Posts Tagged ‘Patient Protection and Affordable Care Act’

« Older Entries

Cross Post: Consumer Assistance: A Guided Tour to Your New Health Care Choices

Thursday, July 29th, 2010

Everyone has heard about some aspect of the Affordable Care Act (ACA), however many people are still confused about the new law. At Community Catalyst, we think Consumer Assistance Programs (CAPs) are vital to ensuring people understand what the changing health care system means for them, and will help people get clear, accurate information about their health care. The ACA set aside $30 million in 2010 to provide grants for state CAPs and ombudsman programs, and last week the Department of Health and Human Services Office of Consumer Information and Insurance Oversight (OCIIO) released the grant guidelines. Today on Say Ahhh! A Children’s Health Policy Blog, one of our senior policy analysts, Christine Barber, explains some of the provisions of the guidelines:

-The grant criteria take steps to ensure that the selected programs are independent. In particular, we are happy to see that the guidelines clearly welcome states to contract with non-profit organizations to provide consumer assistance.

-CAPs must assist people with all types of coverage and provide assistance that is culturally appropriate. In addition, programs must collect data about any problems and questions, which we hope will provide real-time, on-the-ground information about what’s working and what’s not. Regular feedback to state and local policymakers can help improve health reform implementation.

-Each state is eligible for one grant award. Therefore, it is important that states know about this grant program, so consumers can get help, no matter their zip code.

We applaud the guidelines, and have created a summary with the Community Service Society to further explain the grant criteria. Check out the rest of Barber’s post here, or read the full grant guidelines. Applications are due September 10.

– Christine Lindberg, Communications Associate

Tags: , ,
Posted in national health reform | No Comments »

Are we speaking the same language? The problem with medical jargon

Wednesday, July 28th, 2010

Today, many families are struggling not only with the cost of and access to health care, but also with the quality of care they receive. A recent article in the Wall Street Journal, “Taking Medical Jargon Out of Doctor Visits”, articulates an incredibly important issue that sometimes gets swept under the rug in the talk about cost and quality of care: patient health literacy.

According to the Centers for Disease Control and Prevention, about nine out of 10 adults find it hard to follow routine medical advice, mostly because they don’t understand what their care providers are saying. The complex instructions and jargon that doctors use make patients more likely to skip necessary medical tests or not take their medication as prescribed. This confusion leads to poorer health outcomes and increased health care costs currently estimated at $238 billion a year.

There is a common assumption that lack of health literacy is limited to racial and ethnic minority populations. While these populations are disproportionately affected by low health literacy, according to a report from the National Patient Safety Foundation, Low Health Literacy: Implications for National Health Policy, the majority of people with low health literacy skills are white. Older people, recent immigrants and those with chronic conditions are likely to have low health literacy, as well.

Of particular note from the WSJ article is the federal strategy around health literacy entitled the National Action Plan to Improve Health Literacy. The plan seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked, multi-sector effort to improve health literacy

We are headed in the right direction. However, there is still a fundamental need for greater change in the health care system – particularly in the areas of how care is delivered and paid for – if we are truly to achieve better access to quality, affordable care.

As our population grows older and larger, the impact on the health outcomes of patients and the costs to the health care system will only increase. These problems are compounded by the lack of care coordination for those with multiple chronic illnesses. People with multiple chronic diseases have increased interaction with the health care system, leading to more opportunities for confusion surrounding their medical care – which is in turn influenced by the number of doctors they see and what they hear from their doctors.

An older person with five or more chronic conditions (e.g. diabetes, hypertension, heart disease, arthritis, obesity), has an average of 37 doctor visits, 14 different doctors, and 50 separate prescriptions each year. How incredibly confusing would it be for that person to manage his or her own health? Older adults and their caregivers should be full partners in their care, and they should be provided with the information and support to manage their conditions so they can make informed health care decisions.

With the advent of the Patient Protection and Affordable Care Act (PPACA), the Campaign for Better Care, led by the National Partnership for Women and Families, Community Catalyst and the National Health Law Program, is working to ensure the needs of older adults and their families are highlighted and addressed.

Helping patients and providers communicate effectively with each other will be a crucial component to the quality of care that patients receive. The Campaign’s national consumer coalition has developed a “Yardstick” for Better Care, which identifies key elements of patient-centered practice for inclusion in new models of care

The Campaign for Better Care hosted a public event today in Washington, D.C. – the “Building Better Care” forum – and the forum webcast will be available online Friday. Special guests included Senator Sheldon Whitehouse, award-winning author Gail Sheehy, UCLA Geriatrics Division Chief David Reuben, journalist and activist Jonathan Rauch, HHS Director of Delivery System Reform Peter Lee, and more.

To learn more about these issues and how the Campaign is tackling them please visit www.campaingforbettercare.org.

– Jenelle Holder Williams, Field Director, Integrated Care Advocacy Project

Tags: , , , ,
Posted in care coordination/quality, national health reform | No Comments »

Consumer Assistance: What makes health reform go

Monday, July 12th, 2010

It’s no secret that the passage of the Affordable Care Act means lots of new opportunities for health care coverage and access – and that most Americans are confused about what the law actually means for them.  Here at Community Catalyst, we have seen health reform as an opportunity to improve consumers’ ability to get clear information in lay terms from trusted sources to help them understand their health care options.  And consumer assistance programs (CAPs) are a critical way to make this happen.

The Affordable Care Act included $30 million in 2010 to fund state ombudsman offices and CAPs (Section 1002).  The grant guidelines for those funds are slated to come out in the next few weeks, and the grants will likely go to states, who will decide how to best use the funds.

While we’re not quite sure how the guidelines will read or play out in implementation, we have  some core criteria we think are necessary to providing consumers accurate, understandable information and helping them navigate the new world of health care.

1.     Be truly independent.  Consumers should be able to trust that the information and enrollment assistance they get is unbiased – not informed by state budget problems or politics.  Especially as 20 states’ attorneys general actively oppose health reform, consumer assistance programs should ensure there’s a wall between state and political issues and helping consumers.
2.    States need to do more than they already do.  Many states are currently overwhelmed and understaffed because of budget woes.  Consumer assistance programs need to be separate and robust from current activities in state Administrations – and actually have the capacity to provide necessary help, navigation and information.
3.    Meet the needs of the community.  Consumer assistance needs to be culturally and linguistically competent, and provided by people who understand working with vulnerable populations.  A well-trained staff should be trusted by members of the community, including people at different levels of income and insurance options (from Medicaid to private insurance).
4.    Allow for feedback to policymakers.  A critical reason for consumer assistance is the ability to get real-time, on-the-ground information about what’s working and what’s not.  Regular feedback to state and local policymakers can help improve health reform implementation
5.    Ensure every state has a consumer assistance program.  Even if a state does not set up a program, the federal government should be able to contract directly with an organization to carry out these important duties.

Based on these elements, we think that the best option for CAPs in most states is often non-profit community advocacy organizations.  Examples like Health Care for All Massachusetts’s Helpline, New York’s Community Health Advocates, and Health Assist Tennessee have shown us that strong consumer assistance programs can mean the difference between a failed attempt and successful reforms. The Helpline in Massachusetts saw their call volume increase from 500 to 4000 per month after the passage of that state’s health reforms in 2006.  People call with questions from enrollment assistance to help with paperwork to navigating the health system.
We hope that the grant guidelines will explicitly permit states to contract or partner with community organizations to provide consumer assistance.  We have seen these models work, and know that they are trusted sources of health care information for communities and families looking for help in understanding a system that’s about to get bigger and more complex.

– Christine Barber, senior policy analyst

Tags: , , , , ,
Posted in national health reform | 2 Comments »

East Room Promises

Wednesday, June 23rd, 2010

baracksigningI was invited to attend an event at the White House yesterday to commemorate the 90th day since President Obama signed health care reform into law, and it was a powerful event that underscored how much the law matters to American families.

Following a private meeting with insurance executives, the President walked into the East Room and was introduced by Amy Wilhite from Ohio.  Amy’s daughter, Taylor, was diagnosed with Acute Myeloid Leukemia (AML), a cancer of the blood and bone marrow, for which Taylor received three rounds of chemotherapy and a bone marrow transplant that produced multiple side effects. Taylor’s father’s insurance plan has a $1 million lifetime limit, and as Taylor approached the limit, the family requested a $500,000 extension.  It was granted.  But Amy said that they still have to pick and choose which tests and follow-ups to go through with, because they don’t want to exceed the cap.  She was very grateful that the Affordable Care Act (ACA) banned lifetime caps and thanked the President for his leadership on the law.  Amy was articulate and her family’s story a powerful one, which moved all of us in the room.

After Amy,  President Obama spoke for about 25 minutes on abusive insurance practices that hurt families, and recent exorbitant rate increases that have captured headlines and prompted state action (such as Massachusetts’ prohibition of rate increases within the Connector).  But acknowledging that the cooperation of insurers is critical to making health reform a go, the President also suggested that he was ready to work with the industry to make the bill work.

The President went on to challenge politicians who are running on a platform of repealing the law–who want to go back to the system we had before. “Would you want to go back to discriminating against children with preexisting conditions?” he asked us. “Would you want to go back to dropping coverage for people when they get sick?”  Would you want to reinstate lifetime limits on benefits so that mothers like Amy have to worry?” The room was quiet.

“We’re not going back,” he said.  “I refuse to go back.”

–Rob Restuccia, executive director

Tags: , , , ,
Posted in children's health, national health reform, private insurance, Repeal Watch | No Comments »

The Insider: All this could be yours someday

Monday, June 14th, 2010

Fuzzy logic
As the “tax extenders” bill makes its way through the Senate, a provision to extend COBRA premium subsidies for the unemployed is in jeopardy. Opponents in the Senate and the Blue Dogs in the House who stripped the provision from legislation two weeks ago argue that it’s unfair to help people who are unemployed when other, equally needy people are getting no assistance.

Just stop and think about that for a minute: It’s not like they’re identifying an alternative beneficiary for assistance, or arguing to accelerate implementation of the Affordable Care Act. They are basically saying, “Because we can’t help everybody, we won’t help anybody.” If you apply that reasoning more broadly it leads you to advocate the repeal, or at least the suspension, of Medicare and Medicaid until 2014, when financial assistance to obtain coverage becomes more generally available–a move few Congressmembers would dare consider, even in a non-election year.

With unemployment remaining high, the COBRA premium subsidies in limbo are badly needed. They are good for the economy, the health care system, and mostly for the thousands of struggling families who will be able to retain their coverage. Find out more at Community Catalyst’s implementation headquarters.

Faulkner on health care
When William Faulkner wrote, “The past is never dead. It’s not even past,” he could have been talking about the politics of health care more than a half-century into the future. Congressional Republicans’ challenge of the White House public education campaign on Medicare changes as misuse of government funds for partisan advantage hearkens back to Democrats’ attacks on the Bush administration over the original Medicare Part D roll-out.

And Senators who opposed PPACA seem intent on re-debating the legislation at every opportunity: first, in the context of Don Berwick’s nomination to head CMS, and now in the debate over the Medicare physician payment fix. Republicans have offered an alternative that does more for the physicians but partially pays for it by eliminating desperately-needed financial assistance for state Medicaid programs—while slipping in a “poison pill” that would roll back the individual responsibility provisions in PPACA. Such a move could appeal to many on the left who are concerned that the affordability provisions don’t go far enough.

Someday, all this could be yours
As the “repeal and replace” drumbeat goes on, a third ‘r’ should be added to the sequence: Recycle. Congressional Republicans are recycling ideas from the debate that were shown to fail to reduce the number of uninsured or eliminate insurance discrimination.

But as several states move forward with anti-Affordable Care Act ballot measures, new research from Massachusetts shows just how wrongheaded such opposition is. Until the coverage provisions of the Affordable Care Act kick in in 2014, Massachusetts provides the closest thing we have to a “beta site” for what the health care system of tomorrow will look like. While critics focus on the continuing cost challenges (problems that pre-dated health reform in Massachusetts  and were not really addressed in the landmark law in 2006) new reports published by the Urban Institute and the National Bureau of Economic Research underscore just what other states can gain as they move forward with implementing the law.

Urban’s latest report shows that the coverage gap between racial and ethnic minorities and non-Hispanic whites has been closed—the only place in the country where this is true. Additional findings show:

  • –high rates of coverage in Massachusetts persist despite continued high unemployment
  • –economic barriers to obtaining care remain low and have declined further for some populations since the inception of the law
  • –four years into implementation, there is still no evidence of ‘crowd-out’ of private coverage, and public support for the Massachusetts system remains high.

Get the details here (pdf).

The NBER paper found that since reform in Massachusetts, there have been fewer preventable hospitalizations and emergency room-generated admissions, and length of hospital stays has been reduced, most likely due to improvements in access to ambulatory care.

Sure makes implementation look like a lot better idea than repeal.

–Michael Miller, director of strategic policy

Tags: , , , , , , , , ,
Posted in affordability, Health disparities, Health Reform Insider, national health reform, Repeal Watch, state reform | No Comments »

The Insider: Last minute collapse on doc payments, Medicaid and COBRA subsidies a bad omen?

Tuesday, June 1st, 2010

In the lead-up to passing the health reform law, Congress debated what to do about the Medicare physician payment problem.  Under current law, the formula for setting Medicare physician payment rates, known as the Sustainable Growth Rate, or SGR, will impose large and escalating annual cuts on physician reimbursement.  The SGR issue was ultimately separated out from health care reform, and doctors were assured that the issue would be addressed before the scheduled payment cut June 1.  Physicians pressed for a permanent solution to the problem but because of the price tag, Congress scaled back, first to a 5-year patch and then to a 19-month fix.  The scaled-back SGR patch passed the House just before the Memorial Day recess, but without enough time for the Senate to act.  Theoretically that means that a Medicare payment cut of over 20 percent kicks in today, but CMS is holding onto claims for a couple of weeks assuming that when the Senate comes back they will enact a retroactive payment increase.

While the physician payment fix is likely to get sorted out, two other critical provisions face a more uncertain future.  With unemployment still high and state budgets still in trouble, House and Senate leaders attempted to extend enhanced federal Medicaid payments to states through the end of state fiscal year 2011 (the enhanced payments are currently scheduled to end halfway through the year) and to continue the subsidy of COBRA premiums created by ARRA last year.  But in what’s being described as victory for House fiscal conservatives, both of these measures were struck from the House legislation late last week, and whether the Senate will restore them remains uncertain.  Roughly 20 states are already counting on the extra Medicaid help in their state budgets.

However, that victory may prove short-lived. Both the COBRA and Medicaid provisions themselves are popular with core Democratic constituencies, and it’s entirely possible that the Democratic Blue Dogs who have drawn a line in the sand in the name of controlling federal spending will be punished at the polls, not rewarded, if the Medicaid and COBRA funding is not restored. They could lose support from the Democratic base without picking up any offsetting support from more conservative voters.

If funding is not restored there are several implications that go beyond politics.  The first is harm these cuts do to low- and moderate-income families who will lose coverage or services as a result. Second, the loss of COBRA subsidies is a blow to the drive to provide health security for all, while the loss of Medicaid funding will certainly turn up the heat on the already charged debate over the role of Medicaid in reform.  Finally, if there is a more conservative Congress in 2011 as anticipated, future debates over federal health care funding and implementation could become similarly difficult, with Congress unable to agree on funding for provisions in PPACA that are authorized but lack an appropriation.

The immediate implication for health care reform advocates is that we need to redouble our efforts to persuade the Senate to revive the COBRA and Medicaid funding.  It’s time to step in to keep reform on the right track.

More on Living in Chicken Little Land

You know it’s Chicken Little time when people can (and do) go on about how awful health reform is without any regard to the available facts.

Exhibit A:  Public opinion. The most recent Kaiser tracking poll (pdf) shows that the top concerns opponents have about health care reform is that it will increase health care spending and is not paid for.

Both the Congressional Budget Office and the CMS Office of the Actuary have refuted these claims in the past.  CBO has found that health reform will reduce the deficit (pdf) while the CMS actuary projects that reform will provide coverage to over 30 million people with a negligible increase in costs.  Recently, a Commonwealth Fund/Center American Progress analysis has suggested that both CBO and CMS are being too conservative in their projections.  Essentially both agencies assume no savings at all from efficiency gains, quality improvements and delivery system changes–sources that could, by moderate estimates, generate a potential $600 billion savings over 10 years.

Exhibit B: state government.  Numerous states have vociferously complained about the burden the Medicaid expansion, a core component of health reform, will impose on them; many going so far as to file a lawsuit to block the expansion.

The facts? A new paper released by the Kaiser Commission and the Urban Institute tells a different story (pdf).  The study shows that on average health reform will add only 1.4 percent to state Medicaid spending between now and 2019.  This is very similar to the 1.25 percent estimate developed by the Center on Budget and Policy Priorities.  And neither of these forecasts take into account savings to states from changes in the delivery system or from reductions in spending on services that are now 100 percent state funded but will be covered by Medicaid in the future.  Although state by state estimates vary, in no state does the federal government contribute less than 94 percent of the cost of the expansion.

Unfortunately, it isn’t much use telling the truth to people whose minds are already made up. Facts don’t matter to Chicken Little, who gets all his information from the Fox (news).  As we noted in the last post, the only thing that will persuade these folks is when the sky doesn’t fall in 2014 and, at least for some, they start receiving benefits under the law.  Then they’ll probably join the “keep government out of my Medicare” crowd.

DoJ presents its case
The Department of Justice has, in several legal briefs, laid out its basic arguments against the lawsuits seeking to undermine health reform.  Here’s a CliffsNotes version of the arguments:

•    States have no standing relative to the individual coverage requirement, which applies to individuals, not states (duh).
•    There is no need to block the law from going forward now since there is no possible injury until April 2015, when penalties for failure to purchase coverage would be due.
•    Individuals who now claim the law would require them to purchase coverage can’t know their circumstances in 2014, so the “injury” is purely speculative.
•    State residents cannot vote to exempt themselves from federal law they don’t happen to like.
•    The minimum coverage requirement is a reasonable part of the regulatory scheme that governs economic activity related to health care and health insurance, and thus falls within the Commerce Clause,
•    Tax penalties associated with the requirement to purchase coverage fall within Congress’ power to tax and spend for the general welfare.

Call it what it is—then change course

When responding to repeal proponents it’s important to:
a) Call the attacks what they are: an attempt to preserve an unsustainable status quo that leaves millions without coverage and millions more who have coverage at risk of financial ruin.

b) Turn to the benefits of the law—reform will:
•    Provide security to millions of working Americans
•    Guarantee people access to the same plans as members of Congress
•    Help women, children and people with serious medical conditions get more affordable and more secure coverage
•    Strengthen oversight of insurance premiums and help people get better value for their premium dollar

–Michael Miller, director of strategic policy

Tags: , , , , , , , ,
Posted in Health Reform Insider, national health reform, Repeal Watch | No Comments »

The Insider: Trench Warfare

Thursday, May 13th, 2010

While political and legal attempts to repeal the Patient Protection and Affordable Care Act may draw the most attention, the real success or failure of the law will play out in hundreds of regulatory battles that will take place largely out of the public eye.

One of the first such battles is the definition of “medical loss ratio” (MLR).  The MLR is the percentage of premium dollars that a health insurer is required to devote to the medical care of its enrollees.  Under PPACA, individual and small group plans must spend 80 percent of premium dollars on medical care (as opposed to advertising, administration and profit), and larger groups must spend at least 85 percent. Failure to meet these required thresholds would trigger a rebate to policy-holders.   However, PPACA allows expenditures designed to improve quality of care and state and federal taxes to be exempted from the MLR calculation.

Industry representatives are not satisfied with these qualifiers, and are lobbying for special transition rules for those carriers that will have trouble meeting the MLR standard, warning that insurers may choose to exit the market rather than pay rebates.  Some are also arguing for special laxer rules for small carriers or for certain types of insurance.  They claim that small carriers have higher administrative costs but lower premiums for comparable coverage, and could be driven from the market without special consideration.

If it is indeed the case that small carriers have lower premiums (despite higher administrative costs), it is likely because these small insurers are underwriting more aggressively—a practice they will be forced to discontinue in 2014.  There doesn’t seem to be any good reason now to allow them to keep cherry-picking healthy enrollees who they will then be able to hang onto in “grandfathered plans” once reform fully kicks in—making the risk pool worse in the Exchanges.

The National Association of Insurance Commissioners (NAIC) is charged with developing recommendations to HHS to implement the MLR provision.  NAIC recommendations are expected by June 1.  The extent to which the NAIC (and ultimately HHS) gives in to the special pleadings of the industry will be one early indication of the willingness of state and federal regulators to stand up to special interests as implementation proceeds.

–Michael Miller, director of strategic policy

Tags: , , , ,
Posted in Health Reform Insider, national health reform | No Comments »

Charity Care: Still A Hospital’s Best Kept Secret?

Friday, May 7th, 2010

Back in 2005, [Manny] Lanza was diagnosed with arteriovenous malformation, a serious brain condition. He had been working 50 hours a week at a fast food restaurant, but his job was considered part-time and his employer did not offer him health insurance. He was referred to St. Luke’s-Roosevelt Hospital in Manhattan for treatment, where they reportedly refused to perform a needed procedure unless he was insured.

Manny’s family attempted to enroll him in Medicaid, but the delay in treatment proved deadly. In 2005, at the age of 24, Manny died in his bedroom at home from causes related to his brain disorder.” (full article here.)

At the time Manny died, New York hospitals were receiving $1 billion every year from the state to care for uninsured and underinsured patients. But there were no conditions attached to that money—they didn’t have to offer free or discounted care to actual patients, and they didn’t have to tell them about financial assistance.

Manny’s Law, passed in 2007, now requires New York hospitals to notify patients of charity care upfront.

Non-profit hospitals get tax breaks, and they’re expected to provide “benefit to the community”—including charity care—in return.

But despite Congressional investigations, a prevalence of stories in the press, and similar laws in a handful of states, a new report released this week from The Access Project and Community Catalyst shows non-profit hospitals still failing to inform patients in need about charity care.

Congress, in the recently-passed federal health care reform law, inserted a provision requiring non-profit hospitals to establish clear financial assistance policies—in writing—that specify eligibility criteria and widely publicize these policies. It also prohibits hospitals from taking extraordinary collection actions before making a reasonable effort to determine if patients are eligible for financial assistance

That’s good news for people who find themselves in Manny’s position: uninsured or underinsured, needing health care they know they can’t afford.  But is the problem solved?

Our report suggests it isn’t. The Access Project wanted to know whether patients who needed hospital care and weren’t able to pay could easily find information about charity care.

Using hospital websites and phone calls, researchers surveyed 99 randomly selected non-profit, AHA-member hospitals in the summer of 2009 to see whether hospitals were complying with the AHA’s voluntary guidelines on hospital charity care. Did hospitals:

  • –Make information on hospital-based charity care policies and other known programs of financial assistance available to the public?
  • –Communicate this information to patients in a way that is easy to understand, culturally appropriate, and in the most prevalent languages used in their communities?
  • –Have understandable written policies to help patients determine if they qualify for public assistance programs or hospital-based assistance programs?

The results were pretty grim. Though 85 hospitals mentioned the availability of charity care, fewer than half of these (42) provided application forms, and only about a quarter of the hospitals (26) provided information about who qualified for charity care. Moreover, only about one-third (34) provided information in a language other than English.

And that’s just one survey. From California to Texas to North Carolina, surveys show that hospital notice and provision of charity care is uneven. While it’s true many hospitals do exemplary work to reach out and meet community needs, others just aren’t pulling their weight.

The new requirements for non-profit hospitals go into effect this year.  But given these results, it seems like hospitals have a long way to go to comply.

(Next week, we’ll look at the hospital industry’s response to the report.)

–Jessica Curtis, director, Hospital Accountability Project

Tags: , , , , , , ,
Posted in Hospital Accountability/Charity Care | No Comments »

The Insider: Repeal Watch

Tuesday, April 27th, 2010

With Enemies Like This, Who Needs Friends?

As they tried to regain their footing after the surprise Senate election of Scott Brown, reformers received an unexpected boost from for-profit insurer Wellpoint. In February, the insurance giant announced it was planning to raise rates by 39 percent in California, and similarly large increases were reported elsewhere. Coming off a $2.5 billion profit in the last quarter of 2009, this didn’t sit so well with much of anyone but insurers, and became a major rallying point in the White House, Congress and advocates’ final push for reform. Some conservative commentators went so far as to blame Wellpoint for reform’s subsequent passage.

Now Wellpoint is at it again.  Recent headlines suggesting that the company routinely targets women with breast cancer for rescission boost the case that, if anything, the tougher insurance oversight that is part of the Patient Protection and Affordable Care Act doesn’t go far enough.   Since it seems the folks at Wellpoint can’t help themselves, it’s up to advocates and regulators to stop them before they kill again (no joke).

Repeal Watch 1: Public opinion
This latest Wellpoint scandal makes it crystal clear: The repeal chorus is defending the indefensible.  And yet, with 45 percent of conservatives getting most of their information from cable news, it’s unclear that the indefensible is making it on air. The latest Kaiser tracking poll (pdf) has some moderately good news for reformers: a plurality of the country supports reform, but many are confused (or misinformed) about what reform actually does.

This lack of understanding underscores both the need and opportunity for an aggressive public education effort using all available means—everything from paid and earned (and social!) media to one to one conversations at the community level.

More bad news for repealers (and good news for us): there is strong cross-partisan public support—among Democrats, Republicans and Independents—for the early provisions of reform like small business tax credits, $250 rebate for seniors with high drug costs and coverage for children with pre-existing conditions.

But people over 65 continue to hold a more negative view of reform than younger adults do—and that’s worrisome, especially in light of their disproportionately big turn out at the mid-term polls, which we’ve talked about here before.

Even so, repeal may not be the ticket to ride that some conservative activists hoped for. A recent poll of Florida voters showed that a majority think that the state Attorney General McCollum’s decision to sue the federal government was a bad idea and that McCollum, the front runner in the Florida governor’s race, was losing ground.

Repeal Watch, Part 2:  Breaking down the repeal arguments

Voters have good reason to be skeptical of the repeal efforts, which have overwhelmingly been advanced by candidates seeking higher office or as part of a larger right-wing electoral strategy. A growing number of state legislatures hold a similarly skeptical view—so far more than 12 have rejected repeal measures.

And they are right to, since the main repeal arguments are so far-fetched.  Basically, they amount to:

  • The law is illegal because the Medicaid expansion imposes new costs on states. By the same reasoning, other provisions of Medicaid law, such as the requirement to cover certain children or people with disabilities, would also be illegal, and Medicaid would become nothing more than a blank check written to the states. And what of those new costs? A recent CBPP report shows that new state costs through 2019 add up to only 1.25 percent of projected state spending, and that’s before factoring in possible offsetting savings to states.
  • States have the ability to selectively decide which federal laws they will obey. This argument essentially parallels the case made by segregationists almost 50 years ago and has been decisively rejected by the courts.
  • The individual mandate falls outside of Congress’ authority to regulate interstate commerce because it regulates “inactivity” and/or it is an impermissible tax.

But from a legal standpoint, the “mandate” falls squarely within Congress’ authority to raise taxes. Semantics aside, the individual mandate is not really a mandate, but a financial incentive to purchase coverage.  From an economic standpoint, it is no different than the existing tax subsidy that goes to employer-sponsored coverage; lowering the cost of doing something or raising the cost of not doing it are functionally the same (more at the New England Journal of Medicine–subscription required).

In sum, both the legal and political campaigns for repeal (if indeed the two are distinguishable) rest on shaky ground—and more and more voters and political leaders are beginning to figure that out.

–Michael Miller, director of strategic policy

Tags: , , , , , , , ,
Posted in Health Reform Insider, national health reform, Repeal Watch | No Comments »

A big f#*@*!* deal

Wednesday, March 24th, 2010

4458527284_21d7409410_mPresident Obama’s signing of the national health reform bill yesterday marks an historic achievement in American history on par with the passage of Social Security and Medicare.  The Patient Protection and Affordable Care Act (summary here) establishes a framework to provide health security for all, and takes immediate steps in that direction.  Of course, there are flaws and omissions in the law as there were (and still are) with those earlier milestones, but PPACA gives us a strong foundation on which to build. How strong? Our fact sheet tells you.

This victory could not have happened without the commitment of the President and legislative leaders, the tireless dedication of staff, and the amazing work of advocates for the health and economic security of all Americans.

Ugly and Ducking

While we can and should celebrate this victory, it has certainly been sad and sobering to witness the opposition’s extremist acts.  Members of the Congressional Black and Hispanic caucuses, as well as openly gay Congressman Barney Frank, were verbally assaulted and spat on.

Someone threw a brick through the window of Rules Committee Chairwoman Louise Slaughter’s office, and Republican Congressman Neugebauer shouted an epithet at Rep. Bart Stupak from the House floor (Rep. Neugebauer later apologized, saying he was talking about the bill).

Many of the protests have called up the worst mob-like vitriol we saw on the 2008 Presidential campaign. House Republicans have generally declined to distance themselves from these events and instead offered embarrassingly weak rationales.

Apocalypse Now?  No?  Well how about now?

Those watching the House floor debate wouldn’t be blamed for feeling like they’d heard the GOP’s world-ending predictions somewhere before.

It seems through a warp in the space-time continuum (perhaps brought about by health reform’s passage) Congressional Republicans are using the same speechwriters as Alf Landon, the 1936 Republican candidate for president, and as the Medicare opponents who wrote this for then pitchman-for-hire Ronald Reagan.

In one sense, however, those who claim this health reform law marks the end of America as we know it are right.  In America as we know it, thousands of people die every year because they don’t have health insurance, and thousands more face bankruptcy from health care bills they can’t afford.

As of yesterday, that America is on its way to being history—the kind of history we learn from, and move beyond. As REM sang, “It’s the end of the world as we know it and I feel fine.”

The Senate Process—the end of the beginning

Democrats scored a key victory late Monday when the Senate parliamentarian ruled against an effort by Republicans to strike on technical grounds an amendment to the excise tax on high-cost health plans.  Yesterday the Senate voted to take up the amendments and started the clock on the 20 hours of debate allowed under the rules of reconciliation.

During the debate we are seeing Republicans do everything they can to delay passage, but their chance of derailing the bill is minimal. This is political theater, but it’s not responsible governing.

The bill now on the floor of the Senate makes mainly popular fixes to the now-law  reform by closing the Medicare prescription drug “doughnut hole,” increasing Medicaid funding for states, striking special deals, and reducing the excise tax on high-cost health plans.

Everything right is wrong again

With the law signed, opponents’ goal is no longer to stop these things from becoming law on the Senate floor (an almost certainly vain effort), but to offer amendments that will make good fodder and embarrassing ads for the November election.

Amendments are being offered on all kinds of subjects, many of them unrelated to the bill, for the express purpose of forcing Democrats to take hard votes. Although it’s possible that some changes will be made in the Senate, which would necessitate a conference committee or one more vote in the House, there is little doubt as to the final outcome.

While passage of the amendments to PPACA will mark a welcome end to a lengthy and often acrimonious debate, there is little time to pause to enjoy the achievement.

With the ink barely dry, the action is already moving in new directions. State and federal officials must begin the task of implementing the bill, some provisions that take effect almost immediately, while opponents are already launching legal and political challenges.

Not in My Backyard

Seven minutes after President Obama signed health reform into law yesterday, 13 state AGs filed a lawsuit claiming the individual mandate in unconstitutional. More than 30 states have threatened to bring bills and ballot questions to repeal health care reform, or elements of it.

Most legal scholars say such challenges are legally specious and will have little purchase on implementing reform. But rolling back reform isn’t the primary aim of such repeal threats anyway–it’s to drive reform opponents (plus the angry and misinformed) to the polls in November.

But already doubts are growing about this strategy. Some Republican leaders are suggesting that they’d like to repeal some parts of the law, but leave others alone (no one wants to be the guy who re-allows insurers to deny coverage to kids with pre-existing conditions).

And a Gallup poll yesterday suggests public support for health reform has already jumped. As more and more people understand what reform is (and what it’s not) those numbers are likely to improve even more.

And that’s the key to making this thing go—the more real people understand the real help that comes from this bill, the harder it will be for state politicos with dreams of the Governor’s mansion to make the case for taking it away.

So the work goes on. Advocates and others who helped this bill become a law now must step up to the challenge of keeping it strong.

–Michael Miller, director of strategic policy

Tags: , , , , , , , , , , ,
Posted in Uncategorized | No Comments »

« Older Entries