May 24, 2016, Albany Lobby Day for New York Health Act Photographs by barbara c. harrison

May 26, 2016

Annette Gaudino Campaign for NY Health Organizer

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Katie Robbins, Executive Director

Katie Robbins, Executive Director PNHP

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Martha Ferger, Ithaca, NY

Martha Ferger, Ithaca, NY

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Left to Right – Katie Robbins, Assemblyman Richard Gottfried, and Annette Gaudino

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Ithaca contingent meeting with Senator O'Mara's legislative aide.

Ithaca contingent meeting with Senator O’Mara’s legislative aide.

 

Advocates push for state-level single-payer health care system

May 26, 2016

Advocates for a state-level single-payer health care system are ratcheting up their pleas for legislative action to create “Medicare for all” before the session expires June 16.

But while the Assembly’s passage last year of a bill from Assemblyman Richard Gottfried, D-Manhattan, for the first time in more than 20 years marked progress, passage remains unlikely in the Republican-controlled state Senate, where it historically hasn’t come up for discussion.

“Every New Yorker would be entitled to full, complete health coverage — better health coverage than you or I or anybody in New York has today,” Gottfried, the Assembly Health Committee chairman, said at a rally Tuesday. “You would have that as a right just by being a New Yorker.”

In recent years as critics have shellacked the Affordable Care Act’s stumbles, advocates of a single-payer system also have picked up on the Obamacare fervor to point out that their preferred system would be better.

“When everybody’s not in, somebody’s out,” state Nurses Association 1st Vice President Marva Wade said. “There are millions of people who didn’t get healthcare at all. They still don’t have it now.”

Single-payer healthcare has been a difficult fish for lawmakers nationwide, let alone in New York over the past 20-plus years, to snag. Take Vermont as an example: While that state seemed destined to implement its own program, Gov. Peter Shumlin announced in 2014 it was DOA because of potential adverse economic impacts.

Tuesday’s call for a single-payer system wasn’t without its detractors.

“Single-payer advocates are correct in pointing to New York’s high Medicaid and workers compensation costs, but those problems should be addressed by improving each program specifically, not by throwing our hands up and shifting the costs over to a massive new bureaucracy,” said Ken Girardin, policy analyst for the fiscally conservative Empire Center.

The New York Health Plan Association chastised single-payer supporters for having a “utopian view of a universal health care system” in a memo in opposition to the legislation.

Single-payer health care is more popular than ever. Here are 10 questions for its future.

May 26, 2016

http://www.vox.com/2016/5/23/11703190/single-payer-questions?tr=y&auid=16730195

Updated by  on May 23, 2016, 8:20 a.m. ET

Bernie Sanders awakened a single-payer health care revolution.Justin Sullivan/Getty Images

Sen. Bernie Sanders has started a political revolution: not enough of one to win the Democratic presidential nomination, but enough to put the dream of single-payer health care back on the national political agenda in a way few would have expected five years ago.

Sanders’s campaign website states: “The only long-term solution to America’s health care crisis is a single-payer national health care program.” Many Americans — by no means all of them Sanders voters — seem to agree. Just this week, Gallup released a poll indicating that “58% of U.S. adults favor the idea of replacing [the Affordable Care Act] with a federally funded healthcare system that provides insurance for all Americans.” Politico Magazine reports that Sanders’s health plan “is the most popular of the three remaining candidates.”

Critics have noted many shortcomings and gaps in Sanders’s specific plan. Still, the public’s appetite for single-payer suggests that policymakers should take the idea seriously. Though Sanders has thought through some specifics of how to implement his plan, the newly awakened single-payer constituency will have to answer some hard questions about how America might implement a sound single-payer plan.

Here are 10:

 Harold Pollack

1) What taxes should be enacted or raised to pay for it?

Single-payer would greatly increase federal spending, putting hundreds of billions of additional dollars onto the federal budget every year. Proponents estimate that the required increment to federal revenues would be roughly equivalent to a doubling of the federal income tax. Much of this increase would be offset by other reductions in public and private expenditures.

Even if single-payer reduced overall medical expenditures, it would still require big federal tax increases. These would bring correspondingly big efficiency and distributional implications across the American economy. It’s probably unwise to finance single-payer through the income tax.  Some experts have proposed a value-added tax, which causes fewer economic distortions and losses per dollar raised. A carbon tax — which should be enacted anyway for environmental reasons — could be another valuable revenue source.

2) Would patients pay copayments or deductibles?

Sanders’s plan is labeled “Medicare for all.” Yet as Ezra Klein observed here at Vox, Sanders’s proposed coverage is much more generous and comprehensive than the current iteration of Medicare. It apparently includes no patient copayments or deductibles. This generous structure would protect millions of chronically ill Americans who now sometimes face punishing medical bills.

Yet recent analysis by an Urban Institute team indicates that such generous coverage would sharply increase costs. Some patient copayments and deductibles, guided by evidence-based approaches such as value-based insurance design, might improve the quality and cost-effectiveness of a single-payer plan.

3) Who decides what is covered, for whom, and at what price?

A sensible single-payer program should say no to questionable or overly costly interventions more often than our current system is able to do. Private insurers lack the public legitimacy to reject dicey therapies. Medicare is susceptible to pressure from industry, provider, and patient groups.

It’s especially hard for private insurers to refuse coverage for a particular drug, device, or surgical procedure once Medicare agrees to pay. (I haven’t even mentioned bitter social policy disputes over immigration, abortion coverage and birth control. I’ll get into these later.)

A single-payer system requires tougher mechanisms. The Affordable Care Act established the controversial Independent Payment Advisory Board (IPAB). Yet IPAB and most other cost-containment efforts encounter fierce bipartisan congressional resistance. The ACA unwisely limits the use of economic tools such as cost-utility analysis in coverage decisions. An effective single-payer system requires real economic analysis to determine who is covered for what service, and at what reimbursement rates.

4) Is the “public option” the right path to single-payer?

One might think that Congress could pass a short law that simply announced all Americans are now eligible for Medicare. For a million practical reasons, that can’t happen. There are too many delicate and interconnected moving parts to the American health care financing system. Patients, providers, and pretty much every other interested stakeholder would rebel against abrupt radical changes.

No one knows what a careful transition to single-payer would actually look like, and how this transition might be accomplished without causing undue damage to existing systems. A Medicare-based public option such as the one Hillary Clinton endorses offers one strategy to develop infrastructure that might someday evolve into single-payer. This is one reason the public option attracts both fervent support and bitter opposition.

5) What happens to Medicaid and other state programs?

Healthy low-income Medicaid recipients could be subsumed in a single-payer plan. Single-payer could integrate supports for nursing home care now financed through Medicaid. The intricate and costly patchwork of disability, school-based, and medical services would be much more difficult to incorporate or to replace, as would the complicated world of Medicaid-financed social services to vulnerable populations.

State Medicaid programs greatly vary in structure, generosity, and expense. Medicaid subsidizes many state and local social services, too. Plenty of questions remain about how 51 state Medicaid programs might be combined into one national framework, whether states could or should offer complementary programs on top of a single-payer effort, whether the federal government might provide some cost-sharing for such state efforts.

National policy might emulate generous Medicaid programs in Massachusetts and New York. Or it might resemble less generous Medicaid programs in Arkansas or Illinois.

6) What about the potential losers?

Single-payer is potentially cheaper than our current health care financing system because government could use its market power to impose lower prices. There are many advantages to such a system.

Yet if government squeezes too hard or too indiscriminately, it could cause serious harm. It might also provoke a punishing political backlash from virtually the entire supply side of the medical economy. Rural hospitals on thin margins would be one obvious vulnerable constituency. Veterans, current Medicare recipients, and unionized workers with generous tax-subsidized health plans are three others. Single-payer cannot pass until the interests of such constituencies are addressed.

7) How would our kludgy political process produce a decent system while deterring political meddling?

Fragmentation of American governance poses another serious obstacle. Efforts by solid ACA supporters to weaken the ACA’s medical device tax exemplify this challenge. Establishing coherent and disciplined national policies requires a major power shift from Congress to the executive branch health care bureaucracy.

Many Democrats and Republicans oppose a more centralized policy process that might work better for the nation as a whole but would also reduce their individual leverage to help constituents and political supporters. A robust single-payer system must retain proper congressional oversight while constraining toxic micromanagement and special interest pleading.

8) What about abortion, immigration, and other related policy disputes?

Single-payer further nationalizes fights that are now addressed through private coverage or through diverse policies across the different states. Obvious questions remain about low-income women’s access to abortions and reproductive health services in a single-payer system.

One must also address the myriad coverage challenges related to the presence of undocumented children and adults in millions of households. Democrats prefer not to ponder the prospect of a future President Ted Cruz issuing executive orders on sensitive social policy matters. At some point, conservative Republicans will be at the helm, exercising considerable power over national health policy.

9) Could the affluent buy additional or alternative coverage?

Many among the top 20 percent will perceive themselves to be losers within a single-payer plan. As with ACA, they would pay higher taxes to support universal benefits, even as a single-payer plan will likely offer less attractive coverage than they currently have, typically supported by generous tax subsidies.

Many democracies strike an implicit bargain by allowing wealthy people to skip waiting lines or purchase generous wrap-around coverage. Such policies provide a safety valve that reduces some political opposition. Allowing some complementary private coverage also reduces pressure for overgenerous basic coverage. Allowing too many private add-ons runs the risk of unraveling the universal nature of single-payer coverage. An American system would have to manage these trade-offs.

10) How do we get from here to there without replicating the defects of our current system?

Sanders and his supporters rightly note that a well-implemented single-payer system would likely be cheaper, more disciplined, and more humane than our current health system. Yet two huge questions must be answered before the potential of such a single-payer plan can be realized.

First, we need a realistic road map that does not merely describe a sound single-payer system but that also describes how we might get there from here. It’s telling that no detailed single-payer legislative proposal has been advanced that provides a realistic transition plan. Many of the presumed or hoped-for financial savings one might expect from a single-payer system won’t be achieved. The political and administrative obstacles are simply too high.

Second, we require a strategy to ensure that a politically achievable single-payer system won’t replicate prominent defects of our current system. Almost by definition, single-payer cannot cure the pathologies that underlay our current health care system, because single-payer would necessarily be enacted through the same legislative structures, implemented within the same path-dependent $3 trillion medical care political economy, that created and sustained our current pathologies.

These are huge challenges, but at least we have some time to think about them. Single-payer can’t be enacted until progressives win comprehensive presidential and congressional victories on a scale we haven’t seen since the New Deal. If and when that moment comes, progressives will be hard-pressed to provide more solid answers than anyone has provided thus far.

New York Obamacare insurers ask for big rate hikes

May 20, 2016

New York Obamacare insurers ask for big rate hikes

Health insurers are requesting double-digit bumps to premiums across the state, with UnitedHealth seeking a 45.6% hike

New York insurers selling policies on the state’s Obamacare exchange are asking regulators to approve large premium increases as a way to counteract rising costs, and in some cases, gargantuan losses.

Insurers selling plans to individuals on the New York State of Health marketplace requested an average increase of around 17% and those selling small-group plans asked for an average rate hike of about 12%.

New York State of Health has seemed to be more stable than other markets nationally, but insurers here haven’t been immune to national trends that are driving up health care spending and increasing the costs of providing health insurance.

In a statement Wednesday afternoon, the New York Health Plan Association said the hikes are necessary. “The 2017 rate submissions reflect increases that are the direct result of the underlying cost of care and marketplace changes that continue to impact health plans’ operations,” Paul Macielak, HPA’s president and chief executive, said in a statement.

Several notable insurers requested large increases for 2017. UnitedHealthcare, which has pulled out of insurance marketplaces in many other states, asked for a 45.6% increase to premiums. Though UnitedHealthcare is the largest U.S. insurer, it signed up just 2% of individuals who purchased insurance through New York State of Health last year.

Oscar, the venture-capital darling that recently raised $400 million in a financing round from Fidelity, asked for an 18.4% average increase. In a letter to insurance brokers, the Manhattan company said its rate hikes ranged from 8% to 30% around the state. Though the insurer is valued at $2.7 billion, based on the money it has raised, it lost $120 million last year.

Oscar sought to explain the planned rate hikes to insurance brokers in an email sent Wednesday morning.

“There are three main reasons for higher premiums: Medical costs have gone up, government programs that helped cover our costs are ending and our members needed more care than we expected,” the company wrote. “We don’t like raising premiums for our members, but the economics of this market demand as much.”

CareConnect, the insurance arm of Northwell Health, requested a 29.2% increase on average while MetroPlus, the health plan of NYC Health + Hospitals, sought a 20.3% average increase.

Though the rate requests serve as an early indicator of what consumers might expect to pay in 2017, regulators are unlikely to approve them as requested. Last year, the state Department of Financial Services, which must approve all rate change requests, allowed an average 7.1% increase after insurers asked for rates to rise an average of 10.4%.

DFS’ decision on the current rate hikes will be closely watched. The agency was blamed, in part, by the insurance industry for the collapse of Health Republic Insurance of New York, which was shut down by regulators last year. It is also the first rate hike that will be decided under Maria Vullo, who was appointed acting DFS superintendent in January.

In general, consumers have a propensity to seek out lower-cost plans, so during the New York State of Health open-enrollment period, they will have the option to pick a different health plan if their current insurer raised prices too high.

Individual market

Company name 2017 requested rate change
Crystal Run Health Plan, LLC* 89.10%
UnitedHealthcare of New York, Inc.* 45.60%
North Shore-LIJ CareConnect Insurance Company, Inc.* 29.20%
Empire HealthChoice HMO, Inc.* 24.00%
Affinity Health Plan, Inc.* 20.70%
MetroPlus Health Plan, Inc.* 20.30%
Aetna Life Insurance Company 19.40%
Independent Health Benefits Corporation* 19.20%
Oscar Insurance Corporation* 18.40%
Excellus Health Plan, Inc.* 15.90%
Health Insurance Plan of Greater New York* 14.00%
Capital District Physicians’ Health Plan* 11.20%
New York State Catholic Health Plan, Inc. dba Fidelis Care New York* 8.10%
Healthfirst PHSP, Inc.* 6.60%
HealthNow New York Inc.* 6.10%
MVP Health Plan, Inc.* 6.10%
Weighted average on the individual market 17.30%

Source: New York State Department of Financial Services

Small group market

Company name 2017 requested rate change
Crystal Run Health Plan, LLC 66.60%
Crystal Run Health Insurance Company, Inc. 61.90%
North Shore-LIJ CareConnect Insurance Company, Inc.* 16.80%
MetroPlus Health Plan, Inc.* 13.10%
Oxford Health Insurance, Inc.* 12.90%
UnitedHealthcare Insurance Company of New York 12.80%
Empire HealthChoice HMO, Inc. 12.60%
Excellus Health Plan, Inc.* 12.30%
Aetna Life Insurance Company 12.00%
CDPHP, Universal Benefits Inc.* 11.60%
Independent Health Benefits Corporation* 11.20%
Health Insurance Plan of Greater New York* 10.60%
Empire Healthchoice Assur Inc 10.00%
Capital District Physicians’ Health Plan, Inc. 9.60%
MVP Health Services Corp. 6.80%
HealthNow New York Inc.* 5.80%
MVP Health Plan, Inc.* 5.40%
Healthfirst Health Plan (Managed Health) 5.00%
Weighted average on the small group market 12.00%

Source: New York State Department of Financial Services

*Indicates that the company makes products available on the “New York State of Health” marketplace.

Majority in U.S. Support Idea of Fed-Funded Healthcare System

May 16, 2016

Majority in U.S. Support Idea of Fed-Funded Healthcare System
POLITICS

STORY HIGHLIGHTS

  • 58% favor replacing the ACA with federally funded healthcare system
  • About half would also be OK with keeping the ACA as is
  • Separate question shows that just over half would favor repealing the ACA

PRINCETON, N.J. — Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans. At the same time, Americans are split on the idea of maintaining the ACA as it is, with 48% in favor and 49% opposed. The slight majority, 51%, favor repealing the act.

Favor or Oppose Three Proposals Relating to the Affordable Care Act
Please tell me whether you strongly favor, favor, oppose or strongly oppose each of the following.
Favor% Oppose% No opinion%
Replacing the ACA with a federally funded healthcare program providing insurance for all Americans 58 37 5
Repealing the Affordable Care Act 51 45 3
Keeping the Affordable Care Act in place 48 49 2
GALLUP, MAY 6-8, 2016

Gallup included these three questions in its interviewing on May 6-8 to provide insight into how Americans might react to the three remaining presidential candidates’ proposals for dealing with the ACA. Bernie Sanders calls for replacing the ACA with a single-payer, federally administered system that he calls “Medicare for All.” Donald Trump has said he would repeal the ACA, and Hillary Clinton generally says she would keep the ACA in place. Americans were asked in the survey to react to each of these proposals separately, and there was no mention of the candidates in the question wording.

The results show that many Americans are OK with several ways of handling the ACA rather than favoring only one possibility. In particular, 35% of all Americans say they would favor keeping the ACA in place and separately say they favor the idea of replacing it with a federally funded universal health insurance system. Among Democrats and Democratic leaners, 59% favor both of these approaches. In short, many Americans would apparently go along with Clinton’s idea of keeping the ACA in place as it is now, or with Sanders’ bolder proposal to replace it with a Medicare-for-All system.

Gallup also asked those who favor either keeping the ACA in place or replacing it with a federally funded system to choose between these two options. The federally funded system wins among this group by a 2-to-1 ratio, 64% to 32%, meaning this system garners the most support among the initial favor/oppose questions and wins when those who like both approaches are forced to choose.

Additionally, 27% of Americans say they favor repealing the ACA and say they favor replacing it with a federally funded system. This means the group of Americans in this survey who favor the law’s repeal, a core policy proposal of many Republican presidential candidates during this campaign season, includes some who apparently want the ACA repealed to replace it with an even more liberal system. Only 22% of Americans say they want the ACA repealed and do not favor replacing it with a federally funded system.

Democrats Favor Keeping the ACA and Replacing It With Single-Payer System

The breakdown of reactions to these proposals by partisanship shows the expected patterns: Democrats and Democratic-leaning independents are highly likely to favor the two options put forth by the Democratic candidates, while Republicans and Republican leaners are highly likely to favor Trump’s position, repeal of the ACA.

Proposals to Deal With Affordable Care Act, by Partisanship
Democrats/Leaners% Republicans/Leaners%
Replacing the ACA with a federally funded healthcare program
providing insurance for all Americans
Favor 73 41
Oppose 22 55
Repealing the Affordable Care Act
Favor 25 80
Oppose 72 17
Keeping the Affordable Care Act in place
Favor 79 16
Oppose 19 82
GALLUP, MAY 6-8, 2016

One notable exception to the strong partisan skew in reactions to these proposals comes from Republicans when they are asked about replacing the ACA with a federally funded system. Forty-one percent of Republicans favor the proposal — much higher than the 16% who favor keeping the ACA in place. This may reflect either that Republicans genuinely think a single-payer system would be good for the country, or that they view any proposal to replace the ACA (“Obamacare”) as better than keeping it in place.

Approval of the ACA and What Should Be Done About It

Responses to other questions included in the May 6-8 survey show that Americans remain split in their overall views of the ACA, with about as many approving as disapproving of the law. Almost nine in 10 of those who approve of the ACA in general subsequently say they would favor keeping it in place, which is logical. But 72% of those who approve of the ACA also would favor replacing it with a single-payer federally funded health system. This reinforces the idea that ACA supporters can agree simultaneously with several different ways of dealing with this law.

Bottom Line

Americans express considerable support for the idea of replacing the ACA with a federally run national healthcare system, which is similar to the proposal championed by presidential candidate Sanders. To be sure, many Americans, primarily Democrats, also favor the idea of just keeping the ACA in place. But given a choice, those who favor both proposals come down on the side of the Sanders-type proposal. Four in 10 Republicans also favor the idea of a federally funded system.

Additionally, Americans have been more positive than negative in two previous Gallup measures of the idea of a single-payer federally funded system, although when given a chance to say so, a sizable percentage of Americans say they don’t know enough about it to have an opinion.

The current survey used shorthand descriptions to describe the alternatives for dealing with the ACA, and it’s possible that not everyone understands the implications of each approach. Instituting a universal healthcare system, in particular, would be one of the most significant overhauls of a major part of American life in modern U.S. history, and would create huge consequences and challenges. Additionally, other research shows that when given a choice, Americans are philosophically more inclined to favor a private healthcare system than one run by the government. Americans are generally satisfied with their personal healthcare, something that also could slow down the process of adopting a major overhaul of the healthcare system. Still, the general idea of a single payer system seems to play well with the majority of Americans, something both the presumed Democratic nominee Clinton and the Republican nominee Trump will need to keep in mind as they debate healthcare in the months to come.

Historical data are available in Gallup Analytics.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted May 6-8, 2016, on the Gallup U.S. Daily survey, with a random sample of 1,549 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±3 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 60% cellphone respondents and 40% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

View survey methodology, complete question responses and trends.

Learn more about how the Gallup U.S. Daily works.

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