Monday, October 31, 2011

Half-Trillion More in Medicare, Medicaid Cuts?

here is an article about cuts that Baucus is considering for the supercommittee.  Pretty brutal cuts and not all that wise.  But it maybe part of what has to be done to ensure that a deal is reached.   While I don't like these cuts, I respect Baucus because he was the brains behind the affordable care act.  

Friday, October 28, 2011

Medicaid and dual eligibles

previously I posted  thoughts on how to integrate long term services and support (previously called long term care)

today, I went to an Alliance for Health Reform session on Medicaid managed care.  see

A webcast of this session which includes my questions can be seen at

Judy Feder had an interesting paper (see Komisar + Feder, 2011) in which she suggested that Medicare take over the system for duals, perhaps thru special needs plans.  Matt Salo from the new Natl Assn of Medicaid Directors said that Medicare has shown little interest in that. 

In my view, one way or another, we need to integrate the payments between medicare and medicaid especially for the duals, which are the most costly, integrate services between medicare and medicaid, and ensure adequate quality of care, such as using the medicare measures. 

Tuesday, October 25, 2011

Friday, October 21, 2011

The Bottom Line: How the Affordable Care Act Helps America's Families Families USA, October 2011

from facebook

Each average household in U.S. will be $1,571 better off due the Affordable Care Act? households with an income of less than $100,000 will receive the greatest benefit!

Further thoughts on the Critical Role that Obama Played in Health Reform

A few days ago, I posted a blog on this topic.  See

If you agree with me that we need to do more to sell the tremendous accomplishment of health reform, please get in touch with me at  I have just shared my thoughts with several key Congressional staff and State delegates. 

10 Misconceptions About Long-Term Care Insurance Should you make this investment?
from aarp, useful article

Herndon Alliance / Know Your Care Healthcare Poll

The Herndon Alliance recently sent me slides with the results of surveys they conducted on attitudes to the Affordable Care Act and related issues.  They are developing messages to support the Act.  Here is a summary of one set of key slides.  Contact me for the slides. 


A strong majority of voters do not want the ACA repealed or defunded.
•Voters trust President Obama and Democrats more than Republicans on healthcare, Medicare and protecting the middle class.
•Support for healthcare reform is consistently understated by polls – 10 percent of voters both do not think the current law goes far enough and do not support the ACA.
•Not only do voters soundly reject the Republicans’ proposed changes to Medicare, they are also just as concerned that the GOP’s proposed Medicaid cuts would impact 80% of nursing home residents and that the plan would allow insurance companies to continue to deny coverage for pre-existing conditions.
•To increase support for the ACA, stress ending denials for pre-existing conditions and that members of Congress will be required to get their healthcare from the same place as millions of Americans. These consistently emerge as the most popular two benefits of the law.
•Both the attacks on the GOP budget and the positive messages on the ACA increased support for the new healthcare law, though the latter appears to be a little more effective both overall and with key audiences.

Tuesday, October 18, 2011

Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011

a useful report comparing U.S. against other countries, and between states on 42 performance measures

Monday, October 17, 2011

The Critical Role that Obama Played in Health Reform

As a result of some recent events, I have been reflecting on Obama’s role on health reform.  I am well aware that his presidency has had its limitations, especially since the Republicans took over the House.  I am also sensitive to some of the criticisms of the health reform bill. However, I feel that this bill is an outstanding bill that is the best that we could have gotten out of any Congress and the forces that effect their decisions.  There are so many positive features and there are so many potentials features to still unfold that the public has not been able to appreciate.  Obama played a key role in passing this bill as he outlined the main points he wanted to see in the bill, but allowed Congress to take the lead as that is a lesson he learned from the Clinton administration which had taken too much of the lead. 
Below is a summary of what I see as the elevator talk that one can give on the bill and a somewhat more detailed summary that I have prepared.  Unfortunately, the Republicans have sold the public a bunch of myths that are not true.  For instance, it is not a government takeover.  Partly because of the myths, many in the public turned against the bill and voted the Republicans and the tea party into power in the House.  Part of this is an overreaction to the idea of too much government and loss of freedom, part of this is resentment against government support for poor people.  Poor people deserve to suffer in this view. Obama is the first president in 100 years to get health reform passed. This is a tremendous accomplishment and we cannot allow this to be repealed by a Republican President.
We need to figure out how to turn this around. I still feel that we need to do a better job of selling this bill.  We need to take advantage of research that shows how to convince folks of the positive features of the bill and to eliminate the myths/misconceptions about the bill. 
We need to ensure bill is fully implemented rather than repealed by a Republican president. 

Below are key highlights and a brief summary of the bill, myths, and reasons why we need to retain this very important bill.  I just used these in a presentation on Health Reform. 

The Affordable Care Act

·       By 2014, 32 million will have health insurance who now do not  
·        The Affordable Care is not a Federal government run program as it will expand access to private insurance.
·       The non partisan Congressional Budget Office says the Affordable Care Act will reduce the deficit.
·        There are no death panels, and the Federal government is not paying for any abortion services. 
·       As of 2011
o   children  can stay on their parents insurance plan until the age of 26.
o   Children cannot be denied health insurance coverage.
o   seniors will have expanded preventive care 
o   seniors who have prescription drug plans will have reduced drug costs
o   small businesses will get a 35% tax credit to cover employees
·       In 2014, there will be a wider range of insurance choices with better coverage at better costs.


I.                  What are some of the key benefits of the Affordable Care Act

The law is already benefiting many Americans:

·       o Children can stay on their parents' health plan until they turn 26 .
·       o Insurance companies cannot deny or cancel children’s coverage for current or previous medical problems
o    Insurers can no longer put a dollar maximum on health insurance coverage or cancel a plan if a person gets sick 
o   Seniors who have Medicare prescription drug plans and have high prescription drug costs now will pay less for these drugs, and by 2019 all prescription drug costs will be covered 
o   All 46 million seniors with Medicare will get coverage for several preventive services, such as yearly checkups and mammograms.
o  Small businesses get a 35% tax credit to help pay for employees' coverage. 
o    CLASS:  Community living assistance services and supports.  This is a long term care insurance program for nonmedical services.  However, the Secretary of HHS has just indicated that they cannot ensure that it is fiscally sound and will not implement.

Additional benefits and savings in 2014, when the law is fully in place:
o   32 million people who are currently uninsured will get health insurance 
o   Insurance companies won't be able to deny anyone coverage for medical conditions or place a limit on your coverage.  Now only kids cannot be denied.
·       o People who don't get health coverage at work will choose among a number of health plans, in a new marketplace run by state governments.  These will be better health insurance plans than now available, and people will pay based on their income and other financial criteria.
·       o The Act will also improve quality, make health care more efficient, and reduce the deficit.

II.                  Myths: Is there any misleading information being said about the law?
o       Charge: The law creates death panels
+ This is a totally false charge.
o       Charge: The Federal government will pay for abortions
+ The bill specifically states that no Federal funds can be used for abortion services.
o       Charge:  The law covers undocumented or illegal immigrants
+ This is a totally false charge.
o       Charge: This is program run by the Federal Government.
+ The bill specifically states that the Federal Government will not operate any new insurance programs. 
o       Charge: the law increase deficits
+ The Congressional Budget Office (CBO), which has always been regarded by both parties until now as a unbiased scorekeeper says the law will reduce the deficit by a trillion in 20 years.  This is the only time that Republicans have questioned the Congressional Budget Office. 

III.                What is the impact on businesses?
o                   Small businesses get tax credit in 2011
o                   Small businesses employees under 100 can get insurance thru exchanges in 2014
o                   Need to reduce rate of health care inflation, which is twice as high as rest of developed world, seriously hurting small and large businesses
o                   Better health care makes more productive employees which is good both for the employees and their families
o                   More health care jobs

IV.           What about the individual mandate and court challenges?

o       This is the main issue being challenged in court 
o    Requires everyone to have insurance,  same as auto insurance
·       o If a person gets sick, avoids doctors, and ends up in the emergency room, this costs everyone more money
·       o With everyone insured, it spreads the costs to everyone, and makes it cheaper for all of us
·       o If a person chooses not to get insurance, why should we bear the burden when they gets sick.
·       o As indicated the main court challenge is on the individual mandate, we won’t know until supreme court rules
·       o Congress can revise the law if the mandate is rejected

V.               What if the law is repealed?
o       Then 32 million will not have health insurance  and will have trouble getting health care. This is morally wrong, everyone is entitled to education and to health care, it is a basic right
o      Insurance companies will be able to deny if person has had previous medical condition or to set lifetime limits
o       We will have a much greater deficit, poorer quality, and less efficient care. 
We can’t let this happen

Friday, October 14, 2011

Thursday, October 13, 2011

Bonuses Tied to Medicare’s Star System Reward Insurers

this is something I had a hand in encouraging and am glad to see it being implemented.  

Summary of Benefits and Coverage Under the Affordable Care Act: Helping Consumers Understand Their Coverage Options and Benefits

This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees

Monday, October 3, 2011

Electronic Medical Records: A Silicon Valley Gold Rush

from businessweek, a useful article on electronic medical records

Long term services and the deficit

Today, I went to an alliance for health reform session on long term services and support (LTSS) (replaces the term long term care).  The panel is described:

the Alliance for Health Reform and The Commonwealth Fund are sponsoring an October 3 luncheon briefing. Panelists will be: Bob Hornyak, Administration on Aging; Cynthia Woodcock, Impaq and formerly Hilltop Institute; and Carol Raphael, Visiting Nurse Service of New York. Mary Jane Koren of Commonwealth and Ed Howard of the Alliance will co-moderate.

Very worthwhile session. While the panel did not have an asnwer to my question on what changes would they propose re LTSS and the deficit super committee, here are some of my ideas

1) Integrate the funding of medicare and medicaid.  Right now these funds are not that integrated, so that Medicare pays one set of providers or plans, and medicaid pays another set.  Somehow integrate the payment systems, either medicare funds go to medicaid plans and providers or visa versa. 

2) Pay for chronic care/LTSS through managed LTSS.  Ensure that there are bonuses, e.g., pay for performance, for better quality of care. This is especially need for dual eligibles. 

3) Do more to integrate LTSS.  Right now hospitals, nursing homes, home care, etc are not integrated very well.  We need to find ways to integrate.  Some possible ways are  to have a coordination council, or use care managers. Managed care plans could do this, but many are not setup to do so.  Integrate housing programs into the system and other delivery services, e.g, meals, transportation, etc. 

4) Provide more incentives for individuals and families to purchase long term care insurance.