Tag: Health Care Reform

Obama’s Medicare Half-Truth

Sep 14, 2009• 34

By AUSTIN FRAKT

Obama was called a liar during his recent address to a joint session of Congress. Actually, he was not fully truthful
about the implications of cuts to Medicare. Obama repeated that his
health reform plan includes payment cuts for private Medicare Advantage
(MA) health plans:

The only thing this plan would eliminate is the
hundreds of billions of dollars in waste and fraud, as well as
unwarranted subsidies in Medicare that go to insurance companies —
subsidies that do everything to pad their profits and nothing to
improve your care. … So don’t pay attention to those scary stories
about how your benefits will be cut… That will never happen on my
watch. I will protect Medicare.

Obama’s claim that the cuts will trim insurer profits but not Medicare benefits was meant to calm nervous seniors. As I and others
have pointed out the proposed cuts will in fact reduce benefits to some
degree, contrary to the President’s assertion. But seniors, in
general, should not be concerned. First, only about 23% of Medicare beneficiaries are enrolled in an MA plan.

Taxing Health Insurance Companies to Pay for Health Care

Sep 14, 2009• 9

By ROBERT LASZEWSKI

The Congress has investigated about every conceivable way to tax people to pay for the health care proposals—a millionaire’s tax, bigger taxes on home mortgages and charitable contributions, and a couple of dozen more ideas.

Now Congress looks to be the most interested in taxing insurance companies to pay for a big chunk of their health care proposals. The new taxes would come in two parts––a 35% excise tax on any health benefit cost above an $8,000 single and $21,000 family annual premium as well as a flat $6 billion annual tax on the industry to be allocated among the companies proportionate to their premium.

There is certain logic to this. Taxing high priced benefits could help deflate the health care economy. Taxing all of the health insurance companies that stand to get more than a $1 trillion in new business—most of it in the from new private insurance and Medicaid subsidies and the rest from the consumer’s share of those new private plan premiums—seems fair at one level.

Calling for a tax on that big rich insurance company also sounds a lot better to the politicians than looking voters straight in the eye and raising their taxes directly.Continue reading…

CBO: HELP Bill’s Public Plan Not Much Help on Costs

Sep 14, 2009• 5

By MERRILL GOOZNER

The green-eyeshade meanies in the Congressional Budget Office took another whack at the public plan today, at least the one contained in the health reform bill passed by the Senate Health Education Labor and Pensions committee last June. Responding to queries from ranking member Michael Enzi (R-WY), CBO chief Doug Elmendorf noted on his blog that “premiums for the public plan would typically be comparable to the average premiums of private plans offered in the insurance exchanges.”

The reason given was the HELP bill emasculated the public plan’s ability to piggyback on the administrative efficiencies of Medicare and required it to be “financially self-sufficient.”Continue reading…

Not Really an Option

Sep 13, 2009• 16

By GARY NISSEN

To: Executives leading U.S. Hospitals

The public option appears to back in the national dialogue and I’m wondering how concerned you all are about that.

After all, many of you have been quite successful at minimizing the appearance of true profit by growing your cost structure on the backs of private insurers, right?

Thinking back over the last ten to fifteen years, many things have changed.Continue reading…

Reminding Washington of What the Health Care Debate is About

Sep 12, 2009• 6

By ROB DAY

This summer, we witnessed countless demonstrations on the health care debate across the country. The media has broadcast and written about impassioned pleas from conservatives and liberals alike, each swearing, with an alarming level of certainty, that their way is the only way. As we enter the fall and as Washington returns to work, Americans must ask themselves what really matters when it comes to reform. From my standpoint, while I think it’s a good thing the country is discussing much-needed health care reform, there is one important element missing from this enthusiastic debate. The patients. Individual Americans, and their best interests, are, or at least should be, at the core of any health care dialogue. Some will be much more affected than others, regardless of what the makeup of the final language that is passed.

The Speech: Could this have been what he planned all along?

Sep 11, 2009• 17

A conventional look at The Speech: Obama over-learned the lessons of Hillary-care; he gave Congress too long a leash; he lost control of the message; the wacko’s attacked with a barrage of Socialist/Nazi/Plug-Pulling-on-Grandma-isms; not only was health reform on the ropes but the entire Obama Presidency was in danger of imploding (taking the Dems down with him in the mid-terms); Obama had his back against the wall, a make-or-break moment. Then last night, the President gave a great speech that staked out a thoughtful middle ground; Joe Wilson went rogue, horrifying nearly everyone; this led to real sympathy for Obama and the Dems and a shift in the political landscape. In the end, a mild version of health reform – with nearly-universal coverage, some regulatory protections against the most heinous insurance practices, fee hikes to pay for it all, and a little movement toward improving quality and efficiency – passes.

Another look at The Speech:

Obama, a student of history, realizes that health reform is a near-impossible sell since every special interest will come out swinging; he gives Congress the ball knowing that whatever plan emerges from their sausage factory will simply be red meat for demagoguing Republicans and special interests worried about preserving their Gravy Train; Congress obliges by developing plans that overpromise and under-resource, or that push predictable hot buttons (immigrant coverage, palliative care); the Right and its attack dogs go berserk throughout the Wacko Days of August; the left hunkers down, drawing a line in the sand on the Public Option, kyboshing malpractice reform, and avoiding the hard questions about financing.Continue reading…

The Speech: Could this have been what he planned all along?

Sep 11, 2009

By BOB WACHTER

By default 4

White House Photo

A conventional look at The Speech:

Obama over-learned the lessons of Hillary-care; he gave Congress too long a leash; he lost control of the message; the wacko’s attacked with a barrage of Socialist/Nazi/Plug-Pulling-on-Grandma-isms; not only was health reform on the ropes but the entire Obama Presidency was in danger of imploding (taking the Dems down with him in the mid-terms); Obama had his back against the wall, a make-or-break moment. Then last night, the President gave a great speech that staked out a thoughtful middle ground; Joe Wilson went rogue, horrifying nearly everyone; this led to real sympathy for Obama and the Dems and a shift in the political landscape. In the end, a mild version of health reform – with nearly-universal coverage, some regulatory protections against the most heinous insurance practices, fee hikes to pay for it all, and a little movement toward improving quality and efficiency – passes.

Economist: “A huge step forward. With one exception …”

Sep 10, 2009• 39

A thumbs up:

“Cleverly borrowing good ideas from both sides of the party divide, his proposals at least look like a plausible basis for agreement. The plan obliges everyone to take out health insurance while creating a tapering subsidy for poorer families to help them afford it. It also requires insurance companies to end various nefarious practices, such as refusing to insure people with existing conditions or cancelling their coverage just when they need it most. To pay for these long-held liberal goals (the cost is put at $900 billion over ten years), the president has committed himself to several policies that Republicans, if only they could remove their partisan spectacles, should applaud.

Immigrants, Health Reform, and “Lies”

Sep 10, 2009• 47

By NATHAN CORTEZ

In a much-anticipated prime time address to Congress, President Obama made the case for health care reform. One ostensible goal of the speech was to correct misinformation about the bills proposed by Congress. As a scholar who studies both health care and immigration (and sometimes the intersection between the two), I’ve grown increasingly frustrated with the misconceptions surrounding this issue — and I very much hoped the President would deflate the myth that health reform would provide federal benefits to undocumented immigrants.

Of course, when President Obama made this very point (”The reforms I’m proposing would not apply to those who are here illegally”), he was greeted with a heckle from South Carolina Representative Joe Wilson, who shouted “You lie!” Although Rep. Wilson later apologized for his “lack of civility,” he didn’t recant the basic factual assertion, making clear that he still disagreed with the President’s statement that health reform doesn’t cover undocumented immigrants. Of course, the media has jumped on this story, but perhaps unsurprisingly, few bothered to clarify the underlying factual dispute.

Neither bill published by the House or Senate covers undocumented immigrants. In fact, both bills state in pretty plain terms that they don’t do it. The House bill, titled America’s Affordable Health Choices Act of 2009, states in Section 242 that those not lawfully present in the United States are not eligible for insurance subsidies or tax credits. To make it even more clear, Section 246 is titled “No Federal Payment for Undocumented Aliens,” and states “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

Likewise, the Senate Health, Education, Labor, and Pension Committee’s bill, titled the Affordable Health Choices Act, states in Section 3111(h) that “Nothing in this Act shall allow Federal payments for individuals who are not lawfully present in the United States.” The Senate Finance Committee has yet to release its bill, but it’s a good bet that undocumented immigrants similarly will be excluded.

Although nothing in the bills apparently would prohibit undocumented immigrants from purchasing health insurance in the new national marketplace (called an “exchange” and a “gateway” in the House and Senate bills), it’s not clear why anyone would take issue with immigrants purchasing insurance on their own, without federal subsidies. Moreover, although nothing in the bills seems to alter federal funding for emergency care provided to immigrants, nothing creates such a benefit either — thus undercutting Rep. Wilson’s contention with the President.

This controversy should remind us that immigrants remain in a sort of health care purgatory, caught in our two most dysfunctional systems — immigration and health care. In the mid-1990s, Congress severely limited immigrant access to programs like Medicaid as part of welfare reform, making it difficult for even lawful immigrants to enroll. In fact, even lawful immigrants aren’t eligible for Medicaid for five years after entering the United States — and various peculiarities of immigration law often push this waiting period to ten years. At the same time, immigrants do receive indirect federal funding for health care through the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals with emergency departments to screen and at least stabilize patients presenting with emergent conditions. Thus, hospitals must provide emergency care regardless of the patient’s immigration status.

Unfortunately, most immigrants are ineligible for means-tested public insurance programs like Medicaid. This regulatory framework has led to “medical repatriation,” in which hospitals effectively deport immigrant patients to unload expensive long-term care burdens. Of course, hospitals — most of which are run by state and local governments — complain about unfunded federal mandates like EMTALA. Hospitals can be “stuck” treating immigrants whose medical needs have shifted from acute to long-term (as with the car accident victim who needs neurological rehabilitation and nursing care). As Prof. Boozang discussed, a growing number have begun “repatriating” immigrant patients by sending them back to their country of origin — without consulting immigration officials — sometimes by purchasing commercial plane tickets or even hiring air ambulances.

Certainly, there are more humane ways to handle health care for immigrants. California, for example, legalized cross-border health insurance, thus allowing immigrants living in the state to purchase insurance with lower premiums and deductibles that covers care provided in Mexico. Arizona and Texas have considered similar legislation, to no avail. Recently, UCLA researchers estimated that over 950,000 people travel from California to Mexico for medical care every year. For a population being left out of health care reform, traveling to Mexico for care may be the future — whether voluntary or not.

Professor Cortez teaches and writes in the areas of health law, FDA law, administrative law, and the legislative process at SMU School of Law. His scholarship focuses on international and comparative health law, particularly the regulation of emerging international markets in health care and biotechnology, such as cross-border health care, medical tourism, and clinical trials. He also writes about immigration federalism.

Before joining the SMU law faculty, Professor Cortez practiced with the Washington, D.C., law firm Arnold & Porter, where he represented medical technology clients in administrative, legislative, litigation, and transactional matters, with a special emphasis on health care fraud and abuse, FDA enforcement, health privacy, and the Medicare and Medicaid programs. Professor Cortez is a frequent contributor to Health Reform Watch, where this post first appeared.