The Federal State-Based Universal Health Care Waiver Act of 2015

banner picture of Universal Healthcare from http://www.healthcareforallcolorado.org/

One Agenda: Universal Health Care.
Picture courtesy of Healthcare for All Colorado

As part of the Affordable Care Act (ACA), states have been given the ability to innovate or create their own form of health care insurance or coverage starting on January 1, 2017 AS LONG AS “benefits are at least as comprehensive and affordable as those offered by Qualified Health Plans available on the Exchanges,” according to Representative Jim McDermott (D-WA-7).

As a result, at least 14 states—California, Colorado, Hawaii, Illinois, Maine, Maryland, Minnesota, Missouri, , New York, Ohio, Oregon, Pennsylvania, Vermont, and Washington—have community advocates and state legislators working towards implementing a state-level form of universal health care. They have been working for affordable healthcare access for all residents of their states before and since the Affordable Care Act – aka Obamacare – was passed in 2010.

Now that the US Supreme Court has basically settled the fact that the ACA is constitutional both on June 28, 2012 (Florida v. Department of Health and Human Services) and again on June 25, 2015 (King v. Burwell), we can consider ways to improve our healthcare system at both the state and federal level. As a medical doctor and a member of Congress, McDermott voted for the ACA. He also recognizes that “still more needs  to be done to control costs, improve care, and cover everyone.”

One way to further control these costs and improve health care while covering everyone is to create a universal health care system which I’ve previously blogged about (see here, here, here, here, and here). That means we either have the federal government create a federal single payer plan OR we use the waiver clause in the ACA to help states create their own universal single-payer health care program.

Yet even with the waiver currently allowed within the ACA for innovative state-based health care plans, creating a state-based universal care plan that saves funds for states and individuals while providing health care access to all has a big hurdle to overcome. Rep. McDermott explained this issue in a speech on the floor of the House of Representatives on July 28:

One of the many achievements of the Affordable Care Act is its provisions that grant states the authority to innovate in their health care systems. Under Section 1332 of the law, a state may apply for a State Innovation Waiver that will provide it with control of federal dollars that otherwise would have been spent on premium tax credits and cost-sharing reductions for its residents. Through this waiver, a state may design a system to cover its residents, so long as benefits are at least as comprehensive and affordable as those offered by Qualified Health Plans available on the Exchanges.

However, even with this flexibility, numerous barriers limit states’ ability to design true single-payer systems. Existing waivers are narrow in scope, requiring states to seek out imperfect and convoluted solutions to circumvent federal limitations. A sweeping preemption provision in the Employee Retirement Income Security Act (ERISA) denies states authority to regulate employer-sponsored health plans. And, due to the complexities of our existing federal health programs, it is essentially impossible for a state to design a single benefit package that can be administered simply and efficiently on behalf of all of its residents.

This speech was McDermott’s announcement that he was introducing HR 3241, aka the “State-Based Universal Health Care Act of 2015:” If passed, this bill would allow states to apply for a universal health care waiver that would allow them to have access to and authority over federal health care dollars that would otherwise be spent on the residents of that state. More specifically, this additional waiver act goes beyond the ACA to deal with the hurdles mentioned above. The new provisions of this law, according to McDermott, would waive all of the following:

  • The rules governing premium tax credits and cost-sharing reductions, as provided for in existing waiver authority under Section 1332 of the ACA.

  • Provisions necessary for states to pool funds that otherwise would be spent on behalf of residents enrolled in Medicare, Medicaid, CHIP, TRICARE, and the Federal Employee Health Benefits Program.

  • ERISA’s preemption clause, which cur-rently forbids states from enacting legislation relating to employee health benefit program

After the introduction of HR 3241, the House referred this bill to five committees — the Committee on Energy and Commerce, the Committee on Ways and Means, the Committee on Oversight and Government Reform, the Committee on Armed Services, and the Committee on Education and the Workforce. I believe that the large number of committee referrals was done because of the need to review all of the different laws that this waiver would impact.

You can read the bill in its entirety here.

I am pleased that this bill has been introduced. It however needs many co-sponsors and advocates to pressure Congress to actually hear, review, and pass this legislation. Please contact your US Representative and ask her/him to co-sponsor Representative Jim McDermott, MD’s bill HR 3241. Here’s the lookup page to find your US. Representative by zip code.

As this is the summer, your Representative should be in the home district. Call, write, set up a meeting and tell her/him why you want to see a universal health care program in your state and why this bill is so necessary. If your Representative agrees to sign on, have him/her contact Mr. McDermott’s aides that are focusing on this issue. They are Jayme Shoun, located in Seattle at (206) 553-7170 and Daniel Foster, Health Counsel in the DC Office at (202) 225-3106.

Thanks.

Health Care is a Human Right

Mike Stout has just created his newest song entitled Heath Care is a Human Right. Tim Murray made the video of this new anthem for universal single payer health care. Both premiered  on Saturday evening, June 7 in Pittsburgh at a fundraiser for Healthcare for All PA. The video was posted on Sunday on YouTube.

Here’s the video.

And here’s a link to Healthcare for All PA, where you can obtain more information on Single Payer healthcare, how it improves upon the Affordable Care Act (ACA), what’s happening in the US and Pennsylvania to move us toward universal healthcare, and how you can join those of us who see and advocate for Healthcare as a Human Right.

The French Way or the Broken US Way of Healthcare?

Advocates for Single Payer Healthcare Rallying in 2009 in Harrisburg, PA

Advocates for Single Payer Healthcare Rallying in 2009 in Harrisburg, PA

Anya Schriffrin has just written a wonderful piece on universal health care from the French perspective called “The French Way of Cancer Treatment.”  She discusses the differences in the treatment her father received at Sloan Kettering Memorial Hospital v. his treatment at Cochin Hospital, a public hospital in Paris.

The differences she saw in her father’s cancer treatment in both countries included:

Issue

At Sloan Kettering (United States)

At Cochin (France)

 

Average length of treatment day

7.5 hours

90 minutes

How specialists see patients

Patient traveled to each specialist’s office

All specialists came to see patient either in home or in the hospital room.

Treatment received

Chemo selected based on insurance company’s formulary

Chemo selected based on doctor’s determination of best treatment

Who paid for meals while in hospital

Patient

Hospital: Included in treatment

Who paid for transportation to and from hospital

Patient and/or Insurance Company

Hospital: Included in treatment

Type of medical care

Insurance based, for-profit

Universal Health Care

Average cost/person for medical care in each country (2011)

$8,608

$4,086

% of Country’s Gross Domestic Product for Health Care

17.9%

11.6%

 

The one statement that stood out for me on the French system was this:

“There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, ‘It turns out there are solutions for the all the things we put up with in New York and accept as normal [emphasis added].’

As a cancer survivor, I can attest to similar experiences in the United States just about a quarter century ago.  Nothing has changed.  Like Ms. Schriffrin’s father, my visits to the hospital often took 7-8 hours after getting up way before the break of dawn to travel 3 hours to the hospital to be one of the first people to wait in line to see the doctors and other specialists.  I too had one doctor who wandered in to the clinic for my chemo 7-8 hours AFTER he was scheduled for treating patients. In that particular case, he kept patients and nursing staff waiting until about an hour after the clinic should have closed for the day.  And I had to fight for my life with two insurance companies in order to get the bone-marrow transplant I needed.

My story is similar to many others here in the states.  That’s why I support national universal, single-payer healthcare via Congressman John Conyers’ (D-MI) HR 676 in the United States.  It’s why I support federal legislation to expand the Affordable Healthcare Act to all states to create a state-level single-payer plan like what Vermont has already passed and signed into law. It’s why I support the plan that Senator Bernie Sanders (I-VT) has crafted; it’s called the American Health Security Act of 2013 bill and it creates state-level single-payer healthcare programs with Federal support.   It’s why I am a board member of Health Care for All PA Education Fund.  And it’s why I support the Pennsylvania Health Care Plan proposed by Pennsylvania State Senator Jim Ferlo.

We can do better here in the US.  Better than what Ms. Schriffrin’s father and I have both experienced.

Let’s fix this broken US healthcare system.  Let’s create access to quality healthcare for all via a universal, single-payer healthcare program in the United States.  Check it out.  Let’s do healthcare the French Way in the American style as suggested by Congressman John Conyers Jr. (D-MI), Senator Bernie Sanders (I-VT),  PA Senator Jim Ferlo, the state of Vermont, and Health Care for All PA.

Corbett’s at It Again

This time, Corbett is attacking LGBT couples

“Just Close Your Eyes”

Last year, the Pennsylvania General Assembly was considering passage of a transvaginal ultrasound bill to force women to have an unnecessary ultrasound in advance of going to an abortion clinic if they want to terminate their pregnancy. This bill would have required pregnant women to have the intrusive vaginal ultrasound with a video screen pointed at then and then would have required them to carry that report to the clinic the next day along with a signed form indicating that they had the procedure done.  This report would also have to be placed in their medical record despite the fact that this procedure was not medically necessary.

When Pennsylvania Governor Tom Corbett was asked if this was a bill that burdened women, he said that the women who didn’t want the procedure could “Just close their eyes.”

Here’s a clip of that comment (the commentary and the comment start at 02:39 minutes into this video):

This time he says, “I think a much better analogy would have been  brother and sister…”

Now this week, he’s attacking loving gay couples who want to marry just like their heterosexual friends do.  On Friday he responded to another reporter’s question.  He appeared on a Harrisburg TV station program called “Ask the Governor.”  The reporter asked him to comment on the legal argument that his lawyers are proceeding with in a case to stop Montgomery County’s Register of Wills from issuing marriage licenses to gays and lesbians who want to get married in Pennsylvania.

The legal brief compares same-sex marriage to allowing 12-year old children to get married.  His response, just a bit longer than the “Just close your eyes” comment from last year, is just as offensive.  The reporter said to him, “comparing gay marriage to the union of 12-year olds … you called inappropriate.” Corbett responded:

“It was an inappropriate analogy. I think a much better analogy would have been  brother and sister, don’t you? ”

Here’s a clip of this comment:

He later, as with last year’s comment, apologized, saying this time that it’s just a “legal” argument since marrying a 12-year old or having an incestuous marriage, or marrying a person of the same-sex are all illegal.

This is the guy who thinks he represents the Commonwealth?!!?  Women as well as men? I don’t think so! All gays and lesbian couples as well as any heterosexual couple that wants to get married?!!? I don’t think so!

Inappropriate, Offensive, Insensitive, and Hateful

Both of these statements are offensive, insensitive, and hateful.  And, yes just as Corbett later stated they are both inappropriate.  Yet he continues to attack – women, gays, immigrants, etc.  For a sampling of these attacks by Governor Corbett (as well by the Pennsylvania legislature), check out my blog posting earlier this entitled “War on Women in PA: At Least a 20-Year Happening.”

The apologies are not enough.  Corbett has to go.  He needs to be a 1-term Governor in Pennsylvania – something that hasn’t happened since the PA Constitution was amended in 1968 to allow a Governor to succeed himself (or herself, which might change if we ever elect a female governor) with a second term.

The Alternatives (So Far)

We know that Tom Corbett will be the Republican candidate for PA Governor in 2014.  We don’t know who the Democratic (or any other party) candidate will be on the November ballot.  Right now there are at least eight Democrats running: John Hanger, Jo Ellen Litz, Rob McCord, Katy McGinty, Max Myers, Ed Pawlowski, Allyson Schwartz, and Tom Wolf have officially announced and Rep. H. Scott Conklin, Senator Mike Stack, and former Auditor General Jack Wagner are considering a run. We need information on these alternatives.

So I started looking for blogs or commentary on alternatives to Tom Corbett.  So far, there is only one that is not party-based that I could find.  It is written by Cindy Purvis, Treasurer of Healthcare for All PA.  Her blog is titled “Race for PA Governor” and focuses on single-payer healthcare reform.  So check out her blog.

After the fall elections, there should be more websites up that can provide more complete information on the stances of candidates across a wide spectrum of issues, including women’s rights, reproductive justice, marriage equality, and other LGBTQ issues.  One of the best, in my opinion is Project Vote Smart.  Right now there is nothing on any race being held in 2014, but check back later.

Meanwhile, you can let your outrage be known. Contact Tom Corbett by email or phone at 717-787-2500.  Tell him that his wars on women and the LGBT community must stop.  Let him hear your outrage.  Maybe he might reconsider some of his views and actions towards the citizens of Pennsylvania.  I doubt it, but it doesn’t hurt to try.

Honoree, Distinguished Worldwide Humanitarian Award

Three days ago I got a call asking if I would accept a Distinguished Worldwide Humanitarian Award from Worldwide Who’s Who. I said yes. This is their announcement.

Marquis Who's Who Humanitarian Award

Tosti-Vasey, Joanne 1385793Dr. Tosti-Vasey is an optimist and believes that in the civil rights field, one oftentimes runs up against barriers; being flexible and being willing to look for a different way to achieve goals helps in the movement towards equality.

 
 
 
 

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Universal, Single-Payer Health Care Can Save Billions of Dollars

I recently posted a blog about why I support universal single-payer healthcare.  I told you about my personal trials with insurance companies in order to obtain my life-saving bone marrow transplant.  I have been telling that story in my advocacy ever since the early 1990’s when I became a single-payer healthcare advocate.

In 2008, I ran for the Pennsylvania House of Representatives.  Another candidate in another district that year was Cindy Purvis.  Both of us ran for public office with the message that affordable, universal health care was necessary for individuals, families, businesses, and our communities in general.

The following year, Cindy helped found Health Care for All PA, a statewide non-profit organization that educates the public and government officials regarding the scope and seriousness of the health care crisis.  She was their first President.  A year later, she asked me to join their Board of Directors.

In our advocacy for a universal health care plan for Pennsylvania, we have received push-back from the legislature. They told us that the General Assembly would not move the bill unless we had an Economic Impact Study (EIS) that shows that universal, single-payer health care is cost-effective. So a couple of years ago, the legislature considered an EIS bill to find out this answer. Unfortunately it died in committee.

But this question still needed to be answered.  So the Health Care for All PA Education Fund raised monies from individuals and small businesses to fund just such a study to compare the proposed state-based single-payer health care plan to the Affordable Care Act (aka Obamacare) and other health care programs within Pennsylvania.  And we now have the results.

STUDY PROVES PENNSYLVANIA CAN EXPAND HEALTH CARE TO ALL WHILE SAVING BILLIONS OF DOLLARS

ECONOMIC IMPACT STUDY COMMISSIONED BY HEALTHCARE4ALLPA PAVES THE WAY FOR AFFORDABLE UNIVERSAL HEALTH CARE IN PENNSYLVANIA

Health Care for All PA released the results of this economic impact study last week based on and in conjunction with the anticipated introduction of the Pennsylvania Health Care Plan bill by Senator Jim Ferlo on Tuesday, March 19 at 2:00 pm in the Capitol Media Center, Harrisburg.

The results prove that a single-payer health care plan will save families, businesses and tax payers $17 billion annually while at the same time providing comprehensive health care to all.

This study was done by University of Massachusetts – Amherst professor of economics Gerald Friedman, Ph.D.   It compares the cost of the current for-profit health insurance model in Pennsylvania whereby provider choice is limited and health services are rationed by health insurance companies to that of a consumer-driven health care system which lets people have the freedom to choose their own doctors, hospitals and health care providers.

Some of the important advantages of a single-payer system are:

  • Provides comprehensive coverage for every resident of Pennsylvania, including dental, vision and mental health services;
  • Eliminates the need for hospitals to absorb the cost of care for the uninsured;
  • Reduces bureaucracy for private physicians resulting in reduced administrative costs and improved compensation for private physicians;
  • Reduces or eliminates health insurance over-costs for small business, allowing for more job creation, greater reinvestment of profits, and reduced workers’ compensation costs.
  • Radically reduces the total cost of health care to levels more consistent with costs in the rest of the industrialized world.
  • Reduces healthcare spending in Pennsylvania by an estimated $16 Billion +
    (from $144 billion to $128 billion). This includes savings of $7 Billion + for businesses that currently provide health care benefits and over $6 Billion for state and local governments and school boards. It also reduces the cost to the average individual who pays well over the 3% of personal income for health care coverage that is called for in the Pennsylvania Health Care Plan.

Here’s some highlights from the EIS:
EIS SUMMARY AND HIGHLIGHTS OF PENNSYLVANIA HEALTH CARE PLAN

Friedman’s Executive Summary can be read here.

The entire Economic Impact Study can be read here.

Why I Support Universal Health Care: A Right, Not a Privilege

Congressman John Conyers Jr. (D-MI) has reintroduced his National Health Care plan bill HR 676, “The Expanded and Improved Medicare for All Act.” I strongly support a universal national health care program such as HR 676. I also support any effort by any state to implement a state-based single-payer health care plan. Why?  For many reasons.

My life was threatened by the multi-company, private health insurance system we currently have.

I received a bone marrow transplant in 1989 from my identical twin sister. Although I had no problem finding a match, I had to jump through many hoops and barriers put up by the two health insurance companies covering my sister and myself. In the case of my insurance provider, I was refused coverage of the donor portion of the transplant because my twin sister wasn’t on my health insurance plan. In the case of my twin sister’s insurance provider, they refused to cover her portion of the transplant because she “wasn’t sick.” Then the hospital administration said that they would not perform the transplant until this conflict between the two insurance agencies was resolved with a guarantee of payment by either or both companies. And my doctors said that if the resolution did not occur rapidly, I would be dead within the year due to the seriousness of the form of leukemia that I had.

According to Health Care for America, health insurance companies profit by denying–not by providing–healthcare. Health insurance CEOs of the top 10 health insurance companies today typically enjoy an average of $10,000,000 in annual compensation–salary, bonuses, stock options, etc.

Back to my story. I went into battle mode against the insurance companies when I was told that they would let me die because of their bottom line and attempts to deny coverage. Because of the support and advocacy I had through the organization where I self-purchased my health insurance (the National Organization for Women), we were finally able to get me the life-saving transplant that I needed. And I am here today.

This experience is why I became an advocate for a single-payer health care system rather than the current system that allows private companies the ability to deny critical health care to “save” their bottom line for profit only.

Other Reasons why I support a Universal Health Care Plan at Either the National or State Level.

It is the ethical and moral to treat all people, regardless of economics or status when they are sick.

A 2009 article in the Journal of Public Health reports that approximately 45,000 people on average die each year due to lack of health insurance. One of the goals of The Affordable Care Act (ACA) is to reduce the number of people without health insurance, so that premature deaths from lack of coverage would also be reduced.

People will continue to struggle to receive health care coverage and treatment with both passage of the ACA and the Supreme Court’s decision declaring the ACA as constitutional while allowing states to opt out of the expanded Medicaid program for low-income people.

The Centers for Disease Control acknowledges that access to coverage will improve under the ACA. But that acknowledgement holds a caveat; they state, “Even after ACA is implemented fully, some persons eligible for coverage might go uninsured.” The ACA will not fully resolve this ethical and moral threat to peoples’ lives. 

Some states are threatening people’s health care and lives based on decisions either by their legislature and/or their governors.

These states place people who could have been covered under the Expanded Medicaid program in continued jeopardy since they will neither be able to sign up for Medicaid nor be able to afford private health insurance through the ACA’s health care exchanges. The 13 states that have already threatened the healthcare of their citizens are Alabama, Georgia, Idaho, Louisiana, Maine, Mississippi, North Carolina, South Carolina, South Dakota, Oklahoma, Pennsylvania, Texas, and Wisconsin. Five states – Iowa, Nebraska, New Jersey, Virginia, and Wyoming—are leaning towards opting out of coverage. Kentucky, New York and Oregon haven’t yet made their decision, but do appear to be leaning towards opting into full ACA with the expanded Medicaid coverage. All remaining 22 states plus the District of Columbia have opted into full ACA with the expanded Medicaid coverage.


Where the States Stand

Via: The Advisory Board Company

For the low-income people living in the 18 states that have either opted out of or are considering opting out of the expanded Medicaid coverage, nothing changes for them since most of these individuals will not be able to afford private health insurance in the new health care exchanges under the ACA.

A Single Payer, Universal Healthcare program would cover everyone.

According to predictions by the Congressional Budget Office and the Joint Commission on Taxation, we will we still have 30 million uninsured in 2023 under Obamacare. At the same time, health care costs for our nation, states, and families will continue to increase. A single-payer, universal healthcare program could cover everyone at lower cost. Everyone in and no one out regardless of income or health status.

The BETTER Alternatives: National and State-Based Single-Payer Plans

The plan introduced by Representative Conyers is basically an expansion of the efficient and cost-effective Medicare system currently used by the elderly and people with disabilities. Its overhead (all costs other than for healthcare) is much lower–and patient satisfaction is much higher–than under for-profit healthcare. And it would cover everyone regardless of their economic or health status without fear of an insurance company denying coverage to save their bottom line.

Similarly, legislation is being considered in about half of the states to create state-based single-payer healthcare programs. Some of these states’  legislatures have held hearings and/or had votes on universal healthcare. Vermont has already passed a law that sets in place the possibility of a single-payer healthcare program by 2017. 2017 is the year that the ACA—aka “Obamacare”—allows states to try other healthcare plans IF they cover at least the same number of people with at least the minimum coverage under the ACA.

Obamacare is now the law of the land. It is an improvement over what we had before 2009. It is also the basis from which we can work towards a comprehensive healthcare program. We could do it nationally, such as with HR 676. Or, like Canada, we can start at the state level.

So check out HR 676. See if your Representative is one of the 40 current co-sponsors. If not, meet with him/her, tell your personal story about why you support an expanded and improved Medicare for All, and ask them to co-sponsor the bill. If he/she is already a co-sponsor, ask your Representative to take the next step. They can hold a town-hall meeting on universal healthcare to hear from their constituents. They can also call on the chairs of the three committees reviewing HR 676 to hold Congressional hearings on HR 676. These three committees are the House Energy and Commerce Committee, the House Ways and Means Committee, and the House Natural Resources Committee.

Also get active with your state-based single-payer organization. These local and state-based single-payer health care groups will let you know how can help with your state-based legislation. Healthcare NOW has a full listing of state- and local-based organizations. If your state does not have a single-payer chapter yet, contact Healthcare NOW at their national office in Philadelphia, PA; they can help you to organize a plan for your state.

All other “advanced” nations have already adopted comprehensive healthcare systems. All deliver better health outcomes at a lower per capita cost than the USA. Let’s get cracking. Let’s do it here in the US of A as well.