HB 2922 Moves to Health Care Committee

The Affordable Health Care for All Oregon Plan (HB 2922) would cover all Oregon residents with no co-payments, deductibles, or premiums and be funded by dedicated taxes, based on ability to pay. We believe that universal health care will result in a healthier population, a more prosperous economy, and a better business environment for the state. 
 
Information on progress: http://openstates.org/or/bills/2013%20Regular%20Session/HB2922/
text of the bill: http://www.leg.state.or.us/13reg/measpdf/hb2900.dir/hb2922.intro.pdf
 
The bill has been referred to the House Health Care Committee. The members are Mitch Greenlick (Democrat, District 33, Portland), Alissa Keny-Guyer (Democrat, District 46, Portland), Jim Thompson (Republican, District 23, east of I-5), Brian Clem (Democrat, District 21, Salem), Jason Conger (Republican, District 54, Bend), Chris Harker (Democrat, District 34, Beaverton), Bill Kennemer (Republican, District 39, Oregon City), John Lively (Democrat, District 12, Springfield), and Jim Weidner (Republican, District 24, Yamhill).

If you live in any of these committee members’ districts, please let them know of your support for HB 2922, and urge them to vote for the bill.
 
HB 2922 endorsed
PNHP Portland has applied for and received the Oregon Public Health Association's official endorsement of HB2922 and their pledge to support it as it moves through the process.  


The HCAO Legislative Committee is: tracking HB 2922 and the accompanying financial study; preparing for the HB 2922 hearing; seeking a pollster to establish a baseline for our efforts. Visit http://hcao.org/health-care-legislation/ for updates on the HCAO legislative campaign. Lou Sinniger, Chair, HCAO Legislative Committee

Oregonians’ courage can bring health care to all

BY MARY SHARON MOORE

Published: February 18, 2013, The Register-Guard

Even with the 2012 Affordable Care Act, access to affordable health care remains out of reach for too many Americans. People needing medical attention often go without or hope for some unexpected intervention (the lottery, say, or some miraculous healing).

America can do better. And right now Oregon stands a chance of doing just that.

But what does “doing better” actually look like? My recent trip to the steps of our state Capitol to rally with others for health care finance reform offered me a first glimpse.

Oregon Rep. Michael Dembrow, D-Portland, has drafted the Act for Affordable Health Care for All Oregon (House Resolution 2922). The bill has garnered some backing among Dembrow’s colleagues, but needs much more support in the House, the Senate, and from Oregonians who feel pinched by health care costs.

The purpose of Dembrow’s Health Care for All Oregon bill is to ensure access to high-quality, patient-centered and affordable health care for all Oregonians, to improve public health overall, and to reel in costs of health care. Who wins? Individuals, families, businesses and society as a whole.

The bill, which covers all people living or working in Oregon, would eliminate copayments and deductibles. This bill is not about changing the actual delivery of health care, but about reforming the convoluted means of financing it. Under this bill you and I would no longer be penalized for “going out of network” to get the care we need, nor would we lose our coverage through the loss of a job.

How is this new plan funded? Not by paying ever-increasing premiums to some Wall Street-driven company that dictates which health conditions and medical procedures it will cover. Rather, it will be funded by a progressively structured tax that will be paid directly to the Affordable Health Care for All Oregon Fund. If you think you don’t want to pay another tax, just consider the hidden “tax” in every insurance premium and every bill you pay for doctors’ visits, lab tests, scans, surgical procedures, emergency room visits and hospital stays — not only to cover those who cannot pay, but also to “give a little something” to insurance companies’ shareholders.

Socialized medicine? Not at all. With socialized medicine doctors and hospitals are employed by the government. With Dembrow’s plan, doctors retain their private practice, and the patient-doctor relationship is not dictated by an outsider as it is today with insurance companies. The government would not own or manage doctors’ practices, clinics or hospitals. Yes, we definitely can do better.

Which brings me to a second glimpse of what “doing better” in health care looks like. I think of the paralytic in the Gospels who was carried on his mat by some people who recognized his need and his obvious inability to get to a source of healing. These people took him to the house where Jesus was. But the house was so packed that the four men carrying the man climbed up and tore a hole in the roof over the place where Jesus was, and lowered the man down. They would not let anything stand in the way of this stranger’s needs.

That’s the point: These people who befriended the paralytic recognized the situation and did the courageous thing. Because of their bold action Jesus healed the man.

If we want our loved ones, our neighbors, our fellow Oregonians to have access to affordable health care, we each and together need to do the next courageous thing. That might mean educating yourself — as I have had to do — on the proposed legislation (hcao.org/legislative-tools). It might mean writing your state representatives (contact the League of Women Voters of Lane County at www.lwvlc.org) and telling them we urgently need their support of the Affordable Health Care For All Oregon Plan.

Or the next courageous thing might be attending a health care rally, or a health care house party, or making noise in the public square until affordable health care as a basic human right is established in our state.

As hole-in-the-roof friends of the medically afflicted, we still have work to do. It’s high time for real conversation and courageous action on the moral and social dimensions of affordable health care for all Oregonians.

Mary Sharon Moore of Eugene is active in health care finance reform and other issues through Occupy Interfaith Eugene (contact Patty Hine at 541-343-5091, or e-mail occupyinterfaith@gmail.com). Rep. Dembrow’s plan will be discussed at the HCAO-Eugene meeting at 7 p.m. Feb. 21 at the Eugene Water & Electric Board building (www.hcao-eugene.org ).

Rally Summary by Bud Laurent

The February 4th Rally for Health Care Reform in Salem can be characterized thus: IT WAS A SMASHING SUCCESS!! Nothing with so many moving parts ever comes off perfectly, but if there were glitches and goof-ups, they were more than compensated for by the turn-out (at least 1,000 committed supporters from ALL OVER Oregon), the level of positive energy and enthusiasm, and the general karma of the event as reflected in the faces and attitudes of all of the participants.

I am especially proud of our Mid-Valley contingent – not only did we provide more than 120 participants to the rally, but everyone with a role to play performed wonderfully- MVHCA was one well-oiled human machine! While there are many individuals responsible for creating a fantastic event, two especially stand out for achieving TWO FULL BUSES of happy riders from Corvallis and Albany, with additional riders from Newport and Bandon: Bobbi Hall and Dagmar Johnson. And – – MVHCA raised several hundred dollars by selling our new bumper stickers and “Rosie” buttons at the rally!

Congratulations to HCAO for doing a great job on their first mass event. (Dr. Mike
Huntington, as usual, knocked himself out by doing all the stage and sound system set-up.) As Corvallis’ own Dr. Hsichao Chow, president of the local PNHP chapter (and also a bus rider), was quoted as saying: “…the momentum is building!”

--Bud

 

Here are a couple of videos in the media from the rally:

This Friday morning, February 8, the Oregon Public Health Association will unveil its legisaltive goals at the capitol.

Rally for universal health care in Oregon!

To read a summary of the Affordable Health Care for All Oregon Plan (Draft), click here.

To download the complete document, click here.

 

Parking Information

Buses only: park at the Willamette Heritage Center (formerly Mission Mill Museum) on Mill St off 12th across from the Amtrak station

Best carpool/individual parking: Airport Rd between State St and Mission (Hwy 22) - I believe this is offramp 253, turn right at the second light (Lowes is on the left and AAA is on the right), and first driveway on the right (bus shelters there). Parking is free, bus runs every 30 minutes and lets folks out in front of the Capitol - $1.50 each way

2nd best: Yellow lot between Center and Marion and Summer and Winter Sts (across from the church where we met last time). $6.00 all day

Street parking 10 hour meters - I think it is $.75 per hr. These will probably be at a premium due to this being the first day of session. These are scattered around the Capitol Mall area.

Ross Lampert, Organizer

Health Care for All - Oregon

619 SW 11th Ave. #121

Portland, OR. 97205

(503) 680-1834

organize@hcao.org

Ryan's "premium support" proposal for Medicare: Myths and facts

By Ida Hellander, M.D.
PNHP, August 14, 2012

Background:

“Premium support” or voucher proposals for Medicare are a mainstay of conservative health policy. They have been defeated for over three decades, starting with President Reagan’s FY 1981 budget proposal. They are a key feature of “managed competition”-type reform proposals. Although President Clinton embraced managed competition in his ill-fated health reform bill, he vetoed the 1995 Balanced Budget Act which would have turned Medicare into a voucher program. Premium support proposals were defeated again in 1997 and 2003.

Rep. Paul Ryan (R-Wis.), chairman of the House Budget Committee and candidate for vice president on the presumptive GOP ticket with Mitt Romney, resurrected the idea of a premium support proposal for Medicare in April 2011 with his “Path to Prosperity” budget proposal. Seniors would receive a fixed federal contribution or “defined contribution” to apply towards the cost of a private plan, and traditional Medicare, with its guaranteed coverage, or “defined benefits,” would be eliminated. The plan also called for increasing the age of Medicare eligibility from 65 to 67.

A so-called bipartisan variant of this scheme was proposed by Ryan in November 2011, with Sen. Ron Wyden (D-Ore.); in this version traditional Medicare would continue to be an option alongside private plans, and subsidy levels would be set at the cost of the next-to-cheapest plan, as determined by competitive bidding rather than be set by CMS. Medicare growth would be capped at GDP + 1 percent.

The latest version of “premium support” promoted by Rep. Ryan is the virtually the same as this more recent proposal with one major change; it sets the cap on Medicare growth lower, at GDP + ½ percent.
With the exception of the choice of traditional Medicare, the scheme is similar to the Affordable Care Act’s exchanges.

At the heart of all premium support proposals – and indeed the Affordable Care Act itself - are a number of myths:

1.  Myth: Private health insurance is more efficient than Medicare. Fact: Medicare has controlled costs better than private insurance and has much lower administrative overhead. According to CMS, Medicare spending rose by an average of 4.3 percent each year between 1997 and 2009, while private insurance premiums grew at a rate of 6.5 percent each year. The CBO has estimated that the private insurance equivalent of Medicare would cost almost 40 percent more in 2022 for a typical 65-year-old. Administrative costs in Medicare are less than 2 percent of expenditures, compared to 17 percent of revenues for private insurers.

2.  Myth: Expanding private plans in Medicare will reduce Medicare’s costs. Fact: Private Medicare Advantage plans have raised Medicare costs. Private insurers profit by selectively enrolling the healthy and shunning the sick, as documented in a New England Journal of Medicine article subtitled “The healthy go in and the sick go out.” Hence, they collect premiums paid by the Medicare program, and provide little care. As a result, the Congressional Budget Office estimates that Medicare Advantage plans cost Medicare 12 percent more per enrollee than the traditional program. New research from the National Bureau of Economic Research indicates that the true cost of private plans to Medicare may be much higher than the CBO estimate. Since Medicare launched a new risk adjustment scheme based on 70 diagnostic codes in 2004, overpayments to private plans have increased dramatically and accounted for $30 billion in excess spending, or 8 percent of total Medicare spending, in 2006 alone. Since then the overpayments have likely risen as the proportion of Medicare recipients in private plans has jumped from 16 percent to 24 percent.

3.  Myth: Premium support will reduce Medicare’s costs. Fact: Premium support plans don’t reduce costs, they shift them onto the patient. The rising cost of premiums will quickly outstrip the value of the fixed federal contribution, and seniors will have to pay more in either premiums or out-of-pocket payments for care. The Congressional Budget Office estimates that Ryan’s original Medicare proposal would raise out-of-pocket costs for the typical 65-year-old Medicare beneficiary in 2022 by $6,240. They haven’t estimated the cost of the latest plan yet.

4.  Myth: Competition among private plans will control costs. Fact: Private plans profit by competing to enroll the healthy and shun the sick. The industry is so consolidated that there is no effective competition in most regions of the country.

5.  Myth: Paying private plans in Medicare via “competitive bidding” will lower costs. Fact: There’s no evidence for this. Private plans compete by selectively enrolling healthier beneficiaries. Private insurers have been competing on price in the under 65 market for decades, yet costs and premiums have skyrocketed even as benefits and choices have been reduced.

6.  Myth: Premium support will increase choice for seniors: Fact: Premium support will decrease choice for seniors. Private plans with limited networks dictate which physicians seniors may see and which hospitals they may use. Medicare gives beneficiaries completely free choice of physician and hospital.

7.  Myth: Competition among private insurers will reduce administrative costs. Fact: Premium support will likely boost administrative costs since patients will move from the low-overhead traditional Medicare program to private plans with far higher overhead.

8.  Myth: There are no alternatives to reduce Medicare spending besides premium support. False: There are many better options for reducing Medicare spending, including the 9 listed below. Ultimately, the only way to preserve Medicare is to replace it with a single payer program with comprehensive benefits and effective cost controls. Currently Medicare is only one payer among thousands of different plans. Only a true single payer covering the entire population can slash administrative costs and control costs with budgets, negotiated fee schedules and drug prices, and health planning. Separate budgets for hospital operating costs and capital investment will permit the real health planning needed to reduce the costly and dangerous proliferation of expensive high-tech facilities.

Nine ways to reduce Medicare costs now -

  1. Eliminate Medicare Advantage plans.
  2. Give Medicare the power to negotiate drug prices.
  3. Eliminate private Part D plans, which have high overhead, and replace them with a public drug benefit along traditional Medicare principles
  4. Proscribe participation by for-profit providers, and mandate that participating providers (like hospitals) not pay any individual more than the president of the U.S.
  5. Extend the self-referral ban to include doctors who refer patients to their own MRI, CT, PET, and other complex imaging equipment (about half of total cardiologists income currently comes from imaging studies that they order and perform).
  6. Ban participating physicians from prescribing medications or medical devices (including orthopedic and cardiac implants) produced by drug or device makers from whom they receive payments.
  7. Reduce fees paid to the highest paid specialists, generally those who prescribe or use expensive drugs and devices. Doctors should be paid for the time they actually put in.
  8. Revamp Medicare's payment policies for subacute hospital care and so called "long-term acute care" (LTAC). Hospitals currently collect a set fee based on diagnosis for the acute hospital stay, and quickly transfer Medicare patients to a second inpatient facility that collects an additional fee. The result of this financial incentive has been a huge upswing in subacute and LTAC utilization, without any evidence that patients benefit. A colleague who is knowledgeable on this issue informs us that the proportion of Medicare patients with a subacute or LTAC admission after discharge from an acute care hospital has gone from 10 percent to 28 percent since these financial incentives came into effect, with about 600 LTACs appearing de novo.
  9. Abolish the Medicare pay-for-performance and ACO schemes, which are causing increases in administrative costs without any evidence of benefit.

9.  Myth: Medicare is already a single payer system. Fact: Currently Medicare is only one payer among thousands of different plans. Only a true single payer covering the entire population can slash administrative costs, implement effective cost-control methods like globally budgeting hospitals, negotiating fees, and doing real health planning with teeth to reduce the costly and dangerous proliferation of expensive high-tech facilities.

10.  Myth: Premium support will provide all seniors with the security that quality, affordable coverage will always be there. False: Premium support eliminates traditional Medicare with its defined benefits and substitutes a fixed contribution that, over time, will cover less care. Only a single payer plan can control costs while eliminating financial barriers to care for all. Ultimately, the only way to preserve Medicare is to replace it with a single payer program with comprehensive benefits and effective cost controls.

Outline of Rep. Ryan’s proposal for Medicare and Medicaid reform

Medicare

  1. Starting in 2023, transforms Medicare from a program that entitles seniors to “defined benefits” to one in which beneficiaries receive a “defined contribution” or “premium support” towards the purchase of private coverage or traditional fee-for-service Medicare.
  2. Although Ryan has claimed that people 55 and older would not be affected by his changes to Medicare, today’s seniors would be hard hit by Ryan’s $800 billion in proposed cuts to Medicaid because that program funds nursing home care. Few seniors have the resources to pay for nursing home care, and the cost of even a short stay in a nursing home can lead to impoverishment. Today’s Medicaid program allows the surviving spouse to protect a home and some assets so they may live out the rest of their lives with dignity. When Medicaid’s funding is slashed and benefits are determined by the states, that may no longer be the case.
  3. The plan gradually raises the eligibility age of Medicare from 65 to 67 by 2034. Private coverage is prohibitively expensive for many at this age. Research shows that the uninsured have worse health before they gain access to Medicare, and have more medical expenses for the first few years they are in the program, than their insured counterparts. Lengthening their wait by two years would lead to even greater health disparities before gaining coverage and higher unmet medical needs and higher costs among this cohort once they are on Medicare.
  4. Private Medicare plans would compete with traditional Medicare on a Medicare exchange. Seniors would be responsible for the additional premiums of any plan (including traditional Medicare) costing more than the next-to-cheapest plan. Private plans have been shown to selectively enroll healthier seniors while shunning the sick. Thus, the cheapest plans would be those private plans most effectively able to cherry pick the healthy (e.g. by offering gym memberships as a covered benefit), while other plans and traditional Medicare’s costs would rise. The cost of the additional premiums on top of cost-sharing could quickly add up to many thousands of dollars per year. The result would be a massive shift of the burden of health care costs to beneficiaries, particularly anyone with serious health needs.
  5. There is no evidence that private plans will reduce Medicare’s costs, and a lot of evidence they will raise them. Private plans have already been shown to cherry-pick healthier patients, raising costs by 12 percent compared to the cost of caring for the same patients in traditional Medicare. Administrative costs are much higher in private plans (about 17 percent) than in Medicare (under two percent), shifting funds from clinical care to bureaucracy.
  6. The plan calls for “risk adjusting” plan premium payments so that plans with healthier patients receive less funding. However, there is no evidence that risk-adjustment can work in the dynamic reality of profit seeking health care insurers/providers. Private plans quickly learned to game Medicare’s new risk-adjustment system to garner an extra $15 billion annually, about 4 percent of total Medicare spending. Interestingly, private plans were able to obtain more lucrative overpayments after the newly enhanced risk adjustment was put into place.
  7. The plan calls for capping overall Medicare growth at GDP plus 1/2 percent. This limits the financial exposure of the federal government, but exposes beneficiaries to increasing risk and larger out-of-pocket costs over time.
  8. In sum, this is a plan to eliminate Medicare as we know it, including traditional Medicare (since the voucher only has to cover the cost of the second-cheapest plan, not today’s Medicare) and replace it with a private system beholden to Wall Street. Seniors would bear the burden of rising health care costs themselves. In contrast, a single payer system could provide comprehensive coverage to everyone.

Medicaid

  1. Ryan’s plan would turn the joint federal-state program covering 62 million low-income Americans into a federal block grant program starting in 2013 and slash the federal contribution by $800 billion (35 percent) in 2022 and by 49 percent in 2030. States would have flexibility in determining who they cover and what benefits are provided with the remaining funds.
  2. According to the CBO, “states would need to increase their spending on these programs, make considerable cutbacks in them, or both.”
  3. Between 14 million and 27 million fewer people would be covered in 2021 than under Medicaid as it currently exists, according to the Urban Institute. Beneficiaries might also see reductions in benefits and increases in cost sharing.
  4. An additional 11 million people would not gain new Medicaid coverage if the federal health reform law were repealed, as Ryan has proposed, according to the Congressional Budget Office.

Candidates’ Forum on Health Care this Tuesday, September 25

All candidates for the Oregon House of Representatives from the three districts that include some portion of Benton County have been invited to a forum sponsored by Mid-Valley Health Care Advocates. Open to the interested public, the forum will be held at the Corvallis Benton County Library at 645 NW Monroe on Tuesday, September 25th, from 7-9 PM.

Accepting the invitation to attend the health care forum from House District 16, representing Corvallis, Philomath and Adair Village, are Sara Gelser, incumbent Democrat, and challenger Rachel J. Feigner, Libertarian.  From House District 23, a largely rural area surrounding HD 16, will be Jim Thompson, incumbent Republican, and challengers Ross Schwartzendruber, Democrat, and Alex Polikoff, Pacific Green and Independent Party. Attending from House District 15, representing Albany and a slice of north Benton County will be challenger Ron Green, Democrat; Andy Olson, incumbent Republican in HD 15 and Andrew Decker, Republican challenger for HD 16 have indicated that they will not be attending.

Candidates will be asked to describe their views on health care in Oregon and what reforms, if any, they support. Audience members will be able to submit additional questions to the candidates through the moderator.  Initial topics will include Coordinated Care Organizations, Health Insurance Exchanges, the role of private and public sectors in health care, health care delivery systems, and the future of a single payer system in Oregon.