Posts Tagged ‘Green Mountain Care’

Will the ACA Survive the Supreme Court, 2012 Election?

Wednesday, February 1st, 2012

The 26 states that have challenged President Barack Obamas healthcare law face several dilemmas as they try to convince the Supreme Court to declare the law’s Medicaid expansion unconstitutional   The two lower courts that heard the Medicaid challenge ruled in favor of the Obama administration, even as those judges struck down the healthcare law’s individual mandate. Legal experts on both sides of the mandate debate were surprised that the Supreme Court agreed to also hear the Medicaid piece of the state’  lawsuit.  The healthcare law’s supporters claim that the states erred in their initial brief on the Medicaid expansion, which was filed with the Supreme Court.

According to the states involved in the lawsuit. the ACA’s Medicaid expansion is “coercive.” Although state participation in the program is strictly voluntarily, the brief argues, the healthcare law makes it impossible for states to opt out of Medicaid.  The brief tries hard to link the Medicaid expansion to the individual mandate, arguing that states won’t be able to exercise their legal right to leave Medicaid because it’s the only way for Medicaid-eligible residents to fulfill the mandate.

“While the (Affordable Care Act) purports to leave states’ participation in Medicaid nominally voluntary, multiple aspects of the Act evince Congress’ keen awareness that, in fact, no state will be able to reject its new terms and withdraw from the program,” the brief says. “Most obviously, the ACA’s individual mandate requires Medicaid-eligible individuals to obtain and maintain insurance.”  But most Medicaid-eligible people would be exempt from the mandate, said Timothy Jost, a law professor at Washington and Lee University and a supporter of the health law.

Then there’s the Supreme Court case, which will be heard in the spring and a verdict announced prior to the November presidential election. According to Kurt Mainwaring, a ksl.com contributor, “Far-reaching consequences of the court’s ruling will likely impact both the cost of healthcare and the outcome of the 2012 elections.  If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  At present, healthcare costs make up approximately 18 percent of GDP. If expenditures continue on their current trajectory, “the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.”  Translated to real numbers, the Department of Health and Human Services (HHS) notes that Americans paid approximately $1,000 annually in healthcare costs in 1960; more than $7,000 per year in 2007; and are projected to pay more than $13,000 per year by 2018.  This kind of increase in healthcare costs is not sustainable — and these kinds of projections are part of the reason ACA was enacted in the first place.

Beach Conger, a Vermont internist writing in the Burlington Free Press believes that “Medicare for All” — a possibility that was raised during the lengthy debate over the ACA — should be reconsidered.  According to Conger, “Medicare and I were born in the same year. Professionally speaking, that is. We were raised together, and we have been married to each other for what seems an eternity. As with any long-term relationship, we have had our ups and downs, but we have both matured over the years, and I believe we are both the better for it. Without being too vain, I have to say I have done a better job at providing health care, and I have to admit that Medicare has helped me do it.  At first, it just made sure that those retired people who wished to pay me the fees to which those in my line of work have become so accustomed, could actually do so. But eventually it realized that there was more to the business than just money, and it began to keep an eye over my shoulder, making sure I was not leaving undone those things which ought to be done and not doing those things which I ought not.  So I can’t help but think, why not Medicare for everyone? It would be so simple. And that’s when I realized.  It was too simple.”

Dr. Conge, it should be pointed out, lives in Vermont, to date the only of 50 states to enact a single-payer public option — Green Mountain Care.

Medicare for All!

Thursday, June 2nd, 2011

As Vermont becomes the first state in the nation to enact single-payer healthcare coverage, Senator Bernie Sanders (I-VT) and Representative Jim McDermott (D-WA) have introduced legislation to make Medicare for all the law of the land. Called the American Health Security Act of 2011, Senator Sanders said the legislation is necessary because “The United States is the only major nation in the industrialized world that does not guarantee healthcare as right to its people.  Meanwhile, we spend about twice as much per capita on healthcare with worse results than others that spend far less.  It is time that we bring about a fundamental transformation of the American healthcare system.  It is time for us to end private, for-profit participation in delivering basic coverage.  It is time for the United States to provide a Medicare-for-all single-payer health coverage program.”

Sanders and McDermott have strong backing from Arlene Holt Baker, executive vice president of the AFL-CIO; Jean Ross, co-president of the National Nurses United; and Greg Junemann, president of the International Federation of Professional and Technical Engineers.  All three groups are encouraging this fight for real reform.  “Providing a single standard of high quality care for all is a priority for registered nurses who have seen their abilities to act as patient advocates made more difficult as for-profit interests control more patient care decisions,” said Ross, whose union has been in the forefront of the fight for single-payer. “We commend Senator Sanders and Representative McDermott for their vision and passion to help registered nurses create a more just healthcare system through the American Health Security Act and applaud our brother and sisters in labor for their support,”  Physicians for a National Health Program, which consists of doctors and medical students who want real reform, also are supporting the national legislation, which is unlikely to end up on President Obama’s desk for signature.

Writing in the British newspaper the Guardian,  Sanders says that “Under our dysfunctional system, 45,000 Americans a year die because they delay seeking care they cannot afford.  We spent 17.6 percent of our GDP on healthcare in 2009, which is projected to go up to 20 percent by 2020, yet we still rank 26th among major, developed nations on life expectancy, and 31st on infant mortality.  We must demand a better model of health coverage that emphasizes preventive and primary care for every single person without regard for their ability to pay.  It is certainly a step forward that the new health reform law is projected to cover 32 million additional Americans, out of the more than 50 million uninsured today.  Yet projections suggest that roughly 23 million will still be without insurance in 2019, while healthcare costs will continue to skyrocket.”

All Vermont residents will be eligible for coverage under the system, known as Green Mountain Care.” Originally promoted as a “single-payer plan,” the measure is referred to as a “universal and unified health system.”  Governor Peter Shumlin has said he will sign the bill into law.  “This really is an extraordinarily exciting moment for Vermont,” according to Shumlin.  “We have a long way to travel, but I am convinced we can get healthcare right and this is the bill that will get us there.”

Meanwhile in California, some legislators have revived a bill to create a single-payer healthcare system.  It would replace President Obama’s healthcare reform legislation with a more comprehensive system – one that would cost no more than what people already pay.  Opponents categorically deny that assertion.  One academic observer of healthcare policy said, “If you think the fight over affordable care was nasty, you haven’t seen anything yet.  This plan is going to gore a lot of oxen,” said Gerald F. Kominski, associate director for UCLA Center Health Policy Research.  “No.1 is the insurance industry. They are not about to see their business go up in smoke.”

California’s proposed plan establishes a single- payer “Medicare for All” type of program by pooling the money that government, employers, and individuals already pay and using that money more efficiently by cutting out the middle man – insurance companies.  “There are some 6,000 health plans in California, and health care providers spend about one-third of their resources just getting paid,” said State Senator Mark Leno of San Francisco.  There will be other saving opportunities as well – such as bulk purchasing power for everything from pharmaceuticals to hearing aids, eyeglasses and the investment in primary and preventive care.

When asked if he thought the legislation has a chance to become reality in California, Kominski said, “I’ve seen enough things happen to never say ‘never.’  I don’t know how the ongoing financial crises might change public opinion on healthcare to vote for a more fundamental change of healthcare delivery.”

Vermont Taking the Public Option

Wednesday, April 13th, 2011

Vermont – the nation’s second smallest state with a population of just 625,741, according to the 2010 Censusis moving toward adopting a single-payer healthcare system. The House in the Green Mountain State recently passed a bill by a 92 – 49 vote that would set up a five-member board to design a benefits package that would be available to all Vermonters through a state insurance exchange.  According to the legislation, “All Vermont residents shall be eligible for Green Mountain Care, a universal healthcare program that will provide health benefits through a single-payment system.”

The Senate is expected to approve the legislation and send it to Governor Peter Shumlin, who campaigned to reform the state’s healthcare system. At that point, Vermont would need a federal waiver to implement the plan, something that cannot be provided until 2017 under provisions of the Patient Protection and Affordable Care Act (ACA).  Nationally, single-payer healthcare, also known as Medicare for All, has proven popular in polls, but was rejected during the healthcare reform debate.

“This bill takes our state one step closer to a system that ensures that all Vermonters have access to the care they deserve and contains costs,” House Speaker Shap Smith said. According to Shumlin, passing a state-funded healthcare system would make Vermont “the first state in the country to make the first substantive step to deliver a system where healthcare will be a right and not a privilege, where healthcare will follow the individual, not be a requirement of the employer, and where we’ll have an affordable system that contains costs.”  The so-called RomneyCare system in Massachusetts is the framework for the Affordable Care Act.

We have a historic opportunity to fix a broken health care system,” said Representative Mark Larson (D-Burlington) and chairman of the House Health Care Committee.  He said the goal is to “provide healthcare security to Vermonters” and decelerate the growth of healthcare costs.  Supporters say the bill is designed to provide health insurance to the 47,000 Vermonters who don’t have coverage, provide better insurance to the more than 160,000 underinsured residents and cut costs.  Opponents say that the state is moving too fast into uncharted territory.  They say the proposed health system’s ultimate cost and how it would be funded aren’t made clear in the legislation.

One of Vermont’s leading opponents to Green Mountain Care is the Ethan Allen Institute, which describes itself as a free-market think tank.  John McClaughry, the institute’s president, argues that public option supporters rely on three arguments — that healthcare is a human right and that there is significant unhappiness with the operation and financing of the current system.  The third reason, he said, “is political and rarely stated.  It will put the government in control of all employers, medical providers, insurers (if any), and patients.  That will mean many more jobs for (unionized) government bureaucrats.  It will require unionization of doctors and other professionals who will have to bargain with the public body over their compensation and working conditions.  It will mean more campaign contributions and votes for politicians who will work to rig the system in favor of their particular group of ‘stakeholders.”

The Connecticut Coalition for Universal Health Care disagrees.  “Healthcare providers would be in a fee for service practice, and would not be employees of the government, which would be socialized medicine,” according to the Coalition.  One model of socialized medicine is the Veterans Administration’s (VA) network of hospitals, paid for by the government and managed by federal employees.  Many veterans feel they receive better healthcare outcomes through the VA than at for-profit hospitals.  Another model is TriCare, which administers the worldwide healthcare plan for 9.6 million eligible beneficiaries of the uniformed services, retirees and their families, also a superior system.