Campaign Claims: Health Law Myths And Facts - Kaiser Health News

By Julie Appleby, KHN and N.C. Aizenman, The Washington Post

This story was produced in collaboration with

The debate that preceded passage of the health-care overhaul resumed as a heated issue in the midterm elections. Politicians and advocacy groups seeking repeal of the law are making dramatic claims about its cost and effects. How valid are they? We evaluate some of the most common criticisms.
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A Victory For Health Reform And Good Law – Health Affairs Blog

by Timothy Jost

To understand this controversy, it is necessary to understand what the minimum coverage requirement actually says and why Congress adopted it. The law provides that, beginning in 2014, if you are not covered by health insurance from your job and are not eligible for Medicare or Medicaid; if you do not have a religious objection to having health insurance or belong to a health care sharing ministry; if you have been uninsured for 3 months or more; if you are not a Native American; if you earn more than the tax filing limit (currently $18,700 for a couple); if you can find a health insurance policy for less than 8 percent of your income; and if it does not otherwise cause you a hardship, you must purchase a basic, high cost-sharing health insurance policy or pay a tax penalty. If you don’t pay the penalty, you cannot be criminally prosecuted and the IRS cannot place a lien or levy on your property. Tax credits will also be available to help many of those subject to the mandate (a small minority of Americans) to purchase the required insurance.

The Purposes Of The Minimum Coverage Requirements

Congress adopted this provision for two reasons. First, the requirement was the only way to get to universal coverage using private insurance. If you require private insurers to insure people with pre-existing conditions, the health insurance market will collapse if you do not also require healthy people to participate in the market. Only sick people will purchase insurance, while healthy people will wait until they get sick or have an accident and then purchase insurance. Insurance will soon be unaffordable to all. Congress did not consider an alternative which would clearly have been constitutional—a tax-financed public insurance system like Medicare for all—because it wanted to make our private insurance system work.

Second, the use of health care is in the end unavoidable. We will all need health care sooner or later, and when we do, someone will have to pay for it. If an individual is insured, the insurer will pay for it. Each year, however, $43 billion worth of care is received by people who do not have health insurance and who do not pay for it. This cost is passed on to the rest of us—to our employers, insurers, health care providers, and the government. This level of cost-shifting may be understandable today, when many cannot afford health insurance, but once tax credits are available so that no one needs to be uninsured, it is no longer tolerable, The purpose of the law, that is, is to discourage this freeloading and to encourage individual responsibility (something conservatives used to be in favor of).

Judge Steeh’s Decision

The Michigan case, however, was the first case to reach the merits of the claim. The court squarely upheld the minimum coverage requirements. Judge Steeh ruled first on the jurisdictional claims raised by the federal government. Surprisingly, he held that the plaintiffs did have standing to challenge the law and that it was “ripe” for adjudication, even though it will not go into effect until 2014. He accepted the plaintiffs’ argument that they must already “reorganize their affairs” so that they will be able to afford health insurance in 2014. Although this argument seems spurious (who knows whether the individuals will or will not be insured or required to purchase insurance three years from now), and a claim that the plaintiffs were already suffering an injury was rejected by the judge in the California case, Judge Steeh refused to dismiss the case on this basis, obviously eager to get to the merits.

Once he got to the merits, the judge made short work of the nonsense argued by the opponents to the law. First, he recognized that for nearly six decades the Supreme Court has interpreted the Commerce clause broadly to permit Congress to regulate the use of the channels of interstate commerce; the instrumentalities of interstate commerce and persons and things in interstate commerce; and activities that substantially affect interstate commerce. The court cited Supreme Court cases recognizing that Congress could regulate purely local, non-commercial activity as an integral part of a statutory scheme that permissibly regulated interstate commerce. The court distinguished two cases from a decade ago that had struck down legislation regulating non-economic activity. And the court recognized, quoting earlier Supreme Court cases,

In assessing the scope of Congress’ authority under the Commerce Clause’ the court’s task ‘is a modest one. ‘The court need not itself determine whether the regulated activities ‘taken in aggregate, substantially affect interstate commerce in fact, but only whether a “rational basis” exists for so concluding.

Judge Steeh then turned to the “rational bases” of the minimum coverage requirement. First, he observed that Congress rationally concluded that the decisions of individuals to forego purchasing insurance coverage drives up the cost of insurance for everyone else: “The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers.” The decision whether to purchase insurance or to attempt to pay for health care out of pocket is plainly economic.

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When Republicans Were for Mandates | Gooznews

by MERRILL GOOZNER

Last week, a federal judge rejected the first of a dozen conservative legal challenges to the mandate requiring individuals to buy health insurance starting in 2014. In the first major ruling on the merit of the cases, Judge George Steeh of the Eastern District of Michigan ruled the commerce clause of the constitution gives the federal government the right to regulate health insurance sold within states. As Tim Jost, professor at Washington and Lee University points out in a post on the Health Affairs blog, the mandate is a necessary complement to one of the most important national regulations included in reform - the requirement that insurers cover all comers no matter what their pre-existing medical condition. Coverage would become unaffordable if healthy people were allowed to wait until they got seriously ill before buying coverage.

There's not much left to be said on the wisdom of including the mandate in reform. I argued during the debate that the amount of money lost through free-riding non-payers would be relatively small in the larger scheme of things, and not worth the political liabilities. We'll never know if I was right on the economics. I was obviously correct on the politics. The Tea Party wing of the Republican Party has made opposition to the mandate one of its main rallying cries.

So let us now turn to their hypocrisy. Where were these tea-baggers when a Republican Congress passed the prescription drug benefit for seniors in 2003? That insurance program (Part D charges an average premium of $35 a month, taken directly out of senior citizens Social Security checks) is "voluntary," but you can opt out only if you agree to pay a penalty when you decide you want to get coverage. The penalty is one percentage point increase in the premium for every year the senior stays out of the program.

So what is the takeaway lesson from this little bit of hypocrisy? Republicans back mandates that charge higher prices later as the penalty, while Democrats prefer mandates that charge penalties up front. I'll leave it to you to decide who has the greater claim on political genius.

Web Chat: Midterm Elections Mean Another Battle over Health Policy - Up Front Blog - Brookings Institution

Henry J. Aaron, Senior Fellow, Economic Studies

With the outcome of the rapidly approaching midterm elections unpredictable, the fate of the Affordable Care Act (ACA) hangs in the balance. On October 13, Brookings expert Henry Aaron answered your questions about the high stakes surrounding health policy during the midterm elections in a live web chat moderated by David Mark, senior editor at POLITICO.
The transcript of this chat follows.
Transcript

CLAS Standard Public Comment

The US Department of Health and Human Services’ Office of Minority Health is seeking public input from individuals and professional communities across the country for the CLAS (Culturally and Linguistically Appropriate Services) Standards Enhancement Initiative.  This initiative is an effort to make enhancements to the National Standards for CLAS in Health Care, first released in 2000.  The goal of the enhancement process is to maximize access in gathering public input and stakeholder dialogue to ensure that the CLAS Standards serve the health needs of everyone. 

To submit your comments electronically or attend a public comment session, go to: https://clasenhancements.thinkculturalhealth.org/. 

To access a copy of the CLAS Standards, go to: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15

For more information, please contact Leslie Swann at Leslie.Swann@aoa.hhs.gov or 202-357-3453.   

Changes Wrought By Health Reform? Well, Maybe Not - Kaiser Health News

By Jonathan Cohn, Senior Editor of The New Republic

During the past few weeks, employers, insurers, and providers of medical care have frequently made news by talking about how reform might change the way they do business. Each time, critics of the Affordable Care Act have insisted it was bad news. Each time, the true story has been a lot more complicated.

Maybe the obfuscation is unintentional. Health care policy is pretty complicated, after all. So, for the sake of my friends at Fox News and anybody who might be listening to them, here are three basic questions to ask every time you hear a story about changes the Affordable Care Act is unleashing:

1) Is something actually changing?

2) Is the change related to the Affordable Care Act?
3) Is the change really for the worse?
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Big Insurers Increase Denials for Preexisting Conditions from MedPage Today

Image via WikipediaBy Emily P. Walker, Washington Correspondent, MedPage Today

The number of people denied health insurance from four major insurers because of preexisting medical conditions rose by nearly half in the past several years, according to a memo released Tuesday by a congressional committee.

The House Energy and Commerce Committee investigated coverage denials due to preexisting medical conditions by the four largest for-profit insurance companies -- Aetna, Humana, United Health, and WellPoint. The investigation revealed that the four companies have denied more than 600,000 people coverage because of preexisting conditions during the three years before passage of the Affordable Care Act (ACA).

In addition, the companies refused to pay 212,800 claims for medical treatment related to preexisting conditions.

The denials affected people seeking to buy their own insurance on the individual market.

"Internal company documents show that this increasing use of preexisting conditions to deny or limit coverage would have continued unabated if Congress had not passed health reform legislation," committee chairman Henry Waxman (D-Calif.) and Rep. Bart Stupak (D-Mich.), who chairs the committee's Subcommittee on Oversight and Investigations, wrote in the memo.
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Related articles

• Insurers Denied Coverage to 1 in 7 (online.wsj.com)
• WellPoint, Aetna Led U.S. Insurers in Coverage Denial (businessweek.com)
• Denials up amid large health insurers: lawmakers (reuters.com)
• Health insurance claim denials rose by half (msnbc.msn.com)

How to Talk to Your Doctor, Understand Medical Information, Health Literacy - AARP Bulletin

by: Carolyn M. Clancy, M.D in AARP Bulletin

There is a truism in health care: When you don't fully understand or can't act on information about your health care, you are more likely to be in poorer health.

Nearly all of us, about nine of every 10 American adults, have some problems with health literacy.
Health literacy is not only about reading. It's about understanding difficult health terms and issues. Even highly educated people can have trouble understanding health care information.
For example, health literacy plays a role in how well:
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Report: 'Stigma' at State Department for those seeking mental health treatment

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by Josh Rogin

The State Department is moving to improve how it handles mental health services for employees coming back from high-stress or high-threat postings, but there's still a great deal of stigma attached to seeking this kind of help and the department needs to do more, according to a new internal report.

"Employees believe there is still a significant stigma attached to seeking mental health assistance," the State Department Office of Inspector General (OIG) said in a report released last week. The OIG called on State to remove the stigma by issuing a high-level statement encouraging returning diplomats to use the mental health tools at their disposal.

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The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey: Views on Delivery System Innovation and Improvement - The Commonwealth Fund

Nearly nine of 10 leaders in health care and health care policy believe current financial interests and lack of incentives for integration are significant barriers to the growth of accountable care systems. The latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey finds strong majorities of leaders report that providing special payment arrangements and incentives to providers—like those in the Patient Protection and Affordable Care Act—will be effective strategies for fostering coordination and integration in health care delivery. More than eight of 10 leaders feel that developing performance metrics, implementing provisions to increase transparency and public reporting, and establishing an Innovation Center within the Centers for Medicare and Medicaid Services should receive high priority from the Secretary of Health and Human Services. Survey respondents support development of a national accreditation system for accountable care organizations and public utility-type regulation of payment rates in areas with insufficient market competition.

Additional Materials

First Edition: February 22, 2010 - Kaiser Health News

Today's health policy headlines examine the dynamics of this week's health summit, details of a presidential plan to curb health insurance premium rate hikes and what the nation's governors are thinking about health reform.

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Looking Back, Moving Forward | Health Care Reform Center - NEJM

by Jonathan Skinner, Ph.D., Douglas Staiger, Ph.D., and Elliott S. Fisher, M.D., M.P.H.

The recent Senate election in Massachusetts may reshape or delay health care reform, but we still face the twin challenges of unsustainable cost increases and uneven quality that plague U.S. health care. Recent controversies have left many people confused about how we might wisely move forward.

One such controversy is the debate over the “value index,” a reimbursement approach that would adjust providers’ payments on the basis of regional performance on quality and cost measures. Legitimately concerned that careless implementation of a value index might hurt some preeminent teaching institutions, some leaders of academic medical centers have responded to this proposal by questioning the validity of existing measures of cost performance, many of which have been generated from Medicare data by our Dartmouth research group.
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Health Business Blog: More on the overuse of mammography in elderly women

by David E. Williams
A 2001 article from the Journal of General Internal Medicine (Screening Mammography for Frail Older Women; What are the Burdens?)followed the paths of 216 frail, elderly women who had undergone screening mammography.

The recent debate following the US Preventive Services Task Force recommendations on the age to begin routine mammography screening has focused heavily on the benefits of screening and the potential harm from discouraging screening. I’d like to see the debate broadened to include a frank discussion of the potential harm from too much screening. Excessive screening and associated harm to the frail elderly population is one aspect of that story.
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• Mammograms May Be Overused in Women with Dementia (nlm.nih.gov)

The Costs of Failure: Lessons from Nixon, Carter & Clinton Reform Efforts - The Commonwealth Fund

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By Karen Davis and Kristof Stremikis

The U.S. Congress is on the threshold of historic change that will usher in a new era in American health care. In the last 50 years, three presidents—Nixon, Carter, and Clinton—have made a serious effort to enact reform and failed. The nation simply can not afford to fail again—too much is at stake for those Americans who fail to get the life-saving care they need and for those who pay the bills of ever-rising cost of health care. History makes clear that failing to act on health reform has serious and far-reaching economic ramifications. An examination of trends in health spending over the past 50 years shows that if health reform measures proposed by previous presidents had been enacted and slowed the growth in spending by as little as 1.0 or 1.5 percentage points annually, spending trends in the U.S. would have been closer to those seen in other major industrialized countries and fewer adverse health consequences and economic burdens would have been borne by American families, businesses, and government.

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Is 30 Percent Really Wasted? | Gooznews

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by GoozNews

A new Medicare Payments Advisory Commission study of variation in government health care spending has dealt a serious blow to assertions that 30 percent of Medicare is wasted.

By controlling for differing prices and physician payment rates, the respected MedPAC looked was able to look at service usage rates in every metropolitan area in the country. It then compare them to the national average.

It found the vast majority were within 10 percent of average, with mostly rural and small metros averaging in the low 90-percent range and mid-sized and some large cities accounting for most of the high-spending regions, but usually less than 10 percent the mean.
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Women vs. Elderly in Senate Health Debate - Prescriptions Blog - NYTimes.com

By DAVID M. HERSZENHORN AND ROBERT PEAR

In a pitch to two of America’s potent political constituencies, Senate Democrats and Republicans turned the first full day of debate over major health care legislation into a battle over who would better protect the vulnerable.
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If private health insurance worked, we wouldn't need health reform

by Joe Paduda

Lost in the fight over health reform is a single, huge truth - if the private insurance market worked, there would be no need for reform.

We wouldn't be in this mess if private insurers were able to control cost inflation. And at the end of the day, that's what they are supposed to do. Sure they have lots of experience in underwriting and risk selection, and some have made some progress in some areas of disease management/mitigation, but UHC and Coventry and Wellpoint and HealthNet et al's 'experience' have not been able to consistently deliver lower health care costs.

I know there are lots of reasons/problems/complicating factors, but the stark reality is when it comes to controlling inflation, none of them have been able to.

Why not?
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Let’s Talk Health Care - The Illusion of Health Reform?

As the Senate begins debate on its health reform bill we should ask whether the bill is really about reform. I say this because it appears to be about covering the uninsured (a good thing) potentially at the expense of the currently insured and the federal budget (a bad thing) and about replacing the commercial health insurance marketplace with a government-run plan (also a bad thing).

Consider a few ways the bill is not about reform:

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Medicare, Medicaid spent $54 billion too much in 2009, White House says ... American Medical News

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By Chris Silva, amednews staff.

Improper payments for health care made up a large portion of the $98 billion the federal government spent inappropriately in fiscal 2009. This total was an increase of $26 billion over the previous year, according to a report issued by the White House Office of Management and Budget.

The Nov. 17 report concluded that Medicare fee for service improperly spent $24 billion in fiscal 2009, a rate equivalent to 7.8% of total outlays, and Medicaid improperly spent $18 billion, a rate of 9.6%. Medicare Advantage improperly spent $12 billion in 2009, a rate of 15.4% of total outlays on the private plans.

The Medicare fee-for-service error rate was just 3.6% in 2008.
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• White House: $98 billion in bad payments (money.cnn.com)
• Gov't: $98 billion in improper payments made (cnn.com)
• UPDATE: OMB Reports Medicare Improper Payment Rates for FY 2009 (medicareupdate.typepad.com)
• 55 Billion Reasons to Just Say No (healthcarebs.com)

Efforts To Expand Adult Day Care Programs Threatened By Recession-Driven Cuts - Kaiser Health News

Kaiser Health News, in a story produced in collaboration with The Washington Post, reports on adult day care. It "may soon become harder to find and afford. The almost 4,000 state-licensed centers around the country rely heavily on funding from state legislatures and charities, which have been hit hard by the recession. Advocates for adult day-care programs are pushing to include them in federal health-care overhaul legislation while also lobbying state legislatures and suing state regulators to keep centers from shutting their doors" (12/2). Read entire story.