medicare – R&R – Reachout and Rebuild

Taking the Heart out of Obamacare

David Posnett — Thu, 21 Dec 2017 02:47:53 +0000

Tax bill sets up 2018 attacks on our health care

This week, House and Senate Republicans passed their deficit-busting tax giveaway to corporations and the ultra-rich without a single Democratic vote, clearing it for Donald Trump’s signature. After failing to repeal the Affordable Care Act outright earlier this year, GOP leaders gloated that “doing away with the individual mandate [in the tax bill] makes the ACA unworkable” and “takes the heart out of Obamacare.”

It’s true that repealing the individual mandate will do real damage. According to the Congressional Budget Office, premiums will rise an average of 10% (wiping out any short-term tax cut that low- and middle-income families might see under the bill before their tax rates jump up again in a few years) and 13 million people will lose their health insurance as a result of the Republican tax bill. Combined with regulatory changes proposed by the Trump administration to make “junk” plans more attractive to healthy people and the GOP’s ongoing efforts to sabotage consumer protections, the coming year could be turbulent, expensive and scary for millions of people in need of affordable care.

But while it’s easy to feel despair, Republicans have not taken the “heart” out of the ACA. Not yet!

It will be up to us next year to fight against attacks on the true heart of the ACA: the Medicaid expansion, subsidies to help low- and moderate-income families pay their premiums and consumer protections for women and people with pre-existing conditions. That’s because GOP leadership has made clear that, having blown a giant hole in the deficit with tax cuts, they intend to use that hole as an excuse to dismantle core safety net programs including the ACA, Medicaid, food stamps and more.

Help Raising Women’s Voices protect the true heart of the ACA in 2018 by making a tax-deductible charitable donation before year’s end! You can donate through the Network for Good page

Our 2017 work isn’t over yet!
Meanwhile, our fight for affordable health care isn’t even over for the week. Having now given themselves and their donors an expensive Christmas bonanza with the national credit card, Republicans are hoping to leave town for the holidays without reauthorizing the Children’s Health Insurance Program (CHIP), which expired in September. CHIP funds health insurance for nine million kids, including two million kids with serious chronic conditions, but without federal support, states are spending down reserves and moving to cut off new enrollments as a first step to shutting down their CHIP programs altogether.

Today, the Georgetown University Center for Children and Families released new analysis which found that if Congress does not act soon to fund CHIP, an estimated 1.9 million children in separate CHIP programs could lose coverage in January. An additional 1 million children would also be at risk of losing coverage by the end of February.

According to congressional Republicans, “The reason CHIP’s having trouble is we don’t have any money anymore.” Having just voted to add $1.5 trillion to the deficit in order to slash taxes on the rich, Republicans are refusing to fund the $14 billion CHIP program unless they win deep health cuts elsewhere. They hope to push off dealing with CHIP until after the New Year, even though states like Alabama have already announced that they will be forced to freeze enrollment on January 1.

Also left without continuing funding are community health centers, which provide vital primary care to many low-income families, the Maternal Infant Childhood Home Visiting Program, and the Medicaid disproportionate share hospital payments program, which supports safety-net hospitals that serve large numbers of Medicaid and uninsured patients. Word today is that Congress will pass yet another short-term extender of government funding until early in 2018.

There’s still time to push Congress to take more decisive action this week! The number for the Capitol switchboard is 202-224-3121. You know what to do!

From Raising Women’s Voices, NY, NY

Individual Mandate Repeal in Latest Tax Bill Draft

David Posnett — Wed, 15 Nov 2017 16:30:36 +0000

Author Shannon Muchmore @stmuchmore

Published Nov. 15, 2017

Dive Brief:

Republican leaders said Tuesday the latest version of their bill to overhaul the tax system would repeal the individual mandate in the Affordable Care Act (ACA).
Sen. Orrin Hatch (R-Utah) said he estimates the repeal would save $338 billion that could be used to offset tax cuts elsewhere in the legislation, Politico reported.
The Congressional Budget Office and Joint Taxation Committee earlier issued an analysis that concluded eliminating the individual mandate would result in 14 million people losing coverage by 2025 and premium increases of about 20%.

Dive Insight:

As anyone who has watched Congress debate ACA legislation this year knows, a proposed bill can change frequently during negotiations. The individual mandate repeal could still be tossed before a vote, but several Republicans are still looking for any way to deal a blow to the ACA.

The mandate is an essential part of the law, although it’s an unpopular one. Requiring most people to have insurance helps more young and healthy people to enter the risk pool. This helps payers offset the costs of covering people with pre-existing conditions. A repeal of the mandate would likely lead to more insurance companies choosing to pull out of the ACA exchanges.

Repealing the mandate would add to a string of actions weakening the law. President Donald Trump’s administration has taken a number of steps to undermine the ACA, including putting an end to cost-sharing reduction payments to insurers and paving the way for more catastrophic health plans. HHS has also drastically scaled back efforts to promote the open enrollment period.

Call Lee Zeldin to voice your opinion! (202) 225-3826

There is a Phone-in “townhall” tonight on the topic of taxes!

https://zeldin.house.gov/contact/opt-request-telephone-town-halls

You’re Probably Going to Need Medicaid

David Posnett — Tue, 13 Jun 2017 14:49:53 +0000

I could not say it any better… Mr.Zeldin’s vote will directly affect you and your family and you wont like it!

By DAVID GRABOWSKI, JONATHAN GRUBER and VINCENT MORJUNE 13, 2017

in the NYTimes Opinion Section

Photo Niko J. Kallianiotis for The New York Times

Imagine your mother needs to move into a nursing home. It’s going to cost her almost $100,000 a year. Very few people have private insurance to cover this. Your mother will most likely run out her savings until she qualifies for Medicaid.This is not a rare event. Roughly one in three people now turning 65 will require nursing home care at some point during his or her life. Over three-quarters of long-stay nursing home residents will eventually be covered by Medicaid. Many American voters think Medicaid is only for low-income adults and their children — for people who aren’t “like them.” But Medicaid is not “somebody else’s” insurance. It is insurance for all of our mothers and fathers and, eventually, for ourselves.The American Health Care Act that passed the House and is now being debated by the Senate would reduce spending on Medicaid by over $800 billion, the largest single reduction in a social insurance program in our nation’s history. The budget released by President Trump last month would up the ante by slashing another $600 billion over 10 years from the program. Whether the Senate adopts cuts of quite this magnitude or not, any legislation that passes the Republican Congress is likely to include the largest cuts to the Medicaid program since its inception.Much focus has rightly been placed on the enormous damage this would do to lower-income families and youth. But what has been largely missing from public discussion is the radical implications that such cuts would have for older and disabled Americans.

Medicaid is our nation’s largest safety net for low-income people, accounting for one-sixth of all health care spending in the United States. But few people seem to know that nearly two-thirds of that spending is focused on older and disabled adults — primarily through spending on long-term care services such as nursing homes.

Indeed, Medicaid pays nearly half of nursing home costs for those who need assistance because of medical conditions like Alzheimer’s or stroke. In some states, overall spending on older and disabled adults amounts to as much as three-quarters of Medicaid spending. As a result, there is no way that the program can shrink by 25 percent (as under the A.H.C.A.) or almost 50 percent (as under the Trump budget), without hurting these people.

A large body of research, some of it by us, has shown that cuts to nursing home reimbursement can have devastating effects on vulnerable patients. Many nursing homes would stop admitting Medicaid recipients and those who don’t have enough assets to ensure that they won’t eventually end up on Medicaid. Older and disabled Medicaid beneficiaries can’t pay out of pocket for services and they do not typically have family members able to care for them. The nursing home is a last resort. Where will they go instead?

Those who are admitted to a nursing home may not fare much better. Lowering Medicaid reimbursement rates lead to reductions in staffing, particularly of nurses. Research by one of us shows that a cut in the reimbursement rate of around 10 percent leads to a functional decline of nursing home residents (that is, a decline in their ability to walk or use the bathroom by themselves) of almost 10 percent. It also raises the odds that they will be in persistent pain by 5 % and the odds of getting a bedsore by 2 %.

Finally, these cuts would just shift costs to the rest of the government. Lower-quality nursing home care leads to more hospitalizations, and for Americans over 65, these are paid for by another government program, Medicare. One-quarter of nursing home residents are hospitalized each year, and the daily cost of caring for them more than quadruples when they move to the hospital. Research shows that a reduction in nursing home reimbursements of around 10 percent leads to a 5 percent rise in the odds that residents will be hospitalized. So care for seniors suffers, and the taxpayer pays.

Mr. Trump and the Republicans would lower spending on the frailest and most vulnerable people in our health care system. They would like most Americans to believe that these cuts will not affect them, only their “undeserving” neighbors. But that hides the truth that draconian cuts to Medicaid affect all of our families. They are a direct attack on our elderly, our disabled and our dignity.

Pressing Congressman Zeldin

David Posnett — Sun, 08 Jan 2017 18:18:19 +0000

Nice going, Bob Brody and Betty Mazur, who represented East Hampton residents as protesters at the demonstration in Riverhead on Tuesday Jan 3rd. Here is the full story in the East Hampton Star as reported by Chris Walsh.

Bob was rightly concerned that one can not repeal Obamacare and preserve coverage for kids until they are 26 years old under their parent’s policy, as well as the rule that forbids insurances from denying coverage for pre-existing conditions, etc. The math just doesn’t work. So far the insurance companies benefited from a) government subsidies for Obamacare policies, and b) government pressure on individuals and businesses to increase the pool of insurance premiums. Imagine up to 20-30 million insurance policies disappearing with full repeal: either insurance companies will go broke, or premiums will skyrocket, or deductibles will be huge, or the lifetime caps on benefits will return…

We all should be concerned!

No to Medicare Privatization

David Posnett — Tue, 03 Jan 2017 15:30:55 +0000

Letter to the Editor by Mike Anthony – published in the Southampton Press

Since the November 8^th election, the focus has been placed on public policy options in a fully Republican-dominated federal government. One of those policy areas is Medicare and the direction US House Speaker Paul Ryan would like to take the program under his “Better Way” proposals; specifically, he is interested in privatizing Medicare and using a premium support stipend directed to beneficiaries to purchase their own health insurance in the marketplace.

There is a lot to chew over regarding that proposal, but as a former teaching hospital administrator, I would like to share my concerns solely related to Medicare’s role in teaching the future physicians of America.

Medicare is critical to teaching and training physicians – will that role be jeopardized under a privatization scheme?

Medicare supports nearly a quarter of all direct medical education costs (DGME) associated with training physicians: annual costs are $13 billion of which Medicare directly supports with $3 billion in payments to teaching hospitals. These payments help pay for stipends and fringe benefits, salary for supervision, administrative and overhead costs. (Note: Medicaid also supports medical education costs.)

In addition to the direct costs associated with training our future doctors, Medicare recognizes and pays for indirect costs associated with treating an older Medicare-eligible population that are common in teaching hospitals. Accordingly, Medicare provides an additional add-on called the Indirect Medical Education (IME) payment. Through this IME adjustment, teaching hospitals receive an additional $6.5 billion annually. What is critical to understand is that private insurance companies rarely recognize these additional costs in their reimbursements.

Since New York State has a robust physician training program, and many world-renown teaching hospitals, any diminution of teaching support payments from Medicare (and Medicaid) might place at risk the teaching mission at these hospitals.

For this and other reasons, we need to strengthen and not privatise Medicare.

A key aspect of Medicare: funding medical education. Every physician has benefited! Including myself. David

Medicine for the One Percent

David Posnett — Mon, 21 Apr 2014 13:27:56 +0000

We always suspected this: a new study clearly shows that the richer you are, the longer you live in the US of America (Wall Street Journal). This is no small difference! The top 10% (richest) people live on average 10 years longer than the bottom 10% (poorest). Wow! And this is WITH medicare and medicaid, which the political right would have us get rid of all together.

What I would like to see are 2 things.

(1) A comparison with a similar study in civilized “1st world” countries (Canada, UK, Germany, France, Switzerland, Netherlands, etc.) with better health care coverage that covers the entire population.

(2) A historical comparison: an analysis of life expectancy relative to individual wealth 100 , 50, 20 and 10 years ago in the US. I would like to know whether we have made any progress, and whether (as I suspect) progress has been halted or even reversed.

It will take at least 10-50 years for the effects of Obamacare to show up in such a population wide analysis which measures death rates over many years. At present, only a comparison with other countries can tell us something.

Here is a partial response to my question (2) from the article itself which looks at least at 2 different historical time points: 1920 versus 1940. For men there has been an improvement in longevity (5.9% for the richest men and 1.7% for the poorest men). For women the change in longevity is 3.1% for the richest women. But the poorest women actually live less long -2.1%. This means that if you are a poor woman, you actually would have been better off being born in 1920 rather than in 1940! That is a stunning fact. It is the reverse of progress.

Need help to sign up for Obamacare?

David Posnett — Sat, 08 Feb 2014 15:01:35 +0000

If you are anywhere near East Hampton on the Southfork this is a great place:

East Hampton Health Care Center

for appointments with an “enroller” on Mon and Fri call

Julia Fuentes 631 294 2921
Nancy Moraga Martinez 631 291 5077

for appointments with an “enroller” on Tues and Thu call

Vicki Duran 516 315 1021

All enrollers are fluent in English and Spanish. You can sign up your family within less than 1 hour. It is person to person and you don’t need to have computer skills.

How to sign up for ACA Healthcare Insurance WITHOUT problems on the Southfork

David Posnett — Thu, 30 Jan 2014 18:59:07 +0000

Millions of Americans and documented residents
now have the chance to get quality care that they
can afford.
1. If you need help, financial assistance is available.
2. You can’t be denied coverage, regardless of your health
3. You choose the plan that’s right for you.
4. Sign up through March 2014

This is for those that are frustrated and found it difficult to get good health insurance at a good rate.

I went to visit Sheila Rogers (the head of East Hampton Health Care Foundation).
Forget using state paid navigators in Suffolk county she says. There are only about 3 of them. They show up very infrequently (e.g. once a month for 3 hours at Southampton Hosp. for example).

There are 8 companies that are NYS approved to sell insurance through the ACA individual market place in Suffolk county. But only 3 are providers of Medicaid Managed Care.

Affinity Health Plan (provider of Medicaid Managed Care)
Fidelis Care (provider of Medicaid Managed Care) – no local doctors accept this companies plans! Closest doctors in Riverhead! FAVORITE CHOICE BECAUSE CHEAPEST
United (provider of Medicaid Managed Care) – very expensive if you are not eligible for Medicaid Managed Care!
Emblem Health
Empire Blue Cross Blue Shield
Health Republic (Freelancers) – no local doctors accept this companies plans!
North Shore LIJ – doctors are mostly up island
Oscar

Small Business Marketplace:

Health Republic
North Shore LIJ
United

Probably better to use an insurance broker if you are a business.

Here is the exciting part: Sheila has “enrollers” that come to her clinic 4 days a week for 3 hours. They see and sign up about 10-12 families at each session. People have to make an appointment and the wait is usually about 1 week. These enrollers are fluent in Spanish. They do NOT try to overtly sell/push their own company… (most of them come from Affinity and United).

You can call for an appointment:

MAKE AN APPOINTMENT WITH A
FACILITATED ENROLLER
AT THE EAST HAMPTON
HEALTHCARE CENTER

MON & FRI:
UNITEDHEALTHCARE
JULIA FUENTES: 631-294-2921

TUES & THURS
AFFINITY HEALTHPLAN
VICKY DURAN: 516-315-1021

Insurance Brokers can also sell plans, including plans from other companies like Aetna, these plans are supposed to be in line with the ACA market place.

Sheila organizes a monthly Health Care Fair at our local Most Holy Trinity Catholic Church on Buell Lane, where families get free screening (BP, Diabetes, Cholesterol, etc) and free advice on how to sign up for the ACA. The next such event is Friday, Feb 7th (11AM to 1:30 PM).

Opting out of Medicare Expansion is costing lives: over 7,100 deaths nation wide!

David Posnett — Thu, 30 Jan 2014 18:35:29 +0000

Interesting study (by a Harvard medical student). It is an estimate of the total numbers of people that will be covered by insurance with/without medicare expansion. They they use prior estimates of how non-coverage translates in to real death rates.

For example

NY (which has opted in):

currently uninsured 2 185 195
projected uninsured with ACA 1 122 130 (49% decline in uninsured)

PA (which has opted out)

currently uninsured 1 520 622
projected uninsured with ACA 1 229 171 (19.2% decline in uninsured)

Is Your Medicare Safe under Obamacare?

David Posnett — Sat, 18 Jan 2014 17:13:50 +0000

50 Million Americans have Medicare (including me) and we have been targeted by scare tactics! So some of us may be worried about the changes under ACA (Obamacare) and what that will mean for our Medicare coverage.

This months AARP bulletin (which I always read) has a great readable article by Marsha Mercer with balanced answers from both sides to key questions such as:

what about cuts to Medicare under the ACA?
my copays are going up…why?
my doctor was dropped by the Medicare Advantage company. Why?
what about drug prescription costs?
is hospital care going to suffer because of decreased payments to hospitals?
does the ACA help Medicare in the long run? Will it still be there is 15 years?

Everyone should get educated on these questions and listen to the pros and the facts!