Our Health Policy Matters

You shouldn’t have to worry about anything during vacation season. So this column is my vacation gift to you. It is about all the health policy matters we seem to worry about the least.  I have written close to 150 columns.  If you look down the right side of the page, you will find links to the ten most-read ones.  The subjects won’t surprise you – fairness in mental health treatment, Obamacare and private insurance, and cursed football players lead the way. But do you ever wonder about the columns with the fewest readers? Based solely and unscientifically on my numbers, here are a half dozen or so health policy matters we seem to care about the least. Long Term Care.  Are you worried about continuing high unemployment rates, taxes on small businesses, or another stock market crash ruining your family’s financial security?   If so, you should redirect that worry.  Because US Trust CEO Keith Banks called long term care costs...

You shouldn’t have to worry about anything during vacation season. So this column is my vacation gift to you. It is about all the health policy matters we seem to worry about the least.  I have written close to 150 columns.  If you look down the right side of the page, you will find links to the ten most-read ones.  The subjects won’t surprise you – fairness in mental health treatment, Obamacare and private insurance, and cursed football players lead the way. But do you ever wonder about the columns with the fewest readers? Based solely and unscientifically on my numbers, here are a half dozen or so health policy matters we seem to care about the least. Long Term Care.  Are you worried about continuing high unemployment rates, taxes on small businesses, or another stock market crash ruining your family’s financial security?   If so, you should redirect that worry.  Because US Trust CEO Keith Banks called long term care costs...

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...

If 243 members of Congress knew that they were going to develop Alzheimer’s Disease or related dementia, would it change the way they make Medicaid and long term care policy? Or would they continue to deny the inevitable? When Congress convened in 2011, the average age of a House member was 57, and the average age of a senator was 62.   They were approaching the prime years for dementia. If you don’t already have Alzheimer’s Disease or related dementia by the time you turn 65, then your chances of developing it between the ages of 65 and 74 are greater than one in 20.  Your chances of developing it between the ages of 75 and 84 are almost one in 7.  And after that your chances of developing it are one in 4. At today’s prevalence rates, 28 members of Congress will develop dementia between the ages of 65 and 74, 91 between the ages of 75 and 84, and 124 later on. The only thing that will change this trajectory is if they die sooner of something ...

If 243 members of Congress knew that they were going to develop Alzheimer’s Disease or related dementia, would it change the way they make Medicaid and long term care policy? Or would they continue to deny the inevitable? When Congress convened in 2011, the average age of a House member was 57, and the average age of a senator was 62.   They were approaching the prime years for dementia. If you don’t already have Alzheimer’s Disease or related dementia by the time you turn 65, then your chances of developing it between the ages of 65 and 74 are greater than one in 20.  Your chances of developing it between the ages of 75 and 84 are almost one in 7.  And after that your chances of developing it are one in 4. At today’s prevalence rates, 28 members of Congress will develop dementia between the ages of 65 and 74, 91 between the ages of 75 and 84, and 124 later on. The only thing that will change this trajectory is if they die sooner of something ...

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...

Florida recently elected to turn down – again – over $2 million in Federal money to pay the administrative costs of expanding its Medicaid long term care program’s home and community based services. In March 2011, Florida qualified for over $35 million to join most of the rest of the nation in participating in the Money Follows the Person program.   The program was created during the Bush Administration as a way of helping people move back out of nursing homes into the community.   It became so popular in the 29 states (and District of Columbia) participating in it that it was expanded as part of health reform.   Thirteen additional states, including Florida, were invited to participate.   Former Governor Charlie Crist authorized Florida’s Agency for Health Care Administration (AHCA) to file Florida’s application. Rejecting the program means that people who want to leave Florida nursing homes won’t be given control of the resources they need to do so.   ...

Florida recently elected to turn down – again – over $2 million in Federal money to pay the administrative costs of expanding its Medicaid long term care program’s home and community based services. In March 2011, Florida qualified for over $35 million to join most of the rest of the nation in participating in the Money Follows the Person program.   The program was created during the Bush Administration as a way of helping people move back out of nursing homes into the community.   It became so popular in the 29 states (and District of Columbia) participating in it that it was expanded as part of health reform.   Thirteen additional states, including Florida, were invited to participate.   Former Governor Charlie Crist authorized Florida’s Agency for Health Care Administration (AHCA) to file Florida’s application. Rejecting the program means that people who want to leave Florida nursing homes won’t be given control of the resources they need to do so.   ...

For over thirty years, states have tried and failed to contain Medicaid costs. And if they continue to do what they’ve always done, then “more flexibility” through block grants – code words for cutting people and benefits from the programs – isn’t going to help.   This is because the strategies they have used don’t work.   I wrote a few weeks ago about problems with some of the specifics of Florida’s Medicaid reform bill this year.   In this column, I want to add a more global perspective.   source: US DHHS, 2007 Between 1980 and 2004, total personal health care expenditures in the United States increased by 726%.   Total Medicaid expenditures increased by 1,028%.   That’s a pretty compelling opening argument against the four common “cost containment” strategies -- cutting provider rates; reducing the number of people eligible; eliminating chronic disease detection, prevention, and management services; and making recipients ...