A Most Important Demo You’ve Never Heard of… “One Care”

A new report from the Kaiser Family Foundation puts a welcome spotlight on a most important U.S. health reform demonstration — called One Care — going on first and right now in Massachusetts.   How wonky is this?  The report title says it all: Early Insights from One Care: Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible BeneficiariesWhat’s it all about?

1-care-banner-headerA population of Americans known as the “dual eligibles” is among the nation’s most needy and expensive groups.  They are 9.6 million elderly and disabled low-income Americans who are dually enrolled in both Medicare and Medicaid.  For most of the 50 year history of the two programs, the “duals” fell between the cracks, getting poorly coordinated or no care.  Twelve years ago, with federal support, Massachusetts’ Medicaid program, called MassHealth, started a “Senior Care Options” (SCO) program for coordinated/managed care for duals over age 65. Continue reading “A Most Important Demo You’ve Never Heard of… “One Care””

Hidden ACA (1) — An Alternative Report Card

In my experience, only a tiny fraction of Americans recognize the variety and depth of policies included in the Affordable Care Act. In fact, a vast array of policies reside in the law’s 10 titles, and so many involve interesting and compelling stories. So I’m going to start using this blog as a place to write about many of these stories, and I will call the series “Hidden ACA” so you know what I’m doing.

To start, I offer an alternative 5-year report card on the ACA. Of late, we’ve seen many columns and op-eds evaluating the ACA on its five year anniversary in March. I offer a different approach – grading the law by evaluating the success or failure of the 10 titles individually. Here’s my summary report card based on an assessment of how each ACA title has been implemented, followed by a more detailed discussion of each:

  1. Quality Affordable Coverage for all Americans — Private insurance reform — Grade A-
  2. The Role of Public Programs — Medicaid — Grade B+
  3. Improving the Quality and Efficiency of Health Care — Medicare and Delivery System Reform — Grade A-
  4. Prevention of Chronic Disease and Improving Public Health — Grade B-
  5. Health Care Workforce — Grade C+
  6. Transparency and Program Integrity — Grade A-
  7. Improving Access to Innovative Medical Therapies — Grade A-
  8. Community Living Assistance Services and Supports — Grade F
  9. Revenue Provisions — Grade A
  10. Strengthening Quality Affordable Health Care for All.

Overall Grade – A-

A combination file photo shows opponents (L) and supporters (R) of Affordable Healthcare Act rally on the sidewalk at the Supreme Court in Washington on March 28, 2012 and on June 28, 2012 respectively. The Obama administration said on July 2, 2013 it would not require employers to provide health insurance for their workers until 2015, delaying a key provision of President Barack Obama's healthcare reform law by a year, to beyond the next election.  REUTERS/Jonathan Ernst (L) and  REUTERS/Joshua Roberts (R)  (UNITED STATES - Tags: POLITICS HEALTH) - RTX11B3H
REUTERS/Jonathan Ernst (L) and REUTERS/Joshua Roberts (R)

Let’s consider each Title, one by one: Continue reading “Hidden ACA (1) — An Alternative Report Card”

11.7 + 11.7 = 23.4 million Enrolled via ACA

We had previously  learned in March that an estimated 11.17 million Americans took advantage of private insurance coverage offered through the ACA’s exchange/marketplaces through the second enrollment period ending in February.  Today, we learn that a similar number, 11.7 million, represents the number of low income Americans newly enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) between 2013 and February 2015.  That’s Pappy_O'Daniel's_logo23.4 million Americans directly benefiting from the expansion provisions of Titles I and II of the ACA.

Take a look at the report released last Friday by the US Department of Health & Human Services with the details, including state by state breakdowns.  Some details:

  • From 57,594,096 in September 2013, Medicaid/CHIP enrollment reached 70,515,716 in February 2015
  • 29,245,000 of the 70.5 million are children, nearly 30 million
  • States expanding Medicaid saw enrollments jumps averaging 27%, while the states refusing to expand saw only an 8% increase
  • Eye-popping increases — Kentucky 85%; Oregon 69%; Nevada 67%; New Mexico 51%; Washington 50%; Arkansas and West Virginia 49%; Rhode Island 41%
  • Surprises among non-Medicaid expanding states — North Carolina and Tennessee 16%; Montana 14%; Mississippi 12%
  • Just depressing — Alaska, Nebraska, Utah <1%; Wyoming 1%; Alabama and Missouri 3.5%.

Of course, if the resisting states had expanded Medicaid, we would see approximately 4 million more already enrolled in Medicaid — they will come, it’s just a matter of time (Montana is only the latest, not the last).

Republican lawmakers in DC, by and large, despise Medicaid — during the ACA debate in 2009 on Capitol Hill, Sen. John Cornyn (R-TX) called it the “gulag” of the American health care system.  They say this in spite of the fact that, these days, most of the 70+ million Americans enrolled in Medicaid get their coverage through private managed care plans.  Oh well, as Governor Pappy O’Daniel remarked in the movie, “O Brother, Where Are Thou,” “there ain’t no accountin’ for taste.”  The Romans, more elegantly, would have said: “De gustibus non est disputandum.”

Here’s something that’s hard to dispute.  More and more Americans are coming to appreciate Medicaid as a reliable and affordable source of health insurance coverage.

The Good News and the Bad — Another ACA Day

If you’re like me — and I pray you’re not — your email inbox drowns every day with news about the ACA and health policy in every imaginable direction.  Sometimes, two messages get juxtaposed next to each other in ways that illuminate a higher truth.  I felt that way today.

First, came an email update from the Urban Institute and their Elevate the Debate project.  Just look at these headlines, all based on newly released data:

Brief30Fig1TOPBig things, good news.  I am especially impressed with the drop in uninsurance among adults with chronic health conditions such as diabetes, cardiovascular disease, hypertension, and asthma.  Real progress and something to feel good about.

Then, the next email is from the Blue Cross Blue Shield Foundation of Massachusetts offers a wealth of new data on rising health insurance costs, especially deductibles and other cost sharing, confronting Massachusetts health consumers: Rising Health Care Costs in Massachusetts: What It Means for Consumers.  What it means is not encouraging:

“The impact of these changes in health insurance products can be seen in spending trends, which show that by 2013, nearly one in ten adults spent over 10 percent of income on out-of-pocket health care costs.  For an insured family of four with an income three times the federal poverty level (about $71,000 in 2013), that represents a burden of more than $7,000 per year over and above the cost of insurance premiums.”

Lots of progress and good news, and lots of discouraging trends as well.  The the Blue Cross data only covers Massachusetts, the same trends are in evidence all over the nation, and worse in many other states.  In the polarized craziness of the ACA, the news has to be all good or all bad, with no room for ambiguity or complexity.  That’s not real and that’s not life.

The ACA is responsible for some of the most important gains in social and economic justice in our lifetime.  And, we still have many vitally important gaps to close and gains yet to be made.  That’s reality.

 

Advertising the ACA’s Winners

In the five-plus years since the signing of the Affordable Care Act in March 2010, precious little media advertising has been purchased to promote the law and its benefits for so many Americans.  This failure has happened in the context of an avalanche of negative advertising funded by the law’s many affluent opponents.  Hence, one important element that explains the law’s lack of broader popularity.

In the time leading up to the US Supreme Court’s expected decision in late June on the King v. Burwell suit that could eliminate health insurance subsidies for nearly 10 million working Americans, the Community Catalyst Action Fund has attracted some $250,000 in support to launch some pro-ACA advertising with an explicit political pitch and punch.  It will run only a few times during shows such as Meet the Press and Face the Nation.  You can see the ad below:

More important will be the push to get the ad out and around social media.  The point is to help folks make the connection between this abstract lawsuit and their political power.  Let me know what you think of the ad — and if you like it, please circulate it around.  (Disclosure: I sit on the board of the CCAF which is affiliated with Community Catalyst.)

Diagnosing Vermont’s Single Payer Crash

I have a commentary in this week’s New England Journal of Medicine on “the demise of Vermont’s single payer plan.” Beyond what’s in the article, here are some points of note.

First, as some of ardent single payer proponents note, the plan was never “pure” single payer because VT Gov. Peter Shumlin never envisioned including Medicare in the system.  So it would have been single payer — except for Medicare and other federal programs that would have been challenging to include.  Though including Medicare in the original plan would, quite likely, have been politically suicidal, the point is well taken.

VermontSP

Second, Vermont’s move in this direction in 2011 was the most exciting and important pro-single payer development in a generation at least.  A state chief executive with a strongly Democratic legislature in a small, progressive and compact state — one could hardly imagine a more auspicious opportunity.  Add to that the disappointment among so many Democrats in 2010 that the Affordable Care Act did not go further.  I admit to being caught up in the exuberant enthusiasm. Continue reading “Diagnosing Vermont’s Single Payer Crash”

8% of Americans Know the ACA Costs Less than Expected

A new Kaiser Family Foundation tracking poll on the Affordable Care Act is out today showing a teensy increase in public favorability toward the ACA.  The biggest surprise is from this chart below regarding public beliefs on whether the ACA is turning out to be more expensive than anticipated, on target, or less so.  See the results below:

1 kff

One had to wonder where public opinion would be if Americans understood that the law is coming in as far less expensive than projected by the Congressional Budget Office when the law was signed in 2010.  Maybe not at all.  And certainly, one significant reason the law is coming in as less than projected is because of the US Supreme Court’s ruling in 2012 that the expansion of Medicaid had to be optional, and not mandatory, for states.  The 22 states that have not expanded Medicaid, including the behemoths of Texas and Florida, have played a role in keeping costs down.

Though so has the unexpected and dramatic slowdown in the rate of health spending growth played a substantial role in the decline.  And perhaps, just perhaps, the avalanche of anti-ACA advertising as well as the common assertions by ACA opponents that that ACA’s costs are exploding has had an impact on public beliefs as well.

For the record, the chart below shows the decline in cost estimates of the coverage provisions of the ACA (by far, the biggest cost items in the law).  It’s been a steady decline and far below the 2010 estimates:

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