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eridani
eridani's Journal
eridani's Journal
March 26, 2012
Commentby Don McCanne of PNHP: The title of today's message, "Controlling costs through HHS rate reviews," is deliberately deceptive to make a point. Supposedly, the Affordable Care Act (ACA) was designed to help control spending in health care, and the insurance premium Rate Review process was a component of cost containment. In fact, not only does the process have no impact on health care spending, it doesn't even have any federal control over increases in health insurance premiums.
ACA regulations require that any plan with premium increases of 10 percentor more be reviewed. Although states may have some influence over rate increases, the federal government has no authority to do anything about the increases other than expose the insurers to public ridicule.
In the last six months, 20 rate increases reviewed by the federal government have been found to be unreasonable, primarily because they exceeded the 20 percent of the premium that they could use for
administrative services and profits. Many of these insurers in the individual market will find that their inefficiencies are so great that they will be unable to comply with this requirement, so they really don't
need ridicule to drive home this point.
In the meantime, insurers will be able to increase their premiums 9.9 percent each year with no questions asked, at least not by the federal government. Compound that rate over several years, and then where will we be?
Obviously this ACA measure to "control costs" will have very little impact, if any, on insurance premiums and absolutely no impact on total health care spending.
There is a much more efficient model of health care financing that actually would slow the increase in health care spending while ensuring health care for everyone. Instead of playing ACA games, we should move forward with an improved Medicare for everyone.
There is no federal control over increases in health insurance premiums
March 22, 2012
2012 Progress Report: Health Reform is Opening the Insurance Market and Protecting Consumers
http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html
The Affordable Care Act?s Rate Review policies bring an unprecedented level of scrutiny and transparency to health insurance rate increases. They ensure that, in every state, every proposed increase of 10% or more is evaluated by independent experts to assess whether they are based on reasonable assumptions and sound data.
Rate review is expected to help moderate premium increases and provide consumers with greater value for their premium dollar. Additionally, health insurance companies must provide easy to understand information to their customers about their reasons for significant rate increases, as well as publicly justify and post on their website any unreasonable rate increases.
The Affordable Care Act?s Rate Review program started for most individual and small group plans on September 1, 2011.
Through March 10, 2012, 186 increases affecting more than 1.3 million people have been posted on companyprofiles.healthcare.gov. Each provides an explanation from the insurer, including the rate increases determined to be unreasonable rate increases.
States are taking a strong lead in reviewing proposed rate increases. Of the 186 requested increases posted on HealthCare.gov as of March 10, 2012, two-thirds (125 filings) of these are being reviewed by rate review programs in the states. Only one-third (61 filings) is under review by HHS.
In the 61 instances to date where HHS is charged with conducting reviews, the Department has completed 28 determinations. HHS has determined that 20 of the 28 proposed rate increases are unreasonable. The most common reason for this determination is that the proposal would result in projected medical loss ratios (MLRs) below the 80% applicable threshold.
2012 Progress Report: Health Reform is Opening the Insurance Market and Protecting Consumers
http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html
The Affordable Care Act?s Rate Review policies bring an unprecedented level of scrutiny and transparency to health insurance rate increases. They ensure that, in every state, every proposed increase of 10% or more is evaluated by independent experts to assess whether they are based on reasonable assumptions and sound data.
Rate review is expected to help moderate premium increases and provide consumers with greater value for their premium dollar. Additionally, health insurance companies must provide easy to understand information to their customers about their reasons for significant rate increases, as well as publicly justify and post on their website any unreasonable rate increases.
The Affordable Care Act?s Rate Review program started for most individual and small group plans on September 1, 2011.
Through March 10, 2012, 186 increases affecting more than 1.3 million people have been posted on companyprofiles.healthcare.gov. Each provides an explanation from the insurer, including the rate increases determined to be unreasonable rate increases.
States are taking a strong lead in reviewing proposed rate increases. Of the 186 requested increases posted on HealthCare.gov as of March 10, 2012, two-thirds (125 filings) of these are being reviewed by rate review programs in the states. Only one-third (61 filings) is under review by HHS.
In the 61 instances to date where HHS is charged with conducting reviews, the Department has completed 28 determinations. HHS has determined that 20 of the 28 proposed rate increases are unreasonable. The most common reason for this determination is that the proposal would result in projected medical loss ratios (MLRs) below the 80% applicable threshold.
Commentby Don McCanne of PNHP: The title of today's message, "Controlling costs through HHS rate reviews," is deliberately deceptive to make a point. Supposedly, the Affordable Care Act (ACA) was designed to help control spending in health care, and the insurance premium Rate Review process was a component of cost containment. In fact, not only does the process have no impact on health care spending, it doesn't even have any federal control over increases in health insurance premiums.
ACA regulations require that any plan with premium increases of 10 percentor more be reviewed. Although states may have some influence over rate increases, the federal government has no authority to do anything about the increases other than expose the insurers to public ridicule.
In the last six months, 20 rate increases reviewed by the federal government have been found to be unreasonable, primarily because they exceeded the 20 percent of the premium that they could use for
administrative services and profits. Many of these insurers in the individual market will find that their inefficiencies are so great that they will be unable to comply with this requirement, so they really don't
need ridicule to drive home this point.
In the meantime, insurers will be able to increase their premiums 9.9 percent each year with no questions asked, at least not by the federal government. Compound that rate over several years, and then where will we be?
Obviously this ACA measure to "control costs" will have very little impact, if any, on insurance premiums and absolutely no impact on total health care spending.
There is a much more efficient model of health care financing that actually would slow the increase in health care spending while ensuring health care for everyone. Instead of playing ACA games, we should move forward with an improved Medicare for everyone.
March 21, 2012
Plans to use health care reform as an excuse to eliminate Medicare entirely
Voters over 55 now trust Repukes over Obama and Democrats on Medicare and Social Security, despite the firm commitment of the former to abolish both. I picked up a 56% button at Senior Lobby Day last month. It stands for the percentage of likely voters over 55 this November.
http://www.pressherald.com/news/GOP-Medicare-plan-borrows-from-and-repeals-Obamas.html
But if Obama is re-elected and his health care law is upheld by the Supreme Court, Wyden sees Medicare exchanges and a premium support system as the basis for a deal to reduce health care costs. He said Democrats would be hard pressed to argue against the idea if it is working for people under 65 as a result of the health care overhaul.
March 18, 2012
Oh--we'll only go after Medicare for those under 55. We'll leave current recipients strictly alone!
Surely if you give the school bully your lunch money on the first day of school he'll leave you alone for the rest of the year. If Dems don't make big politial hay out of this, we deserve to lose.
http://www.washingtonpost.com/opinions/a-republican-mediscare/2012/03/16/gIQAfoWYGS_print.html
But DeMint and his colleagues think the time to end Medicare is now — with a cold-turkey conversion to a private program, effective in 2014. “I think if Americans actually find out the truth about what we’re doing, it will be a very big positive for Republicans in the fall,” DeMint forecast.
All the details aren’t out, but Paul says his plan would cut funding of Medicare by $1?trillion over 10 years and reduce Medicare’s liabilities by $16 trillion. It would do that by enrolling Medicare recipients in the health plan now used by federal workers. The government would pay 75 percent of the insurance premium on average but 30 percent or less for those who earned more than $100,000 a year. The eligibility age would gradually be raised to 70 from 65. If seniors can’t afford their share of the premium, they can apply for Medicaid, the health program for the poor.
With each answer, the senators seemed in danger of sparking an all-out Mediscare in the populace. No, seniors could not opt to keep Medicare as it now exists. Yes, this would sharply increase insurance costs for federal workers.
March 11, 2012
Analysis by Democratic pollster—
http://capsules.kaiserhealthnews.org/index.php/2011/08/pollster-medicare-not-just-a-seniors-issue
Her bottom line: It is an even more important political issue now than in the past. “It’s not just a seniors’ issue by any matter or means,” she said. The Medicare changes in the budget plan advanced by House Budget Committee Chairman Paul Ryan, R-Wis., “really elevated it, because it was such a clear distinction” between the Democratic and Republican positions. ”You saw it play out in the N.Y. special . And it is the top testing message in congressional races right now,” Lake added.
She’ll be watching how aggressively Democrats rally around protecting Medicare but believes it will be harder for the party “to draw the distinction that many of us believe in” because President Barack Obama talked about Medicare cuts in the context of the budget deal. “So I think it’s going to depend on how strong a stance Democrats take or whether they muddle it.” Regardless, she adds, “it has the potential to be THE voting issue in 2012.”
Obama's wussiness on "entitlement" reform is further eroding the Dem brand on protecting our lifeling programs. On Senior Lobby Day in Olympia, WA, the AARP was passing out 56% buttons, to emphasize that in 2012, 56% of voters are expected to be over 55. PAY ATTENTION, DAMMIT!! Despite Eric Cantor's pledge to eventually eliminate Social Security, voters trusted REPUKES over Dems on this issue in 2010!
My addendum to the SSW report--we also must defend Medicare against "bipartisan" voucher proposals like that of Ron Wyden/Paul Ryan, or be prepared to lose all of Congress.
With all due respect to FDL, it was refusal to defend Medicare in 2010 that killed Dems
In reference to the thread discussing this--
http://firedoglake.com/2012/03/10/come-saturday-morning-hoyer-finally-admits-the-obvious-health-care-bill-killed-the-dems-in-2010/
The Repukes lied about cutting Medicare in 2010, and this was their winning message, as Dems refused to defend the GOVERNMENT traditional Medicare over Medicare Advantage, which merely had its subsidies cut. If the private sector is so much better and more efficient, then why would it need help from the government?
That the Repukes want to destroy Medicare and Social Security does NOT prevent them from sending out stuff like the following.
REPUBLICAN MAILER ON MEDICARE
http://www.gop.com/index.php/briefing/comments/reach_out_and_touch_medicare#ixzz1US9aru7F
For The Record…It Was Obama Who Offered To Cut Hundreds Of Billions In Medicare During The Debt Debate
OBAMA AND DEMOCRATS PUT MEDICARE CUTS IN DEBT CEILING DEAL
USA Today: “Cuts in Medicare and other entitlement programs are on the table.” (Susan Page and Fredreka Schouten, “Political Damage Even If A Debt Deal Is Done,” USA Today, 7/31/11)
Obama Agreed To Medicare Cuts In Debt Ceiling Deal. “The deal announced on Sunday by Congressional leaders and the White House would make across-the-board cuts in military spending, education, transportation and Medicare payments to health care providers if Congress does not enact further deficit-cutting legislation by the end of the year.” (Robert Pear, “Congress Must Trim Deficit To Avoid Broader Cuts,” The New York Times, 7/31/11)
Obama Said “Adjustments” Must Be Made To Medicare. OBAMA: “Yes, that means making some adjustments to protect health care programs like Medicare so they’re there for future generations.” (President Barack Obama, Remarks On Budget Control Act, Washington, D.C., 8/2/11)
DURING DEBT CEILING DEBATE, OBAMA OFFERED $650 BILLION IN CUTS TO MEDICARE, SOCIAL SECURITY, AND MEDICAID
Obama Put “Major Changes” To Medicare On The Table During Debt Ceiling Negotiations. “To hit the $1.5 trillion in spending cuts, the congressional committee is likely to reconsider major changes to Medicare that the White House and congressional leaders put on the table during this summer's debt-ceiling negotiations.” (Janet Adamy, “Debt Deal May Hit Medicare,” The Wall Street Journal, 8/2/11)
http://www.gop.com/index.php/briefing/comments/reach_out_and_touch_medicare#ixzz1US9aru7F
For The Record…It Was Obama Who Offered To Cut Hundreds Of Billions In Medicare During The Debt Debate
OBAMA AND DEMOCRATS PUT MEDICARE CUTS IN DEBT CEILING DEAL
USA Today: “Cuts in Medicare and other entitlement programs are on the table.” (Susan Page and Fredreka Schouten, “Political Damage Even If A Debt Deal Is Done,” USA Today, 7/31/11)
Obama Agreed To Medicare Cuts In Debt Ceiling Deal. “The deal announced on Sunday by Congressional leaders and the White House would make across-the-board cuts in military spending, education, transportation and Medicare payments to health care providers if Congress does not enact further deficit-cutting legislation by the end of the year.” (Robert Pear, “Congress Must Trim Deficit To Avoid Broader Cuts,” The New York Times, 7/31/11)
Obama Said “Adjustments” Must Be Made To Medicare. OBAMA: “Yes, that means making some adjustments to protect health care programs like Medicare so they’re there for future generations.” (President Barack Obama, Remarks On Budget Control Act, Washington, D.C., 8/2/11)
DURING DEBT CEILING DEBATE, OBAMA OFFERED $650 BILLION IN CUTS TO MEDICARE, SOCIAL SECURITY, AND MEDICAID
Obama Put “Major Changes” To Medicare On The Table During Debt Ceiling Negotiations. “To hit the $1.5 trillion in spending cuts, the congressional committee is likely to reconsider major changes to Medicare that the White House and congressional leaders put on the table during this summer's debt-ceiling negotiations.” (Janet Adamy, “Debt Deal May Hit Medicare,” The Wall Street Journal, 8/2/11)
Analysis by Democratic pollster—
http://capsules.kaiserhealthnews.org/index.php/2011/08/pollster-medicare-not-just-a-seniors-issue
Her bottom line: It is an even more important political issue now than in the past. “It’s not just a seniors’ issue by any matter or means,” she said. The Medicare changes in the budget plan advanced by House Budget Committee Chairman Paul Ryan, R-Wis., “really elevated it, because it was such a clear distinction” between the Democratic and Republican positions. ”You saw it play out in the N.Y. special . And it is the top testing message in congressional races right now,” Lake added.
She’ll be watching how aggressively Democrats rally around protecting Medicare but believes it will be harder for the party “to draw the distinction that many of us believe in” because President Barack Obama talked about Medicare cuts in the context of the budget deal. “So I think it’s going to depend on how strong a stance Democrats take or whether they muddle it.” Regardless, she adds, “it has the potential to be THE voting issue in 2012.”
Obama's wussiness on "entitlement" reform is further eroding the Dem brand on protecting our lifeling programs. On Senior Lobby Day in Olympia, WA, the AARP was passing out 56% buttons, to emphasize that in 2012, 56% of voters are expected to be over 55. PAY ATTENTION, DAMMIT!! Despite Eric Cantor's pledge to eventually eliminate Social Security, voters trusted REPUKES over Dems on this issue in 2010!
Social Security and the Future of the Democratic Party
Preliminary research from Strengthen Social Security
1. Public support for Social Security is very high – it is a core value for people so Democrats take it away at their peril.
• Numerous surveys show that 75% to 80% oppose cutting Social Security benefits to reduce the federal deficit. The public understands it has no relationship to the federal deficit because they pay special taxes for it.
• 2010 election eve/day poll showed STRONG opposition to Social Security cuts – 73% Democrats, 72% Independents, 72% Republicans, 61% Tea Party.
• 7 out of 10 voters oppose raising the retirement age. It is especially strong among blue collar voters: non-college men and especially non-college women, which are core labor constituencies in the key battleground states.
2. Democrats have limited credibility on Social Security issue at this point in time.
• Democrats used to crush Republicans when voters were asked: who do you trust to better handle Social Security? Today, they are losing badly to Republicans.
• Election Day 2010 voters favored Republicans on Social Security 31% to 28%. But
• Oct. 2006 poll: 48% Democrats to 20% Republicans
• Oct 2002 poll: 43% Democrats to 20% Republicans
• Oct. 1998 poll: 44% Democrats to 21% Republicans
• Same pattern is true for Presidents:
• Obama on 2010 Election Day: Voters said Republicans could be more trusted than Obama on Social Security by 33% to 26%.
• Bush in 2005: Democrats in Congress were favored over Bush on Social Security by 50% to 37%.
• Clinton in 1995: He was favored over Republicans in handling Social Security by 53% to 34%.
3. A damaged Democratic brand on Social Security will spell electoral disaster in 2012 and beyond. [This section is still being researched; we are looking at Senate races to make the strongest case. Obama believes he can win in 2012 even with a large loss among seniors, as long as he comes close to replicating his large surge in 2008 (a big if), although they have not said how large the seniors loss can be.]
• Democrats will not win seniors in 2012, but we must hold down our losses to a manageable level – maybe a 10% advantage for Republicans – if we are to hold (or at least minimize losses in the Senate and make up lost ground in the House.
• 2006: Republicans had no advantage among seniors – 49%-49%, when Democrats won big in congressional races.
• 2010: Republicans had a 21% point advantage among seniors – 59% vs. 38%.
• 2008: Republicans had an 8% point advantage among seniors – 53% vs. 45% in a wave election favoring Democrats
• 2004: Republicans had a 5% point advantage among seniors – 52% to 47%
• 2000: Democrats had a 3% point advantage among seniors – 50% to 47%
• 1996: Democrats had a 7% point advantage among seniors – 50% to 43%
• Beyond 2012, Republicans will have an easier time garnering the support of baby boomers if Democratic support for Social Security becomes blurred, an outcome that could impact national politics for many years.
4. Cutting Social Security will demoralize the Democratic base.
• It will be very hard to motivate activists in the party if the President leads the effort to cut Social Security. It will be seen as a betrayal of everything we have worked decades for.
• For unions in particular, the union leader’s credibility with its own members will be at great risk if the President leads the effort to cut Social Security.
5. The President can and should build support for his reelection and congressional Democrats by embracing Social Security as a crucial component of the economic security of American families. He should emphasize that:
• In an economy that is increasingly risky, it is the only program American families can count on to provide effective life insurance for their young children, disability insurance and retirement protection.
• Social Security as a core part of his commitment to protecting the middle class.
6. Protecting Social Security would be a bipartisan bonanza for the President and regain ground lost due to Republicans on Medicare.
• The President wants to be seen as working with Republicans. Why not ask them to join him in pledging to not cut Social Security. He will hit a grand slam with the public, which wants no cuts to the program and would like both parties to work together to protect the program. It will be a surprise move to the Republicans and put them in a box.
• Republicans were very effective in the 2010 campaign skewering Democrats as Medicare cutters. This was probably the single greatest attack Republicans had on Democrats with older voters. This could happen again with Social Security. The way to get this age group back is to go on offense on Social Security.
Preliminary research from Strengthen Social Security
1. Public support for Social Security is very high – it is a core value for people so Democrats take it away at their peril.
• Numerous surveys show that 75% to 80% oppose cutting Social Security benefits to reduce the federal deficit. The public understands it has no relationship to the federal deficit because they pay special taxes for it.
• 2010 election eve/day poll showed STRONG opposition to Social Security cuts – 73% Democrats, 72% Independents, 72% Republicans, 61% Tea Party.
• 7 out of 10 voters oppose raising the retirement age. It is especially strong among blue collar voters: non-college men and especially non-college women, which are core labor constituencies in the key battleground states.
2. Democrats have limited credibility on Social Security issue at this point in time.
• Democrats used to crush Republicans when voters were asked: who do you trust to better handle Social Security? Today, they are losing badly to Republicans.
• Election Day 2010 voters favored Republicans on Social Security 31% to 28%. But
• Oct. 2006 poll: 48% Democrats to 20% Republicans
• Oct 2002 poll: 43% Democrats to 20% Republicans
• Oct. 1998 poll: 44% Democrats to 21% Republicans
• Same pattern is true for Presidents:
• Obama on 2010 Election Day: Voters said Republicans could be more trusted than Obama on Social Security by 33% to 26%.
• Bush in 2005: Democrats in Congress were favored over Bush on Social Security by 50% to 37%.
• Clinton in 1995: He was favored over Republicans in handling Social Security by 53% to 34%.
3. A damaged Democratic brand on Social Security will spell electoral disaster in 2012 and beyond. [This section is still being researched; we are looking at Senate races to make the strongest case. Obama believes he can win in 2012 even with a large loss among seniors, as long as he comes close to replicating his large surge in 2008 (a big if), although they have not said how large the seniors loss can be.]
• Democrats will not win seniors in 2012, but we must hold down our losses to a manageable level – maybe a 10% advantage for Republicans – if we are to hold (or at least minimize losses in the Senate and make up lost ground in the House.
• 2006: Republicans had no advantage among seniors – 49%-49%, when Democrats won big in congressional races.
• 2010: Republicans had a 21% point advantage among seniors – 59% vs. 38%.
• 2008: Republicans had an 8% point advantage among seniors – 53% vs. 45% in a wave election favoring Democrats
• 2004: Republicans had a 5% point advantage among seniors – 52% to 47%
• 2000: Democrats had a 3% point advantage among seniors – 50% to 47%
• 1996: Democrats had a 7% point advantage among seniors – 50% to 43%
• Beyond 2012, Republicans will have an easier time garnering the support of baby boomers if Democratic support for Social Security becomes blurred, an outcome that could impact national politics for many years.
4. Cutting Social Security will demoralize the Democratic base.
• It will be very hard to motivate activists in the party if the President leads the effort to cut Social Security. It will be seen as a betrayal of everything we have worked decades for.
• For unions in particular, the union leader’s credibility with its own members will be at great risk if the President leads the effort to cut Social Security.
5. The President can and should build support for his reelection and congressional Democrats by embracing Social Security as a crucial component of the economic security of American families. He should emphasize that:
• In an economy that is increasingly risky, it is the only program American families can count on to provide effective life insurance for their young children, disability insurance and retirement protection.
• Social Security as a core part of his commitment to protecting the middle class.
6. Protecting Social Security would be a bipartisan bonanza for the President and regain ground lost due to Republicans on Medicare.
• The President wants to be seen as working with Republicans. Why not ask them to join him in pledging to not cut Social Security. He will hit a grand slam with the public, which wants no cuts to the program and would like both parties to work together to protect the program. It will be a surprise move to the Republicans and put them in a box.
• Republicans were very effective in the 2010 campaign skewering Democrats as Medicare cutters. This was probably the single greatest attack Republicans had on Democrats with older voters. This could happen again with Social Security. The way to get this age group back is to go on offense on Social Security.
My addendum to the SSW report--we also must defend Medicare against "bipartisan" voucher proposals like that of Ron Wyden/Paul Ryan, or be prepared to lose all of Congress.
March 9, 2012
Comment by Don McCanne of PNHP: This new report adds to the profusion of policy studies confirming that Americans continue to experience financial burdens in paying their medical bills. Unfortunately, this problem will not go away after the Affordable Care Act is fully implemented.
Well over 20 million people will remain uninsured, and perhaps a third or more of our population will be under-insured, due to the low actuarial value plans to be offered in the exchanges, and especially due to the increasing prevalence of high-deductibles in employer-sponsored plans. In fact. under-insurance likely will soon be the norm.
Contrast that with John Conyers' HR 676, the "Expanded and Improved Medicare for All Act," which states, "The health care benefits under this Act cover all medically necessary services... No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits."
For those who say we can't afford this, many other nations provide all of their people comprehensive care with no out-of-pocket expenses, at an average cost of only half of what we are spending on health care.
We can't afford not to do it.
My comment: We are altready paying for universal health care--we just aren't getting it.
One in five families have trouble paying medical bills
National Center for Health Statistics
March 2012
Financial Burden of Medical Care: Early Release of Estimates From the National Health Interview Survey, January-June 2011
http://www.cdc.gov/nchs/data/nhis/earlyrelease/financial_burden_of_medical_care_032012.pdf
Previous work has shown that in 2010, more than one in five Americans were in families reporting problems paying medical bills. In 2011, three new questions addressing financial burden of medical care were added to the National Health Interview Survey (NHIS) Family component. These questions addressed problems paying medical bills, paying medical bills over time, and having medical bills that cannot be paid at all.
In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.
March 2012
Financial Burden of Medical Care: Early Release of Estimates From the National Health Interview Survey, January-June 2011
http://www.cdc.gov/nchs/data/nhis/earlyrelease/financial_burden_of_medical_care_032012.pdf
Previous work has shown that in 2010, more than one in five Americans were in families reporting problems paying medical bills. In 2011, three new questions addressing financial burden of medical care were added to the National Health Interview Survey (NHIS) Family component. These questions addressed problems paying medical bills, paying medical bills over time, and having medical bills that cannot be paid at all.
In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.
Comment by Don McCanne of PNHP: This new report adds to the profusion of policy studies confirming that Americans continue to experience financial burdens in paying their medical bills. Unfortunately, this problem will not go away after the Affordable Care Act is fully implemented.
Well over 20 million people will remain uninsured, and perhaps a third or more of our population will be under-insured, due to the low actuarial value plans to be offered in the exchanges, and especially due to the increasing prevalence of high-deductibles in employer-sponsored plans. In fact. under-insurance likely will soon be the norm.
Contrast that with John Conyers' HR 676, the "Expanded and Improved Medicare for All Act," which states, "The health care benefits under this Act cover all medically necessary services... No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits."
For those who say we can't afford this, many other nations provide all of their people comprehensive care with no out-of-pocket expenses, at an average cost of only half of what we are spending on health care.
We can't afford not to do it.
My comment: We are altready paying for universal health care--we just aren't getting it.
February 25, 2012
Comment by Don McCanne of PNHP: Conservatives who oppose health care reform often argue that
being uninsured is a consequence of the individual's own personal irresponsibility. Those individuals merely need to shape up and go out and get a job, and then they would have health insurance. The conservatives lose their credibility on this point when the actual data show that 38 percent of low-wage workers, who do go out and get a job, lack health insurance from any source.
Because of such deficiencies in our system reform advocates were able to muster the political support to pass the Affordable Care Act - a half-glass reform. Those who view this as a glass half full celebrate the fact that over half of these uninsured workers will become insured under ACA.
The advocates of reform who view this as a glass half empty bemoan the fact that ACA will still leave about 17 percent of low-wage workers without insurance. The diversionary half full, half empty debate is particularly tragic when you consider that a single payer national health program would have brought us a full glass.
The addendum explains the roots of the decline in coverage rates - an important concept indicating that our battle for health care justice is only a part of the offensive that must take place to expedite social justice throughout the United States.
Health-insurance Coverage for Low-wage Workers
Health-insurance Coverage for Low-wage Workers, 1979-2010 and Beyond
By John Schmitt
http://www.cepr.net/documents/publications/health-low-wage-2012-02.pdf
In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979.
Coverage problems are particularly severe for Latino workers. Almost 40 percent of all Latino workers (not just low-wage workers) have no health insurance of any form. African American (about 22 percent) and Asian (about 17 percent) workers are also much less likely to have coverage than white
workers (about 12 percent).
Affordable Care Act of 2010
For simplicity, if we assume that all adults--workers and non-workers--have the same coverage rate, then under CBO?s projections, workers as a group would have a 5.8 percent non-coverage rate after the ACA. By comparison, in 2010, the actual non-coverage rate for all workers was about 17.7 percent. The CBO gives no guidance about how the coverage improvements for workers would be divided across the wage distribution. If, at the extreme, we assume that all of the uncovered workers are low-wage workers by our definition--that is that all 5.8 percent of workers remaining without coverage are in the bottom quintile--then the non-coverage rate for low-wage workers would be about 29.0 percent. This would be a reduction of one-fourth in the share of low-wage workers without coverage relative to the actual non-coverage rate for low-wage workers in 2010 (38.5 percent). A less extreme assumption about the distribution of non-coverage rates by wage level after the ACA would produce larger gains for low-wage workers.
For example, if instead we assume that the top 80 percent of workers have a fractional 3 percent non-coverage rate, then an overall non-coverage rate for workers of 5.8 percent implies a 17.0 percent non-coverage rate for low-wage workers, well short of universal coverage, but a non-coverage rate that is less than half of the current rate.
The ACA will not produce universal coverage for low-wage workers. But, if the ACA is not enacted--due to judicial or legislative action--every indication is that coverage rates will continue their three-decades-long decline.
ADDENDUM
The decline in coverage rates has its roots in two long-standing economic processes. The first is the rising cost of health care, which has squeezed workers' wages and made it less economical for firms to offer health insurance, especially to low-wage workers. In the absence of reforms to the existing health-care system, these costs--and implicitly the pressure on workers' after-health-insurance compensation--are projected to continue rising indefinitely.
The other force behind falling coverage rates, especially for low-wage workers, is the decline over the last three decades in the bargaining power of most workers. Beginning in the late 1970s, a set of structural changes in the economy has significantly reduced the bargaining power of workers, especially those at the middle and the bottom of the wage distribution. These structural changes include: a steep decline in unionization; an erosion in the inflation-adjusted value of the minimum wage; the deregulation of many historically high-wage industries (trucking, airlines, telecommunications, and others); the privatization of many state and local government functions (from school cafeteria workers to public-assistance administrators); the opening up of the U.S. economy to much higher volumes of foreign trade; a sharp rise in the share of immigrant workers, who often lack basic legal rights and operate in an economy that provides few labor protections regardless of citizenship; and a macroeconomic policy environment that has typically maintained the unemployment rate well above levels consistent with full employment. All of these changes have acted to reduce the bargaining power of workers, especially those at the middle and bottom of the wage distribution. As a result, workers as a group have seen their relative (and even absolute) wages fall and the availability and quality of health-insurance and retirement plans decline.
By John Schmitt
http://www.cepr.net/documents/publications/health-low-wage-2012-02.pdf
In 2010, over 38 percent of low-wage workers lacked health insurance from any source, up from 16 percent in 1979.
Coverage problems are particularly severe for Latino workers. Almost 40 percent of all Latino workers (not just low-wage workers) have no health insurance of any form. African American (about 22 percent) and Asian (about 17 percent) workers are also much less likely to have coverage than white
workers (about 12 percent).
Affordable Care Act of 2010
For simplicity, if we assume that all adults--workers and non-workers--have the same coverage rate, then under CBO?s projections, workers as a group would have a 5.8 percent non-coverage rate after the ACA. By comparison, in 2010, the actual non-coverage rate for all workers was about 17.7 percent. The CBO gives no guidance about how the coverage improvements for workers would be divided across the wage distribution. If, at the extreme, we assume that all of the uncovered workers are low-wage workers by our definition--that is that all 5.8 percent of workers remaining without coverage are in the bottom quintile--then the non-coverage rate for low-wage workers would be about 29.0 percent. This would be a reduction of one-fourth in the share of low-wage workers without coverage relative to the actual non-coverage rate for low-wage workers in 2010 (38.5 percent). A less extreme assumption about the distribution of non-coverage rates by wage level after the ACA would produce larger gains for low-wage workers.
For example, if instead we assume that the top 80 percent of workers have a fractional 3 percent non-coverage rate, then an overall non-coverage rate for workers of 5.8 percent implies a 17.0 percent non-coverage rate for low-wage workers, well short of universal coverage, but a non-coverage rate that is less than half of the current rate.
The ACA will not produce universal coverage for low-wage workers. But, if the ACA is not enacted--due to judicial or legislative action--every indication is that coverage rates will continue their three-decades-long decline.
ADDENDUM
The decline in coverage rates has its roots in two long-standing economic processes. The first is the rising cost of health care, which has squeezed workers' wages and made it less economical for firms to offer health insurance, especially to low-wage workers. In the absence of reforms to the existing health-care system, these costs--and implicitly the pressure on workers' after-health-insurance compensation--are projected to continue rising indefinitely.
The other force behind falling coverage rates, especially for low-wage workers, is the decline over the last three decades in the bargaining power of most workers. Beginning in the late 1970s, a set of structural changes in the economy has significantly reduced the bargaining power of workers, especially those at the middle and the bottom of the wage distribution. These structural changes include: a steep decline in unionization; an erosion in the inflation-adjusted value of the minimum wage; the deregulation of many historically high-wage industries (trucking, airlines, telecommunications, and others); the privatization of many state and local government functions (from school cafeteria workers to public-assistance administrators); the opening up of the U.S. economy to much higher volumes of foreign trade; a sharp rise in the share of immigrant workers, who often lack basic legal rights and operate in an economy that provides few labor protections regardless of citizenship; and a macroeconomic policy environment that has typically maintained the unemployment rate well above levels consistent with full employment. All of these changes have acted to reduce the bargaining power of workers, especially those at the middle and bottom of the wage distribution. As a result, workers as a group have seen their relative (and even absolute) wages fall and the availability and quality of health-insurance and retirement plans decline.
Comment by Don McCanne of PNHP: Conservatives who oppose health care reform often argue that
being uninsured is a consequence of the individual's own personal irresponsibility. Those individuals merely need to shape up and go out and get a job, and then they would have health insurance. The conservatives lose their credibility on this point when the actual data show that 38 percent of low-wage workers, who do go out and get a job, lack health insurance from any source.
Because of such deficiencies in our system reform advocates were able to muster the political support to pass the Affordable Care Act - a half-glass reform. Those who view this as a glass half full celebrate the fact that over half of these uninsured workers will become insured under ACA.
The advocates of reform who view this as a glass half empty bemoan the fact that ACA will still leave about 17 percent of low-wage workers without insurance. The diversionary half full, half empty debate is particularly tragic when you consider that a single payer national health program would have brought us a full glass.
The addendum explains the roots of the decline in coverage rates - an important concept indicating that our battle for health care justice is only a part of the offensive that must take place to expedite social justice throughout the United States.
February 25, 2012
Comment by Don McCanne of PNHP: Being the fine gentleman he is, Professor Jost politely states, "One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services."
You don't have to wonder. Not only should we have a national standard calling for comprehensive benefits for everyone, we also should have simplified the financing system to make it more equitable and much more efficient so that health care would be accessible and affordable for everyone.
Implementing Health Reform: Essential Health Benefits And Medical Loss Ratios
Implementing Health Reform: Essential Health Benefits And Medical Loss Ratios
By Timothy Jost
http://healthaffairs.org/blog/2012/02/18/implementing-health-reform-essential-health-benefits-and-medical-loss-ratios/
The FAQ do go some distance toward clarifying a number of the issues left open by the initial bulletin, in particular how plan flexibility will (and will not) work, that states will not establish a new EHB every year, and that a state?s commercial plan EHB need not apply to Medicaid. The approach selected by HHS will allow states to maintain their coverage mandates (or at least those that apply to the small group market) until 2016, but will preclude the addition of new mandates. It is still hard to imagine how this is all going to work out in practice, however, and more to the point how plan compliance will ever be monitored, given the ability of plans to substitute services within categories. One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services.
CMS - FAQs on essential health benefits:
http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf
By Timothy Jost
http://healthaffairs.org/blog/2012/02/18/implementing-health-reform-essential-health-benefits-and-medical-loss-ratios/
The FAQ do go some distance toward clarifying a number of the issues left open by the initial bulletin, in particular how plan flexibility will (and will not) work, that states will not establish a new EHB every year, and that a state?s commercial plan EHB need not apply to Medicaid. The approach selected by HHS will allow states to maintain their coverage mandates (or at least those that apply to the small group market) until 2016, but will preclude the addition of new mandates. It is still hard to imagine how this is all going to work out in practice, however, and more to the point how plan compliance will ever be monitored, given the ability of plans to substitute services within categories. One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services.
CMS - FAQs on essential health benefits:
http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf
Comment by Don McCanne of PNHP: Being the fine gentleman he is, Professor Jost politely states, "One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services."
You don't have to wonder. Not only should we have a national standard calling for comprehensive benefits for everyone, we also should have simplified the financing system to make it more equitable and much more efficient so that health care would be accessible and affordable for everyone.
February 20, 2012
Dear candidate:
Medicare is currently under attack by many in Congress, and seniors in your district are very concerned that this vital program remain intact and not be subject to cuts which force more cost sharing for the sickest and most vulnerable members of this population.
The Ryan/Wyden plan to gradually voucherize Medicare means that the program as we know it will be destroyed. A coupon for a discount to be applied to the same kind of insurance that the elderly could not afford before Medicare was enacted will only result in the elimination of access to health care for significant numbers of older people.
In addition, some have proposed increasing Medicare eligibility from age 65 to 67. Not only will this bankrupt more people, but it will not even save money. Studies have shown that, relative to those with insurance before age 65, those without insurance prior to Medicare eligibility spent much more money on health care after they became Medicare eligible. In other words, people wait to get care until their Medicare kicks in. This is bad both for health and for the federal government’s bottom line.
We are requesting that you sign the enclosed pledge to defend Medicare.
Sincerely,
(Your organization here)
Open Congressional seats? Do NOT support any candidate who will not defend
--Medicare, Social Security and Medicaid.
Get your organization (or better yet, coalition) to ask all candidates sign a pledge.
Pledge to Defend Medicare
Since 1965, Medicare has given America’s seniors access to health care which only the wealthier senior demographic could pay for before it was implemented. It covers all needed care, and is frugally administered with only 3% administrative expenses.
In the interests of my constituents – the men, women and children who are Medicare’s current and future beneficiaries – I pledge to:
• Oppose unconditionally the Ryan/Wyden proposal to incrementally turn Medicare into a voucher program; and
• Oppose unconditionally any proposal to raise the Medicare eligibility age; and
• Oppose any and all efforts to reduce the federal deficit on the backs of the sickest and most vulnerable members of our population.
Signed ___________________________________
Date: _____________________________________
Since 1965, Medicare has given America’s seniors access to health care which only the wealthier senior demographic could pay for before it was implemented. It covers all needed care, and is frugally administered with only 3% administrative expenses.
In the interests of my constituents – the men, women and children who are Medicare’s current and future beneficiaries – I pledge to:
• Oppose unconditionally the Ryan/Wyden proposal to incrementally turn Medicare into a voucher program; and
• Oppose unconditionally any proposal to raise the Medicare eligibility age; and
• Oppose any and all efforts to reduce the federal deficit on the backs of the sickest and most vulnerable members of our population.
Signed ___________________________________
Date: _____________________________________
Dear candidate:
Medicare is currently under attack by many in Congress, and seniors in your district are very concerned that this vital program remain intact and not be subject to cuts which force more cost sharing for the sickest and most vulnerable members of this population.
The Ryan/Wyden plan to gradually voucherize Medicare means that the program as we know it will be destroyed. A coupon for a discount to be applied to the same kind of insurance that the elderly could not afford before Medicare was enacted will only result in the elimination of access to health care for significant numbers of older people.
In addition, some have proposed increasing Medicare eligibility from age 65 to 67. Not only will this bankrupt more people, but it will not even save money. Studies have shown that, relative to those with insurance before age 65, those without insurance prior to Medicare eligibility spent much more money on health care after they became Medicare eligible. In other words, people wait to get care until their Medicare kicks in. This is bad both for health and for the federal government’s bottom line.
We are requesting that you sign the enclosed pledge to defend Medicare.
Sincerely,
(Your organization here)
February 20, 2012
Are you too obsessed with politics?
Take this simple questionnaire to find out.
1. What I know about my friends and neighbors
a) What Congressional Districts they live in.
b) That, plus what state legislative districts they live in.
c) Hell, I know what precincts they live in.
2. My legislators
a) I know who they are.
b) I occasionally write them about issues of concern.
c) They know who I am.
3. My radio dial is mostly tuned to
a) Music or sports.
b) 94.9 FM (NPR).
c) 1090 AM (Air America).
4. I do household chores
a) Daily. Maintenance tasks are an essential part of a balanced life.
b) Once a week, whether they need to be done or not.
c) Whenever I notice that a new life form has evolved at the bottom of my kitchen sink
5. The last time I was at Safeco Field, I
a) Watched the Mariners play. It’s a baseball diamond, right? Duh.
b) Collected signatures for Initiative 1068.
c) Leafleted or participated in a demonstration, and multitasked by collecting signatures for one or more initiatives also.
6. The last movie I saw was
a) A whole bunch of them at the film festival.
b) One of this month’s new releases.
c) Whatever documentary was shown at Friday Night at the Meaningful Movies.
7. The number of different political campaigns I have donated to this year is
a) 0 to 5.
b) About five.
c) Way more than five.
8. I see a dentist
a) The recommended once every six months.
b) Whenever their office calls and bugs me about it.
c) Only during odd-numbered non-election years.
9. Wow! October already! Time to
a) Enjoy the World Series and the start of football season.
b) Get ready to vote in the general election.
c) Walk my precinct for the general election.
10. The websites I have bookmarked are
a) Less than 10% political.
b) 10-70% political.
c) More than 70% political.
11. On Saturday nights, my spouse (or partner or boyfriend or girlfriend) usually says
a) Why don’t we slip into something a little more comfortable?
b) How about dinner and a movie?
c) Another meeting? You’re kidding, right?
12. Since the November 2000 elections my aerobic conditioning has
a) Improved.
b) Stayed pretty much the same.
c) Gone dramatically downhill.
Score one point for every a) answer, three points for every b) answer and five points for every c) answer.
46-60: You are skating perilously close to major physical and/or mental breakdown. How about one of those Balancing Life and Work classes?
29-45: You are a good citizen, and it probably won’t drive you nuts.
12-28: Dammit, neofascists and racist Talibaggers are running the country right into the ground! Get off your ass and do something about it!
Profile Information
Gender: FemaleHometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 02:52 AM
Number of posts: 51,907
