Common Dreams | 'Medicare for All' Only Way for Trump to Keep Healthcare Promises Common Dreams But "single-payer reform could," write the co-founders of Physicians for a National Healthcare Program (PNHP). "Such reform would replace the current welter of insurance plans with a single, public plan covering everyone for all medically necessary ... |
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'Medicare for All' Only Way for Trump to Keep Healthcare Promises - Common Dreams
LONDON While most people born in rich countries will live longer by 2030 with women in South Korea projected to reach nearly 91 Americans will continue to have one of the lowest life expectancies of any developed country, a new study predicts.
Scientists once thought an average life expectancy beyond 90 was impossible but medical advances combined with improved social programs are continuing to break barriers, including in countries where many people already live well into old age, according to the studys lead researcher, Majid Ezzati of Imperial College London.
I can imagine that there is a limit, but we are still very far from it, he said.
Ezzati estimated that people would eventually survive on average to at least 110 or 120 years. The longevity of South Korean women estimated in 2030 is due largely to investments in universal health care, he said. South Korea also led the list for men.
Its basically the opposite of what were doing in the West, where theres a lot of austerity and inequality, he said.
Ezzati and his co-authors used death and longevity trends to estimate life expectancy in 35 developed countries. The calculation is for a baby born in 2030. The study was published online Tuesday in the journal Lancet.
Women were ahead of men in all countries. Behind South Korea, women in France, Japan, Spain and Switzerland were projected to live until 88. For South Korea men, life expectancy is expected to reach 84. Next were Australia, Switzerland, Canada and the Netherlands at nearly 84.
At the bottom of the list: Macedonia for women at nearly 78, and Serbia for men at about 73.
While some genetic factors might explain the longevity in certain countries, social and environmental factors were probably more important, Ezzati said.
The study estimated that the U.S., which already lags behind other developed countries, will fall even further behind by 2030, when men and women are projected to live to 80 and 83. American women will fall to 27th out of 35 countries, from their current ranking of 25, and men will fall from 23rd to 26th.
The researchers note that among rich countries, the U.S. has the highest maternal and child death rates, homicide rate and is the only high-income country without comprehensive health care. The researchers also predicted how much longer 65 year olds in 2030 would live; they guessed that among men, those in Canada would live the longest, surviving another 23 years. Among 65-year-old women in 2030, they estimated that South Koreans would live the longest, another 28 years.
In an accompanying commentary, Ailiana Santosa of Umea University in Sweden wrote that the projections raise crucial issues about which strategies are needed to tackle worsening inequality problems.
Achieving universal health coverage is worthy, plausible and needs to be continued, she said.
The study was paid for by the U.K. Medical Research Council and the U.S. Environmental Protection Agency.
Originally posted here:
Want to live longer? Move to a country with universal health care, study finds - The Mercury News
Brandon Rittiman, KUSA 7:08 PM. MST February 21, 2017
(Photo: American Action Network)
KUSA - While we haven't seen a concrete plan from Republicans to replace Obamacare, the replacement is already getting rave reviews -- at least in TV ads supporting GOP members of Congress.
The "American Action Network," which doesn't disclose its donors, is running one such ad in Colorado.
It's technically an issue ad, suggesting you call Congressman Mike Coffman to give him an "attaboy" for working on healthcare.
CLAIM: Our healthcare system isn't working. Mike Coffman has a plan to fix it. VERDICT: Overstatement
Mike Coffman doesn't have a plan to replace Obamacare, but his staff points out he "does have some very specific principles that he expects to see included in the plan to replace the Affordable Care Act."
That is not the kind of thing you'd write if the plan was actually done.
In fairness to Coffman, this isn't an ad *he* made.
But he is meant to benefit from it.
And if the ad is a bit over-the-top in singing Coffman's praises about changing healthcare laws-- well, at least he's got plenty of company.
This same ad is running claiming that several other congressional Republicans also have plans in TV ads running in other states.
Theres also a generic version that simply promises Republicans have a plan.
And the group cut versions of the ad with the same visuals, but with scary music and a more somber voiceoverattacking Democrats who supported Obamacare.
So the key message here is that whatever Republicans come up with, the American Action Network group thinks it's gonna be great.
CLAIM: [Obamacare has led to] rising premiums and deductibles. VERDICT: True, but needs context
It's true premiums and deductibles have increased since Obamacare, but this needs a little context: premiums and deductibles were also increasing before Obamacare.
CLAIM: [Obamacare has led to] Washington intruding between doctors and patients. VERDICT: Too vague to test
Without a more specific claim, this is too vague for us to factcheck.
One could argue this has been the case for more than a century-- since the first time Congress passed a law on healthcare.
CLAIM: [Obamacare has led to] expensive mandates that destroy jobs. VERDICT: Fair
While the ad-makers can point to a study from their own think tank, we can look at more neutral sources to find evidence to support this claim.
The New York fed surveyed companies and found roughly one in five cutting jobs in the service and manufacturing sectors in response to Obamacare.
There's also evidence a relatively small number of workers were dialed back to part time due to the A-C-A.
Despite all that, it's worth pointing out that the national jobs reports have been steadily improving with the broader economic recovery.
The idea that we can experience job growth and the idea that healthcare policy might cause some companies to dial back on their hiring plans are not mutually exclusive.
PROMISES, PROMISES
The ad goes on to make several promises about what will be in the new plan, which does overlap with what congressman Coffman's office told us he wants to see.
Many of the promises in the ad mirror policies already enacted by Obamacare, such as addressing pre-existing conditions, tax credits to help people buy insurance, and targeting small businesses to pool their resources.
Coffmans office told us he wants to keep the changes Obamacare made for pre-existing conditions, the ability for parents to keep children on their plans until age 26, and maintaining coverage for people who gained it under the ACAincluding the Medicaid expansion, which has been criticized by some of Coffmans fellow Republicans.
In any case, we've seen some G-O-P proposals to replace Obamacare, but since they haven't settled on one we can't really fact check those promises yet.
BOTTOM LINE
And that gets us to the bottom line: this ad is glossing over the fact Republicans have yet to unite behind a plan on healthcare in an effort to make you think it's going to be awesome, no matter what plan they end up with.
( 2017 KUSA)
Original post:
Truth Test: Does Coffman have a plan to fix healthcare? - 9NEWS.com
Health insurance reform will be high on the agenda as the U.S. House of Representatives reassembles after Presidents Day. Cutting through the high-decibel pitches from supporters and critics of the Affordable Care Act (ACA), experts discern a leaner alternative taking shape.
A Republican policy brief notes that under the ACA, or Obamacare, premiums have risen an average of 25% this past year and that nearly a third of all U.S. counties have uncompetitive markets with only one insurer offering plans. It faults the Medicaid program for being too bloated and rendered less effective by fraud, waste, poor oversight and by being misdirected at able-bodied people instead of more vulnerable sections of the population.
The Republican plan put forth last week offers an alternative, promising lower costs, more choices and flexibility for employers in the plans they may offer and also for individuals, who would be able to buy insurance across state lines and also obtain coverage regardless of age, income or pre-existing medical conditions.
Highlights of the Republican plan include: portable, monthly tax credits that can be used towards buying insurance, and that are not tied to employers or to a government-mandated program. Individuals can use the credits to shop for health insurance plans across state lines. It includes a measure to expand Health Savings Accounts (HSAs), which would offer more freedom for contributions by individuals and their spouses, and more flexibility in terms how they spend their savings.
It promises Medicaid reform by empowering states to design their own plans and by putting the program on a tighter budget, something critics read to mean sharp cuts in federal funding with block grants to states to run Medicaid, many of whom would want to make cuts overall. The policy brief offers no details as yet, but that is because the Congressional budget office is reviewing the plan. The latest proposals are based on House speaker Paul Ryans plan that he unveiled last year.
The biggest detail is the little question of money, said Robert Field, Wharton lecturer and professor of law and health management at Drexel University. He referred specifically to a proposal to grant tax credits based on age instead of income: How big they will be everyones expecting they will be less generous than under Obamacare. Age-based tax credits would replace the ACA feature where subsidies kept pace with premium increases so that employees could continue to afford them. Delinking those subsidies from income criteria and linking them with age changes those protections.
Katherine Hempstead, senior advisor to the executive vice president at the Robert Wood Johnson Foundation, pointed to what she described as two semi-contradictory things going on at once. On one hand, the motivation in changing the age rating could allow insurers to charge more for older people and charge less for younger people, she said. At the same time, subsidies for older people are aimed making health insurance more affordable to them, she added.
Do the taxpayers want to be moderately generous to many or highly generous to a few? Mark Pauly
The hope then is that policies for younger people would be affordable enough, and the take-up rates of people buying those policies would improve, said Hempstead. But she didnt expect the Republican alternative to pan out exactly that way. Many people suspect that the lower-income part of the market is going to drop out, she noted. That is going to have huge implications for the risk pool if that happens. I dont know how affordable these policies will be for anybody.
Field and Hempstead discussed the pros and cons of the Republican health care proposals on the Knowledge@Wharton show on Wharton Business Radio on SiriusXM channel 111. (Listen to the podcast at the top of this page.)
Age vs. Income
At first glance, the move to link subsidies to age and not income seems the right approach. The reason to have subsidies independent of income is to avoid the relatively high implicit tax on income of Obamacare recipients when your subsidy goes down as your income goes up, said Mark Pauly, Wharton professor of health care management, and business economics and public policy. He noted that the implicit tax rates were above 100% for some groups.
However, making the subsidy a flat amount regardless of income at a level that still provides adequate help to lower-income people could have adverse effects, according to Pauly. It means very high additional taxes which also discourage work effort of everyone, not just the 3% of the population buying in exchanges, he said. Or you can set the subsidy low which keeps taxes down but will leave more low income people uninsured. That situation would arise because the premium those low income people would have to pay will be much more than the average amount they would have to pay if they were uninsured and received charity care, he explained.
So they have a serious dilemma, Pauly noted. Do the taxpayers want to be moderately generous to many or highly generous [in a targeted way] to a few? And probably the credits will be claimed more by the reasonably well-off rather than the lower-income people who will stay out.
Removing tax exemptions for employer-sponsored plans will be more efficient because then there will be neutral incentive for people getting insurance through their job or in the individual market, said Pauly. He did not expect large firms with good benefits departments to change their policies, but it may cause some smaller firms to switch to paying more cash wages and having workers buy their insurance as individuals. He noted that individual insurance is administratively about five times costlier by than large group insurance.
Hempstead noted that the absence of penalties for not buying health insurance would not help increase take-up rates, either. If subsidies are based solely on age and not on income, you will have lower-income younger people particularly those who are 26 or 27 years old who have just moved on from their parents policies who will not be able to afford [coverage] and we will lose them from the market, she said. She saw an inherent unfairness in lower-income younger people not getting much in the way of subsidies, while older people who are quite wealthy would qualify for them.
According to Hempstead, the Republican plan is much less redistributive than the ACA is, especially as it relates to deepening risk pools to gain more efficient pricing. The market is very heavily juiced with public money, she said. If you pull a lot of that public money out, there will be consequences. Such a scenario would also bring up anti-poverty issues, she added.
An End to Employer-sponsored Coverage?
Moves to remove tax exemptions for people in employer-sponsored plans face opposition from unions and employers who use health insurance as an incentive in recruiting, but many on both sides of the political aisle see those bringing longer-term gains. The idea is that people would get more of their compensation in the form of wages and less in the form of health insurance benefits, said Hempstead. That would lead people to ultimately chart a course away from employer-sponsored insurance which after all is just an historical artifact that a lot of people have gotten used to, but there is no particular reason that your employer should be taking out your health insurance for you.
If there are a lot of really dire projections about people getting thrown out of coverage and about affordability issues, its not going to be simple. Katherine Hempstead
Hempstead pointed to arguments that reducing those tax exemptions would eventually help create a much larger and more vibrant individual market. She thought that scenario would also solve problems in making risk pools more efficient. But other people are naturally very wary about that, including large employers who see it as a major recruitment strategy and are uncomfortable about transitioning to a phase where they are not the providers of those benefits.
Field characterized that proposal as just the Cadillac tax from the ACA in another name. Under the so-called Cadillac tax that is set to take effect in 2020, insurers will have to pay an annual 40% excise tax on high-end employer-sponsored plans that have annual premiums exceeding $10,200 for individuals or $27,500 for a family. The idea is to make it less attractive to give overly generous plans which encourage people to over-use medical services, he said. [The Republicans] are taking something from Obamacare that amounts in a way to a tax increase and firing the shots in terms of making it into policy.
Hempstead noted that there is a lot of bipartisan support and empathy for this, adding that she, too, agreed with it. I thought the Cadillac tax was a move in the right direction, even if there were some other ways it could be modified.
Will Wages Really Increase?
However, employees worry that the removal of the tax exemption for their health insurance premiums may not be replaced fully by higher wages, Hempstead said. Another concern is whether they would be able to find good alternative products if they were to lose coverage from their employers. In any event, she noted that many people see the push towards employees buying their own health insurance as inevitable, although [it] isnt going to be an overnight change. She pointed to some moves already underway in the direction of direct-to-consumer markets, such as with the Medicare Advantage plans and the growth of private exchanges.
Field was skeptical about how the transition to a removal of the tax exemptions would protect employee wages. If employers stop [offering health coverage] and say they will give employees the money rather than the health insurance, would it be a one-for-one exchange? he asked. Would they give you all of the money they would have given the insurance company? I think the answer is no, but how much of it would they give you? Would workers actually see an increase in their paychecks?
Employees would be worse off in that any wage increase would be taxable, which means they would have less money on hand to buy their health insurance, Field noted. That could have the effect of leaving policies less generous than earlier. It would have a profound effect on the structure of health finance and health care provisions because the flow of money would change.
It is imperative to have a well-functioning health insurance market for those changes to work, said Field. If that is where we are going, then we better have a pretty vibrant individual market, he argued. Whatever they do to change those markets better hold up, because we are throwing people into them and if they cant buy policies there, where are they going to go?
Getting Medicaid Right
Money is again central to the plans to reform Medicaid, said Field. He noted that the Trump administration could provide states block grants to manage that program, perhaps on a per-capita basis. If they do that with enough money, maybe the system will be better, because states could innovate more, he said. If they do that without enough money, which is what the critics fear, this could be a major cutback and could lead to a lot of people losing their health coverage.
The outcomes of a badly run Medicaid program could be serious, according to Field and Hempstead. Field notes that Medicaid is unloved; everyone likes to take hits at it, but it is the backbone of our safety net hospitals, of our pediatric hospitals. Its influence is beneath most peoples radar, but its throughout the system, so if you tinker with it, a lot of harm can be done. Hempstead noted that Medicaid is the single-biggest category with 72 million people enrolled in it. Its a huge lifeline for a lot of providers and [has] widely different beneficiary groups, she said. [They are] kids, pregnant women and healthy adults, but also some very sick people, the aged and disabled.
If there is a way to provide more coverage for less money, then [Trump has] got a brand new business line, even better than resorts and hotels. Robert Field
A policy of caps on per-capita funding for Medicaid must consider how appropriate it is for groups with varying per-capita expenditures, and how those patient populations grow over time, Hempstead said. You can think about some really bad scenarios, especially for the very vulnerable populations of the aged and disabled, and also some huge shifting of burdens on family caregivers as the programs run out of money, she added. She noted that many states expanded their Medicaid offerings in recent years to fix deficiencies. Now you can imagine a lot of transitions that wont necessarily bode well for vulnerable people.
The Road Ahead
Health insurance costs could also be tamed by people adopting healthier lifestyles, Field said. He noted that the ACA included provisions to encourage prevention, including making preventive services available with no co-pays or deductibles. It also fostered innovation in payment models. For example, providers get incentives where they are rewarded more for the health of their population than for the number of services that they provide.
But achieving all that is not easy, Field said. How do you change behavior? Were not going to shut down McDonalds, were not going to outlaw cigarettes, and were not going to force you to go to the gym, he explained. There are limits to how far the nanny state can go. Additionally, even if people make those lifestyle changes, it would take 20, 30 or 40 years before their effects are seen on the health care system, he added.
More on the immediate horizon, Hempstead said there is no certainty that the Republican proposals would become reality. Its not clear there are the votes for this, she added. If there are a lot of really dire projections about people getting thrown out of coverage and about affordability issues, its not going to be simple. Field said he expected heated debates in the town hall meetings over the proposals. A lot of people now are scared and angry that they will lose their health coverage, and that will have a big effect on what Congress ends up doing.
Field, too, is not sure the Trump administration will find a way to make the various disparate objectives of the new plan coalesce into a workable alternative. If [Trump] has a magic formula, then that is amazing, he said. If there is a way to provide more coverage for less money, then hes got a brand new business line, even better than resorts and hotels. If he can do it, great, but [it is] just a little bit dubious. Added Hempstead: Were taking public money out of the market, which is not going to bode well for people that get coverage and for the markets to really thrive.
Continue reading here:
The Republican Health Care Plan: Do the Promises Add Up? - Knowledge@Wharton
French presidential candidate Franois Fillon | Lionel Bonaventure/AFP via Getty Images
Embattled center-right candidate waters down policy proposals.
By Natalie Huet
2/21/17, 1:09 PM CET
Updated 2/21/17, 9:40 PM CET
Frances beleaguered Franois Fillon sought to win back voters Tuesday by promising free glasses, hearing aids and dentures.
The center-right presidential candidate had been widely expected to win the election in May until he tripped on plans to slash health spending, and on a major scandal over payments to his wife and children.
Eager to regain the ground that polls suggest hemay have lost to far-right leader Marine Le Pen and independent candidate Emmanuel Macron, Fillon has now seriously softened his pitch for health care reform.
There is no question of touching public health insurance, even less privatizing it or lowering its coverage, Fillon tolda conference hosted by the Mutualit Franaise, the French federation of non-profit complementary health insurers.
Fillonplans to fully reimburse eyeglasses for children starting this year, he told Le Parisien newspaper and to negotiate a new deal with private health insurers to better cover hearing aids and dental implants. The aim isto bring household out-of-pocket costs for these productsas close as possible to zero by 2022, he said.
Former economy minister Macron, who has yet to unveil a detailed campaign manifesto, was quick to point out that he had been the first candidate to promisefull reimbursement of glasses, hearing aids and dental implants in the next five years.
Theyve been telling me, you dont have a platform but somehow it gets copied, he quipped.
Macron also wantstoinvest 5 billion in over-stretched hospitals whileboosting prevention and access to primary doctors. By relying more on outpatient care,heforesees15 billion in spending cuts over five years.
Fillon initially came under fire this fall over his radical plan to limit public health insurance to serious and chronic diseases. By Christmas, he had backpedaled on the proposal, deleted it from his website and took his whole health care reform back to the drawing board.
The former prime minister still plans to slash 20 billion in health care costs over five years by focusing on efficiency gains, capping health spending growth at 2 percent per year and ensuring patients have better access to primary care doctorsso they dont rush to hospitals to seek care.
But hesought to show he was far from caricatures and open-minded about how to make Frances generous health care system more sustainable. If elected, he said he plans to call a major conventionat the end of the year to discussits future with all the stakeholders concerned.
This article has been updated.
More:
The Cover All Kids bill now before the Oregon Legislature has worthy goals, but its likely to face strong opposition from many voters.
House Bill 2726 would ensure that all kids have access to health care as a basic human right. Currently, an estimated 17,600 children about 2 percent of children in the state arent covered for injuries, even serious ones; illnesses, including communicable ones; or preventive care.
The bill is already facing opposition on two fronts: 1) The children targeted by the Cover All Kids bill are currently uninsured because they are not legal residents. 2) This expansion of health care benefits would come at an estimated cost of $55 million over the next two years at a time when Oregon is facing a $1.8 billion budget gap.
Its hard to imagine that any Oregonian would walk by a suffering child without wanting to help or would demand to first see proof of legal residency.
But most voters arent being faced with an actual child, only the abstract idea of illegal children receiving free insurance through the Oregon Health Plan, the states version of Medicaid. To make it worse, the state would have to cover the full cost of insuring these children, as opposed to the rest of Oregons 1 million Medicaid recipients, whose health-care costs are mostly paid by the federal government.
Gov. Kate Brown told the House Committee on Health Care on Monday that money from the general fund already has been allocated for this purpose. Shes now going to have to convince legislators and voters that this is the best use for the money.
It helps that the bill has bipartisan support, but that doesnt mean its a slam dunk.
The bill and its counterpart Senate Bill 558 have been tagged with emergency clauses, which means that if they pass theyll go into effect immediately, instead of 90 days after the session ends, and cant be referred to voters.
But if voters already annoyed by the Legislatures abuse of emergency clauses in the last session are upset enough about HB 2726 and SB 558, they can still act to repeal them if they are passed. This would have to be done by forcing an initiative vote not a quick and easy process, but not an impossible one.
And voters in the past have said no to some measures that would aid illegal immigrants, such as one to allow them to have Oregon drivers licenses.
Supporters of the expansion of health care to undocumented children need to think about how to make their case to the voters by appealing not just to their emotions, but to logic and self-interest.
They need to talk about the larger cost both financial and to public health of not providing health care to almost 18,000 children. This includes preventing and treating communicable illnesses and providing care before a health issue worsens and costs more to treat or repair. Coverage also reduces the number of people who rely on emergency rooms for their care or who are unable to pay medical bills, both of which increase overall health-care costs.
Some opponents of the bills objected to them on the grounds that providing health care to children will increase illegal immigration. In reality, the majority or illegal immigrants to the United States are working-age adults, with almost two-thirds ages 25 to 44, according to procon.org, a nonprofit research organization. And illegal immigration from Mexico, the largest single source of illegal immigration to Oregon, has declined as Mexicos economy has improved, falling to a near-historic low in 2015.
If Oregonians want to decrease illegal immigration, their best option is to lobby their representatives in Washington, D.C., to maintain strong trade relations with Mexico not withhold health care from children. That hurts, not helps, the state.
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Credit: Courtesy of Rep. Darrell Issa
Above: Rep. Darrell Issa, R-Vista, is shown in this undated photo.
Aired 2/21/17 on KPBS News.
Rep. Darrell Issa, R-Vista, may not attend a town hall meeting on health care in Vista Tuesday night, but organizers said they will go ahead without him.
UPDATE: 10:43 a.m., Feb. 21, 2017
Rep. Darrell Issa (R-Vista) may not attend a town hall meeting on health care in Vista on Tuesday, but organizers said they will go ahead without him.
A coalition of local and statewide groups, including faith leaders, community health advocates and labor groups have called the town hall. They invited Issa and took out a full-page advertisement in The San Diego Union-Tribune after they did not hear back from him.
RELATED: Rep. Issa's Constituents Call On Him To Attend Town Hall On Health Care
Organizers said the event is the second in a series of statewide town halls to draw attention to the danger of repealing the Affordable Care Act without a replacement plan.
They said 300 people attended a town hall in Modesto last week, hoping to hear from their representative, Rep. Jeff Dunham (R-Turlock). He did not attend.
RELATED: Town Halls Not On The Agenda Of Most Local Congressional Reps
Earlier this month Rep. Tom McClintock (R-Elk Grove) of Northern California was met by angry crowds at a town hall and had to be escorted out by police.
Issas office said he has a prior commitment Tuesday.
Issa spokesman Calvin Moore said district staff have met with coalition members and relayed their concerns to the congressman.
Large numbers of these groups were able to participate our first telephone town hall and ask him questions directly on that call, Moore said. The congressman has written back and responded to their letters and phone calls to our office.
Issa has proposed replacing the Affordable Care Act with access to the health benefit plan that federal employees use. He released a draft of his proposal Tuesday.
In a statement, Issa said he encourages "feedback so that together we can advance a solution that protects patients, and truly puts your needs first. He said he hears every day from constituents who have lost coverage or are worried they will lose it.
"The plan Im proposing frees us from Obamacares burdens, while focusing on what works, to create a simpler, patient-centered, market-based health care alternative that puts patients back in the drivers seat of their health care, he said in a press release.
Issa has supported federal block grants that could leave states or counties responsible for much of the subsidies to make that insurance coverage affordable.
More than 370,000 San Diego county residents are enrolled in health insurance plans under Covered California or the expanded Medi-Cal coverage provided under Obamacare.
RELATED: Medi-Cal Recipients Statewide Would Feel The Pain Of Obamacare Repeal
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Town Hall On Health Care To Go Ahead With Or Without Issa - KPBS
VIDEOS: OBAMACARE, HEALTHCARE EXCHANGE ISSUESObamacare may not be replaced until next year | 1:15
When will America get a new healthcare plan? President Donald Trump is now saying it could be a year from now. Aaron Dickens reports. Buzz60
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The prospect of repeal has made Obamacare more popular than ever! Rob Smith has all the details. Buzz60
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GOP Congress Members recently introduced legislation that would give the authority to states to keep ObamaCare. Jose Sepulveda (@josesspulveda87) has more. Buzz60
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Gov. Bill Haslam is calling on Congress to cede more control over health policy and regulation to the states, as the debate over repealing or replacing the Affordable Care Act rages on in Washington. Wochit
4 of 9
Chris Kane had insurance through Community Health Alliance before it went defunct then moved to Blue Cross Blue Shield Tennessee, now will have to go to Humana. He has concerns about finding the right doctors for his family, a wife and infant. Amy Smotherman Burgess / News Sentinel
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The health care heavyweight is grappling with hefty losses and ongoing uncertainty on the marketplace. Karen Kraft / The Tennessean
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Changes to the Affordable Care Act in Tennessee Kyleah Starling/ The Tennessean
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Insurance broker Jonathan Katz of Virginia Medical Plans speaks with USA TODAY healthcare reporter Jayne O'Donnell about some the problems facing those enrolling for Obamacare. USA TODAY
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Five states are expected to have just one company selling insurance on the 2017 Obamacare exchanges and consumers in most of the counties in nine other states won't find any competition for their exchange business either. Martin E. Klimek, USA TODAY
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Obamacare may not be replaced until next year
Why Obamacare is more popular than ever
Potential GOP ObamaCare replacement wouldn't really 'replace' it
Haslam: States need more control over health care
BCBST departure from 3 metro areas
BlueCross BlueShield of Tennessee is leaving the Obamacare marketplace
Obamacare Exchange 'Very Near Collapse'
Obamacare exchanges still troubled by enrollment issues
As insurance companies dwindle, patients left frustrated with lack of choice
Christa Dansereau, far right, is concerned about how her family will be able to buy health insurance in 2018 since Humana has left the healthcare.gov exchange. Dansereau is considering looking for a new job with the top priority being health insurance benefits.(Photo: Submitted by Christa Dansereau)
WithTennessee's healthcare.gov market for 2018 at a breaking point, some are ramping up calls on federal lawmakers to take action to make sure people aren'twithout health insurance options next year.
Since Humanas decision last week to leave the federally run exchange, the Tri-Cities area is the only region of the state that will have two insurers from which residents can choose in 2018. The Greater Knoxville area will have none.
Yet,without progress on repeal-and-replace or repair of the Affordable Care Act in Washington, D.C., the exchange's existence in the state beyond 2017 will depend on business decisions by insurers BlueCross BlueShield of Tennessee and Cigna.
And there could come a point at which there is one insurer or none.
If Cigna leaves, Memphis and Nashville will have no on-exchange option.If BCBST leaves, then dozens ofcounties will have no insurer on the exchange from which to buy.
Humana exit shakes up 2018 ACA exchange, leaves Knoxville coverage gap
They dont even have to change legislation they are creating chaos. They are playing games while real Tennesseans are sitting around their kitchen tables worried about their health care," said Michele Johnson, executive director of the Tennessee Justice Center, which advocates for health care and coverage. "Its time for them to govern.
The number of people who enrolled in 2017 plans on the federally run exchange the market that offers tax subsidies to offset premiums for more than 80 percentof peopleis about 3.5 percent of Tennesseans. The number that is eligible is roughly twice that.
Its a small slice of the state most people get employer-sponsored coverage but many rely on the exchange and its tax credits to buy coverage. For some with pre-existing conditions, the Affordable Care Actgave them the opportunity to get coverage.
Even one decision from BCBST or Cignawill propel peopleinto a situation similar to Christa Dansereau, a married mother of three in Knoxville who is wondering where she's going to buy insurance in 2018 since Humana left the exchange.
Sheworks at a preschool and her husband is a real estate agent,and neither has access to employer-sponsored coverage. With three kids, one with a life-threatening nut allergy, going without coverage is not an option.
I am seriously considering changing jobs and looking only at companies that offer health insurance. It is a big life decision," Dansereau said. "It is not one I want to do because I like to teach preschool, but I have to put my family first."
Her family has shopped for private insurance for years and the ACA brought some relief, she said, to the years of high deductibles and being concerned about pre-existing diseases. The increases in premiums and deductibles in recent years didn't impact Dansereau's family because the coverage was better than what the family had before the ACA.
McPeak: 'Timing is critical' for Congress to stabilize individual health insurance
"It wasnt until we were able to shop on the marketplace we didnt have to be concerned every time we went to the doctor," she said.
As days turn to weeks without a repair or replacement plan from Republican lawmakers in Washington who campaigned on repeal-and-replace insurers are getting cold feet and shoppers are anxious about whether they will have insurance options next year.House Speaker Paul Ryan, R-Wis., said a proposal would emerge from congressional Republicans as early as this week.
Even action in the coming weeks might not keep insurers on the market. If lawmakers delay enacting a replacement plan until after midterm elections in 2018, people could be left with no options on the market, something many, including U.S. Sen. Lamar Alexander, R-Tenn., have repeatedly warned.
Alexander urgedCongress to heed the developments in Tennessee as a reason to take swift action to keep insurers on the exchange through 2018.
Activists for the ACA willholdrallies or panels around the state this week as the impact of federal uncertainty begins to take hold.
More than two-thirds of Tennesseans oppose repealing the Affordable Care Act, according to a poll by Public Policy Polling in Januarycommissioned by the Alliance of Healthcare Security, a group that supports the federal law.
With Obamacare repeal, devil is in the details for Nashville companies
Proponents of the ACA are expected at an "alternative town hall" outsideU.S. Rep. Marsha Blackburn's town hall in Fairview on Tuesday. Blackburn, R-Tenn., is expecting ACA questions at the one-hour event, according to a spokeswoman.
The "Save My Care" national bus tour will make a stop in Nashville on Wednesday at Centennial Park. Protesters are expected to walk to the Nashville offices of Alexander and U.S. Sen. Bob Corker.
Dr. Thomas Phelps is trying to get his concerns about the chaos in Tennessee heard by the state's federal lawmakers deciding to give Twitter a shot.
Im worried for my patients because the chaos caused by the Republican rush to repeal the Affordable Care Act is already harming Tennesseans, like causing Humana to leave the market," Phelps said in a statement.So Im reaching out the only way President Trump, Sen. Alexander, and Sen. Corker seem inclined to communicate: via Twitter.
On Thursday, there will be a town hall in Knoxville as well as a forum in Chattanooga.
Dansereau said she's very frustrated that she may have to resort to finding a new job.
"The two major problems: being able to have health care and also being afraid of pre-exiting conditions having those be the most important of my job search feels ridiculous," Dansereau said. "It isa (situation) that is going to impact a lot more people than just me and my family.
Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.
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Amid health care 'chaos,' Tennesseans push lawmakers for assurances - The Tennessean
As President DonaldTrump begins his second month in office, his team is trying to move past the crush of controversies that overtook his first month and make progress on health care and tax overhauls long sought by Republicans.
Both issues thrust Trump, a real estate executive who has never held elected office, into the unfamiliar world of legislating. The president has thus far relied exclusively on executive powers to muscle through policy priorities and has offered few details about what he'll require in any final legislative packages, like how the proposals should be paid for. The White House also sent conflicting signals about whether the president will send Congress his own legislative blueprints or let lawmakers drive the process.
White House chief of staff Reince Priebus told The Associated Press that he expects a health care plan to emerge in "the first few days of March." Pressed on whether the plan would be coming from the White House, Priebus said, "We don't work in a vacuum."
On Sunday, White House advisers held a three-hour meeting on health care at Trump's South Florida club, their third lengthy discussion on the topic in four days. Gary Cohn, the former Goldman Sachs banker now serving as Trump's top economic adviser, and newly sworn in Treasury Secretary Steve Mnuchin have been leading talks with Republican lawmakers and business leaders on taxes. Neither man has prior government experience.
Republicans long blamed Democrats for blocking efforts to overhaul the nation's complicated tax code and make changes to the sweeping 2010 health care law signed by President Barack Obama. But with the GOP now in control of both the White House and Congress, making good on those promises rests almost entirely with the president and his party.
To some Republicans' chagrin, both issues were overshadowed during Trump's first month. The president spent more time publicly fighting the media than selling Americans on his vision for a new health care law. Fresh questions emerged about Trump's ties to Russia, particularly after national security adviser Michael Flynn was fired for misleading the White House about his conversations with a Russian envoy. The White House botched the rollout of a refugee and immigration executive order, Trump's most substantive policy initiative to date, and the directive was quickly blocked by the courts.
Priebus said the distractions did not slow down work happening behind the scenes on the president's legislative priorities.
"Obviously with the White House staff, you're able to walk and chew gum at the same time," Priebus said. "The economic team isn't screwing around with the legal case and the lawyers aren't screwing around with tax reform."
One of the biggest questions on Capitol Hill is how involved Trump plans to be in legislative minutia. One GOP leadership aide whose office has been working with the White House described the president as a "big picture guy" and said he expected Trump to defer to Capitol Hill on health care in particular. The aide was not authorized to speak publicly and insisted on anonymity.
Priebus said he expects Congress to pass both a tax package and legislation repealing and replacing Obama's health care law by the end of the year. But the White House's outward confidence belies major roadblocks on both matters.
After spending years criticizing "Obamacare," Republicans are grappling with how to replace it and pay for a new law. While some lawmakers worry about getting blamed for taking health insurance away from millions of people, others worry the party won't go far enough in upending the current system.
"My worry now is that many people are talking about a partial repeal of Obamacare," Rep. Rand Paul, R-Ky., said. "If you only repeal part of it and you leave it some sort of Obamacare light, which some are talking about, my fear is the situation actually gets worse."
Trump has said he wants to keep popular provisions like guaranteeing coverage for people with pre-existing medical conditions and allowing young people to stay on their parents' insurance plans until age 26. He's also raised the prospect of allowing people to buy insurance across states lines, which is not part of the law.
On taxes, Republicans have a potentially more vexing impasse. House Republicans want to scrap the 35 percent tax on corporate profits, which is riddled with exemptions, deductions and credits, and replace it with a "border adjustment tax." The system would tax all imports coming into the U.S., but exclude exports from taxation.
House Speaker Paul Ryan's office has been vigorously promoting the idea to Trump, who has called the system "too complicated." Some House aides have privately voiced optimism that the White House is coming around, though Priebus would only say that border adjustment was "an option we're all discussing and debating."
The president has said he plans to release a "phenomenal" tax plan in the coming weeks.
Published 3 hours ago | Updated 13 minutes ago
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President Trump Turning to Health Care, Tax Overhaul in Second Month: Analysis - NBC 7 San Diego
Peggy Kearns keeps the motto of the Department of Veterans Affairs, coined in 1865 by President Abraham Lincoln, front of mind as she works to ensure that military veterans in Southern Nevada receive prompt, quality medical attention: Care for him who shall have borne the battle and for his widow, and his orphan.
But Kearns, director of the Veteran Affairs Southern Nevada Healthcare System, said living up to Lincolns edict in his second inaugural address is challenging, despite a $464 million annual budget.
The biggest problem, she said, is recruiting and retaining doctors and health care professionals in an area thats short of them.
Were working on our access challenge by looking at our processes and how we can be more efficient in using our staff, our physicians and how we schedule people, she said. Everyday we track how we are getting people in, and how fast were getting them in, and looking at how we can do that quicker and better.
Kearns, speaking Thursday to the Military Officers Association of Americas Southern Nevada Chapter, said she and the VA staff at the North Las Vegas VA Medical Center and satellite clinics in Laughlin and Pahrump are nonetheless making progress in reducing appointment wait times.
Average wait times for primary care decreased from 9.91 days a year ago to 5.71 days as of Feb. 1, while specialty care remained virtually unchanged at 14.57 days. The district offers same-day access in primary care and mental health for vets with urgent needs.
The declines come amid a growing caseload for the VA district that serves 158,000 veterans who live in Clark, Nye and Lincoln counties, as well as parts of southern Utah, northern Arizona and southeastern California.
The number of outpatient appointments has increased 72 percent since fiscal 2011, reaching 857,295 in 2016, Kearns said.
EXCEEDING EXPECTATIONS
And more than 59,000 individual veterans were treated in the Southern Nevada VA system last year, a total that already exceeds the projection that the district would treat 55,000 veterans by 2022.
Those numbers serve as a Presidents Day reminder how far the VA system has come since Lincolns address on March 4, 1865, when his intent was to bind up the nations wounds from the Civil War.
The federal government authorized its first medical facility for veterans 54 years before Lincoln promised to expand care to all veterans.
Now the collection of what were originally known as old soldiers homes is a much more elaborate system of health care facilities more than 1,200 in all in all 50 states, as well as Puerto Rico, Guam and the Philippines, serving 8.9 million veterans.
We are the largest integrated health care system in the United States, some say the world, Kearns said.
The VA expanded locally with the 2012 opening of the North Las Vegas VA Medical Center, dubbed the crown jewel of the network by then-VA Secretary Eric Shinseki because it was the first major VA hospital built in 20 years.
Two years later, however, the nationwide VA scandal over wait times erupted. Long appointment wait times in Phoenix and other VA facilities, including the North Las Vegas hospital, forced Shinseki to resign. His successor, Robert Bob McDonald, vowed to change the VAs culture and improve access to health care.
Under the Trump administration, Kearns predicts former VA Undersecretary of Health David Shulkin unanimously confirmed Feb. 13 as VA secretary will carrys McDonalds torch for better access and a veteran-friendly culture.
Contact Keith Rogers at krogers@reviewjournal.com or 702-383-0308. Find him on Twitter: @KeithRogers2
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Local VA health-care chief thinks of Lincoln as she whittles wait times - Las Vegas Review-Journal
SALEM When an errant baseball hit her in the face years ago, Fatima Preciados lip split. Soon, the 8-year-olds cut became infected.
Preciados mother tried to clean the cut with rubbing alcohol and heal it with ointments, but never took her to a doctor. Without health insurance, those types of house remedies were often the only medical treatment her family could turn to, Preciado said.
Norma Baltazar says she struggled for years to get dental health care for her young son, Raul. Finally, when a molar in the back of his mouth grew too painful, she rushed him to the emergency room. Without health insurance, she had to pay $900 to have the tooth removed.
Both Preciado and Baltazar are unauthorized immigrants, having separately come to the United States from Mexico more than a decade ago.
Today, Preciado is an 18-year-old Portland State University student and a so-called Dreamer, having secured a work permit and deportation deferral under former President Obamas DACA program.
Baltazar, a Salem house cleaner, brought Raul to America when he was only 3, making him an unauthorized immigrant as well. Shes since had another child, a daughter, who, by virtue of her birth of U.S. soil, is a legal U.S. citizen.
Now, both women are advocating for a new state law, dubbed Cover All Kids by supporters, that would extend government-funded health insurance in Oregon to many unauthorized immigrants under the age of 19.
The proposal would give government-funded health insurance to an estimated 17,600 unauthorized immigrants, at a cost of $55 million in the biennium that starts July 1. Critics blast the concept and the price tag, especially given state governments cash crisis.
But supporters say its a humane and sensible idea.
My mom always was scared that I would get hurt or get sick because we didnt have insurance, Preciado said of her childhood. I just wanted to play.
Kids dont worry about getting hurt, they dont understand, she added.
The proposed policy would let those young immigrants receive free health insurance through the Oregon Health Plan, the states version of Medicaid, if their families make less than 300 percent of the federal poverty level.
Thats the same eligibility requirement as that for an Oregon minor who is a legal resident now, and it translates to an annual income of $73,000 for a family of four. The coverage would apply only to the unauthorized immigrant children of the household, not the adults.
Faces opposition
The proposal is backed by Gov. Kate Brown, House Speaker Tina Kotek, a Portland Democrat, a contingent of Democratic and Republican state legislators, and many Oregon health care providers.
Similar policies are in place in California, Washington, New York, Illinois and Massachusetts.
Still, the costly proposal in Oregon faces significant headwinds this session as the state must close a $1.8 billion budget gap a hole thats in large part the result of the growing cost of the Oregon Health Plan for legal Oregon residents.
Senate Bill 558 and House Bill 2726 would make 17,600 noncitizens newly eligible for the Health Plan, according to early estimates.
The state would have to cover the full cost of their health insurance, a projected $55 million in the 2017-19 budget. Thats different than for the rest of Oregons 1 million-strong Medicaid population, where the federal government picks up most of the tab.
The policy and its cost anger opponents of illegal immigration.
We have a state that thinks it has a $1.8 billion budget gap and yet were considering giving more state benefits to thousands of illegal immigrants, said Jim Ludwick of Oregonians for Immigration Reform. It boggles the mind.
Ludwick said his group doesnt want any harm to come to children. But, he added, the bill, if passed, could well be the foot in the door for Oregon Health Plan coverage to be extended to unauthorized adult immigrants as well.
Despite progressive stances on many social issues, Oregon voters have sometimes resisted policies favoring unauthorized immigrants. In 2014, they thrashed, by a 2-to-1 ratio, a proposal to grant them short-term driving licenses.
Emergency clauses
SB 558 and HB 2726 both contain emergency clauses, however. That means that, if they pass, theyll go into effect immediately and couldnt be referred to voters.
Supporters say the cost of expanding Medicaid coverage to unauthorized minors would be a smart investment for the state. It would mean they could get more preventative health care, reducing their need for expensive emergency care, and allowing them to be more successful in school and later life.
Oregon children should have the opportunity to be healthy and ready to learn, and Oregon families should feel confident that a medical event will not dramatically change the trajectory of their lives, Gov. Brown told the House Health Care Committee on Monday.
Rep. John Huffman, a Republican from The Dalles, said the insurance expansion makes sense morally and economically.
Covering kids up front saves us money down the road, he added.
Patchwork of care
Both Preciado and Baltazar on Monday described a complicated patchwork of health care options available now to unauthorized immigrants. Many of them dont or cant get health insurance through work. They arent eligible for the subsidies to help people buy their own health insurance policies on the exchanges set up by Obamacare.
But unauthorized immigrants can receive primary medical care in some public schools and, for a fee, at 200 safety net community health centers around the state.
Hospitals, meanwhile, are required by federal law to provide free emergency care to all people, regardless of their residency status, when a patient is at risk of dying, losing a limb or is pregnant.
Many nonprofit groups also help unauthorized immigrants cover their regular health and dental care costs or help raise money for expensive treatments.
For example, Baltazar said Raul was recently found to have a heart condition that could eventually require surgery. She said shes already identified a church-affiliated nonprofit that might help pay for the operation.
But, she added: It still worries me. Theres no guarantee.
I dont want (Raul) to worry about how we will pay for it, Baltazar said. Any child deserves to have a healthy life.
Preciado said her older sister is intellectually disabled and prone to epileptic seizures. There were times during her childhood when the family, for weeks, couldnt afford the daily medication her sister needed, Preciado recalled.
There would be nights when I would awake from my mothers frightened screams as she watched my eldest sister uncontrollably experience an epileptic seizure, she said. It was very traumatic.
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Texans want to dump the previous presidents signature health care program, but only a small minority want to move on without replacing it, according to the latest University of Texas/Texas Tribune Poll.
If the Affordable Care Act, better known as Obamacare, were to be repealed and replaced, 68 percent of Texans said lawmakers should wait until they have a replacement plan worked out before they repeal the current law. A smaller group 23 percent would repeal Obamacare immediately and figure out the details of a replacement plan later.
That figure-it-out-first strategy is more popular with Democrats than with any other group, but a majority of Republicans and independents agree with them. Still, a third of Republicans and 45 percent of Tea Party Republicans said the ACA should be repealed immediately, even if a replacement hasnt surfaced.
Asked about the health care law generally, 52 percent said they would like to repeal it. Two-thirds of that group, asked what the next step should be, said they would replace the law with an alternative. Only 30 percent said they would repeal the law and not replace it at all.
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There are many features of the Affordable Care Act that Republicans are not opposed to; in fact, they embrace Obamacare in a number of areas, said Jim Henson, head of the Texas Politics Project at the University of Texas at Austin and co-director of the poll. Thats why you dont see a consensus around repealing without replacement or even repealing before a replacement is presented.
When you look at the large number of Republicans who want to repeal Obamacare but want to make sure there is a replacement, it underlines why Congress and the national leadership are moving cautiously, Henson said.
Thirty-five percent of Texans said the ACA should not be repealed, but only 25 percent of that group would leave the law as it is now. Most of the dont-repeal contingent 64 percent said they would expand what the law does.
Overall, 83 percent of Republicans and 18 percent of Democrats would like to see the law repealed. On the other side, 67 percent of Democrats and a scant 7 percent of Republicans would leave it be.
Regardless of party flag, Texans who want the law repealed also want it replaced, a sentiment shared by 65 percent of Republicans, 64 percent of Democrats and 77 percent of independents surveyed.
The University of Texas/Texas Tribune internet survey of 1,200 registered voters was conducted from Feb. 3 to Feb. 10 and has an overall margin of error of +/- 2.83 percentage points. The 623 Texans who wanted to repeal the ACA were polled separately about the next step; that group had an overall MOE of +/-3.93 percentage points. The 409 respondents opposed to repeal were also polled; the overall MOE was +/-6.85 percentage points. Numbers in charts might not add up to 100 percent because of rounding.
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This is one of several stories on the latest University of Texas/Texas Tribune Poll. Yesterday: What Texans think of the new president, and their views on the economy and the direction of the country and state. Coming Wednesday: Texas voters on education.
Disclosure: The University of Texas at Austin has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewedhere.
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UT/TT Poll: Texans want a health care program that's not called Obamacare - Texas Tribune
We are in the tail end of the Q4 reporting cycle, which is on track to witness the highest growth momentum in the last two years. As of Feb 17, 2017, 411 S&P 500 members, accounting for 88.4% of the indexs total market capitalization, have reported results, according to the latest Earnings Preview Their performance point to total earnings growth of 8% on 4.9% higher revenues. The beat ratio is strong with 68.9% companies surpassing bottom-line expectations and 54.7% outperforming on the top line.
Meanwhile, the earnings growth momentum is expected to ramp up in the future quarters. As per our report, total earnings for the S&P 500 companies will grow 7.4% year over year on 3.9% higher revenues. Notably, estimates for the current period (1Q17) are also looking up.
Healthcare, under the Medical umbrella, is one of the seven sectors in the S&P 500 group. So far, 83.3% of the total Medical sector companies have reported fourth-quarter results. The beat ratio is strong with 80.0% companies surpassing bottom-line expectations and 53.3% outperforming on the revenue front.
Here we take a sneak peek at two healthcare stocks scheduled to report fourth-quarter figures on Feb 21:
HealthSouth Corporation (HLS - Free Report) is the one of the nation's largest providers of outpatient surgery and rehabilitative healthcare services. The company provides these services through its national network of inpatient and outpatient healthcare facilities, including inpatient and outpatient rehabilitation facilities, outpatient surgery centers, diagnostic centers, occupational medicine centers, medical centers and other healthcare facilities.
Last quarter, HealthSouth beat the Zacks Consensus Estimate by 8.33%. This time, the company is unlikely to come up with a beat. HealthSouth an Earnings ESP of -3.18% as the Most Accurate estimate of 61 cents per share is lower than the Zacks Consensus Estimate of 63 cents. Further, the company has a Zacks Rank #4 (Sell). We caution against Sell-rated stocks (#4 or 5) going into the earnings announcement, especially when the company is seeing negative estimate revisions.
Surgical Care Affiliates, Inc. (SCAI - Free Report) operates surgical facilities, including surgery centers, surgical hospitals, and hospital surgery departments. It serves customers throughout the United States. Surgical Care Affiliates Inc. is based in United States.
Last quarter, Surgical Care Affiliates missed the Zacks Consensus Estimate by 17.5%. This time again, the company is unlikely to come up with a beat. Surgical Care Affiliates carries a Zacks Rank #4. On top of this, it has an Earnings ESP of 0.00% as the Most Accurate estimate is the same as the Zacks Consensus Estimate of 78 cents per share. You can uncover the best stocks to buy or sell before theyre reported with our Earnings ESP Filter.
You can seethe complete list of todays Zacks #1 Rank (Strong Buy) stocks here.
Surgical Care Affiliates, Inc. Price and EPS Surprise
Surgical Care Affiliates, Inc. Price and EPS Surprise | Surgical Care Affiliates, Inc. Quote
Zacks' Top 10 Stocks for 2017
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Healthcare Stock Q4 Earnings Due on Feb 21: HLS, SCAI - Zacks.com
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Posted: Feb 19, 2017 12:01 AM
Twenty million. That is the number foisted upon us by the Obama administration and all of its believers as to how many people got health insurance because of his signature health care program and how many will lose it if the evil Republicans tinker with the program; i.e., repeal and replace. Have you ever seen the figures behind that 20 million number? No you have not because it is a phantom number. Like the 97% of scientists believing in global warming sorry, climate change. Or that the day of the Super Bowl has the highest number of domestic violence incidences. The Left repeats things often enough, echoed by the compliant media, that they begin to believe their own lies.
The Affordable Care Act (ACA aka Obamacare) brought a sledgehammer to something they should have brought a ball-peen hammer to fix. It should have addressed only the uninsured plus the major challenge for the rest of us: pre-existing conditions. Instead, because they really wanted to make our health care system single payer (i.e. government run), they gave us a slew of new taxes (most of them hidden) and really covered very few new people outside of Medicaid. The real number appears to be about 2.2 million gaining coverage outside of Medicaid in 2013-2015. That should have happened through normal hiring and other processes. Medicaid added 11.8 million covered during that period so the real number is 14 million new people with insurance.
We have previously discussed the fact thatmany of those 11.8 million may have health insurance, but no health care because of the lack of physicians who accept Medicaid with its low reimbursement rates. People cannot find doctors in most rural areas. The doctors they might get in densely populated urban areas may require hours for transit to/from for services.
One of the elements of proposals floated by Republicans is a cap on how much an employer can pay for an employee's health insurance. I never like caps like this. For example, if we had not changed insurance companies we would have exceeded the caps with a $12,000 deductible. Arbitrary caps are just that -- arbitrary. For example, the IRS still thinks a $25 gift to a customer is appropriate or even achievable. These caps dont work.
Here are some suggestions for the Republicans while they are recreating the system bludgeoned by ACA:
1. Get the government out of the private sector health care. Too many requirements for people to have too many criteria loaded on their health insurance. Just require a clear, concise statement by the insurance companies of what is included and what is not included in a policy. Let the companies develop their options to meet the marketplace.
2. The only insurance people should be required to buy is catastrophic insurance or what was referred to as hospitalization (if you end up in a hospital from a traffic or skiing accident.) A 26-year-old should not be required to buy comprehensive insurance that will never be used. That is why they have not participated in Obamacare. That grand experiment failed. If the 20-somethings do not get insurance through work, they are not going to pay exorbitant rates to subsidize their parents and grandparents.
3. Dispense with the penalties and the enforcement by the IRS -- a despicable aspect of Obamacare. A lot of people got hit with penalties this past year and the Obama administration did not tell the world how many owe the government money because of premium supports that were overstated. Stop with the punishment. Emphasize rewards for acquiring insurance.
4. Lets get real about FDA approval of drugs. Not allowing legalization of medications tested and used in Europe is absurd. Not allowing people with virtual death sentences from disease to try an experimental process or medication is near criminal. Having drug tests taking eons and costing hundreds of millions is government in overdrive.
5. For the 9,548th time, the biggest problem with Obamacare was it increased demand, but did nothing about increasing supply (doctors, nurses, hospitals). There may not be a need for more hospitals as stays are shortening, but it does no good to have insurance if you cannot see a practitioner. We need to push down some services that do not need doctors or dentists to lower-level practitioners to increase the supply, especially in primary care. We need to address this issue and no one is looking at it. We keep building law schools to create lawyers to sue doctors, but few, if any, new medical schools.
6. Pricing for services has to become more of a marketplace. People need to know what the cost of their services are going to be before they are incurred. Being told not to worry because insurance will pay for your medical services is not good enough.
7. Please, please, please stop this nonsense that you have to be at a doctors office to get medical advice. In an era where we have modern communication including Skype where a doctor can physically see a patient why does everyone need to travel across town, sit in a waiting room with people coughing and sneezing to get a diagnosis on simple matters as if it is still 1966? The government insists on doctors only billing for office visits. I beg my doctor to just tell them I was there, give me the prescription and bill me, but no. That is what happens when government bureaucrats and policy wonks make up health care rules.
8. Reasonable levels of deductibles have to be established. Having significant deductibles is good to put the power of decision making back into the hands of the consumer. But $10,000 deductibles do not cut it for average Americans. This is where Health Savings Accounts need to come back into play after being attacked by Obamacare.
9. We need to consider high-risk pools for people with significant pre-existing conditions. These people are the most challenging part of the medical system and the reason people not in this group have the greatest fear. They fear becoming part of this group and not having proper coverage.
These are just some of the points that need to be addressed in this round of revamping our medical system. Dr. Tom Price, Secretary of Health and Human Services, understands these points because he was actually a practicing orthopedic surgeon. This is unlike the current system that was designed by a bunch of policy wonks. Price has had a plan ready for years to replace ACA despite the lie that has been perpetuated that Republicans have no plan, much like the lie about 20 million losing coverage.
Let us remember Obamacare actually threw millions of Americans out of their plans. I was one of them. That actually happened versus the projected number of people who might lose their plans in hypothetical scenarios.
The idea is that we can replace this government controlled top-down plan with one that focuses on control by citizens and their medical professionals.
P.S. They now say (Robert Reich/MoveOn.org) it will be 32 million losing their insurance. They are unhinged.
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U.S. President Donald Trump applauds his crowd as he holds a Make America Great Again rally at Orlando Melbourne International Airport in Melbourne, Florida, U.S. February 18, 2017. Photo by Kevin Lamarque/Reuters
WEST PALM BEACH, Fla. President Donald Trump on Sunday was stepping up his search for a national security adviser, with several interviews on tap, and focusing on health care in talks with his health and budget chiefs, while his team pushed back against depictions of a young administration in disarray.
His chief of staff used appearances on the Sunday news shows to echo his boss complaints about media coverage of the White House and cited what he said were multiple accomplishments in the first few weeks of the Trump presidency.
The truth is that we dont have problems in the West Wing, Reince Priebus told NBCs Meet the Press.
Priebus also denied a report that Trump advisers were in touch with Russian intelligence advisers during the 2016 campaign, and said he had assurances from the top levels of the intelligence community that it was false.
After weeks of tumult in Washington, Trump returned to Florida and his private club for a third straight weekend as he tries to refocus. After a raucous campaign rally Saturday night, Trump and his wife, Melania, stopped by a fundraiser at his private Palm Beach club, put on by the Dana-Farber Cancer Institute. A White House official confirmed his attendance, requesting anonymity to discuss the presidents schedule.
207297207301207301Shields and Brooks on Trump using the press as punching bagSyndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the weeks news, including President Trumps contentious press conference, National Security Adviser Michael Flynns resignation, as well as the continued scrutiny over other potential contacts with Russia and more.2017-02-17 18:00:00disabled2365960431Ix4fSdvuQrU
High on Trumps to-do list is finding a replacement for ousted Michael Flynn as national security adviser.
Scheduled to discuss the job with the president at Mar-a-Lago were his acting adviser, retired Army Lt. Gen. Keith Kellogg; John Bolton, a former U.S. ambassador to the United Nations; Army Lt. Gen. H.R. McMaster and the superintendent of the U.S. Military Academy at West Point, Lt. Gen. Robert Caslen.
Trump pushed out Flynn last Monday after revelations that Flynn misled Vice President Mike Pence about discussing sanctions with Russias ambassador to the U.S. during the presidential transition. Trump said in a news conference Thursday that he was disappointed by how Flynn had treated Pence, but did not believe Flynn had done anything wrong by having the conversations.
Trumps first choice to replace Flynn, retired Vice Adm. Robert Harward, turned down the offer.
Trump also was expected to discuss health care policy in a meeting Health Secretary Tom Price and Mick Mulvaney, director of the White House budget office.
Top House Republicans last week presented a rough sketch of a health overhaul to rank-and-file lawmakers that would void of President Barack Obamas 2010 law and replace it with conservative policies. It features a revamped Medicaid program for the poor, tax breaks to help people pay doctors bills and federally subsidized state pools to assist those with costly medical conditions in buying insurance.
House Speaker Paul Ryan, R-Wis., has said Republicans would introduce legislation repealing and replacing the Affordable Care Act after Congress returns in late February, but he offered no specifics.
Also on Trumps Sunday schedule: calls to the leaders of Panama, and Trinidad and Tobago.
The day of presidential business follows a return on Saturday to campaign mode when Trump held a rally before thousands of supporters at an airplane hangar in Melbourne. He revived campaign promises to build a border wall along the U.S.-Mexico border, reduce regulations and create jobs and continued his attacks on the media.
The rally was put on by Trumps campaign, not the White House. Trump told reporters he was holding a campaign rally because life is a campaign.
Trump, who held a rally in the same spot in Florida in September, clearly relished being back in front of his supporters, welcoming the cheers and letting one supporter up on stage to offer praise for the president. He also enjoyed reliving his victory over Democrat Hillary Clinton.
Trump has lurched from crisis to crisis since the inauguration, including the botched rollout of his immigration order, struggles confirming his Cabinet picks and a near-constant stream of reports about strife within his administration.
Priebus would have none of it.
The fact of the matter is the level of accomplishment that hes put forward so far in the first 30 days has been remarkable, he told CBS Face the Nation.
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Trump steps up security aide search, focuses on health care - PBS NewsHour
Even many people eligible for a health savings account who have extra cash to contribute to one dont do it. Therapists say thats partly because nobody wants to admit they will get old or sick.
Spending your own money on health care might mean that youll be more frugal with it. Thats the theory behind health savings accounts, a decades-old GOP concept thats sparking renewed interest on Capitol Hill as Republican lawmakers look for ways to replace the Affordable Care Act.
HSAs are like personal savings accounts with a difference. As with a retirement account, money put into an HSA can be invested, and any growth in the fund accumulates tax-free. Withdrawals can be made at any time, and they are tax-free, too but the money can be used only to pay for certain medical expenses, such as health insurance deductibles, or for copays for hospital care or a visit to the doctor.
Currently, HSAs are only available to people who have high-deductible health plans, meaning they usually pay a few thousand dollars for medical care each year before their insurance kicks in to pay its share. While HSA participation is growing, only about 20 million people out of the 176 million who have health insurance participate in these savings accounts, according to a 2015 report by the Association of Health Insurance Plans.
Why dont more people who are eligible for HSAs have them? For one thing, not everyone has money to contribute upfront. But psychologists and behavioral economists point out that even many people who have the extra cash on hand confront big psychological barriers to saving.
How we think and feel is directly tied to our ability to make good financial decisions, says Alycia DeGraff, a board member and secretary of the Financial Therapy Association. DeGraff says when faced with financial decisions about the future, many people simply get stressed out.
These stressors can become so overwhelming that we can become debilitated and ignore the situation altogether, she says. Or we can practice any kind of defense mechanism entitlement, suppression, overcompensation, isolation, etc. to try and deal with [it].
This may explain, at least in part, why middle-class Americans are pretty bad at saving money in general. Only about half of us have money in any sort of retirement account. And those of us who are parents have only saved, on average, enough to pay for about one year at an in-state college for our kids.
Saving money is hard. It means setting aside what we want now for something we think well want or need later. And we live in a culture that offers a lot of pretty, shiny, things to buy RIGHT NOW.
Plus, we all pretend we wont get old or sick.
People are predictably irrational, says Dr. Mitesh Patel, especially when it comes to money. Hes a behavioral economist, physician and assistant professor at the University of Pennsylvanias Perelman School of Medicine.
But many of us really hate to lose money, Patel says, which is what makes the concept of HSAs is so appealing.
For example, he and his colleagues published a study last year in the Annals of Internal Medicine on what motivates people to lose weight, and found that the way a financial incentive was framed made all the difference.
The researchers observed three groups of people for 13 weeks. They told one group to walk 7,000 steps a day. About 30 percent of the group did so. Meanwhile, people assigned to the second group were told theyd be paid $1.40 every day they walked 7,000 steps. About 35 percent of the second group did so.
Heres the kicker: Each person in the third group was paid $42 upfront and was docked $1.40 each time they failed to meet their goal. Forty-five percent of that group met the assigned goal, Patel says. People hate to lose money.
Another way to encourage more saving might be to make HSAs operate more like the 401(k)s that required people who didnt want to participate to actively opt out of the plan rather than requiring people who want to contribute to opt in. This creates a path of least resistance, Patel says.
Of course, setting up and overseeing such a plan would likely cost the government some money, he notes.
People with HSAs do use less health care than those without such plans, a recent study from the Employee Benefits Research Institute suggests. But its unclear whether they actually improve their health. Prescription drug costs went down for people enrolled in HSAs in the EBRI study, but emergency room visits went up particularly for lower-income families.
Then theres the issue of figuring out how much you, as an individual or a family, would need to save for health care its not easy to find out the average price for a medical test or procedure in your town, let alone how much that price varies from doctor to doctor or hospital to hospital.
If you want to save for a house, you can pretty much figure out the math, Patel says. But if you go to a doctor, they dont give you a menu for prices.
To really increase their health savings or any savings wed all need to change our mindset, says Degraff, the financial therapist.
People would have to first take a dose of reality and get real about their future selves, she says. Naturally, we think our future selves will be better, healthier, more financially secure, she adds. But, for many of us, health and income eventually decline with age. We need to save more now for later.
HSAs can be useful, Degraff notes, but only for those who have enough cash to pay their day-to-day expenses plus a little left over.
A lot of people dont even have a regular emergency fund savings, DeGraff says, especially those that are already struggling to pay for health insurance.
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The Perplexing Psychology Of Saving For Health Care - Houston Public Media
Lions of Healthcare West Hawaii Today KEALAKEKUA - The Lions Club of Kona sponsored the third annual Health Fair Saturday at Konawaena Elementary School in Kealakekua. Vision, dental, hearing, blood pressure and blood glucose screenings were available for the community free of charge ... |
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Nurses should not have to suffer broken bones and concussions to spur action against workplace violence. Unfortunately, at Arbour-HRI psychiatric hospital in Brookline, it took that level of violence for the federal government to investigate and levy a fine (OSHA cites Brookline psychiatric hospital, Metro, Feb. 9).
Arbour-HRI failed to protect employees from aggressive patients, according to the Occupational Safety and Health Administration, leading to nurses and mental health workers being punched, hit, scratched, bitten, and hit with objects, including a wooden dresser drawer.
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It does not have to be this way. We already know that health care workers are vulnerable. Serious violence is four times more common in health care than private industry on average, OSHA reports. Legislation filed last month by the Massachusetts Nurses Association would help prevent assaults at every hospital in the Commonwealth. The bill would require health care employers to perform annual risk assessments, implement programs to minimize violence, provide time off for assaulted workers to address legal issues, and regularly report assaults.
Hospitals should be a place for patients to heal and health care professionals to provide care in a safe environment. Legislative action would ensure that employers take the steps necessary to prevent violence.
Donna Kelly-Williams, president
Massachusetts Nurses Association
Canton
The writer is a registered nurse.
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Health care employers must do more to protect staff from workplace violence - The Boston Globe
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Construction work continues on the new wing at Samaritan Hospital on Thursday, Feb. 16, 2017, in Troy N.Y. (Will Waldron/Times Union)
Pressure is on to hire more in health care field
It's one of the major drivers of the Capital Region economy, employing thousands of people locally.
But health care is facing pressures, thanks to an aging population, Medicare reimbursement rates that haven't kept up with costs, and competition for job candidates in an area with one of the state's lowest unemployment rates.
More than 61,000 people are projected to be employed in occupations ranging from physicians and nurses to home health aides and medical assistants by 2022, said state labor markets analyst James Ross, up from 51,000 in 2012.
But far more positions will need to be filled, thanks to turnover as baby boomers reach retirement age.
"We know we have a whole demographic, large numbers in the 55 to 63" age group that are approaching retirement age, said Barbara McCandless, vice president for human resources, at St. Peter's Health Partners in Albany.
St. Peter's has 12,500 employees, many of them at its hospitals in Troy and Albany, with others spread out among 180 locations throughout the region. A multi-story expansion of Samaritan Hospital in Troy is scheduled to open later this year.
And while health care providers have been merging and consolidating the most recent was the announcement that Community Care Physicians and CapitalCare Medical Group would merge by summer resulting job losses have been minimal.
Health Career Job Fair
The Times Union's annual Health Career Job Fair will include more than three dozen exhibitors and recruiters. Admission is free to job seekers.
When: Wednesday, 2 to 7 p.m.
Where: Albany Marriott Hotel, 189 Wolf Road, Colonie
More details: timesunionjobfair.com
"The mergers and consolidations eliminated administrative and management overhead," said Ross, "but not the health care delivery.
"Doctors, nurses, technicians, home health aides all continue to show growth," he said.
At Albany Medical Center, which has 9,300 employees, additional physicians will be hired in the coming year.
"We expect to hire physicians, advanced practice providers and support staff in 2017, including those needed to support the continued growth of our EmUrgentCare facilities," said spokeswoman Sue Ford. Albany Med, like St. Peter's and Schenectady-based Ellis Medicine, has continued to expand its network of urgent care clinics throughout the region.
Ellis Medicine, which has more than 3,500 employees, expects to make 200 hires, both in new positions and in vacant positions being filled.
The jobs most in demand and hardest to fill? Registered nurses, an Ellis spokeswoman said.
"The one thing this year that may slow (job growth) down a bit is the uncertainty over the Affordable Care Act," Ross said.
The Republican-controlled Congress has made the repeal of Obamacare, as it's also called, a top priority, although that is appearing harder to accomplish than many in Congress originally thought.
"We're hearing different interpretations," said McCandless of St. Peter's. "We don't want to overplan for what we're not certain about."
And in any case, changes to Obamacare would likely take years to phase in, some observers say. Hospital officials say another government program, Medicare, doesn't adequately reimburse them.
"We're getting paid about 22 percent less than we should be in this region," said St. Peter's spokesman Elmer Streeter. "It's clearly a major issue."
Meanwhile, health care providers are seeing their labor costs increase, thanks to the tight labor market.
The Capital Region's unemployment rate in December was just 4 percent, a 10-year low for the month.
Competition for employees isn't just focused on health careers.
"Large health care systems are like a little city," said McCandless. "There's security, maintenance, finance; we have hundreds and hundreds of jobs."
With housekeeping and food service jobs, she said, "in some ways we're competing with a casino for the applicant pool," referring to the recently opened Rivers Casino in Schenectady, which employs 1,000 people.
"We have Sunnyview (Rehabilitation Hospital) in Schenectady. For that community the casino is drawing from the same pool of talent" for some non-clinical positions.
Albany Med is completing work on its newest EmUrgentCare center on Union Street in Niskayuna, a facility that's expected to open this spring, Ford said.
As demand for health care workers grows, wages also are rising.
The 19,000 workers classified by the Labor Department as ambulatory health care services workers, people who provide support and assistance to patients outside hospitals, saw their average wage climb 3.2 percent to $58,227 from $56,399 a year earlier.
There's a wide range of annual earnings. While home health aides make as little as $25,000 a year, surgeons averaged $296,000, according to the most recent state Labor Department data.
And even within specific areas, titles are multiplying. Registered nurses may also be case managers, or navigators who help patients move through the hospital.
And some doctors are hospitalists who focus on the overall care of hospitalized patients.
That may be the most lucrative career. LinkedIn ranked it No. 1 in its recent list of top 10 jobs in 2017, citing strong demand (87 percent year-over-year growth), and its median base salary ($222,000).
eanderson@timesunion.com 518-454-5323
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Pressure is on to hire more in health care field - Albany Times Union