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Newsletter, What's Going On, March 19, 2011

Dr. William Hsiao, New England Journal of Medicine: State-Based, Single-Payer Health Care — A Solution for the United States?  Dr. Hsiao’s team developed the single-payer healthcare reform proposal now under consideration in the Vermont legislature.  He also developed the single payer system now in effect in Taiwan, and has consulted widely with other governments about their single-payer systems. 

Jonathan Cohn, Kaiser Health News: Healthy Indiana: Conservatives' Reform Poster Child Or Another Costly Program?  Governor Mitch Daniels of Indiana is a leading contender for the Republican nomination for President.  He has experience with fiscal issues; previously, he was the Director of the U.S. Office of Management and Budget under George W. Bush.  This is his program for his state; it’s considered as a starting point that Republicans might propose for other states or nationally.  

Many of us are appalled.  We watched the change in the political composition of our state legislature and governor’s office, the political development in Wisconsin, Indiana, Michigan and Ohio just to name a few.  And most of us sit on the sidelines and wring our hands.  A few of us, through, take the steps to do what we can to make this world, this country, this state into what we can be proud of.  For those who want to join those few, the news that Mobile Democrats are hosting a Democracy for America Campaign Training Academy the weekend of March 26 may be useful information. 

Please.  Don’t underestimate our opposition.  Be aware that they’d seriously like to dismantle Medicare.  This is their most recent move to accomplish that objective. 

And…Center on Budget and Policy Priorities: Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs To States And Beneficiaries

And…Mother Jones: Republican Attacks on Medicaid (and possibly Medicare) scheduled for early April

This is one of the longer headlines I’ve seen.  From the Commonwealth Fund. Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief—Findings from The Commonwealth Fund Biennial Health Insurance Survey of 2010. 14 million lost insurance over the past decade. The most recent years in insurance coverage have been the bleakest, with 9 million working-age adults losing coverage between 2008 and 2010. 

And…from a report on the report: “A recession-driven spike in unemployment levels, rising treatment costs and unaffordable insurance coverage caused four in 10 Americans to struggle to pay their medical bills last year, according to a report by the Commonwealth Fund.  The Commonwealth survey also found that more than 40 percent of the respondents said that high costs had compelled them to forgo the care they needed—up from 29 percent in 2001.” Kaiser Daily Health Policy Report.

And…The Incidental Economist picked these data out of the Commonwealth Fund’s report:

         43 million adults are in families with a job loss in the last two years. Of those, almost half lost their insurance because of the job loss, and almost 60% of those (or 9 million) became uninsured.

         Of adults age 19-64 who tried to buy individual coverage, 19 million of them had serious issues or couldn’t find affordable coverage at all. More than 80% of those people had health problems.

         Over 120 million adults age 19-64 were uninsured, went without health care because of cost, or paid large shares (more than 10%) of their income on medical costs.

As we approach the one-year anniversary of the Affordable Care Act, there are:

         Talking points  For small business.

         And more for small business. 

         From the Herndon Alliance, “Protecting Seniors Health”, “Protecting Small Business”, “Protecting Our Care”, “Protecting Women’s Care”, “Protecting Young Adults” and information on ACOs (Accountable Care Organizations), Exchanges (now called ‘competitive health insurance marketplaces’) and Quality Care Pricing (that used to be called payment reform).  Anyone with an urge to write a letter to an editor, feel free…

         News of first anniversary events.  From Huntington Post.

         Nanci Pelosi’s celebration.

         Ezra Klein’s assessment on how the bill is polling on its first birthday.

         The Society for Human Research Management has a somber view of ‘progress’ during the past year. 

         And the Wall Street Journal’s take on the White House effort:

And…POLITICO Pulse: NEXT WEEK: PRO-REFORMERS HOLD EVENTS THROUGHOUT THE COUNTRY- As reported yesterday, a progressive coalition will be flooding the country with events in support of the ACA next week. Two hundred pro-reform events will take place in 35 states, though the majority of the grass-roots efforts will take place in five states in particular: Florida, Ohio, Michigan, Montana and Pennsylvania, sources tell PULSE. HCAN, one of the many groups sponsoring events, tells PULSE that it's releasing a list of locations next week.  (HCAN=Healthcare For American Now, not to be confused with the single-payer supporter, Healthcare-NOW)

Health Reform GPS: Primary Care Physician Workforce. “Strengthening and modernizing the health care workforce was a major goal of the Patient Protection and Affordable Care Act (ACA). The ACA contains dozens of provisions related to health care workforce issues, including strengthening primary care, national workforce policy development, increasing the supply of health care workers, and more. This Implementation Brief focuses on those provisions of the ACA that specifically target the strengthening of the primary care physician workforce.”

POLITICO Pulse: KAISER POLL: PUBLIC STILL SPLIT, CONFUSION REIGNS, PUBLIC WANTS STATE FLEXIBILITY- One year out, the law's favorables are just slightly more negative, according to the March Kaiser Health Tracking Poll. Unfavorable: 46 today, up from 40 in 2010; Favorable: 42 today, down from 46 in 2010. The individual mandate remains unpopular, with 67 percent supporting its repeal. And half of the country (53 percent) says they're "confused" by the law.   --LITTLE IMPACT, BUT MORE BAD THAN GOOD- Thirteen percent of respondents say their family has benefited from the law and 20 percent say they've suffered a negative effect of the law. The most cited benefit? Better access to care. The most frequently cited negative effect: cost.   --PAGING RON WYDEN- Two-thirds of the public think states should be allowed to substitute equally comprehensive and affordable health programs. The idea is backed by 75 percent of Republicans, 72 percent of Independents and 55 percent of Democrats.

Maggie Mahar, Health Beat: Can Academic Medical Centers Become Accountable Care Organizations?  She starts with “an excerpt from a superb post by Bob Wachter, Associate Chairman of the Department of Medicine at the University of California, San Francisco, that was originally published on Wachter's World. There, he questions whether academic medical centers (AMCs) will be able to turn themselves into the accountable care organizations (ACOs) that reform legislation favors. Or as Wachter puts it: ‘Are Academic  Medical Centers Toast in a Post-Healthcare Reform World?’”

The Wonkbook: Medicaid expansions under health reform may run up against doctor shortages, reports Jessica Marcy: "States in the South and Mountain West, which traditionally have the lowest rates of primary care physicians, could struggle to provide medical services to the surge of new patients expected to enroll in Medicaid under the health overhaul and federal incentives may not provide much help, according to a report issued today by a Washington health research group. The study, by the Center for Studying Health System Change, noted that many of the states with low numbers of primary care doctors per capita are also expecting some of the highest percentage increases in Medicaid enrollment...The new federal health law will expand Medicaid eligibility starting in 2014 to those making up to 133 percent of the federal poverty level."

Health Wonk Review: There is limited evidence to support claims that pay for performance programs improve quality and reduce the costs of health care, according to Jason Shafrin, who posts on The Healthcare Economist. Shafrin reviews Massachusetts’ pioneering P4P program and several other ones that failed to improve care.

POLITICO Pulse: --McDERMOTT VS. RUC? Psychiatrist and Washington liberal Congressman Jim McDermott is taking up the cause of primary physicians and targeting an AMA committee that recommends payment values for doctors. McDermott tells PULSE he is considering legislation to beef up the analytic abilities of CMS to sort through pay data that the AMA committee, known as the RUC, recommends to CMS. Rep. Tom Price, a Georgia Republican and orthopedic surgeon, also complained during a Ways and Means health subcommittee hearing Tuesday that primary care specialists are underrepresented on the RUC and that data used to set Medicare pay for the services they perform most often - office exams, emergency room visits etc. - is nearly 21 years old.  (CMS=Center for Medicare and Medicaid Services.  The RUC is a committee, set up by the American Medical Association and composed mostly of medical specialists which recommends changes in what Medicare pays doctors for medical services.  The CMS has generally accepted most of the RUC recommendations, so, as a result, medical specialists are much better paid in this country than are primary care physicians…general internists, family doctors, pediatricians and geriatricians.  OB-GYNs provide much primary care, too.  In other countries, there’s much, much less difference between specialist and primary care physician incomes.) 

POLITICO Pulse: --LIVE ON TAPE: ANTHONY WEINER - The New York representative talks about the White House's "lackluster" defense of health reform in the newest edition of the POLITICO video series.  Listen near the very end when the Congressman says, almost under his breath, that Medicare for All would have been his preferred solution to the health care problem.

Kaiser Health News: The 'Missing Link' In ACOs: Patients Regulations will soon be released providing insight into how health care entities and networks qualifying as ACOs will be compensated by Medicare for "bending the cost curve" and improving care. It's commonly held that these systems will lead to better treatment for individuals, improved population-wide health and lower costs. ... But is it realistic to leverage the success of these organizations on physician incentives alone? What about patient acceptance?  (Mark Lutes and Joel Brill, 3/15).

The Sacramento Bee: Blue Shield Drops Latest California Rate Hike Angry ratepayers found some relief Wednesday when Blue Shield of California dropped its plan to further raise insurance rates on hundreds of thousands of its customers in 2011. Hikes that average 6.5 percent were set to go into effect in May and would have been the third since October levied by the San Francisco-based health insurer (Smith, 3/17).  Kaiser Daily Health Policy Report. 

Brokers Seek To Preserve Role In Health Insurance Marketplace Kaiser Health News staff writers Jordan Rau and Julie Appleby, working in collaboration with The Washington Post, write: "Insurance brokers, worried their livelihoods are in jeopardy from the health law, are pressing Congress and state legislatures to safeguard agent commissions and guarantee them a key role in new marketplaces being created for consumers to obtain coverage" (Rau and Appleby, 3/16). Read the story.    This, from the New Republic, is what the fuss is all about.

National Journal: Long-Term Care Hearing Not A CLASS Act House Republicans picked at their latest target in the health care law on Thursday -- long-term care insurance -- but could not explain how they would control costs beyond repealing a voluntary program established in the legislation. The program, Community Living Assistance Services and Supports, is one piece of the health care law that the Obama administration has made clear needs serious fixing. Democrats agreed that CLASS does not quite work, but they want to leave the fixing of it to Health and Human Services Secretary Kathleen Sebelius. CLASS is intended to cover volunteers using premiums alone, not federal money. But critics have said the current thresholds could allow far too many high-risk people to enter the program who could drain its funds within 10 years (McCarthy, 3/17).   Kaiser Daily Health Policy Report. 

Center on Budget and Policy Priorities: In recent months, proponents of converting Medicaid into a block grant have cited a Medicaid waiver demonstration project in Rhode Island as evidence that a block grant would produce substantial federal and state savings while giving states greater flexibility over their Medicaid programs.   These claims, however, are off the mark.  The Rhode Island waiver was a “sweetheart deal” between the Bush Administration — in its final week of office — and the Republican governor of Rhode Island, in which the federal government effectively unloaded additional federal money on the state and gave Rhode Island federal funds beyond what it would receive under the regular Medicaid program, in return for the state accepting a cap on its Medicaid expenditures at an inflated level that it never expected to reach anyway.  more… Kaiser Daily Health Policy Report.

The Hill: Reid: Rider On Planned Parenthood Won't Be Included In Budget Deal Senate Majority Leader Harry Reid (D-Nev.) on Thursday drew a firm line with Republicans, declaring that a controversial Planned Parenthood measure will not be included in any deal on the budget (Bolton, 3/17). Kaiser Daily Health Policy Report.

Training Family Doctors: an Accountable Care Organization that’s working.

Healthcare NOW: In Vermont, Single-Payer Bill Set To Pass Health Care Committee

Healthwatch: The court of appeals for the District of Columbia has decided to fast-track its review of a legal challenge to the healthcare reform law.  The challenge, filed by the conservative American Center for Law and Justice (ACLJ) and five individual plaintiffs, is one of several court challenges against the law's individual mandate. Federal District Court Judge Gladys Kessler dismissed the case last month.  The ACLJ had appealed that decision and claimed victory on Thursday.

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Thursday, March 24, 2011. 8 PM. CST   PNHP Leader/Activist Conference Call.  Call me for the number and access code.  

Wednesday, March 30, 2011. Please join NAHA (North Alabama Healthcare for All), for a fun lunch with no agenda, just some good discussion. 

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

Sunday, April 3, 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, April 4, 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.

Thursday, April 21, 2011.  @5:30 PM.  Third Thursday happy hour (social gathering), at the Preve lounge, upstairs at Monaco, 370 The Bridge Street (6782 Old Madison Pike), Huntsville.  Rob Kilpatrick would appreciate knowing you’re coming.  rob2020@mac.com

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