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Newsletter, What's Going On, February 15, 2011 (Early, due to vacation)

Vermont Governor Shumlin’s proposal for a single-payer health insurance system (a .pdf file) for Vermont was unveiled Tuesday. This is the testimony with which it was presented to the Legislature; this is a summary of the bill prepared by the Governor’s staff and these are the PowerPoints (as .pdf files) that accompanied the presentation.  This phase of legislation doesn’t include the funding mechanism; Gov. Shumlin has elected to get the payment system in place first before coming back in 2013 to work on funding.   His proposal is summarized and discussed by the Associated Press, among others.

Gov. Peter Shumlin (D-VT) In Vermont, this is all about cost containment. There are 625,000 people in Vermont. We were spending $2.5 billion on health care a decade ago. Now we’re above $5 billion. And we project we’ll be spending a billion dollars more in 2014. This is where everyone has failed in health-care reform. And this will go after three of our main drivers of costs.  First, Vermont spends 8 cents on every dollar on administrative costs, just chasing the money around. That’s a huge waste of money. Second, we’ll use technology to conquer waste. You'll get a Vermont medical card, and everyone’s medical records will be on that card, so you’ll go into a doctor’s office and they’ll know what the last doctor did to you. That helps avoid duplication of services. And the last piece, the most challenging, is remaking the payment system so providers are paid for making you healthy, not for doing the most procedures.

Ezra Klein interview of Governor Shumlin. 

JOB KILLER!!!!!  "CBO: ObamaCare Will Destroy 800,000 Jobs," was the headline from the National Republican Congressional Committee.  “Eager to exploit an opening to attack the healthcare reform law, Republicans on Thursday touted testimony by Congress' budget scorekeeper that the law would result in 800,000 fewer people working.” The Hill  However, the CBO prediction is a little more nuanced. Last summer's CBO report said the projected labor reduction is "largely" the result of more people voluntarily staying out of the workforce because the healthcare reform law gives them better healthcare options through an expansion of Medicaid and new state-run health insurance exchanges. The Hill  So to review - folks who have wanted to retire or leave their jobs but could not because they were terrified of getting sick and going broke and needed to hold onto their employer-provided health insurance can now do what they want.   JOB KILLER!!!! 

Austin Frakt reminds that over 85% of health insurance premiums go to pay health care providers.  Hence, tinkering with MLRs, or increasing competition by selling insurance across state lines or instituting exchanges or public options might squeeze a little savings out of the administrative side of insurance, but only plans that deal with the income that goes to providers has a chance to limit growth of health care cost.

The Hill: HHS Extends Reform Law Protections To College Students The health care reform law's popular consumer protections will be extended to student health plans offered by colleges under a regulation proposed Wednesday. Student health plans, offered by as many as 2,000 higher education institutions, will no longer be able to impose lifetime coverage limits, suddenly drop students from enrollment because of an unintentional application error or discriminate against pre-existing conditions (Millman, 2/9)  Kaiser Daily Health Policy Report.

Seventy-four House Democrats are asking Supreme Court Justice Clarence Thomas to recuse himself from any health care reform cases, citing reports that his wife financially benefited from efforts to repeal the legislation.  Politico.

State health spending is facing deep cuts, reports Julie Appleby: "Washington (state’s) quandary is shared by many states: Demand for health-related services is growing, voters don’t want to raise taxes, payments to doctors, hospitals and clinics have already been reduced and states risk losing federal funds if they cut eligibility for the joint federal-state Medicaid health program for the poor and disabled...Health and Human Services Secretary Kathleen Sebelius told them they can trim some optional services, such as dental care, and those with budget deficits can cut eligibility for non-disabled, non-pregnant adults above 133 percent of the poverty line, which is $14,500 for an individual. Twenty-one states and the District of Columbia currently cover adults above that level."  Ezra Klein’s Wonkbook.   The Center on Budget and Policy Priorities reminds that there’s human cost to reductions in services. 

COMMUNITY HEALTH CENTERS THREATENED - The National Association of Community Health Centers criticized the House Appropriations Committee's proposal to slash $1.3 billion from the CHC budget. The proposal is akin to terminating all health care to residents of Chicago, NACHC CEO Tom Van Coverden said. That's 11 million patients, or the equivalent to everyone living in the states of Wyoming, Vermont, North and South Dakota and Alaska combined.

--FAMILY PLANNING PROGRAM WIPED OUT – The Appropriations Committee also wants to take away $327 million from family planning ... which is conveniently the exact same amount Title X, the only federal program dedicated to family planning, was appropriated last year. POLITICO Pulse.  Planned Parenthood is the primary target of the reduction proposal.  It uses family planning funds for contraception and cancer screenings, but not for abortions. 

House Republicans Consider Privatizing Medicare Months after they hammered Democrats for cutting Medicare, House Republicans are debating whether to relaunch their quest to privatize the health program for seniors. House Budget Committee Chairman Paul Ryan, R-Wis., is testing support for his idea to replace Medicare with a fixed payment to buy a private medical plan from a menu of coverage options.   Healthcare-NOW.

With Virginia's petition for an expedited hearing on its health reform lawsuit filed, all eyes on the high court as to whether they'll take it. Here's a clue on the Court’s current thinking: Speaking at a George Washington University seminar, Justice Ruth Bader Ginsburg said challenges to the law would have to work their way up through "the ordinary route." "The court itself is a reactive institution," Ginsburg was quoted as saying in the student newspaper. "We don't decide, 'We better get this or that case sooner rather than later.'" 

-- SCOTUSblog has several factors suggesting the high court is unlikely to move early: They can't find a single circumstance where the Court has done so over the federal government's objection (the Department of Justice opposes the petition), and cases the Court does expedite are usually tied to another that already went through the normal process. POLITICO Pulse.

House Majority Leader Eric Cantor says the bill to fund the government for the rest of the year will have language to withhold funding from the health care law by the time it passes the House next week. ... It’s sure to set up a clash with the Democratic-controlled Senate, which won’t approve any spending bill that doesn’t fund the health care law, and with President Barack Obama, who wouldn’t sign that kind of bill into law anyway. Politico 

WBUR: Health Plan Charges Up To $1,000 More For 'High-Cost' Hospitals The state's largest insurer, Blue Cross Blue Shield of Massachusetts, is out with a plan that charges members more -- as much as $1,000 more -- when they check-in or have tests at one of 15 hospitals Blue Cross calls "high-cost." ... Will much higher co-pays persuade patients to spend less on health care by checking-in to or scheduling tests at cheaper, less-well-known hospitals? Many employers hope the answer is yes (Bebinger, 2/10).  The Boston Globe: Plans Steer Patients To Lower-Cost Hospitals Other Massachusetts insurers also report brisk business in plans that offer lower premiums in exchange for limits on use of high-cost care. The plans either charge consumers extra for receiving care from popular but expensive hospitals or doctors, or bar them altogether from seeking treatment at those institutions and practices. ... Companies and workers that sign up get a significant break on their health insurance premiums: a 4.5 percent increase for the first quarter of the year instead of a 10 percent increase (Kowalczyk, 2/10).  Kaiser Daily Health Policy Report.

GRUBER NOT SOLD ON MANDATE ALTERNATIVES- The MIT economist asks in a Center for American Progress paper: Can any mandate alternative provide coverage equivalent to a mandate? The short answer is no: "First, no alternative to the individual mandate can cover more than two-thirds as many uninsured as the Affordable Care Act does as passed by Congress and enacted into law. Second, no alternative to the mandate saves much money - even removing the mandate altogether, which cuts the number of uninsured covered by 50 percent to 75 percent but only reduces government spending by 25 percent to 30 percent."  POLITICO Pulse. And…”The insurance industry, who lobbied hard for the mandate and felt the final version was not tough enough, are staying out of the political fray but warn that proposed alternatives will be expensive and unsustainable.”

And Dr. Gruber is versatile.  Christine McConville of The Boston Herald published this delectable scoop yesterday: MIT’s Jonathan Gruber, a leading health economist and adviser to the Obama administration, is writing a long comic book to explain federal health reform to the public.  “I’m going to use the facts to tell the story,” Gruber, 45, told the Pulse yesterday. “I’m the narrator guiding the reader through the law. It’ll have lots of pictures and text.”  Hill and Wang, a division of publishing powerhouse Farrar, Straus and Giroux, plans to release Gruber’s book, tentatively titled “Health Care Reform: What It Is, Why It’s Necessary, How it Works” this fall.  POLITICO Pulse. 

Wendell Potter warns not to be fooled by the apparent “absence of the insurance industry from the fray.”  It’s very actively working to preserve the mandate because the mandate means billions of dollars in income for them, but to gut the rest of the law.

An influential Republican member of the Federal Trade Commission, J. Thomas Rosch, said that without “vigorous antitrust enforcement,” the new alliances of health care providers (ACOs, Accountable Care Organizations) could reduce competition and increase costs to consumers.   Translated: ACOs could become the target of anti-trust lawsuits. 

21 GOP governors refuse to implement "present form" of health law Twenty-one Republican governors (including the Governor of Alabama), in a letter sent to HHS Secretary Kathleen Sebelius, said they refuse to be agents in implementing the health reform law "in its present form" because of the law's provisions that will negatively affect insurers and state budgets. The governors urged HHS to give them "complete flexibility" in running health insurance exchanges as well as to create objective and comprehensive assessments in identifying participants of the exchanges. Reuters  American Academy of Pediatrics SmartBrief.  But if states don’t act, the federal government will

Last week, Gov.. Mitch Daniels publicly complained about lack of flexibility in the Affordable Care Act.  It wasn’t clear what he was complaining about.  This week, Ezra Klein contacted one of his health policy advisors.  Turns out a major problem is the definition of the “essential benefits package”, the regulation defining what health plans have to cover.  Here’s part of his post: “Right now, states decide what insurers have to cover. And as this ever-helpful report (PDF) from the Council for Affordable Health Insurance shows, Indiana has its own basket of demands. Where New Mexico names 57 different classes of care that insurers must cover and Idaho names only 13, Indiana holds it to 34, including surgeries for cleft palettes, colorectal cancer screening, treatment for morbid obesity, mastectomies, alcohol and substance abuse treatment, and quite a few more. So perhaps it's not surprising that Daniels wants control of this decision.”

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Thursday, February 17, 2011.  @5:30 PM.  Third Thursday happy hour (social gathering), at The Scene, restaurant and lounge, upstairs at Monaco, 370 The Bridge Street, Huntsville.  Rob Kilpatrick would appreciate knowing you’re coming.  rob2020@mac.com

Wednesday, March 2, 2011. Please join NAHA (North Alabama Healthcare for All), for a fun lunch with no agenda, just some good discussion. 

Location in March to be determined.  .  Wednesday before each monthly meeting.

Sunday, March 6, 2011  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, March 7, 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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