Health Reform

“The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law or curtailing the coverage expansion could result in continued erosion of adults’ access to care.”

http://content.healthaffairs.org/content/31/5/899.abstract

The Wisconsin Department of Health Services (DHS) announced these and other changes to the BadgerCare+ program that will go into affect on July 1, 2012:

• Some adults who receive BadgerCare+ may see an increase or new monthly premium payment if their income is above 133% of the Federal Poverty Level (FPL).
• Some families who have access to coverage through an employer will no longer be eligible. Other families, depending on how much of the cost is covered by the employer, will remain eligible but will be subjected to higher premiums.
• An adult who receives BadgerCare+ must report any income changes within 10 days with documented proof.

Families currently getting their coverage through BadgerCare+ will receive a letter in the next couple of weeks outlining the changes. They will also receive a letter in mid-June that will provide details about the changes that specifically affect their family.

For more information:

• DHS updates page
• Journal Sentinel article
• Wisconsin State Journal article
• Wisconsin Council Children and Families’ blog

According to “For the Public’s Health: Investing in a Healthier Future,” a report issued by the Institute of Medicine in April 2012, the US health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society.

Among the 10 recommendations the committee on Public Health Strategies to Improve Health included is one focused on setting national targets for life expectancy, and another on establishing a basic array of programs and services that enable every health department to provide a standard level of health protection in the communities they serve.

This figure from the Organisation for Economic Co-operation and Development demonstrates that the USA has the highest spending on health per capita, but is behind other nations in life expectancy at birth.  (Click on figure to enlarge.)

Housing and Health Care Go Hand in Hand, an article in Role Call by Bostic and Lavizzo-Mourey, discusses the role of neighborhoods and communities in health.

Read the entire article and consider the question posed by the authors: How do we move forward? and of course their response.

Raphael Bostic is assistant secretary for policy development and research at the Department of Housing and Urban Development. Risa Lavizzo-Mourey is president and CEO of the Robert Wood Johnson Foundation.

For those of you following all the current events, news and opinions surrounding Health Reform and the Supreme Court, we are sharing the following links and blogs:

• The single-payer plan reborn:  How Obama could turn a health care defeat in the Supreme Court into a major progressive victory (This originally appeared on Robert Reich’s blog.)
• From the New York Times:  Supreme Court Challenges to Obama’s Health Care Law
• And for those who are wanting to read nearly everything available, Kaiser Health News is posting numerous analyses and news summaries of the current events on a page titled “The Supreme Court Decides: Health Law At The High Court.”

1 in 5 US families say they struggle to pay medical bills; half say they can’t pay a cent according to an article in the Washington Post, on-line, 3/6/2012.

The article notes that it is the first time the Centers for Disease Control and Prevention has looked at the issue in such a comprehensive way.

The full report, Financial Burden of Medical Care: Early Release Estimates From the National Health Interview Survey, January-June 2011, is easy to read and clearly highlights the results of the survey.

The first of several charts illustrates that a third of those surveyed were in a family experiencing financial burden of medical care.  The next chart demonstrates that the financial burden of medical care decreased with age and the notes highlight the medical financial burden on children including:

• In the first 6 months of 2011, children aged 0-17 years were three times more likely as adults aged 75 and over to be in families having problems paying medical bills in the past 12 months.
• Children aged 0 – 17 were more than five times as likely as adults aged 75 and over to be in families that currently had medical bills they were unable to pay at all.

The balance of the report describes the financial burdens by poverty status.

Feds deny Wisconsin’s request to allow health insurance companies to use more of their income for non-health related expenses.

In an article posted 2/16/2012 on The Hill by Julian Pecquet we have learned that the Obama administration denied Wisconsin’s request for a waiver from the healthcare law’s medical loss ratio.

Steve Larsen, the deputy administrator and director of  the Department of Health and Human Services, wrote in a letter that the evidence presented did not establish a reasonable likelihood that the application of an 80 percent MLR standard would destabilize Wisconsin’s individual market.   As a result, HHS will not adjust the MLR standard in Wisconsin’s individual market and, thereby, ensure that consumers receive the benefit of this provision of the Affordable Care Act.  His letter to the Wisconsin commissioner of insurance, Theodore Nickel, provides all he details of the decision.

One of the big policy propositions of the Affordable Care Act was the establishment of “Affordable Care Organizations” (ACOs).  These new kind of HMOs are to be paid for taking care of the whole patient and rewarded for keeping that person healthy.  The first ACOs were rolled out in December 2011 and geared at Medicare patients.

There is an excellent commentary by Mr. El-Sayed that explains how the poor, usually the sickest, will likely be left out of this new type of health care arrangement.  He compares their likely inability to achieve equity to that which happened in schools trying to improve educational outcomes of students in poor areas.  Too many other social determinants impact both educational and health outcomes to expect either schools or health care systems to provide services adequate to overcoming those deficits and producing better outcomes.  It will just too expensive for these ACOs to provide care to the poorest.

In this excellent and readable brief from the Kaiser Foundation, the issues being considered by the Supreme Court to those challenging reform are detailed.  The two major Constitutional issues concern: 1) the individual mandate, the requirement that all be insured and 2) the Medicaid expansion which requires all states to cover all people under 138% of the federal poverty line in their state Medicaid programs.

The main issue for the individual mandate is whether or not the mandate violates the Commerce Clause of the Constitution.  Requiring the purchase of insurance is considered by the plaintiffs to be outside of the authority of Congress because the federal government does not have authority to compel people to enter any commercial activity.  Further, taxing authority is called into questions related to the penalties/fines associated with not being insured.  There is disagreement as to whether the current set up of collecting fines for non-compliance through the tax system oversteps Congress’s power to tax.

The main issue for the Medicaid expansion is whether or not it the mandatory coverage criteria coerces states to participate in Medicaid.  Currently all states do participate in Medicaid (that has not always been true) but it is a voluntary federal-state partnership.  When states participate, they are always bound by federal rules governing how they can set up Medicaid.

Some important data analyses predicting continued growth in health care spending due to aging of population and rising treatment costs.  Read David Morgan’s article.