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UPDATE: Medicare, SCHIP and Kids

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By MAGGIE MAHAR

Last night the Senate voted 68 to 31 to renew and expand the State Children’s Health Insurance Program SCHIP). A day earlier the House voted 225-204, largely along party lines, to approve a larger expansion of the SCHIP program. As Matthew notes below, the Senate, unlike the House, would not try to help fund SCHIP by eliminating Medicare’s overpayments to Medicare Advantage for-profit insurers. (See my post below)

Meanwhile, President Bush has said that he would veto either version of the legislation. But the Senate bill garnered enough votes for its version of the bill to overcome a veto. (18 Republicans joined 48 Democrats and 2 Independents in the vote.)

According to PBS, the House and Senate plan to meet after their August recess to reconcile the differences between the two bills before sending a final measure to President Bush.

Below, Matthew offers his best guess as to what will happen next. He suggests if the Senate/House compromise avoids taking a whack at the Medicare Advantage private sector insurers, the President might well sign it. Nevertheless, Matthew believes that Democrats won’t be able to resist the temptation to include the provision cutting over payments to insurers in order to provoke the veto and then campaign on the fact that Republicans hate children.

I’m cynical but frankly, Matthew is so cynical. I take this as an ethnic (i.e. British) trait. On the other hand, I’m Irish, so I probably shouldn’t open a discussion about ethnic Achilles heels . . .

But I am idealistic enough to think that there are enough Democrats and Republicans who care about healthcare for uninsured children that they will eliminate the cuts to insurers in hopes of avoiding a veto.

It’s worth noting that on Tuesday, Sen. Orrin Hatch (R. Utah) and Sen. Edward Kennedy, (D-Mass), told the Washington Post that House-Senate negotiations will aim to keep the final bill within the scope of the Senate’s measure in order to try to avoid that Presidential Nix.In the end, if Congress doesn’t touch insurers’ profits, would President Bush say “no” to expanding SCHIP for kids? I don’t know.

What do you think?

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

POLICY/HEALTH PLANS: SCHIP passes the Senate, but I think for now Medicare Advantage is safe…for now

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A version of SCHIP that doesn’t touch Medicare passed the Senate last night. It has a veto proof majority. Of course it now has to be reconciled with the house bill that raises more taxes and cuts Medicare Advantage. So this will now go one of two ways. Either the bills will get reconciled along the lines of the Senate bill and probably get signed by Bush, or the emerging bill will have a hack at Medicare Advantage and get vetoed.

My guess is that it’ll be the latter. It’s just too tempting for the Democrats to provoke the veto and then campaign on the fact that Republicans hate children. (Some temporary extension for the current SCHIP will be worked out as it expires in the background).

Meanwhile despite all the rhetoric remember this:

The Congressional Budget Office says the Senate bill would cover 3.2 million uninsured children, including 2.7 million who are currently eligible but not enrolled. The House bill, it said, would cover 4.2 million children, including 3.8 million already eligible for benefits. In addition, both bills would provide money to prevent 800,000 children now on the program from losing coverage.

According to KFF there are 8 million uninsured children today. So we’re only talking about covering up to half of currently uninsured kids. Which makes all the rhetoric about socialized medicine a little overblown. Even though unlike some of the more timid moderate Democrats I’m happy to say that socializing the insurance side of health care —as in putting everyone in one pool — would be a very good idea.

Meanwhile, perhaps the recent pressure on managed care stocks is a little over done? (Far be it from THCB to recommend a buy on UNH, but it’s at $48 which is way below where it’s been for a while!)

UPDATE: AHIP isn’t taking any chances, Its headline in its propaganda this morning is (I shit you not) "House Votes to Push Millions of Seniors out of Medicare Advantage"  Click thru and you can see a video of my favorite lobbyist telling only a small number of lies in 44 seconds. Did you know that Medicare Advantage is a "safety net" for seniors? Neither did I….

QUALITY/POLICY: Medpundit right on on cancer treatment

I didn’t get around to talking about the cancer treatment article in the NY Times last weekend, but Syd at Medpundit did. And I agree with her—we should be figuring out when to say no, heartbreaking though it is. Although buying a few extra months for a 35 year old mother in my mind is different from doing it for a 93 year old (even if he was President once). Look in the comments for a note from the subject of the NY Times article.

HEALTH PLANS: SCHIP and Medicare Advantage

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You’ll be seeing more and more of Maggie Mahar here as she works blogging into her new role at The Century Foundation. But of course, she’s not the only one who’s made this connection. If you want to see more of your host’s caustic comments on Medicare Advantange, and lots of good comments around it, try here, here here, here or here. Here’s Maggie on this week’s dust up.

By MAGGIE MAHAR

A debate rages in Congress: Who needs the money more  – UnitedHealth or the kids?

This week, a storm hit the House of Representatives when law-makers began  to debate a proposal that would, in the words of a Wall Street Journal editorial, “steal nearly $50 billion from Medicare Advantage, the innovative attempt to bring private competition to senior health care” in order to beef up the State Children’s Health Insurance Program (SCHIP), a program that delivers health care to poor children.

Last night, the House voted 225-204 to pass the legislation.

SCHIP is scheduled to expire September 30; the House bill would renew the program while expanding it to include another 5.1 million children at a cost of an extra $50 billion over five years. The bill’s backers propose to fund the legislation by increasing the federal cigarette tax by 45 cents while   simultaneously paring the premium that Medicare pays private insurers who provide Medicare to seniors. The goal of the bill, reformers say, is to ensure that all children in the United States have health insurance. The Wall Street Journal’s editors see things otherwise: “Democrats apparently want to starve any private option for Medicare,” the editorial concluded.

Rupert Murdoch hasn’t yet weighed in, so I decided to take a look at the proposal. Would the House bill really make it impossible for private sector insurers to continue to offer needed benefits to seniors?

Continue reading…

PODCAST: Fine art and healthcare–a conversation with David St Clair, MeDecision

A while back I got a rather unusual email from MEDecision– an interesting tech company I’ve interviewed before on THCB. It was actually quoting their CEO David St Clair who’d just seen Malcom Gladwell and it said this:

Picasso was able to produce his greatest masterpieces by the time he was in his
mid-twenties. After that, it seems the quality of his output leveled off, or may
have even dipped a bit. Cezanne was kind of the opposite. He learned from
trial-and-error and leveraged a half-century of life experience, development and
growth to create his best art after the age of 50. I think Mr. Gladwell is dead-on in his assessment that
proposals to fix our health care system can be categorized as taking either
Picasso or Cezanne approaches. Like Picasso, a lot of folks are focused on
finding that one, major, “big bang” idea that will comprehensively solve every
problem. While this methodology may work in certain circumstances (it certainly
worked for Picasso for awhile), I have to agree with Mr. Gladwell that health
care is far too large and complex a system for us to realistically think that
some monumental “burst of innovation” is going to cure its every ill and set it
back on course. No, my money is on the Cezanne approach. After 20 years in the
health information technology business, I truly feel that there isn’t a single
magical solution – even if Michael Moore seems to think there is. It’s got to be
a lot of little solutions building momentum toward larger, system-wide reform.
And we need to engage as many people as we can in the process and give them the
means and resources they need to keep trying new approaches that might work.
Like Cezanne, we need to build on our experiences and develop and grow our ideas
before we can expect the masterpiece to emerge.

As you might imagine, I’m not a fan of incremental piecemeal change in health care, even though I’m not in complete agreement with Michael Moore–whatever certain of my readers might think. And it’s not often that a health care tech company CEO goes off the tech-only reservation (so to speak)  So yesterday I had a long chat with David. It certainly was spirited, and I hope you’ll be interested in the outcome!

PODCAST/TECHNOLOGY: Shiftwise Founder Jason Lander

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Shiftwise wants to become the Travelocity or the Orbitz of the nurse staffing business by bringing web-based solutions to a field that has been dominated for years by agencies using outdated technology. By allowing HR managers to match available staff and allowing staff to bid for available shifts, the company says its technology allows hospitals — and agencies too — to save big bucks on the process of dealing with temporary staffing.  I had a chat with founder Jason Lander about the company’s model and plans for the future.

HEALTH PLANS: Mega Life and Health — Time to call AHIP, Goldman Sachs, Credit Suisse and BlackStone out

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I spent a little time last year on the issue of Mega Life and Health. There’s only one term for this company, and what’s really frightening is that it’s a major player in AHIP. If AHIP is ever going to get itself out of the self-serving position it’s in and transition to being an organization of responsible private health plans that can have a reasonable conversation about the positive role health plans can play , the plans who could live in a future of community rating need to leave, or jettison the scumbags like Mega.

What’s the activity I’€™m so upset about?

Mega Life and Health sells health insurance door to door to poor to middle and low income working people. They claim that they are selling a product which their customers understand. But the point their customers clearly do not understand is that the insurance€ has severe limits on what it pays, especially what it pays per day in cases of expensive care. So if a policyholder gets sick and needs hospital care, Mega only pays out a fraction of what the hospital charges, leaving the poor sucker patient on the hook for the rest. Last year the California Supreme Court ruled that this con, like all the best cons, is legal. And this type of policy continues to be sold (more or less legally) in most states.

Continue reading…

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