Posts Tagged ‘exchange’
Momentum Must Not Waver
Author : Toni Bigby
Jan 26th, 2010 | by
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.
Article Tags
Affordable Health Coverage • Children’s Health Insurance Program (CHIP) • congress • exchange • health care reform • Health Coverage • Kaiser Foundation • Massachusetts Miracle • Medicaid • Medicare • poverty • Scott Brown • Senator Scott Brown • Senator-elect Scott Brown • support health care reform
More Is Not Better – The Story of Fragmentation of Care
Author : Craig Thiele, M.D.
Nov 4th, 2009 | by
It’s the Fragmentation, People
I heard a story that didn’t surprise me, but may surprise you, especially if you haven’t heard much about fragmentation of care. It was called “The Telltale Wombs of Lewiston, Maine,” on National Public Radio. At the start, the story seemed to be pointing a finger at doctors for providing services (especially surgeries) that their patients don’t really need, sometimes with negative results. This point of view has been around awhile, and frankly, does not do justice to a complex situation.
In the end, here’s what I heard that concerned me:
“(Dr.) Elliott Fisher…compared Medicare recipients with similar levels of sickness in areas throughout the whole United States. Fisher looked at places where elderly people used relatively few health care services and compared them with places where elderly people used a lot of health care services.
‘The patients in the high-spending regions were getting about 60 percent more care; 60 percent more days in the hospital; twice as many specialist visits,’ Fisher says. ‘And yet when we followed patients for up to five years, if you lived in one of these higher-intensity communities, your survival [rate] was certainly no better, and in many cases a little bit worse.
This is probably because of something called fragmentation of care. In high-use areas, it’s often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.”
For most Americans, fragmentation of care is a difficult idea to accept: It’s hard to understand that more care isn’t necessarily better for you.
But study after study has borne out the truth of this completely anti-intuitive conclusion. In fact, Fisher and other researchers estimate that almost one-third of the care given in our country today is that kind of care — care that may not help.
In some studies, it is estimated that the United States spends more than $2 trillion on health care every year. If 10 percent of this care provided is unnecessary, this would cost $200 billion. Some estimate it may be as high as 30 percent, or roughly $600 billion.
What lesson should we take from this about health care reform overall? It seems to me that whatever the final form it takes, reform must confront and solve these issues, including fragmentation of care. Whether we go with “exchanges,” “co-ops,” a “public option,” Medicaid expansion, or a combination of all of them, attention must be paid to avoid fragmentation by coordinating care.
It seems too obvious to point out that non-profit insurers like CareSource have been improving outcomes and controlling costs through care coordination for years now. We certainly hope that Congress, in its wisdom, will put that experience to work.
Ask your health care reform questions here
Article Tags
Co-op • Dr. Elliott Fisher • exchange • fragmentation • fragmentation of care • health care • health care reform • Kaiser Family Foundation • Medicaid • Medicare • NPR • Public Option • public plan • Public Radio • WOSU-AM
Dissecting the Senate Finance Committee Proposal
Author : Toni Bigby
Oct 9th, 2009 | by
Senate Finance Committee Completes Mark-up; Expected to Vote Out of Committee on Oct. 13
The Senate Finance Committee completed debate on proposed health care legislation at 2:18 am last Friday. The Finance Committee was the last congressional panel to consider a health care reform bill and plans to vote this week after the bill’s final language has been made public and the Congressional Budget Office has provided final cost figures. Democrats hold a 13-10 committee majority which clears the way for the full Senate to begin debating the measure on October 13, 2009.
The panel considered many amendments over a two-week period and voted to reduce or waive fines for people who fail to buy coverage and give states money to help insure low-income Americans.
The legislation, estimated to cost $900 billion over 10 years, mandates that Americans get insurance and provides subsidies to those who need them, creates nonprofit cooperatives to offer an alternative to private insurance companies, and prohibits insurers from denying coverage to people with pre-existing medical conditions.
Instead of approving a public option amendment, the finance panel voted 12-11 for a compromise plan offered by Sen. Maria Cantwell, D-Wash., that would give federal funds to states to negotiate with private managed care plans to buy coverage for people who would not qualify for the Medicaid program. This compromise option would be eligible to people with income between 133-200% FPL. For individuals, that means income between $14,403 annually and $21,660. For families of four, the eligibility would be $29,326 to $44,100.
Individual mandate – Lowering the Penalty & Allowing Exemptions Dismays Insurers
An amendment proposed by Senators Charles Schumer (D-NY) and Olympia Snowe (R-ME) was also approved that reduce the penalty for those who fail to comply with an individual insurance mandate to $750 per adult, from $1,900 per family as originally proposed. It also waives the penalties in 2013 and phases them in through 2017. In addition, people who would have to pay more than eight percent of their income to buy insurance would be exempt from the penalties, down from 10 percent.
This amendment is of significant concern to commercial insurers as it could allow 2 million Americans to remain uninsured without contributing to the insurance pool.
Insurers are outraged by the risk involved as they would be required to guarantee coverage for all Americans should the health reform measure pass. A strong individual mandate made this option feasible.
Other notable items:
- By a vote of 13 to 9, the committee approved an amendment by Senator Jay Rockefeller (D-WV) that would keep low-income children in the Children’s Health Insurance Program (CHIP), instead of covering them through the Exchanges. This was a key interest for CareSource as we hope to continue to provide coverage to children who qualify through CHIP in Ohio and Michigan.
- Physician groups were upset to find out that the hospital industry is exempt from a crucial cost-cutting measure related to Medicare payments included in Senate Finance Chairman’s mark. Hospitals were held exempt because they were able to negotiate a $155 billion cost-cutting agreement with Baucus and the White House.
What’s Next?
The bill that emerges from Baucus’s panel must be merged with one that passed the Senate Health, Education, Labor and Pensions (HELP) Committee for debate and vote by the full Senate and eventually reconciled with a House measure.
Across the Capitol, Democratic leaders in the House met privately with moderate members, with liberals, and then with first-termers as they struggled to achieve a consensus on legislation to bring to the floor. Majority Leader Steny Hoyer announced it would probably be at least two more weeks before House legislation was ready.
Article Tags
Charles Schumer • CHIP • co-op plan • exchange • health care reform • health insurance • Jay Rockefeller • managed care • Maria Cantwell • Max Baucus • Medicaid • Medicare • non-profit • Olympia Snowe • public plan • senator • Steny Hoyer
Paying for the Sins of Others
Author : Toni Bigby
Oct 2nd, 2009 | by
“Funny or Die”, the comedic website developed by Will Ferrell, Adam McKay and Chris Hench posted a hilarious video about the health insurance industry called “Protect Insurance Companies PSA”. Obviously satiric, the clip showcases many Hollywood personalities supporting the need for health care reform to protect Americans from the interests of greedy health insurance executives. The clip ends with a call to action to support the public option, and email your Congressman.
The only unfortunate thing about this video is that it lumps all insurance companies together. But there are some insurance companies – ours for instance – that actually support reform efforts that offer the uninsured an array of affordable health care options from which to choose. Look, the truth is we are embarking on a new era in health care. The entire health care industry – providers, hospitals and insurance companies alike – will be completely revolutionized once reform is introduced. And the legacy insurance companies who have profited unscrupulously will find it hard to adjust because they’ve operated the same way for years.
The insurance companies of the future – those that are non-profit, customer-focused first, and genuinely engaged in finding ways to decrease spending while increasing quality – are the companies ready to thrive in this new era. Do we stand to benefit? Of-course we certainly hope so. But I’d rather have a system that rewards transparency, honesty, inclusion, wellness and empathy than one that rewards profitability and size.
Public option, co-op, exchange, expanded Medicaid and/or individual mandates …whatever shape reform ends up taking, there are a handful of progressive companies ready to embrace this new world. Will Ferrell and team are funny indeed! I just hope they know there are some insurance companies out there that support his team’s ideals and don’t make us all pay for the sins of others!
