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Posts Tagged 'health care reform'

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Trump's Executive Order on Healthcare is Bad Medicine

With all the skill of a surgeon wielding a machete, President Trump signed an executive order today that could undermine the affordability and quality of health insurance in America.  Republicans in Congress couldn’t enact their ill-considered legislation to repeal Obamacare, so the President hastily reached for his pen, despite admitting earlier this year that he had no idea “healthcare could be so complicated.”

The executive order instructs Trump’s cabinet agencies to look at ways to allow insurers to sell health policies across state lines.  The aim is to open-up association health plans (currently covering employees of various businesses and organizations) to people in the individual market.  These insurance policies would not be subject to Obamacare rules mandating coverage for pre-existing conditions or essential benefits, in theory making them cheaper – but also skimpier.  

These lower-cost, bare bones plans could siphon off younger and healthier enrollees, leaving older and sicker patients in the Obamacare exchanges and driving up their premiums. Ultimately, this could result in a death spiral for Obamacare, as we discussed on today’s Behind the Headlines Facebook Live broadcast. The administration’s own Centers for Medicare and Medicaid Services (CMS) says on its website:

Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. 

To some, the idea of selling insurance across state lines sounds appealing. (Republicans have been proposing this scheme in one form or another since 2005.)  Senator Rand Paul (R-KY) has been pushing it hard this year. But evidence – and history – indicate that the idea doesn’t work.  This Kaiser Health News video briefly and crisply explains why.

Not only does the selling-across-state-lines concept undermine important patient protections and drive up premiums for the most vulnerable, it has never proven viable for insurers or the insured.  According to today’s Hill newspaper:

A few states have opened their borders to out-of-state health insurers, and the response has been a uniform, “Thanks, but no thanks.”

One of Obamacare’s architects, Dr. Zeke Emanuel, told CNN today that, in addition to other concerns, association health plans have a “checkered history” and are especially vulnerable to fraud and scam artists. “Hundreds of thousands of people could be affected by fraud, unreimbursed medical bills,” he warned.  Emanuel also cautioned that patients with employer-provided insurance could see their rates rise “significantly.”

The biggest problem of all, though, is that Trump’s executive order may well be illegal.  The New York Times reports:

Several experts in healthcare and employment law said Trump’s plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations.

In fact, a coterie of Democratic states attorneys general are poised to sue the administration if it enacts these harmful changes.

For all the Republicans’ talk of federalism, the executive order would actually weaken states’ power to regulate insurance markets, which is one of their primary responsibilities in the health care arena.

But as with the President’s trickle-down tax plan and other haphazard policies, history, precedent and data don’t seem to matter to this White House.  That’s especially troubling when – once again – the most vulnerable members of society will pay the price.

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"Bitter Pill" - A Time Magazine Article Every Senior in Medicare Should Read

Time Magazine’s cover story this week is an incredible read and one we highly recommend.  Steven Brill’s “Bitter Pill: Why Medical Bills are Killing Us” provides a remarkably in depth look at our American health care system including Medicare.  Using many personal case studies, Brill breaks down and describes the economic devastation being reaped by our for profit medical industrial complex. 

As we’ve said here repeatedly, America doesn’t face a Medicare crisis -- we face a national health care crisis. Rather than targeting Medicare for cuts we should be using it as the model to improve out health care system nationwide.  As Brill reports:

“Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.”

Consider Time’s example of Susan S. She was 64, one year away from qualifying for Medicare, when she went to the hospital with chest pains.  Her bill for 3 hours of tests and a false alarm was $21,000. If she had Medicare she would have paid less than $500. Compare her costs:


Time’s survey of this same hospital found that in 2010 its total charges were 11 times its actual costs. And that’s not unusual in our current private profit and even non-profit health care system.

Not only does Medicare manage these outrages costs better than the private market, Medicare’s administrative costs are two-thirds of 1% or less than $3.80 per claim. Private Insurers administrative costs run much higher.  Brill reports Aetna’s for example, run 29% or $30 for each claim.

However, Medicare isn’t immune from the skyrocketing costs that are burdening our economy. Brill points out that Congress has tied Medicare’s hands in many instances forcing the more efficient Medicare program to perform like the less efficient private market:

Our laws do more than prevent the government from restraining prices for drugs the way other countries do. Federal law also restricts the biggest single buyer — Medicare — from even trying to negotiate drug prices. As a perpetual gift to the pharmaceutical companies (and an acceptance of their argument that completely unrestrained prices and profit are necessary to fund the risk taking of research and development), Congress has continually prohibited the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services from negotiating prices with drugmakers. Instead, Medicare simply has to determine that average sales price and add 6% to it.

Similarly, when Congress passed Part D of Medicare in 2003, giving seniors coverage for prescription drugs, Congress prohibited Medicare from negotiating.

Nor can Medicare get involved in deciding that a drug may be a waste of money. In medical circles, this is known as the comparative-effectiveness debate, which nearly derailed the entire Obamacare effort in 2009.

The health care industrial complex spends more than three times what the military industrial complex spends for Washington lobbying. Is it any wonder why so many in Congress have chosen to ignore the true system wide health care problem in favor of targeting Medicare for benefit cuts, arbitrary caps, cost-shifting, means-testing and privatization.

They know what the core problem is — lopsided pricing and outsize profits in a market that doesn’t work.

In spite of this, Congress appears ready to protect that broken health care market that is wrecking our economy in favor of targeting the program that works for cuts -- all in the name of deficit reduction.  Cutting benefits to seniors in Medicare not only ignores the real challenges we face as a nation but it also threatens the health security of millions of Americans.

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Court Ruling Means Seniors Can Keep New Medicare Benefits

 Seniors have plenty to celebrate today as the Supreme Court has upheld health care reform and all the benefits it brings to Americans in Medicare. 

“Health care reform is vital for the economic health of our nation and the Medicare and Medicaid programs.  Today’s decision helps move our nation forward while also protecting America’s elderly, poor, sick, and uninsured by preserving billions of dollars in benefits and countless provisions to cut waste, fraud and abuse that extend these programs’ solvency.” Max Richtman, NCPSSM President/CEO
“The Supreme Court’s decision is the most important safety net related decision since the Social Security Act was upheld by the Court in 1937.  It validates Congress’ clear intent to improve seniors’ health and well-being and uphold all of the provisions important to all older adults.”  Paul Nathanson, National Senior Citizens Law Center Executive Director

Virtually every American family will be touched by today’s ruling but here's a reminder of just some of the benefits this ruling preserves for America’s elderly :

·            Seniors will continue to receive prescription drug savings through brand name and generic discounts

·            The Part D prescription drug coverage gap known as the ‘donut hole’ will continue to be phased out

·            Covered annual wellness visits for beneficiaries will continue to be provided in Medicare

·            Seniors will pay less for preventive services. Under the ACA, Medicare will fully cover screenings like mammograms, pap smears, bone mass measurements, depression screening, diabetes screening, HIV screening and obesity screenings

·            8 years has been added to Medicare’s solvency thanks to the Affordable Care Act

Unfortunately, the future of an estimated 3.3 million uninsured young seniors, ages 50-64, who would have received health coverage under Medicaid and many of the 16 million older adults and individuals with disabilities who rely on Medicaid for long-term services and supports, is less certain with this ruling as the Court has limited the government’s ability to penalize states who do not participate in the expansion of Medicaid. That means some states could limit their expansion to seniors. We'll have more details on what the Medicaid ruling really means for seniors nationwide.

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Did You Know? - Busting Medicare/Healthcare Myths

Confused by what health care reform really means for seniors?  Join the crowd.  Take a few minutes and let this video help break it all down for you... The Patients Aware campaign, created by the National Committee to Preserve Social Security and Medicare Foundation, the Herndon Alliance, and the National Physicians Alliance, has released a new video to help America’s seniors understand the new Medicare benefits available to them thanks to the Affordable Care Act.  The video, “Did You Know?”, highlights new preventive benefits for seniors, Part D coverage improvements like closing the donut hole, and describes how savings have already reduced Part B premiums for seniors.  The video can be seen on the Patients Aware website at: www. Patients Aware has assembled a national network of doctors, nurses, and other healthcare experts to give Medicare presentations during educational meetings and town halls beginning in March.  Medical professionals are among the most trusted sources of health care information for seniors and their families.  They understand how vital Medicare is to the health and wellbeing of their older patients which is why they have agreed to donate their free time to provide information and answer questions for seniors in cities throughout the country. “America’s seniors want and deserve the facts about Medicare, prescription drug policy, and what federal health reform will mean for them.  Most Americans know very little about the important new benefits and protections provided by the Patient Protection and Affordable Care Act.  The National Physicians Alliance has found that providing non-partisan, factual information about the law is the best antidote to widespread confusion and anxiety.” Dr. Valerie Arkoosh, NPA President The video release and town hall tour follows a successful December 2011 campaign kick off in which more than sixty thousand Americans participated in a Patients Aware tele-town hall with Assistant Secretary for Aging Kathy Greenlee, and a panel of doctors, nurses, and healthcare policy experts.  Seniors and their families dialed in to this national forum to ask questions about the Affordable Care Act and what it means for millions of Medicare beneficiaries. The hour-long event kicked-off one of the most effective education efforts to date since the law was passed in March 2010.

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Telling the WHOLE Medicare Story

While Presidential candidates and Washington politicians continue to claim “we can’t afford Social Security and Medicare”, few-- if any--want to talk about what their proposals will actually mean for millions of middle-class Americans who depend on these programs.  Columbia Journalism Review’s Trudy Lieberman wrote a memo to political journalists urging them to start asking some tough questions so that voters can understand what their plans to cut benefits will actually mean for our nation.

Last week, speaking to business leaders in Detroit, GOP presidential candidate Mitt Romney mentioned that Medicare-eligible Americans ought to wait longer for their benefits. The media glossed over Romney’s remarks; but I kept thinking about them as I was chatting with a woman who had one leg, amputated because of complications from diabetes. And they stayed in my mind as I talked to another woman—a 67-year-old who had a stroke last year, and had had to quit working as a presser for a local dry cleaner ten years ago, when she was 57. She had a seizure, and a hot press fell on her hand. A long scar shows how her work life ended. She qualified for a Social Security disability check—all of $795 a month that’s been her only income ever since. How on earth could someone like her pay for medical care if she had had to wait a few more years? A CNBC blog picked up an AP story which noted that Mitt had said the federal health reform law was too expensive; that it raised taxes and cut $500 billion from Medicare. Not another half truth! For the fourteenth time, the law did cut payments to hospitals and to sellers of Medicare Advantage plans, but it did not cut basic benefits for seniors. Yet the GOP keeps using the number to scare seniors into voting for them. The blog post linked to a CNBC primer on Medicare and Medicaid, which at least offered some basics. For the record, the CNBC primer didn’t correct that misperception. Please indulge me in a digression. Research from respected sources like the Kaiser Family Foundation has challenged the notion that raising the age for Medicare benefits saves money. Kaiser found that lifting the age from 65 to 67 would reduce Medicare spending by $7.6 billion. But before you run with that number, you need to know that cost would merely be shifted to employers and individuals, who would have to pay more for health coverage to replace the lost Medicare benefits. It would mean spending $10.1 billion in the private sector to save $7.6 billion for the government. How’s that for bending the nation’s cost curve?
You can see the Kaiser Family Foundation report here.  The Center on Budget and Policy Priorities also looked the costs of raising Medicare’s eligibility age here.

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