UPDATE:
"Governor Maggie Hassan, a Democrat, applauded the bipartisan deal."
Well, so much for... sigh.
"N.H. Republicans blocking Medicaid expansion; Obamacare provision would boost aid to working poor" by Tracy Jan | Globe Staff, July 21, 2013
WASHINGTON — With partisan bickering, delays, and confusion on the rise nationally over the impending launch of President Obama’s health care law, tens of thousands of low-income people in New Hampshire are watching the calendar, caught up in their own anxious uncertainty.
That's what you get if it's not money for Israel, Wall Street, the war machine, well-connected corporations, or lavish political lifestyles.
Republicans in the Legislature have blocked the state from participating in a federally funded expansion of the Medicaid program, meaning that up to 58,000 Granite State residents are in line to be denied coverage.
But the decision may not be final....
Meanwhile, the clock is ticking....
This is the sort of bureaucratic bind and confusion that is spurring predictions of turbulence surrounding Obamacare’s liftoff, and generating anger among representatives of the poor in New Hampshire who say Republicans are seeking to sabotage the national health care law.
It's sabotaging itself.
“Once again, they’re playing a political game in saying no to all aspects of Obamacare, no matter how common sense and right for us as a state and as a nation,’’ said Kary Jencks of the New Hampshire Citizens Alliance, a social justice advocacy group. “The folks who end up paying a price are the hard-working middle- and low-income people.’’
A sweeping national expansion of Medicaid was a central component of the 2010 health care law, but the US Supreme Court in 2012 deemed the expansion optional for states.
The result is a patchwork of policies sprouting around the country, including within New England, highlighting how health care access is becoming highly dependent on where you live.
Maine was the first New England state to opt out, and New Hampshire became the second, at least temporarily, with its move last month. At the other end of the spectrum, neighboring Vermont is pursuing a universal health care program, following in the footsteps of Massachusetts....
Sorry, but our path isn't the single-payer plan Vermont is constructing.
I'll tell you, the agenda-pushing obfuscations, distortions, and deceptions are enough to make you sick.
On Thursday, Obama continued his efforts to sell the law’s benefits politically, with a speech centering on how health reform is already holding insurance companies accountable by requiring them to spend the majority of their premiums on medical care. A day earlier, House Republicans held its 38th vote to dismantle Obamacare.
I will tend to those below.
Under health care reform, the Medicaid expansion was supposed to help 17 million new people get coverage nationally, including childless adults, a group most states currently do not cover under the government-subsidized health insurance program for the poor and disabled....
In Maine, Governor Paul LePage, a Tea Party-backed Republican, has vetoed legislation authorizing an expansion. Maine is not only refusing to expand Medicaid, it has already begun rolling back existing coverage, freezing out 44,000 Mainers.
See: Slow Saturday Special: Maine and Medicaid
In states that do not plan to expand Medicaid such as Maine and New Hampshire, low-income individuals above the poverty line still must obtain health insurance under the national mandate, putting them in the uncomfortable position of facing a financial penalty or spending at least 2 percent of their income to sign up for private coverage through state online marketplaces — called exchanges — that will debut in October.
Related: The Health of American Democracy
They may not be ready on time.
“It is sad that in New Hampshire, you can stay at home, raise your kids and not work and get food stamps and health care, but then those of us who are actually working and paying taxes and trying to help ourselves can’t get a little bit of insurance for health care,” said Billie Jo Buskey, owner of a Plymouth hair salon.
Buskey, 35, and her husband, a landscaper, both started working at age 14 and make just under $28,000 a year. But that is too much to qualify for Medicaid under New Hampshire’s current income guidelines. Neither can afford health insurance so they go without. Their sons, ages 5 and 13, are covered by Medicaid, which has more generous eligibility criteria for children.
Buskey prides herself on paying her bills – mortgage, phone, electricity, and day care — on time. Last year she needed to have her gall bladder removed, and now owes the hospital more than $8,000, which will take her nearly six years to pay off at $115 a month.
“I’d much rather pay $115 a month for health insurance than $115 a month to pay off one hospital bill,” she said. It is still unclear what private coverage options would be affordable to Buskey and her husband, if any, without Medicaid expansion.
Echoing the national discord and wrangling in Washington, New Hampshire Republicans doubled down during recent debates over the state budget....
Okay.
State Senator Andy Sanborn, one of three Republican legislators appointed to the nine-member commission to study the issue, compared Obama’s health care law with the Asiana plane crash in a radio appearance last week, saying that Obamacare is “barreling down on us like a jet landing in San Francisco.”
Oh!
Related: Slow Saturday Special: Runway Murder
Regardless of how you feel about Obamacare, that is an out-of-context statement and poor choice for an analogy!
New Hampshire ranks among the least generous when it comes to determining Medicaid eligibility....
Democrats expect Governor Maggie Hassan to call the Legislature back into a special session in the fall to vote specifically on Medicaid expansion, but some Republicans are already balking at that suggestion, preferring instead to take up the issue next year when the Legislature reconvenes....
Related: The Birth of the Perry Presidency
Why is it only Republicans who are effective at getting what they want?
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Also see: Slow Saturday Special: New Hampshire Hates State Workers
This is what is going to happen to New Hampshire now:
"Problems arise after Ky. shifts to private health plans; Issues are seen as harbinger" by Jenni Bergal | Washington Post, July 21, 2013
GREENSBURG, Ky. — Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread.
You gotta be kidding me! The global payments rationing that was going to save us all has health problems?
Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network....
Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people enrolled in Medicaid, the state-federal program for the poor and disabled, to private managed-care plans in hopes of cutting costs and improving quality.
Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.
Beginning in January, millions more people will become eligible for Medicaid under the federal health law, and many will be placed in managed care.
You didn't like that the first time, America, so WTF?
‘‘The Kentucky case is a harbinger of what can happen when states don’t allow enough time and devote sufficient resources to strengthen the Medicaid agency’s oversight capacity and systems — or develop strong contracts and care-monitoring systems from scratch if they haven’t contracted with managed care plans before,’’ said Debra Lipson, a senior researcher at Mathematica Policy Research.
Kentucky health officials admit there have been problems because of the speed of the changeover, which started in late 2011. But they insist that claims are now being paid promptly and that the quality of care has improved.
Except for one little boy.
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You will be the Kentucky of New England, New Hampshire.
Related:
"Obama says 8.5m will get rebates from their insurers; President insists law is producing tangible benefits" by Mark Landler | New York Times, July 19, 2013
WASHINGTON — President Obama, slipping back into his episodic role as a vigorous campaigner for his health care act, said Thursday that thanks to the law, more than 8.5 million Americans were getting rebates this summer from their insurance providers.
Obama was flanked by families who have benefited from a provision in the law, which requires health insurers to spend at least 80 percent of the revenue from premiums on medical care rather than on administrative costs. Insurers who fail to meet that benchmark must reimburse customers, a process that began in 2012.
“Last year, millions of Americans opened letters from their insurance companies, but instead of the usual dread that comes with getting a bill, they were pleasantly surprised with a check,” Obama said in a midday ceremony at the White House.
So how much is the check worth?
The checks typically amount to no more than a few hundred dollars.
We call it chump change.
But the president, recounting stories of middle-class families arrayed on the stage behind him, celebrated these modest windfalls as an early sign of the tangible benefits of the law.
For Obama, it was a high-profile return to a debate in which his voice has sometimes seemed like it was missing. For example, he has said nothing publicly about the administration’s decision to delay for a year a part of the law dealing with employer-provided insurance.
Related: Obama Bends Over For Big Business
And you know who is getting it -- and where.
With the Republican-controlled House of Representatives voting yet again this week to repeal the Affordable Care Act, however, he seized on new statistics that demonstrate the law is driving down premiums in New York, California, and several other states.
That is a LIE!!!
The Department of Health and Human Services just released a report asserting that, in 11 states and the District of Columbia, proposed health insurance premiums for 2014 are nearly 20 percent lower than the administration projected.
I love $elf-$erving reports from lying government, don't you?
Thursday’s carefully choreographed event in the East Room was intended to put the White House back on the offensive on health care, after a messy period following its decision to delay requiring employers with more than 50 employees to offer health insurance or pay a penalty.
Do you know how sick I am of illusion and imagery?
The delay came after heavy pressure from businesses, which said the law was too complex and cumbersome to implement on time, and it provided critics with fresh ammunition for their claim that the law was putting unfair burdens on individuals and employers.
Yeah, and now that big business doesn't have to report their health plans, there is no way of getting you a government subsidy to pay for health care.
Republicans did not let up Thursday, claiming that the benefits extolled by Obama would be more than offset by higher costs. In some cases, they did not even wait for him to speak.
“Even though we expect the president today to tout about $500 million of these types of refunds, what he won’t say is that next year Obamacare will impose a new sales tax on the purchase of health insurance that will cost Americans about $8 billion,” said Senate Republican leader, Mitch McConnell of Kentucky. “That’s a 16-to-1 ratio!”
In a statement after Obama spoke, House Speaker John A. Boehner said: “The picture the president paints of his health care law looks nothing like the reality facing struggling American families. They know that the law is turning out to be a train wreck.”
Yup!
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"House votes to delay parts of health care law" by Donna Cassata | Associated Press, July 18, 2013
WASHINGTON — House Republicans voted on Wednesday to delay core provisions of President Obama’s health care law, emboldened by the administration’s concession that requiring companies to provide coverage for their workers next year may be too complicated.
After a day of heated rhetoric, the House voted largely along party lines, 264 to 161, to delay by one year the so-called employer mandate of the Affordable Care Act. It voted 251 to 174 to extend a similar grace period to virtually all Americans who will be required to obtain coverage beginning Jan. 1, the linchpin of the law.
It's not going anywhere, but thank you.
The dual political show votes marked the 38th time the GOP majority has tried to eliminate, defund, or scale back the law since Republicans took control of the House in January 2011. The House legislation stands no chance in the Democratic-run Senate.
The goal of the health care law is to provide coverage to nearly 50 million Americans without health insurance and lower skyrocketing costs.
But in the three years since Obama signed his signature law, the public remains highly skeptical and the administration’s abrupt decision earlier this month to delay the employer provision only fueled more doubts.
Costs being up doesn't help.
Republican foes welcomed it as a political gift, not only to assail Obama but to arrange votes that put House Democrats on record ahead of next year’s congressional elections.
‘‘This administration cannot make its own law work,’’ Representative Dave Camp, Republican of Michigan, chairman of the Ways and Means Committee, said during House debate.
Majority leader Eric Cantor, Republican of Virginia, said the decision was ‘‘a clear signal that even the administration doesn’t believe the country is ready to sustain the painful economic impact this law will have.’’
He's right on that.
Eager to counter the criticism, Obama plans to deliver remarks Thursday focusing on rebates that consumers are receiving from insurance companies under the health care law.
As full-time work is being eliminated.
White House spokesman Jay Carney said Obama will draw attention to the 8.5 million consumers who have received an average consumer rebate of about $100.
I was told a couple hundred above, but.... SIGH!!
Carney also highlighted reports that some states are already anticipating lower premiums under the Affordable Care Act....
That is a LIE!!!
The House vote delaying the employer requirement codified the administration’s decision, but the White House insisted it was unnecessary and issued a tough veto threat. Democrats dismissed the entire GOP effort as just another fruitless attack on a law that has been upheld by the Supreme Court.
‘‘Well, here we go again. Another repeal vote, another political sideshow,’’ said Representative Sander Levin, Democrat of Michigan.
Related: The Return of Congress
It's all a s***-fooley sideshow, folks.
Democratic leader Nancy Pelosi said it was ‘‘nothing more than a waste of time’’ as the health care issue has been settled in Congress, the courts, and in last year’s presidential election when Obama won a second term.
No, it's not settled at all!
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Related: Slow Saturday Special: Waiving Goodbye to Obamacare
And about those costs:
"National health care overhaul apt to push up costs; Mass. may end up violating own limits; but impact will vary widely, study says" by Robert Weisman | Globe Staff, July 17, 2013
Rule changes stemming from the national health care law are likely to drive up average insurance premiums for small businesses and individuals next year, according to a study funded by the insurance industry.
The analysis, by Wakely Consulting Group, projects President Obama’s health care law — supported by the Patrick administration — will tack an average of 3.7 percent on to premiums.
That would be on top of typical base rate increases, driven by hospital and doctor’ fees and demand for medical care, which have ranged from 2 to 4 percent in recent years.
Combined, the cost of insurance would almost certainly exceed the state’s benchmark for increases....
The study also predicts the impact of the national law on individuals, families, and businesses in Massachusetts will vary widely....
New federal rating factors could mean increases of as much as 57 percent for some families and businesses or decreases of as much as 57 percent for others. “You’ll see winners and losers,” said Lora Pellegrini, president of the Massachusetts Association of Health Plans. “Overall, there will be additional costs.”
That's strange because the sales pitch behind the plan was we would all be winners.
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Maybe Washington can help:
"Mass. tries to retain $250 million for hospitals" by Tracy Jan | Globe Staff, May 23, 2013
WASHINGTON — The Massachusetts congressional delegation, after holding a rare emergency meeting Wednesday, launched what could be a final effort to preserve more than $250 million in bonus Medicare payments to the state’s hospitals that critics call the “Bay State boondoggle.”
Related: Sunday Globe Special: The Nantucket Effect
Also see: Massachusetts Hospitals Are $ick
But the prospect of holding on to the windfall is dimming. The Democrat-controlled Senate voted earlier this year to end the payments, enacted under President Obama’s health care overhaul law and which come at the expense of most other states. A similar bill was introduced in the Republican-led House this week.
“We’re all on high alert,” Representative Richard Neal, a Democrat from Springfield, said in an interview following the hourlong meeting during which he briefed the delegation about the impact of the House bill.
Neal said Massachusetts members would argue that the state’s hospitals are a national treasure and urge Congress “not to do anything in haste, because you jeopardize one of the crown jewels of the American medical system.”
Massachusetts hospital representatives said the bill would affect every hospital in the state and, if passed, could result in layoffs and harm patient care if hospitals can no longer afford to invest in state-of-the-art facilities and technology.
But many members of Congress from other states believe that Massachusetts is getting unfair treatment. The additional payments are being made under an obscure provision that sets rates based on payments at a state’s rural hospitals....
“I just think the Bay State boondoggle is the worst kind of policymaking — it’s done behind closed doors and favors one specific group over the nation’s interests,” said Representative Kevin Brady, a Texas Republican who heads the Ways and Means Committee’s health subcommittee and who sponsored the bill, along with 12 other Republicans. “It is my hope that Congress will act this year to repeal this misguided policy. It’s time to stop rewarding one state at the expense of all the others.”
The fight to preserve the Medicare payments is also a test of how much influence the Bay State’s once-powerful delegation still wields. Four members have left in the past year alone, including former senator John Kerry and former representative Barney Frank....
The Medicare provision initially was pushed by Kerry and Senator Robert Menendez, a New Jersey Democrat.
Related: Mucking Around With Menendez
As long as Menendez advances the agenda he is safe.
Eight other states, including Connecticut, New Hampshire, and Rhode Island, benefited from the amendment, but none nearly as much as Massachusetts. Bay State lawmakers defended the Kerry-Menendez measure....
Now, with Kerry serving as secretary of state, some hospital executives worry that Massachusetts will end up waging a lonely battle, with a delegation that lacks the clout to defeat Senate and House bills that would benefit the majority of states at no additional cost to taxpayers.
That is gong to be an adjustment for Massachusetts.
The Senate in March passed a budget amendment to kill the provision. The vote — 68 to 31 — represents a significant symbolic step toward repealing the provision, but does not carry the force of law since the budget is a nonbinding measure, said an aide to Senator Thomas Coburn, a Republican from Oklahoma who cosponsored the amendment and a similar bill in January with Senator Claire McCaskill, a Missouri Democrat.
Filibuster and veto-proof vote!
With the House bill on the horizon, a McCaskill spokesman said she will be working to reintroduce the Senate bill either as stand-alone legislation or as an amendment to another bill as soon as possible.
In the Senate vote in March, 22 Democrats joined 45 Republicans and independent Angus of King of Maine to kill the provision. Senators Elizabeth Warren and William “Mo” Cowan of Massachusetts were among the 30 Democrats who voted against the amendment along with Vermont independent Bernie Sanders.
Related: Slow Saturday Special: Sanders $ells Out on Immigration Bill
And a few other things.
The Massachusetts Hospital Association called the House bill introduced Monday “ill-advised” because it would lead to “significant financial repercussions for many hospitals” across the country. The association said it supported a “comprehensive review” instead of “narrowly directed tweaks to individual adjustments,” said Tim Gens, executive vice president of the association.
Cowan said the bill unfairly targeted Massachusetts and would have “a devastating impact on our local communities that are served every day by some of the finest hospitals in the nation.”
Warren spokeswoman Lacey Rose said the senator “strongly opposes this punitive proposal, which threatens the quality of medical care in several states while doing nothing to reduce the deficit.”
No Democrat has yet agreed to cosponsor the House bill, given the political sensitivity around Obama’s health law, which Republicans have promised to make an issue in the 2014 midterm elections. But Republicans control the House by a 233 to 201 margin, and the party expects to gain some Democratic support for the measure given how much money is at stake for their states.
The biggest losers under the current system are Texas, New York, Michigan, Florida, and Illinois, which lose tens of millions of dollars each year, according to 2013 federal data.
Significantly, the federal Centers for Medicare and Medicaid Services has recommended changes to the system that could eliminate the provision that benefits Massachusetts.
Dr. Donald Berwick, Obama’s former CMS administrator, said earlier this year that the payment system is so complex that it’s highly “susceptible to gaming and manipulation.”
“It’s a zero-sum game,” Berwick said. “What Massachusetts gets comes from everybody else.”
During the March budget debate in the Senate, Menendez, along with Warren and Cowan, had introduced an amendment calling for a comprehensive approach for wage index overhaul, but it was narrowly defeated.
Given that a comprehensive overhaul is unlikely to pass, Massachusetts congressmen said they are prepared to lobby their colleagues to preserve the status quo, citing the extraordinary care Massachusetts hospitals displayed following the Boston Marathon bombings.
“Sometimes it’s the tug of regionalism, rather than the tug of substance” that sways members, Neal said. “I happen to think that on this issue, we are right on both region and substance.”
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Related: As clout fades, state delegation gets unity push
UPDATE:
"Curing the ‘Bay State Boondoggle’" by Tom Keane | May 28, 2013
It’s us versus them, and normally you want to side with the home team, but when it comes to the so-called “Bay State boondoggle” — the extra hundreds of millions the feds are sending to Massachusetts hospitals — we are, regrettably, in the wrong. Rather than fighting a rear-guard action to justify the unjustifiable, Massachusetts’s pols need to stand up and lead the way to a reformed and more equitable system.
The scam was, no question, wicked clever....
Bay State lawmakers are now in a tizzy, reportedly huddling together in emergency meetings to figure out how to keep the money flowing. The argument is that Massachusetts hospitals are special — “the crown jewels of the American medical system” in the words of Representative Richard Neal — and, of course, they are. But as every parent knows, while all your children may be special, you still have to treat them fairly.
This might just seem an amusing tiff among states but for two deeper problems. One is that the trickery involved feeds into the notion that the new health care law is rigged and flawed: “another Obamacare sweetheart deal,” according to House Ways and Means Chairman David Camp. The upcoming mid-term elections look to be, as they were four years ago, a referendum on national health care. The Bay State boondoggle will doubtless be held up as an example of its failings.
Second, it underscores the flaws of how government pays for health care. In the Nantucket case, the rules were exploited to seemingly pump up all hospitals’ expenses. That illustrates a more general problem: Because we reimburse health care providers for what they spend, the system only encourages them to spend more. And the complexity of such rules is so overwhelming that much of health care today requires specialists to help providers maximize their payments. Little of that has to do with medical quality. Rather — as with the tax code and loopholes — it’s just a matter of figuring out how to game the system....
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Also see:
Four of five Mass. pioneer ACOs cut medical spending last year by better coordinating care
Medicare ‘cost-savings’ rules pushing costs onto patients
Thanks, Obama.
MDs seek MBAs as health care gets more complex
That is the problem with U.S. health care: you are a cu$tomer, not a patient.
"UnitedHealth Group’s second-quarter net income rose almost 8 percent, buoyed by steady enrollment growth and slower-than-expected use of health services. The largest US health insurer earned $1.44 billion, but executives continued to warn that federal cuts to the Medicare Advantage program would put pressure on the company in 2014 and beyond."
"Cubist Pharmaceuticals said second-quarter net revenues were up. The Lexington-based biotech reported total net revenue of $258.8 million"
Also see: Catholic hospitals accept birth control compromise
Time to scrap Obamacare and either leave it in the hands of states or go to a good, decent, single-payer health system like the rest of the industrialized world. Watch "Sicko" and choose a model. Is that $o hard?
NEXT DAY UPDATE: House GOP has no alternative to health care law
