Category Archives: Medicaid Expansion

No Socialists Here

Dear Insurance company execs, pharmaceutical company execs, employee benefits consultants and executives, Wall Street investors, and all other stakeholders in the current dysfunctional, broken, complex, complicated, and bloated mess called the US health care system.

You have heard many politicians, and journalists, not to mention your own peers, or even you yourselves label the push for Medicare for All as “Socialism.”

We even have the Administrator of CMS, Seema Verma, calling it, and the public option plan,  “radical and dangerous for the country” recently when she spoke to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

Her solution, and probably yours as well, is to keep selling Medicare Advantage plans, which only makes the current system worse.

So, to help you get over your fear and loathing of Socialism, and to prove to you that the only reason why the US is the only Western, industrial nation to not provide its citizens with universal health care is because you are making money off of other people’s health, or lack thereof.

You are doing so, because you are greedy. There I said it. Now I hope you will pay attention to the following graphic:

Do you see any socialist countries? Do you see any radical and dangerous regimes that are hostile to the interests of the US? Well, maybe Slovenia. After all, they did send us Melania and her illegal family.

But back to the case at hand. I defy any of you hotshots in the health care space to prove to me that all of these Capitalist, free-market countries are flaming Reds, or even a bit Pinko.

You can’t, because it is not true. You and those who call Medicare for All, Single Payer, or even the so-called “public option” radical, just don’t want the government to interfere with your looting the pockets of the American people for your financial gain.

And that is why we are the only country with an “X”, instead of a check mark below our name.

16,000 Unnecessary Deaths Tied to Failure to Expand Medicaid

The Los Angeles Times reported Monday that a new study found that Medicaid expansion brought appreciable improvements in health to enrollees, but also that full expansion nationwide would have averted 15,600 deaths among the vulnerable Medicaid-eligible population.

This is in contrast to the view of opponents of Medicaid expansion who have said that lack of evidence that enrollment in Medicaid improves health and saves lives, and therefore they believed that expansion was a waste of money.

In the 22 mostly red states that refused expansion, the cause of the 15,600 deaths of their state’s residents was attributed to failure to expand.

“This highlights an ongoing cost to non-adoption that should be relevant to both state policymakers and their constituents,” the authors of the study said.

Fourteen states are still holding out, States such as Wyoming and South Dakota, the article states, have a warped sense of “freedom.” States such as Maine and Louisiana, who have had a change in governors from Republican to Democrat, have recently adopted expansion.

medicaid

Fourteen states still resist Medicaid expansion, at great cost to their residents (Kaiser Family Foundation)

The article takes a dim view of the entire rationale for refusing to expand Medicaid, and cites a few noted Conservative voices against the entire idea of expansion and Medicaid itself.

Conservatives have worked hard to depict Medicaid as ineffective, the article reports. They’ve done so, it continues,  by overinterpreting limited studies such as a 2013 study of a Medicaid expansion in Oregon.

Critics focused on the researchers’ finding of “no significant improvements in measured physical health outcomes in the first 2 years” of expansion, but they overlooked the findings that the expansion did “increase use of healthcare services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

Conservative health policy Avik Roy has crowed, the article states, that the result “calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program.”

Another right-wing critic of Medicaid expansion, and not to mention, also of Medicare for All, and now more recently, the public option for Medicare, is CMS Administrator Seema Verma, a Trump flunky.

(Credit: Getty Images )  Picture worth a thousand words was never more true. What a piece of work!

Verma has argued that the expansion hasn’t been a success despite its enrollment figures and has been a leader in undermining the program by allowing states to impose premiums, work requirements and punitive disenrollments on patients. (Her efforts have been blocked by a federal judge, for now.)

This is why advocates for Medicare for All are so passionate and determined, in the face of even the slightest opposition to improving the health and lives of millions of Americans for small changes to our nation’s health care system.

Failure to expand Medicaid, failure to enact universal health care, even if it is a public option, is challenged from the right for morally indefensible and reprehensible reasons.

The cry of “freedom” from conservatives is a smoke-screen to hid their true purpose. To dismantle all social programs and funnel that money to the wealthy and corporations, as they have already done with the Trump tax giveaway.

Now they are trying to cut three million Americans off of food stamps.

All these schemes have one purpose in mind, to kill off their most ardent supporters in Southern and Midwestern states that continue to vote for these sociopaths. To them, freedom means, freedom for a company to profit off of your misfortune, whether that misfortune is due to poor diet, poor personal habits such as smoking and drug abuse, and poor health outcomes due to poverty and economic distress.

Naturally, any attempt to improve the health and lives of the poor, black or white, or Latino, etc., is viewed as “Socialism” and is deemed bad for the country, as Ms. Verma did this week to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

No, it’s not bad for the country. It’s bad for the profits of the insurance companies, the pharmaceutical companies, the benefit managers industry, the health care consultants, and Wall Street investors.

Wanting to cut of food stamps, fail to expand even Medicaid, tightening rules for who is eligible for these programs, is not only bad for the health of average Americans, it is bad for the economic vitality of the nation in an era of global competition.

The men and women at Trump rallies are angry, but they are angry at the wrong people. The clown on the stage is the person they really should be angry at, and his entire swamp of “the best people.”

The Providers: A Film About Rural Health Care in America

Saturday evening, I came upon a documentary film in the Independent Lens series on PBS about the problems facing a part of rural America in providing health care to a poor, mostly elderly, and under-served population.

The film, The Providers, presented a very human face to the physician shortage, as well as the opioid epidemic in rural America, specifically by following three healthcare professionals at El Centro, a group of safety-net clinics that offer care to anyone who walks through the doors in northern New Mexico.

The providers in the film are Matt Probst, a Physician’s Assistant, Leslie Hayes, a Family Physician, and Chris Ruge, a Nurse Practitioner.

The first clinic shown is located in Las Vegas, New Mexico, a far cry from that other Las Vegas, many of you have gone to for conventions and gambling trips. The population of this Las Vegas is 13,201, and the per capita income is $15,481.

As the opening segment states, in 2016, 70,000 deaths in rural American could have been prevented with better access to health care.

Among some of the other points the documentary brings to mind are:

  • Hospital closures due to cuts to Medicaid
  • Failure to expand Medicaid, or repealing expansion Medicaid under the ACA

Chris Ruge, the Nurse Practitioner, is part of a program funded by insurance companies called ECHO Care™, which is an innovative program designed to improve access to primary and specialty care for patients with complex needs while also reducing the cost of care by utilizing a multidisciplinary team-based approach.  In New Mexico, the ECHO Care program expanded the capacity of primary care clinicians through:

  • The assembling, training and placement  of “Outpatient Intensivist Teams” (OIT) which dramatically improve care and reduce costs for the Medicaid beneficiaries served in this program.
  • Special teleECHO clinic designed to support the OITs as they care for patients with significant multi-morbidity, including mental health and substance abuse.

At some point, as the viewer will learn, the companies funding the program want to terminate it, but the CEO of the clinic wants to continue it, whether or not it makes a profit, as long as they break even, because she recognizes the benefits outweighs the cost and profitability.

In order to make sure that they can continue to provide health care to the community, both in Las Vegas, and in another town, they are recruiting from the local high school for students interested in careers in health care.

This was a very eye-opening film and should be watched by anyone who cares about health care and access to care for rural populations, and those who deal with patients suffering from substance abuse, either opioids or alcohol.

 

 

Medicare for All – the three versions – Managed Care Matters

Hot on the heels of my post this morning, Health Care Is Not a Market, comes another post from Joe Paduda.

This time he discusses the three versions of Medicare for All that have already been introduced, or soon will be.

However, there is one item that I have with Joe’s version of MFA that I believe is not a viable option – Medicaid for All.

As we have seen in Kentucky, one governor, a Democrat, expanded Medicaid in his state, only to see his successor, a Republican, eliminate it, thereby tossing millions of Kentuckians to lose health care right after getting it,

All it takes is one gubernatorial or legislative election, and millions in that state will lose coverage.

The better option is Medicare for All, since the federal government, and not the states will finance it.

Anyway, here is Joe’s article: 

There is no consensus about what MFA is – and that makes it really easy for supporters and opponents to convince the uninformed it is great or awful. They do that by picking out whatever they think you’ll love/hate – … Continue reading Medicare for All – the three versions

Source: Medicare for All – the three versions – Managed Care Matters

Health Care Is Not a Market

For the next twenty-one months, there will be a national debate carried on during the presidential campaign regarding the direction this country will take about providing health care to all Americans.

However, to anyone who reads the articles, posts and comments on the social media site, LinkedIn, that debate is already occurring, and most of it is one-sided against Medicare for All/Single Payer. The individuals conducting this debate are for the most part in the health care field, as either physicians, pharmaceutical industry employees, hospital systems executives, insurance company executives, and so on.

We also find employee benefits specialists and other consultants to the health care industry, plus many academics in the health care space, and many general business people commenting, parroting the talking points from right-wing media.

That is why I re-posted articles from my fellow blogger, Joe Paduda last week and yesterday,  who is infinitely more knowledgeable than I am on the subject, and has far more experience in the health care field, that not only predicts Medicare for All (or what he would like to see, Medicaid for All), but has vigorously defended it and explained it to those who have misconceptions.

For that, I am grateful, and will continue to acknowledge his work on my blog. But what has caused me to write this article is the fact that most of the criticism of Medicare for All/Single Payer is because those individuals who are posting or commenting, are defending their turf.

I get that. They get paid to do that, or they depend on the current system to pay their salaries, so naturally they are against anything that would harm that relationship.

But what really gets me is that they are deciding that they have the right to tell the rest of us that we must continue to experience this broken, complex and complicated system just so that they can make money. And that they have a right to prevent us from getting lower cost health care that provides better outcomes and does not leave millions under-insured or uninsured.

However, not all these individuals are doing this because of their jobs. Some are doing so because they are wedded to an economic and political ideology based on the free market as the answer to every social issue, including health care. They argue that if we only had a true free market, competitive health care system, the costs would come down.

But as we have seen with the rise in prices for many medications such as insulin and other life-saving drugs, the free market companies have jacked up the prices simply because they can, and because lobbyists for the pharmaceutical industry have forced Congress to pass a law forbidding the government from negotiating prices, as other nation’s governments do.

Yet, no other Western country has such a system, nor are they copying ours as it exists today. On the contrary, they have universal health care for their citizens, and by all measures, their systems are cheaper to run, and have better outcomes.

None of these countries can be considered “Socialist” countries, and even the most anti-Socialist, anti-Communist British Prime Minister, Winston Churchill said the following, “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Notice that Sir Winston did not say, free market competition. He knew that competition is fine for selling automobiles, clothing, food, and other goods and services. But not health care.

He also said that you can always count on Americans to do the right thing, after they have tried everything else. We’ve tried the free market in health care, and drug prices and other medical prices are through the roof.

However, another thing they have not done, and I believe none of the other OECD countries have done about health care, is to divide the “market” into silos such as the elderly with Medicare, the poor with Medicaid, children with CHIP, veterans with the VA, and their families with Tricare, etc.

No, they pay for all their citizens from a global budget, and do not distinguish between age level, income level, or service in the armed forces.

And their systems do not restrict what medical care their people receive, so that no only do they have medical care, but dental care, vision care, and hearing care. It is comprehensive. And if they have the money to pay for it, they can purchase private health insurance for everything else.

In the run-up to the debate and vote in the UK on Brexit, the point was raised that while Britain was a member of the EU, their retirees who went to Spain to retire, never had to buy insurance because the Spanish providers would bill the NHS.

However, once Britain leaves the EU, they will have to buy insurance privately, because the NHS won’t pay for it. But not all retirees can afford private insurance, so many British citizens will have a problem.

As I have mentioned before in this blog, I was diagnosed with ESRD, and am paying $400 every three months for Medicare Part B. I was doing so while spending down money I received after my mother passed away in 2017. My brother and I sold her assets and used that money to purchase property so that she could go on Medicaid, and eventually into a nursing home when the time came for her to be cared for around the clock.

Since my diagnosis, and prior, I was not working, so spending $400 every three months, and paying for many of my meds, has been difficult. I am getting help with some of the meds, and one is free because my local supermarket chain, Publix gives it for free (Amlodipine).

I hope to be on Medicaid soon, but would much rather see me and my fellow Americans get Medicare for All, and not have to pay so much for it. (a side note: we have seen that Medicaid expansion has been haphazard, or reversed, even when the government is paying 90% of it)

So why are we not doing what everyone else does? For one thing, greed. Drug companies led by individuals like Martin Shkreli, who is now enjoying the hospitality of the federal government, and others are not evil, they are following the dictates of the free market that many are advocating we need. No thanks.

For another, Wall Street has sold the health care sector as another profit center that creates a huge return on investment by investors and shareholders in these companies and hospital systems. Consolidation in health care is no different than if two non-health care companies merge, or one company buys another for a strategic advantage in the marketplace.

There’s that word again: market. We already have a free market health care system, that is why is it broken. What we need is finance health care by the government and leave the providing of health care private. That’s what most other countries do.

So those of you standing in the way of Medicare for All/Single Payer, be advised. We are not going to let you deny us what is a right and not a privilege. We will not let you deny us what every other major Western country gives its people: universal, single payer health care.

Your time is nearly up.

1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

Readers of this blog will recall that I wrote four earlier posts about the closing of rural hospitals, so the article from Healthcare Dive.com comes as no surprise.

Previous posts ( https://wp.me/p2QJfz-GeL, https://wp.me/p2QJfz-IZ3, https://wp.me/p2QJfz-N0u, and https://wp.me/p2QJfz-QSn) go into greater detail about the seriousness of the issue.

But once again, we have to remind the readers that until we enact Single Payer health care, more Americans will lose access to medical care at rural hospitals.

Here is the article:

More than 60% of those facilities are “highly essential” to the heath and economic well-being of their communities, according to a new report.

Source: 1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

ACA Declared Unconstitutional: Now What?


In another example of how cruel and inhumane the radical Conservative/Libertarian Republican Party has been regarding health care, a Federal judge in Texas late Friday, struck down the Affordable Care Act as unconstitutional.

The judge, Reed O’Connor, appointed by George W. Bush, struck down the law on the grounds that its mandates requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it, as reported yesterday in the New York Times.

According to the Times article, the ruling was over a lawsuit filed earlier this year by a group of Republican governors and state attorneys general. States led by Democrats promised to appeal the decision, which will not have immediate effect.

However, the Times reports, it will make its way to the Supreme Court, where the survival of the law and the health of millions of Americans will be in doubt.
Judge O’Connor said, the Times quoted, that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.” In addition, the judge said, “the individual mandate is unconstitutional” and that the remaining provisions of the ACA are invalid.

The main issue, pointed out in the Times piece, was whether the law’s mandate still compelled people to buy coverage after Congress zeroed out the penalty as part of the tax overhaul this year.

20 states, led by Texas, argued that with the penalty zeroed out, the mandate had become unconstitutional, and that the rest of the law could not be severed from it, the Times wrote.

The Justice Department under former Attorney General Sessions, declined not to defend just the individual mandate, but the pre-existing conditions provision as well.

A spokesman for California attorney general Xavier Becerra said that California, and other defendant states, would challenge the ruling with an appeal in the US Court of Appeals for the Fifth Circuit in New Orleans.

Becerra’s statement, reported by the Times, said the following, “ Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the ACA’s consumer protections for health care, on America’s faithful progress towards affordable health care for all Americans…The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court.”

The chief plaintiff in the case, Texas attorney general Ken Paxton, applauded the decision, and was quoted in the Times in a statement, “Today’s ruling enjoining Obamacare halts an unconstitutional exertion of federal power over the American health care system.”

Meaning that the American “health care system” can only be a private insurance-based system that allows companies to profit off some people’s health, or lack thereof. He is upholding the “right” of insurance companies, drug companies, medical device manufacturers, and others to profit at our expense and to play with the lives of millions of Americans who will lose what coverage the ACA gave them.

This also means, that any attempt to enact Medicare for All/single payer health care will result, at some future date, to a judge or court striking it down as unconstitutional.

Simply put, Conservative jurisprudence believes that the Constitution enshrines free-market health care.

The Times added that Paxton also said, “Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the ‘failed’ [quotes added] social experiment with a plan that ensures Texans and all Americans will again have greater choice (to be ripped off and overcharged) about what health coverage they need and who will be their doctor.”

In other words, Mr. Paxton wants the American health care system to stay where it is, so long as companies can make money from it.

Here are a few takeaways from the rest of the Times’ article:

• If the judge’s decision stands, about 17 million Americans will lose their health insurance, according to the Urban Institute. This includes millions who gained coverage through Medicaid expansion, and millions more who receive subsidized private insurance through the ACA marketplaces.
• Insurers will also no longer have to cover young adults up to age 26 under their parents’ plans
• Annual and lifetime limits on coverage will again be permitted
• And there will be no cap on out-of-pocket costs
• Also gone will be the law’s popular protections for people with pre-existing conditions

This last takeaway was front and center of the Democrats midterm campaigns, and while most Republicans insisted that they did not want to withdraw those protections, the article reported that most were silent after the ruling.

Without those protections, insurers could deny coverage to such people or charge them more; they could also return to charging them based on age, gender or profession, according to the Times.

The Kaiser Family Foundation, the Times noted, estimated that 53 million adults from 18 to 64 — 27 percent of that population would be rejected for coverage under practices in effect before the ACA.

Larry Levitt, senior vice president of the Kaiser Family Foundation wrote on Twitter, “If this Texas decision on the ACA is upheld, it would throw the individual insurance market and the whole health care system into complete chaos…But the case still has a long legal road to travel before that’s an immediate threat,” the Times quoted.

Democrats attacked the decision as absurd. Incoming House Speaker Nancy Pelosi said that when the party took control of the House next month, it would “move swiftly to formally intervene in the appeals process to uphold the lifesaving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.”

Healthcare Dive.com, in reporting Friday about the decision, wrote that a decision had been waiting in the wings since September, when the Justice Department asked Judge O’Connor to wait until the individual market’s open enrollment period ended, which was also a convenient time for Republicans running in the midterms.

Healthcare Dive.com also stated that the decision would be appealed to the conservative Fifth Circuit, and possibly to the Supreme Court, where advocates worry that it will be struck down.
Providers such as the American Hospital Association (AHA) and American Medical Association (AMA) urged a stay until a higher court could take it up.

One state not a part of the defendants was Maryland, according to Healthcare Dive.com. Maryland’s Democratic Attorney General, Brian Frosh, brought its own case seeking a reaffirmation of the ACA’s constitutionality.

Attorney General Frosh argued that Maryland residents who became insured under the ACA would be harmed if the law was unconstitutional or eliminated. About 150,000 people in Maryland gained insurance through the ACA marketplace in 2018, and more than 300,000 are insured through the state’s expanded Medicaid program.

The Maryland case is still ongoing.

So now what?

In the short-term, nothing will change, as mentioned in the two articles above. However, in the long-term, there will be serious consequences, just as Larry Levitt said on Twitter Friday.

But more importantly than chaos in the insurance market and health care system, millions of Americans will once again be at the mercy of insurance companies, be denied coverage for pre-existing conditions, including pregnancy, cancer, and a whole host of illnesses, be denied life-saving drugs, or rejected for surgeries, etc.

And among those millions, many will die needlessly because of the greed of the insurance companies and the actions of a Cowboy judge.

What does this mean?

Allow me to put on a different hat here and offer an opinion as to what may transpire in the future, since none of us are clairvoyant. As someone who studied both American history and American government and politics, in my opinion, we will not see universal health care in this country unless and until, to use a medical metaphor, this Conservative/Economic Libertarian virus is eradicated from the American political system, or at least is brought under control.

I do not say this lightly, nor am I being flippant here. Let’s face facts. The Republican Party stands in the way of the adoption of rational, universal health care for all Americans because they are the defenders of a rapacious, greedy Capitalist health care system that demands that investors, shareholders, insurers, manufacturers, and service providers and consultants, be allowed to profit by the health and welfare of the American people.

However, as also reported in the New York Times on Sunday, the ACA could be hard to knock down, despite the judge’s ruling, according to legal scholars quoted in the article.

Yet as Ezra Klein writes in Vox.com, Republicans have refocused Democrats on building what they failed to build in 2010: a universal health care system simple enough and popular enough that it is safe from constant political and legal assault. And that means some version of Medicare-for-all. Democrats are promising swift action once they take over the House in a few weeks, so we wait and see how that will turn out.

But on the other hand, as I have pointed out in previous posts, both those penned by myself, and those that I reposted from other sources, the medical-industrial complex is pushing back hard against any move to alter this broken system.

Two recent posts, Healthcare Lobbying Group Double-Crossing Democratic Voters and Establishment looks to crush liberals on Medicare for All – POLITICO highlights the attempt by the health care industry to keep the status quo, or at least to convince Democratic politicians who might be opposed to full single payer health care, to offer alternatives that will allow the insurance companies to profit from providing coverage to only those who are not sick, which is called adverse selection.

There are some people in this country who argue that what we need is not less competition in health care, but more. However, this misses the point. Whether or not there is more or less competition is not the reason why our health care system is broken. The reason why it is broken is because there is competition in the first place. No other Western country has this problem, and they all have some form of universal, single payer health care.

So, the prognosis for the future of universal health care is cloudy, if not downright gloomy. Advocates for single payer, improved Medicare for All must take a sober hard look at reality and formulate a strategy to meet this new and regrettable challenge. And they must do so with a clear eye and mind on the realities of the political landscape, and not be lulled into thinking that just because polls indicate approval by voters, that enacting Medicare for All will be easy or accomplished quickly. We have enemies, and one of them is Reed O’Connor.

Additional Reading:

Judge Rules Obamacare unconstitutional, endangering coverage for 20 million
Obamacare ruling delivers new shock to health system