts to consider ways to rescue Medicaid.
The President has made it very clear that he supports state innovation in development of health reform plans that they find more appropriate to their needs than the ACA. Article from Vermont.
Broader eligibility announced for healthcare tax credit
The Health Care Blog points out that many web sites that advertise themselves as Canadian Pharmacies aren’t really in Canada…and that it really, really does matter.
TO BE OR NOT TO BE…MARRIED. Under the Affordable Care Act, an individual with an income of less than $14,945…138% of poverty…is eligible for Medicaid. A family of two, with income under $20,107…also 138% of poverty…, is also eligible for Medicaid but with income above that figure, not eligible. So two people living together, each with incomes of…say…$11,000, are eligible for Medicaid if they’re not married, but ineligible if married.
POLITICO Pulse: A deal has been reached on the Medicare "doc fix", reports Jennifer Haberkorn: "Senate leaders have reached a tentative, one-year deal on the Medicare 'doc-fix,' sources close to the negotiations say. The deal pays for the must-pass extension of Medicare doctors’ payments with changes in the tax subsidy program that some consumers will use after 2014 to buy health insurance on the new exchanges...The rest of the Senate was to review the deal Monday night with hopes of passing it with a unanimous consent agreement later this week, possibly on Wednesday...Democrats are under pressure to pass a full-year patch of the doc-fix during the lame duck session, because Republicans are already eyeing it as a vehicle to tie to repeal efforts in the next congress."
POLITICO Pulse: MINI-MED CRACK DOWN: COMMERCE INVESTIGATES CIGNA, AETNA - The Senate Committee on Commerce, Science and Transportation is probing two huge providers of mini-med plans: Aetna-owned SRC and Cigna's Starbridge, a Senate aide familiar with the investigation tells PULSE, expanding on a Tuesday WSJ report. The committee, chaired by Sen. Rockefeller, has spent months now pouring over data on the plans' premiums, what benefits subscribers get in return and even digging up old advertisements that position the plans as a way to tout health benefits while barely picking up a tab. Commerce definitely wants to make their findings public at some point, possibly sharing it with HHS or publishing a series of reports similar to Rockefeller's work on MLR. The issue comes to a head today at the committee's 2:30 p.m. hearing on mini-med plans, where you can expect senators to press the issue of who absorbs medical costs when subscribers exhaust mini-med benefits (likely answer: taxpayers via public hospitals). --UNDER OATH - Witnesses at today's hearing plan to use real world anecdotes to hammer home how mini-meds are inadequate. "Too often young workers think they're getting real insurance when they're not and end up hugely in debt," Young Invincibles President Aaron Smith tells PULSE. "We're going to talk about one of those stories in our testimony." Expect American Cancer Society's Stephen Finan to compare the cost of cancer treatment (often upwards of $100,000) to the few-thousand in benefits that mini-meds usually offer.
The Wonkbook: A federal judge tossed out a challenge to health care reform, reports Jennifer Haberkorn: "A federal judge in Virginia threw out a case brought by Liberty University that claimed the health care reform law is unconstitutional and would allow the religious institution’s insurance payments to cover abortions...Liberty University, a Christian university in Lynchburg, Va., had argued that the legislation’s requirement that nearly all Americans purchase insurance coverage and its incentives for large employers to cover employees would allow the university’s money to cover abortions, violating the religious values of the institution. The court flatly rejected that argument." And from the Kaiser Daily Health Policy Report: The Associated Press: "University law school dean Mathew Staver said in a telephone interview that he will promptly appeal the ruling to the 4th U.S. Circuit Court of Appeals in Richmond." The White House responded in a blog post: "In the weeks ahead, there will be additional court cases. ... We can't predict the outcome of each case, but we are confident that we will ultimately prevail in court and continue to deliver the benefits of reform to the American people" (O'Dell, 11/30). On Intrade, where you can literally bet, the odds that the law will be held to be unconstitutional by the Supreme Court by October 31 2011 have fallen to 4 in 100.
The Virginia attorney general's office is considering a petition to fast track the state's challenge to federal health-care legislation so the case would bypass the appellate court and be heard directly by the U.S. Supreme Court.
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7 PM. Thursday, December 9, 2010. “Why Does American Health Care Cost So Much?” Dr. Wally Retan. Ireland Room, 3rd floor, Lister Hill Library, University of Alabama Library, 1700 University Blvd, Birmingham. At that time, free parking is available along 7th Avenue South, between 16th and 18th Street (street-side parking) and in the UAB lot and garage off 9th Avenue South, between 16th and 17th Street. Open business meeting of the coalition, Health Care for Everyone-Alabama at the same place at 6:30 PM
Thursday, December 16, 2010. @5:30 PM. Third Thursday happy hour (social gathering), at 801 Franklin (Huntsville).
Thursday, December 16, 8 PM CDT. PNHP’s monthly activist phone call. Please call me for the phone number and access code.
Wednesday, December 29, 2010. Lunch, (social gathering) Nothing but Noodles, Village on Whitesburg Shopping Center, 4800 Whitesburg Drive, Huntsville. Wednesday before each monthly meeting.
Sunday, January 2 (?), 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.
Monday, January 3, 2011 @ 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.
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