Friday, March 29, 2013

Talk of Medicare Changes Could Open Way to Budget Pact

Talk of Medicare Changes Could Open Way to Budget Pact

This appears to be a major change proposed by the administration, which Obama first made in 2011.  This is a very significant change and appears from the article to be gaining much traction recently.  While the proposal makes a lot of sense, I am concerned that the increase in the deductible for physician office visits and related part B services will be a significant increase to many beneficiaries.  This could discourage the use of such services.  I hope a way is figured out to reduce the proposed increase for such services.  The overall concept of combining parts A and B seems very appropriate.  What do you think? 

Saturday, March 23, 2013

3rd anniversary and related items

This blog captures a number of thoughts as we celebrate the 3rd anniversary of Obamacare.

  1) This video from Kaiser is wonderful 
   2)      Here are a set of blogs from Secretary Sebelius for the 3rd anniversary
   3)      Here is an article that raises issues re Obamacare

Health-care law uncertainty grips Old Town Alexandria cafe — and other small businesses

4) Kaiser Poll: Public still does not understand Obamacare

As indicated in this blog

I am particularly looking for ideas on how to educate consumers more effectively on Obamacare.  This is critical!! 

I hope to develop such a project and welcome any ideas and advice, including persons who might be good to work with on such a project or ways to find such ideas and persons.

5) This blog posting discusses

1) The high price of health care; 2) Obamacare priorities

The good news is that health care inflation has lower the last 4 years than previous years.  What is not fully known is how much Obamacare is contributing, but it is speculated that it is playing a factor.   If nothing else it builds on the trends by encouraging more work on accountable care organizations, pay for performance, etc.  that are contained in the bill.

6)      These blog entries contain useful info on explaining Obamacare.

Summary of Key Benefits and Myths re Obamacare

This was written in October 2011, so does not take into account the Supreme Court decision. 

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:

·       Children can stay on their parents' health plan until they turn 26 .
·       Insurance companies cannot deny or cancel children’s coverage for current or previous medical problems
·       Insurers can no longer put a dollar maximum on health insurance coverage or cancel a plan if a person gets sick
·       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
·       All 46 million seniors with Medicare will get coverage for several preventive services, such as yearly checkups and mammograms.
·       Small businesses get a 35% tax credit to help pay for employees' coverage.
·       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:
·       32 million people who are currently uninsured will get health insurance
·       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.
·       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.
·       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?
·       Charge: The law creates death panels
Ø This is a totally false charge.
·       Charge: The Federal government will pay for abortions
Ø The bill specifically states that no Federal funds can be used for abortion services.
·       Charge:  The law covers undocumented or illegal immigrants
Ø This is a totally false charge.
·       Charge: This is program run by the Federal Government.
Ø The bill specifically states that the Federal Government will not operate any new insurance programs. 
·       Charge: the law increase deficits
Ø 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?
·                   Small businesses get tax credit in 2011
·                   Small businesses employees under 100 can get insurance thru exchanges in 2014
·                   Need to reduce rate of health care inflation, which is twice as high as rest of developed world, seriously hurting small and large businesses
·                   Better health care makes more productive employees which is good both for the employees and their families
·                   More health care jobs
IV.           What about the individual mandate and court challenges?

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

V.               What if the law is repealed?
·       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
·       Insurance companies will be able to deny if person has had previous medical condition or to set lifetime limits
·       We will have a much greater deficit, poorer quality, and less efficient care. 
·       We can’t let this happen

Thursday, March 21, 2013

Kaiser Poll: Public still does not understand Obamacare

The latest Kaiser polls show that 3 years after passage of Obamacare, most Americans still do not understand the laws major provisions.  With less than a year to implementation of most of the major provisions of the law, 57% of Americans do not understand the law.  An even greater percent applies to low income and uninsured groups who will benefit the most.  Awareness of the law has declined even further over time since the law was passed.   Further, the public do not know whether or not their state has made a decision about Medicaid expansion and agreed to implement a health insurance exchange.

What disturbs me is that when folks participate in focus groups, in which the provisions are explained, they have a much more favorable attitude towards the law.  Thus, there is a great need for much more education.  So far, I have not seen any comprehensive plan to educate the consumers

I would be very interested in comments on this.

I am particularly looking for ideas on how to educate consumers more effectively on Obamacare.  This is critical!

I hope to develop such a project and welcome any ideas and advice, including persons who might be good to work with on such a project or ways to find such ideas and persons.

Thursday, March 14, 2013

1) The high price of health care; 2) Obamacare priorities

this blog covers

1) The high price of health care and possible solutions

2) Obamacare priorities

I.   The high price of health care and possible solutions
A complex ecosystem of costs in health care

this article was in the washington post on 3/14/13

points out the incredible variations within a region on health care prices for MRIs, doctor visits, and many other aspects of the health care system.  The article is based on the work of Gio Colella, CEO, Castlight Health

This paper fits in very well with a program sponsored by the Center for American Progress (CAP) entitled


The High Price of Health Care

A Conversation with Steven Brill

This program builds on Brill's special issue in Time Magazine

 Bitter Pill: Why Medical Bills Are Killing Us

The program included Brill, Colella, and Ezekiel Emanuel who contributed key parts of the Affordable Care Act. 

Brill papers discusses both the wide variations in prices, and also the large profits and salaries for executives and practitioners in the medical care field.  Further these prices are increasing in health care while other prices remain constant. 

The speakers proposed the following key solutions to reducing these inequities:

  • Expand competitve bidding based on price and quality

  • Increase transparency as to price and quality.  The above articles drive this point very well re prices.   

  • The health exchanges will put pressure on the providers to control prices.  

  • An all payor system

    Other ideas that were discussed

  • Malpractice reforms

  • Limit self-referrals

  • Improved care for chronically ill

  • More prevention through public health systems

  • More consumer education

    Here are my thoughts

  • Test and evaluate accountable care organizations

  •  Test and evaluate integration of services such as post acute services

  • Examine options for alternatives to the high costs to the last year of life and end of life care. 

  • Expanded use of electronic health records and greater integration of the different systems.

  • Integration of payments and services for dual eligibles

    Here is an earlier blog that I wrote on this topic. Particularly see the CAP paper. 

    Medicare and Deficit Reduction, Health Reform Strategic Plan 

    II. Obamacare priorities 

     I would be very interested in thoughts from each of you as to the next key steps to implementing Obamacare.  My guess would be how well the Health exchanges get off the ground is one key. Obviously there will be successes and failures in terms of getting the information out, enrollment, and the quality of the plans.   What other keys are there that the administration and the health care field need to focus on.