Tag Archives: affordable care

Wisconsin has the power to make healthcare cheaper and better

The much-maligned Affordable Care Act (ACA) passed in 2010 will stay in place.

“Obamacare is the law of the land,” House Speaker Paul Ryan told the nation. “We’re going to be living with Obamacare for the foreseeable future.”

Self-employed older Americans and state budget directors breathed a sigh of relief. The Republican healthcare plan would have raised rates for older people on Healthcare.gov, shifted taxes away from the well-off, and shifted to states more costs for low-income, disabled and elderly (through Medicaid).

But the problems of the ACA — rising premiums, customers left with little choice and insurance companies leaving the marketplace in some states — still remain.

Why do these problems exist? Is there anything Wisconsin can do to improve things?

Insurance companies act to share risk. Inevitably, healthier patients subsidize the less fortunate sicker patients. This has been the case since Benjamin Franklin invented the first American insurance company (that I’m aware of) when he created a “mutual fire aid society” to help defray the risk of fire.

Insurance companies are betting you will stay healthy, you are betting you’ll get sick.

When companies entered the healthcare.gov market place, they kept premiums low. Conservative columnist David Brook wrote in 2015 “Healthcare inflation has been at historic lows.” Quoting expert Jason Furman, Brooks wrote prices were growing as an annual rate of 1.6 percent since 2010, “the slowest rate for such a period in five decades.” Federal government health expenses slowed too.

For a number of reasons, the low inflation was not sustainable. Young people were not buying their own policies but staying on their parents plan as long as possible. Many people who got insurance for the first time had numerous costs due to delayed care. Insurance companies didn’t make the money they expected, and decided to either drop providing coverage in the exchange or raise premiums to cover the higher costs.

Covering self-employed or small businesses (known in the insurance industry as “individual coverage”) has always been expensive. Administrative costs are high; risk is high. The ACA protected consumers in many ways, such as not being charged more if you had cancer but are now healthy. However, the rules left fewer ways for insurance companies to recoup costs. So, they raised premiums or completely left the individual market.

The result is higher cost insurance, less choice and in some cases no choice.

Wisconsin historically has a competitive insurance market with many competing plans, especially in the southeast. Many players should give us lower costs (however, the health care market does not follow normal economic patterns), but seeking an unprofitable venture does not make a good business model.

Which may lead us to one option. Some insurance companies are not-for-profit; some have very low overhead. Everything else being equal, these companies should be better at competing. However, so much depends on the luck — or lack of it — in taking care of a high cost patient.

We could return to a successful plan that helped health insurance companies manage risk. In 2013, Gov. Walker eliminated the state’s “Health Insurance Risk-Sharing Plan” known as HIRSP. This was a mistake.

The HIRSP plan was paid for with funds from insurance companies. We could create a similar plan to allow people with conditions that require expensive care to continue under their own insurance plan. Their insurance company could use a plan like HIRSP to share risk with other companies. Basically HIRSP 2.0 could work seamlessly in the background to help manage high-risk patients.

A recent National Governor’s Association briefing suggested states could save up to 15 percent on insurance premiums if they created such a plan. Other state innovations could include promoting enrollment in the healthcare marketplace, and focusing on methods to reduce the cost of care.

In a 2015 report, Citizen Action of Wisconsin proposed several changes that could bring down health insurance premiums. Medicaid expansion could cover an estimated 81,000 Wisconsinites through existing federal law and bring many high cost patients into a less expensive system. Creation of a Wisconsin-based marketplace, state scrutiny over premium hikes, use of state purchasing power to gain value — lower costs and better care — are all options that merit investigation.

Healthcare policy is complex. But solving problems is possible. If those in Washington have given up, let’s consider new ideas at our state Capitol. We might land on an idea that really works.

Sen. Kathleen Vinehout, D-Eau Claire, represents Wisconsin’s 31st Senate District.

 

On Medicaid money, GOP has win-or-lose proposition for states

New England’s bucolic countryside looks much the same on either side of the Connecticut River separating Vermont from New Hampshire. But Medicaid beneficiaries are far better off in Vermont.

Vermont generously funds its Medicaid program. It provides better benefits, such as dental care, and pays doctors more than New Hampshire’s program does. That brings more doctors into the program, giving enrollees more access to care.

New Hampshire has twice Vermont’s population, but Vermont spends almost as much on Medicaid and covers more enrollees. Under the complicated formulas that set federal funding, Vermont’s substantial investment helps it capture nearly as much aid from the government as New Hampshire gets.

States’ policies differ about who or what to cover in Medicaid, and those decisions have led to historical variances in how much federal money they receive. House Republicans’ effort to shrink federal Medicaid spending would lock in the differences in a way that favors those already spending high amounts per enrollee.

“Republicans are finding out why changing Medicaid is so hard and why the easiest thing to do is to do nothing given the substantial variation in federal spending across states,” said John Holahan, a health policy expert with the nonpartisan Urban Institute.

Here’s why.

Medicaid, the national health program for low-income people that covers about 1 in 5 Americans, is 60 percent funded by the federal government and 40 percent by states. Total spending in 2015 was about $532 billion, according to the latest official data.

Federal funding is open-ended, which means the government guarantees states it will pay a fixed rate of their Medicaid expenses as spending rises.

Those matching rates are tied to average personal incomes and favor the lowest-income states. Mississippi has the highest Federal Matching Assistance Percentage — 76 — while 14 wealthy states, including New York and California, get the minimum 50 percent from the federal government.

But state Medicaid spending varies significantly, too, and that influences how much federal money each receives to fund its program. State policies about how generous benefits should be and how much to pay doctors and hospitals account for those differences.

GOP leaders want to give states a set amount of money each year based on the number of Medicaid enrollees they had in 2016, a formula known as per-capita caps.

A per-capita system would benefit high-spending states already receiving relatively rich allotments from the government, the Urban Institute said in a paper last September.

According to its estimates, if the system were in effect this year, Vermont would receive $6,067 per enrollee — one of the highest allotments in the country — while New Hampshire would get the least, just $3,084 per enrollee.

Per-capita caps would limit the government’s Medicaid spending because it would no longer be on the hook to help cover states’ rising costs. But caps also would shift costs and financial risks to the states and could force them to cut benefits or eligibility to manage their budgets.

“It would present a huge problem,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative, an advocacy group.

Under the GOP bill, federal Medicaid funding to states would be adjusted annually based on a state’s enrollment and medical inflation. But that would not be enough to keep up with rising Medicaid spending per enrollee, which would force states to put up more of their money or scale back the program, the nonpartisan Congressional Budget Office said March 13.

Other analyses of the GOP plan have reached the same conclusion.

Since 1999, however, the average annual growth rate in Medicaid spending per enrollee has risen more slowly than medical inflation, according to MACPAC, the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Republicans argue that overhauling federal Medicaid spending as they propose would hold down federal costs while giving states more leeway to run their programs as they see fit. “This incentive would help encourage efficiencies and accountability with taxpayer funds,” House Speaker Paul Ryan wrote last June in his white paper, A Better Way.”

Rep. Greg Walden (R-Ore.), chairman of the powerful House Energy and Commerce Committee, which has oversight of health care matters, sounded a similar note at a press conference in Washington, D.C., when the GOP plan was announced. “I think it’s really important to empower states and to put Medicaid on a budget,” he said.

But Fox argued the opposite would happen under a per-capita system — instead of gaining more control over their Medicaid programs, states would not be able to meet their needs because they’d have fewer dollars to decide how to spend, he said.

Bill Hammond, director of health policy for the nonpartisan Empire Center for Public Policy in New York, said House leaders’ decision to tie future Medicaid funding to medical inflation could help mute concerns that funding wouldn’t keep up with rising costs, but would not address the fairness issue of giving some states higher per-capita amounts than others.

“If a low-spending state decides it wants to spend more money on paying hospitals and doctors or adding more benefits, they would have a harder time doing that without breaking the federal cap,” he said.

Medicaid advocates in New Hampshire are worried because their state has few alternatives to make up for a loss in federal funding. New Hampshire lacks an income or sales tax.

“There is a tremendous amount of fear among families here as Republicans try to dismantle the ACA,” said Martha-Jean Madison, co-director of New Hampshire Family Voices.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Survey: Health care improving for LGBT Americans

The number of American hospitals striving to treat LGBT patients equally and respectfully is on the rise, according to a report released on June 19 by the Human Rights Campaign Foundation.

HRC joined U.S. Health & Human Services Secretary Kathleen Sebelius at Howard University Hospital in Washington, D.C., to release the annual survey.

“Just a few short years ago the health care industry wasn’t having conversations about LGBT health care equality,” said HRC president Chad Griffin. “Now, thanks to advocacy by the LGBT community and some standout leaders, growing numbers of health care providers are making an explicit commitment to treat all patients with dignity and respect. The health care industry is beginning to heed the call for fairness and compassion.”

The report contains HRC’s Healthcare Equality Index, an annual review of 407 health care facilities in the United States.

More than 90 percent of participants in the survey explicitly prohibit discrimination against LGB patients and 76 percent ban discrimination against transgender patients.

Additionally, about 75 percent of respondents have a written policy explicitly granting equal visitation rights to same-sex couples and same-sex parents. This represents a significant increase since 2011, when HHS issued rules requiring all hospitals that receive federal Medicare and Medicaid funding – nearly every hospital in America – to protect the visitation rights of LGBT people.

Also, more than 1,000 health care administrators across the country participated in training on LGBT issues this past year.

“I commend the LGBT and health care communities for the progress made and I am proud to be part of an administration that has a historic record of accomplishment for the LGBT community,” said Sebelius. “We will continue to take action to ensure that LGBT Americans get equal treatment in health care settings and that all patients are treated with the dignity they deserve.”

Studies, including a 2011 Institute of Medicine report, have shown that the LGBT community faces health disparities and health care discrimination and that many LGBT Americans are concerned about experiencing bias in care.

“Equal and inclusive health care saves lives,” said Griffin. “Increasing numbers of hospitals across the country are working to ensure LGBT patients receive care free of prejudice and discrimination.”

LGBT Health Awareness Week begins

National LGBT Health Awareness Week takes place through March 30, with organizers asking people to share their health care stories online.

The week, sponsored by the National Coalition for LGBT Health, coincides with Supreme Court oral arguments over the constitutionality of the federal Affordable Care Act.

The coalition partners and the Rainbow Access Initiative want to hear from LGBT consumers on:

• How federal healthcare reform has or how it will impact them.

• What unmet health care needs they have.

• The importance of LGBT culturally competency when searching for a health care provider.

The information collected will be provided to the U.S. Department of Health and Human Services, which is working to improve care for LGBT people.

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