Posts Tagged ‘public plan’
Nov 6th, 2009 | by
You’ve probably noticed that the health care reform debate has shifted from health care reform to health “insurance” reform. Despite its efforts to work collaboratively, the insurance industry is the simple target to blame for the health care mess we so urgently need to fix. (There is no single villain, of course. It’s the entire system that’s broken.)
However, that may explain the “co-op” approach passed as part of the Senate Finance Committee bill. But, as 30 Senators pointed out in a letter to Senate President Harry Reid, co-ops (as currently written in America’s Healthy Future Act) are pretty much a non-solution:
The Senate Finance Committee included a cooperative approach to insurance market competition. While promoting more co-ops may be a worthy goal, it is not realistic to expect local co-ops to spring up in every corner of this country. There are many areas of the country where the population is simply too small to sustain a local co-op plan. We are also concerned that the administrative costs associated with financing the start-up of multiple co-op plans would far outstrip the seed money required to establish a public health insurance program.
There’s another point made further down in that letter that really is something to think about:
The major differences between the public option and for-profit plans are that the public plan would report to taxpayers, not to shareholders, and the public plan would be available continuously in all parts of the country.
Guess what? We’re already here. Established and ready to serve. A health plan that is accountable to taxpayers. CareSource, the nation’s second largest, not-for-profit Medicaid health plan and a number of other organizations like us around the country have been helping Americans get the care they need at the right place, at the right time and at a lower cost.
My point here is that even though the health care system is broken, there are still a lot of working parts, including a number of proven, experienced and effective non-profit insurance companies in place that can help get a “public option” off the ground. The best part – we can do it fast and transparently.
And while 47 million Americans now have no health care at all, speed and honesty is a big part of what we all need.
Article TagsACAP • American's Healthy Future Act • America’s Healthy Future Act • Co-op health plan • health care reform • health insurance • health insurance reform • Medicaid • michigan medicaid • non-profit • Ohio medicaid • Public Option • public plan • Senate Finance Committee • Senator Harry Reid • taxpayers • uninsured
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.
Article TagsCo-op • Dr. Elliott Fisher • exchange • fragmentation • fragmentation of care • health care • health care reform • Kaiser Family Foundation • Medicaid • Medicare • michigan medicaid • michigan medicaid program • NPR • Ohio medicaid • Ohio medicaid program • Public Option • public plan • Public Radio • WOSU-AM
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.
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 TagsCharles Schumer • CHIP • co-op plan • exchange • health care reform • health insurance • Jay Rockefeller • managed care • Maria Cantwell • Max Baucus • Medicaid • Medicare • michigan medicaid • michigan medicaid eligibility • michigan medicaid program • non-profit • Ohio medicaid • ohio medicaid eligibility • Ohio medicaid program • Olympia Snowe • public plan • senator • Steny Hoyer
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!