Single-Payer

July 31, 2015

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.

March 9, 2015

Universal Health Care: Let’s Do It!

I am not an economist. But I am a strong advocate for universal access to healthcare in the United States. See why here.

A couple of days ago, Thom Hartmann at The Big Picture RT posted a YouTube video on why economists are demanding a universal national healthcare plan. In this video he reports that more than 100 economists sent an open letter to Vermont’s Governor Peter Shumlin (D) after Shumlin “bailed” on implementing Vermont’s state-based single-payer healthcare plan.

Governor Shumlin stated that he was stopping the implementation process because he believes that “This is not the right time” for enacting single payer. He stated that there were too many costs associated with the program and could not go forward with the plan “at this time.”

The economists argued otherwise:

As economists, we understand that universal, publicly financed health care is not only economically feasible but highly preferable to a fragmented market-based insurance system…. Public financing is not a matter of raising new money, but of distributing existing payments more equitably and efficiently. Especially when combined with provider payment reforms, public financing can lower administrative costs, share health care cost much more equitably, and ensure comprehensive care for all.

We support publicly and equitably financed health care at federal and state level, and we encourage the government of the state of Vermont to move forward with implementing a public financing plan for the universal health care system envisioned by state law.

Hartman then goes on to say that part of the economic concerns about Vermont’s single-payer healthcare plan arises from its small population base. He believes that the economy of scale makes it harder for a small state to go it alone in “innovating” new healthcare plans as allowed by the Affordable Care Act starting in 2017. Then he goes on to urge the federal government to expand Medicare to all citizens over a 10-year period of time.

I agree that it would be great to have universal Medicare for All across the United States. But I also believe that the only way that will happen is if some states implement single-payer healthcare at a state level to concretely show that a universal healthcare plan is economically viable and distributes existing healthcare payments more efficiently and equitably while lowering administrative costs WITHOUT raising the overall cost to individuals, businesses or communities. In fact, in many instances, cost would be lower.

Studies on how this might happen have been done by well-known economists across the country. For example, Dr. Gerald  Friedman, Professor of Economics and Department Head at the University of Massachusetts-Amherst has done several of these studies, including one for Pennsylvania, one for Maryland, and one for expanding Medicare to all at the national level. Every economic impact study on implementing universal healthcare plans that I have read indicates that “A single-payer health care finance system would produce substantial health and economic gains” when implemented at either a state or the national level.

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 healthcare. And advocates across the nation continue to work for Medicare for All at the national level.

Whichever way comes first is fine with me. We just need to get moving and create healthcare for all in the USA.  Let’s make it sooner rather than later.

February 28, 2015

The Supreme Court, the ACA, Healthcare.gov, and an Alternative Plan

The US Supreme Court will be hearing a case – known as King v. Burwell – this coming week on whether or not the federal healthcare exchange program, known as Healthcare.gov, is legal. The question before the Court is whether or not the Affordable Care Act (ACA) allows for subsidies for healthcare premiums in any of the 34 states that refused to set up their own healthcare exchanges under the ACA.

The plaintiffs – four people from Virginia – argue that the federal government misinterpreted the ACA in regards to the subsidies. They argue that the law only allows for subsidies in states that set up a state-based exchange. Virginia in one of the 34 state who opted out of a state-based exchange. These four individuals, who don’t want to purchase insurance, say that without the subsidies, they would not have to either buy insurance or pay a penalty since they do not make enough to afford healthcare without the subsidy*. The Obama administration argues that this is a politically motivated argument to narrowly interpret a couple of words found in the ACA in order to gut it.

If the US Supreme Court invalidates the Healthcare.gov websites in all of the states that refused to set up their own healthcare exchanges, everyone who gets a subsidy to purchase their health care through the exchange will lose that subsidy. According to the Washington Post, this type of ruling would affect about eight million people across the country. That’s about 87% of all Healthcare.gov users nationwide in the 34 states that did not set up a state-based exchange receive. In Pennsylvania, somewhere between 70-84% of all users of healthcare.gov receive these subsidies.

The subsidies in Healthcare.gov currently reduces healthcare premiums by up to 72% of the full premium, depending on the size of one’s family and family income. So if the Court holds that subsidies within the Federal Healthcare exchange are illegal, premiums for individuals needing these subsidies will dramatically increase; out-of-pocket premium increase could amount to an average increase of 256%. This increase could begin in as little as 25 days after the ruling is made in June 2015. OR the Court could set a date further in the future to allow some time for transition.

What would the end of these subsidies mean?

Healthcare in the 34 states in the federal exchange program would destabilize. The predictions include lots of people – mostly the young and the healthy – ending their insurance, insurance companies pulling out of the exchanges in these states, lots of layoffs, and a return to uncovered people attempting to get care in hospitals without any coverage. Those left in the exchanges after the young and healthiest leave are the older and the sickest individuals. Insurance companies will begin to feel the pain and start to pull out of the exchanges as participation in the exchanges would no longer be financially viable. With fewer people seeking care on the federal exchange, thousands of people hired by the insurance companies and by the federal exchange system will likely face layoff. In addition, hospitals will once again see a surge in the uninsured arriving on their doorstep for care.

Here’s how the Kaiser Family Foundation summarizes this issue:

People Leaving the Market Followed by Premium Increases for Those Who Remain. As a result, the elimination of the subsidies would destabilize the individual insurance markets in states not running their own marketplaces. Under the ACA, insurers would still be required to guarantee access to coverage irrespective of health status and prohibited from charging sick people more than healthy people. Even without the subsidies, many people who are sick would likely find a way to maintain their insurance in the face of substantial premium increases. However, people who are healthy would likely drop their insurance.

Insurers in the affected states would immediately find themselves in a situation where premiums revenues were insufficient to cover the health care expenses of the remaining enrollees, who would be far sicker on average than what insurers assumed when they set their premiums for 2015. This would trigger a classic adverse selection “death spiral,” where insurers would seek very large premium increases, which in turn would cause the healthier of the remaining enrollees to drop coverage….

Insurance Companies Leave the Market and Layoff Employees…Under ACA regulations, premiums for insurance sold inside the marketplaces are locked in for a full calendar year. So, the earliest those premiums could change would be January 1, 2016, though even that would be tricky since insurers will have already submitted proposed 2016 premiums to state insurance departments by the time the Court issues a decision. Depending on state laws, premiums for products sold outside of the marketplaces could potentially be increased more quickly. And even if insurers could adjust rates, establishing stable and sustainable premium levels in this type of environment is extremely difficult, because as rates move higher, more of the relatively healthy enrollees drop their coverage.

Because this may all happen very quickly, it is possible that many or all insurers would choose to exit the individual markets in these states rather than facing significant losses in a quickly shrinking market. Insurers that remain in the market risk being one of the only carriers continuing to guarantee access to coverage to people in poor health (since people who lose coverage from exiting insurers have special enrollment periods to choose new coverage).

Since it is unlikely that Congressional opponents to the ACA would be willing to craft a law allowing for subsidies within Healthcare.gov should the Court overturn this portion of the ACA regulations, the burden of the fix falls upon each of the 34 states. Some of these 34 states will allow the healthcare exchange to die with the dire predictions quickly coming to fruition. Others, in advance of the Court’s hearing and decision of this case, are starting to talk about alternatives should the Court outlaw the subsidies in their states.

One of these states attempting to deal with this possibility is Pennsylvania, where I live. The insurance companies and hospitals throughout the state, fearing for their livelihood, are lobbying the PA General Assembly to set up a state-based exchange system. Tom Wolf (D), our new Governor, has said he is interested in setting up a state-based exchange.

The question then becomes, where would the money for the set-up of a state exchange come from in a state that has a large budget deficit since federal dollars for such a set-up are no longer available.

Might this be a great time to lobby for a universal health care plan for Pennsylvania? As well as in the other 21 states currently working towards such a solution as well?

Healthcare for All PA, in conjunction with some of our state legislators, are working on re-introducing the Pennsylvania Health Care Plan. This bill, if it becomes law, would

…create one insurance plan that has one single payer, to cover all Pennsylvania taxpayers.  The premiums for The Pennsylvania Health Care Plan would be a flat rate of 3% of income for individuals and 10% of payroll for businesses.  The Pennsylvania Health Care Plan would place you and your healthcare provider in charge of you and your family’s healthcare. The plan will be a public/private hybrid with the insurance function provided by the state government and the medical care would be privately delivered.

It’s cost effective. It covers everyone. It’s comprehensive in that it covers all medical treatment, dental care, eye care, physical therapy, mental health treatment,  hospice care, treatments for addiction, long-term care, access to wellness programs, prescription drugs and emergency transport. And you won’t need an army of navigators in either a state- or a federal-based healthcare exchange to help you interpret your plan.

Check out Healthcare for All PA for more information on this bill and become a citizen lobbyist for comprehensive health care that allows you access to the healthcare you need and want without bankrupting you, your family or your neighbors.

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*NOTE: The four plaintiffs in this case before the Supreme Court–David King, Douglas Hurst, Brenda Levy and Rose Luck—appear to be either ideologues and/or guinea pigs for the libertarian Competitive Enterprise Institute (CEI). CEI is an organization committed to overturning the Affordable Care Act. If the subsidies are overturned, all four of these individuals may not even be affected by the Court’s ruling according to a February 9 article in Mother Jones. Three of the four – Levy, King and Hurst – are now or soon will be fully eligible for Medicare. Two of them – King and Luck – already qualify for a hardship exemption from purchasing healthcare and/or paying a penalty due to their relatively low-income levels. However, the issue of “standing” (the legal argument that they would actually be harmed if the law were to continue), for some reason, has not been raised in this case by the Obama administration and will not be considered when the Court hears the case next week.

June 10, 2014

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.

March 13, 2013

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.

February 20, 2013

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.