FIELD REPORT from Familes USA

A wealth of ideas are in this report, click the link in the main title to review the report in it's entirety, requires Adobe Reader. i have cut and pasted a few excerpts here...rw

July 2005

The Good, the Bad, and the Ugly: Analysis of the National Governors Association’s Medicaid Reform Proposal

On June 15, the National Governors Association (NGA) released “Medicaid Reform : A Preliminary Report,” a proposal that describes the NGA’s vision for the future of Medicaid, as well as some aspects of the broader health care system. The proposal is the culmination of several months of discussions among a small group of governors that includes both Democrats and Republicans. At NGA’s July 15 meeting, governors voted to adopt this proposal as official NGA policy.

NGA’s adoption of this proposal comes at an inauspicious time. This is because
the congressional budget resolution requires that as much as $10 billion1 be cut
from the Medicaid program by mid-September as part of the so-called “budget
reconciliation” legislation. In making these cuts, Congress has placed the cart
before the horse, requiring that budget cuts be made before policy changes can
be fully examined. The NGA proposal should not be adopted in the context of
Congress’s effort to obtain short-term budget savings. Instead, the changes
proposed by NGA should be postponed until they can be carefully analyzed and
until their impact on Medicaid beneficiaries are fully understood.

In this preliminary analysis, we highlight key concerns about the NGA proposal
and describe some of the promising ideas as well. The analysis also assesses
NGA’s ideas for expanding federal assistance to the uninsured.
Contents:

1. Proposals that Hurt People Who Rely on Medicaid
2. Medicaid Reform that Makes Sense
3. Expanding Federal Help to the Uninsured

Proposals That Hurt People Who Rely on Medicaid

Erecting Barriers to Health Care for the Poor

The NGA proposes giving states broad discretion to dramatically increase cost-sharing—the amount that people pay out of their own pockets in premiums, copayments, and deductibles to receive services through Medicaid. This proposal would remove the current reasonable limits on how much states can charge people who must rely on Medicaid—including low-income children, pregnant women, and people with disabilities, as well asseniors on low fixed incomes...

Arguments for higher out-of-pocket costs suggest that the low-income people served by Medicaid (most live on budgets that are below the federal poverty level—some are well below that level) will thus be less likely to make unneeded visits to the doctor or to seek out unnecessary treatment. There is absolutely no evidence to support the assertion that low-income people are over-utilizing the health care system.

However, there is ample evidence that increased cost-sharing discourages people from seeking necessary care:
Increasing the copayments charged to the poor has been shown to reduce their access to critical needed services, leading them to seek more costly care later. Further, a significant body of research has shown that charging premiums to low-income people deters them from enrolling in coverage and thereby increases the ranks of the uninsured.

Picking and Choosing Who Gets What Health Care

The NGA proposes eliminating federal assurances that people who rely on Medicaid have access to critical health care services. In place of the current federal requirements that spell out the minimum set of benefits that must be provided to Medicaid enrollees, the NGA proposes that states be given very broad discretion to determine the services provided and to “tailor” services to meet the needs of broad categories of people.

Under current law, individuals in Medicaid only get the health care services that are medically necessary for them. Thus, it is unclear how much savings could be generated from “tailoring” the Medicaid benefit package for individuals or groups—unless the “tailoring” consists of eliminating coverage of health care services...To contain costs, we should pursue the use of disease management, home- and community-based care, and other methods that promise to deliver
quality health care services more efficiently, ather than arbitrarily strip away vital services from those who need them.

Medicaid Reform that Makes Sense

Prescription Drug Cost Savings

The NGA proposes reducing Medicaid costs by cutting spending on prescription drugs. Prescription drugs have consistently been among the fastest growing Medicaid costs in the past several years, and there is widespread agreement that Medicaid is paying too much for drugs. This is one area where savings can be found without reducing services essential to those with Medicaid and where improvements are long overdue.

Specifically, the NGA has identified the following positive reforms that will save significant federal and state Medicaid dollars:

• increase the minimum rebates that states collect on brand-name and generic drugs;
• require that authorized generics be included in “best price” calculations for purposes of determining rebates;
• force discounts on the front end of drug purchasing;
• enact sanctions for companies and individuals that fail to accurately report the average sales price;
• allow states to join purchasing pools; and allow managed care organizations to obtain rebates directly for the Medicaid populations they serve.

In addition to these proposals, policy changes that encourage states to restructure pharmacists’ reimbursements could also result in very significant savings. In particular, moving away from payments based on Average Wholesale Price (AWP) to another pricing calculation, such as one based on average sales price (ASP—the weighted average of all non-federal sales prices to all purchasers, excluding sales exempt from the best price calculations,net of rebates, discounts, and other price concessions), would save money for both states and the federal government without hurting the people who must rely on Medicaid.

With this change, pharmacy dispensing fees should be set at a flat rate that adequately covers reasonable costs and that does not create incentives for pharmacists to dispense higher-priced drugs. The administration of the current drug rebate program also needs to be strengthened.

read more in the report by clicking the main title in this post or @ http://tinyurl.com/cu5e5

American Healthcare Crisis: A Perfect Storm

The growing proportions of this crisis put all Americans at risk. Fewer and fewer employers can even afford to offer insurance. Insurance that is offered is often inadequate, and in many cases unaffordable at todays wages which have failed to keep up with the growing cost of even the barest neccessities. Follow the link to one writer's perception of the problem and what extremes may need to be reached for the American voter to make this a priority. Please post any comments, articles or personal experiences you would like to offer.
rw



Patrick Lannigan - Winter 2004

A perfect storm is in the forecast. 43 million Americans have no healthcare, a tsunami of baby boomers will retire in the next 15 years, and health costs are soaring. Yet - Americans sleep soundly at night. On occasion, there is a wakeup call but the groundhog sees no shadow, hits the snooze button, and goes back to sleep. Is this sustainable? Will Americans continue spending their hard-earned tax dollars on vote-getting missions to Mars or Iraq - versus that of life itself? Are Americans that cruel?

I say no. The America I lived in, (Massachusetts), rallied to the misfortune of a neighbour, or a crisis, with as much passion as a Canadian would. So why, then, do Americans not rally around the healthcare cause?
Healthcare as a Taboo Subject.
I discovered that when you break bread with Americans, and bring up the subject of national healthcare, the debate loses all life support when those in opposition paint images of wait-times and higher taxes. In some cases the feedback I received would make the late Senator McCarthy proud. "Socialism", they say. "Big Government", they protest. I quickly got the message. National Healthcare was a Do-Not-Discuss item at the lunch or dinner table.

Americans face a terrible dilemma. On one hand they're a great nation that has faced and survived many a crisis. Yet, they have a disdain for anything that smacks of Big Government and Government Control of their lives.
Healthcare Bill: Do Not Resuscitate
Is there a solution in politics? Is there some visionary politician that could mobilize support for a healthcare system that wouldn't turn suffering people away? Unfortunately, the last real attempt at material change (Bill and Hillary's health bill) died on the operating table. Furthermore, opposing politicians spray-painted DO NOT RESUSCITATE graffiti all over capitol hill.
The telegram for most politicians?

DO NOT TALK ABOUT FIXING HEALTHCARE. STOP.
TALK BAND-AID FIXES ONLY. STOP.
NEVER IMPLY RAISED TAXES. STOP. OVER.

Will change ever occur? I believe it will, but the crisis will have to worsen. If the number of uninsured Americans were to pass the 100 million mark, then we're talking real vote power. Politicians will have no choice. As much as I love Arthur C. Clarke, the proposed social-science-moon-base-project may have to wait.
A certain segment of Americans I spoke to, had a me-vote-Republican
'cause-me-want-low-taxes approach to their political views. Lower taxes was all that mattered to them. Death and suffering could change that. There's nothing like the death of a father, mother, uncle, or brother, who just happens to be uninsured, to help change somebody's outlook.

One Nation, Uninsured

An excellent assessment and evaluation of solutions to the worsening healthcare crisis in this country from the well known and respected economist Paul Krugman. Sharing the risk among a large single payer is an option that will bring down the skyrocketing costs of healthcare, which has already led to reduced access for many hard working americans and their families...
rw


The New York TimesJune 13, 2005

One Nation, Uninsured

By Paul Krugman

Harry Truman tried to create a national health insurance system. Public opinion was initially on his side: Jill Quadagno's book "One Nation, Uninsured" www.booksense.com
tells us that in 1945, 75 percent of Americans favored national health insurance.

If Truman had succeeded, universal coverage for everyone, not just the elderly, would today be an accepted part of the social contract. But Truman failed. Special interests, especially the American Medical Association and Southern politicians who feared that national insurance would lead to racially integrated hospitals, triumphed.

Sixty years later, the patchwork system that evolved in the absence of national health insurance is unraveling. The cost of health care is exploding, the number of uninsured is growing, and corporations that still provide employee coverage are groaning under the strain. So the time will soon be ripe for another try at universal coverage. Public opinion is already favorable: a 2003 Pew poll found that 72 percent of Americans favored government-guaranteed health insurance for all. But special interests will, once again, stand in the way. And the big debate among would-be reformers is how to deal with those interests, especially the insurance companies.

These companies played a secondary role in Truman's failure but have since become a seemingly invincible lobby. Let's ignore those who believe that private medical accounts - basically tax shelters for the healthy and wealthy - can solve our health care problems through the magic of the marketplace. The intellectually serious debate is between those who believe that the government should simply provide basic health insurance for everyone and those proposing a more complex, indirect approach that preserves a central role for private health insurance companies. A system in which the government provides universal health insurance is often referred to as "single payer," but I like Ted Kennedy's slogan "Medicare for all." It reminds voters that America already has a highly successful, popular single-payer program, albeit only for the elderly. It shows that we're talking about government insurance, not government-provided health care. And it makes it clear that like Medicare (but unlike Canada's system), a U.S. national health insurance system would allow individuals with the means and inclination to buy their own medical care.

The great advantage of universal, government-provided health insurance is lower costs. Canada's government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. Medicare has much lower administrative costs than private insurance. The reason is that single-payer systems don't devote large resources to screening out high-risk clients or charging them higher fees. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured. Nonetheless, most reform proposals out there - even proposals from liberal groups like the Century Foundation and the Center for American Progress - reject a simple single-payer approach. Instead, they call for some combination of mandates and subsidies to help everyone buy insurance from private insurers.

Some people, not all of them right-wingers, fear that a single-payer system would hurt innovation. But the main reason these proposals give private insurers a big role is the belief that the insurers must be appeased. That belief is rooted in recent history. Bill Clinton's health care plan failed in large part because of a dishonest but devastating lobbying and advertising campaign financed by the health insurance industry - remember Harry and Louise? And the lesson many people took from that defeat is that any future health care proposal must buy off the insurance lobby.

But I think that's the wrong lesson. The Clinton plan actually preserved a big role for private insurers; the industry attacked it all the same. And the plan's complexity, which was largely a result of attempts to placate interest groups, made it hard to sell to the public. So I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained. We need to do this one right. If reform fails again, we'll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can't pay their medical bills.