Sestak Talks Healthcare

Senate candidate Joe Sestak visited West Reading this morning to discuss healthcare.  He walked .42 miles from Reading Hospital to Chatty Monks cafe with about 30 supporters.  The distance reflects the 422 miles he walked across the Commonwealth this spring.  Joe spoke at length and in detail about the Affordable Care Act (ObamaCare) and the beneficial effect it is having on people’s lives.  The CBO estimates that it is already reducing the deficit by $100 billion over the next decade.  16.4 million Americans have gained healthcare coverage under the Act though many more remain uninsured due to Republican Governors who refuse to enact Medicaid expansion through the program.

He also spoke about issues such as long term care and elder abuse and often compared details with his career as a three star Admiral in the Navy.  He criticized Sen. Pat Toomey for voting for war then against veterans health care.  You can’t send our young people to war then not take care of them when they return.  That’s the deal we strike with our military, a sacred covenant.  If we can’t afford to care for our veterans once they come home don’t send them in the first place.

ObamaCare Is Helping Pennsylvanians

The Affordable Care Act, popularly known as ObamaCare, is helping Pennsylvanians as the Supreme Court readies a major decision which could eviscerate the health program.  Congressional Republicans filed suit and SCOTUS is prepared to rule on that litigation before the end of this month.  If it rules that subsidies are illegal millions of people could lose the coverage they’ve now had for a year and a half.

This is such a stupid lawsuit even GOP Sen. John Thune saw fit to condemn and end to the subsidies as he condemned the ACA.  He got pilloried on Twitter for his stupidity but stupidity hasn’t prevented millions of Americans from voting these morons into office.  Perhaps what we really need is a plan which prohibits stupid people from running for office.  With all this talk of bringing literacy tests back for voters we should require one for office seekers.

The White House sent this fact sheet today showing how ObamaCare has helped Pennsylvania:

After Health Reform: Improved Access to Care

·         Gallup recently estimated that the uninsured rate in Pennsylvania in 2014 was 10.3 percent, down from 11.0 percent in 2013.

·         Prohibits coverage denials and reduced benefits, protecting as many as 5,489,162 Pennsylvanians who have some type of pre-existing health condition, including 656,877 children.

·         Eliminates lifetime and annual limits on insurance coverage and establishes annual limits on out-of-pocket spending on essential health benefits, benefiting 4,582,000 people in Pennsylvania, including 1,769,000 women and 1,136,000 children.

·         Expands Medicaid to all non-eligible adults with incomes under 133% of the federal poverty level.  153,468 more people in Pennsylvania have gained Medicaid or CHIP coverage since the beginning of the Health Insurance Marketplace first open enrollment period.

·         Establishes a system of state and federal health insurance exchanges, or marketplaces, to make it easier for individuals and small-business employees to purchase health plans at affordable prices through which 427,454 people in Pennsylvania were covered in March 2015.

·         Created a temporary high-risk pool program to cover uninsured people with pre-existing conditions prior to 2014 reforms which helped more than 7,106 people in Pennsylvania.

·         Creates health plan disclosure requirements and simple, standardized summaries so 7,586,200 people in Pennsylvania can better understand coverage information and compare benefits.

After Health Reform: More Affordable Care


·         Creates a tax credit to help 348,823 people in Pennsylvania who otherwise cannot afford it purchase health coverage through health insurance marketplaces.

·         Requires health insurers to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low.  Last year, 90,485 consumers in Pennsylvania received $5,198,874 in rebates.

·         Eliminates out-of-pocket costs for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children.  This coverage is guaranteed for more than 6,127,383 people in Pennsylvania including 2,511,285 women.

·         Eliminates out-of-pocket costs for 1,801,768 Medicare beneficiaries in Pennsylvania for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.

·         Phases out the “donut hole” coverage gap for 297,058 Medicare prescription drug beneficiaries in Pennsylvania, who have saved an average of $948 per beneficiary.

·         Creates Accountable Care Organizations consisting of doctors and other health-care providers who share in savings from keeping patients well while improving quality, helping 289,927 Medicare beneficiaries in Pennsylvania.

·         Phases out overpayments through the Medicare Advantage system, while requiring Medicare Advantage plans to spend at least 85 percent of Medicare revenue on patient care.  Medicare Advantage enrollment has grown by 152,265 to 1,009,759 in Pennsylvania since 2009.

After Health Reform: Improved Quality and Accountability to You

·         Provides incentives to hospitals in Medicare to reduce hospital-acquired infections and avoidable readmissions.  Creates a collaborative health-safety learning network, the Partnership for Patients, that includes 157 hospitals in Pennsylvania to promote best quality practices.

We’re not done.  Other legislation and executive actions are continuing to advance the cause of effective, accountable and affordable health care.
This includes:

·         Incentive payments for doctors, hospitals, and other providers to adopt and use certified electronic health records (EHR).  In Pennsylvania more than 53.2 percent of hospitals and 41.8 percent of providers have electronic health records systems.

·         A new funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities.  Health Center grantees in Pennsylvania now serve 680,017 patients and received $189,115,545 under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.

·         Health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps.  As of September 30, 2014, there were 208 Corps clinicians providing primary care services in Pennsylvania, compared to 62 clinicians in 2008.

 

AIDS Advances May be Compromised by Legislative Inaction

by Walter Brasch

Researchers at Temple University in Philadelphia may have found an entry-way to the cure for AIDS.

Once the HIV virus enters the body it can lie dormant for years. It can also evolve into AIDS.  But, until now, it could never be removed.

It’s far too early to claim an AIDS cure-there still has to be several years of clinical trials- but this may be as close to a solution as scientists have come.

There can be a lot of politics in medical science, but the researchers at least have the wisdom to know they must work together and focus upon the people not the politics.

Even if there is a cure for AIDS, even if there are significant advances in the treatment and cure of other communicable diseases, it may not mean much if patients can’t get the medical treatment they need because obstructionists are doing their best to separate the people from the solution.

Two hours west of Philadelphia is Harrisburg, the Pennsylvania state capital. This is where Gov. Tom Corbett and his well-oiled legislature shut down 15 of 60 public health clinics, have plans to shut down nine more to “save” about $3 million a year, and laid off 73 nurses and support staff. In July, the state Supreme Court issued an emergency injunction to prevent the state from shutting down more health clinics, and is reviewing a petition to force the administration to reopen the other clinics. Under the Corbett administration, Pennsylvania ranks 43rd of 50 states in per capita public health spending, according to the Robert Wood Johnson Foundation. The governor also vetoed a budget item to spend $2 million a year from tax revenue generated by oil and gas companies to do research about the effects of fracking upon the people’s health, to provide health care information, to treat those who may have been affected by air and water pollution from fracking, and to establish a health care registry that would help identify problems. But he was more than willing to give all kinds of tax breaks to oil and gas companies, including Royal Dutch Shell, a foreign corporation, which he handed a $1.7 billion tax credit. If the state taxed gas extraction companies at a rate at least that of other states, there would be at least another $500 million a year that could be used to help protect the people’s health and their environment.

More than 50 times, the Republican-controlled U.S. House of Representatives has tried to wipe the Affordable Care Act (ACA) off the books. This quixotic mission will continue to fail for two reasons. First, the Supreme Court of the United States, which has a majority of conservatives, ruled the Act is constitutional. Second, all evidence shows the Act has led to better health care and at least 2.3 million Americans covered who couldn’t get insurance prior to the passage of the ACA. More than eight million Americans have already signed up for ACA coverage, and are now receiving better health care at lower insurance rates.

Further, because of the ACA, more than 5.5 million senior citizens and disabled have saved about $4.5 billion on prescription drugs in the past three years, according to the U.S. Department of Health and Human Services. Fourteen “red” states have chosen not to be a part of the ACA, their legislatures adamantly refusing to agree to anything that President Obama has proposed, even if it means the people suffer. The impartial Rand Corp. estimates these states will spend about $1 billion more taxpayer funds than if they expanded Medicaid under ACA provisions. Because of their refusal to agree to the ACA, almost four million residents of their states will continue to be uninsured, forcing the state and hospitals to pay for emergency medical care for low-income individuals. (In Pennsylvania, with a Republican governor and legislature, if the state agreed to implement the ACA, the savings would be about $600 million the first year.) However, the rabid Right Wing has continued to sling a barrage of lies and half-truths, usually picked up, channeled, and reported by the mass media. The time and money devoted to this political gesturing by Right Wing politicians could better be spent on funding research to find cures for Ebola, multiple sclerosis, numerous forms of cancers, and dozens of other life-threatening diseases.

This is the same Congress that had blocked funding to improve the VA system, while spending $3 million this year alone to investigate what they have created as the Benghazi Scandal. It’s already been investigated and re-investigated. Senior military commanders and impartial diplomats have already told the truth, but the House still wants to throw out its chest and throw a junior-high tantrum. Think of what that $3 million can do to help the nation’s homeless, about one-fourth of them veterans.

Members of Congress believe they have to travel all over the world on what they call “fact-finding tours.” These tours often find facts in tropical island nations.  And now, thanks to a decision by the apparently misnamed House Ethics Committee, members of Congress don’t even have to report if their trips were funded by lobbyists. Think of what several million more dollars can do to help improve the health of the impoverished rather than help members of Congress get sun tans.

It’s just politics. But, how many more will suffer and die from our misguided priorities.

Dr. Brasch’s latest book is Fracking Pennsylvania, which looks at the health, environmental, economic, and political effects from fracking.]

 

ObamaCare Is Succeeding

Enrollment figures for the Affordable Care Act are up 53% this year as over 3.3 million Americans have enrolled and are now covered.  Another 9 million have been enrolled in Medicaid expansions under ObamaCare.  The Department of Health and Human Services announced the following statistics:

Key findings from today’s report include:

·        Nearly 3.3 million (3,299,500) people selected Marketplace plans from Oct. 1, 2013, through Feb. 1, 2014, including 1.4 million in the State Based Marketplaces and 1.9 million in the Federally-facilitated Marketplace.

·        Of the almost 3.3 million:

o   55 percent are female and 45 percent are male;

o   31 percent are age 34 and under;

o   25 percent are between the ages of 18 and 34;

o   62 percent selected a Silver plan, while 19 percent selected a Bronze plan; and

o   82 percent selected a plan and are eligible to receive Financial Assistance, up from 79 percent during the Oct. 1 through Dec 28, 2013 reporting period.

 

Gov. Corbett Should Accept Real Medicaid Expansion

More than 500,000 Pennsylvanians need health care coverage now

This is a guest column.

by State Rep. Frank Dermody

It’s easy to get caught up in – and turned off by – the political mudslinging that has dominated the federal Affordable Care Act, commonly known as ObamaCare.

What often gets lost in all the political noise is the fact the law will help millions of Americans – including hundreds of thousands of Pennsylvanians – get access to affordable health care for themselves and their families.

Two issues related to ObamaCare are in the news lately, and they’re both important.

First, the new Health Insurance Marketplace, www.healthcare.gov, was launched this month, allowing people, for the first time, to shop online for a health insurance plan that works best for them.

The second issue is Medicaid expansion – the option under the new law for states to expand insurance to a larger group of working people with less income who currently don’t qualify for Medicaid but also can’t afford private insurance on the Marketplace.

Under the Affordable Care Act, the federal government will pay for 100 percent of the cost of Medicaid expansion for the first three years. Starting in 2017, the federal share will gradually drop to 90 percent of the cost, meaning states will pay no more than 10 percent of the costs annually after the first three years.

Twenty-five states have accepted Medicaid expansion, including neighboring New York, New Jersey, Delaware, Maryland and West Virginia.

Here in Pennsylvania, Gov. Tom Corbett has refused to expand Medicaid, despite the fact that it would provide health care coverage for more than a half-million uninsured, working Pennsylvanians, and despite the fact that it would bring an infusion of tens of billions of federal dollars into our state and local economies.

Instead, Corbett has chosen a needlessly complicated – and potentially more expensive – approach that would send federal Medicaid dollars to private insurance carriers, while also adding unnecessary, and likely illegal, hurdles for Pennsylvanians to get coverage.

Even if Corbett receives federal approval, which is by no means guaranteed, it will likely take months of negotiations. That means that those 500,000-plus Pennsylvanians, who need health care coverage, will have to wait while their neighbors in other states start getting covered as of Jan. 1, 2014, using Pennsylvanians’ federal tax dollars.

With zero cost to the state for the first three years, there’s no reason to delay Medicaid expansion. Corbett can still negotiate with the federal government over his Medicaid privatization plan, while hundreds of thousands of Pennsylvanians get the health care coverage they need.

It’s important to understand who those uninsured Pennsylvanians are.

The vast majority of people who would receive coverage through Medicaid expansion are working men and women who either do not have health insurance provided by their employer, or they can’t afford it. We’re talking about restaurant workers, child care workers, cashiers, home health aides and many other hardworking Pennsylvanians.

They need health care coverage for themselves and their families. They cannot afford to wait.

Gov. Corbett should do the right thing for Pennsylvanians and say “yes” to true Medicaid expansion.

State Rep. Frank Dermody serves as Democratic leader of the Pennsylvania House of Representatives. He represents the 33rd Legislative District in Allegheny County.

 

Health Law Saves Consumers by Requiring Insurers to Spend Premium Dollars on Medical Care

By Chris Lilienthal, Third and State

Medical Loss Ratio ExplainedA key reform in the Affordable Care Act requires health insurers to spend 80% to 85% of premium dollars directly on medical care or quality improvement expenses as opposed to other administrative costs, marketing, or profits. If an insurer does not meet the standard, it must provide rebates to consumers or businesses.

Insurers issued $1.1 billion in rebates to nearly 13 million consumers for 2011, the first year the rule was in effect, and are expected to return more than $500 million in rebates to 8.5 million consumers for 2012. The 2012 figures include nearly $6.9 million that will be returned to 123,581 Pennsylvania consumers — an average of $77 per family.

These rebates are among the more tangible ways that consumers have benefited from the law so far, but it is important to remember, as researchers with the Kaiser Family Foundation recently noted, that rebates represent only a portion of the savings to consumers from this provision, known formally as the "Medical Loss Ratio" Rule (MLR):

The primary role of an MLR threshold is to encourage insurers to spend a certain percentage of premium dollars on health care and quality improvement expenses (80 percent in the individual and small group market and 85 percent in the large group market). The MLR rebate requirement operates as a backstop if insurers do not set premiums at a level where they would be paying out the minimally acceptable share of premiums back as benefits…

Consumers and businesses, therefore, can realize savings in two ways as a result of the MLR requirement: by paying lower premiums than they would have been charged otherwise (as a result of lower administrative costs and profits), or by receiving rebates after the fact.

Final Pa. Budget Fails to Make Up Lost Ground

By Sharon Ward, Third and State

The Pennsylvania Budget and Policy Center has released a full detailed analysis of the 2013-14 state budget plan spending $28.376 billion, roughly $645 million (or 2.3%) more than in the 2012-13 fiscal year.

Governor Tom Corbett signed the budget into law late in the evening of June 30, 2013. Overall, the plan is $64 million less than the Governor proposed in February, reflecting nearly $113 million in reduced spending for public school pensions and school employees’ Social Security payments along with a shift of $90 million in General Fund spending off budget to other funds.

2013-14 General Fund Summary

The plan includes a small increase to basic education funding, $122.5 million overall, with $30.2 million allocated to 21 school districts through a supplemental allocation, on top of the $90 million increase in the Governor’s proposal.

After many years of cuts, most programs received small increases in the Governor’s proposed budget, which remained in the final plan.

Changes to pension benefits for current employees, the cornerstone of the Governor’s original budget proposal, did not occur. The Legislature does not seem inclined to tamper with benefits for current employees. A proposal to move to a 401(k)-style retirement plan for new employees gained traction later in the session but was not adopted. This proposal may return in the fall.

Also abandoned was an $800 million education initiative to be funded through the sale of state liquor stores. While the privatization vs. modernization debate held center stage until the last week of the session, the school funding component was quickly abandoned and was not part of legislative proposals. Privatization is likely to be considered in the fall, as well.

For the first time in two years, there were no major cuts to services for vulnerable Pennsylvanians; however, a bill that would expand Medicaid coverage in 2014, a state option under the federal Affordable Care Act, was left undone. Legislation including the Medicaid expansion won bipartisan support in the Senate, but the House stripped out the expansion provision from the bill. When the bill returned to the Senate, a last ditch effort to restore the Medicaid expansion provision failed in a dramatic Senate committee vote on July 3.

Finally, a transportation funding package that would repair crumbling infrastructure and give a much needed shot in the arm to Pennsylvania’s flagging job growth failed to pass the House, despite overwhelming support in the Senate.

Get all the details from PBPC's budget analysis.

Lives Are on the Line in PA’s Medicaid Expansion Debate

By Chris Lilienthal, Third and State

Cover the Commonwealth: Lives on the Line RallyLast week, hundreds of people from across Pennsylvania took the Capitol by storm to put faces to the debate over expanding Medicaid health coverage in Pennsylvania.

The "Lives on the Line" rally featured a number of speakers who talked about the stress of working full-time without health insurance. One woman named Petrina has diabetes, but her employer doesn't offer health insurance. She had to fight back tears as she talked about the struggle to control her insulin. She is understandably terrified.

Mary Lou struggles to get through the days, given that she's needed new glasses for years.

Cheryl from Washington County recently incurred thousands of dollars in ER charges and has no idea how she'll ever pay it back.

And it goes on…

Cover the Commonwealth: Lives on the Line RallyAll of the speakers would have the security of knowing they can see a doctor when they get sick if Pennsylvania opted to take a federal opportunity provided by the Affordable Care Act (ACA) to expand Medicaid coverage in 2014 to adults with incomes up to 138% of the federal poverty line (roughly $32,000 for a family of four).

The federal government will pay 100% of the cost of new enrollees for the first three years—2014, 2015 and 2016—and will cover 90% of the costs by 2020.

Hundreds of thousands of Pennsylvanians will be eligible for health coverage under expansion, cutting the state's uninsured rate in half. Acting on this opportunity will create jobs, strengthen Pennsylvania’s economy, and make its citizens healthier and more financially stable. Get all the facts about the expansion in a new fact sheet prepared by the Pennsylvania Budget and Policy Center (PBPC).

Despite the tremendous upside, Governor Corbett has yet to decide on whether the state will expand, and there are only a couple weeks left before the Legislature breaks for the summer. That’s why the Cover the Commonwealth Campaign (of which PBPC is a member) organized last week’s Capitol rally.

And it was a success, generating good press coverage. The Governor’s office and legislators took notice, and the crowd was fired up. But more needs to be done to keep the pressure on Harrisburg to do the right thing.

You can help by calling your state legislators at 1-800-515-8134 and the Governor at 717-787-2500. Tell them: My name is ___ and I'm calling because Pennsylvania needs to accept federal funding to expand Medicaid. Thank you.

Republican Governors Opt-In to Medicaid Expansion

By Sharon Ward, Third and State

There is growing bipartisan agreement that the optional expansion of Medicaid provided by the Affordable Care Act is too good an opportunity to pass up.

This month, the Governors of Arizona and North Dakota, both Republicans, announced their intention to opt-in to the Medicaid expansion, joining their counterparts in Nevada and New Mexico. To date, 14 states have decided to expand Medicaid in 2014, and another seven are leaning toward expansion. Pennsylvania remains among the 21 undecided states.

Support for Medicaid Expansion Growing

Here’s what Arizona Governor Jan Brewer had to say about Medicaid:

By agreeing to expand our Medicaid program just slightly beyond what Arizona voters have twice mandated, we will:

• Protect rural and safety-net hospitals from being pushed to the brink by their
   growing costs in caring for the uninsured;
• Take advantage of the enormous economic benefits – inject $2 billion into our
   economy – save and create thousands of jobs; and,
• Provide health care to hundreds of thousands of low-income Arizonans.

Saying ‘no’ to this plan would not save these federal dollars from being spent or direct them to deficit reduction. No, Arizona’s tax dollars would simply be passed to another state – generating jobs and providing health care for citizens in California, Colorado, Nevada, New Mexico or any other expansion state … With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms … Weigh the evidence and do the math. With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the State budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead. I’m committed to doing this, and I want you on my side. Let’s work together in an atmosphere of respect and do what is BEST for Arizona.

For Pennsylvania, the expansion of Medicaid is projected to bring in $17 billion in new federal investments by 2019, while expanding coverage to between 482,000 and 683,000 uninsured adults.

When Governor Corbett gives his budget address on February 5, he will offer a glimpse into the state’s plans to take advantage of this opportunity. Opting-in will create jobs, strengthen our health care system and provide health coverage to working parents, veterans, and seniors.

Governor Corbett and the Pennsylvania General Assembly should consider the benefits and savings that come with a Pennsylvania Medicaid expansion as well as the price of forgoing this opportunity – fewer jobs, a weakened health care delivery system and hardworking people without affordable insurance.

Mind the gap: Opting Out of Medicaid Expansion Leaves Low-income Families Behind

By Michael Wood, Third and State

Federal health care reform is moving forward thanks to the U.S. Supreme Court’s ruling last year – and it is a great deal for Pennsylvania. Unless the state decides to “opt out,” Medicaid coverage will be expanded to include many Pennsylvanians who are uninsured.

One group that will benefit immediately are parents with incomes up to 133% of the federal poverty level ($25,390 for a family of three). The benefits don’t end there: others who don’t receive health coverage through their work will be able to buy insurance on a competitive health marketplace or exchange – making coverage more affordable.

However, if Governor Corbett prevents the Medicaid expansion, it will create a coverage gap for families between 46% and 100% of poverty, as the chart below shows (click on it for a larger view).

Those families between 46% and 100% of poverty earn too much to qualify for Medicaid (for a family of three, this means earning over $8,781 but less than the federal poverty line of $19,090). These families won’t receive Medicaid coverage, and they won’t receive subsidies to buy health coverage.

We all benefit when more people have health coverage. Let’s make the right decision in Pennsylvania and expand Medicaid coverage.