If You Can’t Beat ‘Em…

 Health Care, Politics  No Responses »
Feb 062013
 

While many states have refused to set up health insurance exchanges, resistance to the Obamacare Medicaid expansion appears to be crumbling. I previously wrote about Arizona Governor Jan Brewer’s decision to proceed with the expansion. And now Ohio’s John Kasich, another Tea Party favorite, has declared his own support for a Medicaid expansion. Not wanting to feel left out, Michigan’s Rick Snyder embraced an expansion as well.

These governors deserve some praise for placing the welfare of their constituents above political ideology. But their change of heart occurred only after an electoral drubbing for Republicans. Would they have been as willing to advocate for a Medicaid expansion if Romney occupied the White House? Probably not. These governors discovered pragmatism only after political defeat. That’s not how good governance should work. We shouldn’t have to endure nearly three years of paranoid hysterics before political leaders can come to their senses and do the right thing. I’m glad and relieved that low-income people in these states will have health coverage, but it shouldn’t have been such a slog to reach this point.

Making Obamacare User-Friendly

 Health Care, Wonkery  No Responses »
Jan 302013
 

Sarah Kliff writes about the challenges of  creating a health insurance exchange that is easy to use and that doesn’t overwhelm consumers with information. I’m not closely involved in the design of Minnesota’s exchange, but I’ve sat in enough design sessions to understand that this will be an iterative process. No state exchange (or the federal exchange, for that matter) will be perfect on day one. It will take time for officials to get the kinks out and optimize how information is presented. Unflattering news reports about how State X bungled its exchange implementation are a near-certainty in the coming months, but they shouldn’t be interpreted as the Fall of Obamacare. This is complicated stuff and complicated stuff takes time to get right.

The most important function of these exchanges is to ensure that people can get timely access to affordable health insurance. As long as that happens, states should have the breathing room they need to make necessary improvements.

ER Visits For Everyone!

 Health Care  1 Response »
Jan 232013
 

Like a lot of conservatives, Governor Phil Bryant of Mississippi doesn’t think low-income Americans have any trouble accessing health care because, hey, there’s always the emergency room. And like a lot of conservatives, he doesn’t seem to grasp that emergency rooms cannot adequately serve the primary care needs of millions of uninsured and underinsured Americans. What’s even more depressing is that Bryant uses this tired argument to justify his refusal to expand his state’s Medicaid program to cover more low-income people at no additional cost to the people of Mississippi. Even after an election that seemed to reaffirm popular demand for a strengthened safety net, Bryant prefers to stand behind ideology rather than acting in the best interests of his constituents.

Fortunately, other governors are rediscovering pragmatism. Arizona Governor Jan Brewer, Tea Party favorite and unabashed finger-wagger, recently announced that her state will proceed with a Medicaid expansion.

The Public Trust And Private Actions

 Health Care, Politics  No Responses »
Dec 112012
 

MPR is running an interesting investigative piece about two state legislators whose business dealings and legislative agendas intersect to a point where colleagues are questioning their ethics. Last year, as part of the deal to end the state government shutdown, the Republican-led legislature passed a law that would require some people enrolled in state-subsidized MinnesotaCare health insurance to purchase private insurance with the help of a state voucher. Individuals purchase coverage with the help of an insurance broker. After the law passed, Representative Steve Gottwalt and Senator David Hann, both sponsors of the legislation, became licensed insurance brokers. Gottwalt is now associated with a firm that lobbied for the Healthy Minnesota voucher program. Both legislators claim they do not serve anyone in the program.

It’s doubtful that either man has done anything unethical. They are free to pursue a living and it doesn’t appear that they have personally profited from the program. Still, their career choices seem a little tone-deaf to public perception. Gottwalt in particular might have given more thought to joining a firm that had testified before his committee just last year.

Meanwhile, the Healthy Minnesota program that both men championed isn’t proving too popular. It might have something to do with the fact that coverage is both costlier and less comprehensive than what was available under MinnesotaCare.

Evangelizing Obamacare

 Health Care, Wonkery  No Responses »
Nov 212012
 

If health care reform is to be a success, the Obama administration must find a way to educate people about how the law affects them. As Sarah Kliff notes in another typically smart article, those who stand to benefit most from the Affordable Care Act have no idea how the law affects them. They don’t know that they may be eligible for insurance subsidies or Medicaid. They don’t know that they will be able to purchase insurance even if they have preexisting conditions.

A massive public education effort will be needed to spread the word about the law’s benefits before open enrollment begins in the exchanges next October. The administration has a clear interest in ensuring a successful kickoff, but so does another critical stakeholder group—the insurance companies. They need lots of people to enroll in their plans to cover the costs of covering people with more chronic health care conditions. That gives me some confidence that we’ll see a coordinated and effective public outreach campaign. The last thing the administration wants to see at this time next year is news headlines proclaiming the lack of interest in Obamacare.

Medicaid: A State Of Disunion

 Health Care, Wonkery  No Responses »
Nov 162012
 

Last week, I wrote about how many GOP-led states are declining to establish health insurance exchanges, choosing instead to cede to a federally-administered exchange. Residents of these states will still be able to purchase insurance and receive subsidies through the federally-facilitated exchange. But as Sarah Kliff explains, these states are also declining to participate in the Medicaid expansion that the Supreme Court made optional in its June ruling. Low-income people in these states will suffer as a result. They can go to the Exchange, but coverage will not be nearly as affordable as Medicaid. Hospitals and other providers will also lose out on funds to deliver what is currently uncompensated care to these individuals.

Denying access to affordable health care for what amounts to geographical reasons is both cruel and unnecessary, but those are the politics of the moment. Perhaps these states will be more inclined to expand Medicaid once bordering states do so, sparking complaints from local advocates and health care providers. Some states are pushing the Obama administration to lower the income threshold required for the expansion, but I’m not sure that diluting the law’s intent is a good idea. Medicaid is already a fragmented program with wildly varying eligibility requirements across states. Allowing states to duck that requirement would only perpetuate that fragmentation, which the Affordable Care Act was designed to remedy. An all-or-nothing expansion requirement might not help some people in the short term, but it will eventually result in a stronger Medicaid program.

On The Sidelines Of Health Care Reform

 Health Care, Wonkery  1 Response »
Nov 092012
 

I’m looking forward to a long weekend free of obsessively refreshing the FiveThirtyEight blog. For your Sunday health policy reading, I recommend Sarah Kliff’s piece on how recalcitrant Republican governors are letting the federal government step in to run health insurance exchanges instead of establishing state-based exchanges. GOP governors figure that, rather than try to do all the heavy lifting necessary to set up an exchange, it’s better to let the feds shoulder the burden.

It’s hard to disagree with their reasoning. Minnesota is creating an exchange and it’s a gargantuan task requiring lots of planning and coordination. I’m learning more about business process modeling than I ever anticipated or desired. Minnesota will be successful in its efforts, but I don’t see how a state that previously resisted health care reform could now reverse course and have an exchange ready to go by next year.

Medicaid And The Election

 Health Care, Politics  No Responses »
Oct 292012
 

Paul Krugman provides a good overview of Medicaid and its success in providing quality health care to millions of Americans. He rightly points out that, should Romney become president, huge cuts will almost certainly be made to the program. And then there’s his threat to undo the Affordable Care Act, effectively taking away access to Medicaid for countless low-income individuals and families. Medicaid, more than any other entitlement program, is politically vulnerable should Obama lose the election. Republicans have exhibited deep hostility to the program in recent years as their ideology careens ever rightward and Medicaid has few potent allies.

Don’t give any credence to Republican claims to “reform” Medicaid and “give more power to the states”. Such high-minded language merely distracts from their true intent: to hollow out one of the nation’s most effective public health care programs.

Protecting Medicaid

 Health Care, Politics  1 Response »
Oct 092012
 

The Obama campaign is running this ad in several swing states highlighting Romney’s plans to gut Medicaid:

It would be nice if the ad featured some kids and adults with disabilities, but I get that most voters probably know or knew an elderly person living in a nursing home. The prospect of Grandma being thrown out on the street is more likely to provoke a reaction than the neighbor kid with cerebral palsy losing his attendant services. I’m just glad to see that the future of Medicaid is finally getting some attention as a campaign issue. Medicaid, more than any other major entitlement program, is vulnerable to devastating cuts if Republicans win the White House and Congress.

Man Of Conviction

 Health Care, Politics  No Responses »
Sep 262012
 

Romney in 2006: By law, emergency care cannot be withheld. Why pay for something you can get free? Of course, while it maybe free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes.

Romney on 60 Minutes a few days ago: If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance and take them to the hospital and give them care. And different states have different ways of providing for that care.

Romney seems to have experienced a dramatic change of heart regarding the cost-effectiveness of emergency rooms as primary care centers. Back in the Aughts, he made a sensible case for ensuring that people had other options for accessing medical care besides the ER. Now, he seems to be implying that going to the ER is better than nothing.

The 2006 version of Romney would probably be a much more formidable opponent than the current model.

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