Posts Tagged ‘public option’

Will California Opt for the Public Option?

Wednesday, March 7th, 2012

Although Vermont became the first state in the union to adopt a public option in healthcare, it may soon have company.  As Vermont Governor Peter Shumlin said when signing the legislation, “We gather here today to launch the first single-payer healthcare system in America, to do in Vermont what has taken too long – have a healthcare system that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, isn’t required by an employer –  that’s a huge jobs creator,” Shumlin said.

The enormity of creating a public option hasn’t stopped tiny Vermont, which might seem like an unlikely place for a major revamp of the health insurance system: “By most standards, Vermont’s health care system already is one of the nation’s best. The United Health Foundation has ranked Vermont the healthiest state in the country four years in a row. Fewer than 10 percent of Vermonters lack health insurance, one of the lowest rates in the country.”

And then there’s California.  In a giant warehouse in Alameda, an army of  phone operators are employed by a large health insurance plan, and they’re willing to go the extra mile for their customers. They’ll schedule a doctor who will make home visits, a pharmacist who will drop off a prescription, and even help fill out an application for food stamps.  “We do things for them that a traditional, commercial health plan doesn’t do,” says Ingrid Lamirault, chief executive officer of the Alameda Alliance for Health, a county-run, not-for-profit insurer.

Although the much celebrated, and much maligned, public option may have died in Congress, it’s alive and well in California, which is unique in the nation for having public health insurance plans that are run by its counties.  California’s plans stretch from San Francisco to the Mexican border and cover 2.5 million residents.

The Alameda Alliance for Health — like a private insurance company — has a network of doctors and hospitals and covers 200,000 people in Oakland and neighboring communities.  Much like private health insurance companies, the alliance also runs a managed care plan for Medicaid beneficiaries and additional plans for county workers.   The alliance’s Lamirault thinks this is just the beginning.  In 2014, when the Patient Protection and Affordable Care (ACA) becomes law, millions of Americans will be able to buy coverage through state-based insurance exchanges. In California, government-run public plans, like the Alameda Alliance for Health, will compete with private insurance companies for all those new customers, those who run the county plans believe they can offer a robust network of doctors and hospitals to bargain shoppers looking for affordable coverage. “I think when some people get to make a choice,” according to Lamirault, “having local offices they can walk into and get help with things and get their questions answered, and when they call customer service they get their calls answered in under two minutes. Those kinds of things are important to them.”

California is unique in that many public county systems also contract with private physicians and top-notch research hospitals. They even share the same lobbying group as the big-named insurance companies, the California Association of Health Plans.  Some of those companies don’t have a lot of love for their public brethren. “Certainly, there are some health plans that didn’t like the idea of having to compete with these public plans,” said Anthony Wright, a public plan booster and executive director of Health Access, a Sacramento-based health care consumer advocacy group. “Especially ones that, having come out of the Medicaid program, are used to providing care at cheaper rate.”

Some California insurance companies say they will happily compete on price so long as the public plans do not get preferential treatment.  Doctors and hospitals already accept low reimbursement rates from public plans, often as part of their charity care. That lets the public plans keep their premiums low, although private plans say they are charged higher prices.

The preferential treatment is not likely to last beyond the 2014 opening of the exchanges in California to people with higher incomes, the government-run plans will have to pay providers more than they do now, according to Sumi Sousa, officer of policy development at the San Francisco Health Plan. Sousa says the belief that public plans always cost less just isn’t true. “Some commercial providers, because they’re so large, they’re able to spread their cost over a much broader network,” Sousa said. That’s not the case for many county-run health plans in California, which are quite small.  Still, says Sousa, the public plans do have low overhead: Executives earn a fraction of the salary paid to the big CEOs, and they have no stockholders.

Additionally, the public option is likely to be on California’s 2012 ballot.   Jamie Court, executive director of Consumer Watchdog, a Santa Monica-based consumer advocacy group, plans to put an initiative to add a state-run healthcare public option on the ballot. Opponents say the initiative doesn’t improve the way healthcare is delivered and paid for.  Despite critics, Court says he’ll push forward on his plans to circulate a petition to the public.  “We believe the premium regulation is definitely something that Californians overwhelmingly favor, and we think the public option is something that they still favor,” Court said.  Court has written that health insurance requirements are a motivating force for the initiative: “By 2014, all of us will be required to buy health insurance or face tax penalties. The problem is that health insurance companies can charge whatever they like and raise premiums at will in California.”

In opposition, Micah Weinberg of the Bay Area Council, say rising rates reflect rising health care costs and extended life spans, and the government should let competition keep rates down. Weinberg calls himself an “enthusiastic supporter of healthcare reform,” and argued on KPCC’s Patt Morrison Tuesday that the system is already making reforms — reforms he feels the public option doesn’t address.  “We’re expanding insurance coverage by giving people insurance subsidies to purchase insurance through the exchanges, so that’s exactly what we’re doing.  A public option doesn’t get us any closer to that goal and it’s not a helpful addition to what we’re trying to accomplish,” says Weinberg.

Hedging Their Bets, Insurers Setting Up Health Insurance Exchanges

Wednesday, February 22nd, 2012

Health insurance companies are trying to play an important role in healthcare reform as the Patient Protection and Affordable Care Act (ACA) threatens to upend their marketplace in 2014 by creating their own exchanges. Health plans are trying to lock in business before government-sponsored health insurance exchanges go online in 2014.  According to Kaiser Health News and reported by Minnesota Public Radio, the largest insurers are creating their own private insurance exchanges to protect themselves against competition from the public exchanges.

The implementation of the ACA is the most significant change to healthcare since Medicare and Medicaid came on line in the 1960s – and the impact for health insurers is virtually unfathomable.  Less than two years from today, the federal healthcare law will bring more restrictions on premium increases, millions of new customers, and the ability for consumers to comparison shop online for the best deal on their health insurance.

According to Sabrina Corlette, research professor at Georgetown’s Health Policy Institute, these are just some of the changes coming in 2014. Just how insurance markets will shake out is anyone’s guess, she said.  “Insurance companies are grappling with the uncertainty like everybody else and trying to look two years down the road and how to position themselves,” Corlette said.  “(What) also needs to be watched closely (is) that it’s working for the consumer.”

According to the Obama administration, 28 states are in the process of establishing insurance exchanges under the ACA, despite multiple lawsuits and a spring date with the Supreme Court.  Fourteen states, including some with Republican governors, have passed legislation or have the authority in place to set up the regulated insurance markets, according to a report by the Department of Health and Human Services (HHS).  Other states have passed executive orders or authorized studies to demonstrate the value of exchanges.  The goal is to bring coverage to 16 million uninsured Americans in 50 states and the District of Columbia.

In their most recent demonstration of progress in health reform, administration officials promised to provide assistance to states that miss the 2013 deadline to ensure their participation.  “We’re going to meet states where they are, and…we’re going to work with them to get them as far down the path as we can,” said an anonymous administration official.

According to the report, some states such as Nevada, Alabama, Mississippi, all with Republican governors, and others are making significant progress.  The irony is that many of these “red” states are also suing the administration over the ACA’s constitutionality.

How does a red state that has taken a lead in lawsuits against the ACA reconcile these differences?  Writing in the Richmond Times Dispatch, Michael Martz says that “Six bills have been filed in the legislature proposing varying ways to set up a benefits exchange, which is required under the federal healthcare reform law that (Governor Bob) McDonnell opposes and the state hopes to overturn in the U.S. Supreme Court.  But the governor is discouraging legislators from approving any of the bills during this session, despite looming federal deadlines that some lawmakers and insurers fear will leave Virginia with a less-competitive federal exchange for individuals and small businesses to buy health benefits.  The state would have to submit a plan for the exchange this year to the U.S. Department of Health and Human Services (HHS) no later than January 1, 2013, to ensure that the entity can begin operating a year later.”

“There is plenty of time to act,” the McDonnell administration said in a series of “talking points” on why legislation is not currently needed.  “There is no need for members of the General Assembly to make untimely and unnecessary decisions surrounding creation of an exchange during the 2012 session.”

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.

Lie of the Year: Reform Equals a Government Takeover of Healthcare

Tuesday, December 28th, 2010

The most egregious lie of the year, according to, is the suggestion that President Barack Obama’s landmark healthcare reform law is a “government takeover of healthcare.” This is the opinion of,  the St. Petersburg Times’ independent fact-checking website.  In early 2009, Republican strategist Frank Luntz urged GOP legislators to call the bill a “government takeover.”  According to Luntz, “Takeovers are like coups.  They both lead to dictators and a loss of freedom.”  PolitiFact’s runner-up lie was Representative Michele Bachmann’s (R-MN) statement that President Obama’s trip to India would cost taxpayer $200 million a day.

Jonathan Oberlander, a health policy professor at the University of North Carolina at Chapel Hill, said “The label ‘government takeover’ has no basis in reality, but instead reflects a political dynamic where conservatives label any increase in government authority in healthcare as a ‘takeover’.”  Although the new law increases government oversight of health insurance companies, it relies on private companies and the free market.

Others are in agreement with PolitiFact’s stance.  The online magazine Slate said “the proposed healthcare reform does not take over the system in any sense.”  Princeton University professor Uwe Reinhardt, a healthcare economics expert, wrote in the New York Times that “Yes, there would be a substantial government-mandated reorganization of this relatively small corner of the private health insurance market (that serves people who have been buying individual policies).  But that hardly constitutes a government takeover of American healthcare.”

When a spokesman for incoming Speaker of the House John Boehner (R-OH) was asked about Republicans’ insistence on using the phrase – even now that it’s been thoroughly debunked – the response was “We believe that the job-killing ObamaCare law will result in a government takeover of healthcare.  That’s why we have pledged to repeal it, and replace it with common-sense reforms that actually lower costs.”

Healthcare Reform Emphasizes Prevention

Monday, May 3rd, 2010

Little-known provisions of healthcare reform bill encourage prevention and healthier lifestyles.  Lost in the war of words about healthcare reform is a series of initiatives intended to prevent disease and promote healthier behavior.  Under the new law, for example, chain restaurants will be required to provide nutrition information on their menus; nursing mothers must be given “reasonable break time” by their employers.

Americans on Medicare will be given free yearly “wellness” physicals to assess their overall condition and screen for symptoms of Alzheimer’s Disease.  Medicaid will cover drugs and counseling to help pregnant women stop smoking.  Additionally, a new federal trust fund will pay for bicycle paths, playgrounds, sidewalks and hiking trails to encourage exercise.  These are just a few of the many provisions Congress added to the healthcare reform bill to reduce preventable diseases – and which ultimately could save the government money.

According to John R. Sefrin, chief executive of the American Cancer Society, the new law will save lives because more people will be screened for diseases like breast and colon cancer.  “When people have insurance, they are much more likely to receive screenings and treatment.  And they are more likely to seek screenings when they do not have to pay co-payments or deductibles.”  These screenings mean that diseases like cancer might be detected earlier when they are more easily treatable.

Senator Tom Harkin (D-IA) and chairman of the Senate health committee, points out that “we don’t have a healthcare system in America.  We have a sick care system.  If you get sick, you get care.  But precious little is spent to keep people healthy in the first place.”

Attacks on Healthcare Reform Similar to Medicare Battle in 1965

Tuesday, April 20th, 2010

Dr. Atul Gawande:  “The battle for healthcare reform has only begunWhen President Lyndon Johnson signed Medicare into law on July 30, 1965, he faced a year of nearly crippling attacks from groups like the American Medical Association (AMA) and conservatives who feared an onslaught of “socialized medicine” and threatened to boycott the new program.  Although memories of the Medicare battle have faded over 45 years, similar battles could be fought over the passage of the Patient Protection and Affordable Care Act. This is the opinion of Dr. Atul Gawande, general and endocrine surgeon at Boston’s Brigham and Women’s Hospital and Associate Professor of Surgery at Harvard Medical School.

Writing in The New Yorker, Gawande notes that because most of the healthcare reform act’s provisions phase in at a slower pace than did Medicare, it is even more open to attack.  “The context, of course, is different.  The AMA endorsed the legislations; hospital associations were supportive.  Once the public option was dropped, most insurers favored the bill.  The medical world will wage no civil resistance.  This time, the threat comes from party politics.  Conservatives are casting the November midterm elections as a vote on repealing the health-reform law.  If they regain power, they are unlikely to repeal the whole thing.  Instead, they will try to strip out the critical but less straightforwardly appealing elements of reform – the requirement that larger employers provide health benefits and that uncovered individuals buy at least a basic policy; the subsidies to make sure that they can afford those policies; the significant new taxes on household incomes over $250,000 – and thereby gut coverage for the uninsured.”

Gawande notes that reform is hardly a government takeover of healthcare, as many opponents contend.  Rather, its success relies on communities and clinicians.  “We are the ones to determine whether costs are controlled and healthcare improves – which is to say, whether reform survives and resistance is defeated,” according to Gawande.  “The voting is over, and the country has many other issues that clamor for attention.  But, as L.B.J. would have recognized, the battle for healthcare reform has only begun.”

Sebelius Warns Healthcare Insurers to Stop Looking for Loopholes

Tuesday, April 6th, 2010

Healthcare insurers’ hunt for loopholes could result in the addition of a public option to reform legislation. Kathleen Sebelius, Secretary of Health and Human Services, has warned insurance companies to stop hunting for loopholes as a way to get around complying with healthcare reform.  Additionally, Sebelius intends to write regulations to assure that all insurers cover children with pre-existing conditions, even though some companies are adamant that this is not one of the new law’s requirements.

“The American people debated and discussed health insurance reform for more than a year.  Congress and the President have acted.  Now is not the time to search for non-existent loopholes that preserve a broken system,” Sebelius wrote in a letter to insurance industry lobbyist Karen Ignagni.

President Obama stressed the ban on denying children with pre-existing conditions as a focus of his argument during the reform fight.  His position is that children should be protected almost immediately after the bill becomes law – in this case, next September.  The insurance companies claim they don’t have to cover children with pre-existing conditions until 2014.

The insurers’ revolt over this presumed loophole could mean that progressive Democrats will reconsider adding a robust public option to the law.  The insurance companies’ threat to turn down sick kids makes the case to include a public option significantly more credible.

Aisle-Crossing Democratic Congressmen May Sink Healthcare Reform

Monday, March 15th, 2010

Dennis Kucinich and Bart Stupak might vote with Republicans to kill healthcare reform efforts.  Two Democratic Congressmen – Representatives Dennis Kucinich (D-OH) and Bart Stupak (D-MI) – may torpedo President Barack Obama’s efforts to reform the way healthcare is delivered in the United States.  Both Congressmen are threatening to cross party lines and vote with House Republicans, who are united in their solid opposition to healthcare reform.

Kucinich justifies his “no” vote on the fact the legislation lacks a robust public option – a provision that the Republicans staunchly oppose – and describes the bill as a “giveaway” to the insurance companies.  Republicans have called on the president to dump the bill, saying it is too expensive, complicated and burdensome on businesses and individuals who will be required to buy healthcare insurance, often with government subsidies.

Stupak is threatening to vote to defeat healthcare reform for an entirely different reason.  His objection is that the legislation might allow federal funds to be used to reimburse patients for abortions.  “Yes.  We’re prepared to take responsibility,” Stupak said on “Good Morning America” when asked if he and 11 other Democrat were willing to accept the consequences for bringing down healthcare reform over abortion. “Let’s face it. I want to see healthcare.  But we’re not going to bypass the principles of belief that we feel strongly about,” he said.

White House Press Secretary Robert Gibbs reiterated that when it comes to this issue, the administration merely wants to maintain the status quo and believes that Stupak ultimately will be persuaded to vote with his fellow Democrats.  “This is not a bill about abortion.  This is about healthcare reform,” Gibbs said.

Baby Steps to Healthcare Reform

Monday, February 1st, 2010

Congressman suggests an incremental approach to passing healthcare reform legislation.Some Democrats think legislating in baby steps to achieve healthcare reform is their best option now that the party has lost its 60-vote super majority with Scott Brown’s upset victory in Massachusetts to fill Senator Ted Kennedy’s seat.

According to Representative Bill Pascrell, Jr., (D-NJ), some House Democrats are proposing an incremental approach to fix the healthcare system via multiple pieces of legislation instead of a single all-encompassing bill.  The goal would remain to reform insurance coverage, assure patients’ rights and improve the way that healthcare is delivered.  Pascrell envisions introducing three or four bills in quick succession.  The legislation would encompass the least controversial elements of the broader reform package now stalled in Congress.

Pascrell believes that his measures might garner some Republican support because they would eliminate the public option, individual insurance mandates and entitlement programs.  Pascrell notes that “You can blame the Senate all you want, but we are our own worst enemy.  We do everything in mega-fashion.  We need to do it in mini-fashion.”

Why Did Joe Lieberman Kill the Public Option?

Thursday, January 7th, 2010

Joe Lieberman claims to be a liberal, yet blocks Democratic healthcare reform.  Why did Senator Joseph Lieberman (I-CT) threaten to filibuster and insist on dropping the public option and a Medicare buy-in for people aged 55 – 64 in the healthcare reform bill?  Even more puzzling is the fact that Lieberman had supported a public option as recently as this past September.  Lieberman, who may classify as a liberal, is pro-choice and supports some gay rights, angered Democrats in his home state of Connecticut when he openly campaigned for Republicans John McCain and Sarah Palin in the 2008 presidential election.

In The Guardian, Chris McGreal writes that “Now, in the view of some, he is plumbing new depths of betrayal by using his deciding vote as an independent member of the Senate to hold hostage Barack Obama’s reform of America’s dysfunctional healthcare system.   Lieberman’s tactics have upset Democratic party members of Congress who are asking why a popular president’s agenda is being stalled by a senator who has repeatedly turned his back on his old party.”

Critics see Lieberman’s opposition to the public option as a result of his acceptance of approximately $1 million in campaign donations from the medical insurance industry – many of which are headquartered in his home state — over his 21-year Senate career.  Lieberman’s wife, Hadassah, works for a lobbying firm as its health and pharmaceutical specialist.  Her previous employers include big pharma companies Pfizer and Hoffmann-LaRoche.  Lieberman’s supporters thought he was “genuinely an independent” who agrees “more often than not with Democrats on domestic policy.  I agree more often than not with Republicans on foreign and defense policy,” Lieberman once told Fox News.

According to McGreal, “Detractors paint a picture of a vain, bitter man still stung by his rejection by Democratic voters who came close to scuppering his Senate career three years ago and now reveling in the power he wields to block Obama’s first piece of major legislation.”  Lieberman says he is not acting out of spite.  “That’s just poppycock,” he said.  “If I had any sense of vendetta against the Democratic party, I wouldn’t be in the Democratic caucus today.”