Insuring Resources Commentary--
Yesterday at the Wisconsin State Capitol a leading expert on cost and quality issues in ehalth care gave a presentation to state lawmakers and others.
Here are some of the details:
Dartmouth Atlas Author Sees ACOs as Solution to Cost, Quality Concerns
Elliott Fisher, MD, Professor of Medicine at Dartmouth Medical School, presented his ideas on how Accountable Care Organizations (ACOs) could be promoted and implemented as a way to improve population health and lower costs. Fisher presented to a group of health care professionals and policymakers on February 25 in the State Capitol at a forum sponsored by the Evidence Based Health Policy Project. Fisher was a principal author of the Dartmouth Atlas that highlighted wide variations in national Medicare spending and utilization. The Atlas showed Wisconsin as having among the nation’s lowest Medicare costs, mainly due to more efficient provision of care.
The ACO model envisions provider organizations that can effectively manage the full continuum of care as real or virtually-integrated local delivery systems. This structure would be joined with targeted spending levels and health care performance measures to help achieve lower costs and better outcomes, with the providers sharing in any savings.
Fisher said while the ACO model is relatively new, it has shown promise in a number of settings. "Aligning financial and professional incentives, together with having better information that engages physicians and consumers, will enhance their ability to improve health and lower costs." He added that those areas of the country that have ACOs in place tend to have shared aims, physician engagement, use of data to drive change, and communities that are energized to make it happen.
Fisher recommends that policymakers promote the proliferation of the ACO model by legislation (as in enacting Medicare ACOs) or by easing regulatory barriers that complicate the formation of ACOs.
Friday, February 26, 2010
So How is "Insurance" Defined- i.e. What is the standard in the Exchange
On this one I'll just highlight some points to think about....
------------------------------------
From the Washington Post's Ezra Klein
The best exchange of the day came moments before the attendees at the Blair House summit broke for lunch. "There is a philosophical difference," Rep. Eric Cantor said. "There is a fear that if you let Washington define what essential health benefits are, there won’t be an end to that."
But is this a philosophical difference? When I interviewed Rep. Paul Ryan, who's one of the Republican participants at the summit, I asked him how his health-care plan ensures that people can trust that the coverage they're buying won't let them down when they get sick. "In the Patient’s Choice Act," he explained, "we do an actuarially equivalent minimum in each exchange that’s equal to the Blue Cross/Blue Shield Standard Option." That seems a lot like how the Senate bill works, I said. "You need to define what insurance is," Ryan replied. "I agree with that."
Everyone agrees with that, in fact. The Wyden-Bennett bill, which many Republicans have co-sponsored, also sets up a basic benefit equivalent to the Blue Cross/Blue Shield Standard Option (politicians like to use this because it's the basic insurance offered in the Federal Employees Health Benefit Program, which all of them use). Similarly, Republicans favor a policy to sell insurance across state lines. That would also mean that there is a single national standard for insurance -- but rather than being decided by Washington, it will be decided by whichever state has the most lax insurance regulations. We'd have a national standard being written by South Dakota's legislature, which would be a strange fate indeed.
Whoever writes the definition, however, both sides agree that someone needs to do: Insurance is a complicated product, and if it's deceptively sold, it can cost people their lives, or their homes. Most of us are not professional actuaries; it's hard for us to truly understand what's contained in the dozens of pages of fine print that our plans contain. We outsource that job to regulators who, we hope, will do some of the work for us. It's not ideal, but it's better than the alternative.
Philosophically, Republicans do have a disagreement with this. It's regulation, after all. But in practice, they accept it. When Republican passed health savings accounts into law, they included definitions of the minimum standards a plan had to meet to qualify. When they passed the Medicare Prescription Drug Benefit into law, they defined what a plan would have to do to qualify for the program. Philosophy is important, but when you're passing legislation, it takes a back seat to making the policy work.
The Senate health-care bill (pdf) explains how it will define essential benefits in Section 1301. It's not particularly detailed:
The Secretary [of Health and Human Services] shall define the essential health benefits, except that such benefits shall include the following general categories and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
The other requirement is that the plans have to fit one of the four actuarial values in the Exchange (an explanation of actuarial values). This is, well, a pretty general definition. It doesn't define how your insurance will work. it sets a floor that says insurers have to cover the basic array of things a person needs, and they need to cover a certain percentage of the costs people are expected to need covered (either 60 percent, 70 percent, 80 percent or 90 percent). But beyond that, it's left to the secretary of Health and Human Services.
The reason it's left to the secretary is because, as one Senate aide explained, "legislation is harder to change." If a future Republican administration wants to add a new type of consumer-directed insurance plan to the exchanges, they have the power and flexibility to do so. If an insurer wants to propose an innovative product legislators never dreamed of, the secretary can give them the go-ahead. If the legislation defined any of this precisely, all that would be impossible.
You may ask, of course, why the Secretary needs to be involved at all. Why not just let insurers add products on their own? The answer, basically, is that they'll need technical issues clarified. "When you say the plans need to cover emergency services," the aide says, "health insurers will want to know if an insurer can use financial incentives to encourage people to use primary care rather than go to the emergency room." That's freedom we want to give them, which means we need a human being in the process able to interpret the legislation in light of its goals rather than just in light of its words.
Democrats are trying to strike a balance between offering necessary definition and protections and making certain that insurers can continue to innovate. That's a delicate project, and Republicans can certainly disagree with the precise way that Democrats propose to achieve it. Maybe they don't think that insurers should have to cover pediatric services, for instance.
But there is no disagreement over whether someone needs to define, in broad terms, what counts as health-care insurance. Republicans do it in their bills, Democrats do it in their bills. Cantor is creating a philosophical dispute out of something more properly understood as a practical question, and it's much harder to compromise between philosophies than over operational details.
------------------------------------
From the Washington Post's Ezra Klein
The best exchange of the day came moments before the attendees at the Blair House summit broke for lunch. "There is a philosophical difference," Rep. Eric Cantor said. "There is a fear that if you let Washington define what essential health benefits are, there won’t be an end to that."
But is this a philosophical difference? When I interviewed Rep. Paul Ryan, who's one of the Republican participants at the summit, I asked him how his health-care plan ensures that people can trust that the coverage they're buying won't let them down when they get sick. "In the Patient’s Choice Act," he explained, "we do an actuarially equivalent minimum in each exchange that’s equal to the Blue Cross/Blue Shield Standard Option." That seems a lot like how the Senate bill works, I said. "You need to define what insurance is," Ryan replied. "I agree with that."
Everyone agrees with that, in fact. The Wyden-Bennett bill, which many Republicans have co-sponsored, also sets up a basic benefit equivalent to the Blue Cross/Blue Shield Standard Option (politicians like to use this because it's the basic insurance offered in the Federal Employees Health Benefit Program, which all of them use). Similarly, Republicans favor a policy to sell insurance across state lines. That would also mean that there is a single national standard for insurance -- but rather than being decided by Washington, it will be decided by whichever state has the most lax insurance regulations. We'd have a national standard being written by South Dakota's legislature, which would be a strange fate indeed.
Whoever writes the definition, however, both sides agree that someone needs to do: Insurance is a complicated product, and if it's deceptively sold, it can cost people their lives, or their homes. Most of us are not professional actuaries; it's hard for us to truly understand what's contained in the dozens of pages of fine print that our plans contain. We outsource that job to regulators who, we hope, will do some of the work for us. It's not ideal, but it's better than the alternative.
Philosophically, Republicans do have a disagreement with this. It's regulation, after all. But in practice, they accept it. When Republican passed health savings accounts into law, they included definitions of the minimum standards a plan had to meet to qualify. When they passed the Medicare Prescription Drug Benefit into law, they defined what a plan would have to do to qualify for the program. Philosophy is important, but when you're passing legislation, it takes a back seat to making the policy work.
The Senate health-care bill (pdf) explains how it will define essential benefits in Section 1301. It's not particularly detailed:
The Secretary [of Health and Human Services] shall define the essential health benefits, except that such benefits shall include the following general categories and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
The other requirement is that the plans have to fit one of the four actuarial values in the Exchange (an explanation of actuarial values). This is, well, a pretty general definition. It doesn't define how your insurance will work. it sets a floor that says insurers have to cover the basic array of things a person needs, and they need to cover a certain percentage of the costs people are expected to need covered (either 60 percent, 70 percent, 80 percent or 90 percent). But beyond that, it's left to the secretary of Health and Human Services.
The reason it's left to the secretary is because, as one Senate aide explained, "legislation is harder to change." If a future Republican administration wants to add a new type of consumer-directed insurance plan to the exchanges, they have the power and flexibility to do so. If an insurer wants to propose an innovative product legislators never dreamed of, the secretary can give them the go-ahead. If the legislation defined any of this precisely, all that would be impossible.
You may ask, of course, why the Secretary needs to be involved at all. Why not just let insurers add products on their own? The answer, basically, is that they'll need technical issues clarified. "When you say the plans need to cover emergency services," the aide says, "health insurers will want to know if an insurer can use financial incentives to encourage people to use primary care rather than go to the emergency room." That's freedom we want to give them, which means we need a human being in the process able to interpret the legislation in light of its goals rather than just in light of its words.
Democrats are trying to strike a balance between offering necessary definition and protections and making certain that insurers can continue to innovate. That's a delicate project, and Republicans can certainly disagree with the precise way that Democrats propose to achieve it. Maybe they don't think that insurers should have to cover pediatric services, for instance.
But there is no disagreement over whether someone needs to define, in broad terms, what counts as health-care insurance. Republicans do it in their bills, Democrats do it in their bills. Cantor is creating a philosophical dispute out of something more properly understood as a practical question, and it's much harder to compromise between philosophies than over operational details.
The Health Care Summit Condensed in 4 minutes
Insuring Resources Commentary:
See this for a quick summary: http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
Philosophical differences between the Democrats and Republicans ruled the day.
Mitch McConnell (Rep- KY) argued for starting over one step at a time starting with a blank page. Sen. LaMar Thompson (R-Tenn) argued, "We don't do comprehensive well."
Sen. Tom Harkin (Dem- Iowa) argued that a comprehensive bill is necessary because its all intertwined. He's right and here's why.
1. Everyone agrees we need to eliminate pre-existing conditions. Slam dunk.
2. The first item however requires the implementation of an individual mandate or else people will wait to purchase health insurance until they get sick. If we allow that prices will be much higher because of the risk associated with insuring those individuals.
3. #2 requires the implementation of health insurance exchanges to cover individuals and small businesses to pool the risk and put millions of people in to groups to spread the risk. If we require individuals to purchase their own insurance premiums will be astronomical.... but that is what Cong. Paul Ryan (Rep- Wisconsin) wants to do by providing individuals a $2500 tax credit. That would buy about two- three months of health insurance if we have people do it on their own.
The Republicans oppose both # 2 and # 3.
Here's more from Paul Ryan- fact checking provided by Politico.com
Ryan overhypes Medicare Advantage hit
Rep. Paul Ryan (R-Wis.) claimed that under the Democrats’ plan, millions of seniors will lose their Medicare Advantage plans.
Not quite.
According to health policy experts, it’s fair to say that if the Democrats have their way, the benefits provided by Medicare Advantage will be reduced — which means that a number of seniors might choose not to enroll in the program in the future. That doesn’t mean people are going to “lose” their plans, exactly — just that fewer are likely to enroll. Seniors would still be guaranteed their traditional Medicare benefits.
Then I saw former Senator Bill Frist on MSNBC this morning and he talked about cost and changing how health care is performed and financed. He talked aboput more efficient and quality care through provider incentives. He gets it and a lot of Republicans do as well. I don't get why the Democrats still don't get this point because it could be the bridge to a major compromise..... as I've said here since August. Senator Kohl (D- Wisconsin) offered an amendment to the Senate Bill on Dec. 14th to take a huge step toward this but the amendment FAILED. At the time the Democrats had a 60-40 advantage in the Senate, and yes the amendment offered by a Democratic Senator from a blue state, FAILED.
--------------------
Link to a 4 minute video summary
http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
See this for a quick summary: http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
Philosophical differences between the Democrats and Republicans ruled the day.
Mitch McConnell (Rep- KY) argued for starting over one step at a time starting with a blank page. Sen. LaMar Thompson (R-Tenn) argued, "We don't do comprehensive well."
Sen. Tom Harkin (Dem- Iowa) argued that a comprehensive bill is necessary because its all intertwined. He's right and here's why.
1. Everyone agrees we need to eliminate pre-existing conditions. Slam dunk.
2. The first item however requires the implementation of an individual mandate or else people will wait to purchase health insurance until they get sick. If we allow that prices will be much higher because of the risk associated with insuring those individuals.
3. #2 requires the implementation of health insurance exchanges to cover individuals and small businesses to pool the risk and put millions of people in to groups to spread the risk. If we require individuals to purchase their own insurance premiums will be astronomical.... but that is what Cong. Paul Ryan (Rep- Wisconsin) wants to do by providing individuals a $2500 tax credit. That would buy about two- three months of health insurance if we have people do it on their own.
The Republicans oppose both # 2 and # 3.
Here's more from Paul Ryan- fact checking provided by Politico.com
Ryan overhypes Medicare Advantage hit
Rep. Paul Ryan (R-Wis.) claimed that under the Democrats’ plan, millions of seniors will lose their Medicare Advantage plans.
Not quite.
According to health policy experts, it’s fair to say that if the Democrats have their way, the benefits provided by Medicare Advantage will be reduced — which means that a number of seniors might choose not to enroll in the program in the future. That doesn’t mean people are going to “lose” their plans, exactly — just that fewer are likely to enroll. Seniors would still be guaranteed their traditional Medicare benefits.
Then I saw former Senator Bill Frist on MSNBC this morning and he talked about cost and changing how health care is performed and financed. He talked aboput more efficient and quality care through provider incentives. He gets it and a lot of Republicans do as well. I don't get why the Democrats still don't get this point because it could be the bridge to a major compromise..... as I've said here since August. Senator Kohl (D- Wisconsin) offered an amendment to the Senate Bill on Dec. 14th to take a huge step toward this but the amendment FAILED. At the time the Democrats had a 60-40 advantage in the Senate, and yes the amendment offered by a Democratic Senator from a blue state, FAILED.
--------------------
Link to a 4 minute video summary
http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/
Wednesday, February 24, 2010
Something has been missing from the debate...
Insuring Resources Commentary:
Please view this very informative podcast on the American obesity epidemic.
https://www.brainshark.com/brainshark/vu/view.asp?pi=801897475
So far on this blog I've barely touched on a key factor within the issue of improving health outcomes facing America's health care system. The epidemic of obesity. Better late than never I guess because this is a costly problem that we need to address and fix very soon. Here's some startling statistics:
Currently 64% of U.S. adults are either overweight or obese. What's an easy test? 80% of U.S. men with a waist size of 40 or above are obese.
Obesity is defined as: A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.
My ideal weight is between 160- 196lbs, that;s a huge range. So let's take the midpoint of 178 lbs. 20% more than that would be about 36 lbs or 214 lbs. At my heaviest when I was 34 I briefly weighed 217. I was most likely obese. Now I'm about 190-192.
34% of US adults are obese.
In the podcast Dr. Handel says that if we returned to 1987 obesity levels we could cover all our uninsured Americans in full right NOW.
What about children? 40% are either overweight or obese today. That means our future workforce is ENTERING employment with a chronic health condition that decreases their productivity and increases their health care costs.
What's the projection for 2030 if we don't get a handle on this?
In 2030 90% of Americans will be overweight or obese.
What's the Solution? Employer incentives within health care reform to introduce and or expand worksite wellness programs focusing on better nutrition, exercise and employee incentives. as Dr. Handel says in the podcast we also need to look at disincentives for not taking action meaning increased health insurance premiums for those who remain obese or for employers without wellness programs.
Please view this very informative podcast on the American obesity epidemic.
https://www.brainshark.com/brainshark/vu/view.asp?pi=801897475
So far on this blog I've barely touched on a key factor within the issue of improving health outcomes facing America's health care system. The epidemic of obesity. Better late than never I guess because this is a costly problem that we need to address and fix very soon. Here's some startling statistics:
Currently 64% of U.S. adults are either overweight or obese. What's an easy test? 80% of U.S. men with a waist size of 40 or above are obese.
Obesity is defined as: A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.
My ideal weight is between 160- 196lbs, that;s a huge range. So let's take the midpoint of 178 lbs. 20% more than that would be about 36 lbs or 214 lbs. At my heaviest when I was 34 I briefly weighed 217. I was most likely obese. Now I'm about 190-192.
34% of US adults are obese.
In the podcast Dr. Handel says that if we returned to 1987 obesity levels we could cover all our uninsured Americans in full right NOW.
What about children? 40% are either overweight or obese today. That means our future workforce is ENTERING employment with a chronic health condition that decreases their productivity and increases their health care costs.
What's the projection for 2030 if we don't get a handle on this?
In 2030 90% of Americans will be overweight or obese.
What's the Solution? Employer incentives within health care reform to introduce and or expand worksite wellness programs focusing on better nutrition, exercise and employee incentives. as Dr. Handel says in the podcast we also need to look at disincentives for not taking action meaning increased health insurance premiums for those who remain obese or for employers without wellness programs.
Tuesday, February 23, 2010
Is Health Care Reform Popular?
Insuring Resources Commentary:
So what do the polls, and the American public actually think about health care reform?
Is it Needed? What do people think?
Overall health care reform itself IS unpopular as the overall poll shows, BUT...
41% favor
51% oppose
Unpopular, right? Not quite...
81% support for a "new insurance marketplace -- the Exchange -- that allows people without health insurance to compare plans and buy insurance at competitive rates."
67% agree with ending discrimination against Americans with pre-existing conditions."
80% said insurance companies should be required to sell coverage to people regardless of preexisting conditions; 67 percent said so "strongly."
56% of those surveyed would be more likely to back a reform package that reduced "the federal deficit by at least $132 billion over 10 years."
68% favor closing the Medicare prescription drug 'donut hole' coverage gap."
56% said they back a requirement "for all Americans to have health insurance, either from their employer or from another source
72% support for requiring businesses to offer private health insurance for their full-time employees.
60% support raising taxes on higher-income individuals to pay for health-care reform
(couples making more than $250,000)
56% of Americans said they would be more apt to back a plan that allowed "children to stay on their parents' insurance plans through age 25."
Popular!
Looking at the specific issues INSIDE health care reform... they are very POPULAR.
According to the article below in the Washington Post, it depends on how close we're paying attention. For those who are paying attention its very popular. For those that don't analyze it, which is the vast majority of us, we don't get it and therefore oppose it. Its pretty simple.
---------------- ------------
Is health-care reform popular?
by Ezra Klein
http://voices.washingtonpost.com/ezra-klein/2010/02/is_health-care_reform_popular.html
It's pretty common for Republicans to say that health-care reform is wildly unpopular. It's not even untrue. But nor is it true, exactly. Rather, it depends on the numbers you look at, and how you interpret those numbers.
I want to show you two graphs charting the popularity of health-care reform. The first summarizes the Republican position. It's a chart from Pollster.com tallying surveys asking whether you support or oppose the health-care reform bill.
Health-care reform is unpopular. But if you actually tell people what's in the health-care reform bill, then it becomes quite popular. A recent Newsweek poll found the same thing: "The majority of Americans are opposed to President Obama's health-care reform plan — until they learn the details."
You can spin this information in a lot of different directions: The GOP has mounted a huge disinformation campaign. People are stupid. The polls are biased in one direction or another. The media covers conflict and ignores substance. Pick your favorite.
Here's how I understand this information: Voters don't pay very close attention to politics, and they pay even less attention to policy. Making the problem worse, the outlets that should inform them don't actually do so: The news focuses on conflict and points of interest, and also what's changing each day, which is, almost by definition, not the most popular parts of the bill. And don't just blame the media for that: It's what audiences want.
Another important contributor to voter opinions is their perception of the political process. If all Democrats and all Republicans harmoniously agreed on a piece of legislation, well, it's probably a pretty good piece of legislation, right? But if the process is relentlessly angry and partisan, there's more natural mistrust of the product. This would be fine if it was actually an accurate way of assessing the content of legislation, but it's really not. It's an accurate way of figuring out whether the opposition party is interested in winning the next election.
They also take their cues from politicians. This is similarly useless. As a thought experiment, imagine that George W. Bush, who proposed the Medicare Prescription Drug Benefit, had also proposed this health-care reform bill. It's actually pretty plausible: The two had fairly similar structures. But in that scenario, many Republicans would have supported the legislation as an effort to bring free market principles to universal health care, and many Democrats would have opposed it.
So what do the polls, and the American public actually think about health care reform?
Is it Needed? What do people think?
Overall health care reform itself IS unpopular as the overall poll shows, BUT...
41% favor
51% oppose
Unpopular, right? Not quite...
81% support for a "new insurance marketplace -- the Exchange -- that allows people without health insurance to compare plans and buy insurance at competitive rates."
67% agree with ending discrimination against Americans with pre-existing conditions."
80% said insurance companies should be required to sell coverage to people regardless of preexisting conditions; 67 percent said so "strongly."
56% of those surveyed would be more likely to back a reform package that reduced "the federal deficit by at least $132 billion over 10 years."
68% favor closing the Medicare prescription drug 'donut hole' coverage gap."
56% said they back a requirement "for all Americans to have health insurance, either from their employer or from another source
72% support for requiring businesses to offer private health insurance for their full-time employees.
60% support raising taxes on higher-income individuals to pay for health-care reform
(couples making more than $250,000)
56% of Americans said they would be more apt to back a plan that allowed "children to stay on their parents' insurance plans through age 25."
Popular!
Looking at the specific issues INSIDE health care reform... they are very POPULAR.
According to the article below in the Washington Post, it depends on how close we're paying attention. For those who are paying attention its very popular. For those that don't analyze it, which is the vast majority of us, we don't get it and therefore oppose it. Its pretty simple.
---------------- ------------
Is health-care reform popular?
by Ezra Klein
http://voices.washingtonpost.com/ezra-klein/2010/02/is_health-care_reform_popular.html
It's pretty common for Republicans to say that health-care reform is wildly unpopular. It's not even untrue. But nor is it true, exactly. Rather, it depends on the numbers you look at, and how you interpret those numbers.
I want to show you two graphs charting the popularity of health-care reform. The first summarizes the Republican position. It's a chart from Pollster.com tallying surveys asking whether you support or oppose the health-care reform bill.
Health-care reform is unpopular. But if you actually tell people what's in the health-care reform bill, then it becomes quite popular. A recent Newsweek poll found the same thing: "The majority of Americans are opposed to President Obama's health-care reform plan — until they learn the details."
You can spin this information in a lot of different directions: The GOP has mounted a huge disinformation campaign. People are stupid. The polls are biased in one direction or another. The media covers conflict and ignores substance. Pick your favorite.
Here's how I understand this information: Voters don't pay very close attention to politics, and they pay even less attention to policy. Making the problem worse, the outlets that should inform them don't actually do so: The news focuses on conflict and points of interest, and also what's changing each day, which is, almost by definition, not the most popular parts of the bill. And don't just blame the media for that: It's what audiences want.
Another important contributor to voter opinions is their perception of the political process. If all Democrats and all Republicans harmoniously agreed on a piece of legislation, well, it's probably a pretty good piece of legislation, right? But if the process is relentlessly angry and partisan, there's more natural mistrust of the product. This would be fine if it was actually an accurate way of assessing the content of legislation, but it's really not. It's an accurate way of figuring out whether the opposition party is interested in winning the next election.
They also take their cues from politicians. This is similarly useless. As a thought experiment, imagine that George W. Bush, who proposed the Medicare Prescription Drug Benefit, had also proposed this health-care reform bill. It's actually pretty plausible: The two had fairly similar structures. But in that scenario, many Republicans would have supported the legislation as an effort to bring free market principles to universal health care, and many Democrats would have opposed it.
Thursday, February 18, 2010
You do realize we already have a public plan, right?
Insuring Resources Commentary:
The House health care reform bill includes a public plan option, meaning its a plan that would compete against insurers. This story is about the public plan that is the last available option, Medicaid, for many folks.
The attached story below is about the huge expansion nationwide of state Medicaid programs in the wake of the recession. During these tough times, Wisconsin has expanded its Medicaid program while most others have seen their enrollment expand without trying. But Wisconsin has expanded Medicaid through its BadgerCare program to cover more low-income uninsured persons... many of whom ARE employed. Wisconsin now covers uninsured persons with and WITHOUT kids up to 200% of fpl if they don't have employer coverage. For a family of four that's about $37,000 annually. The expanded group do pay a subsidized premium. Do you know a family on BadgerCare? I bet you know several. I'd bet several of my son's elementary school classmates are covered by it.
So for those who talk and warn about the "government takeover of health insurance", please get your head out of the sand. Its been happening for awhile.
By most estimates in 2009 we had between 45-47 million uninsured in the US. So now we have a roughly equal amount, according to Kaiser 46.9 million, on Medicaid programs.
Guess what folks, fewer and fewer of us have employer-based coverage- the last number I saw, for 2008, was 59%. You know that's lower now, right? By the way, in 2000 69% of us had employer-based coverage.
Isn't it time for an overhaul?
-----------------------
Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009
Largest Ever One-Year Increase Illustrates Medicaid's Role In Covering People During Economic Downturns But Further Strains Tight State Budgets
WASHINGTON, Feb. 18 /PRNewswire-USNewswire/ --
With the country mired in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. It was the biggest ever one-year increase in terms of absolute numbers, and boosted the June monthly Medicaid enrollment by 7.5 percent to 46.9 million people nationally.
It was the first time in decades that every state experienced an increase in Medicaid enrollment, and in 32 states enrollment grew at least twice as fast as the year before, according to the analysis, which includes data breakouts by state.
"State Medicaid programs have been able to help millions of Americans who have nowhere else to turn in a recession," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of KCMU. "But the states obviously face significant fiscal pressures as increases in enrollment push up costs at a time when state budgets are already severely constrained."
The increase in enrollment reflects the role that Medicaid plays in reducing the numbers of people who become uninsured when the economy falters, with many people turning to the program for help after being laid off and losing their employer-based health insurance. Millions more who were not eligible for Medicaid likely joined the ranks of the nation's uninsured.
A new Kaiser survey of state Medicaid directors finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment, resulting in increased spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits.
Enhanced federal matching money for Medicaid provided through the American Recovery and Reinvestment Act of 2009 has proved critical in helping states maintain coverage. But that money is scheduled to expire on Dec. 31, 2010, which will increase the strain on state fiscal year 2011 budgets, Medicaid directors reported.
Although Medicaid enrollment is on the rise, costs of the program as measured on a per-person basis are not climbing at a faster rate than health costs more generally. (See "An Actuarial Rorschach Test" [link to http://www.kff.org/pullingittogether/021610_altman.cfm]). Moreover, in past recessions, after the economy has improved, Medicaid enrollment growth has slowed and sometimes contracted, suggesting that the record rate of enrollment growth seen in 2009 will eventually subside.
UA-10096920-2
The House health care reform bill includes a public plan option, meaning its a plan that would compete against insurers. This story is about the public plan that is the last available option, Medicaid, for many folks.
The attached story below is about the huge expansion nationwide of state Medicaid programs in the wake of the recession. During these tough times, Wisconsin has expanded its Medicaid program while most others have seen their enrollment expand without trying. But Wisconsin has expanded Medicaid through its BadgerCare program to cover more low-income uninsured persons... many of whom ARE employed. Wisconsin now covers uninsured persons with and WITHOUT kids up to 200% of fpl if they don't have employer coverage. For a family of four that's about $37,000 annually. The expanded group do pay a subsidized premium. Do you know a family on BadgerCare? I bet you know several. I'd bet several of my son's elementary school classmates are covered by it.
So for those who talk and warn about the "government takeover of health insurance", please get your head out of the sand. Its been happening for awhile.
By most estimates in 2009 we had between 45-47 million uninsured in the US. So now we have a roughly equal amount, according to Kaiser 46.9 million, on Medicaid programs.
Guess what folks, fewer and fewer of us have employer-based coverage- the last number I saw, for 2008, was 59%. You know that's lower now, right? By the way, in 2000 69% of us had employer-based coverage.
Isn't it time for an overhaul?
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Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009
Largest Ever One-Year Increase Illustrates Medicaid's Role In Covering People During Economic Downturns But Further Strains Tight State Budgets
WASHINGTON, Feb. 18 /PRNewswire-USNewswire/ --
With the country mired in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. It was the biggest ever one-year increase in terms of absolute numbers, and boosted the June monthly Medicaid enrollment by 7.5 percent to 46.9 million people nationally.
It was the first time in decades that every state experienced an increase in Medicaid enrollment, and in 32 states enrollment grew at least twice as fast as the year before, according to the analysis, which includes data breakouts by state.
"State Medicaid programs have been able to help millions of Americans who have nowhere else to turn in a recession," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of KCMU. "But the states obviously face significant fiscal pressures as increases in enrollment push up costs at a time when state budgets are already severely constrained."
The increase in enrollment reflects the role that Medicaid plays in reducing the numbers of people who become uninsured when the economy falters, with many people turning to the program for help after being laid off and losing their employer-based health insurance. Millions more who were not eligible for Medicaid likely joined the ranks of the nation's uninsured.
A new Kaiser survey of state Medicaid directors finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment, resulting in increased spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits.
Enhanced federal matching money for Medicaid provided through the American Recovery and Reinvestment Act of 2009 has proved critical in helping states maintain coverage. But that money is scheduled to expire on Dec. 31, 2010, which will increase the strain on state fiscal year 2011 budgets, Medicaid directors reported.
Although Medicaid enrollment is on the rise, costs of the program as measured on a per-person basis are not climbing at a faster rate than health costs more generally. (See "An Actuarial Rorschach Test" [link to http://www.kff.org/pullingittogether/021610_altman.cfm]). Moreover, in past recessions, after the economy has improved, Medicaid enrollment growth has slowed and sometimes contracted, suggesting that the record rate of enrollment growth seen in 2009 will eventually subside.
UA-10096920-2
Wednesday, February 17, 2010
White House Summit may Include Unveiling of New Plan
Insuring Resources Commentary:
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
Thursday, February 11, 2010
Judd Gregg Could be Key to Health Care Reform Compromise....
Insuring Resources Commentary:
This could be quite constructive especially since Gregg is open to creating Accountable Care Organization's which have been proven to provide efficient, quality care. Sen. Gregg (R- New Hampshire) is a moderate and focuses his reform ideas on preventive care, disease management, and wellness program incentives for employers. The Democrats need to compromise by including Gregg's proposals and scaling back just a bit. There appears to be some room in the middle here particularly if Gregg can bring along some of his GOP colleagues like Sen. Olympia Snowe (R-Maine).
---------------------------
From Politico, 2/11/2010
Is Judd Gregg a tease or a real potential partner for President Barack Obama in trying to salvage some health care reform in this Congress?
That’s one question the White House has to answer for itself before the much-ballyhooed televised sit-down with Republicans on Feb. 25 on how to break the current stalemate. But it’s clear already that Gregg’s restless energy is drawing him back into the fray, and the New Hampshire conservative brings both a proven ability to swing Republican votes and a background in health care and deficit issues.
In a letter to Obama released late Tuesday, Gregg welcomed the meeting as a chance for “constructive dialogue” and is promoting his own lower-cost approach focused on preventive care and guaranteed catastrophic coverage for all families.
His letter warns the president that the House- and Senate-passed health care bills can’t be the sole basis for the discussions. But in a series of interviews with POLITICO, Gregg has been open to specific deficit-reduction and cost-containment steps that could be taken to win Republicans’ support for health reform.
“I’m not on their reach-out list, so nothing may come of this,” Gregg said in an interview Wednesday. “But I’m ready to sit down and try to be helpful.”
Obama may feel burned already by Gregg, who famously accepted then gave back the president’s nomination to be commerce secretary last year. And the changes Gregg will want are sure to aggravate the White House’s already frayed relationship with the left.
Yet the same qualities that first made Gregg attractive as a Cabinet nominee remain. He brings a record of bipartisan deal making and good personal ties to Senate Majority Leader Harry Reid (D-Nev.). And getting Gregg on board makes it far easier for Maine’s two moderate Republicans, Sens. Olympia Snowe and Susan Collins, to work with the White House.
If anything, the political ground has shifted in his direction since he gave up the Commerce option. And Obama’s own budget projections this month make it harder for Congress to separate health care from the debate over the government’s mounting deficits and debt — Gregg’s natural turf.
What’s more of a mixed blessing is his lame-duck status since he will step down from the Senate at the end of this year.
Gregg is anxious to make a difference in his last months. At the same time, conservatives recently used his retirement date as a way to isolate Gregg and undercut his bipartisan plan — embraced by Obama — to create a statutory fiscal commission empowered to force votes on deficit reduction after the November elections.
Going into the Feb. 25 meeting, the White House is still pursuing a more comprehensive and costly package than Gregg can accept. The half-day session may prove a last gambit by the president to help him bring Democrats together for a final push.
DETAILS
Below is the Essentials of Greg's plan:
The centerpiece is his plan to begin reform by first guaranteeing access to a low-premium policy that protects against catastrophic costs but also expressly allows preventive benefits and disease management under the deductible. He would modify the existing Health Insurance Portability and Accessibility Act to allow employers greater freedom to reward workers who participate in wellness programs, such as giving up smoking or losing weight. And given his New Hampshire roots, he subscribes to a host of the so-called Dartmouth reforms to promote accountable care organizations and incentivize “shared decision making” between physicians and elderly patients about treatment options.
His approach is sure to face criticism for being too late and too small bore. But Gregg’s already shown a willingness to work with Democrats on a compromise related to the HIPAA changes he wants. Having a true catastrophic, major medical option for people being mandated to buy insurance fits his mode of “middle working out.”
“We can all agree that no American should lose their life savings or their home because of illness or injury and that the rising cost of health care severely burdens individuals, families and businesses,” Gregg wrote in his letter to Obama this week. “Report after report also confirms that health care costs are a systemic risk to the long-term fiscal health of our nation.”
Rea
This could be quite constructive especially since Gregg is open to creating Accountable Care Organization's which have been proven to provide efficient, quality care. Sen. Gregg (R- New Hampshire) is a moderate and focuses his reform ideas on preventive care, disease management, and wellness program incentives for employers. The Democrats need to compromise by including Gregg's proposals and scaling back just a bit. There appears to be some room in the middle here particularly if Gregg can bring along some of his GOP colleagues like Sen. Olympia Snowe (R-Maine).
---------------------------
From Politico, 2/11/2010
Is Judd Gregg a tease or a real potential partner for President Barack Obama in trying to salvage some health care reform in this Congress?
That’s one question the White House has to answer for itself before the much-ballyhooed televised sit-down with Republicans on Feb. 25 on how to break the current stalemate. But it’s clear already that Gregg’s restless energy is drawing him back into the fray, and the New Hampshire conservative brings both a proven ability to swing Republican votes and a background in health care and deficit issues.
In a letter to Obama released late Tuesday, Gregg welcomed the meeting as a chance for “constructive dialogue” and is promoting his own lower-cost approach focused on preventive care and guaranteed catastrophic coverage for all families.
His letter warns the president that the House- and Senate-passed health care bills can’t be the sole basis for the discussions. But in a series of interviews with POLITICO, Gregg has been open to specific deficit-reduction and cost-containment steps that could be taken to win Republicans’ support for health reform.
“I’m not on their reach-out list, so nothing may come of this,” Gregg said in an interview Wednesday. “But I’m ready to sit down and try to be helpful.”
Obama may feel burned already by Gregg, who famously accepted then gave back the president’s nomination to be commerce secretary last year. And the changes Gregg will want are sure to aggravate the White House’s already frayed relationship with the left.
Yet the same qualities that first made Gregg attractive as a Cabinet nominee remain. He brings a record of bipartisan deal making and good personal ties to Senate Majority Leader Harry Reid (D-Nev.). And getting Gregg on board makes it far easier for Maine’s two moderate Republicans, Sens. Olympia Snowe and Susan Collins, to work with the White House.
If anything, the political ground has shifted in his direction since he gave up the Commerce option. And Obama’s own budget projections this month make it harder for Congress to separate health care from the debate over the government’s mounting deficits and debt — Gregg’s natural turf.
What’s more of a mixed blessing is his lame-duck status since he will step down from the Senate at the end of this year.
Gregg is anxious to make a difference in his last months. At the same time, conservatives recently used his retirement date as a way to isolate Gregg and undercut his bipartisan plan — embraced by Obama — to create a statutory fiscal commission empowered to force votes on deficit reduction after the November elections.
Going into the Feb. 25 meeting, the White House is still pursuing a more comprehensive and costly package than Gregg can accept. The half-day session may prove a last gambit by the president to help him bring Democrats together for a final push.
DETAILS
Below is the Essentials of Greg's plan:
The centerpiece is his plan to begin reform by first guaranteeing access to a low-premium policy that protects against catastrophic costs but also expressly allows preventive benefits and disease management under the deductible. He would modify the existing Health Insurance Portability and Accessibility Act to allow employers greater freedom to reward workers who participate in wellness programs, such as giving up smoking or losing weight. And given his New Hampshire roots, he subscribes to a host of the so-called Dartmouth reforms to promote accountable care organizations and incentivize “shared decision making” between physicians and elderly patients about treatment options.
His approach is sure to face criticism for being too late and too small bore. But Gregg’s already shown a willingness to work with Democrats on a compromise related to the HIPAA changes he wants. Having a true catastrophic, major medical option for people being mandated to buy insurance fits his mode of “middle working out.”
“We can all agree that no American should lose their life savings or their home because of illness or injury and that the rising cost of health care severely burdens individuals, families and businesses,” Gregg wrote in his letter to Obama this week. “Report after report also confirms that health care costs are a systemic risk to the long-term fiscal health of our nation.”
Rea
Individual Premiums on the Rise 39% in Calif.
Insuring Resources Commentary:
The article below illustrates whats at stake for individuals in the insurance market if they don't have access to group coverage. For instance, if I did my insurance writing for AHIP full time my health insurance would cost me $1,000 / mo for family coverage and I'd have a $5,000 annual deductible. That's a best case scenario.
For those of you who "enjoy" group health coverage through your employer hopefully this article provides a bit of perspective.
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Anthem raises Californian's individual health insurance preiums 39% for 2010LA Times 2/11/2010
The prospects for healthcare reform legislation in Washington are cloudy, but Anthem Blue Cross apparently isn't taking any chances. The company recently informed many of the approximately 800,000 Californians who buy its individual policies that premiums will rise sharply March 1. Although Anthem provided no details, insurance brokers say they're already seeing increases of up to 39%. That's on top of even larger rate hikes last year. With the pending healthcare bills proposing new limits on premiums and profits, the Anthem increases look suspiciously like an attempt to extract as much as possible from customers before the rules change.
The response from state and federal regulators was swift and heartening. California Insurance Commissioner Steve Poizner, who can't regulate rates directly but can limit insurers' profit margins, announced that he was hiring an independent actuary to scrutinize the planned increase. The House Energy and Commerce Committee and Health and Human Services Secretary Kathleen Sebelius also launched inquiries. To truly protect consumers, though, Congress should pass a healthcare reform bill that makes it easier for people to switch insurers without sacrificing coverage.
Anthem's official explanation for the hikes is that rapid increases in the cost of treatments and greater demand for healthcare services are driving up expenses at an "unprecedented" rate. It also asserts that the recession has prompted many healthy people to give up their insurance, leaving fewer policyholders to cover the cost of caring for a sicklier group. Those are valid complaints, but they don't automatically justify jacking rates up to the roof. In fact, Anthem's rate increases are contributing to the problem by pricing younger, healthier people out of the market for individual policies.
The company has called on Congress to start over on healthcare reform, rather than trying to improve on the bills passed by the House and Senate. In particular, Chief Executive Angela Braly of WellPoint Inc., Anthem's parent company, recently told the Wall Street Journal that lawmakers should find more effective ways to prod healthy people to buy insurance, promote competition among healthcare providers and put the brakes on rising costs. Those are all worthy aims, and the pending healthcare bills could be improved on all three fronts.
But the bills do make important changes in those areas -- and others as well. They would bar insurance companies from cherry-picking customers and denying coverage for preexisting conditions, enabling people to switch insurers easily. The bills also would promote competition and clarity in pricing through a new marketplace for individual policies. Anthem's actions offer the best argument yet for Congress to complete work on a comprehensive bill without delay.
The article below illustrates whats at stake for individuals in the insurance market if they don't have access to group coverage. For instance, if I did my insurance writing for AHIP full time my health insurance would cost me $1,000 / mo for family coverage and I'd have a $5,000 annual deductible. That's a best case scenario.
For those of you who "enjoy" group health coverage through your employer hopefully this article provides a bit of perspective.
----------------------- -----------------------
Anthem raises Californian's individual health insurance preiums 39% for 2010LA Times 2/11/2010
The prospects for healthcare reform legislation in Washington are cloudy, but Anthem Blue Cross apparently isn't taking any chances. The company recently informed many of the approximately 800,000 Californians who buy its individual policies that premiums will rise sharply March 1. Although Anthem provided no details, insurance brokers say they're already seeing increases of up to 39%. That's on top of even larger rate hikes last year. With the pending healthcare bills proposing new limits on premiums and profits, the Anthem increases look suspiciously like an attempt to extract as much as possible from customers before the rules change.
The response from state and federal regulators was swift and heartening. California Insurance Commissioner Steve Poizner, who can't regulate rates directly but can limit insurers' profit margins, announced that he was hiring an independent actuary to scrutinize the planned increase. The House Energy and Commerce Committee and Health and Human Services Secretary Kathleen Sebelius also launched inquiries. To truly protect consumers, though, Congress should pass a healthcare reform bill that makes it easier for people to switch insurers without sacrificing coverage.
Anthem's official explanation for the hikes is that rapid increases in the cost of treatments and greater demand for healthcare services are driving up expenses at an "unprecedented" rate. It also asserts that the recession has prompted many healthy people to give up their insurance, leaving fewer policyholders to cover the cost of caring for a sicklier group. Those are valid complaints, but they don't automatically justify jacking rates up to the roof. In fact, Anthem's rate increases are contributing to the problem by pricing younger, healthier people out of the market for individual policies.
The company has called on Congress to start over on healthcare reform, rather than trying to improve on the bills passed by the House and Senate. In particular, Chief Executive Angela Braly of WellPoint Inc., Anthem's parent company, recently told the Wall Street Journal that lawmakers should find more effective ways to prod healthy people to buy insurance, promote competition among healthcare providers and put the brakes on rising costs. Those are all worthy aims, and the pending healthcare bills could be improved on all three fronts.
But the bills do make important changes in those areas -- and others as well. They would bar insurance companies from cherry-picking customers and denying coverage for preexisting conditions, enabling people to switch insurers easily. The bills also would promote competition and clarity in pricing through a new marketplace for individual policies. Anthem's actions offer the best argument yet for Congress to complete work on a comprehensive bill without delay.
Monday, February 8, 2010
Health Care Reform Summit Feb 25th
Insuring Resurces Commentary:
This summit creates a next step for health-care reform. The House and the Senate have not been able to agree on a path forward. The president is bringing the two houses together, but not starting over. The basis for the discussion will be the two bills that have already passed, but the discussion is aimed at leading a way forward which means there may be some alterations in hopes of getting a few Republican votes.
The President, I presume will also use the occasion to change the perception on the back room Senate deals for multiple conservative Democratic Senators. But by setting this summit, he's bought them a few weeks to figure out how to hold a vote themselves. That won't be easy, but it'll be easier with the White House summit giving some structure and narrative to an effort that had collapsed into murky chaos.
Hopefully a way forward will highlight cost efficiency and quality which the GOP has been touting. Now's the time to play that card in front of a television audience.
-------------------- ------------------------------
From the Wall Street Journal- 2/8/10
President Barack Obama, seeking to give new momentum to his languishing health-care legislation, said he would sit down with Republican and Democratic lawmakers to exchange ideas on an issue that has deeply divided the parties.
With the GOP united against the Democratic bill, Mr. Obama said Sunday he would ask Republicans "to put their ideas on the table." The half-day meeting will be Feb. 25 and broadcast live, the White House said.
"I want to come back and have a large meeting, Republicans and Democrats, to go through systematically all the best ideas that are out there and move it forward," the president told CBS in an interview broadcast Sunday.
This summit creates a next step for health-care reform. The House and the Senate have not been able to agree on a path forward. The president is bringing the two houses together, but not starting over. The basis for the discussion will be the two bills that have already passed, but the discussion is aimed at leading a way forward which means there may be some alterations in hopes of getting a few Republican votes.
The President, I presume will also use the occasion to change the perception on the back room Senate deals for multiple conservative Democratic Senators. But by setting this summit, he's bought them a few weeks to figure out how to hold a vote themselves. That won't be easy, but it'll be easier with the White House summit giving some structure and narrative to an effort that had collapsed into murky chaos.
Hopefully a way forward will highlight cost efficiency and quality which the GOP has been touting. Now's the time to play that card in front of a television audience.
-------------------- ------------------------------
From the Wall Street Journal- 2/8/10
President Barack Obama, seeking to give new momentum to his languishing health-care legislation, said he would sit down with Republican and Democratic lawmakers to exchange ideas on an issue that has deeply divided the parties.
With the GOP united against the Democratic bill, Mr. Obama said Sunday he would ask Republicans "to put their ideas on the table." The half-day meeting will be Feb. 25 and broadcast live, the White House said.
"I want to come back and have a large meeting, Republicans and Democrats, to go through systematically all the best ideas that are out there and move it forward," the president told CBS in an interview broadcast Sunday.
Friday, February 5, 2010
More Evidence for Health CARE Reform
This is Data from the federal Centers for Medicare and Medicaid Services:
------------------------
Source: Health Affairs
February 05, 2010
Health care's share of the economy grew 1.1 percentage points in 2009 - the largest one-year increase in GDP share since the federal government began keeping track in 1960:
Rising health care costs are crushing our economy and adding a burden on working families and employers across the country. The new CMS data confirm that rising health care costs are driven by increases in underlying medical costs, not health plan administrative costs. In fact, the proportion of health insurance premiums that go towards administrative costs is declining as overall health care costs continue to soar. Without a national, long-term strategy to address the rapid growth in underlying medical costs, health care spending will continue to grow far faster than the economy as a whole, crowding out other important domestic priorities, such as education, energy, and deficit reduction.
The report, published today in Health Affairs, notes that the "two primary drivers of growth…are medical prices and utilization", which saw a projected increase in spending by 3.2 percent and 1.5 percent in 2009, respectively. Other key findings include:
"Hospital spending growth is projected to have accelerated from 4.5 percent in 2008 to 5.9 percent in 2009, as spending reached $760.6 billion."
"Spending growth for physician and clinical services is expected to have accelerated to 6.3 percent in 2009, up from 5.0 percent in 2008, with expenditures having reached $527.6 billion."
"Prescription drug spending is expected to have grown 5.2 percent in 2009, an acceleration of 2.0 percentage points from 2008, and to have reached $246.3 billion."
This is consistent with national data and information received from health plans (PDF) showing that health care costs are expected to increase even further due to the underlying growth in the cost of health care services.
------------------------
Source: Health Affairs
February 05, 2010
Health care's share of the economy grew 1.1 percentage points in 2009 - the largest one-year increase in GDP share since the federal government began keeping track in 1960:
Rising health care costs are crushing our economy and adding a burden on working families and employers across the country. The new CMS data confirm that rising health care costs are driven by increases in underlying medical costs, not health plan administrative costs. In fact, the proportion of health insurance premiums that go towards administrative costs is declining as overall health care costs continue to soar. Without a national, long-term strategy to address the rapid growth in underlying medical costs, health care spending will continue to grow far faster than the economy as a whole, crowding out other important domestic priorities, such as education, energy, and deficit reduction.
The report, published today in Health Affairs, notes that the "two primary drivers of growth…are medical prices and utilization", which saw a projected increase in spending by 3.2 percent and 1.5 percent in 2009, respectively. Other key findings include:
"Hospital spending growth is projected to have accelerated from 4.5 percent in 2008 to 5.9 percent in 2009, as spending reached $760.6 billion."
"Spending growth for physician and clinical services is expected to have accelerated to 6.3 percent in 2009, up from 5.0 percent in 2008, with expenditures having reached $527.6 billion."
"Prescription drug spending is expected to have grown 5.2 percent in 2009, an acceleration of 2.0 percentage points from 2008, and to have reached $246.3 billion."
This is consistent with national data and information received from health plans (PDF) showing that health care costs are expected to increase even further due to the underlying growth in the cost of health care services.
Obama supposedly, but not really, maps a way forward
Insuring Resources Commentary:
See below for a very non-specific, mediocre strategy
--------------------- ----------------------------
Obama Maps a Way Forward on Health Care Reform
NY Times- Feb 5, 2010
Speaking to enthusiastic supporters at a fund-raiser here, President Obama on Thursday evening presented his clearest plan yet to move forward with comprehensive health care legislation, saying that he wanted to meet with Democrats, Republicans and independent experts, lay out the facts for the American people and then, he said, “I think that we have got to move forward on a vote.”
Mr. Obama said he would first work with Congress to enact a jobs package that would encourage new hiring, which he said was “the thing that is most urgent right now, in the minds of Americans all across the country.” But he also said that he would take the time to refute false statements and misunderstandings about the health care legislation and to hear alternate ideas from Republicans.
After “several weeks” of work, he said, he would be prepared to live with whatever decision is made by Congress, but he also warned that voters, too, would be watching and would decide at the polls in November whether lawmakers had made the right choice.
Mr. Obama still did not chart a specific legislative strategy for moving a bill through Congress.
But the president’s comments, in prepared remarks at the fund-raiser at the Capitol Hilton and then in response to a question submitted by a supporter from Milwaukee, offered more clarity about how he plans to proceed on the health care legislation than the White House has provided in the two and half weeks since a Republican, Scott Brown, won the special election for Senate in Massachusetts.
The victory by Mr. Brown, who was sworn in on Thursday, effectively stalled the health care legislation by ending the Democrats’ 60-vote supermajority in the Senate, which would have allowed them to defeat a Republican filibuster and advance the health care measure.
Congressional Democratic leaders and the White House have been groping for a way forward on the health care legislation. Their main strategy seems to be to work on devising changes to the Senate-passed health care bill that could be attached to a budget measure, which would allow it to be approved by a simple majority. The House could then approve both the Senate bill and the changes and send them in tandem to Mr. Obama for his signature.
The House speaker, Nancy Pelosi, and the Senate majority leader, Harry Reid, attended a meeting with Mr. Obama at the White House on Thursday, but officials said that no firm decisions were reached.
At the fund-raiser for the Democratic National Committee later on Thursday, however, Mr. Obama said that once Congressional Democrats had worked out their differences and settled on a final bill, he would push for a vibrant, public debate over the health care legislation. He said he planned “to call on our Republican friends to present their ideas.”
“What I’d like to do is have a meeting whereby I am sitting with the Republicans, sitting with the Democrats, sitting with health care experts and let’s just go through these bills,” Mr. Obama said. “Their ideas, our ideas. Let’s walk through them in a methodical way, so that the American people can see and compare what makes the most sense. And then I think that we have got to move forward on a vote. We have got to move forward on a vote.”
Mr. Obama said that Americans were apprehensive about the health care legislation because there was too much misinformation that he would now work to clear up.
“They are certain that they would have to go onto a government plan, which isn’t true,” the president said. “But that’s still a perception a lot of people have. They are still pretty sure that they would have to give up their doctor. They are still pretty sure that if they are happy with their health care plan, that it’s bad for them. They are still positive that this is going to add to the deficit. So there is a lot of information out there that people understandably are concerned about.”
He continued, “That’s why I think it’s very important for us to have a methodical, open process over the next several weeks, and then let’s go ahead and make a decision. And it may be that if Congress decides, if Congress decides we’re not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not. And that’s how democracy works, and there will be elections coming up and they will be able to make a determination and register their concerns one way or another during election time.”
At one point, as the president insisted that he would continue to fight for the health care bill, the crowd chanted, “Yes, we can! Yes, we can!”
Despite their enthusiasm and Mr. Obama’s, it is no longer clear that Senate leaders could muster even 51 votes to make fast-tracked changes to the Senate-passed health bill, let alone the 60 votes it would take to approve a revised measure under the normal rules.
In the House, Ms. Pelosi, too, now faces an uphill climb. Perhaps the toughest differences are those that separate Senate and House Democrats, disagreements that were in the process of being resolved when the election in Massachusetts upended the entire process. House Democrats, for instance, still fiercely oppose a proposed tax on high-cost, employer-sponsored insurance policies that Senate Democrats included in their bill and that Mr. Obama has said he supports.
See below for a very non-specific, mediocre strategy
--------------------- ----------------------------
Obama Maps a Way Forward on Health Care Reform
NY Times- Feb 5, 2010
Speaking to enthusiastic supporters at a fund-raiser here, President Obama on Thursday evening presented his clearest plan yet to move forward with comprehensive health care legislation, saying that he wanted to meet with Democrats, Republicans and independent experts, lay out the facts for the American people and then, he said, “I think that we have got to move forward on a vote.”
Mr. Obama said he would first work with Congress to enact a jobs package that would encourage new hiring, which he said was “the thing that is most urgent right now, in the minds of Americans all across the country.” But he also said that he would take the time to refute false statements and misunderstandings about the health care legislation and to hear alternate ideas from Republicans.
After “several weeks” of work, he said, he would be prepared to live with whatever decision is made by Congress, but he also warned that voters, too, would be watching and would decide at the polls in November whether lawmakers had made the right choice.
Mr. Obama still did not chart a specific legislative strategy for moving a bill through Congress.
But the president’s comments, in prepared remarks at the fund-raiser at the Capitol Hilton and then in response to a question submitted by a supporter from Milwaukee, offered more clarity about how he plans to proceed on the health care legislation than the White House has provided in the two and half weeks since a Republican, Scott Brown, won the special election for Senate in Massachusetts.
The victory by Mr. Brown, who was sworn in on Thursday, effectively stalled the health care legislation by ending the Democrats’ 60-vote supermajority in the Senate, which would have allowed them to defeat a Republican filibuster and advance the health care measure.
Congressional Democratic leaders and the White House have been groping for a way forward on the health care legislation. Their main strategy seems to be to work on devising changes to the Senate-passed health care bill that could be attached to a budget measure, which would allow it to be approved by a simple majority. The House could then approve both the Senate bill and the changes and send them in tandem to Mr. Obama for his signature.
The House speaker, Nancy Pelosi, and the Senate majority leader, Harry Reid, attended a meeting with Mr. Obama at the White House on Thursday, but officials said that no firm decisions were reached.
At the fund-raiser for the Democratic National Committee later on Thursday, however, Mr. Obama said that once Congressional Democrats had worked out their differences and settled on a final bill, he would push for a vibrant, public debate over the health care legislation. He said he planned “to call on our Republican friends to present their ideas.”
“What I’d like to do is have a meeting whereby I am sitting with the Republicans, sitting with the Democrats, sitting with health care experts and let’s just go through these bills,” Mr. Obama said. “Their ideas, our ideas. Let’s walk through them in a methodical way, so that the American people can see and compare what makes the most sense. And then I think that we have got to move forward on a vote. We have got to move forward on a vote.”
Mr. Obama said that Americans were apprehensive about the health care legislation because there was too much misinformation that he would now work to clear up.
“They are certain that they would have to go onto a government plan, which isn’t true,” the president said. “But that’s still a perception a lot of people have. They are still pretty sure that they would have to give up their doctor. They are still pretty sure that if they are happy with their health care plan, that it’s bad for them. They are still positive that this is going to add to the deficit. So there is a lot of information out there that people understandably are concerned about.”
He continued, “That’s why I think it’s very important for us to have a methodical, open process over the next several weeks, and then let’s go ahead and make a decision. And it may be that if Congress decides, if Congress decides we’re not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not. And that’s how democracy works, and there will be elections coming up and they will be able to make a determination and register their concerns one way or another during election time.”
At one point, as the president insisted that he would continue to fight for the health care bill, the crowd chanted, “Yes, we can! Yes, we can!”
Despite their enthusiasm and Mr. Obama’s, it is no longer clear that Senate leaders could muster even 51 votes to make fast-tracked changes to the Senate-passed health bill, let alone the 60 votes it would take to approve a revised measure under the normal rules.
In the House, Ms. Pelosi, too, now faces an uphill climb. Perhaps the toughest differences are those that separate Senate and House Democrats, disagreements that were in the process of being resolved when the election in Massachusetts upended the entire process. House Democrats, for instance, still fiercely oppose a proposed tax on high-cost, employer-sponsored insurance policies that Senate Democrats included in their bill and that Mr. Obama has said he supports.
Wednesday, February 3, 2010
Post-mortem
Insuring Resources Commentary:
No timeline, no idea what to do-- are there any leaders left?
-----------------------
From the Wall Street Journal:
2/3/2010
by Janet Adamy and Patrick Yoest
With their sweeping health-care bill on hold, House Democrats plan to revive a sliver of the legislation as soon as next week that would repeal an antitrust exemption for insurance companies.
The move underscores growing doubts on Capitol Hill that Democrats can pass their ambitious plan to expand health insurance to more than 30 million Americans.
After focusing intensely on health care for months, Democratic leaders have removed completion of the overhaul from their agenda indefinitely, and even talk of the subject is scarce.
Instead, House Democrats are turning to a targeted provision with populist appeal in search of a small victory. They say repealing the federal antitrust exemption would drive insurance prices down in regions where one health insurer dominates. Insurers say they already face tight regulation by the states, and the practical impact of the move is uncertain.
Top Democrats said Tuesday they remained confident they would pass a broader health bill, but they acknowledged they had no time frame for doing so and no feasible strategy in sight. House Majority Leader Steny Hoyer, a Democrat from Maryland, when reminded that he said last week Democrats would have a plan by now, responded: "Did I say that? I was in error."
Democrats have struggled to explain the legislation and persuade Americans that the measure, with a nearly $1 trillion price tag over 10 years, would benefit consumers.
Republicans are showing no signs of helping the Democrats out of their predicament, saying Democrats should start from scratch on health care. That would require weeks or months of additional work, which isn't politically feasible when Congress wants to focus on job-creating legislation.
In recent days, supporters of the legislation, including the seniors group AARP and the American Medical Association, have sent letters to the Capitol urging lawmakers not to abandon the legislation. Some supporters say further delay could mean the bill effectively dies without fanfare.
Senate Majority Leader Harry Reid was noncommittal Tuesday. "Don't pin me down as to days or number of weeks," he said. "We plan to do health care this year, and do it as quickly as we can."
Supporters of the overhaul have made some attempts to link the health bill to job creation, pointing out that expanding insurance would spur hiring in the health sector. Republicans say the legislation's new taxes and requirements for businesses to provide insurance could chill job growth.
"It raises considerable concern and raises the cost of doing business," said Sen. Olympia Snowe, a Republican from Maine who voted for a health overhaul in the Senate Finance Committee but voted no on the version that came before the full Senate.
Senate Democrats said their best hope was still for the House to pass the version of the health overhaul that the Senate passed Dec. 24, along with a package of modifications that would use a parliamentary procedure requiring fewer votes for approval. But centrist Democrats in both chambers are nervous that using such a technicality will be unpopular with voters.
Congressional staff members are struggling to surmount legislative hurdles for that route and say it may not be sufficient to resolve all of House Democrats' concerns about the bill.
House speaker Nancy Pelosi confirmed the plan to take up the antitrust exemption Tuesday.
A House Democratic aide said leaders hoped the measure would revive the momentum for the broader bill.
Polls suggest public support for the bill has diminished, and Americans were turned off by provisions in the Senate bill to win the votes of wavering lawmakers.
No timeline, no idea what to do-- are there any leaders left?
-----------------------
From the Wall Street Journal:
2/3/2010
by Janet Adamy and Patrick Yoest
With their sweeping health-care bill on hold, House Democrats plan to revive a sliver of the legislation as soon as next week that would repeal an antitrust exemption for insurance companies.
The move underscores growing doubts on Capitol Hill that Democrats can pass their ambitious plan to expand health insurance to more than 30 million Americans.
After focusing intensely on health care for months, Democratic leaders have removed completion of the overhaul from their agenda indefinitely, and even talk of the subject is scarce.
Instead, House Democrats are turning to a targeted provision with populist appeal in search of a small victory. They say repealing the federal antitrust exemption would drive insurance prices down in regions where one health insurer dominates. Insurers say they already face tight regulation by the states, and the practical impact of the move is uncertain.
Top Democrats said Tuesday they remained confident they would pass a broader health bill, but they acknowledged they had no time frame for doing so and no feasible strategy in sight. House Majority Leader Steny Hoyer, a Democrat from Maryland, when reminded that he said last week Democrats would have a plan by now, responded: "Did I say that? I was in error."
Democrats have struggled to explain the legislation and persuade Americans that the measure, with a nearly $1 trillion price tag over 10 years, would benefit consumers.
Republicans are showing no signs of helping the Democrats out of their predicament, saying Democrats should start from scratch on health care. That would require weeks or months of additional work, which isn't politically feasible when Congress wants to focus on job-creating legislation.
In recent days, supporters of the legislation, including the seniors group AARP and the American Medical Association, have sent letters to the Capitol urging lawmakers not to abandon the legislation. Some supporters say further delay could mean the bill effectively dies without fanfare.
Senate Majority Leader Harry Reid was noncommittal Tuesday. "Don't pin me down as to days or number of weeks," he said. "We plan to do health care this year, and do it as quickly as we can."
Supporters of the overhaul have made some attempts to link the health bill to job creation, pointing out that expanding insurance would spur hiring in the health sector. Republicans say the legislation's new taxes and requirements for businesses to provide insurance could chill job growth.
"It raises considerable concern and raises the cost of doing business," said Sen. Olympia Snowe, a Republican from Maine who voted for a health overhaul in the Senate Finance Committee but voted no on the version that came before the full Senate.
Senate Democrats said their best hope was still for the House to pass the version of the health overhaul that the Senate passed Dec. 24, along with a package of modifications that would use a parliamentary procedure requiring fewer votes for approval. But centrist Democrats in both chambers are nervous that using such a technicality will be unpopular with voters.
Congressional staff members are struggling to surmount legislative hurdles for that route and say it may not be sufficient to resolve all of House Democrats' concerns about the bill.
House speaker Nancy Pelosi confirmed the plan to take up the antitrust exemption Tuesday.
A House Democratic aide said leaders hoped the measure would revive the momentum for the broader bill.
Polls suggest public support for the bill has diminished, and Americans were turned off by provisions in the Senate bill to win the votes of wavering lawmakers.
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