March 2015 Cover Oregon Consumer Advisory Committee Report

Cover Oregon and the current Oregon Healthcare Exchange under the Affordable Care Act

by CAC member Roberta Hall

On Friday, Feb. 27, Cover Oregon’s Consumer Advisory Committee (CAC) met for the last time. The place was the Durham headquarters of Cover Oregon, soon to be dissolved, though the space will be used for several more months. The exchange is not by any means abolished, however, as its activities will continue under the Department of Consumer and Business Services, the state’s largest regulatory agency. (This transfer occurred about a week later.) The important points that the public should know appear to be these:
1. Cover Oregon costs have been reduced significantly. In 2014 the budget was 90 million dollars, of which 80 million were spent, whereas this year the budget is 15 million. Last year, the average cost per enrollee was $48, and this year it is $10. Last year, enrollment was done with both paper and online techniques developed under contract to the state of Oregon, whereas 2015 enrollees used technology developed by the federal government (HealthCare.gov).
2. The King v. Burwell case, heard in the Supreme Court on Wed., March 4, is a legal challenge to federal tax credits offered in the 2010 Affordable Care Act (ACA). It applies to states that did not set up their own exchange; however, Oregon is one of 16 that did. Oregon continues to run its own exchange, albeit using technology developed by the federal government. Still, if the plaintiffs win, and tax credits are not provided in the other states, it would change the ACA’s impacts dramatically.  Regardless of the outcome (expected in June of this year), the extension of Medicaid to persons with incomes less than 138% of the federal poverty level is not affected by the suit. Oregon’s Medicaid system, OHP, is now administered by the Oregon Health Authority (OHA).
3. Once again, at the 11th hour, the OHA extended the deadline for OHP fast-track enrollees to renew their coverage; “fast-track” refers to automatic enrollment because of prior income-certification through the food-stamp program. The previous deadline was 2/28, but that has been extended to March 31. It was estimated that the remaining fast-track population who need to act before the 3/31 deadline is about 32,000. There has been a backlog, but the OHA has announced that it is hiring more call center staff to address that serious problem.
4. One of the obligations Cover Oregon staff are working on, in addition to clearing up problems that the technology collapse caused earlier, is getting the small business healthcare insurance program (SHOP) online. Right now, there is a manual process in place until a permanent solution is found.  You can find out more here. Employers with 1-50 employees face no penalty for not providing insurance, but it is my understanding that they can use the program if they wish, and some have been using it.  Starting in 2016, employers with 51-99 employees will be required to provide insurance.  Employers with 100+ employees are supposed to offer coverage to 70% of their employees this year, 2015.
Ten members of Cover Oregon’s CAC attended the Feb. 27 meeting, seven in person, and three online. Much of the meeting was given to a report and Q and A with Director Aaron Patnode.  Alicia Blevins discussed income tax forms pertaining to the individual insurance obligation and Qualified Health Plans (1095-A); next year a tax form (1095-B) will also be sent to people enrolled in a government-sponsored plan like OHP.  Joel Melton and D’Anne Gilmore from the Department of Consumer and Business Services, together with Director Patnode gave an update on the apparently amicable transition process. Cover Oregon staff members Rachael Oh, Kelly Harms, and Cherie Miller ran the meeting and performed recording and online activities. CAC members thanked them and Director Patnode for their work, and expressed regret that these employees had in effect been held accountable for problems that they had no control over.
Please note that Cover Oregon employees are not state employees, so they will not be transferred to other state jobs, nor do they have PERS. The director of the agency where the exchange is now housed did not keep director Patnode on staff after the take-over, and the agency is laying off about 50 more in March; several current Cover Oregon staff will continue, perhaps through June. I, for one, appreciate their service and believe that the successes the exchange has had in extending healthcare coverage to many more Oregonians – perhaps approaching half a million – are due to their efforts and dedication.
Advocacy groups such as Mid-Valley Health Care Advocates need to follow these changes as they unfold in order to advise people correctly as well as to learn more about the complexities of making changes in the structure of the state’s healthcare-related programs.


Roberta Hall, member, Cover Oregon CAC, March, 2015



A Canadian physician responds to Gov. Pence’s Medicaid program

Yesterday’s Quote of the Day (“Government supports rotten teeth for patients in poverty”) discussed the Medicaid waivers obtained by Indiana Governor Mike Pence. Today’s post continues on that topic.

The Goal Was Simplicity; Instead, There’s a Many-Headed Medicaid

By Margot Sanger-Katz
The New York Times, January 28, 2015

Indiana has become the latest Republican-led state to expand its Medicaid program as part of the Affordable Care Act. As has become the pattern, it was done with a series of waivers from particular federal requirements.

When the state’s governor, Mike Pence, announced the news on Tuesday, the focus of his speech was less about his state’s decision to embrace this part of Obamacare than about the special concessions he’d been able to extract from the Obama administration.

Newly eligible Medicaid recipients will have to pay monthly premiums or be locked out of certain services, he announced, and higher-earning beneficiaries who fail to pay will be shut out of the program for six months. People who use the emergency room frequently will need to pay higher co-payments than the federal government has ever allowed.

The provisions, designed to encourage residents to take more responsibility for the costs of their health care, break new ground in what the Obama administration will allow in exchange for expansion.

NYT Readers’ Comments:

By Bob Solomon, MD
Edmonton, Canada

You live in "Cloud-Cuckoo Land" in the fantasy you have the best medical care system on earth. Baloney. Check it out.

Canada is right next door. Come see how a sane federal health plan works, covering all and ensuring that (1) we live longer, (2) we have fewer chronic ills, (3) we have lower cost drugs, (4) we have lower cost hospitals, (5) we have lower cost operations, (6) we have lower accounting costs for all parties, and (7) we have no medical bankruptcies and impoverishment anywhere, for any income, for the unemployed, for the elderly. Long waits for ER? I waited 4 minutes for an asthma attack to be dealt with, 2.4 hours for a minor ear problem -- wax. In Philly, I waited 2.4 for a back injury. Twice. So no difference.

We get free (tax-paid) care in Alberta. No out of pocket, no minimum, no exclusions, no co-pays, no nothin'.

Premiums exist in certain provinces: $35 a month per person or about that, and some people purchase extended coverage. I also pay approx. $1200 a year for added features: free or nearly free drugs, and a large subsidy for glasses, hearing aids, private rooms, canes, and things like that.

Americans live in a "exceptional" med world -- a medical services madhouse. It was not created by ACA, of course. And because of the med and drug and hospital corporations, I mean "people", and the know-little-or-nothing GOP, it was ensured to endure after ACA. Medical madness is still a disease you need to cure.

And…

By Don McCanne, MD of PNHP

Denying poor people dental care simply because they cannot pay the premium, as Pence's program does, defies logic. Does sentencing poor people to rotten teeth truly motivate them to find money that they don't have in order to provide them with the "dignity to pay for their own health insurance"?

Does Pence propose that we change the rhetoric from "skin in the game" to "rotten teeth in the mouth"?

 

Join the HCAO Rally for single payer on Feb. 11. Sign up Here.

 

Medicaid improving access for the homeless, but…

Below are the comments by Dr. McCanne of PNHP about the article

Early Impacts of the Medicaid Expansion for the Homeless Population
By Barbara DiPietro, Samantha Artiga and Alexandra Gates

Kaiser Family Foundation, November 13, 2014

Comment: By Don McCanne, MD

The experience of the homeless population under the Affordable Care Act (ACA) demonstrates both the benefits of reform under ACA and the flaws of ACA that call for replacement with a single payer system. ACA was better than nothing, but we can have so much more through enactment of a single payer system.

The primary ACA benefit for the homeless is that most of them in expansion states qualify for Medicaid and thus have improved access to health care without financial barriers. Some of the homeless who access health care have been noted to have an increased ability to work and to maintain stable housing. Financial stress is reduced and some have gained access to appropriate disability benefits. These benefits to the homeless are more reasons why calls for simple repeal of ACA are bad policy, devoid of compassion.

Yet the last paragraph from the excerpts above explains why Medicaid managed care is often a poor choice for the homeless (and many other lower-income individuals as well). Homeless patients often are unable to see the health care professionals who would be most accessible and appropriate for them. Transportation concerns are more likely. Essential specialized services may not be available. Managed care intrusions such as prior authorization requirements, limitations and changes in formularies, or other perverse managed care innovations may impair access to important health care services or products. Further, those states that refuse to expand Medicaid are leaving most of the homeless without any coverage and therefore reliant on often inadequately funded safety-net institutions.

There are those who believe that we should merely proceed with implementation of ACA and try to obtain legislative and administrative patches along the way. Compared to the deficiencies in our dysfunctional system, patches have only minimal beneficial impact while increasing the administrative complexity that already overburdens our system. Patches fall way too short of what we need.

We should not repeal ACA since it does provide some temporary benefit until we can implement a single payer system. But we should not let ACA implementation divert us from instituting what we really need - a single payer national health program. Not only would that benefit the homeless, it would benefit all of the rest of us as well.

Read the full post here.  Consider joining MVHCA and attending our Feb. 11 Rally.

The Price of Ideology: A Woman's Life, By Alan Grayson

One of my constituents, Charlene Dill, could not afford it. Last month, at 32, Charlene died of heart disease, leaving her three young children behind.

This young mother didn't have to die.

Charlene knew she had a heart problem, but she couldn't afford the medications and frequent visits to the doctor. She worked three jobs but earned only $11,000 last year. With only $11,000 to feed her three children, keep a roof over their heads and pay the property taxes on her trailer, Charlene couldn't afford standard health coverage. And because she made more than $5,400, she was not eligible for free or reduced-cost coverage under Florida Medicaid.

Floridians with annual incomes between $5,400 and $11,400 are stuck in the "Medicaid expansion gap." Charlene Dill was one of an estimated 1 million uninsured Floridians who fell into that gap. It cost Charlene her life.

When Congress passed Obamacare, it included a provision to expand Medicaid coverage to the working poor, like Charlene. States expanding Medicaid would receive the full cost of that coverage from the federal government for three years, and then 90 percent of the cost after that. The U.S. Supreme Court determined that states could drop that expansion after the first three years, without penalty, and pay nothing.

The federal government committed more than $50 billion to fund Florida's Medicaid expansion. You might think that our cash-strapped state would be clamoring for money to provide health care to the sick and poor. But you would be wrong. Republican ideologues in the Legislature refused the money. And now, Charlene Dill is gone.

Florida has the second highest rate of uninsured individuals in the nation. Twenty percent of our state has no coverage. When these people get sick, they go to the emergency room. Emergency rooms cannot provide long-term care, manage chronic health conditions or provide lifesaving treatments on a one-off basis.

Charlene could never get the care from one single visit to the emergency room that she needed to stay alive. And she won't be the only one. One study estimates that approximately 1,158 to 2,221 Floridians will die each year as a result of Republicans' stubborn refusal to expand Medicaid.

More here.

First Doctor Visit in Five Years-Thanks to the Medicaid Expansion

I went to the doctor for the first time in five years today. Although I'm young, I had neglected a couple of health issues for at least a year. I couldn't afford care and was left hoping none of them developed into anything more serious. As a small business owner who narrowly missed the threshold for buying on the exchanges, I'm enrolled in Medicaid for this year until I can bump my income up a bit. The day my confirmation of benefits and card came was among the best of my life. I nearly broke down in tears.

But that isn't what this diary is about. Today, I went to the doctor for the first time in five years and saw first hand why Republicans have fought tooth and nail for a system that was so broken for every single stakeholder - except the insurers and the politicians who enable them.

What I found made my blood boil. Follow below the fold for a living example of what our "health care system" could have done to me and millions of others before the ACA. Let's just say the cheesy poof holding the fold would have been more than the food in my pantry.

The catch was that I'd have to be reimbursed for today's visit because I wouldn't show in the system until tomorrow. No big deal. But it was this that gave me a peak inside the profits Republicans are paid so well to protect.

Hang with me as I do the math here on paper. It isn't a small number.

13.5 hours of work for the visit + 100 hours for standard preventative lab work + 360 hours for one year of a generic medication = 473.5 hours of work.

At 40 hours a week, that's nearly 12 weeks of work. Or 3 full months. IF you can find full-time work. For one visit, normal lab work, and a necessary medication.

Let that sink in.

Full article here.