Our Health Policy Matters

When the House of Representatives voted by a comfortable margin a few hours ago to approve the American Taxpayer Relief Act (ATRA) and step away from the "fiscal cliff" for another two months, it agreed to two Senate provisions affecting elders and others with long term care needs. The first was the "doc fix," which prevented a nearly 30% cut in Medicare payments to physicians.  This was important.  If it hadn't happened, doctors would have fled the Medicare program. The second was tucked away into Section 643 of the Act .  It establishes a new 15-member Commission on Long Term Care, replacing the CLASS Act provisions of the Affordable Care Act that are now finally, formally repealed by ATRA. The Commission could turn out to be a very big deal if it does it job well, because it could lead the way in changing our system of providing and financing long-term care in America. The Commission is charged with writing a bill over the next six months "to e...

When the House of Representatives voted by a comfortable margin a few hours ago to approve the American Taxpayer Relief Act (ATRA) and step away from the "fiscal cliff" for another two months, it agreed to two Senate provisions affecting elders and others with long term care needs. The first was the "doc fix," which prevented a nearly 30% cut in Medicare payments to physicians.  This was important.  If it hadn't happened, doctors would have fled the Medicare program. The second was tucked away into Section 643 of the Act .  It establishes a new 15-member Commission on Long Term Care, replacing the CLASS Act provisions of the Affordable Care Act that are now finally, formally repealed by ATRA. The Commission could turn out to be a very big deal if it does it job well, because it could lead the way in changing our system of providing and financing long-term care in America. The Commission is charged with writing a bill over the next six months "to e...

Public policy attacks on public health and mental health, intrusions in doctor/patient privacy, the continuing fight over the Affordable Care Act, and our collective loss of faith in private health insurance were among the top health policy story lines of 2011. This year, eight stories make my short list.  Not all of these stories made big headlines during the year.  But they have had, or will have, an outsized impact on our lives. I’ll begin the countdown this week with four that capture and continue some of the major trends of the recent past.   Next week, I’ll offer four more that hint at where health policy may go in the future. 8.  The Shooting of a Congresswoman .  In January, the first big health policy story of the year was about violence and mental illness – the horrible wounding of a member of Congress, and the murder of several people around her.  As the media struggled to make sense of this, it raised once again the relation...

Public policy attacks on public health and mental health, intrusions in doctor/patient privacy, the continuing fight over the Affordable Care Act, and our collective loss of faith in private health insurance were among the top health policy story lines of 2011. This year, eight stories make my short list.  Not all of these stories made big headlines during the year.  But they have had, or will have, an outsized impact on our lives. I’ll begin the countdown this week with four that capture and continue some of the major trends of the recent past.   Next week, I’ll offer four more that hint at where health policy may go in the future. 8.  The Shooting of a Congresswoman .  In January, the first big health policy story of the year was about violence and mental illness – the horrible wounding of a member of Congress, and the murder of several people around her.  As the media struggled to make sense of this, it raised once again the relation...

There are 4 million or more Americans who can’t get regular insurance because of a pre-existing condition.   You might be one of them.  Now there’s a policy that costs less than $300 per month and covers all of your medical needs, including your pre-existing condition.   Will you buy it?  Apparently not. And that may signal the beginning of the end of private insurance in America. I first wrote about the diminished role of private insurance in a column last month entitled America’s Health Insurance Myth .   Privately-financed private health insurance today pays only 17% of America’s health care bill. Two recent developments suggest that this share will become even smaller in the future. The first was last week’s death of the CLASS Act .   As a result, long term care will continue to be an out-of-pocket and government expense only for nearly everyone. The second was the report of first-year enrollment numbers for the new Pre-existing Condi...

There are 4 million or more Americans who can’t get regular insurance because of a pre-existing condition.   You might be one of them.  Now there’s a policy that costs less than $300 per month and covers all of your medical needs, including your pre-existing condition.   Will you buy it?  Apparently not. And that may signal the beginning of the end of private insurance in America. I first wrote about the diminished role of private insurance in a column last month entitled America’s Health Insurance Myth .   Privately-financed private health insurance today pays only 17% of America’s health care bill. Two recent developments suggest that this share will become even smaller in the future. The first was last week’s death of the CLASS Act .   As a result, long term care will continue to be an out-of-pocket and government expense only for nearly everyone. The second was the report of first-year enrollment numbers for the new Pre-existing Condi...

Is the CLASS Act already dead and buried, a full year before it comes to life? A couple of months ago, I wrote a column about the ill-advised, bi-partisan Congressional effort by the Senate “Gang of Six” to deep-six the CLASS Act.   The CLASS Act is the new national privately-financed long term care insurance program authorized by Congress in 2010.   Without going into all the details again, it is intended to make long term care insurance care available to the working middle class.   This would take pressure off of the Medicaid program, resulting in billions of dollars of savings to taxpayers. The CLASS Act won’t even take effect until October, 2012, and the Administration hasn’t even announced exactly how it would be structured.   But the Department of Health and Human Services may be closing down the CLASS office.   This past weekend’s news report from the Hill and other media outlets noted that it has let its actuary go and asked the Senate not...

Is the CLASS Act already dead and buried, a full year before it comes to life? A couple of months ago, I wrote a column about the ill-advised, bi-partisan Congressional effort by the Senate “Gang of Six” to deep-six the CLASS Act.   The CLASS Act is the new national privately-financed long term care insurance program authorized by Congress in 2010.   Without going into all the details again, it is intended to make long term care insurance care available to the working middle class.   This would take pressure off of the Medicaid program, resulting in billions of dollars of savings to taxpayers. The CLASS Act won’t even take effect until October, 2012, and the Administration hasn’t even announced exactly how it would be structured.   But the Department of Health and Human Services may be closing down the CLASS office.   This past weekend’s news report from the Hill and other media outlets noted that it has let its actuary go and asked the Senate not...

The debt ceiling and deficit reduction command the attention of Congress this week.   Its members are trying to find trillions of dollars of cuts to balance the budget. So why are some members of Congress trying to do something that is guaranteed to increase the already sky-high cost of the Medicaid program?   Do they want to drive us further into debt? The Senate Gang of Six wants to deep six the CLASS Act before it takes effect.   The CLASS Act is the new national long term care insurance program that will take effect next year.   It will cost the federal government nothing and is projected to save the Medicaid program billions of dollars. The Medicaid program, as most U.S. citizens now know, is a federal/state partnership resulting in different plans in every state.   In 2010, roughly 55 million people were insured through state Medicaid programs.   If they were all combined into one plan, Medicaid today would be the single largest health insurer in...

The debt ceiling and deficit reduction command the attention of Congress this week.   Its members are trying to find trillions of dollars of cuts to balance the budget. So why are some members of Congress trying to do something that is guaranteed to increase the already sky-high cost of the Medicaid program?   Do they want to drive us further into debt? The Senate Gang of Six wants to deep six the CLASS Act before it takes effect.   The CLASS Act is the new national long term care insurance program that will take effect next year.   It will cost the federal government nothing and is projected to save the Medicaid program billions of dollars. The Medicaid program, as most U.S. citizens now know, is a federal/state partnership resulting in different plans in every state.   In 2010, roughly 55 million people were insured through state Medicaid programs.   If they were all combined into one plan, Medicaid today would be the single largest health insurer in...

Why is it so important that Florida has won a $35.7 million health reform act grant to participate in the federal “Money Follows the Person” program? A recent news story provides the answer.    It tells the story of a 20-something Florida resident who is a quadriplegic living in a nursing home.   He doesn’t want to live there.   But he doesn’t have a choice.   It’s the only option for which the Florida Medicaid program will pay.   We hope he’ll be alive for many years.   A back-of-the-envelope calculation suggests that the cost of his care could approach $4 million by the time he is 65. A December, 2009, AARP Long Term Care Brief showed that Florida spent 86% of its Medicaid long term care dollar on institution-based services.   It spent about half the national average on home and community-based services (HCBS). The “Money Follows the Person” program offers a low cost remedy.   Enacted in 2007, the program has already provided over $1.4 bi...

Why is it so important that Florida has won a $35.7 million health reform act grant to participate in the federal “Money Follows the Person” program? A recent news story provides the answer.    It tells the story of a 20-something Florida resident who is a quadriplegic living in a nursing home.   He doesn’t want to live there.   But he doesn’t have a choice.   It’s the only option for which the Florida Medicaid program will pay.   We hope he’ll be alive for many years.   A back-of-the-envelope calculation suggests that the cost of his care could approach $4 million by the time he is 65. A December, 2009, AARP Long Term Care Brief showed that Florida spent 86% of its Medicaid long term care dollar on institution-based services.   It spent about half the national average on home and community-based services (HCBS). The “Money Follows the Person” program offers a low cost remedy.   Enacted in 2007, the program has already provided over $1.4 bi...