JustCare

Tag: Affordable Care

  • A federal “public option” won’t deliver health security

    A federal “public option” won’t deliver health security

    Merrill Goozner writes that Congress is considering ways to guarantee everyone in the US affordable health care. Senators Tim Kaine and Michael Bennet are proposing to put a “public option” on the state health insurance exchanges, and Representatives Rosa DeLauro and Jan Schakowsky are also proposing to make a “public option” available. For reasons I explain below, their public option proposals will not deliver health security. That said, it is not at all clear that the House or Senate will vote on these proposals any time soon.

    Neither the House nor the Senate bills should go forward as drafted. While they claim to offer a public health insurance option, neither do. Rather, they offer private health insurance options, much like the for-profit insurance options in the state health insurance exchanges today. For this reason and others, they have no chance of reining in costs or guaranteeing Americans the good affordable coverage we need.

    Indeed, calling these options “public” is Orwellian. The public option is supposed to give people the choice of health insurance that is not run by for-profit insurers, that is not private health insurance. The public option is supposed to eliminate the for-profit middleman from the mix.

    That said, even a true public option modeled on traditional Medicare is not likely to deliver health security.  So long as for-profit insurers can compete with this public health insurance option, they will find ways to undermine it, as the Medicare Advantage plans have with traditional Medicare.

    The best approach, working from what we have, is for the government to change the way it pays private insurers in Medicare and Medicaid and then, over time, to open Medicare up to everyone else. The government needs to set the terms of coverage and pay for that coverage and for the insurers to process the claims. We don’t have to do away with private insurers, we have to do away with their control of our health care system, as other wealthy countries have succeeded in doing.

    We need to change the way we pay health insurers so that they don’t have an incentive to delay and deny people care. Handing them money upfront to pay for care they might or might not cover is a recipe for incentivizing them to withhold care.

    We also need to regulate health care prices, so that they are rational and fair. Shifting to this new payment and coverage model would help Americans, bringing down the cost of care and dismantling the barriers to care for-profit insurers impose.

    Goozner suggests that there is some form of national regulation of for-profit insurers that could guarantee everyone in the US continuity of care and affordable care. Regulation of insurers cannot work in practice if insurers are allowed to call the shots. It never has in a way that delivers good affordable care, and there is no evidence either in the US or in any other country that it ever will. There is no way to oversee the insurers effectively.

    What could work, and what does work in other countries, is a health insurance system with private insurers in which the government calls the shots and the insurers’ role is in processing claims.

    Here’s more from Just Care:

  • 33 Senators call for Medicare-like option for all Americans

    33 Senators call for Medicare-like option for all Americans

    Last Thursday, 27 United States senators called for a Medicare-like option in the state health exchanges. Senators Bernie Sanders, Jeff Merkley, Patty Murray, Dick Durbin and Chuck Schumer, along with 22 other senators introduced a resolution that complements Secretary Hillary Clinton’s proposal for a “public option”–a government plan like Medicare–that would be available to every American. Since then, six more senators have signed onto the resolution.

    The senators want to give everyone in America the choice between commercial health insurance and government health insurance, the public health insurance option. A public option would not only give people more choice, but it would drive competition in the marketplace, bringing down health care costs.

    A public option would also guarantee people the continuity of care they value. Right now, people in the state health insurance exchanges and people with employer coverage cannot rely on their commercial health plan coverage from one year to the next. Insurers enter and leave markets as they please. Recently, Aetna announced it is pulling out of many health care markets, claiming that it doesn’t view them as profitable.

    During the debates over the Affordable Care Act, the public option was introduced and ultimately quashed for lack of support in the Senate. At that time, the Congressional Budget Office estimated that it could drive down health insurance premiums as much as seven percent and reduce the deficit $68 billions over six years. But, doctors and hospitals were generally opposed to it for fear that it would bring down their reimbursement rates.

    If you support the Senators’ resolution and want a public option, click here and sign on to a petition at WeWantaPublicOption.com. The resolution currently has support from a range of advocacy organizations, including the Progressive Change Campaign Committee(PCCC), Presente.org, UltraViolet, Working Families Party, MoveOn.org, Democracy for America, Daily Kos, and the AFL-CIO.

    Here’s more from Just Care:

  • ER visits for dental care on the rise, but some states are finding ways to address the problem

    ER visits for dental care on the rise, but some states are finding ways to address the problem

    Data from the American Dental Association reveals that emergency room visits for dental care more than doubled in the 12 years between 2000 and 2012, according to USA Today. Largely because neither Medicare nor standard private health insurance covers dental care, some 2.2 million people ended up in the emergency room because of tooth pain in 2012. But, some states have developed innovative solutions to reduce emergency room visits for dental care.

    A report by the American Dental Association shows that in the majority of cases that people visit the emergency room for dental care, they should be visiting the dentist instead. Nearly 24 percent of emergency room visits for dental care are non-urgent and another 54.8 percent are semi-urgent.

    People often avoid going to the dentist because they lack insurance coverage and don’t want to pay out of pocket for dental care, which can be very expensive. Most insurance does not cover dental care. Medicare never covers dental care. And the Affordable Care Act only covers dental care for children, not for adults. Medicaid pays for some dental services, but what Medicaid covers depends on what state you live in.

    And, most states do not allow dental therapists to provide dental care, even though the data suggests that they can provide several services safely and well and at lower costs. The American Dental Association has blocked dental therapists from providing dental services in all states but Alaska.

    Maine, Michigan and Virginia have developed innovative solutions to reduce the number of emergency room visits for dental care by as much as 72 percent. One Michigan county created a volunteer dental force for patients with low incomes. In Maine, several hospitals are piloting a program that gives patients a painkiller when they present at the emergency room and then refers them to a clinic for treatment. A Virginia pilot program developed an in-hospital urgent dental care clinic to treat patients and reduce costs.

    Emergency rooms must treat anyone who visits, regardless of whether they have insurance or are able to pay for their care. But, they generally only treat the dental pain and do not deliver dental services. As a result, they often end up having repeat visits from people with dental pain. And, by some estimates, the cost for emergency room services is three times more than the cost of a dental visit. For sure, it’s important to choose your emergency room carefully ahead of time, if you have a choice of them, so you get the best care and keep your costs down.

    Here are some ways to get free and low-cost dental care.  Or, contact your local area agency on aging to find out about resources in your community.

  • The Affordable Care Act: What happens between now and the November 2016 elections?

    The Affordable Care Act: What happens between now and the November 2016 elections?

    The Supreme Court’s decision last month affirming, yet again, the legality and structure of Obamacare (the Affordable Care Act) could signal an end to the 5-year slog of bitter political divisiveness over the law. Or not.

    As I see it, one of two divergent scenarios could play out between now and November, 2016:

    (1) The number of people benefiting from the law grows briskly, premium increases remain modest, and Americans finally accept the law as permanent and worth it; that leads Republicans (and their presidential candidates) who have vigorously opposed the law to back off, realizing they’re fighting a losing battle that could cost them control of Congress and their bid for the White House in 2016.

    (2) The number of people benefiting from the law plateaus, premiums in the state-based exchanges increase 15% a year in 2015 and 2016, deductibles and co-pays increase, concern about restricted provider networks grows, and the public remains deeply divided over the wisdom and impact of the law. Skating off that and sensing blood in the water, Republicans double-down on their opposition to the law and make the election a referendum on it.

    These scenarios are oversimplified, of course.   Other events and factors could come into play, such as a foreign crisis that diverts attention from health care.

    But there’s little doubt we are now (sorry for the tired metaphor) at a crossroads.   The Supreme Court’s ruling pretty much means that the only route to dismembering the law is political.

    As a reminder, the Republican-controlled House of Representatives has voted along party lines over 50 times to repeal parts or all of the law.   In the Senate, also controlled by Republicans since the 2014 elections, efforts by members of that party to repeal the law have been bogged down by rules that require 60 votes to get major legislation to a full Senate vote. The Republicans hold 54 seats in the Senate, to the Democrats’ 44, plus 2 independents. Obama has also pledged to veto any bill that undermines the law.

    So the 2016 elections could well decide Obamacare’s fate. If Republicans win the White House and maintain their majorities in Congress, the only way Democrats could block repeal of the law—assuming Republicans pursue that—is through the 60-vote rule in the Senate to break a legislative filibuster.   That assumes Republicans don’t top 60 seats in the Senate in the 2016 elections, a pretty safe bet.

    Your role in all this?   Polls by the Kaiser Family Foundation, (“KFF”), since 2011 show Americans have been persistently sharply divided on the merits of the law, and that opinion is strongly party-affiliated. That is, a large majority of Republicans oppose the law while a large majority of Democrats support it.   This has always signaled to me and many other observers that the bulk of opinion on the law as a whole is driven by a combination of party and ideological loyalty, with a generous dollop of sentiment about the role of government in our lives.

    Results from deeper-dive KFF surveys bear that out: a majority of Americans irrespective of political party affiliation support several major components of the ACA, such as requiring insurers to cover people with pre-existing medical conditions, without making them pay more.

    I might be whistling into the wind, tilting at a big windmill or pushing the proverbial Sisyphian bolder up a steep hill, but I believe this crossroads is a time for opponents of the law (and those on the fence, about 10-15% of the population) to take a step back from the partisan political divide we all say we hate and reassess the ACA on the merits of what it has done to date, its actual provisions, and the concrete arguments pro and con. There’s no dearth of intelligent and easy-to-understand information on the internet, from both sides.

    In short, make up your own mind and don’t be led by your political nose.   This is an issue that should transcend lock-step politics.

    If premiums and costs rise, there’ll likely be more than a few registered Democrats who’ll need to shore up their support of Obamacare, too.

    In very practical terms, take 2 to 3 hours some evening or weekend and learn how the law is actually constructed. Talk to trusted friends on the opposite side of the debate. Read behind the headlines and ignore the political rhetoric—from both sides. Be engaged.

    Every so often, big social changes are needed. Health reform was such a moment (well, it actually took 20 years). Keep in mind that Republicans agree that the old system was broken and unsustainable. The ACA is not a perfect law.   Indeed, the tragedy of the 5-year senseless political fight over the ACA is that it’s made sensible fixes over the last few years impossible.

    Be part of the solution to that, and refuse to perpetuate the problem.

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    To understand how repeal of the ACA would drive the deficit up and leave 19 million uninsured, click here.