Sebelius Lies Before Congress About LTC

By Ross Schriftman, RHU, LUTCF, ACBC, MSAA

Rfs270@aol.com

Secretary of Health and Human Services Kathleen Sebelius testified under oath before the U.S. Senate Finance Committee on February 15th and lied when she defended the need for a government run long term care program called the Class Act and attacked private long term care insurance by saying this:

“One of the challenges right now is that in the private sector right now there isn’t such a product.  There are residential services available as an addendum to a long term care policy.  But the ability to buy really just home health services that would allow people to stay and age in place are really not available in the private sector market right now.”

Notice that she uses the word really twice which indicates to me she is trying to get the Senators to believe what she wants them to believe is real.  What is real is that I cared for my own Mom in her own home to the day she died and her long term care policy helped pay for her care.

See video of her presentation here (Find the statement between 7:33 and 7:56 minutes)

This is an appalling, harmful and untruthful statement.  It isn’t that Sebelius misunderstands how private long term care insurance works.  After all she was Insurance Commissioner of Kansas and President of the National Association of Insurance Commissioner (NAIC).  During her years heading NAIC she oversaw model regulations that dealt with long term care insurance.  She is purposely promoting the Class Act provision contained in ObamaCare by making stuff up and doing so under oath.  Since the beginning, promoters of the Class Act have tried to diminish and attack the value of private long term care insurance in order to say that their government designed and administered solution was needed.  Sebelius statement is just another in a series of incorrect statements.  In her position as our top official on healthcare she knows better.

Her false statement is harmful to the American people.  If someone is considering purchasing this valuable kind of insurance to protect themselves and their family and take her words as truth, they may forgo getting covered thinking home care benefits are not available.  The truth is that almost all long term care insurance being sold today contains home care benefits including home modification, care giver training, care management services and in home professional care through licensed home health agencies.  The policies have fully incorporated home and community care benefits; not some kind of addendum as her dismissive statement indicates. According to the American Association of Long Term Care 49% of all new long term care insurance claims are for home care services and 21% are for Assisted Living benefits in the community.  Only 30% are for Nursing Home care.  In my State of Pennsylvania the law REQUIRES that only comprehensive policies be sold and therefore that those policies include home care benefits.

Secretary Sebelius must apologize and provide an immediate and public retraction of her statement.  Anything less should be investigated by Congress.

The Need For Better Tools.

By Marcy Zwelling, MD

Health information technology is here to stay.  But, is it really a good thing for the medical industry? Does it really improve patient care? The government would have us believe so.

The government has put its foot forward with a huge investment in the electronic health record.  The stimulus package included billions of dollars to induce doctors to purchase an EMR by offering $40-50,000 if the doctor participates in a program that they call meaningful use.  Meaningful use requires that a doctor send data to the doctor and that he participate in E-prescribing.

The electronic health record would be a HUGE opportunity if it collected good clinical data but to date, it still remains mostly a billing opportunity.  The data extracted is financial data and actually gives us bad information. The government will be collecting that information but depending on what they do with it, it could be a step backward rather than forward.  Bad data is worse than no data.

The electronic health record would be a HUGE opportunity if it created a sequential look at our patients’ health relative to the rest of their life.  But, it remains event based and fails to deliver the right clinical data. If we could track our patient’s health using input from their daily activities, we could learn a lot about why things happen.  Health is not an event; it is about a life.  We need to build a better EMR in order to capture useful clinical data.

Finally, the electronic health record along with E-prescribing could be a wonderful opportunity to save time, improve accuracy, and save paper (and money).  But, insurers and pharmacy benefit managers have already undermined vendors by obstructing our ability to put in our drug of choice.  Some programs do not allow doctors to prescribe what the patient needs.  The keyboard actually will not enter the drug into the appropriate space.  The electronic health record and E-prescribing has (in these instances) become obstructive.

It is time the HIT industry hear doctors “better.” They need to address our patients’ needs.  A tool is only good if it helps us perform better. When it is obstructive, decreases productivity, doesn’t answer the questions we are asking, and when it gets in the way of good patient care, we need to go back to the drawing board and get it right.

Medicaid Mess

By Greg Scandlen

The states are trying to figure out what to do with the Medicaid responsibilities of ObamaCare, especially since Judge Vinson in the Florida decision squelched any hope they might have had that it would be tossed out in court.

The issue goes well beyond the expansion to 133% of poverty for all adults. Most of that (90%) will be paid for by the Feds, although that still leaves a lot of benefits and administrative expenses for the states to pick up. The bigger issue is with the people who are currently eligible but not enrolled. Some 11 million of the uninsured are currently eligible for Medicaid or SCHIP. The new law divides the state/federal match for these people at the same place it has been for some time.

 

States Slashing Medicaid

Also of concern is the “maintenance of effort” requirement in the new law. Arizona, for one, expanded Medicaid eligibility to single adults some years ago, to the point of being one of the most generous states in the country. Now, with state finances in the toilet, they would like to cut back on the eligibility levels, but will probably not be allowed to.  Kaiser Health News reports that Arizona’s “Medicaid spending has gone from 17 percent of its general fund in 2007 to nearly 30 percent this year.”

It isn’t just Arizona. The New York Times reports that California’s Jerry Brown wants to cut Medicaid by $1.7 billion, and New York’s Andrew Cuomo wants at least $2 billion in cuts. The Times notes that part of the stimulus package in 2009 included $90 billion to offset rising Medicaid costs, and Congress appropriated another $15 billion last August, but even with that help, “deficits were so deep that 39 states cut Medicaid payments to providers in 2010, and 20 states pared benefits.” Now that money is running out –

On July 1, the enhanced federal aid will disappear, causing an overnight increase of between one-fourth and one-third in each state’s share of Medicaid’s costs. But because of the federal eligibility restrictions, the options for states are largely limited to cutting benefits that are not federally required; reducing payments to doctors, hospitals and nursing homes; and raising taxes on those providers.

 

States Think About Withdrawing from Medicaid

The Wall Street Journal reports that, “At least a half-dozen states have publicly discussed withdrawing from the Medicaid program altogether because of its expense.” For example –

Texas estimates that it will cost an additional $9.1 billion to retain its current Medicaid service levels through 2013. If it tried to plug that gap by cutting health-care provider rates, it would have to reduce them by 48%— and that might drive care providers to stop accepting Medicaid patients, according to the governors’ letter. Texas Gov. Rick Perry, a Republican, has threatened to pull out of Medicaid.

 

Medicaid Panel Crashes

Meanwhile, a new federal commission tasked with recommending better information systems for state Medicaid programs has hit a brick wall, according to an article by Brett Coughlin in Politico.

The story says,

… the Medicaid and Chip Payment and Access Commission (MACPAC) hit the reset button Friday when faced with the complexity and cost of the effort.”

One panel member called for a “do over” and others suggested the panel was poised to hit Congress “in the face” with a big new request for funds. A new survey to Medicaid and Children’s Health Insurance Program beneficiaries, for instance, is estimated to cost $45 million.

So, maybe not so much.

HSAs For Illinois State Employees

By Greg Scandlen

Our friend, Jim Porterfield, has written an impressive study for the Illinois Policy Institute called “Health Savings Accounts: A Win-Win for Illinois Public Employees and Taxpayers.”

In it he describes how the state and its workers could save literally billions of dollars by switching to HSAs for state employees. He writes:

When compared to the state’s HMO and Quality Care Health Plan premium costs for fiscal year 2011, properly-structured health savings account reforms could allow the state budget to show a savings every year through 2023. Under the three scenarios examined in this study, Illinois taxpayers could save as much as $18 billion to $27 billion between 2011 and 2023. Moreover, state employees and non-Medicare retirees can also save on FICA and federal income taxes while building savings for day-to-day and unexpected current and future health care expenses.

The study drills down deeply into the numbers to arrive at the calculations. Very likely you could replicate his work for your own state or entice Jim to do it for you.

 

HIT Privacy in Massachusetts

By Greg Scandlen

A friend forwarded this announcement from Aetna in Massachusetts:

Massachusetts recently passed laws requiring that insurance carriers, HMOs, third-party administrators and self-funded plans report certain data on Massachusetts residents covered under Massachusetts contracts to a new All-Payer Claims Database (APCD). The APCD was created and is maintained by the Massachusetts Division of Health Care Finance and Policy (the Division).

All carriers must start submitting member/claims data to the APCD for calendar years 2008 through 2010 by January 31, 2011. Carriers then need to submit data each month, starting in February 2011. We are working with the Division to report this information for you. You do not need to take action for this reporting.

Content of data and its intended use

The data to be reported to the APCD includes, but is not limited to: subscriber and member identifiers; member demographics; race, ethnicity and language information; plan type; benefits codes; enrollment start and end dates; behavioral and mental health, substance abuse and chemical dependency, and prescription drug benefits indicators; and claims-line detail for all health care services provided to Massachusetts residents covered under Massachusetts contracts.

Massachusetts intends the APCD to serve as a reliable clearinghouse for health care cost and quality information for consumers, employers and governments, so they can make health care purchasing decisions. The APCD also will serve as the central repository for all health care claims data for Massachusetts state agencies. The Division will provide the required APCD data extracts to other Massachusetts government agencies. Massachusetts recently passed laws requiring that insurance carriers, HMOs, third-party administrators and self-funded plans report certain data on Massachusetts residents covered under Massachusetts contracts to a new All-Payer Claims Database (APCD). The APCD was created and is maintained by the Massachusetts Division of Health Care Finance and Policy (the Division).

All carriers must start submitting member/claims data to the APCD for calendar years 2008 through 2010 by January 31, 2011. Carriers then need to submit data each month, starting in February 2011. We are working with the Division to report this information for you. You do not need to take action for this reporting.

Content of data and its intended use

The data to be reported to the APCD includes, but is not limited to: subscriber and member identifiers; member demographics; race, ethnicity and language information; plan type; benefits codes; enrollment start and end dates; behavioral and mental health, substance abuse and chemical dependency, and prescription drug benefits indicators; and claims-line detail for all health care services provided to Massachusetts residents covered under Massachusetts contracts.

Massachusetts intends the APCD to serve as a reliable clearinghouse for health care cost and quality information for consumers, employers and governments, so they can make health care purchasing decisions. The APCD also will serve as the central repository for all health care claims data for Massachusetts state agencies. The Division will provide the required APCD data extracts to other Massachusetts government agencies.

So all of the assurance about privacy are out the window. Your most personal detailed information will be collected along with your personal identifiers

High Risk Pools

By Greg Scandlen

As you know, the risk pool mandate of ObamaCare has been a mess. Rather than the expected enrollment of 375,000 by the end of the year, they actually enrolled only 8,000, but even then were spending more than they had budgeted. Well, this got a whole lot of negative attention, so apparently someone from the White House gave certain reporters a good talking to.

At least that is the impression one gets from reading Sarah Kliff’s more recent article in Politico. Here she spins the available information beyond recognition.  She writes: “Within the past 75 days, enrollment in the federally-run high risk pools has just about doubled.” Wow! Nearly doubled? Well, no. Enrollment went from 8,000 to 10,000, an increase of 25%. I guess that is the kind of math they are teaching in J-School these days.

But, that’s okay. She is even more gung ho on the tremendous out-reach programs the states have launched. North Carolina, for instance, “aired a six-week television ad campaign in late November and put up 14 billboards across the state.” Wow, again! That must have really made enrollment shoot up, right? Well, no. But it did result on increased traffic to the web site, with “overall web traffic seeing a 44 percent increase.” The article doesn’t include information on new enrollment.

But North Carolina did lower its premiums along with the federal pools that lowered premiums by 20%. Double Wow! That must mean the risk pool costs have been controlled, eh? Well, no. Premiums were lowered because not enough people were enrolling. The program was supposed to charge enrollees 100% of standard rates in the private market, but this is government. Premiums can be whatever they want them to be. Who cares when taxpayers (and the Chinese) are paying the difference?

 

State Round-Up

By Greg Scandlen

Next up in the struggle over ObamaCare are the states, which are expected to implement all of the garbage that came out of Congress. Unlike Members of Congress, the state governments are actually expected to know what they are doing. They don’t get to borrow trillions from the Chinese to hide their mistakes. And they are – what’s the word? Appalled? Dumfounded? Flummoxed? Aghast? – insert your own expression.

In any case, an article by David Lightman in the Miami Herald highlights many of the issues the states are dealing with, beginning with the insurance exchanges. Here California has already moved ahead with efforts to create an exchange, even though no one knows what the federal requirements will be or if the law will survive to 2014. But that’s okay, since California has lots of extra money to spend on frivolous things, right? In South Carolina, on the other hand, new governor Nikki Haley has no intention of spending money to implement an unconstitutional law, and the Attorney General of Wisconsin says after the Florida decision, the law is dead unless it is revived by an appellate court.

And then there is Medicaid expansion. Mitch Daniels in Indiana estimates it will cost his state up to $3 billion over the next ten years. We’ll be looking more closely at the Medicaid problem in a separate post.

The Republican Governors’ Association plans to “play a central role in organizing GOP governors against the law,” according to an article by Shane D’Aprile in The Hill.

The article also says,

Regardless of how the RGA’s effort shapes up, one potential GOP presidential hopeful is certain to play a leading role. Mississippi Gov. Haley Barbour, the outgoing chairman who helped raise record amounts of money for the committee this past cycle, is now the RGA’s policy chairman — a newly created position.

In that capacity, Barbour will be a high-profile liaison of sorts between GOP governors and the party’s leadership in Washington.

Haley Barbour is probably the savviest political strategist in the Republican Party today. It is doubtful he will go very far in the presidential race, but when it comes to finding the pressure points on a policy issue there is no one better.

The New York Times also discusses how the states will deal with the court ruling.  It writes,

“in a few states that are party to the litigation, Republican governors and attorneys general declared the expansive health care law effectively null as a result of the judge’s ruling. They suggested they would suspend planning and implementation until appeals courts could rule, although they did not provide details about what precisely might change or whether they would refund federal planning grants already awarded.

It quotes officials from Florida, Wisconsin and Idaho, but also says some Republican governors, especially Nathan Deal in Georgia, are more cautious. And, of course, Democrats like Vermont’s Peter Shumlin are “moving full speed ahead,” which is odd, since Vermont is also moving to set up a single payer system in that state.