While Mexico's reformers admit there is still work to be done, the country as a whole has just crossed the goal line of offering universal health care. Like health care reform in the US, many Mexicans were skeptical that such a plan could work and many special interests stood in the way of change. But after eight years of negotiations, government officials were able to implement a new payment system that ended incentives to provide as many services as possible and a new focus on preventative medicine will help avert illness and its high treatment costs.
A new survey of 1,300 LGBT Coloradans finds that the community faces substantial challenges in obtaining access to affordable and timely health care as compared to their heterosexual counterparts. For instance, LGBT respondents “were more likely to report factors that have been associated with poor health outcomes due to workplace and societal discrimination, family and social rejection, and minority stress” and had a harder time finding LGBT-friendly providers or revealing their sexual orientation or gender identity to their provides. “Transgender/gender non-conforming Coloradans endure even greater challenges to accessing, affording, and receiving quality mental and physical health care when compared to transgender people nationwide,” the report concluded.
Here are the results in five graphs.
Read the full report here.
Can you help share it so that it’s no longer a secret?
Found on Facebook. Originally submitted by Jayne C.
I really am beginning to think that the only possible way the Obama administration will stop chasing independent votes by capitulating to Republicans and letting them screw everything up is to call... Supernanny! Because allowing states to simply shred medical benefits the way they do with Medicaid is not going to inspire people to go out and vote for the president again, and I can't believe they don't see that:
WASHINGTON — In a major surprise on the politically charged new health care law, the Obama administration said Friday that it would not define a single uniform set of “essential health benefits” that must be provided by insurers for tens of millions of Americans. Instead, it will allow each state to specify the benefits within broad categories.
The move would allow significant variations in benefits from state to state, much like the current differences in state Medicaid programs and the Children’s Health Insurance Program.
"Differences"? I think they mean "deficiencies."
By giving states the discretion to specify essential benefits, the Obama administration sought to deflect one of the most powerful arguments made by Republican critics of President Obama’s health care overhaul — that it was imposing a rigid, bureaucrat-controlled health system on Americans and threatening the quality of care. Opponents say that the federal government is forcing a one-size-fits-all standard for health insurance and usurping state authority to regulate the industry.
This criticism has inspired legal challenges to the new law — with the Supreme Court set to decide next year whether the government can require Americans to buy health insurance — and helps explain why public opinion of the law remains deeply divided.
The law is looming as a central issue in the 2012 presidential race, with Republican presidential candidates being evaluated on the strength of their opposition to it. The announcement by the administration follows its decision this year to jettison a program created in the law to provide long-term care insurance, a move that disappointed liberal backers of the program championed by the late Senator Edward M. Kennedy.
The action Friday prompted questions among supporters of the new health care law. Prof. Timothy S. Jost, an expert on health law at Washington and Lee University, said, “The new bulletin perpetuates uncertainty about what benefits an insurer will be required to cover under the Affordable Care Act.” From the consumer’s point of view, Professor Jost added, “I wish the Department of Health and Human Services had signaled that there would be more uniformity and less flexibility.”
Chris Jacobs, a health policy analyst for Senate Republicans, said the new policy “gives states the flexibility to impose more benefit mandates, not fewer,” and would lead to higher insurance premiums, contrary to what Mr. Obama promised in the 2008 campaign.
See? No matter what he does, the Republicans find a way to criticize it. Why try to get their approval?
I read Nicole's post last week about Spike Dolomite Ward, a former Obama supporter who'd been very critical of the president. She's a true believer once again because she was recently diagnosed with breast cancer, and found out she was eligible for the preexisting condition insurance under the Affordable Care Act.
This really rubbed me the wrong way.
I, too, frequently criticize President Obama's policies. And the mere fact that I will use that same preexisting condition plan to get the surgery I desperately need doesn't do a damned thing to help all the other people who aren't eligible, or who can't afford it. (By the way, there's a $1000 co-pay, which is a hardship. I couldn't afford it at all if not for a tiny nest egg left to me by my mother - one I was holding onto in case of car repairs or other emergencies. When that runs out, it's back to the land of the uninsured, and I will still owe $22,000 from my earlier hospital stay.)
Ward sounds like a nice middle-class lady, one who can afford to make a small monthly payment, even if it's a stretch. I, on the other hand, know far too many people my age who are now members of the long-term unemployed, people hanging by a suicide thread. For various reasons, they're not eligible for programs like Medicaid - but there's no way in hell they can afford a monthly premium.
Good for Ms. Ward that she can afford it. But her story annoyed me because it sounds like her disillusion with Obama's policies (and her subsequent reconversion experience after she got finally the help she needed) was rooted only in her own middle class experience. You know, as if it's now perfectly okay as long as it's "only" happening to other people. That bugs me.
Don't get me wrong: The preexisting condition option is an absolute lifesaver for those who can afford it. It's subsidized by the federal government to keep premiums low (mine will run slightly under $300 a month, as opposed to the $600+ a month I paid into COBRA while I was still collecting unemployment). The original version required you to prove you'd been turned down by an insurer, or to show documentation that the premium was so high, you couldn't afford it. When the enrollment numbers turned out to be rather low, they loosened those stricter requirements. (In Pennsylvania, I only had to list which pre-existing conditions I had.)
You still have to have been uninsured for at least six months to be eligible.
The numbers are still low, and the original reason I wanted to write about this was to urge readers to look into their own state's program. (Some are run by the state, others by the feds. Ask Mr. Google how to apply where you live.)
As some of you already know, I've been suffering with gall bladder disease since July, and last month was also diagnosed with a nasty case of diverticulitis. The latter was treated with major-league antibiotics and a liquid diet; the former hasn't been treated because, well, I don't have insurance.
It hasn't been fun, these late-night cab rides to the ER. (911 takes me to the local Medicaid mill, which misdiagnosed me the first time around. I'm not going back for more.) Rolling around on the floor for hours because you're in excruciating pain is never fun; knowing a simple outpatient surgery could fix the whole thing is just plain infuriating.
No, the hospital doesn't have to perform surgery - unless your condition is life-threatening.
Hospitals have a weird subset of the definition. There's "life threatening" as in "we're going to fix it even if you don't have the money" kind of life threatening (the kind I don't have - yet), and then there's "life threatening" as in the GI specialist frowning, patting your hand (never a good sign) and saying, "Your attacks are accelerating, you really need to take care of this now, this is a life-threatening condition. If anything changes or it gets worse, you must go to the ER."
You know, as if I'm stubbornly refusing to get the surgery because I don't take it seriously enough.
Having an inflamed gall bladder is like having an inflamed appendix. If it ruptures, the infection can kill you. I know that. So when I found out about this plan, I was just plain thrilled. Not so thrilled when they told me if accepted, it wouldn't start until Feb. 1st. I called my local (Republican) state representative's office and talked to the constituent services lady, who'd never heard of the program but promised to see if it could be expedited. I wasn't hopeful, but the next day she called me back with a contact number. I spoke to the caseworker, who got my start date moved up to January instead.
When I hung up, I sat there and cried tears of relief.
Now all I have to do is wait. Wait for the official acceptance letter (hoping there's no screw-up in the paperwork), and wait for Christmas to be over, because I can't go to any Christmas parties this year. I might eat something that sends me back to the ER, and I don't want to risk it. (Although if any of you want to send me Christmas cookies in January, I could always celebrate later.)
If everything works out, this very useful government program will solve my individual medical problem. But it won't solve everyone's, and if there's someone else writhing around on the floor late at night because they can't afford insurance, that's one too many and I do feel their pain.
And so should our president, and the cowardly politicians who cobbled together this Frankenstein's monster of medical "reform". We're the richest country in the world, but our priorities are very badly skewed. People shouldn't have to beggar themselves for the help they need. As I said to every single person who dealt with me in the hospital, "This system is insane." Every last one of them agreed with me.
I'm glad I'm getting the help I need. But I won't stop pushing our politicians until they fix it for everyone else.
Sunlight Foundation: 'Back to the Source': Health and Human Services Department Contributes to Big Government Spending on Advisory Committees
Last spring the government technology newspaper Federal Computer Week highlighted the Health and Human Services Department for spending $1.6 billion on advisory committees over the last decade, which is half of the $3.2 billion total the federal government spent on these committees during the same time period.
These numbers were obtained using the General Services Administration's new eFACA website. The website was developed "to make information from the Federal Advisory Committee Act database easier to find, understand, and use," according to the main page. This sort of information has been collected by GSA since 1972, but until recently had been hosted in a notoriously hard-to-use database.
These advisory committees have come under fire for a lack of transparency in other areas as well as spending, such as influence and access. President Obama attempted to address some concerns in June 2010 with a Presidential Memo prohibiting federally registered lobbyists from serving on these committees.
Earlier this fall the House Oversight and Government Reform Committee passed legislation seeking to make these committees more accountable. The legislation then moved to the Ways and Means Committee but has not made any progress since then. GSA's eFACA website and a study being conducted by the Administrative Conference of the United States on FACA are two steps forward for increasing transparency in this regard, according to the Project for Government Oversight.
The FCW article goes on to list the agencies that have spent the most on advisory committees over the last decade. HHS tops the list, followed by the following:
- The Defense Department at $255 million.
- The Environmental Protection Agency at $137 million.
- The Interior Department at $88 million.
- The Energy Department at $74 million.
- The Veterans Affairs Department at $68 million.
The eFACA website breaks down spending by agency starting in 2001 and continuing through 2010. The website allows searches by committee topics, types of committees, committees by agency, and committees terminated. The website also provides contact information for agency Committee Management Officers - the agency contact when seeking information related to advisory committees.
Our Influence Explorer and Transparency Data also include advisory committee data. Using Influence Explorer, just type in the person, politician or organization you are searching for. Your search results will indicate whether that person (or anyone from the organization) has served on an advisory committee. You can also see which committee and when he or she served.
Using Transparency Data you can search by the year (for example, there were 23,398 advisory committee members in 2011), the organization a committee member is affiliated with, the agency associated with the committee, the name of the committee, the name of the member, or any combination of those criteria. Check it out!
He called for rationing Medicare, replacing it with an underfunded voucher system that would dramatically shift costs to elderly Americans. He proposed repealing the Affordable Care Act, slashing Medicaid by $1.4 trillion over the next decade and turning what's left over to the states as block grants. By 2021, his budget would leave up to 44 million more Americans without health insurance. His budget, one which garnered the votes of 235 House Republicans and 40 GOP Senators, would in turn use the savings to deliver $4.2 trillion in tax cuts, most of them to the richest Americans who need them least.
As Politico revealed Tuesday, decimating the U.S. health care system and gutting the American social safety net apparently deserves praise, not scorn. For Politico, the catastrophic impact of Paul Ryan's draconian and dishonest budget matters far less than the fact that people are talking about it:
When House Budget Committee Chairman Paul Ryan released his budget plan in April, the Wisconsin Republican instantly changed the conversation about health care in America. It wasn't always a polite conversation. And it gave way to new Democratic charges that Republicans want to "end Medicare."
But Ryan got everyone talking about ways to get health care entitlements under control -- and he gave Republicans the most detailed illustration to date of how market forces could be used to do that. He has influenced how Republican presidential candidates such as Mitt Romney talk about health care, as they use variations of his Medicare plan in their campaigns. And if Republicans gain power after the 2012 elections, his blueprint is sure to be the starting point for their future health care policies.
As it turns out, Ryan didn't "instantly" change the conversation. Most Republicans, including his party's leadership, refused to endorse his 2010 Roadmap for America's Future until after the November mid-terms were safely won. And Ryan's goal to "end Medicare" is only the beginning of the unraveling of the safety net he would undertake.
To be sure, Ryan's voucher scheme would end Medicare as we know it. As Ezra Klein, Matthew Yglesias and TPM (among others) noted, Ryan's Republican deficit reduction gambit would inevitably lead to the rationing of Medicare.
Because the value of Ryan's vouchers fails to keep up with the out-of-control rise in premiums in the private health insurance market, America's elderly would be forced to pay more out of pocket or accept less coverage. The Washington Post's Klein described the inexorable Republican rationing of Medicare which would then ensue:
The proposal would shift risk from the federal government to seniors themselves. The money seniors would get to buy their own policies would grow more slowly than their health-care costs, and more slowly than their expected Medicare benefits, which means that they'd need to either cut back on how comprehensive their insurance is or how much health-care they purchase. Exacerbating the situation -- and this is important -- Medicare currently pays providers less and works more efficiently than private insurers, so seniors trying to purchase a plan equivalent to Medicare would pay more for it on the private market.
It's hard, given the constraints of our current debate, to call something "rationing" without being accused of slurring it. But this is rationing, and that's not a slur. This is the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need.
Last year, Ryan acknowledged as much.
"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"
Of course, Ryan left out the real culprit - the private insurance market. But with 50 million uninsured, another 25 million underinsured, one in five American postponing needed care and medical costs driving over 60 percent of personal bankruptcies, Congressman Ryan is surely right that "rationing happens today."
As Paul Krugman explained using the chart above:
Medicare actually does a better job of controlling costs than private insurers -- not remotely good enough, but better...
If Medicare costs had risen as fast as private insurance premiums, it would cost around 40 percent more than it does. If private insurers had done as well as Medicare at controlling costs, insurance would be a lot cheaper.
But you don't have to take Paul Krugman's or Ezra Klein's word for it that "the GOP outsources Medicare to private insurers and gives senior citizens checks that cover less and less of the cost of insurance every year." In words and pictures, the nonpartisan Congressional Budget Office issued the same dire warning (see chart at top).
By leaving beneficiaries at the whim of private insurers whose policies cost more and are padded by substantially higher overhead, and by capping the value of their vouchers, Ryan's budget proposal would produce dire consequences. As the CBO concluded in April, "A typical beneficiary would spend more for health care under the proposal." Make that, as Director Douglas Elmendorf explained, a lot more.
Under the [Ryan] proposal, most elderly people who would be entitled to premium support payments would pay more for their health care than they would pay under the current Medicare system. For a typical 65-year-old with average health spending enrolled in a plan with benefits similar to those currently provided by Medicare, CBO estimated the beneficiary's spending on premiums and out-of-pocket expenditures as a share of a benchmark amount: what total health care spending would be if a private insurer covered the beneficiary. By 2030, the beneficiary's share would be 68 percent of that benchmark under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario.
But it's not just America's seniors who would suffer at the hands of Politico's health care prize winner. Paul Ryan's plan to repeal "Obamacare" and gut Medicaid would leave millions of lower-income Americans without health care coverage.
Currently, the $300 billion Medicaid program serves roughly 60 million Americans. On average, the federal government picks up 57% of the tab, with poorer states like Mississippi and Alabama getting 75 percent of the funding from Washington. Medicaid not only pays for a third of nursing home care in the United States; it covers a third of all childbirths. (In Texas, the figure is one-half.) As with Medicare, Medicaid provides insurance for substantially less than private insurers (27 percent less for children, 20 percent for adults.)
But as McClatchy explained, the expansion of Medicaid is central pillar of the health care reform law designed to bring health insurance to millions more Americans:
The 2010 law requires that state Medicaid programs in 2014 begin covering all non-elderly people who earn up to 133 percent of the federal poverty level, which would comprise people with incomes of up to $29,400 for a family of four this year.
By 2019, that expansion is expected to add 16 million people to Medicaid, which now provides health coverage for about 60 million low-income Americans. Childless adults and parents who previously earned too much to qualify for the program will make up the bulk of the new enrollees.
Currently, the federal government pays about 57 percent of Medicaid costs on average, while states pay the rest. Under the new law, the federal government will pay the entire cost of the new enrollees for the first three years, after which it will scale down gradually to 90 percent in 2020 and thereafter.
The future implications of the Paul Ryan's Republican bloodletting are clear. While the Congressional Budget Office estimated the expanded Medicaid program under the ACA would provide coverage for more than 15 million Americans, a Commonwealth Fund analysis projected that almost half of the 52 million people who went without insurance in 2010 could gain it under the new Medicaid provisions in the Affordable Care Act:
Now in its latest state-by-state analysis, Kaiser has detailed the devastating impact on Americans' health care of the Ryan budget backed by 98 percent of Congressional Republicans:
Projected federal spending on Medicaid for the 10-year period 2012 to 2021 would fall by $1.4 trillion, a 34 percent decline. By 2021, states would receive $243 billion less annually in federal Medicaid money than they would under current law, a 44 percent reduction.
The effect on enrollment in state Medicaid programs could vary widely. By 2021, between 31 million and 44 million fewer people nationally would have Medicaid coverage under the House Budget Plan relative to expected enrollment under current law, the analysis finds, examining three possible scenarios using different assumptions about how states might respond to lower federal funding. Most of those people, given their low incomes and few options for other coverage, would end up uninsured.
The House Budget Plan also could affect health centers, hospitals and safety-net facilities that serve low-income and uninsured people and rely heavily on Medicaid revenues. By 2021, hospitals could see reductions in Medicaid funding of between 31 percent and 38 percent annually, or as much as $84.3 billion, under the plan compared with projected funding under current law. The reductions would come at a time when millions more people would lack coverage, increasing the potential demand for uncompensated hospital care.
As Steve Benen pointed out, the health care carnage Paul Ryan would inflict isn't limited to its body count. The truth is another casualty of Ryan's supposed conversation-changer:
Perhaps best of all, independent scrutiny found that the numbers in Paul Ryan's plan simply didn't add up.
Bad math and even worse health care. In a nutshell, that's what qualifies Paul Ryan as the Health Care Policymaker of the year. Of course, Politico is only worried about "winning the morning," not winning America's future. For that, Americans will have to turn to President Obama and the Democrats.
If you wonder why the health insurance industry has to set up front groups and secretly funnel cash to industry-funded coalitions to influence public policy, take a look at the most recent results of the Kaiser Family Foundation’s (KFF) monthly Health Tracking Poll.
In its November poll, KFF added a few new survey questions to find out exactly which parts of the Affordable Care Act/Obamacare are the most popular and which are the least popular. Insurers were no doubt annoyed to see that the provision of the law they want most -- the requirement that all of us will have to buy coverage from them if we’re not eligible for a public program like Medicare -- continues to be the single most hated part of the law. More than 60 percent of Americans have an unfavorable opinion of that mandate.
The individual mandate, a requirement in the Affordable Care Act that individuals buy private health insurance or pay a fine, is still very unpopular according to the newest Kaiser Family Foundation poll. According to the poll 63 percent have a somewhat or very unfavorable opinion of the individual mandate, while only 35 percent have a very or somewhat favorable opinion of it.
The poll also found that the individual mandate was one of the most cited reasons for why people don’t like the overall law.
The fact that the individual mandate has been unpopular since it was proposed and remains unpopular two years after its adoption shouldn’t be news. Yet early this month many different supporters of the Affordable Care Act cited results from a poorly written CNN/ORG poll question to claim the public now supports the individual mandate. That CNN/ORC poll found that 52 percent support the provision requiring all Americans to get insurance, while 47 percent opposed. The CNN/ORG poll language, however, left out any mention of a fine, penalty or punishment for not getting insurance.
Wording of the CNN/ORC poll question:
As you may know, the health care bill passed in 2010 includes a provision that will require all Americans who do not have health insurance to get it. Do you favor or oppose that provision?
Wording of the KFF poll question:
15. Next, I’m going to read you several elements of the health reform law. As I read each one, please tell me whether you feel very favorable, somewhat favorable, somewhat unfavorable, or very unfavorable about it. First, (INSERT AND RANDOMIZE; OBSERVE FORM SPLITS). (READ FOR FIRST ITEM, THEN AS NECESSARY: Would you say you feel very favorable, somewhat favorable, somewhat unfavorable or very unfavorable about that?)
a. The law will require nearly all Americans to have health insurance by 2014 or else pay a fine
Of course people are more likely to say they support an ideal if you don’t mention a critical aspect of concept that is the reason most people have opposed it. But that does not produce an accurate reflection of public opinion.
It is always possible that at some point in the future, potentially after the law is implemented, a majority may come to support the individual mandate. But currently that is definitely not the case.