Lack Of Information And Misinformation Suppressing Enrollment In Insurance Plans

March 26, 2014 — Ron Chusid

Recent polls are showing some of the obstacles to extending coverage among the uninsured. A study published Monday by the National Academy of Sciences showed that a substantial number of consumers lack basic knowledge of how insurance works which would be necessary to intelligently purchase coverage. A new Kaiser Health Tracking Poll shows lack of knowledge of the deadline for obtaining coverage and widespread belief in many of the false claims being spread by opponents of the Affordable Care Act.

Many are unaware of next week’s deadline to obtain coverage and avoid potential tax penalties:

A third of those who lack coverage as of mid-March are unaware that the law requires nearly all Americans to have health insurance or pay a fine. When it comes to the specifics, four in ten of the uninsured (39 percent) are aware that the deadline to sign up for coverage is at the end of March, leaving about six in ten unaware of the March deadline.

When reminded of the mandate and the deadline, half of those without coverage as of mid-March say they think they will remain uninsured, while four in ten expect to obtain coverage and one in ten are unsure.

Many plan to not obtain coverage due to cost concerns, unaware of financial assistance available:

While some report trying to get coverage from new options available under the ACA, large shares of the uninsured remain unaware of two of the law’s key provisions that could help them get coverage. About half the uninsured are unaware that the ACA gives states the option of expanding their Medicaid programs, and more than four in ten don’t know that it provides financial help to low- and moderate-income individuals to help them purchase coverage.

The Kaiser poll showed a reduction in the gap between those who see the law unfavorably as opposed to favorably. While more now have a favorable opinion than previously, the majority continue to have an unfavorable opinion. Much of the opposition is based upon misinformation spread by opponents:

“It’s too expensive for regular people.”
“it’s costing too much money. It’s supposed to help people with low incomes and it’s not.”
“Because it’s a financial hardship on the U.S.”

The first two are based upon lack of knowledge of the assistance available which does make coverage more affordable. The third has been shown by the recent non-partisan report from the Congressional Budget Office to be false. Among its other benefits, the Affordable Care Act will reduce the deficit, reduce unemployment, and help stimulate the economy by freeing people from the insurance trap, enabling more people to work for and start small businesses

Opposition also includes a belief that the individual mandate is unconstitutional despite a Supreme Court ruling upholding the law. Some expressed the false belief that the ACA gives government more control over personal health care choices, echoing further scare stories from the right wing as to what the law does.

Despite unfavorable views about the law, a majority still would prefer to see improvement to the law as opposed to repeal or a Republican alternative:

Perhaps reflecting this sense that the debate has gone on long enough, more of the public would like to see Congress keep the law in place and work to improve it (49 percent) or keep it as is (10 percent) rather than repeal it and replace it with a Republican-sponsored alternative (11 percent) or repeal it outright (18 percent).

The poll found that many aspects of the law are popular, even if many people are unaware of these and other benefits:

As previous Kaiser tracking polls have found, many of the ACA’s major provisions continue to be quite popular, including across party lines. For example, large shares of Americans – including at least seven in ten overall and at least six in ten Democrats, Republicans, and independents – have a favorable view of the fact that the law allows young adults to stay on their parents’ insurance plans up to age 26, closes the Medicare “doughnut hole” for prescription drug coverage, provides subsidies to low- and moderate-income Americans to help them purchase coverage, eliminates cost-sharing for preventive services, gives states the option of expanding Medicaid, and prohibits insurance companies from denying coverage based on pre-existing conditions. Nearly as many (including a majority across parties) have a favorable view of the “medical loss ratio” provision that requires insurance companies to give their customers a rebate if they spend too little money on services and too much on administration and profits. Somewhat more divisive is the law’s Medicare payroll tax on earnings for upper-income Americans, which is viewed favorably by about three-quarters of Democrats and just over half of independents, but just a third of Republicans.

The individual mandate remains highly unpopular. Anticipation of this is one of the reasons I opposed the individual mandate prior to passage of the Affordable Care Act, preferring an alternate system to provide incentives to purchase coverage and penalize those who try to game the system by waiting until sick to purchase insurance.

Much of the opposition to the ACA is based upon beliefs about the law which are untrue:

Misperceptions also persist about things the ACA does not actually do. For example, nearly half the public (46 percent) think the law allows undocumented immigrants to receive financial help from the government to buy health insurance, and another two in ten (22 percent) are unsure whether it does. A third of the public (34 percent, including 32 percent of seniors) believe the law establishes a government panel to make decisions about end-of-life care for people on Medicare, with another quarter saying they are unsure (23 percent of the public, 25 percent of seniors).

Unfortunately both lack of information and intentional misinformation being spread by opponents of the Affordable Care Act is likely to cause a substantial number of people to go without coverage this year. The deadline is fast approaching for purchasing coverage on the exchanges. There is no deadline for those who qualify for coverage due to Medicaid expansion, but Republicans in many states are also denying this benefit to residents of their states even though the federal government picks up almost all of the cost.

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Obamacare Delay Similar To Previous Medicare Delay Under George Bush

March 26, 2014 — Ron Chusid

Republicans are obsessed with Obamacare delays. Some of the delays have been helpful to allow for orderly transition to the new rules. The latest, allowing people to complete the process if they started an application for insurance before the deadline, seems like common sense and basic fairness (which might be why Republicans have such a problem with it). NBC News pointed out that George  W. Bush also had a similar delay with the Medicare D program:

As Republicans complain about the Obama administration’s latest deadline extension for Americans to purchase health insurance, Democrats are countering with this reminder: The Bush administration did something similar in 2006.

Back then, as it was implementing the Medicare prescription-drug benefit Bush had signed into law, the GOP presidential administration announced it was waiving penalties for low-income seniors and those with disabilities who signed up late.

As one Knight Ridder report put it at the time:

The move follows a recent administration decision to allow the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.

“In other words, you can apply after May 15th without penalty. And that’s important for low-income seniors to understand,” President Bush told a group of older Americans in Sun City Center, Fla., on Tuesday.

There’s one key difference between Bush’s Medicare prescription-drug benefit and Obama’s health-care law: Democrats didn’t try to scuttle the Medicare law’s implementation (especially since some of them had voted for it), while the same isn’t exactly true of GOP actions regarding the health-care law.

But the 2006 story is a reminder that when it comes to the implementation of complex new laws, both Democratic and Republican administration have changed the rules to encourage enrollment.

Republicans who complain about delays in the Affordable Care Act under Obama had no problem with a comparable delay under George Bush, showing once again that their positions are motivated by opposition to Obama and not any higher principles.

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Medicare Benefits Under The Affordable Care Act

March 21, 2014 — Ron Chusid

With all the scare stories being sent out in right wing emails, it is worth posting this press released emailed today from CMS regarding how Medicare patients have benefited from the Affordable Care Act.

On the 4th anniversary of the signing of the Affordable Care Act into law, new information released today by the Department of Health and Human Services (HHS) shows that millions of seniors and people with disabilities with Medicare continue to enjoy lower costs on prescription drugs and improved benefits in 2013 thanks to the health care law.

Since enactment of the Affordable Care Act, 7.9 million seniors and people with disabilities have saved $9.9 billion on prescription drugs, or an average of $1,265 per beneficiary. In 2013 alone, 4.3 million seniors and people with disabilities saved $3.9 billion, or an average of $911 per beneficiary. These figures are higher than in 2012, when 3.5 million beneficiaries saved $2.5 billion, for an average of $706 per beneficiary.

Use of preventive services has also expanded among people with Medicare.  In 2013, an estimated 37.2 million people with Medicare took advantage of at least one preventive service with no cost sharing, including an estimated 26.5 million people with traditional Medicare, and more than 4 million who took advantage of the Annual Wellness Visit.  This exceeds the comparable figure from 2012, when an estimated 34.1 million people with Medicare, including 26.1 million with traditional Medicare, received one or more preventive benefits with no out of pocket costs.

“Thanks to the Affordable Care Act, we saw a stronger Medicare program in 2013,” said HHS Secretary Kathleen Sebelius. “Seniors are saving billions of dollars on their needed medications and continuing to enjoy benefits that will lead to healthier lives and lower costs in the long run.”

Closing the prescription drug “donut hole”

The Affordable Care Act makes Medicare prescription drug coverage more affordable by gradually closing the gap in coverage where beneficiaries had to pay the full cost of their prescriptions out of pocket, before catastrophic coverage for prescriptions took effect. This gap is known as the donut hole.

Thanks to the health care law, in 2010, anyone with a Medicare prescription drug plan who reached the prescription drug donut hole got a $250 rebate. In 2011, beneficiaries in the donut hole began receiving discounts on covered brand-name drugs and savings on generic drugs.

People with Medicare Part D who fall into the donut hole this year will receive discounts and savings of about 53 percent on the cost of brand name drugs and about 28 percent on the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed.

For state-by-state information on discounts in the donut hole, please visit: http://downloads.cms.gov/files/Donut-Hole-by-State-2013.pdf

For more information about Medicare prescription drug benefits, please visit:

http://www.medicare.gov/part-d/.

 Medicare Preventive Services

By making certain preventive services available with no cost-sharing, the Affordable Care Act is helping Americans take charge of their own health. By removing barriers to prevention, Americans and health care professionals can better prevent illness, detect problems early when treatment works best, and monitor health conditions.

For Medicare, the Affordable Care Act eliminated coinsurance and the Part B deductible for recommended preventive services, including many cancer screenings and other important benefits. For example, before the Affordable Care Act, a person with Medicare could pay as much as $160 in cost-sharing for a colorectal cancer screening. Today, this important screening and many others are covered at no cost to beneficiaries (with no deductible or co-pay). This will help many seniors to stay healthy.

For state-by-state information on utilization of preventive services at no cost sharing to beneficiaries in Medicare, please visit: http://downloads.cms.gov/files/Beneficiaries-Utilizing-Free-Preventive-Services-by-State-YTD2013.pdf

While these are the major benefits, there are additional potential benefits such as one I reported regarding Hospice patients yesterday.

 

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Three Types Of Obamacare Winners You Might Not Have Thought Of

March 20, 2014 — Ron Chusid

Despite all the fake horror stories being spread by conservatives, the vast majority of people in this country are benefiting significantly under the Affordable Care Act. Some benefit due to being able to obtain health insurance when they were not able to in the past due to pre-existing medical conditions and/or cost. Many also benefit due to receiving heath care coverage which cannot be cancelled, cannot have rates increased due to medical problems, and which do not have limitations in coverage which previous polices had. There are three winners which you might not have thought of before–Medicare patients with terminal illnesses, people who bought insurance without subsidies but still came out ahead, and Republicans who benefit from Obamacare.

In contrast to false claims of Medicare cuts, the Affordable Care Act increases benefits for Medicare beneficiaries such as phasing out the donut hole on prescription drugs and covering preventative services which were not previously covered. There are a number of additional aspects of the Affordable Care Act which have not received much attention. One is a demonstration project to consider allowing Hospice patients to receive both curative and palliative care.

Hospice offers extremely valuable services for dying patients, but currently Medicare does not cover Hospice services if a patient continues to receive treatments aimed at attempting cure of a disease. Quite often I have had patients who are terminally ill who could benefit from Hospice services to increase comfort but do not qualify because they want to continue medical treatment. Under this demonstration project, patients will have the option, for example, to both receive chemotherapy and to receive Hospice services aimed at enabling them to die more comfortably if the treatment is not a success.

This is just one of many areas where the Affordable Care Act provides more choice than patients had previously, and I hope that Medicare does make this change for all Medicare patients.

Andrew Sprung discussed another group of winners who are “satisfied unsubsidized.” We have surpassed five million people receiving insurance on the exchanges and it now appears likely that the number will surpass six million due to the surge in people signing up this month. An estimated six million additional are signing up directly through insurance companies, which can be done if not applying for subsidies. Sprung began:

About half of the 12 million Americans buying health insurance on the individual market are subsidy-ineligible, according to the Urban Institute. Are they all fuming and lining up to appear in anti-Obamacare commercials?

Chances are not. As veterans of the individual market, many are accustomed to its shocks and uncertainties. About a quarter of them received cancellation notices last fall, and others face substantial premium hikes. Some will be forced to pay more than in the past, in some cases in part because they are covered for services they don’t want, like childbirth or mental healthcare. But many are finding their options much better and their status less precarious than in the pre-ACA market.

I spoke recently to several people whose family income disqualifies them for subsidies and who bought insurance on the individual market for 2014. All had family members with preexisting conditions, which means they benefited from the ACA’s prohibition on basing price or eligibility on medical history. All had been paying above-market rates or faced limited choices because of a family member’s medical history…

This special category is huge, though. The percentage of Americans with preexisting conditions is anywhere from 19 to 50 percent, according to an HHS report overviewing various studies. And that’s just individuals—in households with more than one person, the chances that someone will have a medical condition that jacked up the price of insurance in the pre-ACA world multiplies.

Sprung gave some specific examples who are far more representative of the changes under the Affordable Care Act than those shown on television by conservative groups with fake horror stories. The satisfied unsubsidized also includes an additional group, people such as myself who did not have to pay higher rates in the past due to medical problems and are paying more now, but still benefit because of now having a policy which cannot be cancelled due to changes in medical condition. Sprung acknowledged us in concluding:

It’s worth keeping in mind, though, that those untroubled by preexisting conditions or by the need to find insurance in the individual market can lose those advantages at any moment—as well as their financial status. Uncertainty is the universal preexisting condition—and thanks to the ACA, such changes should no longer threaten financial ruin or lack of access to medical care.

When listening to the fake horror stories being spread by Republicans, keep in mind that before the Affordable Care Act medical expenses were a major cause of bankruptcies in this country, and three fourths who declared bankruptcy did have medical coverage at the time they became sick or injured.

Last month I looked at Republicans who have benefited from Obamacare and learned to love it. Scott Brown learned about this last Saturday:

Brown found that out on Saturday, when he stopped by the home of Herb Richardson, a Republican state representative. Sitting in Richardson’s home, Brown called Obamacare a “monstrosity” that members of Congress didn’t even bother to read before they passed. At that point, according to the Coos County Democrat, Richardson chimed in to explain that the law had been a “financial lifesaver” for him and his wife. From the the piece (page 14):

Richardson was injured on the job and was forced to live on his workers’ comp payments for an extended period of time, which ultimately cost the couple their house on Williams Street. The couple had to pay $1,100 a month if they wanted to maintain their health insurance coverage under the federal COBRA law.

Richardson said he only received some $2,000 a month in workers’ comp. payments, however, leaving little for them to live on.

“Thank God for Obamacare!” his wife exclaimed.

Now, thanks to the subsidy for which they qualify, the Richardsons only pay $136 a month for health insurance that covers them both.

With so many people benefiting from Obamacare, many Democrats are making a huge mistake by failing to run for reelection based upon this. As I wrote earlier in the week, Democrats need to go on the offensive on health care reform. Explaining these benefits is the only way to counter negative ads and negative polling results based upon misinformation.

Cross posted at The Moderate Voice

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Democrats Need To Go On The Offensive On Health Care

March 15, 2014 — Ron Chusid

Yesterday I posted in frustration as to how the Democrats managed to allow the Republicans to both sabotage an effort to repeal the Sustainable Growth Formula and use the Affordable Care Act once again as a political pawn. I found that Greg Sargent had interviewed Paul Begala, who had said something similar to my conclusion about Democrats fighting for the Affordable Care Act and added that to the post. In retrospect this message is far too important to leave at the end of the post, and it is well worth repeating (with additional information and commentary).

As I concluded yesterday, despite all of the benefits of the Affordable Care Act, Democrats remain on the defensive politically. The Affordable Care Act is turning into a major success, providing millions with health insurance coverage and ending the ability of insurance companies to abuse the system by finding ways to sell policies and then avoid paying out. No longer are people denied coverage, or have their coverage taken away, due to becoming sick or losing their jobs. In addition,  Obamacare frees people from the “insurance trap” which forced people who otherwise do not need to work to continue working for insurance coverage, along with other overall benefits to the economy. The Congressional Budget Office Report, frequently distorted by Republicans, showed that the Affordable Care Act will reduce unemployment, help decrease the deficit, and allow more people to leave large corporations to start small businesses, further stimulating the economy.

While granted the Republicans have a strong propaganda machine delivering their misinformation, and a media willing to repeat Republican lies as if they are equally valid as statements of fact, Democrats should be able to do a better job of gaining support when the facts are so firmly on their side. The same is true of health care issues in general, as Republicans have managed to put Democrats on the defensive over bogus claims of Medicare cuts while the Republicans seek to turn Medicare into a voucher system which would destroy the program as we know it.

Democrats need to follow the advice of Paul Begala:  Stop being so damn defensive about the law and show people it’s worth fighting for, already.

Begala thinks Dems can address it with a simple flipping of the script. Dems now debating how to talk about Obamacare seem to be leading defensively with their willingness to fix the law. Instead, Begala says, they should lead with an attack on Republicans that is framed as a medical rights issue – before pivoting to fixing the law — and then wrap it all up in a larger message about how Republicans have no answers to people’s health care or economic problems.

“We should open by saying, ‘my opponent wants to repeal your rights,’” Begala said. “He wants to take away your right to be protected against discrimination because you have a preexisting condition. He wants to take away your right to be protected against discrimination for being older or being a woman. He wants to take away the closing of the Medicare donut hole for seniors.”

“That’s point one,” he continued. “Then you say, ‘look, I’m open to working with everybody to fix the law. But I’ll never let them go back to the days where insurance companies could send letters saying your coverage has been canceled because you have a preexisting condition.’”

And then from there to an economic message: “Repeal is their whole agenda. They have no ideas for giving you a pay raise. No ideas for raising the minimum wage. No ideas about how to create jobs. No ideas about how to get your kid into pre-K. Their entire agenda as a party is repeal — to take away rights that you have won. I’m not going to let them do that.”

Elections have increasingly become about getting one’s base out to vote as opposed to converting others. Many on the far right are angry about Obamacare based upon misinformation they have heard, and this will get them out to vote. Democrats need to mobilize their voters by better informing them of what they stand to lose if the Republicans win. If Republicans can run ads with horror stories which aren’t even true, why aren’t Democrats running ads with actual horror stories of people losing their coverage and going into bankruptcy under the old system? Most people going into bankruptcy from medical expenses were insured at the time they first got sick or injured. Is this the system we want to return to?

Sure the new web site began with serious glitches, but buying insurance on the individual market was never a picnic. Policies were expensive, frequently had high deductibles, and often required seeing a limited panel of doctors. These complaints about insurance are nothing new. What has changed is that previously having a pre-existing medical condition might lead to a policy not being sold, or greatly increase the cost. Policies would have limitations, frequently failing to pay enough to cover serious illnesses such as caps on total coverage. Some policies would only cover inpatient or outpatient services, fail to cover prescriptions, or not cover preventative services.

Democrats should never have been placed on the defensive about bogus Medicare cuts when they are the party which is trying to protect the system, and when the Affordable Care Act benefits seniors by phasing out the donut hole and adding preventative services. Point out that the only cuts under Obamacare are to corporate welfare to Medicare Advantage plans, not cuts in benefits, and that the proposed Republican budgets included the very same cuts. Remind them of what the Republican plan for Medicare really is:

Democrats need to remind people of the benefits they are receiving under Obamacare, and what they risk by Republican calls for repeal. Use the over fifty votes by Republicans to repeal or hinder Obamacare to both mock them and  make voters angry about the Republicans wish to do. Ideally this will both motivate more Democratic voters to turn out to vote this November and  maybe even change the minds of some voters.

Cross posted at The Moderate Voice

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Republican House Plays Politics, Screwing Both Doctors And Medicare Patients

March 14, 2014 — Ron Chusid

After several years a deal had been reached to permanently repeal the flawed Sustainable Growth Formula but the House Republicans chose to play politics with it. The House Republicans showed a disregard for both physicians and  Medicare beneficiaries. They attached the fix to a five year delay on the individual mandate, knowing that this would be dead in the Senate.

The Sustainable Growth Formula was initially devised to give doctors increased Medicare reimbursement if medical costs go down and decrease reimbursement if costs rise. The formula was quickly found to be flawed. Individual physicians cannot control the overall trajectory of Medicare expenses regardless of the financial rewards or penalties. The formula failed to take into account overall increases in costs we have experienced over the past decade as a result of an aging population and new medical technology. As a result, the formula would reduce Medicare payments to physicians to a level below what doctors could afford to see Medicare patients for. Reimbursement from Tricare, which covers military families, is also tied to Medicare reimbursement. Congress has realized that the cuts were not tolerable and has repeatedly voted for a “doc fix” to circumvent the automatic cuts called for under the Sustainable Growth Formula.

The persistence of this problem over the past decade has eroded confidence in the federal government and the Medicare program, leading some physicians to stop accepting Medicare patients. Even Congress finally realized that something had to be done and an agreement was reached in principle between the federal government and physician organizations for a new payment structure to replace the Sustainable Growth Formula. The House had the opportunity to pass this as a clean bill today, but instead played politics by attaching it to a delay to the individual mandate.

It is getting difficult to keep count but I believe this is now the fifty-first vote to either repeal or greatly interfere with the implementation of the Affordable Care Act.

The individual mandate is a necessary component of the Affordable Care Act as currently structured. If insurance companies are required to provide coverage to everyone applying, they need protection against the problem of people not buying insurance until they become ill. In order for the system to function, insurance companies need the premiums from healthy people coming into the system every year to cover the expenses of those who are ill.

There are potentially other ways to solve the free rider problem but it is not possible to simply eliminate the individual mandate without implementing alternative measures to provide strong incentives for people to purchase insurance coverage while still healthy. While I had preferred using other measures instead of the mandate when health care reform was being considered, unlike the House Republicans I recognize when an issue has been settled and see no sense in continuing to fight the same battle. The Affordable Care Act is established law which has been upheld by the Supreme Court. Congress should be concentrating on making some necessary fixes (as any law of this complexity would require) to smooth its implementation as opposed to trying to sabotage it.

Twelve Democrats voted with the Republicans out of political fears. The Affordable Care Act is turning into a major success, providing millions with health insurance coverage and ending the ability of insurance companies to abuse the system by finding ways to sell policies and then avoid paying out. In addition,  Obamacare frees people from the “insurance trap” which forced people who otherwise do not need to work to continue working for insurance coverage, along with other overall benefits to the economy. The Congressional Budget Office Report, frequently distorted by Republicans, showed that the Affordable Care Act will reduce unemployment, help decrease the deficit, and allow more people to leave large corporations to start small businesses, further stimulating the economy.

Despite all of these benefits, Democrats remain on the defensive politically. While granted the Republicans have a strong propaganda machine delivering their misinformation, and a media willing to repeat Republican lies as if they are equally valid as statements of fact, Democrats should be able to do a better job of gaining support when the facts are so firmly on their side. The same is true of health care issues in general, as Republicans have managed to put Democrats on the defensive over bogus claims of Medicare cuts while the Republicans seek to turn Medicare into a voucher system which would destroy the program as we know it.

Democrats need to follow the advice of Paul Begala:  Stop being so damn defensive about the law and show people it’s worth fighting for, already.

Begala thinks Dems can address it with a simple flipping of the script. Dems now debating how to talk about Obamacare seem to be leading defensively with their willingness to fix the law. Instead, Begala says, they should lead with an attack on Republicans that is framed as a medical rights issue – before pivoting to fixing the law — and then wrap it all up in a larger message about how Republicans have no answers to people’s health care or economic problems.

“We should open by saying, ‘my opponent wants to repeal your rights,’” Begala said. “He wants to take away your right to be protected against discrimination because you have a preexisting condition. He wants to take away your right to be protected against discrimination for being older or being a woman. He wants to take away the closing of the Medicare donut hole for seniors.”

“That’s point one,” he continued. “Then you say, ‘look, I’m open to working with everybody to fix the law. But I’ll never let them go back to the days where insurance companies could send letters saying your coverage has been canceled because you have a preexisting condition.’”

And then from there to an economic message: “Repeal is their whole agenda. They have no ideas for giving you a pay raise. No ideas for raising the minimum wage. No ideas about how to create jobs. No ideas about how to get your kid into pre-K. Their entire agenda as a party is repeal — to take away rights that you have won. I’m not going to let them do that.”

All Democrats should have also stood up for both physicians and Medicare patients today and demanded a clean vote on the repeal of the Sustainable Growth Formula as opposed to tying it to yet another attempt to thwart Obamacare. If Democrats did something as silly as vote over fifty times to repeal the same thing while otherwise failing to legislate, imagine how the right wing noise machine would be mocking them.

Cross Posted at The Moderate Voice

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Predictions As To The Demise Of The Health Insurance Industry

March 4, 2014 — Ron Chusid

Ezekiel-Emanuel

I’ve been seeing a prediction from Ezekiel Emanual recently that insurance companies will be replaced by Accountable Care Organizations and hospital systems in various medical publications recently and now that The New Republic has picked up on this it is starting to be discussed in the blogosphere. Accountable Care Organizations are basically organizations of hospitals and physicians which form a network to provide care to Medicare patients, receiving financial rewards if able to provide the care more economically.

Conservatives are reacting with their usual knee jerk panic and ignorance. The Gateway Pundit, for example, writes, “Despite all of the accumulating evidence that government will be unable to manage the health care system in America, Emanuel is sticking to his guns and hoping for demise of insurance companies.” This evaluation is wrong on so many levels. First of all, the organizations which Emanual foresees as replacing insurance companies are private organizations, not government. Secondly, historical information has shown that government programs such as Medicare have been more efficient than insurance companies in managing health care in America. Thirdly, assuming that the blogger is referring to the problems with the roll out of the Affordable Care Act, the problems have been due to the use of private insurance companies to continue to provide insurance coverage. One lesson from the events of the past few months has been to verify that a single payer system would be far more efficient and easier to establish, regardless of whether this is the desired model.

Conservative blogs have also been quick to claim high rates of happiness with insurance companies prior to Obamacare but that is misleading as most people did not realize how vulnerable they were to problems such as insurance policies being revoked when people became ill and to caps on insurance coverage. Regardless, these problems have been eliminated under the Affordable Care Act and therefore are no longer an issue with regards to whether it is desirable to see insurance companies be replaced.

It is certainly possible that Emanual’s prediction will take place but personally I wouldn’t be so quick to predict the demise of the health insurance industry. I’ve seen a lot of changes in health care during my career. Lots of fads come and go. The insurance companies always seem to remain around. I’m not as certain as today’s fads such as Medical Homes and Accountable Care Organizations. ACO’s have not been around long enough to say for certain what will become of them, but so far the outcomes have not been what would be expected of an idea successful enough to begin to replace health insurance companies.

There are two different ACO models which vary in terms of how much risk they accept. The more they are willing to risk being out money if costs remain high, the higher their potential rewards. Many ACO’s which started out in the high risk model converted to the lower risk model after they were initially formed. Neither model has shown much success yet. While I receive lots of bonuses from various plans which are adopting pay for performance models, I have yet to see a dime from the ACO I belong to, and neither are many other physicians. Again it is still early, but this does not make me see a strong future for ACO’s at this time.

Hospital systems offering their own insurance policies isn’t a new idea. They have been doing it for a while, and I am seeing an increase in this. Success has been variable. They still have to compete with insurance companies, which have many more years experience in developing insurance products and marketing them. I suspect that plans marketed directly by hospital systems to both business and to individuals (through the exchanges) will grow over the next couple of years but I’m skeptical as to whether they will replace insurance companies. I also wouldn’t be surprised to see insurance companies profit from this trend, offering their services to assist hospital systems and ACO’s which desire to put out a plan under their name.

Again, maybe Emanual is right. If I had to bet on one or the other, my bet is that insurance companies will be around longer than Accountable Care Organizations.

Cross posted at The Moderate Voice

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The Battle For Control Of Congress 2014

February 22, 2014 — Ron Chusid

While the media is increasingly talking about the 2016 presidential election, we have a major election coming up for control of Congress later this year. At present it appears that it is unlikely for the Democrats to take control of the House, and they are now fighting to retain control of the Senate. Predictions that the Republicans will hold the House and possibly take the Senate are based upon historical trends and which Senate seats are up for reelection this year. Of course it is possible to see a break from past trends.

Among the trends causing people to predict this to be a good year for Republicans: minorities and young voters don’t vote as often in off-year elections, a president’s party generally does poorly in the sixth year of the president’s term, a president’s party does poorly when the president has low approval ratings, and a president’s party does poorly when the economy is having difficulties.

On top of this, the Democrats are defending Senate seats in several red states this year, giving the Republicans a chance to pick up some seats. Fortunately the situation is reversed in 2016 with more blue-state Republicans up for reelection. Based upon these fundamentals in a presidential election which is likely to already be more favorable to the party, a Democrat winning the White House should also see a pick up of several Senate seats.

The Republican Party has been working in other ways to pick up votes. They have made voter suppression a major part of their electoral strategy, along with continuing the Southern Strategy based upon racism and now xenophobia. On the other hand, their history of racism may backfire with the increase in minority voters, possibly turning some southern states blue in the near future. We saw this first in Virginia and to a lesser degree in North Carolina. In the future this could extend to Georgia, Texas, and additional states.

Republicans have an advantage in keeping control of the House as so many House districts are gerrymandered to protect the incumbent. In addition, Democrats tend to be more concentrated in urban areas, meaning that even if more people vote for Democrats than Republicans, the Republicans will win more seats by small margins while Democrats will win a smaller number with bigger majorities. More people voted for Democrats than Republicans in Congressional races in 2012 but the Republicans retained control of the House. It would probably take at least  a seven percent margin of victory for Democrats to take control of the House. Republican representation in the Senate is also exaggerated compared to their level of support due to lesser populated Republican states having the same number of Senators as more populated Democratic states.

There are some things which could throw off the fundamentals this year, but we cannot count on voters suddenly no longer being fooled by the GOP line. At present the Republicans receive far too many votes from low-information white voters. Over time the number of younger voters who receive their fake news from Jon Stewart will overtake the older voters who receive their fake news from Fox.

While Obama’s approval rating is low, Congress has an even lower approval rating. Typically in such situations people like their own Congressman even if they disapprove of Congress. This year polls show that many people also think their own Congressman should be thrown out. Based upon this, I wouldn’t be surprised if more incumbents than usual get upset, but that might not necessarily help the Democrats over Republicans. In addition, more people see the Republicans as being more responsible for gridlock, in contrast to a common false media narrative of treating each party as being equally responsible. Maybe they will surprise the pundits and throw the Republicans out.

Another factor influencing whether predictions based upon the fundamentals must occur is that any competent Democratic strategist is aware of every point here, and the party is doing far more than they did in 2010 to try to change this. They are working to increase turnout among Democratic voters this year. They  have a technological edge both in regards to get out the vote efforts and fund raising. It even appears that the same problems which are placing Republicans at a disadvantage with younger voters is also impacting their ability to recruit young tech savvy political operatives. Besides using their technological advantages over Republicans in getting out the vote efforts, they can  motivate Democratic voters with fear of the consequences of the Republicans taking control of the Senate. Tea Party extremism has led to an end to talk of a grand bargain. Democratic compromises on entitlement programs might have discouraged some voters on the left from turning out for Democrats.

I think Democrats will do better if they can successfully explain the advantages of their policies as opposed to Republican policies. Democratic economic policies turned around the economic collapse caused by Republican economic policies, even if the Republicans have managed to slow recovery with their obstructionist moves, decided upon from the start of Obama’s term. The deficit rolled up by George Bush has dropped considerably since Obama took office. The CBO  projects a deficit of $514 billion in 2014, representing three percent of the Gross Domestic Product. This is near the average level for the past forty years, and a vast improvement from 2009 when the deficit was at 10.1 percent of GDP.

Despite early IT problems, which the Obama administration does deserve criticism for, the Affordable Care Act has turned into a tremendous success on a policy level, both in terms of health care reform and its benefits for the economy. Both the Medicare Advantage plans under George Bush and the original Medicare program had early implementation problems which took a couple of years to solve. Of course Republicans will continue to spread unsubstantiated scare stories and it is possible Obama might never received the credit he deserves. Health care premiums will be remain high on the individual market as they were high before Obamacare. Insurance companies will continue to use restricted panels of physicians and hospitals as they did before Obamacare, leaving room for Republicans to blame the Affordable Care Act for problems unrelated to the law.

Other factors could come into play. The Tea Party might oust electable Republicans and replace them with extremist candidates which the Democrats can more easily beat. While doubtful, the Tea Party might force Congressional Republicans into a situation analogous to the government shut-down before the election which reduces public support for Republicans. While it is doubtful it will really alter that many votes, even the changes in the late night comedians could help the Democrats over the Republicans.

The easy prediction is now that the Republicans will keep control of the House and control of the Senate is up for grabs. Depending upon whether the factors discussed above alter the usual fundamentals, we still might wind up seeing the pundits talking about all the reasons they knew we would have a different outcome after the results are known.

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Posted in Barack Obama, Congress, Democrats, Economy, George Bush, Health Care, Politics, Polls, Republicans, Television. Tags: , , , , , , , , , , , , , , . 1 Comment »

Cuts To Medicare Advantage Plans Half Of Amount Expected–Watch For Hypocritical Republican Reaction

February 21, 2014 — Ron Chusid

Paul-Ryan-End-Medicare

One of the ways in which the Affordable Care Act is funded is by reducing subsidies to Medicare Advantage plans which receive more money to care for Medicare beneficiaries than it costs to care for the same patients in the government Medicare program. Republicans have been using this to raise bogus claims of cuts to Medicare patients despite the fact that Republicans have also included similar cuts to Medicare Advantage plans in their budget proposals.

Insurance companies have been predicting cuts of approximately 7 percent. CMS released their calculations today regarding proposed cuts for 2015 (pdf here). The current proposal is for a 3.55% cut in payments to Medicare Advantage plans, about one-half of what they have been projecting.

The Republican Party was already prepared today to use this news to attack the Democrats. They do not explain why it is necessary for private companies, which any Republican believes should be more efficient than a government program, requires more money to care for patients than the government Medicare plan does. Nor do they account for the fact that most Republicans voted for the Ryan budget three years in a row which includes the same cuts to Medicare Advantage plans. Or what about the same Ryan plan which would turn Medicare into a voucher system?

Also don’t expect the Republicans to point out that, while the Affordable Care Act will cut profits to Medicare Advantage plans, it also increases benefits to Medicare patients including phasing out the donut hole for prescription drugs and covering preventative services which were previously not covered.

Cross posted at The Moderate Voice

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Posted in Breaking News, Health Care, Paul Ryan, Republicans. Tags: , , , , . 6 Comments »

More Republican Misinformation On Medicare To Scare Seniors

February 15, 2014 — Ron Chusid

There they go again. Republicans are again trying to scare seniors by spreading misinformation about Medicare. They have been making the same false claims for the past few years. From Politico:

Republican Rep. Tom Rooney of Florida took aim today at Obamacare’s impact on older Americans, saying that seniors across the country are paying “more money for fewer choices, less access and far less peace of mind.”

In the GOP’s weekly address, Rooney castigated President Barack Obama’s very public pledge that Americans of all ages would be able to keep their doctors under the health law. Since the fall, the president has had to backtrack on that statement, acknowledging that the law was forcing changes in insurance plans that meant some people were losing their physicians.

“Here’s the reality,” Rooney said as he blamed Obamacare for “deep cuts” made to the popular Medicare Advantage program that serves low-income seniors, among others. “Constituents tell me they can no longer see the primary care physicians they have been going to for 10 and every 20 years,” he said. “One woman told me that four of her specialists have already been dropped from her plan.”

The truth is that Obamacare is helping, not hurting, seniors.

Medicare Advantage Plans were set up by George Bush as a way to reward insurance companies for all their contributions to the Republican Party. The initial law establishing the plans provided tremendous subsidies for insurance companies. The idea as initially argued by conservatives was that private insurance companies could provide health care more economically than the big bloated government Medicare program. Instead the government pays private insurance companies substantially more to treat Medicare patients than it costs to care for the same patients in the government plan. Any true Republican should think that private insurance companies should not need this corporate welfare.

The Affordable Care Act is paid for partially by reducing this corporate welfare, saving the tax payers about $136 billion over ten years. Private insurance companies will still receive plenty of money to care for seniors. Why should they need more money than it costs to treat them in the government program?

Medicare Advantage plans have been using limited panels for several years to try to save money. The Affordable Care Act does not change that, except now the insurance plans blame Obamacare for what they would do even if Obamacare did not exist.

The Affordable Care Act has helped seniors in many ways. It makes Medicare more sound financially. The donut holes in the drug benefit are being phased out, saving seniors money on their prescriptions. Preventative studies which previously were not covered are now covered by Medicare, saving seniors yet more money.

It is particularly absurd to expect seniors to turn to the Republicans when they have already voted for a plan which would end Medicare as we know it and force those on Medicare in the future to pay more out of their own pockets for health care coverage.

Cross posted at The Moderate Voice

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Posted in George Bush, Health Care, Republicans. Tags: , , , , . No Comments »
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