Our Health Policy Matters        

A column focusing on federal, state and local health policy        

Now that the ACA decision is behind us, what's on the horizon in the world of public health, mental health and health policy?

The truth is that ACA was essentially neutral with respect to prevention and public health.  3% of our nation's health funding went to these services last year, and 3% will continue to go to these services with or without ACA.  That won't stop the assault on public health.

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While the Supreme Court of the United States has in large part resolved questions regarding the constitutionality of the Patient Protection and Affordable Care Act, participants in the health care industry should prepare for ongoing uncertainty in the manner and degree to which states will participate in the expansion of Medicaid.
 
The Supreme Court concluded that the "stick" provision was unduly coercive, amounting to no real choice at all, and therefore is unconstitutional. Per the Supreme Court's decision, the federal government cannot "penalize States that choose not to participate in that new program by taking away their existing Medicaid funding."

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Criticism of Insurance Companies

     Our private health insurance model has failed to meet the needs of the market. Over decades they have withdrawn unprofitable coverage for elderly (hence the govt. developed Medicare); the young (hence, the state and feds developed, Medicaid, Healthy Kids and Kidcare); the poor (hence, Medicaid); those with pre-existing conditions and high lifetime costs. What they have kept is a class of workers locked in jobs that might limit their upward mobility because they are terrified at the thought of losing medical coverage. It is time to embrace a new future where the needs of "people", their health and wellness, supersede the voracious appetite of the healthcare industry and health insurers. We CAN train more physicians and faster, we CAN operate hospitals and clinics more efficiently and, therefore, more economically; we CAN develop pharmaceuticals and technologies for a healthy profit without depriving access to all but the affluent.

-Name Withheld by Request

Is SCOTUS Decision on ACA a Victory for Progressives?

     Although Progressive's are lauding the decision as a huge victory for Obama and America, the SCOTUS endorsement of the ACA is actually, exceptionally weak.  The Individual Mandate is now labeled a tax and will cost the President hugely in political capital.  Meanwhile the Medicaid expansion will no longer be (effectively) mandatory.  I predict many states will opt out.  Another factor often overlooked is the exception to the Individual Mandate whereby many citizens can, without penalty, choose to be uninsured because health plans available do not meet the affordability requirement.  Thus the number of insured will not increase in any significant way.  And therefore, the other provisions of the ACA cannot be funded. 

      My prediction is that within a few months or years we will realize we have made no meaningful progress on Healthcare Reform.  We will still have huge swaths of the population uninsured and seeking healthcare only when there is an acute episode and then going to a high cost provider (a hospital ED).  We will have expanding government programs that can only pay for themselves with borrowed money.  We will continue to have healthcare inflation (perhaps blunted by a weak economy and/or payment reforms, i.e. pay for performance, bundled payments, modernized capitation models etc.).  Health insurance will still be a lousy value.  We will continue to see American companies at a competitive disadvantage in the global marketplace due to the cost of employee health benefits.

      For true Healthcare Reform, we need to activate the capitalists and the entrepreneurs.   We also need bi-partisan support for any new federal laws. Government policy has been successful in creating the environment for innovation and change in other industries and there is no reason healthcare is any different.  Hat's off to the Democrats for coming up with a plan.  Unfortunately, I don't think this one (the ACA) is going to be the solution.

-Tara Pihn

By upholding most provisions of the Affordable Care Act, the U.S. Supreme Court in its watershed ruling has asserted the rule of law over politics. The court was asked to decide two issues: First, whether it was constitutional to mandate individuals to purchase health insurance or pay a penalty. And second, whether it was constitutional to require states to expand eligibility of the Medicaid program.

Whether you agree or disagree with Obamacare, it is indisputable that many will benefit from the individual mandate, while others will benefit from those states opting into the Medicaid expansion program.

Ensuring that all individuals purchase insurance coverage to defray the cost of insuring an unhealthy population is the premise behind the individual mandate requirement. That is because the law prohibits insurance companies from denying coverage based on pre-existing conditions or increasing premiums to a level that makes the purchase of a health insurance policy financially prohibitive.

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Click Jodi Laurence and Karen Schapira to view author’s biographies.

A recent Miami Herald titled "Feds in Miami: Millions stolen from Medicare wound up in Cuban banking system" should belong in the world of fiction but instead represents the sad reality of healthcare in Florida. According to the article federal prosecutors have charged a Miami man, Oscar Sanchez, 46, with engaging in a massive money-laundering scheme and identified him as a key leader in a group that funneled at least $31 million in stolen Medicare dollars to Cuban banks in Havana. While Sanchez was a target of the ongoing investigation, prosecutors say dozens of crooked Medicare providers - who offered HIV and medical equipment services - all took part in the laundering scheme set up for one reason: To hide the money.

In all, 70 medical company owners in South Florida submitted more than $374 million in claims to Medicare, and were reimbursed about $70 million. Most of the money was laundered through foreign banks, including Cuba. The Castro government also extorted Medicare bounty from criminals who are allowed to travel freely between here and the island nation.

I have asked myself the same questions over and over again: how could such a criminal enterprise fed with Medicare money flourish and thrive? Why do Medicare contractors only smell the rat when the rat already left the sinking ship? Why can we not utilize a similar approach applied successfully in Taiwan where all healthcare providers are connected to the Bureau of National Health Insurance (BNHI) a Virtual Private Network (VPN) for e-claim purposes? Any suspicious claims could be detected in real-time and their payment stopped. Instead, in the US we are acting after the criminals already laundered the money and left the country. This incident should serve as (another) reminder that we have to strengthen the accountability and increase the transparency of the Medicare payment process.

Dr. Wollschlaeger is a frequent contributor to FHIweekly and Specialty Focus. You can read more of his articles by visiting http://floridadocs.blogspot.com/.

freeforall health policy and budget wonkery and the politics of where they meet

"CBO has the facts.They estimate the tax paid by uninsured individuals who fail to purchase health insurance (called Penalty Payments for Uninsured Individuals in this chart, but ruled a tax by SCOTUS Thursday) will equal $54 Billion over 11 years. For perspective, the total of all Federal income and payroll tax receipts for the federal government in FY2012 will be around $2.8 Trillion dollars (1 year). So, $54 Billion over 11 years-what the Supreme Court said yesterday was a tax-is somewhat short of the largest tax increase in American history. The aggregate amount in 2015 will be $3 Billion."

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This is the primary blog of Don Taylor, Associate Professor of Public Policy of Duke University that focuses on health policy, the federal budget and the politics of these key public policy issues. Mr. Taylor is the author of Balancing the Budget is a Progressive Priority published by Springer in April 2012.