Source: Colin Gordon, Jacobin, July 25, 2017
In order to win universal health care, we have to understand what — and who — we’re up against. ….
….In health care, private providers and private financing mechanisms were well ensconced long before any meaningful public intervention. The stakes are very high and, historically, a diverse array of private health interests have spent lavishly on political campaigns, and haunted congressional hearings and anterooms. But what has shaped health policy, and stymied reform for the last century, is not so much the combined clout of private interests as it is the tangle of compromise and competition that’s emerged from the scrum as they jockey for influence over policy, for advantage over each other, and for unfettered access to public spending.
Over the last century, the terms of that corporate compromise have been altered through changes in medical care, and changes in the ways medical care is sold, underwritten, packaged, subsidized, regulated, and consumed. The influence of private interests has persisted but, from the first consideration of “health security” in the Progressive Era to the tortuous repeal of the Affordable Care Act over the last few months, which interests have weighed in — or prevailed — has shifted.
Tracing those shifts (sometimes subtle, sometimes profound) is important not just to our understanding of the history, but also to our efforts to win a more just health system…..
Source: Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian Bruen, Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, July 2017
From the abstract:
Issue: A draft Better Care Reconciliation Act (BCRA) has been introduced in the U.S. Senate as an alternative to the American Health Care Act (AHCA), which was passed by the House of Representatives on May 4, 2017. The Congressional Budget Office estimates the BCRA would raise the number of uninsured by 22 million by 2026.
Goal: To determine the consequences of the draft BCRA on employment and economic activity in every state. This report updates an earlier analysis of the effects of the AHCA.
Methods: We compute changes in federal spending and revenue from 2018 to 2026 for each state and use the PI+ model to project the effects on states’ employment and economies.
Findings and Conclusions: While the draft BCRA and the AHCA would have similar effects on the number of uninsured Americans, the BCRA would lead to significantly larger job losses and deeper reductions in states’ economies by 2026. A brief spurt in employment would add 753,000 more jobs in 2018, but employment would then deteriorate sharply. By 2026, 1.45 million fewer jobs would exist, compared to levels under the current law. Every state except Hawaii would have fewer jobs and a weaker economy. Employment in health care would be especially hard hit with 919,000 fewer health jobs, but other employment sectors lose jobs too. Gross state products would be $162 billion lower in 2026. States that expanded Medicaid would be especially hard hit.
Source: LeadingAge and Community Catalyst – Center for Consumer Engagement in Health Innovation, June 2017
The American Health Care Act (AHCA) – passed by House Republicans in May, and currently under consideration in the Senate – would dramatically change Medicaid’s financing structure. Currently, Medicaid operates as a federal-state partnership where each pays a percentage of Medicaid’s costs and federal financial support increases with need. Under the per capita cap system proposed in the AHCA, the federal government would provide states with an aggregate amount of funding based on the number and category of eligible beneficiaries in the state, with nominal differences in the amount per beneficiary category. The proposed per capita cap system would adjust for overall population growth, but would not account for other relevant factors affecting Medicaid expenditures, such as changes in health care needs or costs. The Congressional Budget Office estimates that this change in the financing structure along with other changes proposed in the AHCA would cut $834 billion from the Medicaid program. States would likely have to account for the decreased funding by cutting benefits, cutting payments to providers, changing eligibility requirements, and/or adding to program waiting lists.
A per capita cap system would have serious implications for people receiving long-term services and supports (LTSS) – including millions of older adults with functional and cognitive impairments. LTSS include a range of typically non-medical services designed to help individuals perform activities of daily living such as bathing, dressing and eating. Medicaid is the primary payer for LTSS so reductions in Medicaid funds would have serious consequences for people receiving LTSS.
States provide LTSS both in the community and in institutional settings. Per capita caps would cause a shift away from home and community based services (HCBS) toward institutional care such as nursing homes. This is because providing LTSS services through HCBS is optional under Medicaid rules while institutional care is mandatory. HCBS varies by state but generally includes home health services and other services such as adult day care.
This brief provides information on some of the factors that would affect states’ abilities to provide LTSS in a per capita cap system. Additionally, we look at a portion of the labor force that provides LTSS – home health aides and personal care aides specifically – and predict that across the United States, between 305,000 and 713,000 home health aides and personal care aides would lose their jobs if the proposed per capita cap system in the AHCA were to be implemented.
Source: JB Silvers, The Conversation, July 12, 2017
…. The latest development has been the inability of Republicans to even agree on their own proposal and, worse yet, what should come next if it fails. Should they repeal the Affordable Care Act and worry about a replacement later or just try to “fix” the ACA now?
But the problem is much deeper than just a policy fix. As a former health insurance CEO and professor of health finance, it seems clear to me that Republicans are making five key implicit assumptions that are inherently problematic:
1. If it’s your own money, you’ll be more careful in how you’ll spend it. ….
2. Many or most poor people (Medicaid recipients) can work and should contribute to pay for insurance. ….
3. Government restrictions are holding back insurers from competition that would drive costs lower. ….
4. Physicians should be the only ones making care decisions (with the consent of their patients) since they know best. ….
5. Government should help people – but not too much. ….
Source: Allen Dobson, Joan DaVanzo, Randy Haught, Commonwealth Fund, June 2017
From the abstract:
Issue: Safety-net hospitals play a vital role in our health care system, delivering significant care to Medicaid, uninsured, and other vulnerable patients. The American Health Care Act (AHCA) would make changes to Medicaid that would substantially reduce federal funding, resulting in potential adverse effects on safety-net hospitals and the populations they serve.
Goal: Examine how the AHCA Medicaid provisions, which the Congressional Budget Office estimates will reduce federal Medicaid spending by $834 billion over 10 years, will affect the financial status of safety-net hospitals.
Methods: The Dobson | DaVanzo Hospital Finance Simulation Model uses Medicare Hospital Cost Report data for 2015 and assumptions regarding how states will respond to the AHCA Medicaid provisions to estimate the financial impact on safety-net hospitals.
Key Findings: Beginning in 2020 the financial status of safety-net hospitals will deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. By 2026 total margins will drop to 0.5 percent compared with estimates under current law of 2.9 percent—representing an 83 percent reduction in net income for safety-net hospitals. Small rural safety-net hospitals and safety-net hospitals treating the largest proportion of low-income patients would be hurt the most.
Source: Emily Gee, Center for American Progress, June 27, 2017
….The Center for American Progress has estimated how many Americans would lose coverage by state and congressional district based on the CBO’s projections. By 2026, on average, about 50,500 fewer people will have coverage in each congressional district. Table 1 provides estimates by state, and a spreadsheet of estimates by state and district can be downloaded at the end of this column…..
H.R. 1628, Better Care Reconciliation Act of 2017
Source: Congressional Budget Office, Cost Estimate, no. 52849, June 26, 2017
From the summary:
CBO and JCT estimate that enacting the Better Care Reconciliation Act of 2017 would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law.
Source: Simon Haeder, The Conversation, June 7, 2017
Despite many assertions to the contrary, Senate leaders are now saying they want to vote on the replacement bill for Obamacare before the month is out. Front and center is the planned transformation of America’s Medicaid program, which covers 20 percent of Americans and provides the backbone of America’s health care system. …. To understand how the ACHA’s proposed changes to Medicaid would affect people and our health care system, let’s look more closely at the program….
Source: Matt Bruenig, Jacobin, June 2, 2017
Don’t believe the critics: a new report shows California’s single-payer plan is eminently affordable.
Economic Analysis of the Healthy California Single-Payer Health Care Proposal (SB-562)
Source: Robert Pollin, James Heintz, Andrew Glyn, Peter Arno, Jeannette Wicks-Lim, University of Massachusetts-Amherst, Political Economy Research Institute (PERI), May 2017
SB 562 (Lara) – The Healthy California Act (pdf)
Source: State of California, Senate Comittee on Appropiations, Senate 2017-2018 Regular Session, Version: April 17, 2017
Source: Richie Bernardo, WalletHub, March 20, 2017
…According to estimates by the nonpartisan Congressional Budget Office, the recently proposed American Health Care Act — unofficially going by the names “Trumpcare” and “Ryancare” — would raise the average health-insurance premium for an individual policyholder by 15 to 20 percent just one or two years from now and lower federal subsidies. In contrast, the CBO projected, average Obamacare premiums would decrease 10 percent by 2026.
In order to gauge the AHCA’s impact on people who buy their own insurance, WalletHub’s analysts compared the differences in premium subsidies that the average households in 457 U.S. cities would receive under Obamacare and Trumpcare. Read on for our findings, commentary from a panel of experts and a full description of our methodology….
Source: Congressional Budget Office, Cost Estimate, publication no. 52486, March 13, 2017
From the summary:
CBO and JCT estimate that enacting the American Health Care Act would reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.