Archive for September, 2009

Disparities in dollars: two new studies make the cost case for fixing them

Wednesday, September 30th, 2009

Minorities and immigrants in America are disproportionately hurt by a lack of health insurance, poor access to care, low quality treatment and gaps in service. This results in deadly symptoms. For example, 14 of every 1,000 African American babies in the U.S. die in their first year of life, compared to 6 of every 1,000 white babies. People of color are far less likely to get appropriate care for diabetes, asthma or heart disease, and therefore more likely to suffer complications.

Reducing these racial and ethnic health disparities will save lives and is essential to ensuring that everyone in America has quality affordable health care. It’s the right thing to do, but when the moral argument isn’t enough to move policymakers, two new studies have provided economic ammunition.

Instead of measuring disparities by counting the people of different races who suffer or die from preventable diseases, the new studies measure disparities in dollars.

The Economic Burden of Health Inequities in the United States,” a new report from the Joint Center for Political and Economic Studies, finds that eliminating disparities among African Americans, Asians, Hispanics and whites would have saved $229 billion in medical treatments from 2003-2006. That’s nearly one-third of the cost of all medical care for African Americans, Asians and Hispanics. The report posits that the health gained by eliminating disparities would reverberate through society, resulting in an astounding $1.24 trillion in savings from fewer premature deaths, reduced absenteeism, and increased productivity.

Estimating the Cost of Racial and Ethnic Health Disparities,” by the Urban Institute takes a more narrow look, focusing on the costs of four preventable conditions among African Americans and Hispanics: diabetes, hypertension, stroke and kidney disease. In 2009, disparities in the rate and severity of these illnesses cost the health care system an estimated $24 billion, including nearly $16 billion in Medicare alone. Projected over the next decade, the cost would total $337 billion.

We hope the Congressional Budget Office keeps this in mind as they score provisions in the House and Senate health reform bills that seek to address disparities. As Thomas LaVeist, one of the Joint Center report authors said, “The cost of inaction is tremendous.”

Partly cloudy with a chance of Snowe

Tuesday, September 29th, 2009

The Senate Finance Committee returns to its mark up today, and for health reform junkies, the number one spectator sport of the moment has become watching committee member Sen. Olympia Snowe’s every move like they were tea leaves to her votes.

Over the course of the debate, Snowe’s support has taken on great importance. It would help the Democratic leadership hold onto their own conservative members and could even pave the way for several more Republican votes in support of reform.  And a series of committee votes on which she has voted with Sen. Baucus has sparked speculation that Snowe is moving toward a yes vote on the overall bill.

For her part, the senior Senator from Maine is keeping her cards close to the vest.  While Snowe’s support would be a political dream-come-true for Senate leadership and the White House, liberals in and out of Congress have less reason to be enthusiastic, since Snowe has been clear that she does not support a public insurance plan except as a fallback in the event that there are not an adequate number of private options.

With the Finance mark-up  slated to wrap this week, we’ll be watching to see how the committee addresses affordability, the public option and employer responsibility – and of course, Sen. Snowe’s votes on these issues and the final bill.

For more, check out the Health Reform Insider.

Handicapping the Baucus plan

Tuesday, September 22nd, 2009

With no commitments of Republican support, Chairman Baucus can only afford to lose two Democratic votes and still get a bill out of committee.  Sen. Rockefeller (D-WV) has already committed publicly to opposing the bill in its current form, and Sen. Menendez (D-NJ) has indicated that he might not support the bill due to concerns over the treatment of immigrants. With most other Democrats on the Finance Committee expressing some degree of concern, the Chairman will have to make significant changes in the coming week.  The challenge will be to come up with modifications that will satisfy both liberal and conservative members.

By now, the key issues that the committee will have to resolve are familiar—they are most of the same ones that bedeviled the inconclusive bipartisan negotiations that preceded the release of the Baucus plan.

We recap the most significant ones and assess their prospects in this week’s Health Reform Insider.

Michael Miller, Director of Strategic Policy

Everybody’s Talking About… Affordability!

Friday, September 18th, 2009

September Capitol Hill Affordability Rally

Perfect Timing

On the very day that Senator Baucus finally released a proposal for consideration by the Senate Finance Committee, community and faith leaders came together in Washington to deliver an important message: getting affordability right is the key to health reform.  Over 100 people from PICO National Network and state-based consumer organizations working with Community Catalyst fanned out across Capitol Hill to talk to Congress about why affordability matters so much.  They shared personal stories about what lack of affordable care has meant to them, their families and their communities and delivered a six point agenda for truly affordable health care.  Together, the groups called for a minimum benefit package similar to what members of Congress get; sliding scale premiums and cost-sharing for low and moderate income households; a cap on out-of-pocket costs that protects people against being under-insured; and an exemption from mandate penalties in cases of financial hardship.

The two organizations also released a statement on affordability co-signed by a number of the nation’s leading consumer and voluntary health organizations including AARP, ACS-CAN, American Heart Association, Consumer’s Union, Evangelical Lutheran Church, Lutheran, Families USA and National Urban League.

Affordability has taken center stage in the health care debate as many, both in and out of Congress, expressed concern that the proposal unveiled Wednesday by Senator Baucus would not do enough to make health care affordable for families who lack employer-sponsored insurance.   While concern about middle income families is widespread, a Community Catalyst analysis shows that low-income families could face an unbearable burden under the Baucus plan.  For example: a family of four with an income of twice the federal poverty line could face health care expenses of over 20% of their income.  An individual making only about $14,000 could be expected to pay as much as $2,400 if faced with a major illness.

Hurts So Good

According to Politico, “ insurers… got walloped in the bill – facing taxes, fees and cuts that could amount to almost half of its $856 billion price tag.”  (Politico Pulse 9/17/09) Do they really? Let’s take a closer look:
• Insurers have made opposition to the public option their central issue, and the Baucus plan has no public option.
• Insurers oppose the 2-1 age rating included in other bills and endorse the 5-1 proposal in the Baucus plan. (Translation: With 2 to 1 age rating, insurers can charge the oldest enrollees up to twice what they charge the youngest enrollees for the same plan; with 5 to 1 age rating, the oldest enrollees would pay up to 5 times what the youngest enrollees pay.)
• Insurers support a lower guaranteed benefit level and the Baucus bill complies.
• Insurers want a tough individual mandate with few loopholes and significant penalties for noncompliance, and the Baucus bill has the toughest mandate of any of the proposals.

Sure the insurers are unhappy about the new fees. But under the Baucus plan, they would get millions of new customers who will be compelled to buy their product more or less on the terms the industry prefers.  If that’s getting walloped, the insurance industry is probably saying “hit me again.”

Michael Miller, Director of Strategic Policy

The MD factor: Majority of physicians back public insurance options, study shows

Wednesday, September 16th, 2009

A study released this week in the New England journal of Medicine found that a large majority of physicians support the expansion of publicly-backed health insurance programs. The survey, funded by The Robert Wood Johnson Foundation, polled over 5000 randomly-selected physicians from a broad range of specialties, practice setting, and regions, and the findings represent the opinions of more than 2100 respondents contacted between June – Sept. 2009.

The large majority of respondents – 73 percent – supported a public option in health reform; most surveyed (62 percent) said they think health reform should include a combination of public and private options, mirroring the principles President Obama, three House committees and a Senate committee have all put forward.  A majority of American Medical Association members surveyed also supported a public option.

And in a finding that rebuffs some reform opponents’ claims that expanding or fortifying Medicare would hurt practicing doctors, there was strong, cross-specialty support for expanding Medicare to those ages 55-64.  Check out the paper’s helpful bar graph to see what we mean.

The authors acknowledge that though the American Medical Association’s stand on reform has wavered and changed during health care debates, past and present, it has most recently come out in support of a House reform proposal that includes significant coverage expansions through subsidized private insurance and a public option.   These findings demonstrate that this position is now more consistent with individual physicians’ views on health reform today.  The authors write:

Physicians’ groups have strongly influenced efforts in health care reform throughout modern U.S. history and in so doing may have often obscured the collective views of individual physicians across the spectrum of specialties, interests, and regional affiliations. Given the enormity of the current effort to reform health care and its potential effect on future generations of Americans, policymakers need to hear the views of the whole range of physicians on the key elements of reform.

Both authors, physicians at Mt. Sinai School of Medicine, are members of the National Physicians Alliance. You can hear them talk about their findings on NPR’s All Things Considered.

–Kate Petersen

Full Court Press

Monday, September 14th, 2009

President Obama’s all-out effort to wrest the health care conversation from the right wing and more at the Health Reform Insider, Community Catalyst’s weekly take on what’s happening in national reform.

–Kate Petersen

Worth the Wait

Thursday, September 10th, 2009

For days, the tension has been mounting over what President Obama would say when he addressed the nation on health care.  Last night, with an eloquent prime time address to a joint session of Congress, the President powerfully rebooted the debate on health care.

The President challenged critics to engage in a more civil and fact-based discourse – a challenge that many Republican Congressmen failed to meet.  In an unusual breach of protocol, Republicans sometimes booed the President, and one Republican Congressman even shouted out “you lie!”  In his response to the President’s speech, Congressman Boustany reiterated unsubstantiated charges of “government takeover” and “rationing” that the president had refuted just moments before.  The net effect of all of this was to make Obama seem more reasonable and unflappable – utterly Presidential – in the presence of some of his more vociferous (and less self-possessed) critics.

Coming into the evening, the President had to achieve several big goals.  He needed to reassure a nervous public, explain what he was proposing, and reenergize his base both in Congress and in the nation.

President Obama did that and more. He came across as both passionate and calmly reasoned – again, a sharp and welcome contrast to the wilder critics that have dominated the cable news media.  At same time, the President staked out the high ground in the debate by reaching out and embracing ideas from Republicans.

He also successfully navigated the treacherous political waters around the “public option.”  While he made a clear case for a public option and took on the scare-mongers directly, he also strongly cautioned the left against making the public plan a litmus test for reform.

President Obama did not shy away from engaging with opponents.  He directly addressed the most common charges made against reform, giving special attention to issues affecting seniors.  He clearly restated his commitment to allow people to keep the coverage they have, to protect the Medicare program and to make sure health care reform does not add to the deficit.

Recent polls show that most Americans are confused by the debate. After last night’s speech, the key elements of reform–including insurance reforms, individual and employer responsibility and sliding scale subsidies—should be much clearer to the public. The President also reiterated the need for an exemption for those who still could not afford coverage. However, he did not engage on a crucial question for many low- and moderate-income households: Just what constitutes affordable coverage?

The President’s closing words speak for themselves:

That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling.  It’s not a Republican or a Democratic feeling.  It, too, is part of the American character — our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise….

I understand that the politically safe move would be to kick the can further down the road — to defer reform one more year, or one more election, or one more term.

But that is not what the moment calls for.  That’s not what we came here to do.  We did not come to fear the future.  We came here to shape it.

(You can read the full remarks here.)

–Michael Miller, Director of Strategic Policy

Welcome to the Health Policy Hub!

Wednesday, September 9th, 2009

Today, Community Catalyst proudly launches our new blog, Health Policy Hub. While the word “policy” may sound a bit wonky to some, we hope to hit the wonk-life balance by providing interesting commentary on all things health care without coming off like policy geeks who spend our lunch hours ruminating over subtitle c of section 101(B) of Title I of the Acts of…Obviously, no one here does that.

We’ll bring you the insights, expertise and opinions of our Community Catalyst colleagues who have years of experience (we won’t say how many) and numerous successes working to improve health care at the local, state and national level. They’ve been on the ground organizing grass roots advocacy groups, at the table negotiating with insurers, hospitals and policymakers, and on their Blackberries working around the clock to ensure consumer interests are represented in our health care system. We’ll look at many issues – from health care reform to children’s health to making our hospitals more accountable to the communities they serve – through a consumer lens. We’ll also check in with our state and national partners on their efforts to make health care better, accessible and affordable.

Like any blog, Health Policy Hub’s success hinges on our ability to keep content fresh and interesting. We will work hard to make that happen. But we also need you readers to help out with the interesting part – sharing what you’ve heard and letting us know what you think. We welcome your comments, and hope this is the start of a lively and thought-provoking conversation.