WAS ANYONE ELSE THINKING OF THIS BACK THEN?
At the December 5, 2009
Fall Conference, the LWV of Weston website manager asked the
question: "What about allowing those fifty-five (55) years old and
up be eligible for Medicare?" The answer was that it would be too
expensive, and anyway A.C.A. was designed to fail. Once it was
passed, it was thought the next step was to fix it (speaker on the left,
below). How about this, from a non-LWV source, in 2018: https://www.nationalreview.com/2018/08/medicare-for-all-proposal-fiscally-implausible/
To
go to League video:
Five years later, these words in
response to our question ("Why not just make
medicare available to those 55 years and older?")
sound pretty reasonable, as does the far-fetched
question.
And more on the "public option" from Jacob Hacker: http://www.nytimes.com/roomfordebate/2016/08/24/is-obamacare-sustainable/a-public-option-would-greatly-improve-obamacare
On another note: Connecticut State Motto:
"Qui Transtulit Sustinet" -
Prof. Hacker (2010) - M.S. Wirtenberg graphic.
FALL CONFERENCE 2010 NOW
ONLINE: Click below. Best results
will be obtained by using Internet Explorer,
which will open the video in Windows Media
Player.
http://www.lwvweston.org/LWVCT12-4-10CableVersion.wmv
(385MegaBytes)
http://www.lwvweston.org/LWVCT12-4-10ModemVersion.wmv
(60MegaBytes)
News About
Health Care
LWVCT FALL
CONFERENCE DEC. 4, 2010
At
South Congregational Church, Hartford, Connecticut
Fabulous program for Fall
Conference this year, thanks again so much to Moderator Kay
Maxwell!!!
Moderator Kay Maxwell followed up on
last year's Fall Conference on Health Care by
introducing this year's fantastic presenters and
response panelists, for "One Year Later:
Health Care In Our Country And In Our State."
.
LWVCT President Cheryl Dunson graciously
introduced the program, and closed the event
precisely on time!
FALL CONFERENCE 2010 -
Video to be available in DVD
(2 different versions) around the turn of the
year. Contact LWVCT Office to reserve your
copies for either one or both. Version one is
the entire conference (approx. 2 1/2 hours).
Version two is a one-hour (for Public Access)
version consisting of excerpts from the
presentations of the four speakers. LWVCT office telephone
and e-mail contact information listed just below.
SEVEN YEARS LATER (2017)...
DIRECTIONS TO THE FALL
CONFERENCE BELOW
New York Times article on Vermont experience
here:
http://www.nytimes.com/2015/06/05/us/in-vermont-frustrations-mount-over-affordable-care-act.html?hp&action=click&pgtype=Homepage&module=first-column-region®ion=top-news&WT.nav=top-news
Does Hospital
Conversion Bill Go Too Far?
CTNEWSJUNKIE$
by Christine Stuart | Mar 20, 2014 12:24pm
Tempers flared at the end of last year’s legislative session
over a bill that would have made it easier for a private,
for-profit hospital company to purchase physician practices from
a nonprofit hospital that it planned to take over.
Gov. Dannel P. Malloy vetoed the bill saying that it needed
further consideration “to determine whether current law provides
adequate safeguards to guard against any perceived or actual
threat to the independence of medical decisions made by
providers employed by for-profit entities.”
It’s an area where the state has little experience. The only
for-profit hospital in Connecticut is Sharon Hospital.
Lawmakers, Malloy, and union officials have been wary of
unknowns when it comes to for-profit hospitals and what they
mean for the residents of Connecticut. While the hospitals
seeking to convert are desperate to bring new capital to their
facilities in order to save the community institutions.
“We should not allow additional for-profit hospitals into our
state until we have all of the information on, all of the
various entities that are bidding to make profits on the
healthcare needs of our citizens,” Sen. Majority Leader Martin
Looney, D-New Haven, told the Public Health Committee Wednesday.
[Please read the rest of this article in the archives at the CTNEWSJUNKIE website]
So, what's an exchange?
Arielle
Levin
Becker, CT MIRROR
December 6,
2012
It's a major
piece of "Obamacare," and set to debut in just under 10 months.
But unless you've been paying close attention, you might not be
totally clear on exactly what a health insurance exchange is.
Here's a primer.
What is an
exchange?
An exchange
is a store for selling health insurance. Every state is supposed
to have one as part of federal health reform. Connecticut's is
expected to begin selling coverage in October; the plans will take
effect Jan. 1, 2014.
Connecticut
Health Insurance Exchange CEO Kevin Counihan said it's intended to
be a simpler, more transparent way to buy coverage than the market
that exists now.
Who will use
it?
If you buy
coverage for yourself, you will have the option of buying it
through the exchange. So will small businesses. Anyone who gets
subsidies through the federal reform law to buy coverage (more on
those later) will have to buy their coverage through the exchange.
The exchange
is not intended to replace Medicare or Medicaid. People who
qualify for those programs will continue to receive that coverage
separate from the exchange. Similarly, people who get their
coverage through their jobs won't be using the exchange. And
people will still have the option of buying insurance through the
state's existing individual and small group insurance markets,
outside the exchange.
What will
the exchange sell?
The exchange
will sell health plans offered by private insurance carriers, like
Aetna, Anthem Blue Cross and Blue Shield and ConnectiCare.
(Insurers can decide whether to sell plans on the exchange or not,
so it's not clear which ones will or won't yet.) In addition,
Counihan said two new nonprofits are coming to the state and could
sell plans on the exchange: a new plan called Healthy CT that's
being launched with federal funds, and Harvard Pilgrim Health
Care, a nonprofit Massachusetts insurer.
[Please read the rest of this article in the archives at the CT MIRROR website]
Chief
Justice Roberts for the majority:
"We do not consider whether the Act embodies sound policies.
That judgment is entrusted to the Nation's elected leaders. We
ask only whether Congress has the power under the Constitution
to enact the challenged provisions."
For Insurers, A Daunting Task Ahead — Making Reform
Work
The Hartford
Courant
By MATTHEW STURDEVANT,
msturdevant@courant.com
11:14 PM EDT, June 28, 2012
Insurers face a daunting task now that the U.S. Supreme Court
has declared the health reform act constitutional — creating a
market that delivers affordable coverage to millions more
people while meeting a slew of new mandates and continuing to
underwrite quality medical care.
In some ways, it's as massive a task as private insurers such
as Aetna and Cigna would have faced if the law had been
overturned.
But Thursday's historic decision allows the companies to stay
on the course they've been following for more than two years,
planning for and adapting to the laws. So it's a relief for
the insurers, as it is for doctors and hospitals who no longer
have to change strategies put in place since the law passed.
Now, the job is managing a law that contains provisions many
of these very same people once fought.
[Please read the rest of this article in the archives at the Hartford COURANT website]
Federal opinion undermines state's health-pool concept
Mark
Pazniokas,
CT MIRROR
May 4, 2012
The U.S. Department of Labor has advised the Malloy
administration that opening Connecticut's state employee and
retiree health plan to nonprofits and small businesses could
jeopardize the legal protections it now enjoys as a government
plan.
The advisory opinion sought by Gov. Dannel P. Malloy could
undermine a health care pooling bill passed last year and an
expansion proposed by House Speaker Christopher G. Donovan,
D-Meriden, that is now awaiting action in the House.
The legislature last year passed a law opening the plan to
employees of nonprofits, beginning Jan. 1, 2013. The bill
pending in the House would add employees of small companies,
beginning Jan. 1, 2014.
A third aspect of the pooling concept -- opening the state plan
to municipalities -- is unaffected by the opinion. The state
comptroller's office is marketing the state plan to cities and
towns.
[Please read the rest of this article in the archives at the CT MIRROR website]
Insurance exchange board faces key policy decisions
Arielle
Levin
Becker, CT MIRROR
January 19,
2012
There's
still nearly two years before the major pieces of federal health
reform roll out, but for the planners designing Connecticut's
health insurance exchange, one of the central pieces of the law,
the time line is much tighter.
The exchange
will serve as a marketplace for individuals and small businesses
to buy insurance beginning in 2014, and the board at work
designing it has a number of key decisions to make well before
people start signing up for coverage next year.
Among them:
How will the
exchange, a quasi-public agency expected to employ about three
dozen people, be funded?
Will
insurance plans sold on the exchange be required to cover all
state-mandated benefits, which could leave the state with added
costs?
And in
offering coverage, should the exchange combine the individual and
small group insurance markets, or keep them separate -- a choice
that could have significant ramifications for the costs each group
faces in buying coverage?
Board
members discussed preliminary recommendations on those and other
issues during a meeting at the State Capital Thursday.
[Please read the rest of this article in the archives at the CT MIRROR website]
Health insurance exchange board searching for CEO, quickly
CT
MIRROR
Arielle
Levin Becker
Oct. 11,
2011
Wanted:
Educated, experienced senior-level manager to develop and run a
key piece of health care reform. Must pass muster with the
governor and, preferably, be willing to start work early next
year.
Those are
the basic qualifications to become the first chief executive
officer of the state's health insurance exchange, a marketplace
for individuals and small businesses to buy health insurance that
will launch by 2014. Legislation this year established the
exchange as a quasi-public agency.
The job is
expected to be posted in the next couple days, seeking candidates
with advanced degrees and at least five years of senior-level
management experience. The board that oversees the exchange will
be charged with narrowing down the candidates, first through a
smaller committee of board members that will conduct two rounds of
interviews, and then the full board, which will hold the final
interviews and recommend three candidates to Gov. Dannel P.
Malloy. Malloy will then select the CEO.
The schedule
for picking the CEO is expected to be tight. A timeline for the
search process calls for having the interviews in December and a
CEO in place in February.
[Please read the rest of this article in the archives at the CT MIRROR website]
SustiNet
cabinet
starts work Monday
CT
MIRROR
Arielle
Levin Becker
11
September, 2011
The
SustiNet Health Care Cabinet, an advisory board created as part of
a compromise on the proposed SustiNet state-run health plan, will
hold its first meeting Monday.
The cabinet
will be led by Lt. Gov. Nancy Wyman and includes 16 members
appointed by Gov. Dannel P. Malloy, legislative leaders and the
board that developed the SustiNet proposal. Eleven members of
Malloy's administration are on the cabinet as ex-officio members.
SustiNet was
originally proposed as a state-run health plan that would include
state employees and Medicaid recipients and would be available to
small businesses, nonprofits, municipalities and, eventually,
anyone in the state. That plan did not pass, but a compromise that
became law this year created the cabinet to make health care
policy recommendations, including developing a business plan for
alternatives to private insurance.
The
compromise also allows municipalities and some nonprofits to buy
health insurance through the state, and established an Office of
Health Reform and Innovation to coordinate state and federal
reform efforts.
[Please read the rest of this article in the archives at the CT MIRROR website]
Report: There's
no consensus on what constitutes 'medical homes'
Arielle
Levin
Becker, CT MIRROR
August 16,
2011
The number
of physician practices officially considered "patient centered
medical homes" has grown dramatically in the past six months,
helped along when the state's largest group of primary care
practices earned the designation last week.
The
proliferation mirrors a widespread national push toward the model,
which encourages care coordination and making it easier for
patients to access care. Private insurers are sponsoring pilots to
test the model, and it's being used in state Medicaid programs,
Medicare, and the military's TRICARE health plan, which has a goal
of having 2 million beneficiaries enrolled in medical homes by the
end of the year.
Connecticut
has a medical home pilot program for state employees and retirees,
and is developing plans to encourage health care providers to
serve as medical homes for Medicaid patients. Six months ago, just
21 practices and clinicians in the state had been recognized as
medical homes by the National Committee for Quality Assurance, one
of several accrediting organizations. After the 70 practices of
ProHealth Physicians achieved recognition last week, the number
was up to 412.
But despite
the broad-based support for the concept, there is no broad
agreement on what a medical practice must do to be considered a
medical home, and no solid evidence about what pieces are required
to improve care and reduce costs, a report released this month
warned.
"The medical
home model does have the potential to transform the way health
care is delivered--but potential is the key word here," wrote the
report's authors, Dr. Robert A. Berenson, Kelly J. Devers and
Rachel A. Burton of the Urban Institute. "The danger posed by the
current enthusiasm for the concept is that it could lead to the
adoption of unproven models on a wide scale nationwide before
evaluations of existing pilots can show us what works in what
situations, and what levels of reimbursement are needed to get
providers to engage in all the new activities encompassed by the
medical home model."
[Please read the rest of this article in the archives at the CT MIRROR website]
Connecticut Will Soon Pick A Board To Oversee State Health
Insurance Exchange
Hartford
Courant
By Matthew
Sturdevant
July 15,
2011 4:17 PM
Connecticut
will
soon pick a board and staff members to oversee the development of
a state health insurance exchange, where individuals and small
businesses will be able to compare health plans online or by phone
starting in 2014.
The exchange
is federally mandated as part of healthcare reform and must be
available to consumers by Jan. 1, 2014. U.S. Department of Health
and Human Services offered a framework for developing the
exchanges, which will be a marketplace for health plans first sold
to individuals, and, in later years, to small businesses.
Connecticut
is one of 49 states and Washington D.C. that accepted grants to
plan and develop a state-based health exchange. In September,
Connecticut received a one-year planning grant of $996,848 from
the federal government. The state is applying for $6.6 million to
pay for a second phase of developing the exchange.
"In the past
six months we have taken many critical steps in development of the
exchange and Connecticut is in a good position," said Jeannette
DeJesús, special advisor to Gov. Dannel P. Malloy on federal
healthcare reform. "We have enacted legislation establishing
Connecticut's exchange as a quasi-public agency and have begun
working with multiple stakeholders to address key policy
questions. With the release of these proposed rules, Connecticut
can continue moving steadily forward."
[Please read the rest of this article in the archives at the Hartford COURANT website]
Controversial 'provider tax' being scrutinzed in debt talks
Deirdre
Shesgreen,
CT MIRROR
July 14,
2011
WASHINGTON--One
of
the most contentious elements of Gov. Dannel P. Malloy's
recently-passed budget was a new tax on Connecticut hospitals,
which won legislative approval despite fierce opposition from the
industry. Now, policymakers in Washington may restrict the ability
of states to enact such taxes--and they could even force
Connecticut to scale back or eventually repeal its new levy.
So-called
"provider taxes" are one item under discussion in the
increasingly-fraught debt negotiations between the White House and
congressional Republicans.
Critics say
that states use provider taxes as a "gimmick" to raise revenue for
their share of Medicaid spending--and to generate increased
federal matching funds in the process. And they say it's time to
stop states from "gaming" the system by imposing taxes aimed
mainly at snagging more federal dollars.
States say
the provider taxes are a legitimate way to raise desperately
needed revenue to helps pay for the exploding costs of Medicaid, a
joint state-federal health insurance program for the poor.
Medicaid is often one of the top three ticket items in state
budgets, and the program's rolls have swelled with the recession.
As President
Barack Obama and House and Senate leaders look for ways to trim
federal spending, provider taxes have become a target. The shape
of any final budget-and-debt agreement--if there even is one--is
still murky at best. But the scope of state provider taxes could
still be an issue even if a broader debt deal falls apart.
[Please read the rest of this article in the archives at the CT MIRROR website]
Last-minute windfall pops up in retiree health care
account
Keith
M.
Phaneuf, CT MIRROR
May 27, 2011
It almost sounds too good to be true: State budget
officials, who already saw revenues surge by nearly $400
million over the past month, now say anticipated savings in
retired worker health care costs have grown by some $100
million in the same period.
And though Comptroller Kevin P. Lembo said his office was
somewhat conservative in assessing the account that it
controls, he added that a number of factors made the $117.4
million savings--equal to nearly 20 percent of the entire
annual allocation--difficult to predict before now.
"As soon as you start to see a positive development you
can't just jump up and say, 'We have some extra money here.
What do you want to do with it?'" said Lembo, who inherited
the retiree health care account in mid-fiscal year when he
began his first term as comptroller on Jan. 5. "Since then
I've looked at this on a regular basis, but there were a lot
of factors."
One is that state government converted its health insurance
coverage, both for active and retired workers, to a
self-insured program. Lembo said he believes the previous
legislature and former Gov. M. Jodi Rell's administration
may have underestimated the savings in shifting from paying
private insurance companies to manage the fiscal risk,
particularly involving the older, generally sicker retired
population
Lembo said the reduced spending also results from
higher-than-expected federal cost-sharing for prescription
drug coverage and increased patient use of generic
pharmaceuticals.
But the single-largest and most volatile factor, Lembo said,
simply involves a retiree population that has been healthier
than in most years. A 2009 retirement incentive program that
coaxed 3,800 senior state workers to retire at an earlier
age than they might have otherwise could have contributed to
that.
[Please read the rest of this article in the archives at the CT MIRROR website]
Agencies
welcome chance to join state health plan--at the right price
Arielle
Levin
Becker, CT MIRROR
May 5, 2011
State
leaders are poised to allow nonprofits to buy insurance through
the state employee health plan, and the agency Patrick J. Johnson
Jr. runs is in many ways an ideal candidate.
The agency,
Oak Hill, serves people with disabilities and has faced
double-digit premium hikes in recent years. Its benefits package
is considered high-end for nonprofits, Johnson says, and its
cost--about $7,000 for an individual and $19,000 for family
coverage--is close to the average cost of a state employee plan.
But it won't
be for long.
"We can't
afford to continue what we're doing," Johnson said. "So we're
going to be cutting back."
Many
nonprofit leaders are in a similar position. They have lobbied for
the chance to buy their health insurance through the state
employee and retiree plan, hoping that it would give them another
coverage option. Being part of a larger risk pool could remove the
fluctuations in cost that can occur when even a few employees in a
small pool have major medical problems, they say.
[Please read the rest of this article in the archives at the CT MIRROR website]
Hospitals facing a double hit from
Hartford, Washington
Deirdre Shesgreen
and Arielle Levin Becker, CT MIRROR
April 25, 2011
WASHINGTON--Frank A. Corvino, the CEO of Greenwich Hospital,
is still reeling from the fiscal punch from Hartford, in the
form of a proposed new tax on hospitals across Connecticut.
Now, he's girding for a second hit from Washington, where
federal Medicare officials are fine-tuning a cut to hospital
reimbursement rates.
The two blows, Corvino and other hospital executives say,
would ripple across the health care system and take a toll on
the quality of care.
"The combination of these two... is going to have a
devastating effect on patient care in the state," Corvino
said. "It's going to pierce the safety net that hospitals
provide for their patients."
Even before Gov. Dannel P. Malloy unveiled a budget plan that
included a new levy on hospitals, Connecticut institutions
were focused on a federal proposal to pare back Medicare
payments. The Connecticut Hospital Association and others have
lobbyied against the measure, drafted by the federal Centers
for Medicare and Medicaid (CMS).
But they appear to have lost that battle, at least the first
round. Last week, CMS released a proposal to slice nearly $500
million from its Medicare payments to hospitals across the
country. The Connecticut Hospital Association said it will
file a formal protest against the rule in June. And it's still
subject to public comment, and possibly revision. But
hospitals failed in their efforts to soften a similar cut
imposed at the start of this fiscal year.
[Please read the rest of this article in the archives at the CT MIRROR website]
SustiNet deal reached, but without a 'public option'
Arielle
Levin
Becker, CT MIRROR
April 20,
2011
The Malloy
administration and Democratic legislative leaders have reached an
agreement on the proposed SustiNet state-run health plan, with a
deal that calls for opening the state employee health plan to
municipalities and some nonprofits, but not for offering insurance
to the public.
The
agreement would also establish a "SustiNet cabinet" advisory panel
within the lieutenant governor's office that would be charged with
overseeing health reform efforts in the state, said Ben Barnes,
Gov. Dannel P. Malloy's budget director.
The
agreement does not call for the state to combine the Medicaid and
state employee and retiree health plans into a large pool, as the
current legislative proposal does.
Barnes said
the language for the new proposal is still being developed, with
existing bills and new pieces being combined.
"I doubt
they'll be passed tomorrow, but maybe next week," he said.
The proposed
SustiNet bill, which has drawn passionate support and opposition,
has passed three legislative committees. It calls for combining
state-funded health plans under a quasi-public authority that
would also offer state-run insurance to small businesses,
municipalities, nonprofits and, ultimately, anyone in the state
who wants to buy it.
[Please read the rest of this article in the archives at the CT MIRROR website]
Analysts: SustiNet would cost the state hundreds of
millions per year
Arielle
Levin
Becker, CT MIRROR
April 4,
2011
The proposed
state-run SustiNet health insurance plan could cost the state
hundreds of millions of dollars a year, according to the
legislature's nonpartisan Office of Fiscal Analysis.
The
analysis, released Monday night, offers the first nonpartisan
projection of how SustiNet could affect the state's finances.
Although it does not provide a total dollar figure, the analysis
cites a variety of potential added costs from the proposal, which
calls for reorganizing existing state-funded health plans and
selling state-run insurance to municipalities, small businesses,
nonprofits and, eventually, anyone in the state who wants it.
Previous
assertions about what SustiNet would cost have offered competing
pictures. Supporters have cited estimates that the state could
save more than $224 million a year with SustiNet, although most of
the projected savings were the result of funding from the federal
health reform law and could be achieved with or without SustiNet.
Opponents have argued that SustiNet would likely increase state
spending.
According to
the analysis released Monday, the largest new cost to the
state--between $222.8 million and $478.6 million a year--would
come from offering coverage to low-income adults who earn slightly
too much money to qualify for Medicaid.
Consultants
to the board that developed the SustiNet plan projected that
covering those adults would save the state millions of dollars,
because the state would receive federal funding for it. The Office
of Fiscal Analysis, or OFA, projected that the cost of offering
coverage would exceed the federal funds the state would likely
receive.
The SustiNet
proposal has passed three legislative committees but must still
receive approval from at least three more. It has drawn passionate
support from many people who want a public insurance option for
the state and say SustiNet will make health coverage more
affordable, and passionate opposition from business groups and
insurers who say it is too costly and sends a bad message to the
state's health insurance industry. Gov. Dannel P. Malloy has said
he shares many of the goals of the proposal, but has expressed
concern about several parts of it, including the potential cost.
[Please read the rest of this article in the archives at the CT MIRROR website]
Cardiologists
drop SustiNet support over loss of liability protection
Arielle
Levin
Becker, CT MIRROR
March 22,
2011
A group of
cardiologists and cardiac care associates has pulled its support
for the proposed state-run SustiNet health plan because lawmakers
removed a malpractice liability protection provision from the
bill.
Four other
medical groups previously expressed concern about the move and
warned that they could reconsider their positions on the proposal.
But the Connecticut Chapter of the American College of Cardiology
is the first medical group to withdraw its support.
The group
plans to make its position known in newspaper advertisements this
week that include an open letter to legislators, Gov. Dannel P.
Malloy, and members of the SustiNet board.
In the
letter, the chapter president, Dr. Neal Lippman, and
president-elect, Dr. Gilead Lancaster, said the group was an early
supporter of SustiNet, but that they cannot support it since
lawmakers removed a provision that would have protected health
care providers from liability if they injure a patient covered by
the plan while following clinical care guidelines.
Without the
protection, they wrote, the plan "would result in a dramatic
increase in the cost of healthcare in Connecticut and expose
patients to more tests of limited value" and fail to attract
doctors to participate.
"Without
these protections, we believe that SustiNet will share the fate of
the disastrous Charter Oak insurance plan in which very few
doctors are participating due to its poorly conceived support for
quality medical providers," the doctors wrote, referring to a
program created in 2008 to provide coverage for uninsured
residents.
[Please read the rest of this article in the archives at the CT MIRROR website]
Despite Malloy's
support, expansion of medical homes faces obstacles
Arielle
Levin
Becker, CT MIRROR
February 17,
2011
Dr. Cliff
O'Callahan's practice submitted an application last week to become
officially recognized as a patient-centered medical home and, in
the process, became critical to Gov. Dannel P. Malloy's
administration's goals for providing health care to more than
500,000 state residents.
As part of an
overhaul of state Medicaid programs, the administration plans to
aggressively expand the use of patient-centered medical homes, an
increasingly popular model for delivering care that is still
relatively rare in practice.
Patient
advocates have long urged the state to embrace the model, which
calls for having health care providers coordinate patients' care.
Some were heartened by Malloy's campaign pledge to expand a small
Medicaid pilot program that pays providers for care coordination.
Details have
not been fleshed out, but the administration has indicated that it
wants to go even further, encouraging providers in Medicaid to
become fully recognized patient-centered medical homes--the
designation O'Callahan's practice is seeking. So far, only four
medical practices in the state have achieved it.
The goal of
expanding medical homes to all Medicaid programs, which serve more
than 500,000 people, puts the state in line with physician groups,
private insurers and the federal government in promoting a model
that some studies say can improve care while reducing costs.
But it is
expected to be a gradual process.
[Please read the rest of this article in the archives at the CT MIRROR website]
Hospitals v. Insurance Companies?
New rankings add complexity to health care choices
Arielle
Levin
Becker, CT MIRROR
February 2,
2011
Patients
used to navigating the differences between in-network and
out-of-network providers might soon learn another distinction:
tier one and tier two.
A new Aetna
program divides hospitals in the insurer's network into tiers
based on cost and requires patients to pay significantly higher
out-of-pocket charges if they go to those deemed less affordable.
A woman who gives birth at the "tier one" John Dempsey Hospital,
for example, might pay 10 percent coinsurance under the plan. But
if she had her baby at MidState Medical Center, a "tier two"
hospital, she might pay closer to 35 percent of the total bill.
The program,
"Choose and Save," is small so far, with only a handful of
employers, including Aetna, using it for their workers. But it is
part of a larger push toward making patients more active in
controlling medical costs. And in rating hospitals, the program
represents something that even critics say is likely to become
more common as employers and insurers seek ways to stem the growth
of health care costs.
[Please read the rest of this article in the archives at the CT MIRROR website]
Insurance
industry says no to repeal of health care reform, but reticent
on details
Deirdre
Shesgreen, CT MIRROR
January 10,
2011
WASHINGTON--As
House
Republicans make their first run at the health care reform law,
Democrats say the GOP is doing the bidding of big insurance.
"Why are
they engaged in this effort?" asked Rep. Rosa DeLauro, D-3rd
District. "Because, quite frankly, I believe it's what the
insurance companies want."
It just
ain't so, comes the response from Hartford, where insurance giants
such as CIGNA, Aetna, and UnitedHealthcare all have major
corporate offices.
"Our focus
remains on implementing the law and the various provisions that
just recently took effect, from extended dependent coverage to
enhance preventive care and tax credits for small businesses,"
said Daryl Richard, a spokesman for UnitedHealthcare.
The true
role of Connecticut's big insurance firms, and other industry
players across the country, remains to be seen. But there's little
question they have much at stake as this new twist in the debate
over health reform gets underway.
The House
proposal to repeal the health care law is almost certain to pass,
but it will likely die in the Senate. (The House vote was
originally set for this week, but it has been delayed in light of
the Arizona shootings that targeted, among others, a Democratic
congresswoman from that state.)
If full
repeal fails, Republican opponents have promised a fresh
offensive, going after the law in bits and pieces.
[Please read the rest of this article in the archives at the CT MIRROR website]
Malloy taps
hospital association executive to take the lead on health reform
Arielle
Levin Becker, CT MIRROR
January 4,
2011
Gov.-elect
Dan Malloy has appointed a Connecticut Hospital Association
executive and former head of the Hispanic Health Council to lead
state efforts to implement federal health care reform.
As a deputy
health commissioner and special advisor to Malloy, Jeanette
DeJesús will oversee a wide range of efforts intended to prepare
the state for an expansion of health care coverage. Although the
Patient Protection and Affordable Care Act does not fully roll out
until 2014, it leaves considerable responsibility to the states.
By 2014,
each state must have a health insurance exchange, a marketplace
for purchasing coverage that will also be charged with collecting
data, reporting to the federal government, certifying and rating
insurance plans, and tracking which employers do not offer
insurance to their workers. By 2015, the exchanges must be
financially self-sustaining.
In addition,
states must prepare to ramp up their Medicaid eligibility by 2014.
Connecticut is projected to have 114,000 new Medicaid enrollees,
which will likely require additional staff to process
applications.
DeJesús will
succeed Cristine Vogel, who led health reform implementation
efforts as a special advisor to Gov. M. Jodi Rell. Vogel has also
led a Health Care Reform Cabinet, which includes the commissioners
of 11 agencies.
[Please read the rest of this article in the archives at the CT MIRROR website]
Public weighs in
on SustiNet plan
Arielle
Levin
Becker, CT MIRROR
December 7,
2010
Members of
the public got their chance to weigh in on the SustiNet plan this
week, and their questions and comments offered a hint at what
could lie ahead as policymakers attempt to create a public health
insurance plan for the state.
Many of
those who spoke at presentations in New Haven and Hartford
identified themselves as supporters of the concept, the details of
which are still being hashed out by a board. Some with a
particular interest in the shape of the plan, including a
chiropractor and an optometrist, wondered how it would affect
their fields.
There were
questions about how an expanded state insurance program could be
done in the midst of a massive state budget deficit and whether a
public insurance option would threaten the business of private
health insurers. And some speakers raised concerns or reservations
about what the process would ultimately produce.
The SustiNet
board is expected to make recommendations early next year to the
legislature, which must approve any plan. The board will likely
vote on the recommendations Dec. 15.
[Please read the rest of this article in the archives at the CT MIRROR website]
Who will lead
state's health care reform?
Arielle
Levin
Becker, CT MIRROR
November 12,
2010
Grappling
with a $3.3 billion budget deficit and a bad economy might
dominate the work of Governor-elect Dan Malloy's administration,
but his staff's to-do list will also include implementing federal
health care reform, a law that gives considerable
responsibility--and work--to the states.
Connecticut
is one of many states expected have a change in leadership in
handling the health care law. Twenty-six states are changing
governors, and many, like Connecticut, have a political appointee
in charge of the implementation effort.
The Patient
Protection and Affordable Care Act won't be fully rolled out until
2014, and it could still be revised if Republicans in Congress get
their way. But some provisions require planning now, including
building the health insurance exchange, a marketplace for
purchasing coverage that must be operational by Jan. 1, 2014.
Connecticut's
lead
in implementing health reform, Cristine Vogel, serves as a special
adviser to Gov. M. Jodi Rell and expects to leave the job sometime
before Malloy takes office. Vogel also heads the state's Health
Care Reform Cabinet, which includes the commissioners of 11
agencies.
The
Department of Social Services, which is already facing a surge of
new Medicaid enrollees because of the economy and new eligibility
rules, will need to prepare for a projected 114,000 or more new
Medicaid clients under health reform. The department is certain to
get a new leader: Commissioner Michael Starkowski is already
retired and has been leading the department on a contract basis.
The
Connecticut Insurance Department, which will have more
responsibilities as insurers face more data reporting
requirements, also will get new leadership. Commissioner Thomas
Sullivan, who came under fire after approving double-digit rate
hikes for some individual-market health insurance plans, is
leaving the job after this week.
[Please read the rest of this article in the archives at the CT MIRROR website]
Health reform
reshaping medical practice
Deirdre
Shesgreen,
CT MIRROR
October 20,
2010
WASHINGTON-
Patients who suffer from heart failure are getting a radical new
treatment at Hartford Hospital aimed at significantly reducing
their chances of readmission. It's doesn't
involve new medications or a cutting-edge diagnostic. In some
ways, it's a lot more complicated-entailing a more integrated way
of practicing medicine that is being ushered in, in part, by the
health care reform law.
Hartford
Hospital's new program for heart failure patients, which relies on
intensive post-discharge follow-up, is one element of a larger
effort to retool that institution and its affiliates into an
"accountable care organization", or ACO. Some experts see
ACOs as the linchpin of health reform-a way to bring down
spiraling health costs while also improving the quality of care.
But others are skeptical of their potential, and worry that
Connecticut providers, in particular, will face unique
difficulties in implementing this piece of health reform.
Under the
health overhaul, ACOs are defined as a network of physicians,
working across specialties and even at different institutions, who
team up to provide a highly integrated continuum of care for their
patients. If an ACO delivers quality care at reduced costs, its
members will be able to share in any financial savings.
"What we're
talking about is a complete and total re-engineering of care,"
said Amanda Forster, of Premier Inc., an alliance of hospitals and
other providers that works on improving quality. Premier is
helping Hartford Hospital and others prepare for the new ACO era.
Right now,
hospitals and doctors are paid for every service they provide. So
each surgical procedure, each test, each patient appointment
translates into a reimbursement, whether from an insurance company
or the government's Medicare or Medicaid programs. This
fee-for-service system provides "a perverse incentive," Forster
says, because there are no rewards for keeping a patient healthy
or for successfully managing a disease with minimal complications.
[Please read the rest of this article in the archives at the CT MIRROR website]
State struggles
to implement health care reform
Deirdre
Shesgreen,
CT MIRROR
August 13,
2010
Huge.
Complex. Difficult.
These are
just a few of the adjectives Cristine Vogel throws out as she
tries to describe her new job: special adviser to Gov. M. Jodi
Rell for health care reform.
At the end
of July, Rell tapped Vogel to oversee implementation of the
sweeping Patient Protection and Affordable Care Act, which
President Barack Obama signed into law last March. A 25-year
health care veteran, Vogel started on July 23, and she already
feels way behind. Not to mention short-staffed and under-funded.
But that's
actually an improvement from a few weeks ago, when Vogel was still
deputy commissioner for Connecticut's Office of Health Care
Access, helping to oversee implementation of the massive reform
law on top of her day job.
"We've just
been putting out fires for the last few months on health care
reform, so I'm looking forward to actually doing it in some
coordinated, cohesive manner," Vogel said in an interview last
week, as she was scrambling to meet the latest grant deadline from
the federal Department of Health and Human Services (HHS). "A
little more predictable and planned out would be nice."
[Please read the rest of this article in the archives at the CT MIRROR website]
Where the League stands on
this...
SustiNet board outlines 'public option' for health coverage
in Connecticut
Jacqueline
Rabe,
CT MIRROR
May 27, 2010
A plan for a
public health care option in Connecticut - dubbed SustiNet - was
released today in response to the new federal health care law.
"It's an
outline of what we are looking at," said state Comptroller Nancy
Wyman, also the co-chairwoman of the SustiNet Health Partnership
Board that released the report. "We are ahead of most states. We
have a plan that fits perfectly with the federal law. It’s
amazing. We really are in good shape to go forward with the public
option.”
Final draft
legislation with detailed recommendations for implementing
SustiNet will be made by the end of the year so the new General
Assembly and governor can consider the package in 2011.
Kevin Lembo,
co-chair of the SustiNet board and the state healthcare advocate,
has said this plan, if adopted, would go above and beyond the
federal reform.
"They set
this new federal floor. Some states will chose to do nothing
additional, but Connecticut I am confident will go above that,"
Lembo said two days after the federal law was signed in March by
President Barack Obama.
[Please read the rest of this article in the archives at the CT MIRROR website]
SPEAKERS AT FALL CONFERENCE 2009, "HEALTH
CARE IN CONNECTICUT: WHAT'S NEXT?"
1. Hon. Nancy Wyman,
Connecticut State Comptroller, who provided valuable
information on SustiNet (Wikipedia
information on Sustinet), of which she is Co-Chair.
2. Ms. Carolyn
Salsgiver, Senior Vice President for Planning &
Marketing, Bridgeport Hospital, who gave a most thoughtful and
informative talk (and a creative thought-sharing process
during Q&A);
3.. Elizabeth Rosenthal, MD (Physicians
for a National Health Plan) roused the audience with her inspiring
presentation from the perspective of a practicing
physician.
Moderator Kay Maxwell kept
things moving, the audience had terrific queries!
President of the LWVCT
Jara Burnett pointed out that unfortunately the planned
insurance industry representative was unable to attend the
event, and thus the balance on the panel was askew;
this resulted in a less comprehensive set of viewpoints
than League would ordinarily provide, and thus she urged
those present to be sure to find out about other views.
For background regarding
why and how the League has studied Health Care, please click
here.
TOP: Gray Hall, site of the Conference;
CENTER: Hon. Nancy Wyman, Comptroller, State of
Connecticut; Lyn Salsgiver, Senior Vice President,
Planning and Marketing, Bridgeport Hospital;
Elizabeth Rosenthal, MD, Physicians for a National Health
Plan. BOTTOM: President of the LWVCT Jara
Burnett; Kay Maxwell, moderator.
W A T C H T H I
S I M P O R T A N T D I S C
U S S I O N N O W ! ! !
LWVCT FALL
CONFERENCE DECEMBER 5, 2009 VIDEO NOW ONLINE HERE:
Health
Care: The League’s History
In 1990, the
LWVUS undertook a two-year study of the funding and delivery of
health care in the United States. Phase 1 studied the delivery and
policy goals of the U.S. health care system; Phase 2 focused on
health care financing and administration. The LWVUS announced its
initial health care position in April 1992 and the final position
in April 1993.
The health
care position outlines the goals the LWVUS believes are
fundamental for U.S. health care policy. These include policies
that promote access to a basic level of quality care at an
affordable cost for all U.S. residents and strong cost-control
mechanisms to ensure the efficient and economical delivery of
care. The Meeting Basic Human Needs position also addresses access
to health care.
The health
care position enumerates services League members believe are of
highest priority for a basic level of quality care: the prevention
of disease, health promotion and education, primary care
(including prenatal and reproductive health care), acute care,
long-term care and mental health care. Dental, vision and hearing
care are recognized as important services but of lower priority
when measured against the added cost involved. Comments from
numerous state and local Leagues, however, emphasized that these
services are essential for children.
To achieve
more equitable distribution of services, the League endorses
increasing the availability of resources in medically underserved
areas, training providers in needed fields of care, standardizing
the services provided under publicly funded health care programs
and insurance reforms.
The LWVUS
health care position includes support for strong mechanisms to
contain rising health care costs. Particular methods to promote
the efficient and economical delivery of care in the United States
include regional planning for the allocation of resources,
reducing administrative costs, reforming the malpractice system,
copayments and deductibles, and managed care. In accordance with
the position’s call for health care at an affordable cost,
copayments and deductibles are acceptable cost containment
mechanisms only if they are based on an individual’s ability to
pay. In addition, cost containment mechanisms should not interfere
with the delivery of quality health care.
The position
calls for a national health insurance plan financed through
general taxes, commonly known as the “single-payer” approach. The
position also supports an employer-based system that provides
universal access to health care as an important step toward a
national health insurance plan. The League opposes a strictly
private market-based model of financing the health care system.
With regard to administration of the U.S. health care system, the
League supports a combination of private and public sectors or a
combination of federal, state and/or regional agencies. The League
supports a general income tax increase to finance national health
care reform.
The LWVUS
strongly believes that should the allocation of resources become
necessary to reform the U.S. health care system, the ability of a
patient to pay for services should not be a consideration. In
determining how health care resources should be allocated, the
League emphasizes the consideration of the following factors,
taken together: the urgency of the medical condition, the life
expectancy of the patient, the expected outcome of the treatment,
the cost of the procedure, the duration of care, the quality of
life of the patient after the treatment, and the wishes of the
patient and the family.
As the LWVUS
was completing Phase 2 of the study, the issue of health care
reform was rising to the top of the country’s legislative agenda.
In April 1993, as soon as the study results were announced, the
LWVUS met with White House Health Care officials to present the
results of the League’s position. Since then, the League has
actively participated in the health care debate.
The LWVUS
testified in fall 1993 before the House Ways and Means
Subcommittee on Health, the Energy and Commerce Committee and the
Education and Labor Committee, calling for comprehensive health
care reform based on the League position. The League joined two
coalitions—one comprised of consumer, business, labor, provider
and senior groups working for comprehensive health care reform,
and the other comprised of groups supporting the single-payer
approach to health care reform.
Throughout
1994, the League actively lobbied in support of comprehensive
reform, including universal coverage, cost containment,
single-payer or employer mandate and a strong benefits package.
The League continued to advocate for the inclusion of the state
single-payer option in any health care package and emphasized
LWVUS support for the inclusion of reproductive health care,
including abortion, in any health benefits package. League leaders
participated in countless lobbying visits in Washington, held
grassroots meetings with members of Congress and spoke out in the
media.
Health care
reform advocates, including the League, continued to press for
comprehensive health care reform through September 1994. But
congressional sponsors were unable to reach accord, and
comprehensive reform was declared dead for the 104th Congress. The
focus then shifted to the states, where Leagues have worked in
support of health care reform, while fighting off attempts to cut
back on existing health care.
The LWVEF
initiated community education efforts on health care issues with
the “Understanding Health Care Policy Project” in the early 1990s.
The project provided training and resources for Leagues to conduct
broad-based community outreach and education on health care policy
issues with the goal of expanding community participation in the
debate.
In spring
1994, the LWVEF and the Kaiser Family Foundation undertook a major
citizen education effort, “Citizen’s Voice for Citizen’s Choice: A
Campaign for a Public Voice on Health Care Reform.” The project
delivered objective information on health care reform to millions
of Americans across the country. Local and state Leagues sponsored
more than 60 town meetings in major media markets nationwide,
involving members of Congress and other leading policy makers and
analysts in health care discussions with citizens. In September
1994, the LWVEF and the Kaiser Family Foundation held a National
Satellite Town Meeting on Health Care Reform, with more than 200
downlink sites across the country. The two organizations also
undertook a major television advertising effort to promote public
participation in the health care debate.
In 1997, the
LWVUS joined 100 national, state and local organizations in
successfully urging Congress to pass strong bipartisan child
health care legislation. In 1998, the LWVUS began working for a
Patients’ Bill of Rights, aimed at giving Americans participating
in managed care health plans greater access to specialists without
going through a gatekeeper, the right to emergency room care using
the “reasonably prudent person” standard, a speedy appeals process
when there is a dispute with insurers and other rights.
Also in
1998, the LWVEF again partnered with the Kaiser Family Foundation
and state and local Leagues on a citizen education project, this
time focused on Medicare reform, patients’ bill of rights and
other health care issues. In the first phase of the project, more
than 6,500 citizens participated in focus groups, community
dialogues and public meetings. Their views were reflected in How
Americans Talk About Medicare Reform: The Public Voice, presented
to the National Bipartisan Commission on the Future of Medicare in
March 1999. The report emphasized that people value Medicare but
recognize its flaws. Fairness, responsibility, efficiency and
access were identified as important values for any reforms of the
Medicare system.
In spring
2000, the LWVEF and KFF developed and distributed two guides, Join
the Debate: Your Guide to Health Issues in the 2000 Election and A
Leader’s Handbook for Holding Community Dialogues. The project
focused on five issues under debate in the election: the
uninsured, managed care and patients’ rights, Medicare reform,
prescription drug coverage and long-term care.
Throughout
the 106th Congress, the LWVUS lobbied in support of a strong
Patients’ Bill of Rights. In July 1999, the Senate passed a
watered-down version of patients’ rights legislation opposed by
the League. In October, the House passed a strong, bipartisan bill
that guaranteed basic health care protections supported by the
League. Despite several close votes in 2000, however, Senate
opponents continued to block passage of real patient protection
legislation. At Convention 2000, League delegates lobbied their
members of Congress to pass a strong, comprehensive Patients’ Bill
of Rights and send it to the President.
The League’s
efforts in support of passage of real patient protection
legislation continued throughout the 107th Congress. Delegates to
Convention 2000 met with their Representatives and Senators in
support of the Patients’ Bill of Rights, but the legislation was
essentially shelved as Election 2000 drew near.
The LWVUS
lobbied federal lawmakers in support of the Bipartisan Patient
Protection Act of 2001, legislation that would provide patients
with administrative and legal recourse in dealing with insurers
and Health Maintenance Organizations (HMOs). Despite action in
both the House and Senate and pressure from the LWVUS and other
health care advocates, the legislation died in the conference
committee that should have resolved the differences between the
two bills.
In the 108th
Congress, the League lobbied Congress in support of the Health
Care Access Resolution, which expressed congressional intent to
begin the debate on how to provide health care access to all. In
November 2003, the League opposed the Medicare Prescription Drug
bill that was signed into law by the President because its
particular provisions undermined universal coverage in Medicare.
In May 2006,
the League urged Senators to oppose the Health Insurance
Marketplace Modernization and Affordability Act (HIMMA). While
this proposal purported to expand healthcare coverage, it in fact
limits critical consumer protections provided in many states.
In 2007 and
2008, the League supported reauthorization of the State Children’s
Health Insurance Program (SCHIP) which provided health care
coverage to six million low-income children in 2007. This support
also included encouraging Senators and Representatives to fully
fund the program. The legislation passed the House and Senate, but
was vetoed by President Bush
