Jody Dzuranin

Overview: The Affordable Health Choices Act

Health Care Reform Series: The Affordable Health Choices Act.

by Jenny Kakasuleff

• President Obama has requested that Congress have a bill ready for his signature by the fall. He has largely left the craftsmanship of the legislation up to lawmakers, but has indicated his desire to reach three primary goals:

1. Reform the system by: expanding coverage, improving quality, lowering cost, honoring patient choice, and holding insurance companies accountable
2. Scientific and  technological advancements   
3. Preventative care 

• The AHCA would create state health insurance exchanges, modeled similar to those in the Massachusetts universal health care plan. But unlike the PCA, which left participation in the health exchanges optional, the plan offered by democrats would make participation mandatory. The goal of the exchanges is to streamline services in the health insurance sector by creating a one-stop-shop where consumers can compare different plans.
• Individual mandates are an essential piece to the overall puzzle and the wisdom behind “community rating.” The only way the health care system will be able to absorb the costs of including individuals with pre-existing conditions, is by ensuring the young and healthy demographic are enrolled in a minimal “catastrophic illness” plan, thereby allowing the healthy to subsidize the costs of the sick.
• The AHCA would mandate employers either provide insurance and contribute to premiums for their employees, or contribute to a public option. Small employers would be exempt, but there is no definition yet on what defines a small employer. Since the penalty of not participating will likely be less than the cost of participating, employees can expect their employers to discontinue offering insurance. The economic incentive to not provide coverage has been growing, and with a public option, the moral and social incentive to provide it becomes even less, as employers rationalize it is better for business to allow employees to purchase their own plan—and they are probably right. How many businesses suffer from a one million dollar yearly surcharge when someone on the payroll develops a serious illness?
• According to Jonathan Gruber, an economist with the Massachusetts Institute of Technology, removing the burden of employer-sponsored coverage would incentivize a boom in entrepreneurialism. He further notes:

The example I think of is the 50-year-old engineer at IBM whose wife is a cancer survivor and who wants to start his own company. He's just not going to do it in today's world, because he just can't take that chance on health insurance. In a world of health reform, he can do that.

These points are excerpted from

Health Care Reform Series: The Affordable Health Choices Act.

by Jenny Kakasuleff

Hospitals give and take on Health Reform Proposal

The Associated Press: White House, hospitals reach deal on health care.

Of the $155 billion in projected savings from hospitals, about $40 billion to $50 billion would come from reducing federal payments hospitals receive for providing care to uninsured and low-income patients, according to lobbyists. Those payments are now made through the Medicare and Medicaid programs. The Medicaid cuts would be apportioned by state, as 10 percent annual reductions beginning around 2015.

About $100 billion more would come from reductions in planned Medicare payments to hospitals. A small amount of savings would come from trimming the money hospitals get for preventing patients from being readmitted for additional care.

Hospitals would also get something out of the deal. They won an agreement that if the Finance Committee's legislation includes a public health insurance plan, it would reimburse hospitals at above the rates Medicare and Medicaid pay, which hospitals have long complained are insufficient.

Small Business Summary of House Healthcare Proposal

Health insurance reform details coming into focus - Business First of Columbus: .

How small businesses would fare under House health-care proposal: 

• Small businesses and individuals could comparison shop among private and public plans in a national health insurance exchange. 

• Employers could either provide health insurance to their employees or pay a fee based on 8 percent of their payroll to the government. 

• Employers that offer coverage would have to pick up 72.5 percent of the cost of premiums for full-time employees and 65 percent for a family policy. 

• Employers could contribute a share of the expense of coverage for part-time employees or contribute to the health insurance exchange. 

• Small businesses under a size threshold yet to be determined would be exempted from the employer responsibility requirement.

• Small businesses that can’t afford coverage would get a tax credit to help them pay for it. 

Source: House committees on Ways and Means, Energy and Commerce, and Education and Labor

NPR: Spend More, Get Less? The Health Care 'Conundrum'

A few points in this audio podcast that stood out for me:

1. The Medical Practitioners were hesitant to admit they were practicing over utilization until they were confronted with the numbers.  After that, they admitted they were ordering an extraordinary amount of tests as defensive medicine against lawsuit liability.  
2. When Gawande said to the interviewer, the question is.."When is medicine a profession and when is it a business" 
3. More people die from complications of surgery than due to car accidents.  

I applaud the story for bringing to light, the ongoing system misuse via over utilization. 

Spend More, Get Less? The Health Care 'Conundrum' : NPR.

Higher spending doesn't necessarily correlate with better care, as Gawande discovers when he compares health outcomes in McAllen with those of El Paso, Texas — a city with similar population demographics, but where Medicare spending per enrollee is half that of McAllen. Gawande writes that his findings, based on Medicare's 25 metrics of care, indicate that: "On all but two of these [standards of care], McAllen's five largest hospitals performed worse, on average, than El Paso's. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it's delivering better health care."

Related Article:

Cat’s still in the bag ... - Modern Healthcare.

the AMA’s most militant anti-reform members should clear the June 1 issue of the New Yorker from their waiting rooms. There, patients could read an article by physician/author Atul Gawande focusing on McAllen, Texas, as a lesson in what’s wrong with the nation’s healthcare. The article has become required reading in the Obama administration. It dwells on costs and contains this eloquent statement about systemic dysfunction: “When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the U.S. at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.” If Americans ever fully realize that too much of the system is aimed first and foremost at maximizing revenue for a few rather than improving the welfare of the many, the streets of Washington might be as full as those of Tehran.

Ohio Senate cut Health IT funding in budget proposal

During state budget surgery Republicans in the Ohio Senate eliminated several health insurance reforms backed by Gov. Ted Strickland when they passed their version of the state budget for fiscal 2010 and 2011. 

Here are some of the proposals that were cut: 

• Expanding dependent child coverage in group insurance plans to age 29.
• In open enrollment programs for individual insurance, reducing rates insurers charge people with pre-existing conditions. 
• Requiring employers to offer uninsured workers the opportunity to buy coverage with pretax dollars through Section 125 cafeteria plans. 
• Extending continuation coverage in Ohio’s “mini-COBRA” program to 12 months from six months so employees who lose their jobs at businesses with fewer than 20 employees can maintain health coverage.
• Funding health information technology and other health-care quality initiatives. 
• Requiring insurers to file loss ratio data for the individual, small group and large group insurance markets 

Source: Ohio Department of Insurance 

Philosophical objections, reform effort in D.C. slow Strickland's health-care agenda - Business First of Columbus. (excerpted, full article subscription only)

President Obama Addresses New Health Care and Funding Plan

President Obama explains proposed Health Care Improvements:

Whitehouse.gov: Health Care Reform as the Key to Our Fiscal Future.  

(5 minute video)

Health Care TownHall in Green Bay, WI, 6/11/09

C-SPAN Video Player - Pres. Obama Health Care Town Hall in Green Bay, WI .

(1 hour video)

Fact Sheet on Paying for the plan

Medicare Fact Sheet Final.

Senator Sherrod Brown on Twitter

Sherrod Brown Tweeting & Soliciting Health-Care Stories | OhioDaily.

Yesterday, while speaking about health care at the Campaign for America’s Future conference in Washington D.C., Sherrod Brown announced that he is launching his Twitter account “to engage Ohioans about everything from health care reform to creating jobs in Ohio. And, occasionally, possibly an update or two about the Cleveland Indians.”

@SenSherrodBrown on Twitter

Health insurance exchange is part of Discussions

The Associated Press: Obama plan would provide health care for all.

The president said he supports a new health insurance exchange that Congress is crafting, a sort of marketplace that would allow Americans to shop for different plans and compare prices.

All of the plans should offer a basic affordable package, and none should be allowed to deny coverage to people with pre-existing conditions, Obama said — big changes from how private insurance companies operate today.

"I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans," Obama wrote, weighing in firmly on one of the most controversial issues in the debate. "This will give them a better range of choices, make the health care market more competitive and keep insurance companies honest."

Support the Ohio Distance Learning Pilot

Update: Additional Resource:
Welcome to Conversation on Education: Reforming Ohio's Education System for the 21st Century

Technology for Ohio's Tomorrow - Take Action.

TOT supports Ohio House Bill (HB) 4, the Distance Learning Pilot Project. Join us in supporting exciting, new educational opportunities for Ohio students. 

Why? 

This pilot program would provide all public high school students the opportunity to enroll in Advanced Placement (AP) and additional foreign language courses held via teleconferencing equipment. 

And will ensure that every high school that wishes to participate will have a high-speed connection and a state-of-the-art interactive video system. 

Twenty-eight percent of the schools in Ohio have the broadband capacity of a T-1 line, or 1.5 mbps or less. This initiative would provide those schools with an expansion of broadband that would allow them to share in these classes via two-way interactive television.

Take Action

HB 4 - As Introduced - Establishes an interactive distance learning pilot project..

Ohio Legislative Service Commission  - Fiscal Note & Local Impact Statement

Ohio H.B. 4 of the 128th G.A.

N.Y. insurance enrollment site goes statewide

A Web site that allows people to apply for low-cost or free public health insurance is now available among New York residents. EnrollNY.org features a self-service application that requires users to give demographic data and choose a facilitated enroller, such as a community-based organization or a health plan, that will follow up on the application.

N.Y. insurance enrollment site goes statewide -- Government Health IT.