Health Care Now

In Oregon, a separate measure, giving state sponsorship of a comprehensive study on universal healthcare financing, makes its way through the Committee on Ways & Means.

By Christopher David Gray for the Lund Report –

May 15, 2013 — Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield.

But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn’t submitted his driver’s license.

“Denial and delay, denial and delay are the way these insurance companies work. They make money this way,” Brain vented to the House Health Committee on Tuesday. He had previously lost his daughter after a nine-year struggle with leukemia while contending with insurance companies over access to necessary healthcare services.

Eventually, his policy was approved. He paid $2400 — three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization.

His clock was ticking. His throat cancer could be spreading.

He enlisted his local Rep. Peter Buckley, D-Ashland, to help him. He got the state Insurance Division on his case.

They came through. He received his PET scan, and spent four days at Oregon Health & Science University, receiving additional tonsil surgery. “They cut the hell out of me,” said Brain, who’s now cancer-free.

“There is no way that Regence should have delayed my care at all,” Brain added. “That’s how they do business. They kill people doing it. Let’s get them the hell out of it, and let’s pass this bill.”

Buckley and 23 other Democrats have signed on to support House Bill 2922, which would throw out the private health insurance industry and set up a single-payer health insurance system administered by the Oregon Health Authority.

The bill has no chance of passage this session, but House Health Committee Chairman Rep. Mitch Greenlick allowed fellow Portland Democrat and chief sponsor Rep. Michael Dembrow to lead single-payer health care advocates in an informational public hearing.

Brain and other activists aired their support for a privately delivered, government-sponsored health system that would revolutionize Oregon healthcare and make it similar to health systems in Japan, Europe, Canada and the rest of the developed world.

HB 2922 closely parallels House Bill 3510 from the 2011 session, but at 76 pages, it’s 30 percent longer than the previous measure, repealing newly acted reforms such as Cover Oregon, which offers subsidized private insurance for people with moderate incomes.

No Republicans have yet come on board as supporters, but the single-payer bill has twice as many sponsors this session from Democrats across the state, including rural districts as well as Portland and Eugene. Two of the state’s largest unions – the Oregon Nurses Association and the Oregon Education Association – have also thrown their support behind the measure.

Study Bill Moves Forward

Dembrow has also sponsored House Bill 3260, which had a budget hearing on Tuesday. That bill, which passed unanimously earlier this session from the House Health Committee, would solicit $250,000 to $600,000 in private funds to comprehensively study how best to implement universal healthcare in Oregon.

The study will look at several different options, including single-payer, a public option and the basic health plan envisioned for low-income people who wouldn’t qualify for Medicaid by the Affordable Care Act.

Chunhuei Chi, a professor at Oregon State University’s College of Public Health and Human Sciences, told The Lund Report the study would aim for transparency, be replicable and available for peer review. The Oregon Health Authority could either choose Oregon State or another entity to conduct the study.

Previously, Health Care for All Oregon, which supports the single-payer bill, had considered asking the Northwest Health Foundation to conduct such a study. But according to Dembrow, a state-sanctioned study would lend more credibility.

Earlier, he told The Lund Report that while he expects single payer the best route to universal healthcare, he believes the underlying bill is written well enough to turn into the best solution for Oregon, and he will support its recommendations.

“This is exactly the way it’s done,” said Sen. Elizabeth Steiner Hayward, D-Portland, who favors doing such a study but has not come out in support of the single-payer option. “I like that you’ve laid out a menu of options, and that it doesn’t make a predetermined decision,” she added, calling the study outcome-based rather than motivated by political ideology.

Contrasting Systems

Alan Journet, a retired professor and dual British-U.S. citizen, pointed out that in Great Britain, socialized medicine is so popular even Conservative icon, former Prime Minister Margaret Thatcher, was a big supporter.

While living in the U.S., he came down with cancer and was given two months to live, absent treatment. “Thanks to insurance, I didn’t have to worry much about the cost of treatment, but I did constantly have to worry about the insurance company approving doctor-recommended treatment,” Journet said.

Journet said he felt lucky — his insurance company approved his treatment, unlike his sister-in-law who fell ill earlier.

“Her insurance company denied treatment, and she died,” Journet said. “We often hear the complaint that we should fear government functionaries making decisions on treatment, as though we are better served having insurance company functionaries make such decisions, employees whose income encourages denying treatment and generating a sizable profit.”

Dembrow said his passion for single-payer healthcare started following the birth of his two children. His daughter, who was born in France, received exemplary care, including house calls from physicians for just a small co-payment and a tax taken out of the family paychecks.

His son, on the other hand, was born in Indiana. At the time, insurance companies weren’t required to cover infants for the first 30 days of their life. His son had a digestive abnormality called pyloric stenosis that required surgery. A graduate student at the time, Dembrow and his wife had to deplete their savings to pay for the care.

“The contrast of those experiences have committed me to try to do things differently in this country,” Dembrow said.

Dembrow praised the reform efforts of Gov. Kitzhaber to deliver healthcare for the poor through coordinated care organizations and also lauded many of the aspects of the Affordable Care Act, including the expanded Oregon Health Plan and the insurance exchange. Yet, he said these reforms fall far short of an equitable universal healthcare system.

“We’ll continue to have jobs kept temporary or part-time for no good reason other than to keep workers from being eligible for coverage,” he said. “Our system will still rely on private insurance companies who charge high administrative fees, create administrative burdens for doctors and other healthcare professionals, and whose primary interest is their own profits. … At best what we’re going to continue to have an expensive, complicated patchwork system.”

Healthcare-NOW! is pleased to join with Progressive Democrats of America to support a nationwide call-in day today to increase awareness and co-sponsors in Congress for HR 676–the Expanded and Improved Medicare for All Act.

Call the U.S. Capitol Switchboard toll-free at (866) 220-0044, ask for your representative’s office, and then ask them to sign as a co-sponsor of HR 676. Don’t know your Rep? Put your ZIP in here.

Or you can quickly email them here.

The current cosponsors (42) are listed here.

Once you call and email, please ask your friends and contacts to do so as well.

HR 676 would create a publicly financed, privately delivered healthcare system that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories.

Healthcare-NOW! is committed to building the movement for national, single-payer healthcare and we sincerely hope that you will call and email your Representative to ask them to become a cosponsor of the bill.

By Donna Smith for Common Dreams –

In recent days, many of us have read and tried to follow the reports that Congressional offices are engaged in discussions about how to make sure their health insurance coverage available under the Affordable Care Act (Obamacare) remains affordable for Congresspersons and their staff members. If you’d like to read more about the hullabaloo, this piece from the Washington Post probably explains it as clearly as any.

Basically, a mischievous amendment drafted and inserted by Republicans and later agreed to by Democrats anxious to pass the ACA leaves some challenging issues to be resolved regarding the employer’s (in this case the Federal government, a.k.a., you and me) contributions to paying their share of premiums for Congressional members and their staff members. Negotiations and discussions continue, but some fear that some Congressional staff may leave their positions rather than take on the bigger financial burdens of paying more of their health insurance premiums. Stay tuned, if you are worried about how this plays out.

For the human beings involved who have health needs and families to support just as the rest of us do, I hope a fair resolution is reached in the short term. In the longer term, this should serve as yet another reinforcement of the need to move well beyond the incredibly unaffordable Affordable Care Act to the common sense, common decency, and simplicity of a single-payer, Medicare for all for life model for our dysfunctional health care system.

If Congressional members and their staffs are having difficulties comprehending and navigating the details of the ACA, imagine the millions and millions of “average” Americans who will face incredible confusion, expense, and delays of access to needed health care as we slog through the details of the ACA. Most of us will not have anyone to negotiate or advocate for us when we try to make decisions about health coverage. We will have “navigators” who will explain various plans available on the exchanges but that’s vastly different from having true advocates to make sure we aren’t overburdened with costs or enrolling in coverage that really isn’t coverage at all but simply compliance with the mandate to carry the financial product that is insurance. I am already worried, just as millions of others are.

Why would single-payer, Medicare for all for life be so much better? Simplicity – everybody is in, nobody is out. Vastly reduced administrative costs – strip out the profit made on misery and deception and advertising and claims denials and delays. Incredibly improved access to providers of our choice. No need to navigate me to one plan or another. No need to bankrupt me with co-pays, deductibles and out-of-pocket expenses. No need for anyone in charge of profit-making to lemon drop (get rid of those with costly medical conditions or who are aging) or cherry pick (keep the healthy, less costly folks enrolled). We all have one single standard of high quality care under a social insurance model, not a model aimed at maximizing profits.

Some of us will face harsh realities more quickly than Congressional members of staffers on the Hill. In just four days, I must decide once and for all whether or not to spend more than $800 a month on my coverage for the next several months or just go bare until the exchange (more stealthily named the “marketplace”) is up and running here in Colorado in January 2014. No matter what I, as a two time cancer survivor and 58 year old, think is possible financially for me or even wisest from a health standpoint over the next eight months, once I get to October of this year, I will be able to begin exploring what I may be able to find under the ACA for my coverage. I am so grateful that my husband is covered under Medicare and a supplemental (as are many member of Congress, I suspect).

When my time comes to decide about my health and my life, there will be no committee convened that worries about my costs or my coverage as is the case with the current effort on behalf of the Congressional members and staffs my tax dollars cover. I will decide alone, likely in front of my computer screen, making calculations about paying my bills and other living expenses. And I guarantee that my coverage will be bare bones as no one will want to cover me and though under the ACA they will not be able to deny me coverage, insurance companies will be able to age-rate my premiums and make sure they factor in my health history. My premiums will likely be so high that I will either have to opt to pay a penalty for not having coverage or I will be grossly under-insured.

None of this is necessary. None of it. Under a Medicare for all for life, single-payer model, we are all in one risk pool, we all pay a fair and progressive tax or premium for our coverage, and our medical and health decisions will no longer be business calculations. We will be free of this mess. We must thunder forward through the confusion of this difficult transition to the unnecessary complexity of the ACA to the day when we all are covered simply as a matter of human right and public good.

Donna Smith is the Executive Director of Health Care for All Colorado and the Health Care for All Colorado Foundation.

By Gerald Friedman –

America’s health care system is collapsing, and we can blame the Economics profession. Most economists approach health care in the wrong way, viewing it as a commodity like shoes or the laptop on which I write. Instead, health care is an idiosyncratic commodity, subject to uncertainty and “asymmetric information” leading to destructive behavior. Trying to force health care into a box, treating it like other commodities, economists have promoted cost sharing, market competition, and insurance oversight of health care providers that have inflated the administrative burden while denying ever more Americans access.

Health care spending has been rising throughout the world as aging and more affluent populations spend on their health. Nowhere, however, has the cost of health care risen as fast as in the United States where costs soared because of rising administrative expense. Compared with other affluent countries in the Organization for Economic Cooperation and Development (the OECD), the United States spends over twice as much per person as is spent elsewhere. Before 1971 when Canada enacted its Medicare program, a single-payer government funded health care system, Canada spent a higher share of its national income on health care than did the United States; since then, however, while Canada has controlled costs, spending has soared in the United States so that we now spend over $3000 more per person. That is $12,000 for a family of four that is not available for travel, education, housing, or food.

Elsewhere, increases in health care spending have been associated with improvements in the provision of health care and, therefore, go with increasing life expectancy. In the United States, however, spending has increased because of rising administrative costs and increases in the price of prescription drugs and, therefore, has yielded relatively few benefits in improvements in care. Comparing changes in health-care spending and life expectancy between 1971 and 2008, other affluent OECD members gained a year of life expectancy for every $453 in spending; in the United States, however, life expectancy has increased less and spending has risen sharply more so that each year of increased life expectancy has cost over twice as much as in these other countries. Health care spending in the United States has increased by $1283 for every additional year of life expectancy; had our spending per year of added life increased at only the rate of other countries we would be spending over $4500 less per person, $18,000 saved for the average family of four. Most of the difference in relative expenditures, most of the growing waste in spending in the United States, is due to increasing administrative costs in the provision of private health insurance and in the billing and insurance operations within doctors’ offices and in hospitals. The average physician in the United States now spends four-times as much interacting with insurance companies as does the average physician in Ontario, Canada, over $80,000 per physician compared with a little over $20,000 in Ontario. Prescription drug prices and administrative expenses have been the fastest rising costs in the United States health care system; from 1980 to 2005, administrative costs rose by 1300% while drug prices rose by nearly 2000%. There are now 2.5 million administrative support personnel in the American health care system; more than the number of nurses, and five times the number of physicians. We now have more health-care managers than physicians and surgeons.

Rising costs drive up health insurance premiums so that a family health insurance plan now costs about 40% of the average family wage income, up from 7% in 1960. Rising costs are denying ever more Americans access to health care even while businesses and governments wrestle with rising health care spending that squeezes resources available for other purposes. While other countries have controlled health care costs by restraining administrative expenses and drug prices, ballooning costs in the United States come from policies promoted by economists who have urged governments and providers to control costs by making consumers responsible for more of the costs even while raising administrative costs and ignoring monopolistic pricing of pharmaceuticals. Viewing the injured, sick, and disabled as “consumers,” economists see insurance as the source of rising costs because they are not responsible for the costs of care they receive and, therefore, overuse health care. Rising copayments and deductibles are intended to discourage “consumers” from “abusing” health care, as if the victims of auto accidents or cancer should shop around for cheaper, and competition among insurers while limiting provider services by providing more administrative supervision. Ignoring evidence that Americans are less likely to see doctors and other health providers than are residents of other affluent countries, these economists have blamed the high cost of our health care on insurance which, they assume, leads to wasteful over-practice and the provision of unnecessary health care services. Their solution is greater cost sharing, more regulation of providers, capitation, and even the end to insurance by substituting medical savings accounts for insurance.

For 40 years, many economists’ have promoted increasing cost sharing through higher copayments and deductibles, the replacement of fee-for-service payment systems with capitation where providers are paid a fixed amount for patients as in Health Maintenance Organizations, and competition where multiple insurers offer a variety of plans catered to individual consumer’s interests and in competition with each other. Far from limiting health care cost increases, these practices have produced the worst of all worlds, rising costs along with restrictions on access. Costs have risen because these recommendations have inflated the administrative burden in health care, the costs of the billing and insurance activities within provider offices as well as the cost of the health insurance industry itself. While restricting access, limiting the benefit to Americans of some of the dramatic improvements in health care practice of the last decades, these practices have not bent the cost curve or slowed health care inflation even while denying more and more Americans access to affordable health care.

The failure of price incentives and competition to control health care costs could have been predicted had economists appreciated that health insurance is not a commodity and the sick are not consumers like those shopping for the best pair of sandals or brand of peanut butter. Producers of commodities might try to accommodate consumer wishes because they can profit by selling more. Health insurers, on the contrary, can better increase their profits by selling less, by identifying people likely to need care and driving them away (“lemon dropping”) even while attracting the lucky and healthy (“cherry picking”). Most health care expenditures go to a relatively few people, the unlucky who develop an illness or suffer an accident; insurers, therefore, can dramatically lower their costs by finding those who will be expensive and getting rid of their business; encouraging them to find another insurance plan or even to die.

A form of “adverse selection,” or screening of potential customers by insurance companies, can be profitable for the individual firm but it comes at the cost of raising costs for the community as a whole. As a country, we now spend almost $200 billion administering the health insurance industry and over $800 billion in administering the health care industry, or over a quarter of total spending. Add to this the inefficiency in delivery that comes from a fragmented finance system that inhibits coordination of care, and the inflated prices for prescription drugs, and easily a third of total spending is wasted or going to monopolistic profits.

The waste involved in the current system has a redeeming feature: it provides abundant space for an improved system that could improve access and services even while dramatically lowering costs by eliminating administrative waste. If we lowered administrative costs and drug prices to the Canadian level, we could save nearly $600 billion dollars, more than enough to provide coverage to all of the uninsured while improving access for the millions of underinsured. If we see past the bad recommendations of market-fundamentalists, we can improve health care and save money. An outcome that even economists should favor.

Gerald Friedman Professor of Economics University of Massachusetts at Amherst, Amherst, MA. 01003

Dollars and Sense: Funding a National Single-Payer System by Gerald Friedman.

By Ann Carrns for the New York Times –

About half of United States adults ages 19 to 64 didn’t have health insurance for at least part of last year or were underinsured, a new report from the Commonwealth Fund says.

The fund, a private nonprofit organization that finances research into health care and health policy issues, conducts the health insurance survey every two years.

One bright spot, the report found, is that the proportion of young adults without health insurance fell significantly over the last two years, probably because of a provision of the Affordable Care Act that allows young adults to stay on their parents’ health plans until age 26. The rule took effect in September 2010.

Nearly eight out of 10 (79 percent) young adults reported that they were insured, up from 69 percent in 2010. That marks “an abrupt reversal in a decadelong climb” in the number of uninsured young adults, the report said.

Uninsured rates for other age groups, however, either rose or stayed the same. About half of adults ages 19 to 64 didn’t have health insurance for all of 2012 or were underinsured, meaning that they had insurance but struggled to pay for medical costs anyway.

At the time of the survey, about 30 percent said they were uninsured or were insured but hadn’t been at some point during the year. Another 16 percent had insurance, but had such high out-of-pocket medical costs relative to their income that they were effectively uninsured.

The survey also found that people are increasingly skipping needed health care because they can’t afford it (about 43 percent answered yes to that question). That’s up from 37 percent in 2003, the report noted.

The report found that about two out of every five adults had trouble paying medical bills last year or were paying off medical debt over time, and that many of those struggling with medical debt (42 percent) said they had received a lower credit rating as a result.

The results are based on a telephone survey of 4,432 adults by Princeton Survey Research Associates International from April 25 to August 19, 2012. The margin of sampling error is plus or minus 2 percentage points.

The report is the last one the fund will conduct before the major provisions of the Affordable Care Act are scheduled to go into effect, in January 2014.

Did you have a gap in insurance coverage last year? Do you expect the health care law to help provide you with coverage?

From the Real News Network –

Dr. Margaret Flowers and Kevin Zeese: Obamacare will not put an end to medical bankruptcies – 80% of people going bankrupt due to healthcare costs had insurance.

More at The Real News

How a Single-Payer System Can Save US Health Care

By Dave Dvorak, MD for Common Dreams –

As Minnesota’s physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.

What if there were a simple, streamlined solution that would guarantee health coverage for every Minnesotan while saving the state billions of dollars? A growing number of Minnesota physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans’ administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.

Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every Minnesotan could have comprehensive coverage while the state would save billions annually.

A deeply flawed system

The desire for meaningful reform comes in the face of the U.S. health care system’s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation’s economy—twice that of other wealthy democracies—48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.

At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.

Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans—which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.

The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans (including 262,000 Minnesotans) will remain uninsured after its full implementation.

The solution

The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.

Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.

Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate “job lock,” in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.

A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system—up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.

The Minnesota model

Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for “state innovation waivers” to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont’s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.

In Minnesota, two advocacy organizations—Health Care for All Minnesota and the Minnesota chapter of Physicians for a National Health Program—are garnering public support for a single-payer system. Gov. Mark Dayton has expressed support for single payer, and Sen. John Marty (DFL-Roseville) has authored legislation to establish such a system in Minnesota. Known as the Minnesota Health Plan, it would replace the current inefficient patchwork of private and public health plans with a single statewide fund that would cover the health needs of all Minnesotans—inpatient and outpatient services, preventive care, prescription drugs, medical equipment and mental health and dental care. A 2012 study by the Lewin Group confirmed the feasibility of single payer in Minnesota. It concluded that adoption of a single-payer system would provide coverage to every Minnesotan, including the 262,000 left uncovered by the ACA, while saving the state $4 billion in the first year alone. The average Minnesota family would save $1,362 annually in health costs, while the average Minnesota employer that currently provides insurance would realize savings of $1,214 per employee per year. The analysis showed these savings came primarily from administrative simplification; provider compensation remained unchanged.

Conclusion

With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.

This article originally appeared in the April 2013 issue of Minnesota Medicine.

By Benjamin Day, Director of Organizing, Healthcare-NOW! –

The Boston area, where I live and grew up, has been feeling smaller and smaller since the Marathon bombings and unprecedented manhunt for those responsible. When the names of victims were gradually released to the public, I was astonished by how many I knew or were known by friends. Krystle Campbell, who lost her life in the bombing, was an acquaintance of mine and a coworker of my closest friends a number of years ago. It took an unthinkable act of violence to realize how closely knit our community already was – rarely more than one or two relationships removed from one another – and we had just never needed to rely on the full extent of our community for support until now.

I was struck that our community’s first concern was about the ability of those injured to afford their long-term health care costs. Even among the 282 injured who have health insurance, many will face unaffordable costs since what is seen as quality coverage in the United States typically imposes strict limits on physical therapy, mental health visits, and contributions towards things like prosthetic limbs or modifications to homes necessary to accommodate new disabilities. A “One Fund Boston” set up by the City and State has raised over $10 million in its first week to help pay for these costs. Friends of the victims’ families have set up their own online fundraising drives in the hopes that they will be able to receive comprehensive treatment. A “Bucks for Bauman” fund established to help Jeff Bauman, who lost both of his legs in the blast, has raised over $600,000 in response to the Fund’s plea that “Medical bills are going to start rolling in, let’s get a head start on helping out Bauman and his family! Every dollar counts!!” Similar funds for Brittany Loring; Nicole and Michael Gross; Celeste and Sydney Corcoran; Patrick Downes and Jess Kensky; Ann and Eric Whalley; William, Mary Jo, and Kevin White; and others who were severely injured, have raised millions from small donors across the country.

It’s an inspiring moment of community togetherness for me, but also bittersweet, since we are the only country in the developed world where victims of a terrorist attack have to appeal for charity to receive needed medical care. Every other developed nation provides universal health care for residents as a human right, so that in times of tragedy, accident, or severe illness, patients and their families can focus on recovery without having to worry about medical costs bankrupting them.

In my job I get to see many, similar, moving acts of community support – fundraiser events and online appeals to help patients pay for cancer treatment, or accident recovery. I also unfortunately get to hear about the cases where patients lack access to broad charitable communities, and face medical debt and collections agencies alone. I recall receiving a $5,000 hospital bill myself in 2005 after a three-day inpatient stay, at a time when I was earning $16,000 a year. The day I stepped out of the hospital, facing a difficult recovery, I could barely spare time for my health as the anxiety of having to declare bankruptcy – or to ask my friends and extended family to empty their savings accounts to help me – was all I could think about.

These moments bring out the best in our communities, and the worst in our inhumane health care system. I hope that in addition to rising in support of these victims of an atrocious crime, we also rise to swiftly establish a public, universal health plan that will protect the victims and patients of the future, so that no one has to suffer the quieter, more isolated tragedy of losing their entire savings, sometimes their homes, and eventually their access to desperately needed care.

Kevin is fasting for 30 days, using the money he would normally spend on food to help pay his hospital bill.

He asks you to sign on to this email to LewisGale Hospital telling them not to engage in predatory billing.

Please Share This Action on Facebook

Please read this message from Kevin, and support his 30 day fast to pay off unfair medical bills by signing this email the President of the hospital he visited.

Hi:

My name is Kevin Jarvis; I am currently a seminary student living in Elliston, Virginia. When I briefly visited LewisGale Hospital last October to have a dislocated shoulder put back in place, I had no idea that LewisGale would charge an extraordinary price for this simple procedure leaving me with a $1,500 deductible that my wife and I cannot pay without being unable to afford other basic necessities.

Like many, we are faced with mounting medical bills. Therefore, I have decided to pay LewisGale the only way I am able to: by fasting publicly for thirty days, using the money I would otherwise spend on food to pay off my medical bill.

LewisGale has a history of unethical price gouging. Such as a $26,000 charge for treatment of a cat bite. Health Corporation of America (HCA) – the parent company that owns LewisGale and over 160 other hospitals – has paid the largest fraud settlement ($2 billion) in the history of the United States for overcharging patients. It has become the most profitable hospital chain in the country by aggressively billing, turning patients with less profitable conditions away at their emergency rooms, and keeping staff levels dangerously low.

Having to choose between healthcare and food would not be possible in any other developed country in the world, where universal healthcare is provided at half the cost through a “single-payer” system, such as embodied in H.R. 676.

Until we find the moral courage as a country to recognize healthcare as basic to human dignity, instead of treating it as a commodity, please sign this email to the President of LewisGale Hospital asking him not to engage in predatory billing with patients who will be forced to choose between basic human necessities and receiving necessary care.

Sincerely,
Kevin Jarvis

A note from Healthcare-NOW!: Kevin decided to go on a 30-day fast on his own. He contacted Healthcare-NOW! and we do not suggest that others follow his example without taking necessary precautions.

Sources:
$26,000 Cat Bite, Roanoke Times
HCA’s record fraud settlement, Department of Justice
HCA’s rise to prominence and record profit levels through aggressive billing, New York Times

From USA Today –

The availability of employer-sponsored insurance has fallen by about 10% over the past decade, which has spurred an increase in the overall number of Americans without health insurance, according to a report released today.

“This documents that in virtually every state across the country, there has been a steady decline in employers that provide coverage over the past 10 years,” said Andrew Hyman, director of the Robert Wood Johnson Foundation’s health care coverage team. “It would be a real stretch to say this was caused by anticipation of the Affordable Care Act,” President Obama’s 2010 health care law.

The universal coverage requirement and the state health insurance exchanges needed to make it work will start Jan. 1. Some employers have said they may drop health insurance because it would be cheaper to pay a $2,000 fine and have employees buy insurance through the exchanges instead of paying an average of $15,000 to buy that employee health insurance.

Other employers have said they will drop employees’ hours below 30 a week to avoid the requirement to provide insurance or pay a fee.

If so, employers would be following a trend that started before the health care law passed in 2010. The new study found that employer-sponsored coverage dropped from 69% to 60% between 1999 and 2010. The amount each employee paid annually for insurance more than doubled in that period from $435 to $1,056 for an individual and from $1,526 to $3,842 for a family.

The Johnson foundation’s State Health Access Data Assistance Center conducted the research.

Coverage also varied from state to state, based on state law, regional employment rates and average employer size.

Hyman said the steady decline in coverage has come in spite of changes in the economy and employment rates throughout the decade.

“So now we’re all wondering how it will change with the implementation of the ACA,” he said. The “silver lining,” he said, is that with the new law, even those who don’t receive coverage through their employer will be able to get a plan through the health exchange system.

Predictions vary on the law’s effects. The Congressional Budget Office says between 3 million and 5 million fewer people will have employer-subsidized insurance. A Towers Watson survey of more than 500 companies with more than 1,000 employees found none of the companies plan to drop insurance because of the law. A House Ways and Means Committee study found that 71 Fortune 100 companies said they could save $28.6 billion by dropping health insurance and paying the $2,000-per-employee fine.

However, health insurance brokers say their business clients are “staying the course” on their current health plans, said John Torinus, co-founder of Successful Entrepreneur Investors and who has served on several health care reform task forces. As a former CEO, he said he considered health coverage a benefit not just to the employee, but also to the employer.

In a presentation to the World Health Care Congress Wednesday, Torinus said corporations have the power to turn the tide of rising health care costs. Consumer-driven plans, as well as employers who help employees make good decisions about spending and lifestyle, are a better answer than dropping employees’ insurance. Healthy employees are more productive, take less time off and are happier.

He said more employers are offering health care at the workplace so they can ensure employees receive preventive checks to keep them healthy, the employer isn’t saddled with unnecessary referrals and procedures and the employee goes to a less-expensive, better-quality specialist when there are several options from which to choose.

Kent Bradley, senior vice president and chief medical officer of grocery store giant Safeway, proposed that employers could address the rising costs of Medicare by pushing back the time in a person’s life that he or she starts being unhealthy.

Employers are better able to provide incentives — employees at Safeway pay premiums based on their behaviors, and they can save up to $760 per person — as well as a supportive workplace to help people make healthy lifestyle choices. So rather than having a population of seniors dealing with chronic disease from obesity, such programs could stave off illness until a population turns 75 or older, he said.

Hyman said he expects employers to continue to offer insurance.

“I think, frequently, employers are thinking and projecting based on one or two factors,” he said. “But it will be interesting to see what they do with a range of considerations.”

Please go here to thank the “Medicare 111″ and encourage them to stand strong on their commitment to protect Social Security and Medicare.

Please Share This Action on Facebook

Today, President Obama released a budget that would reduce Social Security benefits and shift healthcare costs onto seniors enrolled in Medicare.

This proposed budget includes a “chained CPI” for Social Security, which Sen. Elizabeth Warren called “just a fancy way to say ‘cut benefits for seniors, the permanently disabled, and orphans.’” Additionally, his budget would shift Medicare costs onto seniors by introducing new premiums for some, cutting safety net payments to providers serving low-income communities, and penalizing the purchase of comprehensive Medigap coverage.

This is unacceptable.

Thankfully, 107 House members signed a letter to Obama saying: “We write to affirm our vigorous opposition to cutting Social Security, Medicare, or Medicaid benefits in any final bill to replace sequestration.”

Please go here to thank the “Medicare 107″ and encourage them to stand strong on their commitment.

Remind them that Medicare costs less than private health insurance. Expanding it to everyone in the US through a single-payer plan, like HR 676, would eliminate the federal deficit.

Go here to sign the petition–it’s easy.

If you want to tell Obama how unhappy you are with his budget, call the White House at 202-456-1111.

The House members on the letter are here: Majority of House Democrats Call on President Obama to Reject Benefit Cuts to Medicare, Medicaid, and Social Security Benefits

Sources:
- President Obama’s budget will include cuts to Social Security, Medicare
- Majority of House Democrats Call on President Obama to Reject Benefit Cuts to Medicare, Medicaid, and Social Security Benefits
- Obama budget splits Medicare cuts between patients and providers
- 2.3 Million Petitioners Urge Rejection of ‘Chained-CPI’ Social Security Cut

From the New York Times –

President Obama next week will take the political risk of formally proposing cuts to Social Security and Medicare in his annual budget in an effort to demonstrate his willingness to compromise with Republicans and revive prospects for a long-term deficit-reduction deal, administration officials say.

In a significant shift in fiscal strategy, Mr. Obama on Wednesday will send a budget plan to Capitol Hill that departs from the usual presidential wish list that Republicans typically declare dead on arrival. Instead it will embody the final compromise offer that he made to Speaker John A. Boehner late last year, before Mr. Boehner abandoned negotiations in opposition to the president’s demand for higher taxes from wealthy individuals and some corporations.

Congressional Republicans have dug in against any new tax revenues after higher taxes for the affluent were approved at the start of the year. The administration’s hope is to create cracks in Republicans’ antitax resistance, especially in the Senate, as constituents complain about the across-the-board cuts in military and domestic programs that took effect March 1.

Mr. Obama’s proposed deficit reduction would replace those cuts. And if Republicans continue to resist the president, the White House believes that most Americans will blame them for the fiscal paralysis.

Continue reading…

By Don McCanne for PNHP –

U.S. to boost rather than cut payments to health insurers

By Sandhya Somashekhar
The Washington Post, April 1, 2013

The Obama administration reversed itself Monday, scrapping plans to cut by 2.2 percent the rates paid to health insurers that take part in the Medicare Advantage program.

The insurance industry and more than 100 members of Congress had objected to the cut in the per capita growth rate, which was proposed in February. The insurers mounted a vigorous campaign, using television ads and phone banks, to persuade lawmakers to oppose the reduction.

On Monday, the Centers for Medicare and Medicaid Services (CMS) announced that it was changing its method of calculating reimbursement rates. Instead of cutting payments for Medicare Advantage plans, it will increase them by 3.3 percent.

“The policies announced today further the agency’s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice,” Jonathan Blum, the CMS’s acting principal deputy administrator, said in a statement.

http://www.washingtonpost.com/national/health-science/us-to-boost-rather…

Comment:

By Don McCanne, M.D.

The private Medicare Advantage plans, offered as options to the traditional government-run Medicare program, were to have their egregious overpayments reduced by provisions of the Affordable Care Act. This year they were to have a 2.2 percent reduction in their rates, but instead received a 3.3 percent increase. That is a rate 5.5 percent higher than scheduled, which increases the payments to the Medicare Advantage plans by over $5 billion! What happened?

It is easier to understand why when you realize that the program was established as an effort to privatize Medicare. The previous effort – private Medicare + Choice plans – didn’t work since the insurers were unable to provide profitable plans at a cost comparable to the traditional Medicare program.

Recognizing that, Congress established the Medicare Advantage program, authorizing payments averaging 14 percent over the costs of traditional Medicare. This would allow the private plans to offer a more attractive option with greater benefits and lower our-of-pocket costs. Once enough people were enrolled in the private plans then they could start to make the traditional Medicare program even less attractive through greater cost sharing, through means testing that chases away the more affluent beneficiaries, and through reducing payment rates causing a further decline in the number of willing providers.

Originally, the private Medicare + Choice plans were successful in enrolling healthier, lower cost patients. With time, many of those patients required more care, and the insurers started dropping out of markets in which they experienced losses. So the next phase – Medicare Advantage.

With Medicare Advantage, risk adjustment was used to transfer funds from insurers that cornered healthier patients to insurers that enrolled more patients with greater needs. Soon it was evident that the insurers became masters at enrolling patients who were not very ill but who could be coded as having expensive problems. Although efforts have been made to further refine the risk adjustments, our government’s payment accuracy website reveals that the insurers are still able to game the system, such that 14 percent of payments remain improper – over $13 billion.

Another one of the methods used to improve payments – but not reduce payments since the proposal was to be revenue neutral – was to retain some of the funds for the Medicare Advantage plans and then use them to reward plans with higher quality ratings, 4 or 5 star. Well, when they were ready to start reducing the overpayments, as required by the Affordable Care Act, the insurers protested that they couldn’t afford the reductions. So the administration revised the quality awards to include 3 star plans, thus assuring that 80 percent of Medicare Advantage plans would have their required reductions largely offset with the quality awards. But this was not revenue neutral. No problem. The administration declared these expanded awards to be a “demonstration,” and thus drew funds from their demonstration project kitty (our tax funds). That diversion of funds will continue through 2014.

So now we’re down to this year, and, of course, the insurance industry said that they would not be able to tolerate the scheduled reductions of 2.2 percent. They called out the forces. They even had more than 160 Representatives and Senators of both parties lobbying the administration to reverse these cuts. Yesterday, it became evident that they were successful – increasing payments 5.5 percent over the scheduled 2.2 percent cut – a $5 billion bonanza. How did they do it?

The sustainable growth rate (SGR) was a formula designed to slow the growth of spending on physician care down to sustainable levels. In response, physicians adjusted the frequency and intensity of their services to make up for what they perceived to be a reduction in their reimbursement rates. The formula would require a reduction in rates that would especially impact primary care physicians. Congress has deferred the reductions for fear of losing too many physicians from the program, but that has resulted in a 25 percent deficit for which Congress needs to enact a “doc fix.” Here’s where the shell game comes in.

In violation of the standards of the Office of the Actuary, CMS decided that Congress inevitably would enact a doc fix, which then they could say represents an increase in the cost of providing care to all Medicare beneficiaries. Thus the phantom increase has been applied to the new Medicare Advantage rates. Little does it matter that there was no increase since Congress has continued to authorize the suspension of the SGR reductions. It is specious for CMS to claim that payments went up this year because of the not-yet-enacted doc fix when they have been up the whole time. Also it seems not to matter that the doc fix which they used in their calculations has not been fixed, and the money will have to come from somewhere… but certainly not from the $5 billion bonus they just gave the Medicare Advantage plans – money that never existed but will have to be drawn from Medicare payroll taxes, from general funds for Part B, and from increases in Part B Medicare premiums that will be paid by Medicare beneficiaries in the traditional plan who are not receiving any of the extra benefits that enrollees in the Medicare Advantage plans are receiving. Unfair.

But it’s worse than this. Not only is the administration bending over backwards to take good care of the private Medicare Advantage insurers, they are now engaged behind the scenes to further impair the traditional Medicare program – a strategy to further push privatization.

The Ryan/Wyden and Frist/Breaux/Thomas premium support voucherization of Medicare has proven to be too hot for the privatizers, considering the backlash that they have experienced. So premium support is off the table during the Obama administration’s negotiations with Congress over the next manufactured fiscal crisis. So what has replaced the vouchers?

It has been leaked, presumably deliberately, that Obama is proposing to combine the Part A (hospital) and Part B (physician) deductibles into one deductible for Parts A & B combined. The intent is twofold – to reduce the amount that the federal government is paying for Medicare, and to increase the sensitivity of Medicare beneficiaries to prices paid for Medicare benefits – making them empowered health care shoppers. This increase in out-of-pocket spending will especially impact the majority who do not require hospitalization and thus have lower total costs. This strategy will make those who have fewer health care needs wonder why they are paying so much more than they thought they would once they were on Medicare.

Bu that’s not all. About 90 percent of Medicare beneficiaries are protected from excessive cost sharing through Medigap plans or through employer-sponsored retirement health benefit programs. The consumer-directed camp has long wanted to bash the Medigap plans so patients would be exposed more directly to the costs. Obama’s team is proposing just that. They want to prohibit the Medigap plans from providing protection for the deductible – removing it, or at least reducing it, as a Medigap benefit. Another option that they are considering is to assess a 15 percent tax on Medigap premiums which would have a similar net financial impact as prohibiting coverage of the deductible.

So what is a person to do? You can accept the traditional Medicare program, but you will face higher deductibles, perhaps a Medigap tax, an even higher Part B Medicare premium, and perhaps means-tested premiums and benefits which will gradually shift down to middle-income individuals. This will not be pleasing to the majority who have only modest health care needs. The other option? You can enroll in a Medicare Advantage plan with greatly reduced cost sharing plus expanded benefits, and perhaps not even a plan premium, all thanks to Congress and the administration who are using our tax funds to provide very generous subsidies to the private Medicare Advantage plans.

A crummy traditional Medicare program with high out-of-pocket costs, or a slick private plan with most costs prepaid, by the government no less? It is presumed that the majority will rush over to the private plans, especially when they see what extra bennies they get.

What then? Congress can then continue to ratchet down government spending on the traditional program, causing an exodus of willing providers – stripping the program down to worse-than-Medicaid. After the private plans have become the standard and Medicare is in the tank, then what? Premium support vouchers! The government gradually pares down the support for the premium you select, so you are now really an empowered shopper – empowered to buy whatever meager benefits you can afford with your measly premium subsidy.

Excuse the length of today’s message, but I hope you understand why. It’s not that I’m a soothsayer… but maybe I am.

A little-known loophole in President Obama’s landmark legislation enables health insurers to extend existing policies for nearly all of 2014.

By Chad Terhune for the Los Angeles Times –

A new fight is brewing over health insurance companies letting millions of Americans renew their current coverage for another year — and thereby avoid changes under the federal healthcare law.

That may offer a short-term benefit for certain consumers and shield some of those individual policyholders from potentially steep rate increases. But critics say this maneuver could undermine government efforts to remake the insurance market next year and keep premiums affordable overall.

At issue is a little-known loophole in President Obama’s landmark legislation that enables health insurers to extend existing policies for nearly all of 2014. This runs contrary to the widespread belief that all health insurance must immediately comply with new federal rules starting Jan. 1, when most provisions of the law take effect.

“Insurers are onto this, and the big question is how many will try to game the system,” said Timothy Stoltzfus Jost, a law professor and health policy expert at Washington and Lee University.

Some of the nation’s biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers’ renewal dates for the end of December. There’s also concern that some insurers and agents could rush to sell more individual policies before year-end so they could be extended in 2014.

Some policy experts are expressing concern about this practice for fear that insurers will focus on renewing younger and healthier policyholders and hold them out of the broader insurance pool next year. Their absence could leave a sicker and older population in new government insurance exchanges, driving up medical costs and premiums there.

“This could undermine the Affordable Care Act, and it opens the door for exacerbating potential rate shock in the exchanges,” said Christine Monahan, a senior analyst at Georgetown University’s Health Policy Institute. “The health insurers can cherry-pick some healthy people and it raises prices for everyone else.”

This issue could affect some of the 15 million people nationwide who purchase their own coverage and millions more of the uninsured who are expected to join government exchanges next year. It would not pertain to the 150 million Americans who get health benefits through their employers.

Many health insurers are still mulling over their options on how to handle these individual renewals.

“Some carriers will require everyone to switch plans Jan. 1, and other carriers will allow customers to stay on their existing plan as long as possible,” said Bob Hurley, senior vice president of carrier relations at online site eHealthInsurance. “We are trying to nail this down with the carriers. I think it would be better for consumers to have that choice to carry their policy forward.”

The nation’s largest health insurer, UnitedHealth Group Inc. of Minnetonka, Minn., said, “We are currently looking at the best way to serve our customers’ best interests while continuing to comply with the Affordable Care Act going into 2014.”

WellPoint Inc., the Indianapolis insurance giant that runs Blue Cross plans in California and 13 other states, said its renewal practices will vary by state. In California, the company said its Anthem Blue Cross unit may allow individual policyholders to renew through March 31.

Kaiser Permanente, a major nonprofit health plan based in Oakland, said it doesn’t plan to renew policies beyond Jan. 1 in California and most of the other states where it sells coverage.

Richard Kern and his wife, a retired couple in Los Angeles, say they would welcome the flexibility to keep their individual policy from Aetna Inc. for another year amid so much uncertainty over next year’s rates.

“We don’t even know what the prices and alternatives are under Obamacare,” Kern said. “We are waiting for the other shoe to drop.”

If an insurer offers this option, it would then be up to consumers to decide whether they want to renew an existing policy into 2014. The length of any renewal may depend on what month their annual plan year begins.

Many lower-income people will qualify for federal premium subsidies, which will be available only when purchasing new coverage available in state- or federal-run insurance exchanges. It would make financial sense to take advantage of that government aid. Individuals earning less than $46,000 or families below $94,000 annually would be eligible for subsidies.

However, many people who are middle income or above could face significantly higher premiums next year with no subsidies. Those premium increases are tied to federal requirements that insurers accept all applicants regardless of their medical condition and the inclusion of more comprehensive benefits.

Renewing an older policy could mean forgoing some of those richer benefits and new limits on out-of-pocket medical expenses.

Last week, California officials estimated that premiums may rise 30% on average for about 1.3 million existing policyholders primarily because of those changes in the federal law. Insurers have warned that some customers could see their premiums double depending on their age and other factors.

Citing that threat of higher rates, Arkansas officials issued a bulletin to insurers last month describing how they could extend individual policies until Dec. 30, 2013, and then renew them for another year.

These health plans “would not be required to comply with the [Affordable Care Act] market reforms until 12/31/2014,” according to the Arkansas bulletin.

“For those folks who don’t qualify for subsidies, this is a consumer-friendly thing because the premium rates for 2014 will be substantially higher,” said Dan Honey, deputy commissioner of compliance for the Arkansas Insurance Department. “You will be exposed to rate shock.”

Other states may oppose that approach, further underscoring the uneven implementation of the federal healthcare law across the country. Oregon Insurance Commissioner Louis Savage said these renewals could be problematic and his office issued a rule barring any extension beyond March 31, 2014.

“We want to get as many people as possible into the exchange,” Savage said. “I think having renewals go deep into 2014 is counterproductive to the goals of the federal healthcare law.”

In California, state lawmakers are working on legislation that could address this renewal issue and other details about how individual policies comply with the federal overhaul.

These questions over renewals are separate from “grandfathered” health policies that existed before the federal law passed in March 2010. Those plans don’t have to meet all the requirements of the healthcare law as long as insurers or employers don’t make significant changes to them.

Searchable and free at www.healthpacbulletin.org.

From HealthPACBulletin.org –

Before there was an internet, with blogs, listservs and web pages to turn to, there was the Health/PAC Bulletin, the hard-hitting and muckraking journal of health activism and health care system analyses and critiques. A new web site, www.healthpacbulletin.org, is a complete and searchable digital collection of Health/PAC’s influential publication, which was published from 1968 through 1993. Health/PAC staffers and authors in New York City and briefly, a West Coast office in San Francisco, wrote and spoke to health activists across the country on every issue from free clinics to women’s health struggles to health worker organizing to environmental justice. Health/PAC both reported on what was going on and reflected back on a wide variety of strategies and tactics to build a more just health care system – a conversation that continues today.

Health/PAC coined the terms “medical empire” and “medical industrial complex” to capture the ways the profit motive distorted priorities in the American health care system. It critiqued big Pharma and rising health care costs, explored the differing forms of health activism, and made it clear that a seemingly disorganized health care system was in fact quite organized to serve ends other than health care. Its first book, The American Health Empire (1970), published by Random House, brought its analysis to national attention. Other edited collections of the Bulletins followed: Prognosis Negative (1976) and Beyond Crisis (1994). Many of today’s leading health activists, reformers and policy scholars got their start at Health/ PAC.

The website adds immeasurably to the resources documenting the history of mid- to late- 20th century American health policy and politics. Activists, scholars, journalists, practitioners, professors, and students will all find these Bulletins a sources of useful analysis and information.. This is not only a way to learn about the late 20th century history, but to consider why certain issues continue to plague our health system.

The site is a work in progress and we welcome your feedback and suggestions. It was a real labor to get these collected and available and we hope you find the site a useful resource.

By John Knefel for Truthout –

A coalition of groups associated with Occupy Wall Street took to the streets of midtown Manhattan on Thursday evening calling for the abolition of the for-profit health care system in the United States and the creation of a government-run single-payer system. Around 70 protesters marched to four major health insurance companies to list their grievances with each corporation, often by comparing what they see as the wildly disproportionate salaries of CEOs with health costs for regular patients or the company’s average worker’s salary.

The march was part of a larger project that Strike Debt (which formed from the creative churn of Occupy) is implementing over the week to draw attention to medical debt, which the group sees as a national emergency. Strike Debt also announced that its latest round of a project known as the Rolling Jubilee has bought and abolished over $1 million in medical debt.

Activists handed out fliers on the march with statistics on just how damaging medical debt can be to households: “62% of bankruptcies are linked to medical bills” was featured prominently on the flier, as well as on a banner at the front of the march. Also on the handout was perhaps an even more surprising number: “78% of those who declared medical bankruptcy had insurance at the time they became sick.”

Strike Debt’s mission is to politicize and organize around personal debt, often by arguing that debt is not a moral failing but rather a societal problem that needs to be addressed and resisted collectively. One of the tactics, called Rolling Jubilee, involves buying “debt for pennies on the dollar, but instead of collecting it, abolish[ing] it.” The group buys debt on the open market the same way a collection agency would, but cancels the debt instead of collecting it. Funding comes from donors who contribute to the group through its website.

The first Rolling Jubilee took place in November of last year and “abolished” more than $100,000 of medical debt. The People’s Bailout, as it was called on Twitter, culminated in a telethon at a New York City music venue and garnered unusually positive press for an Occupy-related action.

The second and latest Rolling Jubilee resulted in an even larger amount of debt abolished: over $1 million, according to a post on the group’s website, for patients in Kentucky and Indiana. “The average debtor owed around $900,” the group wrote, “and we will be abolishing the debt of over 1,000 people.” Strike Debt is in the process of sending out letters to patients whose debt has been bought and abolished, as it did following the first Rolling Jubilee.

One of the most common questions asked of Strike Debt is whether it can buy and cancel specific people’s debt. The answer is no. There are no strings attached for the person whose debt has been bought, though many activists hope that someone on the receiving end of the Rolling Jubilee might throw a few bucks back in the pot – a way of paying it forward, as it were.

Thursday’s action began at Bryant Park around 4 PM with activists opening a dozen shredded umbrellas bearing the insignias of insurance companies, such as Cigna and Aetna. The broken umbrellas represented the activists’ beliefs that even those who have private insurance are often not fully protected by it.

In contrast, the marchers also opened a dozen intact umbrellas with the words “Medicare for all” – another phrase for single-payer – painted on them.

A physician named David, part of Physicians for a National Health Program (PNHP), addressed the crowd before the march. He railed against the high costs of medical care, lambasting the idea that the solution to the problem is complicated or somehow unknowable. “The answer is single-payer,” he said.

The protesters then marched to the offices of United Healthcare Group, Aetna, Blue Cross Blue Shield, and Cigna, chanting “Health care for people, not for profit” and “Bankrupt and broke, insurance is a joke.” The flier that activists handed out on the march claims that “the combined annual compensation for the CEOs” of those four companies “could buy and abolish almost 2 billion dollars of medical debt using the rolling jubilee model.”

Katie Robbins, also with PNHP, said the “flimsy insurance [that] people get in case they get sick is a contract that gets broken all the time,” referring to the many people in the US who have insurance but nevertheless are forced to pay huge medical bills. She said that her deductible was so high that virtually any medical procedure would leave her thousands of dollars in debt. She also said that, by her calculations, having a baby could put her as much as $10,000 in debt, adding “that’s not a great place to be.”

By Allison Kilkenny for the Nation –

Strike Debt, a group that emerged from the Occupy Wall Street movement, has planned a week of actions in multiple cities across the country to mark the abolition of $1.1 million in medical debt belonging to 1,064 people as part of the “Rolling Jubilee” project.

While that may already seem like a huge number, Strike Debt claims it’s only getting started and ultimately hopes to abolish around twenty times what they raised, which would be nearly $12 million.

“What we do is buy debt for pennies on the dollar,” Jacques, a member of Strike Debt, explained to activists gathered at Bryant Park on Thursday evening. “And instead of collecting on it like the debt collectors, we basically abolish it. We’re here today because we purchased over one million dollars of medical debt from over a thousand people in Kentucky and Indiana who had emergency room debt.” (A full report of the purchased debt can be found at the Rolling Jubilee’s transparency site.)

In order to kick off the “Life or Debt” week of action, protesters planned a medical bankruptcy tour to the various health insurance companies who Strike Debt sees as being exploitive of the sick and vulnerable by using insurance payments to fatten the wallets of the companies’ CEOs instead of using that money for actual healthcare.

Paused before Aetna’s offices on Park Avenue, an activist announced to the group that Aetna’s CEO Mark Bertolini received over $10 million in total compensation last year, which is around 300 times the average worker’s pay.

A woman named Jamie spoke in front of Aetna’s office about how she wrote a letter to Bertolini after being denied coverage by the company due to a chronic work industry.

“I was frightened and heartbroken,” Jamie said. “I just couldn’t believe it. How could someone in charge of care turn their back on someone in unrelenting pain?”

Jamie’s letter was returned, unopened.

At the front of the procession, Strike Debt activists carried a banner that read “62% of all bankruptcies are due to medical debt.”

Another activist carried a sign: “Medical bills: death by spreadsheet.”

In front of the insurance giant CIGNA, a protester recounted the death of 17-year-old Natalie Sarkisyan, who died after having her liver transplant surgery first denied and then later delayed by the company.

In 2007, Natalie’s mother addressed a crowd of supporters in front of CIGNA’s Philadelphia headquarters.

“CIGNA killed my daughter,” Nataline’s mother Hilda told security. “I want an apology.” Sarkisyan was not able to speak to [CIGNA CEO] Hanway; a communications specialist talked to her instead. After their conversation, employees heckled the group from a balcony; one man gave them the finger. CIGNA called the police and had the family and their friends escorted from the building.
A CIGNA executive later apologized for the incident in a letter about a month later.

Over the weekend, Strike Debt activists have planned a free health fair and march to highlight hospital closings. The march will feature sites like the closed St. Vincent’s community hospital, which will enjoy a “second life” as the site of luxury condos priced between $1.4 and $8.2 million. The tour will be followed by free legal advice and health care at Judson Church. On Saturday, practitioners will also be on call to answer medical questions at Strike Debt’s website.

“These debts are literally killing patients, students, providers and communities,” the group states at its website. “They deepen the already entrenched inequalities that divide races, classes, and genders. Our healthcare system doesn’t make us well; it prolongs our illnesses in the name of profit.”

Wednesday, March 20 – 60 people rallied in front of Albany Medical Center under the banner, “Protect OUR Health, Not THEIR Wealth.” Speakers and protesters called for “No Grand Bargain” – Hands off Medicare, Social Security and Medicaid,” “Scrap the Cap on Social Security,” “Oppose Privatization of our Public Hospitals and Nursing Homes,” and “Single Payer, Improved Medicare for All.”

A broad coalition representing nurses, physicians, medical students, labor unions, senior citizens, faith groups, grassroots organizations, and Occupy Albany – the driving force behind the event, joined the rally.

Sponsoring organizations:
New York State Nurses Association
Public Employees Federation
Physicians for a National Health Program – Student Chapter
Single Payer NY
Capital District .Area Labor Federation
Albany Central Federation of Labor
The Labor Religion Coalition
Capital District Alliance for Universal Healthcare
Statewide Senior Action
Citizen Action
MoveOn
Occupy Albany

Additional participating unions: AFGE, SEIU, NALC

From the New York Times –

The White House is encouraging skeptical state officials to expand Medicaid by subsidizing the purchase of private insurance for low-income people, even though that approach might be somewhat more expensive, federal and state officials say.

Ohio and Arkansas are negotiating with the Obama administration over plans to use federal Medicaid money to pay premiums for commercial insurance that will be sold to the public in regulated markets known as insurance exchanges.

Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in the option since Gov. Mike Beebe of Arkansas, a Democrat, received a green light from Kathleen Sebelius, the federal secretary of health and human services.

Valerie Jarrett, a top White House aide, has been a catalyst in talks with Ohio and other states.

The idea of using “premium assistance” to buy private insurance for new Medicaid beneficiaries is a sharp departure from the 2010 health care law, in which Congress expanded Medicaid to cover the poorest Americans and assumed that people with higher incomes would obtain private coverage through the exchanges.

In many states, Republicans are trying to create a hybrid of the two alternatives, taking federal money for the expansion of Medicaid but using it to help people buy commercial insurance instead.

State Senator Jonathan Dismang, a Republican from central Arkansas, said the idea appealed to him because it would “use the markets to provide better health care and to increase competition in the health insurance industry,” which could drive down costs.

The Arkansas Medicaid director, R. Andrew Allison, said the state had obtained “conceptual approval” from Ms. Sebelius to use Medicaid money to help low-income adults enroll in private insurance through the exchange in 2014. This arrangement, he said, could double the number of people in the exchange, to perhaps 500,000, while shrinking enrollment in the traditional Medicaid program.

The idea appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid.

“We supported the expansion of Medicaid before this idea came up, and we are more excited now,” said David W. Wroten, the executive vice president of the Arkansas Medical Society. “Providers of all types would be paid at private insurance rates, and that will help recruit physicians for Medicaid, especially in rural areas.”

Advocates for beneficiaries are torn. On one hand, they want to provide coverage to as many people as possible, and the use of private insurance may be the only way to entice Republicans to support the expansion of Medicaid.

On the other hand, they say, private insurance will often be more costly than Medicaid, in part because it pays higher rates to health care providers. They said they feared that higher federal costs would fuel demands in Congress for cutbacks in Medicaid.

In addition, many advocates prefer Medicaid because it has strict limits on co-payments and deductibles and provides benefits that may not be available in commercial insurance. These include long-term care, dental services, medical equipment and even personal attendant services for some people with severe disabilities.

Federal officials said state Medicaid programs could provide these extra services as a supplement to private insurance.

In Ohio, Gov. John R. Kasich, a Republican, wants to expand Medicaid, citing the biblical injunction to help “the least among us.” He wants to provide coverage through private insurance for many of the new beneficiaries, including those with incomes from 100 percent to 138 percent of the poverty level ($11,490 to $15,856 a year for an individual).

Greg Moody, director of the governor’s Office of Health Transformation, said Ms. Jarrett called Mr. Kasich in late January and indicated that the Obama administration was receptive to his ideas. Federal and state officials are working out the details.

“Every day I am a little more encouraged that we can put together a package that is compelling to the State Legislature and can be approved by the federal government,” Mr. Moody said.

Erin Shields Britt, a spokeswoman for the federal Department of Health and Human Services, said, “Our goal in working with states has been to be as flexible as possible within the confines of the law.”

In Florida, state legislators rebuffed a proposal by Gov. Rick Scott, a Republican, to expand Medicaid, but are exploring alternatives that would use Medicaid money to help people buy private insurance.

The 2010 health care law generally required states to make Medicaid available to people under 65 with income less than or equal to 138 percent of the poverty level. The federal government will pay the cost for newly eligible beneficiaries from 2014 to 2016, with its share gradually decreasing to 90 percent in 2020. In upholding the law in June, the Supreme Court ruled that the expansion of Medicaid was an option for states, not a requirement. The ruling touched off ferocious debates in statehouses around the country.

Arkansas Republicans, who control both houses of the Legislature, opposed a straight expansion of Medicaid, but have warmed to the idea of subsidizing private insurance for the same people.

“The feds have agreed to do what my legislators in various conversations have asked me to go ask them to do,” Mr. Beebe said. “Basically they’ve agreed to give us about everything we’ve asked for. What that really amounts to is to take the Medicaid population and expand it all the way to 138 percent of the poverty level and use federal Medicaid dollars to purchase insurance through the exchange.”

“It will probably cost the feds a little more money to do this,” Mr. Beebe said. Arkansas officials said the increase would be less than 15 percent.

Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, said he saw nothing inherently wrong in expanding Medicaid by paying the premiums of private health plans in a state insurance exchange.

With that approach, he said, low-income people can stay in one health plan even if their income fluctuates, so they lose Medicaid and become eligible for subsidies in the exchange, or vice versa. “How better to assure continuous coverage and continuous access to the same doctors?” Mr. Weil asked.

However, Leonardo D. Cuello, who represents poor people as a lawyer at the National Health Law Program, said the use of private plans could lessen protections for beneficiaries and increase costs to the government.

“Congress authorized premium assistance more than 20 years ago as a way to save money, by allowing Medicaid to pay premiums for people who had access to private coverage through an employer’s group health plan,” Mr. Cuello said. “It will now be used to provide individual coverage that is more expensive than Medicaid.”

From the Wall St. Journal –

Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation’s biggest firm projecting that rates could more than double for some consumers buying their own plans.

The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year—a subject of rigorous debate.

The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human Services says that the law will “make health-care coverage more affordable and accessible,” pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower.

The gulf between the pricing talk from some insurers and the government projections suggests how complicated the law’s effects will be. Carriers will be filing proposed prices with regulators over the next few months.

Part of the murkiness stems from the role of government subsidies. Federal subsidies under the health law will help lower-income consumers defray costs, but they are generally not included in insurers’ premium projections. Many consumers will be getting more generous plans because of new requirements in the law. The effects of the law will vary widely, and insurers and other analysts agree that some consumers and small businesses will likely see premiums go down.

Starting next year, the law will block insurers from refusing to sell coverage or setting premiums based on people’s health histories, and will reduce their ability to set rates based on age. That can raise coverage prices for younger, healthier consumers, while reining them in for older, sicker ones. The rules can also affect small businesses, which sometimes pay premiums tied to employees’ health status and claims history.

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