Posts tagged ‘Medicaid’

Republican Officials Work ‘Under The Radar’ To Implement Obamacare In Their States


Republican Officials Work ‘Under The Radar’ To Implement Obamacare In Their States.

By Tara Culp-Ressler on Sep 17, 2012 at 1:30 pm

Mississippi Insurance Commissioner Mike Chaney
Republican lawmakers are continuing to delay setting up the state-run health insurance exchanges required under Obamacare as an act of resistance against President Obama’s health reform law. Even though the federal government will be forced to step in to implement exchanges for the states that don’t turn in their exchange plans for approval by November, some Republican governors are refusing to work on exchanges until after the election in case Mitt Romney wins and repeals Obamacare. However, despite the political battle over health care reform, not all Republican officials are convinced that refusing to set up health exchanges is the best course of action.

Reuters points out that some GOP officials like Mike Chaney, Mississippi’s insurance commissioner, have quietly worked against their party to take steps toward creating state-level insurance exchanges. Although his state’s lawmakers are deeply opposed to Obamacare — Mississippi was one of the 26 states that sued the administration over the health reform law — Chaney explained that resisting Obamacare’s health care exchange will force state officials to scramble after the November election:

Insurance officials like Chaney, however, want a better contingency plan in case the Republicans lose, as the 10-day window between the election and the exchange deadline will not give them enough time to prepare an exchange.

“They can’t just leave this to the will of the wind,” Chaney said in an interview.

“This isn’t about politics. It’s about following the law,” he added. “And I think I’m better equipped to operate an exchange in my state than the federal government.”

Chaney is not the only Republican to take this stance. Reuters interviewed half a dozen other Republican state health officials who agreed they would prefer to plan for state-run exchanges now rather than accept a federally-run exchange when the clock runs out, and some are working to do so. However, the contentious political climates in their states don’t always make this possible. Although Chaney said he worked “under the radar” to prepare for an exchange in Mississippi, mounting pressure from conservatives in the state curbed his work in mid-July, and he has since released a statement promising to hold off on any further work toward establishing an exchange until after the election.

Former Senate Majority Leader Bill Frist (R-TN) has already urged Republican governors to embrace health care reform and take the necessary steps to set up exchanges in their states. As Frist and Chaney both point out, state-run exchanges are actually consistent with conservative federalist ideals. If Republican legislators continue to block them, they could help prove Chaney’s assertion that “this isn’t about politics” very wrong.

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Why Medicare Cards Still Show Social Security Numbers – NYTimes.com


Why Medicare Cards Still Show Social Security Numbers – NYTimes.com.

A Medicare identification card.The New York TimesA Medicare identification card.

Images of a woman waving her Medicare card on television at the Democratic convention last week in Charlotte, N.C., prompted the folks at Credit.com and others to ask: Why do Medicare cards still have Social Security numbers on them anyway, when access to the numbers can post a risk of identity theft?

The answer is that the federal government has been dragging its heels for years on making a change, because, according to various reports from the agency that oversees Medicare, the Centers for Medicare and Medicaid Services, it would be both expensive and complex technologically to re-issue cards with new identification numbers.

According to testimony from a C.M.S. official before Congress in August, “transitioning to a new identifier would be a task of enormous complexity and cost and one that, undertaken without sufficient planning, would present great risks to continued access to health care for Medicare beneficiaries.”

About 48 million Americans carry Medicare cards that use their Social Security number as part of their health-claim number.

In a report issued in 2006, C.M.S. said it would cost $300 million to remove SSNs from Medicare cards. Then, in an updated report last November, it said it would cost at least $803 million, and possibly as much as $845 million, depending on the option chosen. Much of the cost, the agency said, was for upgrading computer systems not only at the federal level, but also at the state level, for coordination with Medicaid systems.

But the Government Accountability Office said in its testimony to Congress in August that the methods and assumptions that C.M.S. used to develop its costs estimates “raise questions about their reliability.”

“Lack of action on this key initiative leaves Medicare beneficiaries exposed to the possibility of identity theft,” the G.A.O. said. It recommended that C.M.S. select an approach to modify or remove the numbers from Medicare cards and develop an “accurate, well-documented cost estimate.”

According to the G.A.O., C.M.S. agreed with its recommendations and will conduct a new estimate with improved methodology. That’s likely to take some time. So don’t expect Medicare cards free of the numbers anytime soon.

Meantime, the AARP and the Privacy Rights Clearinghouse suggest making a photocopy of your Medicare card, cutting it to wallet size and cutting out the last four digits of your Social Security numbers. Carry the photocopy in your wallet instead of the actual card. (You’ll still need your original card the first time you visit a provider, because they’ll likely want a photocopy of it).

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How to Fix Health Care Without the Mandate: Put Single-Payer On the Table by Sarah van Gelder


What happens if the Supreme Court strikes down the “individual mandate” in the health care reform law?

Commentators ranging from former Labor Secretary Robert Reich to Forbes Magazine columnist Rick Ungar agree: Such a decision could open the door to single-payer health care—perhaps even make it inevitable.

We don’t need to assume that our health care policy must be designed to maintain the health-industrial complex.

This may be the best news about health care in years. Because ever since Republicans convinced the Obama administration to drop the “public option” in the Affordable Care Act, health reform has been in trouble. True, most Americans favor many of the provisions of Affordable Care Act. But the overall plan rests on forcing you and me to buy insurance from the same companies that have been driving up the costs of health care all along—the same companies that have been finding creative ways to avoid covering needed care, shifting costs on to patients, and endlessly increasing premiums and out-of-pocket expenses for all of us.

Forcing all Americans into a failed system is bad policy, and it’s not just President Obama’s opponents who say so.

What the Doctors Ordered

When the Supreme Court agreed to hear a challenge to the Affordable Care Act brought by 26 state attorneys general, one of the supporting briefs came from an unexpected source—a group of 50 doctors who believe that single-payer health care is the way to cover everyone and contain costs. As a model for a revamped health care system, they point to Medicare, which covers millions of seniors while devoting just 2 percent of expenditures to overhead (compared to as much as 16 percent for private insurers).

In spite of all the fear about government involvement in health care, Medicare is enormously popular; in a recent poll, two-thirds of Americans oppose changing Medicare to something more like private insurance. In the Medicare model, as in Canada’s single-payer system, health care providers are in private practice, but the government acts as insurer, covering everyone. The money for the program comes from payroll taxes.

This model is just one of a variety of ways that industrialized countries provide universal coverage; only the United States does not yet offer universal coverage at all, and the impact of our fragmented, privatized approach ripples throughout the economy and into the lives of families that face bankruptcy and exclusion from needed treatment.

While we in the United States spend far more on health care, per person, than any other nation, we’re way behind other wealthy countries when it comes to our actual health. The residents of 25 other countries—all of which spend less on health care than we do—can expect to live longer, on average, than U.S. residents. In a recent study of 19 industrialized countries, the United States came in last when it came to averting preventable death. Researchers say that amounts to more than a 100,000 avoidable deaths each year.

We devote 15 percent of our economy (by GDP) to paying for health care (or $6,402 per person each year), and still leave millions without coverage. In contrast, the French spend 11 percent of GDP on health care (or $3,374 per person) and cover everyone; the French live two years longer, on average, than Americans, and have better health by all key measures.

Follow the Money

If we’re spending so much for poor results, where is all the extra money going? Private, for-profit health insurance companies spend big on overhead: covering the paperwork and arguments about who will cover what, finding ways to avoid covering people who might require costly services, disputing charges from health care providers. They spend money on marketing and on lobbying Congress, federal regulators, and state lawmakers. They pay dividends to shareholders and they pay executives six- or seven-figure compensation packages. No wonder premiums keep rising.

None of these costs are incurred by Medicare or other national insurance programs.

Asking each of us to choose among competing plans is like playing against the house in a casino—it might seem as though you’re getting choices among slot machines, but really, the odds are stacked against you.

Some argue that patients are better off with competing insurance companies because that gives them a choice. Perhaps this is true of a patient who spends many hours required to read the small print in competing insurance plans, producing spreadsheets to track the multiple variables, guessing what sort of coverage they and their family will need in years to come, and hoping that they made the right choice when an unexpected accident or illness means their life depends on the bet they made. On the other side, insurance companies have battalions of lawyers and adjusters making bets about coverage, co-pays, and deductibles—coming up with ways to cover less.

Asking each of us to choose among competing plans is like playing against the house in a casino—it might seem as though you’re getting choices among slot machines, but really, the odds are stacked against you whatever choice you make.

Where choice really matters to most people is in choosing health care providers. In France, where public financing of health care is the rule, patients actually have more choices among doctors than do Americans, who must choose among health care providers preferred by their insurance company.

So the doctors who are calling on the Supreme Court to strike down the individual mandate are on to something. Instead of locking us in even more tightly to an inefficient private insurance system, which has built-in incentives to take more of our money and do less for us, they argue we should switch gears. We’re spending $200 billion more per year than we would need to under a single-payer system, they say. We pay more out-of-pocket than other countries, and the Obama Affordable Care Act wouldn’t fix that.

What do Americans Want?

In poll after poll, a majority of Americans have expressed support for single-payer health care or national health insurance. This is true in spite of the near media blackout on this topic, and the failure of most national politicians to even consider single-payer as an option (the Obama administration and Democratic leadership in Congress excluded single-payer advocates from the key summits and hearings leading up to the passage of the health care bill).

In Massachusetts, which has had time to try out policies very similar to those in the Affordable Care Act, over 5 percent of the population remains uninsured. And, according to the doctors’ brief, local initiatives calling for single-payer health care passed by wide majorities in all the Massachusetts districts where they were on the ballot.

Vermont has adopted a single-payer health care plan, and the California Assembly twice passed single-payer, only to have it vetoed by the governor.

Single-payer health care, in short, is far more popular than the political establishment likes to admit—while requiring individuals to purchase health coverage from private insurance companies is wildly unpopular across the political spectrum. According to a recent poll, only a third of Americans favor the individual mandate, but 70 percent favor expanding the existing Medicaid program to cover more low-income, uninsured adults.

Here’s something to ask yourself: If you’re on Medicare now, would you give it up to move to a private insurance plan? If you’re not now covered and you could sign up for Medicare today, would you?

Medicare for All

That contrast offers a good starting point. We don’t need to assume that our health care policy must be designed to maintain the health-industrial complex and their lobbyists in the manner to which they have become accustomed. Instead, we can expand Medicare to cover more and more age groups, until everyone is covered. We could all then have access to a program that keeps overhead low, is wildly popular among its clients, and is similar to programs in Europe, Canada, Japan, and elsewhere that have excellent records of cost containment, universal coverage, and great health outcomes.

So what happens if the Supreme Court overturns the individual mandate or—as now seems possible—rejects the entire package? Such a move could turn out to be a great boon to those who doubt the wisdom of relying on private, profit-focused insurance companies to cover us when we get sick. It could offer us the opportunity to get the sort of proven universal coverage we can count on.


Sarah van Gelder wrote this article for YES! Magazine, a national, nonproifit media organization that fuses powerful ideas with practical actions. Sarah is co-founder and executive editor of YES!.

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Reader Comments

Universal Health Care

Posted by Dilys Collier at Apr 06, 2012 08:14 PM
We Canadians love it even if it isn’t perfect. USA Republicans seem to consider Canadians “socialists.” We aren’t; our country is still run on a capitalist economic system (unfortunately). Socialism is an entirely different economic system. That’s not us. Our geographical circumstances determine our culture. During our extreme Canadian temperatures, we literally can live or die depending on whether we co-operate with one another. We don’t believe in leaving an injured Samaritan on the side of the road and passing by on the other side. Instead, we believe in offering assistance to everyone (regardless of colour, gender, or religion) by ensuring basic available health care to all.

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How to Fix Health Care Without the Mandate: Put Single-Payer On the Table by Sarah van Gelder.