Condados Contra la Revocación de Obamacare

July 27, 2017 by · Leave a Comment 

Mientras el Senado se preparaba para abrir un debate sobre la derogación de la Ley del Cuidado de Salud a Bajo Precio, mejor conocido como Obamacare, miembros de la Junta de Supervisores del Condado de Los Ángeles acusaron el martes a los legisladores de jugar con la vida de las personas y no solicitar aportaciones de los proveedores de la atención sanitaria.

El supervisor Mark Ridley-Thomas dijo que el cuidado de la salud fue un punto crítico de una reunión el pasado fin de semana de la Asociación Nacional de Condados (NACO).

“El debate sobre la salud debe ser sobre la mejoría de los resultados y no solo un ejercicio presupuestario”, dijo Ridley-Thomas, citando un amplio consenso entre los funcionarios del condado en todo el país, sin tener en cuenta la política partidista.

Si se anula a Obamacare, el Congreso creará “un cambio masivo de costos…para que los condados puedan soportar” y dado su tamaño, “el condado de Los Ángeles sería el condado más afectado,” dijo Ridley-Thomas, agregando que el condado podría perder tanto como $1 millón en financiamiento.

La supervisora Kathryn Barger, quien también asistió a la reunión de NACO y es la única republicana en la junta no partidista del condado, estuvo de acuerdo.

“Se está haciendo en Washington sin solicitar aportaciones de los proveedores,” dijo Barger. “Es la vida de la gente que está siendo jugada como un peón político”.

La votación del Senado para abrir el debate sobre la revocación fue de 51-50, con el vicepresidente Mike Pence como el desempate. El senador John McCain votó “si” a su regreso a Washington, D.C., menos de dos semanas después de someterse a una cirugía para extirpar un tumor cerebral.

Los republicanos han buscado durante mucho tiempo la derogación de la ley de salud, diciendo que ha impulsado el costo de las primas de salud y los deducibles hasta un nivel que muchos estadounidenses no pueden pagar y creó desequilibrios del mercado de seguros que no pueden sostenerse.

El presidente Donald Trump presionó al Congreso para que cumpliera su promesa de revocar la ACA en un discurso el lunes, calificando a Obamacare como “desastroso” y una “pesadilla”.

Los funcionarios del condado están particularmente preocupados por los recortes a Medicaid como resultado de una derogación, diciendo que los recortes afectarían de manera desproporcionada a las personas mayores y discapacitadas y quitarían una herramienta critica en la lucha contra la epidemia de opioides en todo el país.

Casi dos tercios de los gastos de Medicaid en 2011 beneficiaron a los discapacitados y los estadounidenses de edad avanzada, a pesar de que constituyeron menos de una cuarta parte de los inscritos del programa, de acuerdo con NACO. Estos datos son anteriores a la puesta en ACA, que amplio el acceso a Medicad.

La supervisora Hilda Solís emitió una declaración tras la votación instando a los republicanos y demócratas a trabajar juntos para encontrar una solución.

“Hay un enorme costo humano para revocar o sabotear y el Primer Distrito será particularmente golpeado si este esfuerzo que niega la salud sea exitoso”, dijo Solís. “Un estimado encontró que aproximadamente 300,000 residentes del Primer Distrito perderán su cobertura de salud, incluyendo alrededor de 50,000 niños y 16,000 ancianos. Otros 60,000 perderán su seguro patrocinado por el empleador, mientras casi 20,000 perderán su seguro a través de Covered California”.

Aunque el voto del Senado despejó el camino para el debate, sigue siendo incierto que proyecto de ley puede finalmente ser aprobado para derogar o reemplazar a Obamacare, dados los objetivos de las facciones dentro la legislatura dirigida por los republicanos.

Health Insurance Expansion Linked to Fewer Sudden Cardiac Arrests

July 6, 2017 by · Leave a Comment 

The incidence of sudden cardiac arrest, a sudden and usually deadly loss of heart function, declined significantly among previously uninsured adults who acquired health insurance through the Affordable Care Act, also known as “Obamacare,” according to a study published June 28 in the Journal of the American Heart Association.

The findings, based on an analysis of emergency medical services in an urban Oregon county before and after the insurance expansion mandated by the ACA, underscore how health insurance can affect outcomes. Most adults in the study gained insurance through Medicaid expansion, a jointly funded federal-state health insurance program for low-income people that was expanded under the federal law.

Among previously uninsured adults ages 45 to 64, the incidence of cardac arrest  decreased by 17 percent. The incidence remained the same among adults age 65 and older, a group that had consistently high rates of health insurance coverage before and after the ACA, primarily through Medicare.

“Cardiac arrest is a devastating and under-recognized cause of premature death for both men and women age 45 and older,” said Eric Stecker, MD, MPH, associate professor of Cardiology at Oregon Health & Science University’s Knight Cardiovascular Institute in Portland, Oregon, and the study’s lead author. “Health insurance allows people to engage in regular medical care, which is crucial for the prevention of cardiovascular disease and the diagnosis and treatment of conditions that can cause cardiac arrest.”

More than 350,000 out-of-hospital cardiac arrests happen yearly in the United States. Although the terms “sudden cardiac arrest” and “heart attack” often are used interchangeably, the conditions are vastly different. A heart attack is caused when one of the major arteries leading to the heart becomes clogged, usually with plaque, disrupting the flow of blood to the heart muscle. A sudden cardiac arrest is an electrical disturbance in the heart rhythm that causes the heart to stop beating. Patients may have little or no warning, and the disorder usually causes instantaneous death. Sudden cardiac arrest has been blamed for the deaths of journalist Tim Russert and filmmaker John Hughes.

“Because so few survive a sudden cardiac arrest, it is imperative that we be able to predict which patients are the most vulnerable,” said the study’s senior author, Sumeet Chugh, MD,  director of the Heart Rhythm Center at the Cedars-Sinai Heart Institute in Los Angeles. “Effective primary prevention is the only way to make a significant impact on this problem. Fewer than 10 percent of these patients are going to make it out of the hospital alive. By the time we dial 911, it’s much too late for most of them.”

The findings published today came out of a larger research enterprise called the Oregon Sudden Unexpected Death Study, a comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the Portland metropolitan area, home to 2.4 million people. The study, led by Chugh, has been underway for more than a decade. Data collected from it provides Chugh and his team with unique, community-based information to mine for answers to what causes sudden cardiac arrest.

Researchers examined records for emergency medical services in Multnomah County, Oregon, to identify patients with out-of-hospital cardiac arrest. They compared this information to U.S. Census Bureau data for the county’s adult population in the years before ACA implementation (2011-2012) and after the law took effect (2014-2015).

The investigators caution that although the study shows a strong association between health insurance and lower rates of cardiac arrest, it does not prove cause and effect. If larger studies among more diverse groups of patients confirm these findings, that would potentially have major public health implications, the study’s authors said.

“It is crucial to more comprehensively identify the health benefits of insurance and to carefully consider public policies that affect the number of uninsured Americans,” Stecker said.

Community Clinic Re-opening Is Reminder of Importance of Health Care ‘Safety Net’

June 29, 2017 by · Leave a Comment 

Andres and Rosa Garcia sat patiently waiting for the grand re-opening program to begin, quietly recalling that it had been over 15 years since they turned to the Arroyo Vista Family Medical Center in Highland Park for their health care.

The temperature was rising and just a couple of hours earlier news broke that the U.S. Senate had released it’s version of a bill to “repeal and replace” the Affordable Care Act. If passed, the change could cut off health care insurance to tens of millions of low-income and middle class Americans, and potentially raise the cost of health insurance to the elderly five-fold.

Councilman Gil Cedillo greets Arroyo Vista Family Health Center patient while touring newly re-opened clinic with CEO Lorraine Estradas. (Office of Councilman Gil Cedillo)

Quality health care that is accessible and affordable is not something to be taken for granted, something the Garcias know firsthand.

“The people who work here [at Arroyo Vista] have always taken good care of us,” said Andres, appearing much younger than his 86 years.

“Everyone here is helpful and friendly, “ adds 81-year-old Rosa, explaining in Spanish that the couple uses the clinic’s dental and vision services as well as its primary health and medical services, a convenience they appreciate having close to their Highland Park home.

“Whenever we need to see a specialist they refer us right away, to White Memorial, and get us to the right doctor” to treat my ulcer and arthritis, Andres told EGP. Rosa says she appreciates that the staff “all speak Spanish.”

The couple was among several dozen people from the Arroyo Vista staff, board of directors, patients, professional and community partners and a local councilman gathered to mark the latest milestone in the community clinic network’s mission to provide quality, affordable and non-discriminating health care services.

Passage of the Affordable Care Act, also known as Obamacare, increased the number of people in California and across the country with health insurance, swelling the demand for providers.

One of five community-based clinics and a mobile clinic operated by Arroyo Vista, the facility on North Figueroa Street was closed to patients for several months as it underwent a $1Million remodel, adding new state-of-the-art upgrades to better serve and accommodate its predominately low-income clients who range in age from newborns to the elderly. An on-site pharmacy allows patients to fill prescriptions with ease.

Arroyo Vista is a very important “safety net for this community,” said Steven Kasten, a Lincoln Heights businessman who served as MC for the grand re-opening ceremony and ribbon cutting. He recalled meeting Arroyo Vista CEO Lorraine Estradas 35 years earlier, marveling at her years of dedication and leadership in growing the clinic network.

Los Angeles Councilman Gil Cedillo (CD-1) represents three of the neighborhoods where Arroyo Vista clinics are located. He said the importance of clinics like Arroyo Vista that treat patients with “dignity and respect” can’t be understated, especially as the country faces forces intent on “cutting Medicaid and health insurance for the poor” and “give tax breaks to the rich,” a reference to Republican House and Senate plans to unravel Obamacare.

“I know firsthand how important these clinics are,” Cedillo said. Years ago, “I was unemployed, without health insurance and then my wife was diagnosed with cancer,” he told the audience. He said he had to call on friends and acquaintances — build his own health care network — to get his wife the medical help she needed.

“My wife got help at clinics like Arroyo Vista,” which take care of people with few resources, no matter their income level or legal status, Cedillo said.

“We have a crisis in leadership,” Cedillo said. “We have to bring business and labor together” to champion the working poor as the country “suffers the policies of Trump.”

Arroyo Vista is doing a great job of providing quality care, and the community has to support its effort, the councilman said.

Tours of the newly renovated facility were offered following the formal program and ceremonial ribbon cutting. Traveling through the facility with Estradas and other guests, Cedillo stopped to shake hands with staff and patients, and ask what each thought of the changes at the clinic.

The responses were overwhelming positive, with doctors and patients alike remarking on the aesthetic improvements, but calling particular attention to changes that made the delivery of care more efficient and responsive to clients’ needs.

“My whole family comes here and we love it, they treat my kids really good,” said one mother, who told EGP she appreciates that the doctors listen to her.

There’s no doubt that challenges to the healthcare system are on the horizon. For Estradas that means staying true to Arroyo Vista’s mission of using all its resources to give their clients the best health outcomes possible.

“We are watching what’s going on very closely,” she told EGP. “We are constantly planning for whatever is to come down the road.”

 

Abucheos en California por el proyecto de salud del Senado

June 29, 2017 by · Leave a Comment 

Políticos, proveedores de atención médica y defensores de los consumidores en California tuvieron ásperas críticas para el flamante proyecto de ley de salud del Senado revelado el jueves 22 de junio, argumentando que podría hacer que la cobertura sea inaccesible para los residentes más pobres, a la vez que recortaría impuestos para los ricos.

“Este proyecto no es un proyecto de atención de salud, dijo Ed Hernandez, demócrata y presidente del comité de salud del Senado estatal. “Este es un proyecto de ley de impuestos que beneficiaría a los individuos más ricos a expensas de aquellos que más necesitan atención de salud: los trabajadores pobres y los adultos mayores”.

El gobernador demócrata Jerry Brown dijo en un mensaje en Twitter que el proyecto de ley tenía el mismo “olor fétido” del proyecto de ley aprobado por la Cámara Baja el mes pasado. “Millones perderán cobertura de atención médica, mientras que los millonarios ganarán”. “El pueblo estadounidense merece algo mejor”.

El proyecto de ley de 142 páginas, revelado el jueves por la mañana, reemplazaría a la Ley de Cuidado de Salud Asequible (ACA) y rechazaría los impuestos establecidos para pagar por muchos de los beneficios de la ley. La legislación propuesta también reduciría de manera significativa los fondos para el Medicaid, el programa para las personas de bajos ingresos, y eliminaría gradualmente la expansión masiva del programa, que se inició con ACA.

También limitaría la elegibilidad para obtener subsidios en forma de créditos impositivos para comprar seguro de salud en los mercados federal y estatales, y permitiría a las aseguradoras cobrar a los adultos mayores hasta cinco veces más que a los consumidores más jóvenes, comparado con tres veces más bajo ACA.

El proyecto de ley del Senado es sustancialmente similar al aprobado por la Cámara el mes pasado, pero difiere en algunos aspectos clave. La medida del Senado propone un calendario más lento para la eliminación gradual de la expansión del Medicaid, y elimina por completo el requisito de que las personas estén aseguradas en vez de simplemente cobrarle más a los consumidores que estuvieron un tiempo sin cobertura, como lo hace el proyecto de ley de la Cámara. También reduciría el gasto federal en el Medicaid a largo plazo, de manera más profunda que el proyecto de ley de la Cámara.

Los dos proyectos también manejan subsidios a las primas de manera diferente: la versión de la Cámara los basaría solamente en la edad, mientras que la propuesta del Senado inlcuiría factores como edad, ingreso y lugar de residencia.

Cerca de un tercio de los residentes de California -13,5 millones de personas- están bajo el Medicaid, conocido como Medi-Cal en el estado. Cerca de 3,8 millones de ellos han ganado cobertura desde que ACA, también conocida como Obamacare, entrara en vigencia en 2014. Otros 1,3 millones tienen cobertura de salud a través de Covered California, el mercado de seguros estatal.

Bajo el proyecto de ley del Senado, las compañías de seguros tendrían que aceptar a todas las personas independientemente de sus condiciones preexistentes. Sin embargo, la medida permitiría a los estados eliminar los “beneficios esenciales de salud” que se requieren bajo el Obamacare, tales como visitas al hospital y beneficios de salud mental. Algunos expertos en salud creen que las aseguradoras podrían usar eso como una excusa para excluir a las personas con historial de enfermedad, simplemente vendiendo pólizas que no incluyan la cobertura que necesitan.

Eso preocupa a personas como Cory Dobbs, cajero en un supermercado Grocery Outlet, quien tiene VIH y cáncer.

“Para algunos de nosotros es la vida o la muerte”, dijo Dobbs, de 42 años, un paciente de Medi-Cal que va a la clínica Cares Community Health en Sacramento. “Algunos de nosotros hasta posiblemente nos vayamos a morir por este proyecto de ley. Es solo la verdad.”

Los críticos de la Ley del Cuidado de Salud Asequible argumentan que el gobierno federal necesita controlar los costos y que los estados deben asumir más responsabilidad para proveer atención de salud. Por ejemplo, los estados podrían derivar el presupuesto destinado a otras áreas si quieren continuar con la expansión del Medicaid, dijo Lanhee Chen, experto en políticas de salud en Hoover Institution.

“Tiendo a tener una respuesta negativa a la idea de que la alternativa del Obamacare dará lugar a que la gente pierda cobertura”, dijo Chen sobre el empuje republicano para derogar la ley. “Esto no es sólo una cuestión de lo que hace el gobierno federal con el financiamiento del Medicaid, sino lo que el estado puede hacer si los cambios de financiamiento se convierten en ley”.

Sin embargo, Sarah de Guia, directora ejecutiva del grupo de defensa California Pan-Ethnic Health Network, dijo que el estado Dorado ha establecido un estándar alto en términos de cobertura bajo ACA, y que los esfuerzos de los republicanos amenazan esa cobertura.

“California es obviamente líder”, dijo. “Pero con los cortes potenciales… es inevitable que el estado tenga que tomar algunas decisiones realmente difíciles”.

En el programa Medi-Cal, eso podría significar ofrecer menos beneficios, disminuir la elegibilidad o reducir los reembolsos para los proveedores, que ya están entre los más bajos de la nación. Eso ha causado ansiedad entre el personal de clínicas comunitarias, hospitales de seguridad social y hogares de ancianos.

“Las clínicas comunitarias continuarán y tratarán de mantenerse abiertas, pero es como sacar la alfombra que tenemos debajo”, dijo Deena Lahn, vicepresidente de política y defensa del San Francisco Community Clinic Consortium. “Ahora, Medicaid es la base financiera de nuestro trabajo”.

El doctor Jay Lee, médico jefe de la Venice Family Clinic con sede en Los Angeles, estuvo el jueves en una marcha de “guardapolvos blancos”, en Washington, DC, en oposición a los esfuerzos de los republicanos por “derogar y reemplazar” el Obamacare.

El proyecto de ley del Senado “básicamente agita al Medicaid” y hace que sea más difícil para los médicos hacer su trabajo, dijo Lee. “Yo también podría escribir mis papeles [de recetas] en tinta invisible si los pacientes no pueden pagar por los medicamentos”.

En el mercado de seguros individual, decenas de miles de personas que reciben subsidios federales ya no calificarían para ayuda debido a una disposición en el proyecto de ley del Senado que reduce los umbrales de ingreso para ser elegible.

Funcionarios de Covered California, el mercado estatal, dijeron que el proyecto de ley podría tener un amplio impacto en los beneficiarios. “A primera vista, no sólo proporcionaría una cobertura de salud mucho más escasa que la que se ofrece hoy, sino que millones de personas no tendrían cobertura alguna”, dijo Peter V. Lee, director ejecutivo de Covered California, en una declaración escrita.

Algunos consumidores apoyan un rechazo de ACA. Sarah Foster, de 83 años, se opone a las propuestas de salud del Senado y de la Cámara de Representantes, pero por una razón diferente: no piensa que vayan tan lejos como para revocar totalmente el Obamacare.

Foster, residente de Sacramento que está en Medicare y Medi-Cal, dijo que nunca tuvo problemas para encontrar un médico antes de ACA. La mujer dijo que, después que la ley se aprobó, pareció que muchos médicos entraron en atención especializada debido a la “burocracia” asociada con la ley.

Ahora, dijo, no tiene médico de atención primaria. “Así que estoy corriendo por ahí tratando de encontrar una persona [de medicina] interna”.

Los hospitales de redes de seguridad, que también se han beneficiado de ACA, temen el impacto de una revisión republicana. Los hospitales públicos de California podrían perder apoyo por más de $2 mil millones al año si se deroga la expansión del Medicaid, según la California Association of Public Hospitals and Health Systems.

El proyecto de ley es un “esfuerzo inútil para ahorrar dinero”, dijo Erica Murray, presidenta y CEO del grupo, en un comunicado. “Simplemente negarse a gastar dinero en atención médica no reduce el costo de la atención, ni la necesidad”.

El doctor Matthew Hickey, de 30 años, residente médico de la Universidad de California en San Francisco, que trabaja en el Hospital General de San Francisco, el hospital de la red de seguridad de la ciudad, dijo que le preocupa que la ley “reduzca drásticamente tanto la cobertura como la calidad de la cobertura”.

Agregó: “En particular los recortes al Medicaid son bastante preocupantes. Muchos de los pacientes que atiendo y que recibieron cobertura a través de la expansión del Medicaid no podrán verme”.

Financiación Futura de Medi-Cal En Riesgo

April 6, 2017 by · Leave a Comment 

La población con seguro de salud en California ha crecido enormemente en los últimos años con Medi-Cal, el seguro médico subsidiado por el estado, aunque el futuro de su financiación no está claro, indica un estudio presentado hoy.

El análisis, “Financiando el programa Medi-Cal”, elaborado por el Instituto de Política Pública de California (PPIC), señala que cada vez California debe disponer de más fondos para mantenerlo al nivel actual, que representa el segundo gasto después de la educación en el presupuesto general.

“Mientras el Gobierno federal ha financiado una gran parte del crecimiento del programa, los costos estatales también han aumentado”, señaló Shannon McConville, autora del informe junto con Paul Warren y Caroline Danielson.

“Este aumento de costos combinado con una política mayor de cambios todavía concebibles a nivel federal, ha creado incertidumbre adicional acerca del futuro de la financiación de medical Medi-Cal”, anotó la analista de PPIC.

Según señala el estudio, actualmente Medi-Cal representa el 15% del total general de gastos del presupuesto del estado, el segundo mayor después de la educación de kínder a preparatoria.

El análisis destacó también que en la última década el costo del programa, conocido en el resto del país como Medicare, aumentó de 40.000 millones de dólares en el período 2005-2006 a cerca de $100.000 millones en el 2016-2017.

En ese mismo período, la participación en la financiación por parte de California ha disminuido de cerca del 40% hasta aproximadamente el 20% y “adicionalmente, la financiación de otras fuentes incluyendo gobiernos locales y proveedores ha aumentado”.

Igualmente el estudio señaló que el Gobierno federal en los años 2014 a 2016 de implementación de la Ley de Salud Asequible (ACA), pagó el 100% de los costos de la cobertura de Medi-Cal para el nuevo grupo elegible, básicamente adultos de bajos ingresos sin niños dependientes.

Sin embargo, bajo los términos de la ley actual, esa aportación federal disminuirá gradualmente para llegar a 90% en 2020.

Otra ayuda federal establecida por ACA representó entre el 2010 y 2015 más de $10.000 millones en pagos a hospitales que atienden un alto número de usuarios de Medi-Cal y pacientes sin seguro médico.

No obstante, de continuar esa ayuda, se reducirá a cerca de $6.000 millones para el 2020, en algunos casos con la obligación de una participación igual por parte de los gobiernos locales o los proveedores de los servicios de salud.

El análisis calcula que actualmente los gobiernos locales pagan cerca de $5.000 millones cada año, equivalentes a un 20% de los fondos de Medi-Cal, a través principalmente de pagos de los sistemas hospitalarios, que provienen mayoritariamente de otros fondos del gobierno como las universidades públicas.

Con la “volatilidad de los ingresos previstos” en el presupuesto general de California, el tema de Medi-Cal se torna un punto de importante discusión en la próxima aprobación del Plan de Gastos.

El estudio recomienda que se busquen fuentes de financiación para Medi-Cal “que puedan ser ofrecidas consistentemente a largo plazo” y que también sean “económicamente eficientes y simples”, entre otras características.

Californianos Luchan Por Mantener Obamacare

March 30, 2017 by · Leave a Comment 

La Coalición Lucha por Nuestra Salud de California, apoyada por el poderoso Sindicato Internacional de Trabajadores de Servicios (SEIU), realizó manifestaciones por todo el Estado Dorado, el 23 de marzo, para pedir que se mantenga la ley actual de Cuidado de Salud Accesible (ACA).

Las protestas fueron convocadas al cumplirse siete años del llamado Obamacare y mientras la Cámara de Representantes se disponía a votar la nueva propuesta republicana para derogar y reemplazar la ley sanitaria, un plan que cuenta con una fuerte oposición dentro de los propios conservadores.

Una marcha que terminó con una manifestación frente al edificio Federal Edward Roybal en el centro de Los Ángeles contó con el apoyo de la supervisora del condado Hilda Solís y de cerca de 70 secciones sindicales y organizaciones comunitarias y de salud.

En Modesto otra protesta se realizó en la sede del representante republicano Jeff Denham en la que los participantes “murieron” frente a las instalaciones para dramatizar el impacto que, según sus denuncias, tendría la nueva ley especialmente entre la niñez y los ancianos.

“Sin ACA habrá un efecto dominó en nuestras comunidades. Más gente dejará de recibir cuidado preventivo y tendrá que ser tratada cuando se enferme y sea más costoso”, aseguró Rogenia Cox, miembro de SEIU y empleada del Departamento de Salud Pública del Condado de Fresno.

Los manifestantes insistieron en la cifra presentada por un informe de la Oficina de Presupuesto del Congreso de “24 millones de estadounidenses que quedarán sin seguro de salud” en la próxima década si se aprueba el nuevo proyecto.

Algunos legisladores estatales también denunciaron durante una conferencia de prensa frente al Capitolio en Sacramento las “pérdidas potenciales” que puede significar para California el nuevo proyecto.

La administración estatal calcula que California tendría que asumir 6.000 millones de dólares en nuevos costos anuales para 2020 si se aprueba la nueva ley de salud y 24.000 millones por año para 2027.

Repealing the ACA Would Hurt Mental Health Care

March 23, 2017 by · Leave a Comment 

Once again Republicans are pushing to repeal the Affordable Care Act (ACA) and it will hurt millions of Americans, especially those who live with a mental health or substance abuse disorder. The Republican bill would limit access to life-saving Medicaid coverage, make private insurance more expensive, and penalize the poor and elderly — all while reducing taxes on the richest.

The GOP proposal specifically targets Medicaid, the biggest provider of health and behavioral health services in the country, by eliminating the ACA requirement that Medicaid plans cover an Essential Health Benefits package and cutting federal funding by setting a limit for federal reimbursement per enrollee, also known as a “per-capita cap,” no matter their need for care. Weakening coverage requirements and limiting the amount of funding provided to deliver services would hurt the ability to qualify and access Medicaid, especially for those with time-intensive and often costly substance abuse and mental health disorders. Under the GOP plan, a child treated through one of Pacific Clinics school-based mental health programs could potentially lose their Medicare (Medi-Cal) coverage due to budgetary constraints and lose access to care. Many of the children and young adults we see will consider, attempt, or complete suicide. This is the third leading cause of death in children between the ages of 10-14 and second cause of death between ages 15-34.

This bill would also negatively affect those who get their insurance through the Exchanges. In particular, the Republicans’ proposal to eliminate the ACA’s “actuarial value” protections, which require insurance companies to pay a fair share of the cost of your care, would mean higher deductibles and out-of-pocket expenses for low-income individuals. For the millions of Americans seeking care for chronic conditions requiring many doctor visits including mental health disorders, this is simply unacceptable and could make seeing a doctor unaffordable.

Older Americans would also see a big increase in out-of-pocket costs. The GOP plan would allow insurers to increase the “age rating” limits put in place by the ACA and charge older Americans five times as much as they would a younger customer. For the 1 in 5 older Americans who live with a mental health condition, this could mean having to make the difficult decision of going without treatment or going without food.

The Republican proposal comes at a steep cost and delivers little benefit for those seeking either mental or physical health care. According to the Congressional Budget Office (a non-partisan entity), under the GOP plan, 14 million people lose insurance in 2018. It would also cut $880 billion from the Medicaid program, which cares for low-income families and the disabled, while cutting $600 billion in taxes on wealthy individuals.

While some have argued that the ACA did not directly modify the federal mental health parity protections, it did extend those protections to millions of Americans who did not have them before. The ACA also helped millions of Americans obtain health care coverage they would otherwise not have. It is undeniable that the ACA has been successful in connecting more people with behavioral healthcare, especially young adults, children and their families. The law has had a tremendous effect in our home state of California, for example, where one in three Californians currently benefit from our state’s Medicaid program, known as Medi-Cal.

Many challenges still remain for behavioral health — too many individuals do not have access to treatment, there is a shortage of behavioral health clinicians, and the suicide rate, sadly including for children, is increasing. Repealing the ACA and replacing it with the Republican plan would hurt those most in need. We encourage all Republicans to work with us to strengthen the ACA in order to ensure that Americans everywhere have access to the health care they need.

 

Congresswoman Grace F. Napolitano (CA-32) is Chair of the Congressional Mental Health Caucus. Dr. Luis Garcia is Vice President of Quality Care, Cultural Diversity, and Outcomes at Pacific Clinics.

 

Deciphering The CBO Estimates On The GOP Health Bill

March 16, 2017 by · Leave a Comment 

The Congressional Budget Office is out with its estimate of the effect that the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government. The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

 

Here are some of the CBO highlights:

—$337 billion reduction in the deficit. That’s CBO’s estimate over the next decade. That takes into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenues from the repeal of the taxes imposed by the ACA to pay for the new benefits.

—24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that drop will begin quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

—15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

—$880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

—14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

—95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024 since the bill would phase out those payments to states as patients cycle in and out of eligibility.

—15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

This California Healthline story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

picture-of-health-frame California Healthline

What Does The House Health Care Bill Mean For California?

As the most populous state with the largest economy in the country, California stands to be dramatically affected by changes to the nation’s health law.

About 1.5 million people buy health insurance through the state’s exchange, Covered California, and most get federal subsidies. About 4 million receive Medicaid (called Medi-Cal here) through the program’s expansion under the Affordable Care Act. Altogether, Medi-Cal covers 14 million people in the state, roughly a third of its population.

The current House bill proposes to significantly change how — and how much — the federal government pays for these programs.

That likely would translate into millions of people in California losing coverage or seeing their costs rise. Medi-Cal might have to cut programs and eligibility. Source: California Healthline

State Senate’s Health Chairman Vows To Defend California Coverage Gains

November 22, 2016 by · Leave a Comment 

A key state health care figure vowed Thursday to defend the coverage gains California has seen under the Affordable Care Act in the face of widely expected efforts by President-elect Donald Trump to overturn much of the health reform law.

“I want to assure you, your staff and Californians that we stand ready to fight to keep what is working in this state,” Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, told the board members of Covered California, the state’s health insurance exchange, in their first public meeting since Trump was elected on Nov. 8.

“What we have is too important to lose,” said Hernandez, an optometrist. He cited examples of people who had come into his optometry office for the first time because of their newly gained health coverage.

Any rollback in coverage, Hernandez said, would hurt millions of Americans.

California’s rate of uninsurance has been cut roughly in half since 2014, when federally subsidized health plans sold through the exchange first took effect and eligibility for Medicaid, the health care program for low-income individuals, was expanded. Both are key features of the Affordable Care Act, also known as Obamacare.

Health advocates who addressed the board Thursday sent the same message as Hernandez, expressing support for the ongoing efforts of the exchange to sign Californians up for coverage in the fourth annual open enrollment period, which started Nov. 1 and ends Jan. 31.

Covered California officials said that Trump’s plan to “repeal and replace” the Affordable Care Act has created confusion among enrollees but that people are still signing up.

In the first two weeks of open enrollment, 44,885 new people have enrolled in health insurance through Covered California, according to numbers provided by the board. That’s down from about 50,000 in the same period last year.

But Peter V. Lee, the exchange’s executive director, noted that Covered California did not run ads at the beginning of this enrollment period because it didn’t want to compete with the election campaign. He said the new numbers are in line with Covered California’s projection of approximately 400,000 new exchange enrollees next year.

This week, the Centers for Medicare and Medicaid Services announced that more than 1 million people had selected plans on Healthcare.gov, the federal exchange website, during the first 12 days of open enrollment. Of those, 250,000 were new to the exchange. The number of people who selected plans was up 53,000 from the same period last year, according to CMS.

Covered California is the largest state-run marketplace. It has 1.4 million members, nearly 90 percent of whom receive federal tax subsidies to help pay their premiums.

Consumer advocates who spoke at the board meeting expressed optimism that California would maintain its status as a leader in health care reform, though many are also changing the conversation to focus on what parts of the Affordable Care Act might be kept.

It is unclear how far Trump will go in dismantling the health law. He conceded last week that he would like to keep some aspects of it — in particular, allowing young adults to stay on their parents’ health plans and banning insurance companies from refusing to cover people with preexisting medical conditions.

Health experts who addressed the Covered California board made it clear that everything is up in the air: The only thing they’d be willing to bet on is that the Republican replacement for the health reform law won’t be called Obamacare

Ian Morrison, a health care consultant and futurist, told board members that the Republicans’ sweep of the White House and Congress will probably mean a less regulated insurance market, the end of mandates to buy insurance, smaller federal subsidies for the uninsured and greater state control over Medicaid — which also means less federal funding for the program.

Both Trump and House Speaker Paul Ryan (R-Wis.) have endorsed the idea of transforming Medicaid into a block grant program, in which states would get fixed allotments from the federal government and would be responsible for any health spending above those amounts.

“When you hear the term block grant, that is code for less money,” Morrison said. “No one talks about block grants and more money.”

The overarching question, Morrison said, is this: Will health coverage for 20 million people be significantly eroded?

He also said he found it hard to understand how guaranteed coverage for people with preexisting conditions could be kept if buying insurance was no longer a requirement for all. The authors of the health reform law believed that a lot of young, healthy people needed to be in the insurance pool in order to ensure that the sick ones didn’t drive up the cost of premiums.

John Bertko, Covered California’s chief actuary, said people should be looking to 2018, since any changes in 2017 are highly unlikely.

“I suspect with the big rate increases, 2017 is going to be a good year for plans that are in exchanges,” Bertko said. He said that was “a bit ironic” given the cloud now hanging over Obamacare.

California Faces Major Reversal If Trump, Congress Scrap Health Law

November 10, 2016 by · Leave a Comment 

California has a lot to lose if President-elect Donald Trump and the Republican-led Congress fulfill their campaign pledge to repeal Obamacare.

The Golden State fully embraced the Affordable Care Act by expanding Medicaid coverage for the poor and creating its own health insurance exchange for about 1.4 million enrollees. Supporters held California up as proof the health law could work as intended.

But now President Barack Obama’s signature law is in serious jeopardy and California officials are left wondering what Republicans in Washington may put in its place.

“There is no doubt that Obamacare is dead,” said Robert Laszewski, a health care consultant and expert on the California insurance market. “The only question is just exactly how Republicans will get rid of it.”

Health policy experts don’t expect Republicans to immediately kick millions of people off their insurance policies. Instead, they predict lawmakers may repeal parts of the law and allow for some transition period for consumers while a replacement plan is put together.

Still, the personal and financial impact for the state could be jarring. The number of uninsured Californians would more than double to 7.5 million people if the Affordable Care Act was repealed, according to a recent study by the Urban Institute.

Researchers also said California stands to lose an estimated $15 billion annually in federal funding for Medicaid expansion and insurance subsidies — more than any other state. That loss of federal money would make it difficult for California to pursue health reform on its own.

State Sen. Ed Hernandez, (D-West Covina), chairman of the Senate Health Committee, said it’s difficult to predict what the next iteration of the Affordable Care Act may look like.

“Will there be federal subsidies? Will the state legislature pay for subsidies to ensure Californians have coverage? Those are open questions,” Hernandez said. “I will do everything I can to make sure California continues to take the lead on this issue.”

Congress already has voted to eliminate funding for Medicaid expansion and premium tax credits to dismantle two key pillars of the health law. Obama vetoed that legislation earlier this year, but Trump made the repeal of Obamacare a centerpiece of his campaign.

If repeal goes through, state leaders and consumer advocates may look to the ballot box, asking voters to fund expanded health coverage through higher taxes or fees. In Tuesday’s election, Californians backed the extension of a hospital fee to help pay for Medi-Cal, the state’s Medicaid program.

State officials could aim even higher and try for a government-funded single-payer health system at the state level. But that’s expensive, disruptive to the current system and a tough sell to the public. Colorado voters soundly rejected a state single-payer initiative during Tuesday’s election.

Some Republican lawmakers in California would applaud a reversal on Medi-Cal expansion. They have argued that state and federal spending increases on the program are unsustainable.

The state’s Medi-Cal program now covers about a third of all Californians. The health law’s Medicaid expansion has added about 3.5 million Californians to the program since January 2014 and total enrollment stands at more than 13 million.

Molina Healthcare, a Long Beach-based insurer, is a major player in Medicaid managed care nationwide and also covers about 600,000 people through exchanges in California and eight other states. The company’s chief executive, Dr. J. Mario Molina, said he thinks Covered California and other exchanges will become a smaller part of health reform under a Republican plan and coverage expansion will shift more to Medicaid.

Molina said Republicans in Congress could grant governors more flexibility on Medicaid benefits to keep costs down while maintaining guaranteed access to coverage regardless of preexisting conditions, a popular provision of the health law.

“Republicans have the benefit of looking back at the experiment of Obamacare and seeing what worked and what didn’t work,” Molina said in an interview. “I think the Republicans will negotiate a deal where Medicaid gets expanded with more state control and exchanges will play a different role. The most cost effective way to do coverage expansion is through Medicaid.”

Consumer advocates acknowledged the financial challenges posed by repeal but also encouraged Californians to keep signing up for coverage in the meantime.

“Californians should continue to enroll in Covered California this open enrollment season, in Medi-Cal, and all the benefits they are still entitled to–and then fight like hell to keep them,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

But some Covered California policyholders expressed concern about what a Trump administration might mean for their coverage.

“I worry it will be gone, and I don’t know what I will do for insurance,” said Jane Henning Childress, 61, who lives in Calaveras County.

Taking into account her federal subsidy, she said she pays about $135 a month for her exchange plan. Earlier this year, she used it to help cover surgery for an ovarian cyst. “It sure helped me out,” she said.

Even before the election, some major health insurers were pulling out of the exchange market nationally and premiums shot up 22 percent, on average, for state and federal exchanges for 2017.

In the Covered California exchange, the average rate increase was 13.2 percent for next year. That’s higher than the 4 percent average rate increases that California negotiated its first two years. Open enrollment started Nov. 1.

Health insurers in California and nationwide face plenty of uncertainty as well from the election outcome. Some analysts said more insurers may exit state marketplaces rather than wait for them to unravel and risk getting stuck with too many expensive patients.

Four big insurers, led by Anthem Inc. and Blue Shield of California, account for about 90 percent of Covered California’s enrollment.

“The unthinkable has happened,” said Ana Gupte, a senior health care research analyst at Leerink Research. “With a Republican sweep of the White House, Senate and the House, we are looking ahead to a 2017 filled with much change and uncertainty in the health care markets.”

Story was originally posted on the CaliforniaHealthline website.

Next Page »

Copyright © 2017 Eastern Group Publications/EGPNews, Inc. ·