Health & Medicine (HMPRG)

The Center for Civic Engagement at Northwestern is hosting event with author Tracy Kidder

The Center for Civic Engagement at Northwestern is hosting the One Book, One Northwestern program this year (the book is Mountains Beyond Mountains, about Dr. Paul Farmer's efforts to bring access to healthcare to impoverished areas of the world, especially Haiti). To create dialogue on the book, they are bringing its ...author, Tracy Kidder, to campus on February 10th. Community members are encouraged to attend.

 RSVP via the Center's facebook page

RSVP through the Center's website

Action Items - Congressional Budget Office (CBO) scoring analysis shows repealing health reform would add $230 billion to nat'l deficit!

  From our friends at the National Health Law proggram:

The non-partisan Congressional Budget Office (CBO) yesterday released scoring analysis showing that the Republican House bill repealing health reform (H.R. 2, the “Repealing the Job-Killing Health Care Law Act”) would add $230 billion to the national deficit by the year 2021, and significantly higher sums in the following decade. The report also notes that 32 million individuals will lose insurance coverage and those who don't lose coverage will end up having higher costs for their coverage if the repeal bill is passed. This scoring puts Republicans somewhat on the defensive in advance of the expected House vote and passage of the repeal bill scheduled for Wednesday, January 12, given that the Republicans have made deficit reduction one of their top stated priorities. The scoring also creates a procedural problem for the Republicans, who altered the House rules to require that all legislation be fully paid for. Republicans stated earlier in the week their intention to skirt this conflict by using a special exception 

See: http://www.politico.com/news/stories/0111/47000.html

Below is the link to the CBO scoring letter followed by  the text of a New York Times article discussing the scoring.

  Download CBO score of HR2 PPACA repeal

Download NY Times Text Defining CBO Scoring

Also,  the National Women’s Law Center is circulating a sign-on letter opposing the repea which can be accessed at the link below:

Download Vote No on HR2 (January 10 2011)

If you’d like to sign on, please send an email by 4pm Monday (EST) to Kate Dickerson at kdickerson@nwlc.org – the sign-on is focused on national groups.  You may also want to call your Representatives and register your opinions directly – the National Women’s Law Center has set up a toll-free line to tell your Representatives to vote no on repealing the health care law – call 877-667-6650.

Physicians for a National Health Program (PNHP):‘Don’t repeal health law – go beyond it to single-payer Medicare for all’

FOR IMMEDIATE RELEASE
Jan. 7, 2011
 
Contact:
Garrett Adams, M.D., president, PNHP
Margaret Flowers, M.D., congressional fellow, PNHP
David Himmelstein, M.D., co-founder, PNHP
Quentin Young, M.D., national coordinator, PNHP, (312) 782-6006
Mark Almberg, PNHP, (312) 782-6006,  mark@pnhp.org

‘Don’t repeal health law – go beyond it to single-payer Medicare for all’: doctor’s group

A nationwide organization of doctors who favor a single-payer health care system today rejected calls by Republican leaders to repeal the new health law, noting that the law contains modest benefits for patients that should not be spurned.

At the same time, the doctors said that the enactment of a single-payer, Medicare-for-all program is the only way to assure high quality, comprehensive care to all Americans and the only way to rein in skyrocketing health care costs.

“We reject the call by Republican leaders to repeal the Patient Protection and Affordable Care Act (PPACA), even as we recognize the new law is incapable of resolving our health care morass,” said Dr. Garrett Adams, president of the 18,000-member Physicians for a National Health Program.

“The health law is flawed because it continues our nation’s reliance on an inefficient and wasteful private-insurance-based model of financing care – a rickety structure that denies health care access to millions, bankrupts patients, ratchets up costs and frustrates efforts to improve quality,” he said.

“That’s why we need to move to a single-payer system,” he said. “In doing so, we’ll save about $400 billion annually by cutting out the unnecessary paperwork and bureaucracy inflicted on us by the private insurers. We’ll also gain the one-system bargaining power we need to negotiate lower prices for pharmaceutical drugs and medical supplies.”

Adams said the “modest” benefits in the administration’s health law include greater funding of community health centers, the expansion of Medicaid coverage, and “measures to restrict some of the most outrageous practices of the private health insurance companies like denying coverage because of pre-existing conditions or rescinding coverage when people get sick.”

“These beneficial measures could have been enacted separately,” Adams said. “But now that they’re part of the law, we cannot in good conscience support the repeal of any provisions that might conceivably benefit our patients.”

Adams said Republican leaders’ call to repeal PPACA is especially objectionable, given that they have no serious alternative to offer by way of health care reform.

“The GOP and conservatives urge greater reliance on the private sector and ‘free market’ mechanisms, including less regulation of the insurance industry,” Adams said. “Such measures include allowing people to purchase insurance across state lines, which would lead them to buy junk insurance policies from companies in states where consumer protections have been all but eviscerated. It would mean a race to the bottom to even skimpier insurance policies than people have now.”

He also dismissed claims by the Republican leadership that tort reform will significantly affect the U.S. health care scene, noting that research has shown malpractice suits have a marginal impact on the costs of medical care.
 
“The proposals emanating from the GOP leaders would do nothing to control costs or reduce the enormous administrative waste in our current health care system,” he said. “They would do nothing to reduce the number of uninsured. In fact, the number of uninsured, now at 51 million, would likely rise much higher – worsening an already catastrophic situation.”

Adams, a pediatric infectious disease specialist who resides in Louisville, Ky., said that, in his opinion, Republican leaders who are vowing to repeal the new health law are not really aiming to do so.

“Despite their bluster, GOP lawmakers don’t really want to repeal the law because some of their chief financial backers, the health insurance companies, like its basic provisions,” he said. “The insurers especially like PPACA’s requirement that millions of people buy insurance from them and that at least $447 billion in federal subsidies will be coming their way over the next 10 years as part of this arrangement.

“We reject such political posturing at the expense of human suffering and human lives,” Adams said. “We call for a real, sustainable solution to our health care woes. PPACA should be superseded by a comprehensive health reform that provides quality, affordable care to everyone – single-payer national health insurance, an improved Medicare for all.”

***

Physicians for a National Health Program (www.pnhp.org) is an 18,000-member organization advocating nonprofit, single-payer national health insurance for the United States. Dr. Garrett Adams is the newly elected president of PNHP. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Health & Medicine's Center for Long-Term Care Reform to Host Conference on Affordable Care Act

Please Join Us on Tuesday, January 25, 2011:

 

“Implementing the Long-Term Care Provisions of the Affordable Care Act in Illinois”

A National & State Perspective.

 

The University Center. 525 South State Street, Chicago IL 60605

*Conference Space is Accessible *

 

8:15am Registration

9:00am Keynote Address

2:30pm Conference Concludes

 

Continental Breakfast and Lunch will be provided

 

Moderator

• Robyn L. Golden, Director, Older Adult Programs, Rush University Medical Center

 

National Speakers:

• Keynote Speaker Carolyn Clancy, MD, MPH

Director, Agency for Healthcare Quality and Research

• Susan C. Reinhard, PhD, RN, FAAN

Senior Vice President for Public Policy, AARP

• Diane Justice

Senior Program Director, National Academy for State Health Policy

 

With response from Illinois leaders:

• Michael Gelder, Senior Advisor on Health Policy to Illinois Governor Pat Quinn
• Julie Hamos, Director, Illinois Department of Healthcare and Family Services
• Grace Hou, Assistant Secretary of Program Divisions, Illinois Department of Human Services
• Paul Stepusin, Deputy Director, Illinois Department on Aging

 The conference will focus on how Illinois can better serve the aging and disabilities communities through Affordable Care Act opportunities, including:

• expanding home and community based services,
• enhancing care coordination and transitional care,
• Medicaid reforms,
• workforce development, and
• the CLASS Act.

 

Please RSVP by January 18^th, 2011 at:

 www.signmeup.com/73621

Please note there is conference fee of $35.

You may pay conveniently and securely when registering at the above link;

or send a personal check made payable to Health & Medicine Policy Research Group to:

HMPRG, 29 E. Madison St. Suite 602, Chicago, IL 60602

(Please write LTC Conference Registration on the subject line of the check.)

 **Space is limited, reserve your seat today**

 **Please inquire about our limited availability scholarships to attend the conference**

 **If you need special accommodations, please let us know prior to January 18^th, 2011**

 

 To inquire about scholarships, or for further information about registration

or the conference, please contact Health & Medicine

email: RSVP@hmprg.org  

phone: 312.372.4292 x 21

"Senate passes ‘bold’ Medicaid reform; measure heads to House." By Mary Massingale, Illinois Statehouse News

January 5, 2011

SPRINGFIELD – Medicaid reform took a “bold” step on Wednesday as the Illinois Senate approved a measure projected to save $800 million during the next five years.

 House Bill 5420 calls for moving half of the state’s 2.8 million Medicaid participants into “coordinated” or managed care during the next four years – a far stretch from the 195,000 participants who now are assigned to a primary “medical home.”

“That is a very aggressive goal, it’s a bold goal, but we believe that by really looking at the holistic needs of our Medicaid clients we will, in fact, succeed in keeping them healthier,” said Julie Hamos, director of the Illinois Department of Healthcare and Family Services.

Lawmakers were assigned the task of tightening the $14 billion state-federal health care system in December and were still hashing out the details Wednesday morning.

“This is probably not a bill that any one of us on this committee would write. But that’s the nature of compromise,” said state Sen. Heather Steans, D-Chicago. “I think where we are and what we’re going to see, though, is something that really does put the state and our Medicaid system in a much better place down the line.”

All states are looking at Medicaid reforms in anticipation of the ramp-up of the federal health care law in 2014, when low-income single adults will be eligible to enroll. State Sen. Dale Righter, R-Mattoon, said the proposal will return the “struggling” program to a safety net for the poor, instead of a catch-all for the potentially ineligible.

“It’s struggling for the people who need it the worst,” he said. “We’re talking about the people who are on the lowest rungs of the economic ladder, the people for whom access is a truly critical issue. The people who aren’t mobile. People who can’t drive two hours and take a day off because it’s not a big deal to make sure that their child can get to a medical provider.”

However, the legislation makes an attempt to crack down on fraud by setting up administrative hearings that can collect and fine individuals who have been scamming the system, and even refer the cases to local prosecutors. But the Senate’s chief budget expert questioned how effective that would be.

“I can see how you recover from if they’re pharmacists or doctors that are scamming the system,” said state Sen. Donne Trotter, D-Chicago. “How do you recover from people like the guy that you said is getting payments out of his check and his brother’s check, assuming he doesn’t have any money? How do you recover that?”

The measure also tightens eligibility by requiring individuals to provide proof of Illinois residency and a month’s worth of income, and to periodically re-apply to the program.

It clamps down on the expanded All Kids program, the state’s health insurance for children of parents who earn too much to qualify for Medicaid. Parents pay health insurance premiums based on their income, which will be limited to 300 percent of the federal poverty level – or $66,150 for a family of four.

The current 3,000 participants will be given a grace period of one year to find new insurance, although state Sen. Dave Koehler, D-Peoria, wondered if exemptions should be made for rural residents lacking close medical care.

“Will the emergency room again become the point of contact for the health care system?” Koehler asked. “Because that’s going backwards, if that happens.”

The legislation also creates a “global budget” for long-term care by allowing up to 4 percent of budget line items for nursing home care for the elderly, developmentally disabled and the mentally ill to go toward shifting those patients into community-based settings, at an annual savings of $100 million.

Changes to the prescription drug program include possible co-pays at federally accepted levels, 90-day prescriptions for medication for chronic conditions, and prior approval for some drugs. Interest on late payments to pharmacists will be cut in half.

Using future appropriations to pay current bills to providers of care will also be phased out during the next 10 years, in an attempt at fiscal responsibility.

The measure now heads to the House, where a vote is expected on Thursday.

Read the article on the Illinois Statehouse News online here.

Read the full ammended House Bill 5420 online here.

State of Illinois receives performance bonus for successful enrollment of children in Medicaid and CHIP

Download the release from US Department of Health & Human Services

News Release

FOR IMMEDIATE RELEASE Monday, December 27, 2010

States get bonuses for boosting enrollment for uninsured children in Medicaid

States also cut red tape and simplified enrollment process

HHS Secretary Kathleen Sebelius today awarded $206 million to 15 states for making significant progress in enrolling uninsured children in Medicaid.  This year’s bonuses are more than double the $75 million awarded to ten states last year.

“Today’s announcement highlights the ongoing and committed efforts by states to improve access to health coverage programs and take the aggressive steps necessary to enroll eligible children,” said Secretary Sebelius. “Their actions reflect President Obama’s serious commitment to assuring that our country’s children get the health care they need. These performance bonuses demonstrate our support for the effective strategies these states have undertaken.”

Funding for the “performance bonuses” was included in the Children’s Health Insurance Program Reauthorization (CHIPRA) legislation signed into law by President Obama in February 2009. The CHIPRA established two sets of performance goals that states must meet to qualify for a bonus – taking specific steps to streamline their enrollment and renewal processes to make it easier for families with eligible children to gain coverage and documenting a significant increase in the number of children enrolled in Medicaid.        

States receiving bonus awards today include: Alabama, Alaska, Colorado, Illinois, Iowa, Kansas, Louisiana, Maryland, Michigan, New Jersey, New Mexico, Ohio, Oregon, Washington state and Wisconsin.  A complete list of state award amounts is included below. Awards vary by state according to a formula set out in CHIPRA but total more than $200 million this fiscal year.

States that received performance bonuses last year were able to extend benefits to children who otherwise would have been without health coverage.

CHIPRA set two types of performance goals that states must meet to qualify for a bonus.  States must have adopted at least five program features—like providing a guarantee of 12 months of continuous coverage, using a joint application for both Medicaid and CHIP and streamlining procedures for renewing a child’s coverage—that are known to encourage enrollment and retention of eligible children.  States must also be able to document significant increases in Medicaid enrollment among children during the year that are above and beyond what would have been expected, even with the economic recession. States with increases of more than 10 percent above this baseline qualify for a higher award amount.

CHIPRA included a series of provisions and additional funding to help states cover more children. A boost in Medicaid reimbursement rates authorized by the American Recovery and Reinvestment Act (ARRA) also provided relief to states with suffering economies, enabling them to extend care to eligible children. These increased Medicaid matching funds are available through June 30, 2011.

“We are pleased to be able to work in partnership with states as they continue to improve their Medicaid and CHIP programs and make them more accessible for families,” said Cindy Mann, deputy administrator of the Centers for Medicare & Medicaid Services (CMS) and director of the Center for Medicaid, CHIP and Survey & Certification (CMCS).  “The increase in both the number of states receiving awards and the amount distributed is particularly encouraging given the difficult economic times states are facing,”

State award amounts today are (in millions):

Alabama	$54,965,407
Alaska	$4,408,789
Colorado	$13,671,043
Illinois	$14,962,171
Iowa	$6,760,901
Kansas	$2,578,099
Louisiana	$3,555,853
Maryland	$10,549,086
Michigan	$9,268,552
New Jersey	$8,788,959
New Mexico	$8,533,431
Ohio	$12,376,346
Oregon	$15,055,255
Washington	$17,607,725
Wisconsin	$23,076,127
Total	$206,157,744

For more information about connecting eligible children to health coverage, visit www.insurekidsnow.gov

Article from Politico: 6 States to Watch on Health Reform

Our friends at the National Health Law Program (NHelp),  an organization providing resources and support with implementation of health reform, shared this article from From Politico, which looks at six states which exemplify the broad range of health reform implementation strategies expected in 2011. 

Link to article:  http://www.politico.com/news/stories/0111/46945.html

6 states to watch on health reform By: Sarah Kliff January 3, 2011 04:33 AM EST

Health reform repeal efforts will generate a lot of noise in the opening weeks of the 112th Congress – but the real action on health reform is going to ramp up outside the Beltway in state capitals. “Unless states move forward as fast and as hard as they can this year, they will be lost in 2014 when the bulk of health reform hits,” says Stan Dorn, a senior health policy researcher at the Urban Institute. “The pressure is just enormous on state policy makers.” In Washington, House Republican attempts to repeal the reform law are likely to die in the Senate – or, failing that – at President Obama’s veto. Meanwhile, state legislatures, whether they are dominated by Democrats or Republicans, must brace for a frenetic and fast-paced year of building the infrastructure needed for reform. Thirty-three states have created some entity to implement the new federal health law and over a dozen require a report on the law by the early part of 2011, according to the National Conference of State Legislatures. All 50 states will take some action on the health reform law in the coming year. Here are six to watch closely in early 2011: Wisconsin – The Badger State has aggressively lead the way on health exchanges, developing an online prototype that Wisconsinites can already take for a spin. In late December, Wisconsin applied for an “early innovator” grant, which would mean increased federal funding and serve as a model for others. But Wisconsin’s assembly, senate, and governorship all flipped from Democratic to Republican control in November. Republican Governor Scott Walker, who takes office today, won’t take a firm line against pursuing health reform grants—but he has also promised to “back off” of a lot of the state has done so far, moving the work in a different direction. “I don’t want to put anything in place that forces us into mandates of what kind of coverage needs to be provided,” Walker told POLITICO. “The concept of an exchange itself is not something I’m against…a system where there’s a defined component to what has to be in the exchange. That to me is where the problem is.” Walker will, however, remain open to pursuing Health and Human Services grants and working with Secretary Kathleen Sebelius. “I’d like to think we can be an innovator as well, but from a much different point of view from what Governor Doyle was doing,” Walker says, noting that he does not plan to withdraw the state’s early innovator application. Within days of his election, Walker began aggressively opposing Wisconsin’s work on health reform. In a November 12 letter to the state’s Department of Administration, he requested they “temporarily freeze any new implementation of the federal health reform law” until after he took office. The same day, Walker announced he would allow Republican attorney general J.B. Van Hollen to join an anti-health reform lawsuit. Walker’s Democratic predecessor had barred Holland from doing so. Vermont – Newly sworn-in Democratic Governor Peter Shumlin ran on an aggressive, single-payer platform. Now, all eyes watch Vermont to see whether it’s possible to turn the single payer promise into policy—and whether it can be implemented in tandem with the reform law. “There’s a lot we can do under the existing law, but also some clear limitations,” says Anya Rader Wallack, health policy advisor to the governor. “We will try and do the maximum we can under the existing law…and I think seek federal permission for flexibility.” The single-payer plan will move forward quickly: by February, Harvard professor William Hsiao will deliver three design options to provide state-wide coverage. The report will likely catalyze legislative action. “We’ve been pushing this rock up a hill for a long time” says Rader Wallack on the slow progress on health reform. “It’s time to see if we can move to a whole new plane. We can only get so far within the current system and need to do something dramatically different to keep fighting this fight.” Alaska – With Minnesota Gov. Tim Pawlenty no longer in office, Alaska’s Gov. Sean Parnell arguably snatches the title for most aggressive, anti-health-reform governor. He has regularly rejected grant opportunities pursued by the vast majority of states; Alaska was one of two states not to pursue an exchange planning grant, one of five that turned down an opportunity for increased rate review funding. “My sense is the individual state agencies are tracking the requirements of the law and implementing those requirements,” says Deborah Erickson, executive director of the Alaska Health Care Commission, a state agency created by Gov. Sarah Palin. “Beyond that, there are so many, essentially new programs that I don’t think Governor Parnell will be pursuing.” Alaska could emerge as a key state to watch to understand how HHS will deal with an adamantly opposed state. With so much uncertainty surrounding federal reform’s fate in Alaska, Erickson’s group will steer clear of making implementation recommendations. When they issue a report on health reform in Alaska on January 15 it will only go as far as to summarize what has been done and what deadlines loom in the future. California – Under Republican Gov. Arnold Schwarzenegger, the Golden State established itself as a health reform leader by passing the first legislation in the country to authorize a health exchange under the federal law. A failed California Health Exchange, which opened in 1993 and shuttered five years ago, left the state “with a pool of people who were will poised to move forward very quickly,” says Dorn of the Urban Institute. “Now you have an incoming Democratic governor [Jerry Brown] who is a ‘small is beautiful’ Democrat. What he’s going to do on health reform, how he uses that pool of expertise, will be interesting to watch.” Insurers have grumbled over the state’s “selective contracting” approach. The exchange will decide which plans can sell on its market, as opposed to a more laissez faire model where all insurers meeting basic benefits qualify. But as the first state out the gate, many others will look to it as a model. Schwarzenegger moved the exchange forward up through the final days of his administration. He appointed two advisors to the California Health Exchange Board of Directors on December 31: current California Health and Human Secretary Kim Belshe and Susan Kennedy, the governor’s chief of staff. Connecticut – If there’s a hope for reviving the public option, it’s strongest in Connecticut. Since 2009, the governor’s office has been at work on an ambitious plan to transform its public plans, like Medicaid and state employee benefits, into a publicly-financed plan that could be sold on the health exchange come 2014. The new plan, dubbed Sustinet, will deliver a progress report to the state legislature on January 7. “I think that if it’s successful, it’s an interesting model,” says Rader Wallack of Vermont. “It could potentially provide competition from the public sector within a private business model.” Massachusetts – Four years after the health reform law passed, Massachusetts boasted record coverage: 98.1 percent among adults and 99.8 percent for children, according to statistics released in December. But less-heartening numbers loom in the background: the state’s health care costs continue to rapidly outpace general economic growth. Cost-control was a key campaign issue and the governor’s race and is positioned to become a legislative priority in the coming Massachusetts session. “It’s quite doable but takes some political courage,” says Rader Wallack who, previously co-chaired Massachusetts’ Cost Containment Committee. “What they really need is for the legislature to move on this and enact something that gets the ball rolling.” Governor Deval Patrick has purposed payment reforms similar to the Accountable Care Organizations championed in the federal health reform law. “The idea, in oversimplified terms is to move from paying for the amount of care to paying for wellness,” Patrick told local radio station WBUR in an October 2010 interview. “There are models for this where we’ve seen costs managed down.” Rader Wallack cautions against moving too quickly into an ACO-model and argues in favor of a gradual approach. “The idea you flip a switch and everyone be in ACO isn’t necessarily feasible,” she says. “Having them move in that direction, at a reasonable pace with incentives to take the next steps, calibrating that all correctly is a complicated endeavor.”

NYTimes Letter to the Editor, by Martha Holstein, from HMPRG's Center for Long-Term Care Reform

Download the letter from the NY Times site

January 3, 2011

Really Old Age: There’s No Denying It

To the Editor:

“Real Life Among the Old Old,” by Susan Jacoby (Op-Ed, Dec. 31), was a welcome dose of reality.

This country’s dominant cultural narrative about old age seeks to deny it out of existence. This narrative and the accompanying lessons in how to be “ageless” are self-defeating.

They rest on the easy assumption of individual control (conveniently forgetting about poverty and its effects on health). They pressure us into believing that we can and should remake ourselves, usually at considerable cost, because what we are — old — is undesirable.

Further, the popular image of healthy, affluent older people undermines support for Social Security, Medicare and other critical safety net programs that respond to the needs of nearly half of older people, primarily women, who live on the economic edge.

Age is more than a number. Ms. Jacoby got it exactly right when she said the important task was not seeking to make 90 the new 50 but making “90 a better 90” — and, I would add, 70 a better 70 and 80 a better 80.

Martha Holstein
Chicago, Jan. 1, 2011

The writer teaches and writes about ethics and aging and consults on long-term care policy.