Single Payer Healthcare National Conference – Oakland – August 22-24

The Campaign for a Healthy California is hosting a conference with three national single payer organizations:  Labor Campaign for Single Payer, Healthcare-Now!, and One Payer States.  We know healthcare justice is a great concern of yours and would love to have you attend.  Our conference agenda is chock full of substantive and interactive workshops we know you will enjoy.

You can register online now for the August 22-24 super-conference that will bring together One Payer States, Healthcare-NOW! and the Labor Campaign for Single-Payer Health Care, in Oakland, CA!  A discounted group rate is available for the Oakland Airport Hilton if you need lodgings and the information on that is also located on the registration page. Just follow the hotel registration step on the Healthcare-Now! registration page.

For $60 registration fee you can now attend the entire One Payer States conference, workshops being organized jointly by Healthcare-NOW! and the Labor Campaign, as well as a reception and keynote speakers for all three groups. We expect over 300 activists to attend, giving attendees a chance to learn from the best organizing going on around the country, build bridges between labor and community groups, and energize the movements for both state and national single-payer reform.

You can view the tentative agenda for the conference: http://www.healthcare-now.org/wp-content/uploads/2008/10/Full-Conference-Agenda.pdf

Please register today, so that you will have time to make travel and housing arrangements! And please, make your hotel reservation as you are registering for the conference.

We’re incredibly excited to be joining the Labor Campaign, One Payer States and Healthcare-Now!, and we will update you with keynote speaker, and other additions as the information becomes available!

Posted in Uncategorized | Tagged | Leave a comment

MGMA ACA Exchange Implementation Survey Report

MGMALogo

Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care Act’s (ACA) insurance exchange implementation on medical group practices.

Summary of Findings

MGMA noted three main themes within the findings:

OBTAINING COVERAGE INFORMATION

Practices have experienced difficulty identifying patients with ACA exchange coverage and obtaining essential information related to that coverage.

  • 62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.
  • Compared to patients with traditional commercial coverage, nearly 60% of respondents indicated that for patients with ACA exchange coverage it is somewhat or much more difficult to:
    • verify patient eligibility
    • obtain cost-sharing or network information
    • obtain information about the plan’s provider network in order to facilitate referrals.

“We are going to have to hire additional staff just to manage the insurance verification processs.”

“Identification of ACA plans has been an administrative nightmare.”

“We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so. “

PATIENT COST-SHARING

Practices are facing a number of challenges related to patient cost-sharing for ACA exchange coverage.

  • 75% of respondents reported that patients with ACA exchange coverage are very or extremely likely to have high deductibles compared to patients with traditional commercial coverage.
  • Practices reported significant patient confusion about the substantial cost-sharing related to many ACA exchange products, and practices are working to help patients understand the complexities of their coverage.
  • Practices cited some of the main reasons for not participating with ACA exchange products were related to concerns about financial burdens from patient collections (such as burdens related to collecting high deductibles from patients and concerns about financial liability from the 90-day grace period).

“Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.”

“The at-risk piece of eligibility is tremendously hard to determine and explain to patients.”

“Patients don’t always understand how health insurance works, so we’ve been engaging in educational events for the community.”

NETWORK LIMITATIONS

Practices have concerns about the impact of the network design of many ACA exchange products.

  • Almost half of respondents reported they have been unable to provide covered services to ACA exchange patients because the practice is out of network.
  • 20% of respondents reported that their practice was excluded from a narrow network that they would have liked to participate in and 10% of respondents chose not to participate in a narrow network.
  • Narrow networks may create challenges related to patient referrals for appropriate treatment and hospital care. Even if the practice is included in the network, without robust representation by a wide range of providers, it may be difficult for a practice to coordinate a continuum of care consistent with the patient’s needs.

“Many patients purchased products with a very narrow network and didn’t understand the ramifications. They are very upset once they learn that they can’t go to the specialist or hospital of their choice. As primary care providers, we are now faced with the extra burden of trying to find them care within their new narrow network. Payer directories are woefully inaccurate and impossible to rely on.”

“Former patients were shocked to learn about their very narrow network of providers. It was terrible to have to inform them of their lack of coverage.”

“We are consistently denied ‘out of network’ approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.”

http://www.mgma.com/government-affairs/issues-overview/aca/aca-exchange-implementation-report/aca-surveyreport_online_2?ext=.pdf

Statement of Susan Turney, MD, MS, FACP, FACMPE, president and CEO of MGMA:

“Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA exchanges. The more administrative complexity introduced into the healthcare system, the less time and resources practices can devote to patient care. Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges.”

http://www.mgma.com/about/mgma-press-room/press-releases/2007-2012/mgma-statement-on-effect-of-aca-exchange-implementation-on-medical-group-practices

****

Comment by Don McCanne

Much has been written about the consequences of the high deductibles and narrow networks of the ACA exchange plans in impairing access and affordability for patients. This new survey demonstrates that these same features add more administrative headaches for physicians who are already overburdened by the administrative complexity of our dysfunctional health care financing system. For those who could care less about the physicians, keep in mind that these ACA plan features are preventing physicians from assisting patients in obtaining the health care that they should have. It is really about the patients.

The quotations in the report above are especially helpful to our understanding of the problems because they reveal the real world consequences of the highly flawed ACA exchange infrastructure.

Single payer would eliminate the confusion over coverage, the barriers of patient cost sharing, and the loss of choice due to network limitations. People would simply get the care that they need when they need it.

Image | Posted on by | Tagged | Leave a comment

Town Hall Meeting to Save Doctors San Pablo

Let’s Demand the County Take Charge town hall meeting May 22 at 6:30pm at Easter Hill United Methodist Church

Let’s Demand the County Take Charge town hall meeting May 22 at 6:30pm at Easter Hill United Methodist Church

Registered nurses, hospital workers and community members are holding a public meeting May 22 to plan the next steps in their effort to keep Doctors Medical Center San Pablo (DMC) and its emergency department open.

Closure of DMC would create a dire public health crisis in the West Contra Costa County.  We are urging Contra Costa County to assume authority to ensure the continued operation of the facility as an acute care hospital with a fully staffed Emergency Room and ICU.

What: Town Hall Meeting to Save Doctors San Pablo
When: May 22, 6:30pm
Where: Easter Hill United Methodist Church – 3911 Cutting Blvd, Richmond

The meeting will provide residents, community groups, and health care providers with a briefing on the latest developments, and then determine the next steps in a campaign to save the hospital including pressuring the County to step in.

Studies have shown that the closure of Doctors Medical Center will lead to medical catastrophe. In 2004, a study by the Abaris Group concluded that in the case of a closure, “it is unlikely that all ambulances could be safely diverted to other regional EDs without some risk to patient care.”

In 2011, further study by the Abaris Group concluded the elimination of DMC would eliminate critical infrastructure needed to support the community in the event of another disaster like the 2012 Chevron refinery. DMC has 80 percent of the inpatient hospital beds in West County and receives 60 percent of the ambulance visits.

Posted in Uncategorized | Leave a comment

FREE HEALTH FAIR and community discussion – April 12th

Have you lost your health care? Will you be covered by Covered California, the Affordable Care Act? Are your deductible or co-pays too high? Were you denied treatment? Are you unable to afford prescriptions? Are you unable to get dental care?

We can have a TRULY COMPREHENSIVE, AFFORDABLE HEALTH PLAN FOR EVERYONE. Learn how. Let’s stand up for our rights! Come to a FREE HEALTH FAIR and community discussion on how to fight for our health care.

The Santa Clara County contingent of the Campaign for a Healthy California is holding its annual  Health Fair at Andrew Hill High School, located at 3200 Senter Road (at Capitol Expressway) on Saturday, April 12th  from 10a – 2p. The Health Fair includes a free health clinic available to all who attend.

Health Fair 2014 – English flyer

Health_Fair_2014 – ESPANOL_flyer

Health Fair 2014 – Vietnamese flyer

Posted in Health Fair | Tagged , , | Leave a comment

Thinking It Through – Health care debate far from finished

Sara Foss's Thinking It Through

Wednesday, February 26, 2014

The other night I attended a debate at The Linda in Albany, WAMC’s performing arts studio, on whether the U.S. should adopt a single-payer health care system.

Sponsored by the Albany Medical College chapter of an organization called Students for a National Health Program, the debate pitted a doctor who favors a single-payer system against a doctor who opposes such a system.

Under a single-payer system, the government, rather than insurers, would pay all medical costs, much as it does through Medicare for Americans 65 or older.

The pro single-payer side was represented by Dr. Paul Song, a California oncologist from the group Physicians for a National Health Program. Offering an opposing view was Dr.

Mitchell Heller, a New Jersey-based emergency room physician representing the Benjamin Rush Society, a libertarian organization that supports limiting the government’s role in health care.

I’ll admit my bias upfront: I support a single-payer model.

And though both men were able debaters, I wasn’t surprised when an after-debate poll showed Song had won. Heller did a great job of articulating his vision for the health care system — a vision most people found horrifying.

When Song cited the fact that medical bills are the biggest cause of bankruptcy in the U.S., and that many of the people declaring bankruptcy actually have insurance, as evidence that America’s health care system doesn’t work, Heller replied that bankruptcy really wasn’t bad at all. If a patient declares bankruptcy, it means he or she received needed treatment, he explained, which is true.

However, most of the people in the audience seemed to think that America can do better — that it can create a system where people receive the treatment they need and don’t have to go into bankruptcy to get it.

Will the Affordable Care Act create such a system? Nobody at the debate seemed to think so.

One of the things I found most interesting about the discussion was the simple fact of its existence.

After all, the U.S. health care system is undergoing a big transformation, courtesy of the Affordable Care Act. But this hasn’t stopped people from advocating for something different. Conservatives often complain that the ACA goes too far, while progressives believe it doesn’t go far enough. Listening to the debate, one thing seemed clear: Nobody is especially happy with the state of health care in America and Obamacare is unlikely to change that.

Recent surveys show health care costs remain the top concern for local business leaders.
The Siena Research Institute’s annual survey of upstate New York business leaders found that 80 percent of respondents cited health care cost as the challenge they are most concerned about; 69 percent said they believe the law will have a negative impact on their business.

Polls show that Obamacare also remains unpopular among the general public.
According to a January Gallup poll, nearly half of Americans say the Affordable Care Act will make the U.S. health care situation worse in the long run, while slightly more than one-third think it will make the situation better. A majority of uninsured Americans who visited a health insurance exchange website reported having a negative experience, which is especially troubling, since these are the people who stand to benefit most from the law.

One of my friends, a self-employed photographer who hasn’t had health insurance in years, was initially very excited about Obamacare and its promise of affordable, easy-to-purchase health insurance. But after spending roughly 30 hours on the federal website and phone, trying to sign up for a plan, her enthusiasm had cooled.

It’s possible that public opinion of the Affordable Care Act will improve as the kinks get worked out and benefits begin to kick in. But only time will tell, and much will hinge on whether patients are satisfied with their overall experience with the health care system.
And since the system is overly complicated, needlessly opaque and expensive, satisfaction seems unlikely.

Costs will continue to rise and employers will continue to pass those costs along to their employees, who will come to regard statements and letters from their HMOs with confusion and dread, if they don’t already. Yes, the Affordable Care Act will enable millions to obtain health insurance. But health insurance comes with its own set of frustrations, as anybody who’s ever seen their co-payments steadily rise or been denied coverage for recommended treatment can tell you.

Meanwhile, the rollout of Obamacare continues. More than 501,205 New Yorkers have received insurance through the state’s online marketplace; in the past two weeks more than 88,000 people enrolled. Will these people be satisfied with their new insurance? Or will they yearn for something better? Again, only time will tell.

Reach Gazette columnist Sara Foss at (sfoss @ dailygazette.net). Opinions expressed here are her own and not necessarily the newspaper’s.

Her blog is at >>

Posted in Uncategorized | Leave a comment

DEMAND Whole Foods’ CEO Stop Spreading Lies about Obamacare

Whole Foods’ CEO, John Mackey, has been using his position as head of one of the most respected companies in America to promote anti-Obamacare lies and deter people from signing up for life-saving health insurance under the Affordable Care Act.Fight back against this kind of confusing misinformation and SIGN THE PETITION to demand John Mackey stop misleading Americans. Statements like these confuse people about the law and scare them away from signing up for the coverage they desperately need. Join Courage’s Obamacare Reality Response Team and add your name to the statement below:

“Mr. Mackey, stop spreading misinformation about the Affordable Care Act. Despite the fact that millions of Americans believe a single-payer solution would work better, Obamacare is a FREE MARKET approach to the healthcare crisis — not a “government takeover,” as you claim it is. It’s shameful that you would use your business prestige and media influence to actively promote destructive confusion and lies about affordable healthcare options when the lives of millions of Americans are at stake.” SIGN THE PETITION!

Posted in Political Action | Leave a comment

Some Middle-Class Families Find Price Of Subsidized Health Coverage ‘Awfully High’

This Kaiser Health News (KHN) story was produced in collaboration with USA Today

The lure used to get uninsured Americans to sign up for health law coverage was the promise of generous premium subsidies.

But the promise comes with a catch for almost 3 million people earning between three and four times the federal poverty rate: They may have to pay up to 9.5 percent of their income toward that premium before the subsidy kicks in.

That could take a substantial bite from their budgets — potentially as much as $600 a month for mid-priced plan for a family of three earning between $58,590 and $78,120.

As a result, some middle-class families may decide health insurance is beyond their reach, and pay a penalty rather than buy coverage.  While consumers in that income range account for a relatively small share of the 17.2 million eligible for subsidies to buy private insurance, that could still spell political trouble for the law. Insurers could also see problems if premium costs deter the sign-up of healthy enrollees, whom they need to offset the costs of covering the sick.

“The real question is, will this be affordable?” said Carmen Balber, executive director of Consumer Watchdog, a California-based advocacy group.

It’s too early to know the big-picture answer because consumers have until the end of March to buy coverage in the federal and state online marketplaces.

But individual families have begun making their decisions.

“Awfully high,” is the verdict of Tim Ross of Madison, Ind., the owner of a light commercial construction firm who canceled coverage for his family of five several years ago during the depths of the recession.

Under the health law, Ross’ income qualifies his family for a subsidy that would cover about half the cost of a mid-level “silver” plan, according to online calculators. There are five silver plans he could choose from, with his share of the cost ranging from $494 to $590 a month.

Ross, 47, would also be responsible for copays for doctor visits and prescriptions and an annual family deductible ranging from $4,000 to $7,000.

“I would love to have insurance,” said the small businessman, who knows he would take a big chance by remaining uninsured.

But he said he is likely to forego buying a policy, hoping that if a family member needs expensive care, he can negotiate lower prices with doctors and hospitals as he has done in the past.

“We are at the point in our lives where if we want to go out to supper,” he said, “we can. “If I want to buy my kid a pair of blue jeans, I can do that. If I had to pay $600 a month out of my income, we could no longer do that.”

How Much Is Too Much?

Half of American families spent 3.1 percent or less of their income on health care before the law took effect—with those who have job-based coverage generally spending less than those who buy their own insurance, studies by Linda Blumberg at the Urban Institute show.

That’s because employers pay a large percentage of the cost of health insurance and those plans tend to be more generous as well.

Still, a quarter of all households spent 8.2 percent or more on health care, which includes premiums and out-of pocket costs, such as copayments for doctor visits, hospital care or prescription drugs. Those are the ones most likely to struggle to pay bills – and who risk falling into medical debt.

Even with new coverage that may require some families to spend more than that “doesn’t mean they are worse off than before,” Blumberg said. “They are still far less exposed than they would be if they got into a car accident and were uninsured” and faced potential financial devastation.

Lower-Income Get More Help

To be sure, the health law’s subsidies sharply reduce costs for many lower income Americans, who account for a majority of the uninsured.

Subsidies are pegged to the federal poverty level and are most generous for those who make the least amount of money. Those who earn between the poverty level and twice that, or up to about $23,000 for an individual and $39,000 for a family of three, must pay between 2 percent to 6 percent of their income towards the monthly premium before the subsidy would kick in.

Extra help in the form of lower deductibles and copayments is available for those who make up to 2.5 times the federal poverty rate, about $48,825 for a family of three. An estimated 75 percent of the uninsured qualify for those subsidies.

Those who earn between two and three times the poverty rate, or up to about $34,500 for an individual and $56,000 for a family of three, must pay up to 8 percent of the premium cost before the subsidy would kick in.

And those who make between three to four times the poverty level — less than 16 percent of all consumers eligible for federal subsidies – must pay the highest percentage of their income, or up to 9.5 towards the premiums before getting federal help. Not everyone will pay that much because premiums vary around the country and some people will be able to purchase a plan for less than 9.5 percent of their income.

The millions who qualify for Medicaid, the state-federal program for the poor, generally pay little or nothing for their health care.

Most people with job-based coverage – the majority of insured Americans — are not eligible for subsidies and therefore not affected by the 9.5 percent requirement.

Origin Of 9.5 Percent Benchmark

The law’s drafters set the 9.5 percent benchmark during final negotiations over the health law, mainly to meet a directive from the White House and congressional leadership that the law cost less than $1 trillion over 10 years and contain provisions to pay for that, which included new taxes and fees on drug makers, insurers and high-income Americans. The primary goal was to get the bill passed, not figure out what struggling middle-class families thought they could afford.  An earlier version would have required some families to pay even more.

“The desire was to get it down as much as possible and stay within the budget target,” said John McDonough, a Harvard professor who was a key adviser to the Senate Committee on Health, Education, Labor and Pensions during the health law debate.

He hopes a future Congress will lower the percentage of income that subsidy-eligible families must pay. Otherwise, he said, “it won’t be affordable to everyone who needs it.”

How much the average American family can afford to spend on health care is a matter of debate.

The Bureau of Labor Statistics has found that the average household spent about a third of its income on housing, 17 percent on transportation and nearly 13 percent on food, the three largest categories, according to the Bureau of Labor Statistics. Health care accounted for nearly 7 percent, including premiums, drugs, doctor visits and medical supplies.

But averages aren’t how most families live.

The Economic Policy Institute, a think tank in Washington, D.C., says that housing costs vary widely across the country. Two parents with one child living in Bowling Green, Ky., for example, would spend about $675 a month on housing, while a similar Los Angeles family would spend $1,421. Adding health premiums and deductibles to the plate can be tough – and many families have no savings.

“I would like to live in a world where people didn’t have to trade off health care versus putting food on the table,” said economist Elise Gould at the Institute. “Should it be fixed in the health care law? Or are there other things we could be doing so people don’t have to make those choices?”

Advocates point to provisions in the law that they say will make coverage a good value to hard-pressed middle-class families, including the provision of preventive care without a copay, broad benefits, the capping of out-of-pocket costs and the requirement that people with medical problems get coverage.

“Compared to where we were before, it’s an enormous improvement,” said Ron Pollack, head of Families USA, an advocacy group that supports the law. “Is it sufficient? That’s a different question.”

Posted in Uncategorized | Leave a comment