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IN THE STATES: The Massachusetts Good, Bad, and Ugly
We all know that Massachusetts has come further than any other state in covering everyone. We also know that it's cost more than expected, and the state is now exploring some significant payment changes to make sure that it spends smarter on health care that actually improves health. It's also worth paying attention to an innovative program called Senior Care Options that deals with both the medical and long-term care needs of the elderly -- in a way that saves money, which Massachusetts needs to keep its health care coverage commitments.
Remember that the federal Medicare program covers all Americans from age 65, insuring hospital and physician services and now pharmaceuticals. It doesn't pay for long term care or most nursing home care, which can easily run to $70,000 a year. Medicaid, a joint federal-state program, pays for nursing homes -- for people who are poor enough to quality, or who become poor enough after paying some of those nursing homes on their own for a while. Many people in long term care are "dual eligibles," on both Medicare and Medicaid. But the two programs have different funding streams, so financing gaps, lack of coordination, and red tape can be a problem.
Enter "Senior Care Options." As Douglas S. Brown describes in an opinion piece in the Boston Globe, Senior Care Option organizations receive the funding for dual eligibles from Medicare and Medicaid but provide care in a unified manner, cutting down on bureaucracy. The results? With 11,000 enrollees in Massachusetts, they've achieved high patient satisfaction and a 25 percent lower nursing home admission rate compared to those not in the program. That saves money and leads to higher quality. It's also completely voluntary; patients choose to be part of it. And they don't need to be so sick or frail that they required nursing home level care, as in the PACE programs.
Massachusetts Medicaid could really use the money. As the only state in the nation with an individual mandate law, Massachusetts has added hundreds of thousands who were previously uninsured to the health care rolls. But because of the recession and resulting budget crunch, they've had to cut 30,000 legal immigrants, who are tax-paying residents, from the Commonwealth Care program. The Times recently profiled Laura Porto, originally from Venezuela, who will lose coverage for treatment and medication for her bipolar disorder because of the change. (Whether that will actually save money if she ends up in ERs in crisis is a whole other story...)
In addition to the cut for legal immigrants, "Commonwealth Care will save an estimated $63 million by no longer automatically enrolling low-income residents who fail to enroll themselves." While this might save money overall, it will result in cost shifting to providers. The uninsured will seek care from emergency rooms and clinics, and hospitals and physicians will either absorb the cost or receive a portion of it in transfer payments from the government.
With an aggressive possible move toward Accountable Care Organizations, the Bay State is currently dealing with the good, the bad, and the ugly in health reform. It could be the first state to move away from fee-for-service medicine, widely perceived as an expensive and inefficient way to deliver health services. Health policy folks would be wise to stay tuned to what's going on up there.
Immigrants: We're Not Cut Yet
Although the legislature proposed temporarily eliminating 30,000 legal immigrants from Commonwealth Care (the sliding-scale subsidy program for low-income adults), Governor Patrick vetoed that provision, and the legislature has yet to take up the veto. So for now, the group is covered through August. The Governor has proposed a compromise plan, cutting the spending for the group by about half. Advocates, hospitals, community health centers, and many legislators are supporting that compromise, which may be voted on in the next week or two.
More importantly, the funding problems being experienced in Massachusetts are not due to program costs soaring. In fact, Commonwealth Care spending has been held to less than a 5% annual increase, much better than commercial coverage. The state has used prudent purchasing and competitive bidding to keep costs down.
Rather, the problems are due to a historic drop in state revenue. As revenues have plunged, the state has been forced to make cuts in a every state program, even cost-effective programs like Commonwealth Care.
Healthcare Reform
NO ONE in this country is willing to address the only true ways to REDUCE Healthcare costs.... the Obama Administration is not reducing costs... they are merely moving money around... cutting Medicare expenditures and then spending that money on "universal healthcare". True reform must involve 2 components 1) Tort reform.... doctors order many unnecessary tests to cover themselves ... so they will not lose a lawsuit.... Doctors cannot operate their practices in fear of litigation at every turn. 2) We need personal accountability. The number 1 and 2 causes for healthcare expenditures are a) Obesity and b) Smoking..... both are life style CHOICES. Why does the government constantly think they have to foot the bill for the bad choices of its citizens? There should be a HUGE penalty/cost to anyone who is obese or smokes.... maybe in the form of additional taxes (HIGH TAXES) on non-diet drinks, high calorie foods etc and extremely higher taxes on tobacco.... use these funds to cover costs of caring for the obese and smoking related healthcare issues.
Our Government leaders are weak..... they are unable to make the hard appropriate decisions ..... including the mess they are calling Healthcare Reform..... their current efforts are no different than "rearranging the chairs on the deck of the Titanic"
ending subsidies for the private insurers on reducing ER visits
Poll Still Finds Public Support for Health-Care Reform: While a majority of Americans still think health-care reform is needed now, some of that support has wavered slightly as Congress wrestles with the details of producing a reform package, according to the July Kaiser Health Tracking Poll. Fifty-six percent of Americans continue to believe that health reform is more important than ever, despite the country's economic problems. And by a better than two-to-one margin (51 percent to 23 percent), Americans think the country would be better off if Congress and President Barack Obama enacted health reform, the poll found.
Aside from the savings created by the prevention and wellness program, medical IT, foreseeable potential stem cell effect, mental stress relief and massive job creation, ending subsidies for the private insurers (on reducing ER visits) and payment reform and so on could be enough to meet the goal of deficit-neutral. The Times in a July 7 editorial argued “As much as 30 percent of all health-care spending in this country—some $700 billion a year—may be wasted on tests and treatments that do not improve the health of the recipients,” .
Public school, public insurance policy, and public clean energy act are the natural parts of life in the free nations.
Thank You !
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