[Reblog] The high cost of free check-ups

Bill Branson (Photographer)

http://commons.wikimedia.org/wiki/File:Doctor_consults_with_patient_(7).jpg

From the 14 February 2014 post at The Health Care Blog

 

A predictable irony of the never-ending Affordable Care Act (ACA) debate is that the one provision that the Republicans should be attacking — free “checkups” for everyone — is one of the few provisions they aren’t attacking. Why should they attack them? Simple — checkups, on balance, are worthless. Why provide a 100 percent subsidy for a worthless good? Where is the GOP when you need it?

How worthless are checkups? Dr. Ezekiel Emanuel — one of the architects of the ACA and its “free” checkup centerpiece — recently recommended not getting them. As if “free” is not cheap enough, the ACA also pushes ubiquitous corporate wellness programs, which often pay employees to get checkups — or fine them if they don’t. This policy establishes a de facto negative price for millions of workers, making checkups the only worthless service on earth that one could get paid to utilize.

Those economics of a “negative price” trump Dr. Emanuel’s advice, and have made preventive care the fastest-growing component of employer health spending. Though hard statistics on checkups themselves are elusive, Dr. Emanuel estimates about 45-millon adult checkups are conducted each year, the equivalent of roughly 8 percent of America’s PCPs doing nothing but checkups, a curious use of their time when experts say the country could soon face a shortage of PCPs.

Shortage or not, subsidies and incentives might make economic sense if checkups improved health. However, when generally healthy adults go to the doctor for no reason, just the opposite is true: the Journal of the American Medical Association (JAMA) supports Dr. Emanuel assertion that annual checkups for asymptomatic adults are at best worthless, saying that additional checkups are “not associated with lower rates of mortality” but “may be associated with more diagnoses and more drug treatment.”

…

The solution to this orgy of overscreening and overdoctoring is remarkably simple: remove the ACA provision that makes annual checkups automatically immune from deductibles and copays; if they are going to be free at all, it should only be every few years. The proposal could still allow employers to override this provision — and even to attach money (incentives and penalties) to checkups — if they are willing to summarize the above-cited clinical findings for their employees.

If the only way they can continue the subsidy is by summarizing the literature, corporate human resources departments would predictably and immediately curtail this expensive corporate medical campaign. That would free up PCP time to work with patients who actually need medical care, while reducing counterproductive and costly healthcare utilization by those who do not.

..

Related articles

• The High Cost of Free Checkups
• Care of patients prior to making a diagnosis rarely assessed by quality measures

[Medical Journal Editorial] Using Drugs to Discriminate — Adverse Selection in the Insurance Marketplace

From the Perspective article by Douglas B. Jacobs, Sc.B., and Benjamin D. Sommers, M.D., Ph.D.at the 5 Feburary edition of the New England Journal of Medicine

Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). Before the legislation was passed, insurers in the nongroup market regularly charged high premiums to people with chronic conditions or denied them coverage entirely. To address these problems, the ACA instituted age-adjusted community rating for premiums and mandated that plans insure all comers. In combination with premium subsidies and the Medicaid expansion, these policies have resulted in insurance coverage for an estimated 10 million previously uninsured people in 2014.1

There is evidence, however, that insurers are resorting to other tactics to dissuade high-cost patients from enrolling. A formal complaint submitted to the Department of Health and Human Services (HHS) in May 2014 contended that Florida insurers offering plans through the new federal marketplace (exchange) had structured their drug formularies to discourage people with human immunodeficiency virus (HIV) infection from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.2

Insurers have historically used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of this approach — which we call “adverse tiering” — is not to influence enrollees’ drug utilization but rather to deter certain people from enrolling in the first place.

…

We found evidence of adverse tiering in 12 of the 48 plans — 7 of the 24 plans in the states with insurers listed in the HHS complaint and 5 of the 24 plans in the other six states (see theSupplementary Appendix for sample formularies). The differences in out-of-pocket HIV drug costs between adverse-tiering plans (ATPs) and other plans were stark (seegraphAverage HIV-Related Costs for Adverse-Tiering Plans (ATPs) versus Other Plans.). ATP enrollees had an average annual cost per drug of more than triple that of enrollees in non-ATPs ($4,892 vs. $1,615), with a nearly $2,000 difference even for generic drugs. Fifty percent of ATPs had a drug-specific deductible, as compared with only 19% of other plans. Even after factoring in the lower premiums in ATPs and the ACA’s cap on out-of-pocket spending, we estimate that a person with HIV would pay more than $3,000 for treatment annually in an ATP than in another plan.

Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans. A recent analysis of insurance coverage for several other high-cost chronic conditions such as mental illness, cancer, diabetes, and rheumatoid arthritis showed similar evidence of adverse tiering, with 52% of marketplace plans requiring at least 30% coinsurance for all covered drugs in at least one class.3 Thus, this phenomenon is apparently not limited to just a few plans or conditions.

Adverse tiering is problematic for two reasons. First, it puts substantial and potentially unexpected financial strain on people with chronic conditions. These enrollees may select an ATP for its lower premium, only to end up paying extremely high out-of-pocket drug costs. These costs may be difficult to anticipate, since calculating them would require knowing an insurer’s negotiated drug prices — information that is not publicly available for most plans.

Second, these tiering practices will most likely lead to adverse selection over time, with sicker people clustering in plans that don’t use adverse tiering for their medical conditions.

Read the entire Perspective here

Related articles

• Health insurers using drug coverage to discriminate
• Do insurers still discriminate against sick people despite the ACA?
• Medicaid ‘fee bump’ to primary care doctors associated with better access to appointments
• Have Insurers Found Way Around Obamacare ‘Pre-Existing Conditions’ Rule?
• Unfair HIV-Drug Pricing Found in US Health Plans
• Blog: Health Insurers May Be Finding New Ways to Discriminate Against Patients
• HIV Drugs Priced Too High for Most Patients Says Study

[Report] A one-year assessment of the ACA | Association of Health Care Journalists

A one-year assessment of the ACA | Association of Health Care Journalists.

From the 31 October 2014 report

The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA.  It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”

The package consists of seven sections that run the gamut, with some key numbers and charts.  Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.

Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.

Here are the seven sections covered, and the nutshell conclusion the Times provided for each.

• Has the percentage of uninsured people been reduced? Yes, the number of uninsured has fallen significantly.
• Has insurance under the law been affordable? For many, yes, but not for all.
• Did the Affordable Care Act improve health outcomes? Data remains sparse except for one group, the young.
• Will the online exchanges work better this year than last? Most experts expect they will, but they will be tested by new challenges.
• Has the health care industry been helped or hurt by the law? The law mostly helped, by providing new paying patients and insurance customers.
• How has the expansion of Medicaid fared? Twenty-three states have opposed expansion, though several of them are reconsidering.
• Has the law contributed to a slowdown in health care spending? Perhaps, but mainly around the edges.

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly.

From the 24 October 2013 article BY ANNE EIGEMAN at NonProfit Quarterly

As the most recent update in an ongoing research project that began in 2011, this week, the Blue Shield Foundation of California released a report on the healthcare experiences and expectations of low-income Californians. Two central goals guided the project: 1) to help healthcare facilities—particularly California’s community health centers—successfully navigate the changes brought about by the ACA, and 2) to help community health centers identify the most effective ways of encouraging patients and providers alike to embrace primary care redesign and move closer toward the goal of patient empowerment. As key findings, the study points to the “wide range of positive outcomes” that come from successful communication between patients and providers and the “broad gap” that currently exists between the information patients possess and the information they want.

The study found that only 28 percent of low-income Californians feel they have easily comprehensible health information for decisions about care. In addition, almost 40 percent rely on media sources to address concerns—“a potential problem” according to the study, because “trust in information is much higher when it comes from a medical professional than from other sources.”

A central theme is the value to patients that comes from a strong patient-provider relationship, which can lead to improvement in a patient’s overall sense of being well informed about his or her health, the level of satisfaction with the quality of care at a specific facility, and trust of the information provided by doctors. In light of upcoming structural changes to healthcare systems from the ACA, the study’s note that “alternative communication approaches also show great promise in helping to improve patients’ relationships with their providers.” is significant. Examples of these new approaches include team based care, decision aids, health coaches, and online or smartphone-accessible health sites, all of which were found to “enhance, rather than diminish, the critical connection between patients and their providers.”

The study devotes considerable attention to the effect of the digital divide on healthcare for specific groups of low-income Californians. “While four in ten low-income Californians overall lack Internet access, that soars to 67 percent of Spanish-speakers, 63 percent of non-citizens, 62 percent of Latinas and 59 percent of those in only fair or poor health,” the study reports. In addition, the fact that 59 percent of low-income residents over 50 lack Internet access and 41 percent lack a text-capable phone makes this “vulnerable population particularly hard to reach with technology-based information and communications.”

 

 

Read the entire article here

Related articles

• Low-Income Patients Want More Health Information, Greater Engagement with Providers (sacbee.com)
• ‘Not Used to Paying an Insurance Premium’: CNN Reports Low-Income Patients Struggle with Obamacare (mediaite.com)
• ACA confusion continues > Most low-income Californians misunderstand their ACA eligibility. (newsreview.com)
• Don’t blame low income patients for seeking care from hospitals (kevinmd.com)
• Central Valley Medi-Cal eligibility grows (fresnobee.com)
• Siouxland providers prepare for patient surge from health law (siouxcityjournal.com)
• Defining Poverty Down: 48% Of School Now Classified As Low-Income (sayanythingblog.com)
• 500,000 Californians Lose Health Policies (nationalreview.com)
• Half a milllion Californians could lose their health care under Obamacare next year (sfgate.com)
• Viewpoints: Are you ready for open enrollment and state’s new health care exchange? (sacbee.com)

 

Expect Snags in Affordable Care Act Rollout (With Links to Additional Information)

Earlier this week I attended a workshop for Ohio Benefit Bank volunteers.  All sessions I attended addressed different aspects of the Health Insurance Exchange.  The take home message was that while there are challenges, there is hope that overall ObamaCare will do more good than bad.

It is very important to go to reliable resources for unbiased and timely information about ObamaCare
I strongly recommend the resources** listed below

 

Some excerpts from the 19th September 2013 Stateline report Expect Snags in Affordable Care Act Rollout

There will be glitches when the major provisions of the Affordable Care Act are implemented starting Oct. 1. Huge glitches. Many glitches. Bet on it.

That is a prediction not only from those resolutely opposed to the ACA. Even those quite excited about President Barack Obama’s federal health law have the same expectation: The rollout of the biggest new social program in nearly 50 years is not going to be pretty.

“When you’re dealing with tens of millions of new clients, mistakes are inevitable,” said Henry Aaron, a health economist at the Brookings Institution. “You’re going to have thousands of mistakes.”

…

“People can make comparisons to Medicare Part D and to Medicare itself, but nothing this big has ever been tried.”

In the simplest terms, the task at hand is to enroll 16 million currently uninsured Americans into health insurance plans or an expanded Medicaid. That process begins Oct. 1 with coverage starting Jan. 1.

…

Although Americans have until the end of March to sign up for health insurance, a crush of demand at the very start could overwhelm exchange call-in centers, websites and personnel. No one will say this out loud, but administrators are hoping for a steady trickle rather than a flood, at least in the early going.

All of the eligibility determinations and subsidy calculations will require a seamless transfer of information. The exchanges will have to interact with the U.S. Treasury for income information. They will have to communicate with the Department of Homeland Security to verify citizenship. And all this information must be handled without violating the privacy of consumers.

“CMS (the Centers for Medicare and Medicaid Services) has designed and tested a system that they think is going to work, and they know where the risks and vulnerabilities are,” said Charlene Frizzera, president of her consulting firm, CF Health Advisors, and a former acting administrator of CMS. “The question is, how will they deal with those vulnerabilities they anticipated and those they haven’t anticipated?

….

Dennis G. Smith, also a former head of what is now CMS, believes one weak point will be in the calculation of Medicaid eligibility. He believes it is likely that the exchanges and state Medicaid offices will use different formulas or time frames for determining eligibility, leading to frustration and confusion for many consumers.

“Exchanges will send a whole bunch of people to Medicaid and Medicaid will say ‘Nope, they don’t qualify,’ and send them back to the exchanges,…

…

states with federal exchanges are doing no outreach at all, which raises the possibility that residents of those states will remain uninformed and do nothing.

….

Even people who get the message may arrive at the exchanges having never before purchased health insurance and unfamiliar with the way premiums, co-pays and deductibles work. Others may lack documentation proving citizenship, residency and income.

…

Perhaps the question that causes the most trepidation in the Obama administration is whether healthy young people will sign up for health insurance as the ACA requires. Because young people tend to be healthy and file relatively few insurance claims, their premiums are supposed to help pay for claims of older, sicker people. If the only people buying insurance are old and the sick, insurance premiums will be prohibitively expensive…

Read the entire press release here

***Related Resources

• Health Reform: Seven Things You Need to Know (Consumer Reports) [2012]- 15 pages with topics as newly enacted protections and benefits,what to expect in 2014, essential benefits defined, and how it will affect you

• About the Law (HHS.gov/healthcare) has information on coverage, costs, and care.

Other pages at HHS.gov/healthcare (US Dept of Health and Human Services)Live Chat courtesy of  the US Department of Health and Human Services (HHS)

• Link to Live Chat in lower right corner of all pages of mostHealthcare.gov, linked pages at including this one)

• Insurance Marketplace with links on information and how to enroll

• Facts and Features including a timeline
  • Other related timelines here and here

• FAQ pages  (Learn – All Topics ) from Healthcare.gov (U.S. Department of Health and Human Services) include
  • Health Insurance Marketplace – a great FAQ page with links to state information. Also answers to some specific questions as dental coverage, how to estimate costs, how to protect from fraud, and unemployed options
  • Getting Lower Costs on Coverage 
  • Health Insurance Basics
  • State by State Information

• Health Reform  (Kaiser Family Foundation)
  • For Consumers: Understanding Health Reform
  • How to Get Coverage in 2014
  • Frequently Asked Questions about Health Reform

• Health Reform-Beyond the Basics (A Project of the Center on Budget and Policy Initiatives)

Related articles

• Online health insurance exchange gearing up quietly in Mo. and Illinois (stltoday.com)
• Lookout for scams related to the Affordable Care Act (quinnscommentary.com)
• What to expect as Affordable Care Act comes into effect (wwltv.com)
• Affordable Care Act enrollment begins Oct. 1 (kgw.com)
• Obamacare to help, but not poorest in states that rejected Medicaid expansion: Tennessee, Georgia (timesfreepress.com)
• Obamacare Hasn’t Drastically Decreased Uninsured Rate (nation.time.com)
• For millions, insurance will cost less than $100/month (usatoday.com)

[Reblog] The ACA and Medicaid: Where You Live Matters

From the 4 September 2013 post at HealthCetera – CHMP’s Blog

What a difference a state makes. Ask my friend, a laborer whom I’ll call John.

Some months ago, John realized that a cyst-like lump on his trunk was growing and becoming bothersome. He has no health insurance so he paid out-of-pocket for a physician to examine it. Tests were negative and he was told it was “probably nothing.” The lump continued to grow and became uncomfortable, but John couldn’t afford to have it removed. When he shared this information with me, I told him that he probably qualified for Medicaid in New York State. He looked into it and discovered that he did. He signed up for it and went to a surgeon to remove the lump, now the size of a baseball and causing him increasing discomfort. After the test results came back, the surgeon told John that it was a malignant tumor. Fortunately, there is no evidence of metastasis, and John can proceed with the necessary treatments under Medicaid.

This story would likely have a very different outcome if John lived in Florida, Maine, Idaho, Kentucky or another of the 26 states that have not signed up to expand their Medicaid programs, as called for under the Affordable Care Act (ACA). As of September 2013, only 24 states plus the District of Columbia have committed to expanding their Medicaid programs.

How can this be? The 2012 Supreme Court’s review of the constitutionality of the ACA supported the federal government’s right to require that individuals purchase health insurance (the “individual mandate”), but it struck down a requirement that states expand their Medicaid programs to all adults under the age of 65 years who earn 138% or less of the federal poverty level (FPL) (in 2013, the poverty level is $15,626 for an individual and $32,499 for a family of four). States that failed to do so were to have forfeited their existing Medicaid programs that covered mostly women and children under the FPL. (Children ages 6 to 18 who fall at or under the FPL were covered by the existing Medicaid program; under the ACA, they are now covered up to 138% of the FPL under a separate section of the law that is untouched by the Supreme Court ruling.)

After the Supreme Court ruling, expansion of Medicaid became an option for states rather than a requirement. Why would states not want to do this? One reason is that it would cost the states some additional monies, though not very much. From 2014 to 2016, the federal government would pay 100% of the cost of the expansion. After 2016, it would pay 90% of the costs and the states would pay 10%. Seems like a deal for the states, but politics enters into the equation. The majority of the states opting out of the expansion are “red” states where the governor and/or legislature oppose “Obamacare”. Many of these states are at the bottom of the rankings of key health indicators.

I thought John would have qualified for the new state health insurance exchange that New York is implementing. The exchange will subsidize the cost of insurance for people in all states from 133% of the FPL (139% for people living in states that have adopted the Medicaid expansion) to 400% FPL. But John’s income is under the 139% in New York State, so he qualified for Medicaid.

John may be living a much longer life because New York opted to expand its Medicaid program. What about the unfortunate folks who live in states that didn’t opt in?

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

Related articles

• IV Costs are High for No Explainable Reason
  
• Health Insurance “Coverage Gap” Coming to a Red State Near You (crooksandliars.com)
• The Math of State Medicaid Expansion (jflahiff.wordpress.com)
• Who Are The Uninsured In America? (sanfrancisco.cbslocal.com)
• Your Affordable Care Act Questions, Answered (aauw.org)
• Study: Nearly half of U.S. births covered by Medicaid (stltoday.com)
• Three reasons why Missouri should expand Medicaid (stltoday.com)

Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns

 

I am hoping that the federal government can do a bit more to provide resources for librarians about ACA.

Back in my public library days, it wasn’t easy working with patrons when the topic was against my views!

However, I always tried to address people’s information needs without bias and as completely as possible with factual information.

“ObamaCare” questions are in the same arena.  While librarians cannot advise or fill out forms, they can at least lead folks to factual information. However, this would work best if the federal government would do everything possible to lighten the load for libraries.  This would include providing readable materials for consumers, as well as “pathways” for librarians.

Also, libraries can welcome trained volunteers and organizations to give in-depth information to folks. Many already do this around tax time with IRS trained volunteers.

Here in Toledo, folks from legal aid organizations “set up shop” in public libraries to assist folks. Representatives from the Ohio Benefit Bank do likewise. These volunteers screen people for government assistance programs as SNAP and the Medicare Savings Program.

It sure would be great if government employees and/or trained volunteers could do likewise for “ObamaCare”.  Areas could include the health exchange marketplace, Medicaid expansion, free preventative care, and more.

And with articles as this, there is a real need for information professionals, including librarians!

Ohio insurance department claims Obamacare premium rates to rise 41 percent (Cleveland Plain Dealer, August 1, 2013)

Ohio insurance regulators Thursday released rates for health insurance to be sold on the new state marketplace and said premiums for individuals will rise an average of 41 percent compared with 2013 rates.

That average brought immediate condemnation from critics of the Affordable Care Act, with U.S. House Speaker John Boehner, a southwest Ohio Republican, calling it “irrefutable evidence” that the law known as Obamacare is driving up costs and hurting the economy……..

Related articles

• [Repost] The ACA Countdown (jflahiff.wordpress.com)
• Got 1:43 minutes to learn about health exchanges? (jflahiff.wordpress.com)

21st Century Library Blog

While I’ve been busy with other things, I let this issue raised at ALA slip past unnoticed. Issues in library world don’t go unnoticed for very long, especially when they deal with government intrusion. Apparently, during ALA 2013 Conference a video was played in which there was a White House appeal to public librarians to help Americans understand the new Affordable Healthcare Act insurance system that goes into effect whenever – maybe. This federal initiative to get public libraries involved in assisting people to sign up goes into effect October 1.

As much as I dislike relying on news media for any valid information, a Washington Times online article “Librarian foot soldiers enlisted to help with Obamacare enrollment” published June 29 states:

CHICAGO — The nation’s librarians will be recruited to help people get signed up for insurance under President Barack Obama’s health care overhaul. Up to 17,000…

View original post 1,492 more words

The Math of State Medicaid Expansion

English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

 

Excerpts from the Rand Report

 

In June 2012, the Supreme Court ruled on the constitutionality of key components of the Affordable Care Act; and foremost among these were the individual mandate and Medicaid expansion. The Court judged the former to be constitutional but allowed states to “opt out” of the Medicaid expansion and some states have indicated that they will exercise this option. How might state choices affect health care coverage and costs?

The Patient Protection and Affordable Care Act (ACA) provides for three basic ways to increase health insurance coverage: the expansion of Medicaid to cover the poorest population; the provision of subsidies for those with low or medium incomes to purchase coverage on the new health insurance exchanges; and the institution of an individual mandate requiring everyone to have insurance. Taken as a whole, the ACA is highly controversial. However, Medicaid expansion and the individual mandate are particularly contentious issues, and the constitutionality of both was challenged, ultimately landing on the docket of the Supreme Court.

In June 2012, the Court ruled that the individual mandate was constitutional but gave states the option of not participating in the Medicaid expansion slated to begin in 2014. As of the spring of 2013, governors from 14 states had indicated publicly that they will choose to opt out.

The state-by-state breakdown as of spring, 2013. States where governors have stated they will not expand Medicaid are indicated in white, states that are leaning toward opting out or seeking alternative options are indicated in gray, and the remainder are red.

Source: The Advisory Board Company

What does Medicaid expansion offer states?

• More federal Medicaid funds: Under the ACA, the federal government will pay 100 percent of the coverage costs for those newly insured under Medicaid expansion. After 2016, the federal share gradually shrinks to 90 percent, substantially more than the 57 percent they currently pay on average.
• Greater access to care for the poor: Medicaid expansion makes health care more accessible to the poorest segment of the population — those earning less than 138 percent of the federal poverty level (this amounts to an income of about $16,000 for a single person or $32,000 for a family of four in 2013).
• Reduced outlays for uncompensated care: Providing insurance to the very poor reduces uncompensated costs of treatment for this group — an estimated $80 billion in 2016. Currently, about one-third of these expenditures come from state coffers.
• Reduces financial risk for the lowest-income Americans: Analysis of Oregon’s Medicaid experiment found that the financial hardship associated with medical coverage was dramatically reduced.

 

The report goes on to explain

• Without Medicaid expansion, the poorest population could fall through a coverage gap.
• What could be done about the coverage gap for low-income populations?
• The bottom line.

 

Related articles

• The math of Medicaid expansion in North Carolina (samefacts.com)
• The Cost of Not Expanding Medicaid | The Henry J. Kaiser Family Foundation (policyabcs.wordpress.com)
• Medicaid Expansion (mackinac.org)
• At southwest Missouri Medicaid panel, public voices against expansion silent (politicmo.com)
• Study: Obamacare could cause 1 million low-income Americans to move from work to welfare (aei-ideas.org)
• Senate Immigration Bill Contains $20 Billion Medicaid Mandate (breitbart.com)
• Medicaid expansion will cost Pennsylvania (triblive.com)
• Could the Obamacare Dream Turn Into a Nightmare for This Industry? (fool.com)
• AFP makes misleading attacks on “private option” for Medicaid expansion (arktimes.com)
• Editorial: Desperately flailing at Obamacare as it saves lives and money (stltoday.com)

 

RAND Shrugged | The Health Care Blog

The comments section was the most interesting part of this Web page.

Why Health Care is a Civil Right

Health care systems (Photo credit: Wikipedia)

 

I rarely overtly “get political” at my  blog.
However, this seems to go beyond politics to what living in a functional democracy or republic is all about.

 
From the 31 October 2012 article at Medical News Today

 

I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.

Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we don’t have a right to vote for any natural reason; we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right.

 

Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled — i.e. ‘patients’ — in society. I’m a patient, and I can tell you: lack of health care makes it impossible for me to participate freely and fully in society. Among the reasons …

• I can’t choose my work. Because health care is tied to employment, and not all jobs have benefits, I can’t do things that might be socially useful or personally satisfying but lack benefits. I can never start a business, for example, because I wouldn’t have health insurance.
• I can’t buy the things I need. Patients are denied the free purchase of goods and services by restrictions on the healthcare market: FDA regulations, prescription requirements, doctor licensing, insurance rules. These restrictions help make health care safer and more effective, but they also sharply curb supply of medical goods and increase their price, which is paid disproportionately by patients.
• I can’t participate fully in the political process. I rarely volunteer in my community — dealing with my healthcare takes up most of my free time. I can’t give money to causes or candidates I support, because I don’t have any to spare. Moreover, a sick person is less likely to risk losing employer-provided insurance by organizing a union, whistle-blowing against fraud, or reporting discrimination in the workplace.

None of these exclusions is intrinsic to illness, but due instead to the structure of our society. And each reason is more compelling to the extent illness and injury are produced by pollution, toxic products, and other societal causes. A patient’s basic right to justice requires us to respond to the likelihood that we — as a society — had something to do with their illness.

One of the counter-claims made against this line of reasoning is that nobody is entitled to claim a health provider’s labor as a right. But there are many other professions which are subject to civil rights claims: teachers, firefighters, lawyers, to name a few. Moreover, physicians and other providers are able to do their job effectively in large part due to public investment in research and technology.

Unfortunately, the Affordable Care Act did not go far enough to guarantee patients right to health care. Access to insurance is not the same as access to care, as any patient will tell you. The ACA was a small step in the right direction, but we still need legislation recognizing patients’ right to health care. Whatever the outcome of the election, health care must be acknowledged as a civil right.

Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.

 

Related articles

 

• Health Care in European Countries (travelwyse.wordpress.com)

 

Community health centers compare well with private practices, Stanford researcher finds

Community Health Center of Burlington (Photo credit: origamidon)

From the 10 July 2012 article at EurekAlert

STANFORD, Calif. — Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.

Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California, San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.

Their study is to be published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.

The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.

“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.

…

Related articles

• What is it like for a nurse in a Community Health Center? (giveacareindy.org)
• Florida health centers receive ‘Obamacare’ funding (tampabay.com)
• Mass. community health centers awarded $600K (bostonherald.com)
• West Hawaii Community Health Center Kealakekua Expands Care to Serve All Ages (damontucker.com)
• Stanford researchers move fetal genome testing ahead (sfgate.com)
• Affordable Care Act Helps Improve Access to High Quality, Coordinated Care (whitehouse.gov)
• Three community clinics receive $2.2 million in federal grants (jsonline.com)
• Health care dilemma (photos.mercurynews.com)

The Health Care Law and You‏ (USA.gov Update) & A Commentary

An updated gateway to information about the Affordable Care Act (“Obamacare”) from the US government including

• Full Text of the Affordable Care Act
  
• Key Features of the Law

Read this section to learn more about your rights and protections, insurance choices, and insurance costs. Get information on important benefits and programs available to seniors and small businesses.

• Timeline: What’s Changing and When
  The health care law puts in place reforms that will roll out through 2014 and beyond. Use the timeline or a printable list of key features in chronological order to learn what’s changing and when.

• Implementation Resources
  Find out how the health care law is being carried out across the country. Find links to regulations, authorities, grants, letters, reports, and other information related to the Affordable Care Act.

 Related news items

• The Supreme Court on health reform: Everybody wins! (KevinMD.com)
• The Supreme Court Ruling on the Affordable Care Act—A Bullet Dodged (with a video) (Brookings Institute)

  “…The outcome can be stated simply. People must pay a tax if they fail to carry approved health insurance. States may extend Medicaid coverage as specified in the Affordable Care Act, but if they don’t, none of the funds for previously eligible Medicaid enrollees will be in jeopardy. All other provisions of the Affordable Care Act stand….

  …

  Behind this seemingly simple outcome stand sharp disagreements over constitutional interpretation.

  For starters, by a vote of 5 to 4, the Court rejected the federal government’s argument that it can use its power to regulate interstate commerce to require people to carry insurance. Congress can impose a tax on those who don’t carry such insurance, but the concept of ‘mandate’ really doesn’t arise. …

• U.S. Supreme Court and the Federal Health Law (National Conference on State Legislatures)

“The U.S. Supreme Court handed down its decision today in U.S. Department of Health and Human Services (HHS) v. Florida. There were four issues before the Court regarding the Patient Protection and Affordable Care Act (PPACA): the applicability of the Anti-Injunction Act; the constitutionality of the individual mandate; the severability of the individual mandate provisions from other provisions of PPACA; and the constitutionality of the Medicaid expansion.”

(Includes a chart explaining the legal arguments for and against each of these issues along with the Court’s ruling)

• Obamacare Seems To Be Reducing Federal Govt Health Costs(MedicalNewsToday, 29 June 2012)
  It appears that federal costs for reimbursing private health insurers are beginning to drop, after Patient   Protection and Affordable Care Act (ACA), also known as Obamacare, has begun to come into effect.
  The Medicare Rights Center released a report today that provides an analysis of Medicare benefits through the Medicare Advantage (MA) program in New York. Before the ACA went into place, its detractors said that insurers would exit the market and prices would rise for everyone. This doesn’t appear to be the case. ….
• The Health Care Bloghas several related posts including
  • SCOTUS Surprise by Robert Reich (28 June 2012)

 “The big surprise, for many, was the vote by the Chief Justice of the Court, John Roberts, to join with the Court’s                              four liberals…Roberts nonetheless upheld the law because, he reasoned, the penalty to be collected by the government for non-compliance with the law is the equivalent of a tax – and the federal government has the power to tax. By this bizarre logic, the federal government can pass all sorts of unconstitutional laws – requiring people to sell themselves into slavery, for example – as long as the penalty for failing to do so is considered to be a tax.Regardless of the fragility of Roberts’ logic, the Court’s majority has given a huge victory to the Obama administration and, arguably, the American people. The Affordable Care Act is still flawed – it doesn’t do nearly enough to control increases in healthcare costs that already constitute 18 percent of America’s Gross Domestic Product, and will soar even further as the baby boomers age – but it is a milestone. And like many other pieces of important legislation before it – Social Security, Medicare, Civil Rights and Voting Rights – it will be improved upon. Every Democratic president since Franklin D. Roosevelt has sought universal health care, to no avail.

• What the SCOTUS ruling means for HealthCare by By DOUGLAS HOLTZ-EAKIN (JUne 28, 2012)
  “…The ACA remains a damaging, anti-growth vehicle for taxation.  The so-called Medicare surtax increases marginal tax rates on the return to saving, investment, and innovation.  The medical device tax will hurt innovation and cost jobs.  A bill to repeal it is gathering dust in the Senate.  Also, the insurers fee – the “premium tax” – will roil insurance markets, disrupt patient-provider relationships, and the vast majority of the burden will fall on the middle class.The ACA remains an unwise expansion of entitlement programs at a dangerous fiscal moment in U.S. history.  The U.S. has suffered a downgrade, has a debt-to-GDP ratio over 100 percent – a level historically associated with 1 percentage point slower growth and a heightened probability of financial crisis – and faces a spending-driven explosion of debt over the next decade.  Also, the ACA does not reform Medicare, which has a cash-flow deficit of nearly $300 billion annually and is responsible for one-fourth of all federal debt since 2001.

  Finally, the ACA is a vast regulatory expansion.  …”