Do Republicans Have a Health Plan? Part 2

During President Obama’s give and take with House Republicans meeting in Baltimore on Friday, he encountered U.S. Rep. Tom Price (R-Roswell) who is one of the GOP’s point people on health care reform. Price has campaigned at Town Hall meetings and other gatherings around Georgia suggesting that millions more people could become insured at a minimal cost to taxpayers by attempting more market-based reforms. But there is no substantive evidence — certainly not anything from the Congressional Budget Office or any other independent analysis — that the market reforms Price and Republicans propose will make a significant dent in the number of uninsured. No doubt it would be cheaper for taxpayers, but it wouldn’t effectively deal with the growing number of workers who have lost insurance coverage. That’s why we appear to be at a stalemate in the negotiations for a bipartisan bill. The Republicans simply have not presented a plan that amounts to a comprehensive approach to either health insurance or health care reform.

The New York Times has a fact check posting online now that deals with Obama’s extraordinary exchange with House Republicans and provides some interesting background on what Price and his GOP colleagues have claimed as their “better plan” for health care reform.

— mike king

Tobacco Tax Helps Budget, Children

This commentary originally appeared in the Atlanta Journal-Constitution.

As the 2010 legislative session opened, Georgia faced a dilemma: With a sluggish economy and unemployment hovering over 10 percent, there is a spike in the need for safety net services at the very time that state revenues are sagging.

Severe budget deficits threaten essential services such as Medicaid and PeachCare for Kids, which serve as lifelines to low-income families who might otherwise be uninsured in this difficult economic climate.

One potential solution is an increase in the state’s tobacco tax, currently one of the lowest in the nation, which could have the dual effect of reducing smoking rates and generating revenue to preserve necessary health services.



Do Republicans Have a Health Plan?

By Mike King

There was snickering on the Republican side of the aisle during Wednesday’s State of the Union speech when President Obama challenged detractors of health care reform to bring him an alternative plan that works. It may have been uncomfortable laughter on their part because the party, as a whole, has no real alternative to offer.

We often hear from Georgia’s senators Saxby Chambliss and Johnny Isakson, as well as the leader of the Georgia House delegation on health issues, Rep. Tom Price, that health reform can be achieved with market-based solutions, such as allowing insurance companies to sell policies across state lines, as well as the party’s favorite excuse for escalating health costs — baseless malpractice suits. Even if legislation dealing with those two issues was passed, the numbers of currently uninsured Americans being able to afford new policies and the bend of the cost curve by malpractice reform would be incremental, at best. And when the GOP was in power in the White House and Congress, it’s interesting to note — as this report on NPR and Kaiser Health News does — that there was hardly any party unity on either issue.

In truth, there was no zeal to do anything about health care reform when the GOP was in power, demonstrated by George Bush’s veto of the State Children’s Health Insurance Plan reauthorization. (Except, of course, unless you count the huge expansion of Medicare when he and Congress agreed to add $700 billion to the deficit by establishing a prescription drug benefit for Medicare patients. Where was the concern for the deficit then?)

As anyone who has studied health care policy has come to learn, occasional tweaking of the massive health care financing and delivery system rarely results in long-term reform or savings. And proposing comprehensive reform — like the effort in 1993-94, and this one now — is inherently complex, subject to willful misinformation by politicians and special interests, and demanding good faith negotiations and uncomfortable trade-offs (i.e. requiring everyone to have insurance so that everyone can afford insurance). That’s why nothing major ever gets accomplished.

The ball’s on the GOP side of the aisle now. Let’s see what they’ve got.

Mike King is a retired journalist who specializes in writing about health policy issues. He also serves as editor and administrator of the Healthy Debate blog.

The Elephant in the Room: Long Term Care

By Kyle Pinion

With so much of the current debate in Washington, D.C. focused on lowering health care costs and increasing access for all Americans, there’s been an important facet of the reform measures that have been forgotten by most pundits, the public and possibly even some legislators: Long-term Care reform.

Long-term care services are needed when a person’s ability to provide their own care has been halted by a disability or disease. Services under the long-term care banner range from dispensing of medications to preparation of meals and bathing.

According to the SCAN Foundation, about 10 million people of all ages need long-term care and about 40% of people with long-term care needs are under the age of 65. About two-thirds of that 10 million receive their long-term support from family and friends, one-fifth receive in-home care from professionals in a community setting, and 14% receive support in nursing homes. Payment for these kinds of services can range in the hundreds per week, creating a rather large cost-burden on patients, families and care partners.

When you’re young and healthy, long term care insurance is available for investment into future planning, but once you’ve already been diagnosed with a disease, the likelihood of being able to obtain insurance is slim to none.

Throughout 2009, two pieces of legislation were being lobbied for by advocates for those living with chronic diseases and disabilities. The first (as written about by the GCDD earlier in this blog) was the brainchild of the late Senator Ted Kennedy. Senate Bill 697 would create a national, disability insurance enrollment program for all employees (with the ability to waive enrollment) and provides cash benefits for the enrolled if they find they are unable to perform two Activities of Daily Living (ADL’s) any longer due to the course of their disease or disability, these cash benefits (with average around $75 per day) are to be applied towards in-home health care.

The second piece that was being discussed was The Community Choice Act (HB 1670), which is based around the idea that all states that receive Medicaid must provide nursing home services, but needed community based services are optional, which is reflect in Medicaid spending nationally where 67% goes towards institutional services and 33% covers community based wavers. HB 1670 provides an essential alternative for people in need of long-term care services, providing a choice for people receiving Medicaid benefits. Those now living in institutionalized settings would be able to receive community supports, additionally families and caretakers will be able to choose where there loved one receives services. This bill would build on the money-follows-the-person concept and effectively ends Medicaid’s institutional bias.

In the Senate health care reform bill (HR 3590), the CLASS Act has been included as an amendment onto the bill as it is currently written. While the CLASS Act addition onto the bill has some detractors (both within the insurance industry and on Capitol Hill), it remains an integral part of the reform legislation effort, and recently survived a very close vote to keep it within the bill (51 for vs. 47 against). The Community Choice Act, while not in the bill, has been addressed in a manner of speaking, by Senator Tom Harkin’s amendment to the bill in the “Community First Choice Option.” This amendment rather than requiring states to provide the choice between institutionalized and in-home care, instead encourages that states do so. Whether this change proves to be effective remains to be seen, but it at the very least it highlights a very important issue for people receiving attendant care.

While the future of the HR 3590 remains in doubt in light of the recent special election in Massachusetts, we remain hopeful that these long-term care reforms receive the proper attention they deserve by our elected officials on Capitol Hill in order to effectively eliminate the institutional bias in Medicaid and provide greater incentives for people living with disabilities and chronic illnesses to reenter the work force.

Kyle Pinion is director of public policy and advocacy for the National Multiple Sclerosis Society, Georgia Chapter.


Taxing Hospitals to Pay for Medicaid

By Mike King

Thanks to a big infusion of federal stimulus dollars last year, the 2009 Georgia General Assembly was able to avoid some harsh decisions about how to finance the increased spending needed to pay the state’s portion of the Medicaid program for the poor. The 2010 Legislature won’t be so lucky and already Gov. Sonny Perdue has returned to last year’s idea of taxing hospitals to help pay for the program.

The so-called “bed tax” on Georgia’s hospitals could generate as much as $350 million annually, Perdue’s office estimates. That money would go toward drawing down additional federal Medicaid dollars — the feds pick up about two-thirds of the cost of the program in Georgia — and would help reduce Medicaid’s drain on the tight state budget. The governor’s office and advocates for the tax believe the additional federal dollars will also keep the state from having to cut Medicaid rolls and/or reduce benefits for the nearly 1.8 million Georgians covered by the program.


Who Will Regulate Insurance Exchanges?

One of the key differences between the House and Senate versions of health reform — and perhaps one of the most difficult to hammer out — involves whether the proposed insurance exchanges will be regulated by the federal government or the states. (The Senate plan gives that authority to the states; the House keeps it with the federal government.) But, as a story in today’s New York Times illustrates, even if the House plan prevails, experts believe there will still be a substantive role the states must play to oversee compliance.

That’s why consumers and activists must pay particular attention to the actions of the Georgia General Assembly. Already, leading Republicans in the Legislature have indicated they will take action — something, they’re not sure what yet — that will attempt to thwart the impact of Washington’s plans on Georgia.

Think about how politics has played a role in how Georgia and other states have set up and administered their federally-subsidized Children’s Health Insurance programs (PeachCare in Georgia). Think about the Rube Goldberg-designed financing mechanisms for the state’s Medicaid program, two thirds of which comes from federal taxes. Historically, Georgia has never played well with federal rules, especially when it comes to health and human services, even when drawing down more federal financing than most other states. As the General Assembly begins the laborious budget-making process, think about how it might want to finance a state compliance office to regulate Georgia’s health insurance exchange. This is a key reform issue that advocates must watch closely.

— mike king


By Georgia Council on Developmental Disabilities

The national health reform legislation moving through Congress includes provisions that would impact people with disabilities. The CLASS Act, for example, is incorporated in the current legislation. What would the CLASS Act do?  The Community Living Assistance Services and Supports Act (CLASS Act) would offer a meaningful non-means-tested complement to the Medicaid program with a focus on helping individuals overcome barriers to independence that they may confront due to severe functional impairments.  It would create a new national insurance program to help adults who have or develop severe functional impairments to remain independent, employed, and stay a part of their community.  Financed through modest voluntary payroll deductions (with opt-out enrollment like Medicare Part B), this legislation would help remove barriers to choice and independence (e.g., housing modification, assistive technologies, personal assistance services, transportation) that can be overwhelmingly costly, by providing a cash benefit to those individuals who need support for basic functions.  The large risk pool to be created by this approach would make added coverage affordable.  It would give individuals added choice and access to supports without requiring them to become impoverished to qualify for Medicaid. You can learn more about the Georgia Council on Developmental Disabilities’ health care agenda here.


Struggling Georgians Deserve Better Health Care Options

By Cindy Zeldin

This piece originally appeared in the Macon Telegraph.

In these difficult economic times, the loss of a job is frequently compounded by the loss of the health insurance that had been tied to it. With unemployment rates hovering near 10 percent, more and more Georgians are facing this dual predicament.

For many recently unemployed Georgians, a popular program that subsidizes the continuation of employer-sponsored coverage has served as a lifeline since it was enacted into law in early 2009.  Under the program, known as the COBRA subsidy, most workers laid off between September 1, 2008 and December 31, 2009 were made eligible for a 9-month subsidy to ease the financial load of paying full freight to stay on their old plan.

In normal times, people losing their jobs can remain on their previous employment-based plan for 18 months by paying the entire premium, including the portion their former employer had previously contributed. For someone who has just lost his or her primary source of income, however, paying the entire premium can be cost prohibitive. To address this challenge, the subsidy puts COBRA coverage in reach for many Georgians:  according to a study recently released by Families USA, monthly premiums for subsidized COBRA coverage average $369 in Georgia, while the average monthly premium without the subsidy is $1,053.



Resolving the Bills and What Could be Implemented Quickly

There’s an interesting post today on Slate that deals with what needs to be done to iron out major differences between the House and Senate health care reform bills. While the public option difference is getting the most attention, there are other major topics — from whether to keep the Childrens Health Insurance Program separate or merge it into Medicaid, to how to pay for reform — that will need to be ironed out.

Another story by the Washington bureau of McClatchy Newspapers looks at what provisions of the reform plan would kick into effect quickly if it passes. This would have major implications for the states, including a budget-challenged Georgia, which is about to open the 2010 General Assembly uncertain as to what it might have to do to implement new rules coming out of Washington.

— mike king

Bending the Curve on Insurance Costs

Here’s an interesting piece from Slate on how insurance companies measure “loss” and how difficult it is to define what are legitimate administrative costs in managing plans. The author makes the point that both the House and Senate versions of health care reform build in significant cost savings for people who rely on the private insurance market, which is the most problematic in offering decent coverage at an affordable price. But there are other methods to accomplish the same thing. This is a very quiet part of the debate that has not received a lot of attention.

Here’s the link:

mike king