What realistic state level health reform could be coming down the pike

Great Debates
1

Health reform on the national level seem unrealistic. In between the partisan gridlock, the iron grip of the plutocrats and the ideological rigidity I don’t see much happening. The ACA is just a starting point, but even that is considered radical.

Vermont enacted single payer which should take effect in 2014.

Are there any other states that could enact dramatic health reform anytime soon?

California passes single payer laws, but only when they have a GOP governor they know will veto the law. Once they had a democratic governor they couldn’t get the law past congress. So they are just doing what they do for show.

States like CA, IL, PA, NY, etc. etc. seem to have one party rule, are open to progressive ideology and may be more open to meaningful health reform. Meaningful health reform to me includes things like

  1. A strong public option, or medicare buy in option
  2. Single payer
  3. A system with transparent pricing, open negotiations, bulk negotiations, strong regulations, etc.
  4. A rationing system based on medical need and medical efficiency
  5. Meaningful pilot projects to reduce costs of care
  6. Changing payment plans to reward efficiency and health rather than procedures, although I ‘think’ there was an element of this to the ACA.

The guy who designed Vermonts single payer plan said it would save about 25% over traditional health plans over the 2020s. But he also found a public option would save about 16%. Single payer could be hard to get passed in various state legislatures, but I could see a strong public option (or a medicare buy in) being realistic in CA, NY, IL, etc. within 10 years to compete on the exchanges. Would that be legal to allow a medicare buy in on the state level? Failing that, if a strong public option could be created on the state level and medical insurance prices drop 10-20% over a decade, other states would take notice.

A medicare buy in for a 63 year old would run about $700/month, about the price of a silver plan in California. I don’t know all the ins and outs of medicare, but wouldn’t that provide better coverage than the silver plan with a $2000 deductible? I think medicares annual out of pocket limit is higher though. Also that $700 figure is actually $634, but that was in 2011. I have no idea what it would be around 2015 or so. Plus it was created by the CBO, which figured only sicker people would sign up for medicare so the premiums could be inflated.

Either way, is any realistic health reform on the state level coming down the pike, or is it mostly just smoke and mirrors to get money and support from the netroots w/o actually doing anything like California’s efforts at single payer?

2

Medicare B has no out of pocket limit, (while Medicare A is deductibles only.) Things like chemotherapy can easily reach towards 6 figures, of which subscribers would be liable for 20%. Most people on Medicare buy commercial insurance to supplement or replace it.

3

Also, Medicare’s payments aren’t currently sustainable for a lot of providers. It’s not a big probable now because they can offset the money they lose on Medicare patients with private insurance and private pay patients, but If everyone / a lot more people had Medicare, then Medicare would have to pay more or providers would have to figure out how to get by with less.

4

Thanks for that info. Does medigap cover those high copays in part B to create a sustainable out of pocket limit? What would a decent monthly plan add? The article I posted said about $600-700 for parts A, B & D for a 62-64 year old. But I don’t know what a decent medigap plan would add to that.

5

And the plan to acquire an eleventh province enters its mid-phase. heh heh heh…

6

A typical medigap (the correct term now is Medicare Supplement) will usually cover whatever Medicare “allows” but doesn’t pay for. For example Medicare won’t pay for durable medical equipment in a nursing home stay that’s otherwise noncovered, so Medicare Supplement won’t either even though a regular commercial plan would. But Med Sup will cover the entire amount of the 20% coinsurance, the hospital deductibles; Medicare A can get exhausted so Med-Sup would continue to provide coverage at 100%,

There are some exceptions the the rule that if Medicare doesn’t cover it than Med-Sup doesn’t either: preventive care may be covered at 100%, substance abuse, medevac, and out-of-country care are covered at 80%.

7

Also, it’s worth noting that Med-Supp claims are a lot less labor intensive for commercial insurance to process than commercial policies.

8

So how much does a medicare supplement plan add to the premium for medicare? Is it about $100-200/month per person? What about just a high deductible one that covers 100% of the copay after something like $3000 in a calendar year?

9

Speaking on the political side, I think there are good chances for single-payer in California now that the Democrats have a super-majority to both chambers of the State Legislature. However Pennsylvania seems to be controlled by the GOP at the state level for now and I don’t see the same sort of Democratic dominance in the near-term future as in say California or Vermont.

10

Mr. Clark,

Actually nobody knows what is going to happen to national health care in 2014.
Each state’s adjustment to the Affordable Care Act will be different.

11

I just don’t see it in California anytime soon. back when they knew a gop governor would veto it they had no problem getting 21 votes in the state senate. they used to get 25 for single payer. once a democratic governor showed up, now they can’t get more than 19. I think it is just symbolic in California and not something they are serious about. however I could see California doing a strong public option as part of the exchanges if that is legal. a strong public option could provide 2/3 the cost savings of single payer and be more politically feasible. I hope I’m wrong about California though. either way, single payer alone won’t fix our system. it will still be far more expensive than other systems, including European multipayer systems. we also need strong competition, negotiation, transparent pricing and comparative effectiveness legislation too.

12

I don’t see any major health care reform as politically feasible in the near future. Republicans are too fired up about Obamacare to support anything other than bills to limit its implementation, and Democrats are going to want to wait until it goes into effect and see if it works and what effect it will have on their state before they talk about any other plans.

13

Yes, six figures easily, and seniors on fixed incomes, and over a period of years, it doesn’t take too much for that 20% to completely wipe them out, especially if done over a period of years. And under Obamacare isn’t 76 the age they won’t even treat you? Somebody correct me on all of this if I’m wrong.

We are always told that they have to charge this for the drugs because of the research. In 2012 Nature did a review of these chemotherapy drugs and found in 89% of the studies, they were not able to replicate the claims that the drug companies made for their drugs in making it safer and/or more effective. So if competent organizations are not able to replicate these findings, who is responsible for still letting these drugs get introduced? “Professor B.M. Hegde, M.D., Ph.D., says that the competitive publish-or-perish climate in cancer research prompts scientists to sometimes omit unfavorable data or manipulate their results in order to assure that their grants continue.”

And research supposedly isn’t even the biggest expense for the drugs, but the marketing behind it, which takes up 24.4%. If the drug again was effective as they claim, it seems like they wouldn’t have to spend near as much on advertising.

Doesn’t any of the patents on these chemotherapy drugs ever expire? Or do they supposedly tweak it, by giving it a different color, shape, name, or change the chemicals ever so slightly to call it a new drug entirely, and off the pharmaceuticals go again.

This article doesn’t break it all down, but when considering the drugs costs, seems like the largest portion of it is going to corruption.

14

I pulled up the billing info for a random Med-Supp contract and found they’re $215 a month. As for the second question, we don’t have a product like that so I can’t pull up billing information for it. The people that deal with how much different patient responsibilities affect the premiums are sales, marketing, and underwriting; I don’t work there or know anyone that does.

15

I take back my earlier comment, in that there does seem to be one thing I think you’ll see coming, and that’s Medicaid reform. There’s a push to cut costs and inefficiencies, and what the states see as insufficient federal support, and a bunch of states; New York, Florida, Michigan, Kansas, and more, are talking plans to change the way Medicaid is structured.

16

I don’t know how they will change it. Medicaid is already accepted by very few medical professionals because the reimbursement rates are too low.

True health reform will involve finding ways to improve quality and drive down price. That is the reform this country needs, more than single payer or UHC. But doing that will require pissing off a lot of people, so it will only be done as a last resort.

17

Here’s New York’s plans

A lot of it involves streamlining administration, changing the funding structure so that less is funded by property taxes, finding ways to increase means testing, coordinating payment systems, and so on.

Here’s Florida’s, which sets up HMOs in coordination with private insurers.

http://ahca.myflorida.com/medicaid/medicaid_reform/index.shtml

And here’s Kansas’s:

http://www.kancare.ks.gov/medicaid_reform.htm