I read an interesting opinion piece today by Rep. Joe Baca (D-California) in the Huffington Post. He brings up an issue that he feels hasn’t been addressed enough in the health care reform debate – “emergency care in many of our nation’s hospitals is in bad shape, and doctors and patients are paying the price.” The article goes on to explain that hospitals are in bad shape because of their requirement to provide emergency care for any and all people whether they have insurance or not. He cites the unfortunate fact that over 70 hospitals in his state have closed down due to financial pressures.

His solution: “adequately reimburse for the mandated emergency services they provide.”

This is certainly a solution, and probably a fair one at that – hospitals should be reimbursed appropriately for the services and care they provide. But part of the reason why the financials of our hospital’s emergency rooms are an issue is due to how they are being used. Too many people use emergency rooms as a primary care facility – seeking medical care for the flu or a sore throat or a minor fever.

This is a behavioral issue, not necessarily a money issue. We as an industry need to do a better job in educating people on how to responsibly engage the health care system. This is particularly important for the underserved population that accepts publicly funded health coverage. As a Medicaid managed care company, we believe this is a significant part of our role since many of our members are faced with poverty and typically access health care when and where it is most convenient. It’s why we assign case managers to our members. It’s why we look closely at ER utilization rates to identify opportunities to reach out to our members and educate them on appropriate usage. It’s why we have a 24-hour nurse line devoted to helping our members determine if their medical condition is a true emergency. It’s why we provide value-added services to our members like transportation to doctor appointments.

But providing these services must be balanced with patient accountability and sufficient access to primary care providers. The entire industry – insurance plans, providers, hospitals, advocacy groups, government – needs to embrace the idea that educating people about proper health care engagement is a critical strategy to lowering costs and increasing quality of care.

We certainly see the prospect of increasing Medicaid eligibility nationwide as a positive step toward helping underserved people access care without sending them to bankruptcy court. But giving people a shiny, new medical card means little without investing in resources which guide people to the appropriate setting – especially those who are more worried about where to get their next meal or how to put off an eviction.

People need to understand the difference between an emergency and non-emergency medical need. People need to understand the potential impact they have on the system when they miss a doctor’s appointment. Or the effect it has on the system when a person decides not to take his/her medication as prescribed.

This needs to become an industry effort. We can keep on throwing money or taking away money from various aspects of the health care system. But when it comes down to it, we need to address the behavioral aspect of users. We need to educate people about how to engage, and we need to find creative ways to do so.

What ideas do you have around how to better educate people about accessing the health care system?

So there are some Democrats threatening to use reconciliation to get a health care plan passed (CNN article). Well, first things first. Let’s get through the President’s summit and see how it goes. Who knows what surprises may be in store? They may actually be “welcomed” surprises for a change.

This entire debate has been one surprise after another. As a result of this summit, we may actually see a few members of the minority party decide that the President’s plan (albeit not perfect) is currently the best option we have given the times. What do the Dems have to lose? Reconciliation should be used as a last resort and quite frankly, that is exactly what they seem to be doing. All we ask is – just do something – and do it soon – and don’t make it a band-aid approach.

So much debate and finger pointing and arguing and going back to the table threatens to completely dilute any meaningful reform. Despite the fact that the majority of Americans have said that reform is what they want and what America needs. Meanwhile, another $25-billion in Medicaid relief has been included in the President’s budget proposal to states that are seeing current enrollment numbers rise due to our economic environment.

The President’s plan has some really good aspects that will change the course of the health care system today and we finally have the momentum to actually make the health of our nation better. Why stop now?

Why stop when it includes a meaningful expansion of Medicaid so that our most vulnerable citizens can get the monetary relief and care they need to stay healthy? Why impede the development of an insurance exchange to make it easier for Americans to purchase health care? Why prevent important insurance reforms from taking place? Why dilute a requirement that says all of us have to buy coverage to ensure the health care system will be there when we need it and not bankrupt the nation in the process? And why in the world would we want to encumber a real focus on managing high-cost chronically ill populations?

All of these things that make a lot of sense are included in the President’s plan, and can be passed with or without reconciliation.

It will be interesting to see what plays out with the President’s health care summit. Perhaps some consensus can be met that may not address everything, but will at least garner enough votes to put something meaningful in place that we can build upon over the next decade.

A couple question to our readers – Do you think imposing reconciliation is the right way to go? Do you think the President’s health care summit will prove productive?

We all hear “Presidents Day” and think “Washington and Lincoln.” Banks and post offices are closed and for some, another well deserved federal holiday. But that’s just habit.

This year, we might do well to remember another group of presidents–those who have done their best to establish a better health care system for the nation. Every president for the past 75 years has been part of the struggle, yet we still have a system that not only bankrupts individual citizens without regard, it decimates state budgets and paralyzes the federal government from making substantive improvements to the nation’s economy.

While Lyndon Johnson gets much of the credit for getting Medicare and Medicaid passed into law, the true hero of Medicare was John F. Kennedy, who worked, negotiated, and hammered out a solution that would help Americans – and actually found a way to get it approved by Congress.

Medicare has worked fairly well for fifty years—but at the time, the same doubts were voiced that we are hearing today—the bill’s imperfections were too great. At a rally in New York to support health care for the elderly, Kennedy confronted the question: “We’ve got great unfinished business in this country,” he said, “and while this bill does not solve our problems in this area, I do not believe it is a valid argument to say ‘This bill isn’t going to do the job.’ It will not, but it will do part of it.”

The comprehensive health care reform we need today is even more critical than when Kennedy spoke those words in 1962. No, it may not be entirely accomplished by the plans now being discussed in Congress. Yes, it’s imperfect, but the cost of doing nothing is unacceptable. Turning our backs now, when we have a solid plan that insures over 90 percent of Americans; that bends the health care cost curve; that brings down premiums and that strengthens Medicare for seniors, is simply irresponsible. This plan is the closest we’ve ever come to true reform.

There’s no need to give up. Let’s call upon Congress to deliver a bill to the President in recognition of President’s Day. Moreover, for all the presidents before him who have fought tirelessly to get Americans a health care system that will move us one step closer to handling this country’s “unfinished business.”

What do you thing has been the most significant achievement in reforming health care up until now, and which President do you think gets the most credit?”

There’s really only one thing that worries me about the Massachusetts election. I’m not troubled by the fact that the Democrats lost filibuster-proof control of the Senate. Control shifts back and forth as often as who is going to host the Tonight Show on NBC.

It doesn’t worry me that Senator Elect Scott Brown will try to block any potential of health care reform. We’ve come too far over the past year…really over the past half century…to turn back now.

I’m also not concerned that the Democrats will try to force through a health care reform policy -just to get it done. Forcing through policy doesn’t always go over well to voters in an election year – especially those with long-term memories. However, a recent poll by the Kaiser Foundation indicates the American public, including skeptics, become more supportive of health care reform after being told about many of the major provisions in the bills.

But what is worrisome…troubling…concerning to me is that momentum will waver, and the true ideals of health care reform will be lost. We must be sure the following elements of health care reform stay in place:

• Increase Medicaid eligibility – whether its 133% or 150% (which I would prefer), we need to make sure reform protects our most vulnerable citizens
• Protect our children – CHIP programs work…that’s why so many of our policy-makers rose to the occasion to protect in the current bills – Sen. Casey, Sen. Rockefeller, Sen. Reid, etc.
• Affordable Coverage for All – Don’t let purchasing health insurance be burdensome to the majority – continue with plans to provide government assistance through subsidies to those under 400% of the national poverty level
• Use of a state based health care exchange to act as a transparent clearinghouse for consumers to purchase coverage
• Cost containment to bend the unsustainable curve of health care costs
• Medicare & Medicaid benefit integration and financing for dual eligibles within a managed care model to rebalance the long-term care system to increase use of home and community based support services. Shifting more of this high-need population into coordinated managed care arrangements could produce significant savings while ensuring options for consumers where they desire to reside.

Sure, CareSource is a non-profit health plan that believes there is always room for improvement, but we support health care reform. Give non-profits wider opportunities to control costs, enable insurance companies to accept anyone with pre-existing conditions, include an individual mandate so that we all pay our fair share and, reimburse for positive outcomes, etc.

So to do my part in making sure Congress knows that I don’t want the momentum to subside in Washington, I used this source to send Congress – and my local newspapers – a letter:
http://www.progressohio.org/page/speakout/deliverchange

This one is for Ohio citizens…but if you live outside of Ohio, you can go to FamiliesUSA to send your own letter to Congress.

Please let Congress know that we cannot afford to take our eye off the goal just because of one election. We must move forward with health care reform. Our country deserves it.

Martin Luther King, if he had been given the time, must eventually have tackled the health care issue as an essential civil right.  As a nation, we’ve focused so much on the tactics and details—public options, mandates, “Cadillac plans” and so on—that we may be forgetting why increasing health care accessibility is important to us as a nation.

So this is just a reminder for all of us: without health care, personal growth and success are limited indeed.  Children with sensory or behavioral problems are not treated, or whose simple illnesses are not cared for, cannot learn.  Adults with a chronic disease (like diabetes or asthma) can earn a living—but only if they have the care and medications they need.  Families that lose a parent to a disease that could have been cured if caught earlier, suffer consequences that can hardly be measured – stability, opportunity, potential.

If we are serious about equal opportunity, education, stable families, social justice at any level, we must embrace health care accessibility as an essential civil right.

At its most basic level, health care reform has to do two things: It would get nearly everyone into the system and it would reduce overall costs. But according to former national Medicaid director Sally Richardson, those goals are really the same thing. Richardson was a member of the Clinton administration health care task force and is now the executive director of the WVU Institute for Health Policy Research. She says the key is getting people to move away from crisis medicine and toward prevention.

Former Medicaid Director: Health Care Reform Will Probably Work

Health care reform is proceeding toward the president’s desk, likely to become law in the new year. Supporters promise the bill will cut costs and extend coverage. But here’s the real test: What will the trillion-dollar expense of this bill actually buy? Will it improve America’s health? My guess: No. For all the money Americans spend on health care (60 percent more per person than any other advanced country), Americans are not an especially healthy people.

Unhealthy habits are what’s killing us

We know. We don’t want to “make the perfect enemy of the bad” and all.


But really, this new thing about the insurance company tax exemption?  We need to take another look.  As of now, non-profit insurance companies that operate in the private marketplace (primarily the Blue Cross/Blue Shield companies) and spend at least 92% of premiums directly on medical costs would be exempted from the new tax on insurers in the Senate bill. (Wall Street Journal’s explanation of this “bright spot” ).

This needs to be extended to companies serving the public through Medicaid, Medicare and CHIP.  Otherwise, millions of state tax dollars currently being used to provide health care to children, seniors and others will instead be sent straight back to Washington, leaving the states to find some way to make up the difference.

We don’t think anyone meant the new tax on insurers to actually be a tax on states, but that’s how it works out in the current iteration of the bill. It doesn’t make sense to us.

By the way, Associated Press offers a pretty comprehensive list of all the compromises in the Senate bill as it stands, here.

It’s true…the cost of health care for most families in our country has put them in a seriously helpless situation.  It’s sad to think that one playground accident could bankrupt a family of four.  A fall from the monkey bars, a broken leg from a football game, an ill-timed sprint in front of the swings.  It’s enough to keep many parents up at night.

However, Senator Robert Casey’s (D-PA) recent amendment to the Patient Protection and Affordable Care Act (H.R. 3590) should be applauded because of its focus on protecting and improving the successful Children’s Health Insurance Program (CHIP).  Our country’s children have a lot at stake in health reform. More than eight million children remain uninsured, and more are losing employer-sponsored coverage daily.  Each day a child is uninsured is a lost opportunity to strengthen America’s future.  Casey’s amendment goes a long way toward protecting and improving coverage for millions of children in low-income working families across the nation by:

• Providing full funding for CHIP through 2019;
• Maintaining current CHIP eligibility through 2013, and setting a floor for income eligibility for children in all states at 250 percent of poverty ($55,125 for a family of four) beginning in 2014;
• Streamlining enrollment procedures making it easier for children to get coverage and keep it;
• Ensuring that coverage for children remains affordable;
• Guaranteeing all children in CHIP the comprehensive care they need from head to toe; and
• Requiring an HHS report in 2016 that will compare coverage for children in CHIP with coverage for children in the new Health Insurance Exchange and if coverage (including benefits, cost-sharing, premiums, and other features) is comparable or better, children can be transitioned from CHIP into the Exchange in 2019.

Our nation has made great strides over the last decade in securing health coverage for low-income children of working families.  We must now seize this historic opportunity to build on the success of prior efforts and the bipartisan CHIP program, and ensure that children will be better off, not worse off, as a result of health reform.  This amendment will do just that.

Along with 610 organizations/individuals across the nation, we offer our strong support for the CHIP Amendment (#2790). We stand ready to work with the Senate to achieve our common goal of reforming our nation’s health care system and ensuring that all children, indeed everyone in America, have access to the health coverage they need and deserve.

Whenever a new concept is proposed, those at the deliberation table automatically ask “what would happen if?” before they decide to act. With health care reform for example, the driving questions are more like: “Are the changes going to result in more Americans getting coverage? Are the proposed changes budget neutral?” Given the broad scope of the proposed health care legislation, it’s easy to see how details can get overlooked. And when time is ticking, unintended consequences have a higher chance at prevailing.

One concern that should be brought to light is the $6.7B annual fee proposed on insurers. While conceptually this might make sense given the number of Americans who will be required to obtain coverage and the new revenue that insurers stand to gain, a portion of this fee would not be limited exclusively to commercial health insurance companies. Health plans that contract with federal and state governments to serve Medicaid, Medicare, and beneficiaries of the Children’s Health Insurance Plan (also known as CHIP) would also get taxed too.

Well, the challenge is that a significant portion of this fee will fall on state budgets because of the way states are required to reimburse health plans that serve its most vulnerable residents. The new fee will unintentionally require states and the federal government to ultimately come up with additional public dollars to pay for this added fee.

Also, this fee would unfortunately raise the overall costs of these government programs and place additional strains on programs that are already in extreme financial distress. For example, Ohio’s Medicaid program would have to potentially come up with an estimated $65 million annually. Subsequently, the burden of this fee will be paid for by taxpayer-funded government programs and beneficiaries that use these health plans.

Easy solution to the problem? Just exempt health plans administering government entitlement programs from the application of this fee. Problem solved; Unintentional consequence diverted.