Category Archives: Health Policy

Fallout of the End of ACA Subsidies

Joe Paduda today gave a very succinct and clear-minded assessment of the fallout of the ending of the ACA subsidies, also known as Cost-Sharing Reimbursement (CSR) payments.

Here is Joe’s article.

It makes perfect sense that what the Orange man said yesterday will do more damage to health care than his false and misleading pronouncements of the past year that the ACA is failing and doing harm.

It is you, sir, who are doing harm. To the poor, to minorities like those in Puerto Rico despite your morning mea culpa, to African-Americans and Latinos,  to women, to international agreements and organizations,  and to our credibility with our allies and adversaries.

 

Advertisements

ACA Subsidies to End

Here is the New York Times article tonight which will appear in tomorrow’ paper.

The Orangutan is blowing up the health care law, and with it, the health care system.

Cutting off subsidies to cover low-income individuals and signing an Executive Order that will create chaos and uncertainty is dangerous, reckless, and despicable.

Not even Gru is that mean-spirited and inhumane.

The Roman Senator Cato the Elder ended his speeches by declaring that “Carthago delenda est”. which means Carthage must be destroyed.

We need a modern Senator to declare that “Trump sit remotus”, means Trump must be removed.

Executive (Dis)order

The signing this morning of an executive order by the Orangutan will have, in the opinion of some of the bloggers and politicians, spell disaster for the nation’s health care system.

It will, if carried into action, likely siphon healthy people from the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA.

The rationale for such a move that has been given is that since Congress has not been able to repeal and replace the ACA, an executive order will, piece by piece.

Coupled with the recent budget move to eliminate the CHIP program for children’s health (New York State faces dire consequences if Congress does not act on CHIP), and cut backs to Medicare and Medicaid, the intent here is to privatize health care for some, and eliminate it for others, and to get government out of health care providing altogether.

There are provisions in this order for greater competition, short-term coverage, and lower premiums with less coverage. Why this is better is beyond me, unless the Orangutan is seeking to destroy health care so that single-payer will be the only option.

Cutting healthy people out of the ACA means leaving sick people to struggle with a health care law that many say needs to be fixed, not repealed and replaced. But because the Tea Party ranted and raved before it was enacted, and the Orangutan and the GOP campaigned on getting rid of it, they had no choice but to sabotage it if they could not do so through legislation.

I predict that we will soon see the total collapse of our health care system thanks to this stupid, overreaching, and ill-advised Executive Order. I even read today that the Vice President had to remind the Orangutan to sign the darn thing, something that almost slipped what is left of his so-called mind.

Welcome to Crackerbox Palace.

The Wisdom of Solomon?

You all know the story of King Solomon in the Bible where he was called upon to settle a dispute between two women, each claiming to be the mother of a baby. Solomon’s “solution” was to order the baby be cut in half, so that each mother would have half a baby. But when she realized what this would mean, the real mother spoke up and spared the child from being split in two.

Well, something posted today on LinkedIn, sort of reminded me of that story. Rather than paraphrasing it, I am posting the item here for you.

Trump plans to split Obamacare in two

President Trump plans to sign an executive order this week that takes aim at the Obama-era Affordable Care Act, according to sources. Among the changes, the order would give individuals and small businesses in association health plans more options to opt in for lower-cost — albeit less comprehensive — plans not allowed under the ACA, leaving older and sicker individuals with fewer options and pricier premiums. It would also provide short-term insurance for up to a year, reversing the three-month deadline put forth by the previous administration. If the order is signed, the market could divide in two, adding more difficulties to traditional markets under the ACA while opening the door to new types of insurance.

It seems the Orangutan now fancies himself with the wisdom of Solomon in regard to dealing with the “problem” of getting rid of the ACA. Like the two women in the story, the two parties in Congress each claim their own view of health reform, and since neither side is getting their way, the Orange King is doing it for them by signing an Executive Order.

And like the proverbial baby, splitting health care in two solves nothing. But don’t let that stop the Orangutan. He’s the wisest person there ever was, or didn’t you know that?

Single Payer Supported by Majority of Physicians

A shout-out to Dr. Don McCanne for posting the following article from Merritt Hawkins.

Merritt Hawkins
August 14, 2017
Survey: 42% of Physicians Strongly Support a Single Payer Healthcare System, 35% are Strongly Opposed
By Phillip Miller
A plurality of physicians strongly support a single payer healthcare system, according to a new survey by Merritt Hawkins.
The survey of 1,033 physicians indicates that 42 percent strongly support a single payer health care system while 14 percent are somewhat supportive. Over one-third (35 percent) strongly oppose a single payer system while six percent are somewhat against it. The remaining three percent neither support nor oppose single payer.
The results contrast with a national survey of physicians Merritt Hawkins conducted in 2008, which indicated that 58 percent of physicians opposed single payer at that time while 42 percent supported it.
In Merritt Hawkins’ experience, there are four reasons why a growing number of physicians are in favor of single payer. First, they are seeking clarity and stability. The fits and starts of health reform and the growing complexity of our current hybrid system are a daily strain on most doctors. Many of them believe that a single payer healthcare system will reduce the distractions and allow them to focus on what they have paid a high price to do: care for patients.
Second, it’s a generational issue. The various surveys that Merritt Hawkins has conducted for The Physicians Foundation in the past show that younger doctors are more accepting of Obamacare, ACOs, EHR, and change in general than are older physicians As the new generation of physicians comes up, there is less resistance among doctors to single payer.
Third, there is a feeling of resignation rather than enthusiasm among some physicians about single payer. These physicians believe we are drifting toward single payer and would just as soon get it over with. The 14% of physicians surveyed who said they “somewhat” support single payer are probably in this group.
Fourth, there is a philosophical change among physicians that I think the public and political leaders on both sides of the aisle now share, which is that we should make an effort to cover as many people as possible.
However, while single payer has gained acceptance among some physicians, it remains strongly opposed by over one third and strongly or somewhat opposed by over 40 percent. It is still a polarizing issue among physicians and is likely to remain so for the foreseeable future.
So, if a majority of physicians support single payer, and they are the ones we should listen to when it comes to taking care of our health, and if a growing majority of Americans are coming around to this idea, then the only ones standing in the way are our politicians.
POTUS, the Secretary of Health and Human Services, Mitch McConnell, Paul Ryan, Rand Paul, and the medical-industrial complex of insurance companies, drug companies, and medical device manufacturers are all opposed and are preventing this nation from joining the rest of the developed world in providing health care to ALL its citizens.
And there is one more obstacle in our way: Wall Street investors and their clients who are funding insurance and medical companies, engaging in adverse selection and determining who lives and who dies. Who gets covered and who goes into bankruptcy.
They need to removed from the equation.

Insurers Jacking Up Premiums Ahead of End of CSRs

An article in Healthcare Finance News.com on Friday, said that insurers are factoring in the end of the cost-sharing reduction payments into their rate increases from 2 to 23 percent, according to a report from the Kaiser Family Foundation.

The article states the following:

“Insurers in 20 states and the District of Columbia have filed premium rate requests for the federal exchange ahead of an August 16 deadline, many on the assumption that cost-sharing reduction payments will not be paid and that the individual mandate will either not be enforced or weakly enforced, according to a Kaiser Family Foundation report released Thursday.”

According to Kaiser, silver premiums would have to increase by 19 percent on average to compensate for the loss of CSR payments.

Susan Moore, the Associate Editor for Healthcare Finance News.com, also said that insurers are building uncertainty into their rates, filing under multiple scenarios involving CSRs and the individual mandate.

The threat from the POTUS to Mitch McConnell to push him to repeal and replace the ACA means that if POTUS does get his way, CSR’s would end and so would the individual and employer mandates. Also, the health insurance tax return in 2018 will add 3 percent to premiums.

You can read the rest of the article yourselves, but consider this. Isn’t time to end this nonsense of charging people insurance premiums that are constantly rising just so that a bunch of greedy health insurance companies and their Wall Street investors profit from people’s health?

When are we going to wise up and put and end to this game of playing with people’s health and forcing many into bankruptcy because they have severe medical issues?

When are we going to realize that health care is a human right, and not a commodity that can be marketed like consumer goods?

Medicare for All will end this constant round of rate increases and shenanigans the health insurers perpetrate on the American people.

Trump and the Social Determinants of Health

Here’s a little light reading for your weekend, courtesy of Patricia Illingworth, writing today in Health Affairs blog about the Social Determinants of Health and the take on it by the current administration.

Ms. Illingworth rightly points out that those below the poverty level and without a college degree, both whites and minorities, suffer more serious illnesses such as diabetes, asthma, heart disease, as well as smoking, drinking and using illegal drugs more than those with college degrees.

She also states that cuts to education, energy, the environment, housing and urban development, among other social sectors, impacts health, and that if these social determinants are underfunded, people will need more health care. And now that the health care reform debate is stalled, the current POTUS is still trying to destroy the ACA, and has threatened members of his own party, including the Senate Majority Leader, Mitch McConnell.

Ms. Illingworth cites a study published by the Brookings Institution, that showed that “deaths of despair”—those associated with drugs, alcohol, and suicide—have risen significantly among middle-aged white non-Hispanic Americans without a college degree.

Living conditions, Ms. Illingworth reports, also affects rates of asthma, which are the leading cause of children’s visits to ER’s, hospitalizations, and absenteeism. And, it is more prevalent in poor and minority communities.

All of this is not surprising, since 1980, this nation has waged a relentless war against its poor and minority citizens. This war began the day Ronald Reagan took the oath of office and began dismantling not only the New Deal programs, but cutting back the programs created under the Great Society of the 1960’s.

With each successive Republican administration, as well as the rise of Republican power  in Congress since the ascension of Newt Gingrich to Speaker of the House, and in many states, especially in the formerly solid Democratic South, poverty and illness among the poor and minority, as well as whites have increased. And the loss of manufacturing and other support services jobs associated with manufacturing have resulted in the current opioid crisis, which only yesterday was addressed as a national emergency by the POTUS.

But Democrats are not without fault here too. Failure to stand up to the Reaganite Counter-Revolution, the pursuit of a failed “free trade” policy that has outsourced jobs or allowed companies to offshore jobs, as well as paying deference to the will of Wall Street and Corporate America, has brought us the current occupant of the Oval Office.

In the recent health care debate in Washington, many placed their confidence in moderate Republican senators to defeat the repeal and replace measures, but as Andrew Sullivan wrote four years ago in his blog, The Dish, “What Moderate Republicans?”, Sullivan says the following:

“There is effectively no Republican party any more. There is a radical movement to destroy the modern American state and eviscerate its institutions in favor of restoring a mythical, elysian, majority-white, nineteenth-century past. This crisis is proving that more powerfully than even watching Fox. We need to see what is in front of our nose: a cold civil war has broken out between those properly called conservatives, defending the credit of the government, empirical reality, and adjustments to modern life and those properly called radical reactionaries declaring our current elected president and Senate as illegitimate actors, bent on the destruction of America, and therefore necessitating total political warfare, even to the point of threatening to destroy the global economy.”

The current architect of this destruction is not the man with the orange hair, but one Stephen K. Bannon, the former head of Breitbart. Bannon’s radical agenda is to destroy the “deep state”, and to create what Sullivan so rightly predicted four years ago, as he said above.

Bannon has been identified as a racist, anti-Semite, and has no business in the White House. Another member of this cabal is Stephen Miller, who a few weeks ago, revealed his true colors by openly defending restricting legal immigration, something that brought his family, and mine, as well as millions of others, to this country.

I could go on, but this post is about health care.

The main point is, we need to stop playing games with people’s health and do what other Western and developed countries provide to their citizens, health care for all.

If you don’t believe me, then maybe the words of a billionaire will convince you. Warren Buffett, one of the richest men in America, and an astute and very successful businessman, unlike a certain neophyte politician, has said the following with regard to single payer.

“…government-run health insurance “probably is the best system” because it would control escalating costs. We are such a rich country. In a sense, we can afford to do it, … In almost every field of American business, it pays to bring down costs.”

It is time to give every American health care. Then we will see a vast improvement in the social determinants of health.