Public Health Insurance

Public Health Insurance Option Key to Obama Healthcare Plan

If Congress passes Obama's plan and Americans are given the choice of a public health insurance option similar to Medicare, we could all save up to 30% on our health care premiums. That's a huge savings, and we'd still get high-quality coverage and be able to choose our doctors.

And even if you choose to keep your current insurance, you'd save anyway. HMOs and big insurance companies are the only game in town right now—so they overcharge us to boost profits and pay out CEO bonuses. If Obama's plan passes, they'd have to compete with it, and their prices would have to be more honest.

Lower premiums for us means lower profits for them, so insurance companies are putting extreme pressure on Congress to drop the public health insurance option. But Americans deserve to have this choice—and it's necessary to help rein in out-of-control health care costs.

Imagine how different things would be if we all had quality health care that costs up to 30% less than what we're paying now. Would you use the money toward college for a child? A safe retirement? Or maybe you'll finally be able to afford the treatment or medicines you need.

The simple truth is that having the choice of a public health insurance option would make all of our lives better. Here's why:

Health care costs are spiraling out of control. From 2000 to 2008, health insurance premiums increased five times faster than wages.

A public health insurance option would provide an affordable, quality alternative. Two new studies show that Americans could save 25% or more off of a traditional private plan. The New York Times says this would "keep the private plans honest."They'll have to lower rates and offer better value to compete.

Plus, a public health insurance option would be reliable coverage for all.

Private insurers are notorious for dumping people with little notice. A public option would allow consumers who've been dropped—or just don't like their current coverage—to switch to a steady public choice.

Thankfully, the public health insurance option is gaining steam in Congress. The 77-member Progressive Caucus recently endorsed the policy. And the chairmen of five critical congressional committees came out in support. Now we need to get the rest of Washington on board. Click below to

Health Insurance Bailout

Is There a Health Insurance Bailout in our Future?

Governments have short time horizons. Faced with a long-term problem such as the actuarial bankruptcy of Social Security, it almost always makes political sense to stall, to find some way of putting off the political costs of dealing with it. With luck, the problem may go away. If not, the costs will fall on some other politicians in the future. Now that Obama's health care plan has passed, he will be under pressure to produce results that look to most voters better than the past, or at least no worse. In the short run that should not be a problem, since most of the provisions of the plan are set well in the future. Most of the taxes to pay for it come into effect in 2013, the requirement that health insurance companies take anyone who applies, including those with pre-existing issues, in 2014, the tax on high end health plans in 2018. The fine for not having health insurance starts in 2014 at $95 or 1% of income, and reaches its full value in 2016. For the next few years, at least through the end of Obama's current term of office, the controversy over the plan will be mostly a war of words, without much evidence on its real consequences. Eventually that will change. If, when most of the provisions of the plan are in effect, it appears to be working very badly, if health insurance is more expensive than it used to be, if many younger workers find they are being required to spend a lot of money for insurance they don't want, there will be two political consequences. One is that the Democratic party, strongly identified with the changes, will suffer a decline in its reputation. The other is that whatever politicians are in office will look bad, since voters will blame current problems on those currently in charge. The obvious solution is to find ways of pushing the costs of the program into the future. Insurance companies take in money now in exchange for the promise of future payments. Under political pressure to charge less and promise more, they may adopt the policy followed by General Motors when it solved its labor problems by paying striking auto workers with the promise of future pensions: Make promises they cannot fulfill, in the belief that when the crunch comes the U.S. treasury will come to their rescue.

The Health Care Clock

The Health Care Clock, and Why Obama Has to Act Quickly

Universal health insurance won't happen unless Obama can light a fire under the Senate Finance Committee this week. Within the next two weeks, the Committee must report out a bill that contains a public option and a credible source of money (either limiting deductions of the wealthy to 28 percent or capping tax-free employer-provided health care, or some of both). Obama then has to get both the Senate and the House (which reports out a bill today) to approve their respective bills before August 7, when Congress heads home for recess. Why is timing so important? Because the health-care clock is ticking, and doesn't have many weeks left. Universal health care is so complicated -- touching on so much of the economy, stepping on the toes of so many vested interests -- that to allow the bills to languish past recess risks the entire goal. Speed is essential. Recall that after Bill Clinton was elected, universal health insurance looked inevitable; a year later, it was doomed. As Lyndon Johnson warned his staff after the 1964 landslide, "every day while I'm in office, I'm gonna lose votes." Republicans don't want any bill. Blue Dog Democrats are afraid of the costs of any bill. The AMA, private insurers, and pharmaceutical companies would be delighted if universal health care died. If bills aren't passed in the House and Senate before August 7th, the fights in both chambers over the public option and money will carry over into the Fall, where they'll become more intense and more prolonged. Obama won't have a bill on his desk before the end of the end of the year. That's a death sentence for health-care reform. The gravitational pull of the mid-term elections of 2010 will frighten off Blue Dogs and delight Republicans.

Encouraging Advancement for Nursing Home Care

Early in my career I was the Director of Planning at a multi-level care facility in Massachusetts that included a nursing home. While the NH provided excellent care, it was still an institution. I always have thought since then that there has to be a better way. This link describes a very promising concept in MA that provides the same level of care but in a more home-like setting:

http://www.stateline.org/live/details/story?contentId=527585

Key excerpt:

Klein’s nursing home lifestyle is also notable for what it isn’t. There's no long gray linoleum corridors with doors that open onto shared rooms with nothing but a curtain between the beds. No beeping monitors or carts full of soiled linens and no patients in wheelchairs parked in the hallways. Few rules govern when, what and where residents can eat.

The brand new facility is one of a new breed of small, homey nursing facilities cropping up around the country, thanks to state collaborations with the nursing home industry, federal regulators and advocates for the elderly and disabled. It looks like a place only wealthy families could afford, but about half of its residents get their bills paid by Medicaid, the federal-state health care program for the poor.

MS Insurance Commssioner's Take on the ACA

From the Commercial Appeal in Memphis, TN:

The top insurance official in Mississippi said Wednesday that the volume of changes under the federally mandated health care reform are "mind boggling" and partly come from "pure socialist-communist ideas."

"Some of the ideas are Republican. Some of the ideas are Democratic. Some of them are pure socialist-communist ideas," state Insurance Commissioner Mike Chaney told the Olive Branch Chamber of Commerce. "It is taking money from one class of people and giving it to another. It is a socialist system and it's not going to work."

Healh Insurers Role in the ACO

As I have noted in previous posts, Accountable Care Organizations or ACOs are being heavily promoted as a way to both increase the quality of care while at the same time lowering its costs. It is a given that ACOs will have to include at least one hospital and a group of physicians. But what about health insurers? Are they guaranteed a place at the table and if they are, what will it be?

How about facilitator? With all of the stakeholders engaged in one form or another with the health plan, the health plan has the potential to be the hub for the ACO should they adopt that role. In a comment on a blog I read recently, the author suggested that an ACO is just an “HMO on steroids”. If that is the case, the health plan is certainly at the center. Unlike the HMOs of the 1990s though, an effective ACO relies on the provider physicians to police and optimize their own work rather than the payors. In a recent article by Mr. Jamie Gooch in Managed Healthcare Executive, he believes the success of an ACO is dependent upon the partners that are engaged. He suggests starting small and working with strong partners that can advance the ‘better-care-at-lower-cost’ model. Using this crawl/walk/run scenario, partners can be selected, and the program can be clinically integrated to optimize the cooperation. Again, the health plan has the opportunity of adopting a leadership role and facilitating these relationships and subsequent outcomes to meet the overall goals of the ACO program.
Additionally, I have talked previously about the critical role of evidence-based medicine in the healthcare reform debate. If we have the information from which best practice can be established, documented and communicated, we all stand to benefit by delivering better healthcare to the patients with greater efficiency and at a lower cost. Again, the health plan can play a key role here. With their reach and access to aggregated clinical information, evidence-based data can be collected, analyzed and made available for the physician and associated clinical organizations to better administer care to the patient. Models that are continuously referenced include Geisinger[3], Mayo Clinic[4] and Intermountain Healthcare[5] – they have integrated care and have created very effective ACOs.
The health plan also stands to be at the center of the operation in that it can recruit and retain members. Gaining membership in commercial health plans is a sales function. Whether they sell to employers or to individual members, membership must be recruited and becomes part of the administrative overhead of the plan. Quasi-governmental plans like Tricare, Medicaid and others may still need to recruit membership. For many ACOs, the initial covered lives are likely to come from the employers within the ACO’s provider panel. For example, a 300 bed hospital with 400 physicians and post acute care facilities may have 5000-6000 employees. If you add dependents, a ready made 10,000 member population is available. This represents lives that likely come out of an existing health plan. This is more than enough to meet the minimum requirements of an ACO. Additional membership may be driven by the community affiliation and demonstrated outcomes.
it will be interesting to track what roles health plans play in the development of ACOs, particularly the major national carriers.

Good Article on Formation of CA Health Exchange

California is one of the first out of the gate in forming its health insurance exchange. This article is a good summary of a conference that talked about the lessons learned by CA officials:

http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2010/Nov/November-8-2010/Lessons-from-the-California-Exchange.aspx

Good summary paragraph:

So what does California's experience thus far suggest? Among the lessons from a recent forum on the subject: If possible, get outside advice to help with the highly technical process of creating an exchange; be careful how you pick its board; make it easy for the public to understand what the exchange is doing, and spur the kind of competition that is going to make premiums affordable.
On Sept. 30, California became the first state in the nation to pass a law creating an exchange under the health care overhaul law.

VA Anthem Leads the Way for Health Care Reform

The VP of PR at Anthem VA must be thrilled about this puff piece of an article:

The Anthem CEO said that his company is moving away from just being a payer of claims to one that helps its members manage their health. He also talked about the need to become more efficient. The end of the article also mentions the strength of the BC/BS brand which i s going to be a huge advantage for Blues Plans as the market shifts more and more to individual coverage in the coming years.

Update on MA's Cost Control Efforts

As I have noted many times, the health care scene acts as an excellent bell weather on how health care reform will play out throughout the country, This article from the Boston Globe provides the latest update (http://www.boston.com/news/health/articles/2010/11/05/us_watching_mass_fight_on_health_costs/?rss_id=Boston.com+--+Health+news )

Interesting excerpt:

Patrick is ready to move forward with a “global payment’’ plan that is supported in principle by most of the state’s health care companies, though they have yet to agree on the elements.

The plan, in broad form, would put hospitals and doctors on an annual budget for each patient’s care. Providers would be expected to assemble into partnerships — known as accountable care organizations — to coordinate care and distribute payments. It would replace the current “fee for service’’ system in which providers are paid negotiated fees for each visit and procedure.

Your Pharmacist: The Center of Your Medical Care

I saw Walgreens present this concept at an AHIP Conference two years ago:

Walgreens will "step up investments in services to help Americans manage chronic diseases," the drugstore chain's CEO announced, because "the company wants to capitalize on what he called the 'retailization' of the nation's health care system." The pharmacy giant "increasingly has been lobbying to give pharmacists a greater role in medical care such as providing immunizations in its stores as well as establishing retail health clinics staffed by nurse practitioners." Walgreens' health professionals could help "provide certain primary medical care service amid a national shortage of primary care doctors" and assist patients in managing chronic conditions like diabetes, hypertension, and high cholesterol, the company's CEO said.

Given the predicted stress on the primary care network once ACA kicks in beginning in 2014, this actually makes some sense. Of course I am sure the AMA would disagree.

CMS Must Launch Physician Comparison Site by 1/1/11

This is a great article on the issues that CMS faces in launching its website on physician comparison (http://www.healthleadersmedia.com/page-2/PHY-258341/CMS-Under-the-Gun-to-Launch-Physician-Compare-Site). It is not going to be easy. The biggest concern continues to be risk adjustment. According to an AMA official:

"But our concern is that individual doctor level data right now is not read for prime time, especially in complex situations. The attribution of who's really responsible for that care is not worked out."

Risk adjustment is still a big problem as well. "Some elective claim submission forms are limited in the number of co-morbid conditions they'll accept. Some take 4, 6, but the patient has 10."

This is really going to be interesting.

State Mandates: Do They Increase the Cost of Health Insurance?

This article examines what effect mandates have on health insurance costs in a particular state (http://www.aishealth.com/Bnow/hbd110410.html). One health insurance executive believes that mandates add 17% to the cost of coverage in Maryland. mandates vary from 13 in Idaho to 69 in Rhode Island. The most expensive mandate is fertility coverage. Coverage for autism has also increased nationwide.

Rhode Island Hospital Payment Innovation

The Providence Journal (http://www.projo.com/news/content/LIFESPAN_BLUE_CROSS_CONTRACT_10-29-10_KVKKJMB_v17.1ebf635.html) has an interesting article on payment agreement between BCBS of RI and hospitals in the state:

Rather than paying for each procedure or each day in the hospital, Blue Cross will provide a flat fee to cover all care for a given condition. That way, the hospital doesn’t make more money if it does more tests and procedures or keeps the patient longer.

Other insurers in the state will also be making similar arrangements.

Update on State Health Exchange Funding

In another bid to help states implement the new healthcare law, the Obama administration Friday unveiled a new competitive grant program that will give five states money to develop Internet-based insurance exchanges. ... Administration officials said they hope the winning states will come up with systems that could serve as models for the remaining states. The grants follow awards of $1 million to 48 states and the District of Columbia to help set up the online market places -- Minnesota and Alaska refused the money.

I can understand Alaska returning the money but what is up w/MN?