December 20, 2006
HP-209
Washington, DC- President George W. Bush signed the Health Opportunity Patient Empowerment Act of 2006 today, enhancing Americans' access to tax-advantaged health care savings. The law, part of the Tax Relief and Health Care Act of 2006, provides new opportunities for health savings account (HSA) participants' to build their funds.
"Health savings accounts are improving the way Americans obtain the care they need. This bill makes HSAs more flexible and makes it easier for participants to put money aside for their personal health care," said Treasury Assistant Secretary for Tax Policy Eric Solomon.
HSA provisions of the Act include:
Allow rollovers from health FSAs and HRAs into HSAs through 2011. Employers can transfer funds from Flexible Spending Arrangements (FSAs) or Health Reimbursement Arrangements (HRAs) to an HSA for employees switching to coverage under an HSA-compatible health plan. The amounts rolled over to HSAs from FSAs or HRAs are over and above the amounts allowed as annual contributions. The maximum contribution is the balance in the FSA or HRA as of September 21, 2006, or if less, the balance as of the date of the transfer. The provision is limited to one distribution with respect to each health FSA or HRA of the individual. If an individual does not remain an eligible individual for the 12 months following the month of the contribution, the transferred amount is included in income and subject to a 10 percent additional tax.
Increase in annual HSA contribution. Previously, the maximum HSA contribution was the lesser of the deductible of the individual's HSA-eligible plan or a statutory maximum. The new rules make the limit the statutory maximum contribution, regardless of the individual's deductible. For 2007, the maximum contribution for an eligible individual with self-only coverage is $2,850, and the maximum contribution for an eligible individual with family coverage is $5,650. These limits are indexed for inflation.
Full HSA contribution regardless of month individual becomes eligible. Normally, the HSA contribution is pro rated based on the number of months that an individual during the year a person was an eligible individual. The new provisions provide an exception to this rule that will allow individuals who become covered under an HSA-eligible plan in a month other than January to make the maximum HSA contribution for the year based on their coverage in the last month of the year. This eliminates a common barrier to switching to HSA-eligible coverage. If an individual does not stay in the HSA-eligible plan 12 months following the last month of the year of the first year of eligibility, the amount which could not have been contributed except for this provision will be included in income and subject to a 10 percent additional tax.
One-time transfer from IRAs to HSAs. The new rules allow for a one-time contribution to an HSA of amounts distributed from an Individual Retirement Arrangement (IRA). The contribution must be made in a direct trustee-to-trustee transfer. The IRA transfer will not be included in income or subject to the early withdrawal additional tax. The transfer is limited to the maximum HSA contribution for the year, and the amount contributed is not allowed as a deduction. Generally, only one transfer may be made during the lifetime of an individual. If an individual electing the one-time transfer does not remain an eligible individual for the 12 months following the month of the contribution, the transferred amount is included in income and subject to a 10 percent additional tax.
Certain FSA coverage treated as disregarded coverage. Under previous law, if an FSA had a grace period following the end of the plan year allowing participants to incur additional reimbursable expenses, participants were treated as having disqualifying coverage, reducing their HSA contribution for that year, even though they had switched to HSA-eligible coverage at the first of the year. The new rules treat certain FSA coverage during a grace period as disregarded coverage, eliminating any resulting reduction in the HSA contribution for the year. First, the coverage is disregarded if the balance in the health FSA at the end of the plan year is zero. Second, the coverage is disregarded if the year-end balance is transferred directly to an HSA fom the FSA, as noted above.
Earlier indexing of cost of living adjustments. Previously, indexing was based on a 12-month period ending on August 31. The new rules change the base period to the 12-month period ending on March 31 and require that adjusted amounts for a year be published by June 1 of the preceding year. This change will provide employers and health plans with more time to design qualifying HSA-eligible plans and individuals with more time to make decisions about their health care for the next year.
Allow greater employer contributions for lower-paid employees. Previously, employer contributions under the comparability rules had to be the same amount or percentage of the deductible for all employees with the same category of coverage. Consequently, employers could not contribute higher amounts to lower-paid employees. The new rules provide an exception to the comparability rules allowing employers to contribute more to the HSAs of non-highly compensated individuals. For this purpose, the definition of "highly compensated employee" is based on same definition used for qualified retirement plans.
-30-
Wednesday, October 15, 2008
Sunday, October 12, 2008
Health care takes a back seat in the election
By: Lelia Chaisson
Posted: 10/9/08
Two years ago, Americans couldn't get enough of the health care debate. With Massachusetts leading the way to universal coverage, health care dominated the headlines. Forty-seven million uninsured, staggering U.S. expenditures on medical technology and lagging U.S. health statistics were disturbingly familiar, and it seemed certain that America was on its way to health care reform.
So what happened?
Right in the middle of our attempt to fix the "broken system," health care lost its momentum, much as it did in the 1990s with Hillary Clinton's failed attempt to revolutionize it. In both cases, huge movements swiftly lost their authority and eventually faded into the background, leaving Americans to deal with the ever increasing costs of health care. It seems that, despite the perpetual health care calamity in America, every time we get close to making some progress, health care disappears from the headlines.
Health care has once again taken a back seat in the 2008 election, despite the fact that recently published reports show that access to health care remains a considerable problem for more American families than ever before. Indeed, the Center for Studying Health System Change recently disclosed that almost one in five families struggled to pay medical bills last year; Twenty percent of those having problems even considered declaring personal bankruptcy. Nor is the issue limited to those without medical insurance. Reports indicate that of the 57 million Americans under pressure, 43 million have some form of insurance. The health care crisis is far from over, yet real reform is not even on the horizon.
Why is it so hard to get the ball rolling on health care? It's not because Americans don't want health care reform. While the issue has slipped behind the financial crisis and the Iraq war in the current election, it remains firmly in the top three issues among all demographics. Nor is it for lack of ideas. Over the years myriad diverse plans have been proposed by Republicans and Democrats alike.
I can only conclude that the standstill is due to the public's wishy-washiness. Americans simply don't know what they want. Or, rather, they know what they want, but they aren't willing to take any of the necessary steps to get it. What is perhaps the most interesting thing about this debate is the combination of America's conviction that every person should have access to affordable, high-quality care, and its simultaneous skepticism concerning every proposed plan for change.
Just look at the public's reaction to some of the ideas for reform. To the suggestion that we require coverage for every American to promote preventive care comes the loud retort that forcing everyone to have insurance is un-American. To the notion that we should cut spending on costly, infrequently used procedures comes the cry that Americans should have access to any medical procedure they could ever possibly want, nevermind the price tag.
Now, I'm not saying that all of these ideas are perfect. I'm just pointing out the irony that Americans demand affordable coverage and access for all, yet reject any policy that has the potential to address these problems.
America's fickleness has reared its head once again in the current election. On the one hand, Barack Obama has suggested creating a national health plan available to all Americans, with guaranteed eligibility, benefits similar to those offered in the plan available to members of Congress and subsidies for those who do not qualify for Medicaid or SCHIP but still need financial aid.
Seemingly, his plan has addressed every criticism. No mandate for universal coverage. Affordable care for every American. Guaranteed access. Choice between private and employer-based coverage.
The public's reaction? Obama's plan is too costly and will create too much regulation.
Senator McCain, on the other hand, wants nothing close to a national health care plan, and instead advocates stimulating the private market and doing away with tax breaks for employer-based health insurance.
Now, come on. Voters say they want to ensure affordable coverage for every American. They say they want to take some of the power away from greedy insurance companies that deny care to the sick and disadvantaged. Is there really any question as to which plan will better address these issues? Granted, Obama's plan is going to be expensive. But let's be serious. Doing away with tax breaks will encourage employers to do away with their health care plans. And a $5,000 tax credit will be a drop of water in a sea of health care costs, which now average $12,680 a year for U.S. families. In addition to this, it is widely speculated that McCain's plan will leave millions of people uninsured and give more power to the insurance companies everyone despises.
But, in the end, no matter who gets elected, I doubt we'll ever get far enough to see either of these plans enacted. America loves to talk the talk, but won't walk the walk. When given the choice of actually addressing their constantly reiterated concerns about health care or doing nothing, Americans consistently choose the latter.
Posted: 10/9/08
Two years ago, Americans couldn't get enough of the health care debate. With Massachusetts leading the way to universal coverage, health care dominated the headlines. Forty-seven million uninsured, staggering U.S. expenditures on medical technology and lagging U.S. health statistics were disturbingly familiar, and it seemed certain that America was on its way to health care reform.
So what happened?
Right in the middle of our attempt to fix the "broken system," health care lost its momentum, much as it did in the 1990s with Hillary Clinton's failed attempt to revolutionize it. In both cases, huge movements swiftly lost their authority and eventually faded into the background, leaving Americans to deal with the ever increasing costs of health care. It seems that, despite the perpetual health care calamity in America, every time we get close to making some progress, health care disappears from the headlines.
Health care has once again taken a back seat in the 2008 election, despite the fact that recently published reports show that access to health care remains a considerable problem for more American families than ever before. Indeed, the Center for Studying Health System Change recently disclosed that almost one in five families struggled to pay medical bills last year; Twenty percent of those having problems even considered declaring personal bankruptcy. Nor is the issue limited to those without medical insurance. Reports indicate that of the 57 million Americans under pressure, 43 million have some form of insurance. The health care crisis is far from over, yet real reform is not even on the horizon.
Why is it so hard to get the ball rolling on health care? It's not because Americans don't want health care reform. While the issue has slipped behind the financial crisis and the Iraq war in the current election, it remains firmly in the top three issues among all demographics. Nor is it for lack of ideas. Over the years myriad diverse plans have been proposed by Republicans and Democrats alike.
I can only conclude that the standstill is due to the public's wishy-washiness. Americans simply don't know what they want. Or, rather, they know what they want, but they aren't willing to take any of the necessary steps to get it. What is perhaps the most interesting thing about this debate is the combination of America's conviction that every person should have access to affordable, high-quality care, and its simultaneous skepticism concerning every proposed plan for change.
Just look at the public's reaction to some of the ideas for reform. To the suggestion that we require coverage for every American to promote preventive care comes the loud retort that forcing everyone to have insurance is un-American. To the notion that we should cut spending on costly, infrequently used procedures comes the cry that Americans should have access to any medical procedure they could ever possibly want, nevermind the price tag.
Now, I'm not saying that all of these ideas are perfect. I'm just pointing out the irony that Americans demand affordable coverage and access for all, yet reject any policy that has the potential to address these problems.
America's fickleness has reared its head once again in the current election. On the one hand, Barack Obama has suggested creating a national health plan available to all Americans, with guaranteed eligibility, benefits similar to those offered in the plan available to members of Congress and subsidies for those who do not qualify for Medicaid or SCHIP but still need financial aid.
Seemingly, his plan has addressed every criticism. No mandate for universal coverage. Affordable care for every American. Guaranteed access. Choice between private and employer-based coverage.
The public's reaction? Obama's plan is too costly and will create too much regulation.
Senator McCain, on the other hand, wants nothing close to a national health care plan, and instead advocates stimulating the private market and doing away with tax breaks for employer-based health insurance.
Now, come on. Voters say they want to ensure affordable coverage for every American. They say they want to take some of the power away from greedy insurance companies that deny care to the sick and disadvantaged. Is there really any question as to which plan will better address these issues? Granted, Obama's plan is going to be expensive. But let's be serious. Doing away with tax breaks will encourage employers to do away with their health care plans. And a $5,000 tax credit will be a drop of water in a sea of health care costs, which now average $12,680 a year for U.S. families. In addition to this, it is widely speculated that McCain's plan will leave millions of people uninsured and give more power to the insurance companies everyone despises.
But, in the end, no matter who gets elected, I doubt we'll ever get far enough to see either of these plans enacted. America loves to talk the talk, but won't walk the walk. When given the choice of actually addressing their constantly reiterated concerns about health care or doing nothing, Americans consistently choose the latter.
Tuesday, September 2, 2008
DONUT HOLE MEDICARE PART D PROBLEM
September 2, 2008
Editorial
Medicare’s Troubling Drug Gap
Probably no aspect of the new Medicare drug program has caused more confusion and irritation than the notorious “doughnut hole,” a gap in coverage that forces people who had been getting their drugs cheaply to suddenly pay the full price out of pocket. Now, for the first time, an analysis has quantified what happened last year when millions of beneficiaries fell into the gap. For patients with serious chronic conditions, the medical implications were very troubling.
Congress crafted the “doughnut hole” to limit federal spending on the drug benefit. Beneficiaries pay only deductibles and co-payments, with the rest covered by their insurance plan, until their drug purchases reach a specified limit. Last year, the gap began when beneficiaries purchased $2,400 worth of drugs. Then they fell into the doughnut hole and had to pay the full cost until their out-of-pocket spending reached $3,850, at which point they qualified for catastrophic coverage.
Last year, an estimated 3.4 million beneficiaries reached the coverage gap, according to a study by researchers at the Kaiser Family Foundation, Georgetown University and the National Opinion Research Center, or NORC, at the University of Chicago. Beneficiaries taking drugs to treat such chronic conditions as Alzheimer’s disease, diabetes, depression, osteoporosis and high blood pressure were especially likely to reach the gap.
What’s disturbing is that 15 percent of the beneficiaries taking drugs in eight categories said they stopped taking their medications when they reached the gap. Another 1 percent reduced their use by skipping doses, and 5 percent switched to another drug that was cheaper but might or might not be as effective.
For the 10 percent of diabetics who stopped taking their medication after reaching the gap, the health consequences could be immediate and serious. For those with high cholesterol or osteoporosis, the harm could take longer to show up but could still be serious.
There is no easy solution short of increasing federal spending or finding a way to drive down the cost of drugs. The program has helped millions of older Americans. The next administration and Congress will have to revisit the wisdom and need for the gap.
Home
World U.S. N.Y. / Region Business Technology Science Health Sports Opinion Arts Style Travel Jobs Real Estate Automobiles Back to Top
Copyright 2008 The New York Times Company
Editorial
Medicare’s Troubling Drug Gap
Probably no aspect of the new Medicare drug program has caused more confusion and irritation than the notorious “doughnut hole,” a gap in coverage that forces people who had been getting their drugs cheaply to suddenly pay the full price out of pocket. Now, for the first time, an analysis has quantified what happened last year when millions of beneficiaries fell into the gap. For patients with serious chronic conditions, the medical implications were very troubling.
Congress crafted the “doughnut hole” to limit federal spending on the drug benefit. Beneficiaries pay only deductibles and co-payments, with the rest covered by their insurance plan, until their drug purchases reach a specified limit. Last year, the gap began when beneficiaries purchased $2,400 worth of drugs. Then they fell into the doughnut hole and had to pay the full cost until their out-of-pocket spending reached $3,850, at which point they qualified for catastrophic coverage.
Last year, an estimated 3.4 million beneficiaries reached the coverage gap, according to a study by researchers at the Kaiser Family Foundation, Georgetown University and the National Opinion Research Center, or NORC, at the University of Chicago. Beneficiaries taking drugs to treat such chronic conditions as Alzheimer’s disease, diabetes, depression, osteoporosis and high blood pressure were especially likely to reach the gap.
What’s disturbing is that 15 percent of the beneficiaries taking drugs in eight categories said they stopped taking their medications when they reached the gap. Another 1 percent reduced their use by skipping doses, and 5 percent switched to another drug that was cheaper but might or might not be as effective.
For the 10 percent of diabetics who stopped taking their medication after reaching the gap, the health consequences could be immediate and serious. For those with high cholesterol or osteoporosis, the harm could take longer to show up but could still be serious.
There is no easy solution short of increasing federal spending or finding a way to drive down the cost of drugs. The program has helped millions of older Americans. The next administration and Congress will have to revisit the wisdom and need for the gap.
Home
World U.S. N.Y. / Region Business Technology Science Health Sports Opinion Arts Style Travel Jobs Real Estate Automobiles Back to Top
Copyright 2008 The New York Times Company
Saturday, August 30, 2008
Funding health care uninsured
In New England, several states have turned to one-time sources of revenue to initially
fund coverage expansions. For example, Maine, Massachusetts, and Vermont have redistributed
federal funding obtained through Medicaid waivers to expand eligibility and coverage to certain segments of the population.
Maine, Rhode Island, and Vermont have used their tobacco settlement allocations to seed partial funding.
A problem with one-time sources of revenue
is that when they run out, states may need additional money to sustain expansions
in coverage. With this in mind, Rhode Island has created a trust out of its tobacco settlement to fund in perpetuity a program to reduce the health insurance premiums for small businesses. Other states have implemented
or are exploring excise taxes on tobacco
to fund coverage expansions.
One New England state—Massachusetts—
is using a unique source of revenue to fund its coverage expansion, gradually tapping
its $693 million uncompensated care pool. Massachusetts’ pool—the only one of its kind in the nation—is funded by assessments
levied on hospitals and insurers. The money in the pool was previously used to reimburse hospitals and health care clinics for services that were provided to uninsured individuals. In redirecting these funds from care to insurance coverage, it is unclear how much revenue individual hospitals and clinics
may lose and whether they will be able to continue to provide care in the face of such losses. “This issue,” said Nancy Turnbull, President of the Blue Cross Blue Shield of Massachusetts Foundation, “is so touchy that nobody wants to directly answer questions about it.”
Many reform plans are funded upon the belief that coverage expansion will induce more cost savings because hospitals will no longer have to incur large costs for bad debt and charity care and more of the uninsured will receive routine medical care, which will reduce their reliance on expensive emergency
room visits. Combined with a diversification
of the insurance risk pools through the addition of relatively young and healthy uninsured populations, states are hoping that these savings will curb the growth of private insurance premiums and allow for future coverage
expansions.
However, states will encounter significant
fiscal difficulty if such cost savings fail to materialize. In Maine, the DirigoChoice plan was designed to be partially funded by an assessment on the amount of cost savings the insurer saw as a result of providers reducing
their fees in response to less charity care and bad debt. But disagreement over the size of the cost savings and the subsequent size of the assessment ultimately ended up in court. Currently, Maine is searching for new sources of funding for its fledgling plan.
Employers are another source of potential
revenue for states. Health care legislation
passed in Massachusetts and Vermont in early 2006 requires annual fees of $295 and $365 per full-time employee, respectively, to be paid by employers that do not offer health benefits to their employees, subject to some exemptions. But these assessments are not large enough to cover the complete cost of expanding coverage to employees who are not offered insurance, especially as the cost of health insurance continues to rise. The current
political climate makes the possibility of higher taxes to pay for coverage unlikely.
Businesses may respond by encouraging eligible employees and their dependents to enroll in Medicaid and SCHIP. Commenting
during the second panel discussion at the conference, Trish Riley, Director of the Governor’s
Office for Health Policy and Finance in Maine, wondered whether increased coordination
between large employers and the state would address this contentious issue. For example, it might be more efficient if coverage for low-wage and part-time workers were administered through a Medicaid program,
with partial funding from employers.
As long as health care spending decelerates
and state revenue collections remain strong, state fiscal conditions for coverage expansions remain on steady ground. But over the long term, any sort of fiscal stress will affect a state’s implementation of reform and expansion of coverage, especially as aging
Baby Boomers place additional pressure on the health care system. Moreover, a significant
amount of funding for state coverage
Over the long term, any sort of
fiscal stress will affect a state’s
ability to expand coverage.
fund coverage expansions. For example, Maine, Massachusetts, and Vermont have redistributed
federal funding obtained through Medicaid waivers to expand eligibility and coverage to certain segments of the population.
Maine, Rhode Island, and Vermont have used their tobacco settlement allocations to seed partial funding.
A problem with one-time sources of revenue
is that when they run out, states may need additional money to sustain expansions
in coverage. With this in mind, Rhode Island has created a trust out of its tobacco settlement to fund in perpetuity a program to reduce the health insurance premiums for small businesses. Other states have implemented
or are exploring excise taxes on tobacco
to fund coverage expansions.
One New England state—Massachusetts—
is using a unique source of revenue to fund its coverage expansion, gradually tapping
its $693 million uncompensated care pool. Massachusetts’ pool—the only one of its kind in the nation—is funded by assessments
levied on hospitals and insurers. The money in the pool was previously used to reimburse hospitals and health care clinics for services that were provided to uninsured individuals. In redirecting these funds from care to insurance coverage, it is unclear how much revenue individual hospitals and clinics
may lose and whether they will be able to continue to provide care in the face of such losses. “This issue,” said Nancy Turnbull, President of the Blue Cross Blue Shield of Massachusetts Foundation, “is so touchy that nobody wants to directly answer questions about it.”
Many reform plans are funded upon the belief that coverage expansion will induce more cost savings because hospitals will no longer have to incur large costs for bad debt and charity care and more of the uninsured will receive routine medical care, which will reduce their reliance on expensive emergency
room visits. Combined with a diversification
of the insurance risk pools through the addition of relatively young and healthy uninsured populations, states are hoping that these savings will curb the growth of private insurance premiums and allow for future coverage
expansions.
However, states will encounter significant
fiscal difficulty if such cost savings fail to materialize. In Maine, the DirigoChoice plan was designed to be partially funded by an assessment on the amount of cost savings the insurer saw as a result of providers reducing
their fees in response to less charity care and bad debt. But disagreement over the size of the cost savings and the subsequent size of the assessment ultimately ended up in court. Currently, Maine is searching for new sources of funding for its fledgling plan.
Employers are another source of potential
revenue for states. Health care legislation
passed in Massachusetts and Vermont in early 2006 requires annual fees of $295 and $365 per full-time employee, respectively, to be paid by employers that do not offer health benefits to their employees, subject to some exemptions. But these assessments are not large enough to cover the complete cost of expanding coverage to employees who are not offered insurance, especially as the cost of health insurance continues to rise. The current
political climate makes the possibility of higher taxes to pay for coverage unlikely.
Businesses may respond by encouraging eligible employees and their dependents to enroll in Medicaid and SCHIP. Commenting
during the second panel discussion at the conference, Trish Riley, Director of the Governor’s
Office for Health Policy and Finance in Maine, wondered whether increased coordination
between large employers and the state would address this contentious issue. For example, it might be more efficient if coverage for low-wage and part-time workers were administered through a Medicaid program,
with partial funding from employers.
As long as health care spending decelerates
and state revenue collections remain strong, state fiscal conditions for coverage expansions remain on steady ground. But over the long term, any sort of fiscal stress will affect a state’s implementation of reform and expansion of coverage, especially as aging
Baby Boomers place additional pressure on the health care system. Moreover, a significant
amount of funding for state coverage
Over the long term, any sort of
fiscal stress will affect a state’s
ability to expand coverage.
Thursday, August 28, 2008
Cost of Health Care out of control
Health care costs are rising. The price of oil is at an all time high. Americans are struggling to save for the future. But when I turn on the TV or read a newspaper, the story too often seems to be the latest poll, gaffe, or controversy.
We need to hear less about the process, and more about the substance. We deserve serious, in-depth investigative reporting on plans to ensure all Americans have access to quality health care and long-term financial security.
When the next President of the United States takes office in January, what will he do for Americans who can't afford their health care bills? How will he guarantee that Americans who work hard are able to save for retirement, or plan for the unexpected?
More importantly: how will he cut through the partisan gridlock and work across the aisle to actually deliver for American families?
I sincerely hope you will dig into the substance and specifics of the plans of our elected leaders. I'm looking to the media for hard-charging investigative reporting - not sound bites and the horserace. And I'm sure I'm not the only one.
We need to hear less about the process, and more about the substance. We deserve serious, in-depth investigative reporting on plans to ensure all Americans have access to quality health care and long-term financial security.
When the next President of the United States takes office in January, what will he do for Americans who can't afford their health care bills? How will he guarantee that Americans who work hard are able to save for retirement, or plan for the unexpected?
More importantly: how will he cut through the partisan gridlock and work across the aisle to actually deliver for American families?
I sincerely hope you will dig into the substance and specifics of the plans of our elected leaders. I'm looking to the media for hard-charging investigative reporting - not sound bites and the horserace. And I'm sure I'm not the only one.
Tuesday, August 19, 2008
Small Business Health Care Comment
Their top concern, according to a survey conducted by the National Federation of Independent Business and Wells Fargo, was the expense of being in business, and the entrepreneurs singled out those factors “that are difficult to control, such as health insurance, energy and inflation.”
The survey is conducted every four years, and the high cost of health care has been the No. 1 in the last five surveys.
“For four years, the economy provided a good, stable foundation for Small Business
The survey is conducted every four years, and the high cost of health care has been the No. 1 in the last five surveys.
“For four years, the economy provided a good, stable foundation for Small Business
Wednesday, August 13, 2008
Health Care Insuance Reform
FOR IMMEDIATE RELEASE Contacts:
Aug. 11, 2008 David Himmelstein, M.D., (518) 794-8109, (617) 312-0970
(cell), Benjamin Day, (617) 777-3422, director@masscare.org , Mark Almberg, (312) 782-6006, mark@pnhp.org
Copy Massachusetts' health reform?
Not so fast, researchers say
Citing the failure of seven state-based health reforms over the past two
decades - initiatives that bear a strong resemblance to the
Massachusetts health reform of 2006 - a group of Massachusetts-based
researchers cautions that early declarations of the latter's success may
be premature.
In an article titled "State Heath Reform Flatlines," published in the
most recent issue of the International Journal of Health Services, three
researchers, two of whom teach at Harvard Medical School, examine the
experiences of earlier reforms in Massachusetts, Oregon, Minnesota,
Tennessee, Vermont, Washington state and Maine. The plans were enacted
from 1988 through 2003.
All seven reforms, which when launched were widely trumpeted by
political leaders and leading newspapers as breakthroughs in providing
universal health care, were based on the expansion of private insurance
coverage, the authors say. But in each case the plan had little impact
on the state's number of uninsured persons and produced no sustained
improvements in delivering care.
Dr. David Himmelstein, a co-author of the study, said the 2006
Massachusetts reform appears poised to follow the pattern of the 1992
Tennessee plan, which featured a large expansion of coverage under a
Medicaid-like program. "In Tennessee, the number of uninsured dipped for
two years, then rose to levels higher than ever," he said. "And the plan
proved to be unaffordable in the long term.
"According to the latest figures on Massachusetts from the National
Health Interview Survey," he continued, "the uninsurance rate has fallen
by only 2 percent, from 7.7 percent to 5.8 percent, since the reform was
passed, while the plan is already $147 million over budget."
Himmelstein, who is an associate professor of medicine at Harvard and a
primary care physician in Cambridge, Mass., said the seven failed plans
incorporated virtually all of the reform elements being advanced today
by leading Democrats, including Sen. Barack Obama. The problem, he said,
is that such reforms leave the private health insurance industry in a
dominant position.
"Politicians like to claim they've passed bold health reforms, but
they're afraid to rock the private insurance boat," he said. "So they
keep pushing gussied-up versions of reforms that have failed time after
time. Our health care system is sick to death, and our politicians keep
prescribing placebos."
The authors note that all of the failed plans included expansions of
Medicaid or similar programs for the poor and near-poor. Three states'
reforms (Massachusetts in 1988, Oregon in 1989-1992 and Washington state
in 1993) included mandates requiring employers to cover their workers,
and the Massachusetts and Washington plans also included an individual
mandate on the self-employed.
The authors analyzed Census Bureau data on uninsurance rates in each of
the seven states. Massachusetts' uninsurance rate rose from 7.2 percent
to 9.7 percent in the three years after the passage of then-governor
Michael Dukakis' universal health care reform in 1988. Uninsurance went
from 14.1 percent to 14.7 percent in the three years after
implementation of Oregon's universal health care reform in 1993. The
percentage of residents lacking coverage in Washington state increased
from 10.7 percent to 11.6 percent in the three years after passage of
its universal health care initiative.
Similar patterns occurred in Vermont and Maine. Tennessee's program
(which included the largest Medicaid expansion) was probably the most
successful, dropping the share of uninsured in the state from 12 percent
to 9 percent in its first year, before a rebound to 14 percent by year
three. (See charts in links below.)
All of the plans eventually "flatlined," or died quiet deaths, the
authors said.
According to Benjamin Day, executive director of Mass-Care, a health
care advocacy coalition based in Boston, "It's easy to build political
consensus for expanded health coverage. But experience shows that you
can't achieve universal coverage at an affordable price unless you throw
out the insurance companies with their massive overhead and profit, and
replace them with a more efficient single-payer national health
insurance program.
"Senator Obama should learn this lesson," Day said. As for Sen. John
McCain's health care proposals, "they are so obviously unworkable that
it's hard to take them seriously."
*******
The text of the study is available in PDF to the press at
www.pnhp.org/states_flatline
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=zNcwNfjJAnJf0TMLo94BkfXmr35TzF3j
Password: *himmelstein*
Additional charts in PowerPoint format are available at
www.pnhp.org/five_states
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=YNqed33VWwZ3%2FwCWnJiiV%2B8pcMbyAF%2B6
"State Health Reform Flatlines," Steffie Woolhandler, MD, MPH; Benjamin
Day; and David U. Himmelstein, MD. International Journal of Health
Services, Vol. 38, No. 3.
Physicians for a National Health Program, a membership organization of
over 15,000 physicians, supports a single-payer national health
insurance program. To contact a physician-spokesperson in your area,
visit www.pnhp.org/stateactions
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=W1SCD%2BJYJOe309bI23pT%2B%2B8pcMbyAF%2B6
or call (312) 782-6006.
*Physicians for a National Health Program*
29 E Madison Suite 602, Chicago, IL 60602
Phone (312) 782-6006 | Fax: (312) 782-6007
www.pnhp.org
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=cGQcvuaDs3pWB3gv9jboUO8pcMbyAF%2B6
| info@pnhp.org mailto:info@pnhp.org
PNHP 2008
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=mgJJAv5YFLJ2XnjhLax%2Fe%2B8pcMbyAF%2B6
--------------------------------------------------------------------------------
Looking for a car that's sporty, fun and fits in your budget? Read reviews on AOL Autos.
Aug. 11, 2008 David Himmelstein, M.D., (518) 794-8109, (617) 312-0970
(cell), Benjamin Day, (617) 777-3422, director@masscare.org , Mark Almberg, (312) 782-6006, mark@pnhp.org
Copy Massachusetts' health reform?
Not so fast, researchers say
Citing the failure of seven state-based health reforms over the past two
decades - initiatives that bear a strong resemblance to the
Massachusetts health reform of 2006 - a group of Massachusetts-based
researchers cautions that early declarations of the latter's success may
be premature.
In an article titled "State Heath Reform Flatlines," published in the
most recent issue of the International Journal of Health Services, three
researchers, two of whom teach at Harvard Medical School, examine the
experiences of earlier reforms in Massachusetts, Oregon, Minnesota,
Tennessee, Vermont, Washington state and Maine. The plans were enacted
from 1988 through 2003.
All seven reforms, which when launched were widely trumpeted by
political leaders and leading newspapers as breakthroughs in providing
universal health care, were based on the expansion of private insurance
coverage, the authors say. But in each case the plan had little impact
on the state's number of uninsured persons and produced no sustained
improvements in delivering care.
Dr. David Himmelstein, a co-author of the study, said the 2006
Massachusetts reform appears poised to follow the pattern of the 1992
Tennessee plan, which featured a large expansion of coverage under a
Medicaid-like program. "In Tennessee, the number of uninsured dipped for
two years, then rose to levels higher than ever," he said. "And the plan
proved to be unaffordable in the long term.
"According to the latest figures on Massachusetts from the National
Health Interview Survey," he continued, "the uninsurance rate has fallen
by only 2 percent, from 7.7 percent to 5.8 percent, since the reform was
passed, while the plan is already $147 million over budget."
Himmelstein, who is an associate professor of medicine at Harvard and a
primary care physician in Cambridge, Mass., said the seven failed plans
incorporated virtually all of the reform elements being advanced today
by leading Democrats, including Sen. Barack Obama. The problem, he said,
is that such reforms leave the private health insurance industry in a
dominant position.
"Politicians like to claim they've passed bold health reforms, but
they're afraid to rock the private insurance boat," he said. "So they
keep pushing gussied-up versions of reforms that have failed time after
time. Our health care system is sick to death, and our politicians keep
prescribing placebos."
The authors note that all of the failed plans included expansions of
Medicaid or similar programs for the poor and near-poor. Three states'
reforms (Massachusetts in 1988, Oregon in 1989-1992 and Washington state
in 1993) included mandates requiring employers to cover their workers,
and the Massachusetts and Washington plans also included an individual
mandate on the self-employed.
The authors analyzed Census Bureau data on uninsurance rates in each of
the seven states. Massachusetts' uninsurance rate rose from 7.2 percent
to 9.7 percent in the three years after the passage of then-governor
Michael Dukakis' universal health care reform in 1988. Uninsurance went
from 14.1 percent to 14.7 percent in the three years after
implementation of Oregon's universal health care reform in 1993. The
percentage of residents lacking coverage in Washington state increased
from 10.7 percent to 11.6 percent in the three years after passage of
its universal health care initiative.
Similar patterns occurred in Vermont and Maine. Tennessee's program
(which included the largest Medicaid expansion) was probably the most
successful, dropping the share of uninsured in the state from 12 percent
to 9 percent in its first year, before a rebound to 14 percent by year
three. (See charts in links below.)
All of the plans eventually "flatlined," or died quiet deaths, the
authors said.
According to Benjamin Day, executive director of Mass-Care, a health
care advocacy coalition based in Boston, "It's easy to build political
consensus for expanded health coverage. But experience shows that you
can't achieve universal coverage at an affordable price unless you throw
out the insurance companies with their massive overhead and profit, and
replace them with a more efficient single-payer national health
insurance program.
"Senator Obama should learn this lesson," Day said. As for Sen. John
McCain's health care proposals, "they are so obviously unworkable that
it's hard to take them seriously."
*******
The text of the study is available in PDF to the press at
www.pnhp.org/states_flatline
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=zNcwNfjJAnJf0TMLo94BkfXmr35TzF3j
Password: *himmelstein*
Additional charts in PowerPoint format are available at
www.pnhp.org/five_states
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=YNqed33VWwZ3%2FwCWnJiiV%2B8pcMbyAF%2B6
"State Health Reform Flatlines," Steffie Woolhandler, MD, MPH; Benjamin
Day; and David U. Himmelstein, MD. International Journal of Health
Services, Vol. 38, No. 3.
Physicians for a National Health Program, a membership organization of
over 15,000 physicians, supports a single-payer national health
insurance program. To contact a physician-spokesperson in your area,
visit www.pnhp.org/stateactions
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=W1SCD%2BJYJOe309bI23pT%2B%2B8pcMbyAF%2B6
or call (312) 782-6006.
*Physicians for a National Health Program*
29 E Madison Suite 602, Chicago, IL 60602
Phone (312) 782-6006 | Fax: (312) 782-6007
www.pnhp.org
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=cGQcvuaDs3pWB3gv9jboUO8pcMbyAF%2B6
| info@pnhp.org mailto:info@pnhp.org
PNHP 2008
http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=mgJJAv5YFLJ2XnjhLax%2Fe%2B8pcMbyAF%2B6
--------------------------------------------------------------------------------
Looking for a car that's sporty, fun and fits in your budget? Read reviews on AOL Autos.
Subscribe to:
Posts (Atom)