February 25, 2017
Crain’s Health Pulse
Friday, February 24, 2017
The future of the Affordable Care Act has provoked heated discussions at town hall meetings across the U.S., particularly those convened by Republican members of Congress.
Here in New York, at an overflowing and overwhelmingly friendly town hall Wednesday night hosted by Rep. Yvette Clarke in progressive Brooklyn, the Democratic congresswoman predictably defended the ACA.
But audience members, who numbered in the hundreds, showed their most enthusiastic support for an alternative that gets far less attention in the political sphere: universal, or single-payer, health care that provides access to everyone.
Democrat-backed bills have long been kicking around the New York Legislature and the U.S. Congress that propose variations on that idea.
Sen. Bernie Sanders, Democrat of Vermont, championed a “Medicare for All” concept during his presidential campaign. But such proposals haven’t come close to achieving bipartisan support.
The New York Health Act—sponsored by Assemblyman Dick Gottfried and Sen. Bill Perkins, both Manhattan Democrats—passed the majority-Democratic state Assembly in the last two sessions, but it has been stalled in the Republican-controlled Senate.
Of the dozens of audience members who posed questions to Clarke and her invited speakers, just one directly addressed the future of the ACA.
“We could increase subsidies and we could expand Medicaid further, but those are just Band-Aids, not proper solutions,” the young man asking the question began. “At what point will congressional Democrats come out in full force in full support of universal, single-payer health care?”
After sustained applause and cheers from the crowd, Clarke replied, “You’re talking my kind of language. I’ve been for single-payer health care ever since I’ve been in Congress.”
Clarke suggested that the reason there’s pushback against the ACA is that it’s “taking us down that road.”
While President Barack Obama paid lip service to a single-payer system during his 2008 campaign, the Affordable Care Act has maintained a diverse insurance market.
The law did greatly expand the number of people enrolled in government-funded and subsidized insurance plans, though, particularly in New York. As of Jan. 31, more than 2.4 million people signed up for Medicaid through the state’s Obamacare marketplace. The state also has enrolled more than 665,000 people in its Essential Plan, a federally subsidized option created under the ACA for New Yorkers earning less than twice the federal poverty level who don’t qualify for Medicaid.
Clarke is one of 63 members of Congress, all Democrats, who have signed onto the Expanded and Improved Medicare for All Act, calling for single-payer health care. But she said her focus remains on organizing constituents to resist the proposed repeal of the ACA.
Some New Yorkers might have a “certain level of comfort that we have a Democratic state that does to a certain degree do everything it can to preserve the right to health care,” Clarke told Crain’s after the event.
Grassroots efforts to pressure Congress to preserve coverage and federal funding are essential, she said.
“We’re continuing to promote the need for the ACA and to encourage New Yorkers to make their preference known for the ACA, because it would be catastrophic to our health care infrastructure if this is repealed without any replacement,” she said. “And who knows what type of replacement they would offer in any event.”—C.L
February 24, 2017
BUFFALO, NY – On Tuesday, February 21 2017, the Buffalo Common Council unanimously passed a resolution in support of the New York Health Act (A.4738 / S.4371) — legislation that will guarantee health care to all New Yorkers by creating a universal, publicly-financed healthcare system. The resolution was introduced by David Rivera and Rasheed Wyatt in a February 14 meeting of the Community Development Committee where Council members heard testimony from health care advocates with the Campaign for New York Health, a broad coalition of labor, nurses, physician groups, community healthcare clinics, organized labor and grassroots community activists.
The New York Health Act passed by a large majority in the Assembly in 2015 and 2016. It has been reintroduced in the Assembly and Senate for the 2017 legislative session by Assembly member Dick Gottfried and Senator Bill Perkins, respectively. The resolution reflects the growing public support for this solution, especially as Congressional proposals threaten current health coverage for millions of New Yorkers.
Niagara District Council Member David A. Rivera stated, “I want to thank the members of the community, from labor, nurses, and community organizations who brought this to the Common Council’s attention. It is important we continue on in establishing health care as a right in this country. Our basic human needs should not be left up to the market to decide the price and accessibility of goods and services. Health, housing, food, and other needs need to be equal and equitable for all. If one level of government cannot provide for our needs, other levels of government will need to step up to deliver. That’s why I am supporting the NY Health Act and look to our state representatives to make this a priority for 2017 Legislative Session.”
“While Congressional Republicans consider repealing the Affordable Care Act, the New York State legislature could take action to guarantee health care to all of us New Yorkers,” said Jim Anderson, State Vice President of Citizen Action of NY and Buffalo resident. “The destructive policies being pushed in D.C. would negatively impact health coverage for over 2.7 million New Yorkers, driving the number of uninsured individuals to over 4 million statewide. In Erie County alone, the Governor’s office estimates that over 93,000 people would lose health care coverage. This is inhumane and unacceptable. A universal, public healthcare program is the only solution to the current healthcare crisis. We need to guarantee healthcare for all. Our city and county elected officials need to actively support passage of New York Health Act.”
“As a healthcare consumer, I have been uninsured, and my family underinsured,” said Sara Palmer, a Buffalo resident and member of the Campaign for New York Health who testified at the Buffalo Council meeting.. “At times we’ve gone years without dental or proper vision coverage, high co-pays and deductibles, diagnostic tests deemed elective and denied by insurance companies, inability to afford necessary medications, or even a primary care physician, has caused medical debt that follows us still today. I support the New York Health Act because healthcare is a human right as defined in our U.S. Constitution, “to promote the General Welfare” of our people.”
“In every set of contract negotiations we participate in, health insurance is one of the most difficult issues we confront,” said Debora Hayes, Area Director Communications Workers of America. “Employers are constantly proposing to shift more health care costs to workers in the form of increased cost sharing of premiums increased deductibles, co-insurances and co-pays. With annual premium costs rising about 14% per year, it is almost impossible to negotiate wage increases that keep up with increasing out of pocket health care expenses. New York Health would treat health care as a human right and solve many of the problems faced by the uninsured and underinsured.”
“There’s only one way to cover everyone and save money, and that’s with the New York Health Act,” states Ursula Rozum, Upstate Coordinator with the Campaign for New York Health. The New York Health Act will provide universal, comprehensive health care coverage and billions of dollars in savings for New York families, businesses, and local governments. All New Yorkers would be covered for all medically necessary services, including: primary, preventive, specialists, hospital, mental health, reproductive health care, dental, vision, prescription drug, and medical supply costs. The care provided under New York Health would be more comprehensive than plans offered by health insurance companies today. There would be no out-of-pocket costs as barriers to health care.
A detailed study of the New York Health Act, conducted by Professor Gerald Friedman of the University of Massachusetts in Amherst, showed tens of billions in savings by streamlining the administration of our healthcare system to a single-payer funding stream. Most of the savings is found in eliminating insurance company administrative cost and profits, and slashing the enormous administrative costs health care providers spend to deal with insurance companies. Another significant area of savings is due to negotiating better prices for drugs with the pharmaceutical companies; and for medical devices with their manufacturers.
The New York Health Act will establish a trust fund that pools federal funding from Medicare, Medicaid, children’s health plans and other federal entitlements. A progressive payroll tax on income and a capital gains tax on unearned income will also be paid into the fund. These sources of funding will replace health care premiums, deductibles, and copays. This is vitally important: the health act creates new taxes, but those taxes replace all other health care spending. 98% of all households will be spending less on health care under the New York Health Act.
While it is funded through taxes based on ability to pay, it relieves tax burdens in other areas. For example, New York is one of the only states that requires counties to contribute to Medicaid. The New York Health Act will shift those costs from the county back to the appropriate level of government – the state. This will reduce counties’ costs significantly. In 2012, Erie County paid $242 million into Medicaid, which is equal to 82% of what the county collected in property taxes. Eliminating the local share of Medicaid will give Erie County the ability to lower property taxes, create an emergency surplus for economic downturns, rebuild infrastructure like failing roads and bridges, and fund other important programs.
February 18, 2017
David Blumenthal, M.D.PresidentThe Commonwealth Fund email@example.com 212.606.3825
- Time is a new president’s enemy when it comes to health care legislation
- Republicans will need to act fast to enact what history will call Republican health reform
In the fall of 1964, Wilbur Cohen, then assistant secretary of legislation at the U.S. Department of Health, Education and Welfare (now the U.S. Department of Health and Human Services), was summoned to the White House along with his peers from throughout the fledgling Johnson Administration. Lyndon Baines Johnson had just been elected president in his own right after succeeding the slain John F. Kennedy as president in November 1963. Johnson had won 61.1 percent of the popular vote and 486 electoral votes, and his party had large majorities in both houses of Congress.
According to Cohen’s oral history, Johnson told his staff: “‘Now look, I’ve just been elected by the overwhelming majority. And I want to tell you that every day while I’m in office, I’m going to lose votes. I’m going to alienate somebody.’ And then he took about 20 minutes and traced the history of other presidents . . . and he says, ‘The President begins to lose power fast once he has been reelected . . . We’ve got to get this legislation [his Great Society Program, including Medicare] fast. You’ve got to get it during my honeymoon.'”
Johnson knew whereof he spoke. In addition to being Kennedy’s vice president, he had served in the House of Representatives, and then the Senate, where he was perhaps the most powerful and effective majority leader that body has ever seen. He understood Washington better than any president before or since.
In health care, history has driven Johnson’s point home. Time is a new president’s enemy when it comes to bold health care legislation. When Bill Clinton delayed in proposing his sweeping health reform package in 1992, his initiative collapsed in a legislative tangle. Learning from this, Barack Obama made the Affordable Care Act (ACA) his first priority and pushed hard for its quick approval. He succeeded, but just barely.
Johnson’s remarks carry huge potential significance for President Trump and his congressional allies if they are serious about replacing the ACA, not just repealing it. Unless Washington’s rules have changed completely, Republicans need to act fast to succeed. They can repeal the law quickly, but creating its replacement, as they are discovering, is every bit as complicated and fraught as the ACA’s enactment. In fact, repeal and replace cannot be separated because the details of the repeal affect the shape and viability of replacement.
The entire endeavor is probably mislabeled. The Republicans call their effort “repeal and replace,” but history will call it “Republican health reform.”
Although Republicans have tried repeatedly to repeal the ACA, and were clear during the election about their intent to dramatically change it, they did not do the technical or political work necessary to break swiftly from the starting blocks in January. The more legislators seem to learn, the more they seem inclined to slow down. One potential strategy is to repeal the ACA and then “repair” it with incremental steps. But step-by-step legislating takes time, and time is the enemy. As Johnson would counsel, each incremental piece of legislation will cost some measure of support for the president and his party. This is a particular problem in the Senate, where Republicans need eight Democratic votes to overcome a possible filibuster of key replacement provisions. And those votes must be gathered repeatedly, for each new proposal.
What is more, as time passes, other legislative priorities will come barreling through to sideline the health care process: tax reform (with its huge health care implications), infrastructure, modifying NAFTA, regulatory relief, foreign crises and responses, and potentially, new staff embarrassments and scandals. All of these will be complicated and costly for the new president and the majority congressional party. Every day the president and his party will lose votes. Every day he and his congressional advocates will alienate somebody.
Of course, we may be in different times. We may have a new administration that will change all the rules that have governed the rhythms of Congress and the presidency in modern times. We may. But we may not.
February 15, 2017
Good morning! You are reading a complimentary synopsis of the POLITICO New York Pro Health Care newsletter. Pro subscribers receive a premium version of this newsletter, which includes an enhanced look-ahead and robust analysis of the health care news driving the day, weekdays at 5:45 a.m. Contact us here to learn more.
LOOKING FOR SUGGESTIONS — I will be moderating a panel for the Association of Health Care Journalists this evening. The topic is drug pricing and the panelists are Sarah Emond of ICER and Dr. Peter Bach of Memorial Sloan Kettering. What questions would you like these experts to answer? Email me at firstname.lastname@example.org.
SHARE ME: Like this newsletter? Please tell a friend to sign up. Give them this link.
BILL TRACKER — The Assembly Health Committee on Tuesday once again passed Assemblyman Richard Gottfried’s single-payer health care bill. The legislation seeks to reduce health care costs and would be funded through a progressive income tax and payroll assessments. For the last two years, the Democratic-dominated Assembly has passed the legislation, a largely symbolic move, while the Republican-led Senate has never brought it to a vote in the chamber. Read the bill here.
… Another piece of legislation, which would require registered nurses to be on staff at facilities certified for enhanced assisted living or special needs assisted living, was withdrawn from the committee because it lacked the votes to pass. This is the fourth consecutive session the bill, also sponsored by Gottfried, has been introduced. It has never come to the floor of the Assembly for a vote. Read the bill here.
NOW WE KNOW — A group of scientists has created a Lexicocalorimeter, which measures the calories of a tweet. But tweets aren’t food, you rightly point out. Well, this machine gathers geo-tagged Twitter posts from across the country looking for food words such as “apples” or “ice cream.” It also looks for terms that relate to activities such as “watching television.” Then it figures out whether a given area is taking in more calories than it is expending. Vermont, for example, consumes more calories than any other state according to Twitter because Vermonters tweet a lot about bacon. In New Jersey, a top activity tweeted about is “getting my nails done.” Not exactly a calorie burner. These scientists are also considering creating an insomniameter to measure sleeping habits and a hangoverometer to measure, well, you get the idea. See the PLOS One study here.
WE’D LOVE TO HEAR FROM YOU: This roundup is for you, so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to email@example.com.
BRONX BACTERIA — New York City’s health department is alerting physicians to three cases in the city of leptospirosis, a potentially deadly bacteria usually spread through the urine of farm animals. One of the three cases has resulted in death.
NEW DONOR LAW — Legislation allowing 16- and 17-year-olds to register as organ donors takes effect Tuesday. See the bill here.
FUN PHOTO — Click here to see New York City health commissioner Dr. Mary Bassett receive a cake celebrating her three years on the job.
MAKING ROUNDS — The trauma center at St. Luke’s Cornwall Hospital has been verified as a Level III Trauma Center through 2019 by the Verification Review Committee.
ALSO MAKING ROUNDS — Dr. George Wanna, a hearing and balance surgeon and researcher, has been named Site Chair of the Department of Otolaryngology-Head and Neck Surgery at the New York Eye and Ear Infirmary of Mount Sinai.
— THAT OUGHT TO DO THE TRICK — Plagued by headlines of enormous price hikes, the Generic Pharmaceutical Association, the industry’s largest trade group, is changing its name to the Association for Accessible Medicines. See their press release here.
WHAT WE’RE READING:
— OBAMACARE LATEST — The Republicans are splintering. The House and Senate do not agree on a path forward and conservatives do not agree with more moderate members of the party. Read more from POLITICO here.
— WEAKENING THE MANDATE — The Internal Revenue Service will accept 2016 tax returns that do not indicate whether the taxpayer complied with the Affordable Care Act’s individual mandate, according to the San Francisco Chronicle.
… Does this mean repeal won’t happen? Hardly. Remember how often in 2009 it looked as if Democrats — with 60 senators — would falter? Also, keep in mind that pressure will grow on the right the longer this takes.
— OBAMACARE FALLOUT — My colleagues in D.C. report: “Health insurance giant Humana on Tuesday said it will quit Obamacare’s insurance markets altogether, announcing it will stop selling individual coverage in 2018.” Read more here.
… Cigna and Anthem appear headed for a messy divorce. Bloomberg has more.
— WHAT PETER ORSZAG THINKS WILL HAPPEN — Former president Barack Obama’s budget director thinks Obamacare will be replaced through the waiver process. Read it here.
— DON’T DO THAT — Reuters reports: “The former chief executive of Nebraska pharmaceutical benefits manager Pharmaceutical Technologies Inc has pleaded guilty to making illegal kickback payments in order to obtain business from employee benefit plans.”
— FIVE THINGS TO WATCH — Dr. Robert Califf, the recently departed head of the Food and Drug Administration, explains what to look for from the Trump administration and why he is concerned about plans to speed up drug approvals. Read it here.
— MEDIA CRITICISM — Health News Review takes The New York Times to task for a recent article extolling bariatric surgery. See it here.
TODAY’S TIP — Comes from New York City health commissioner Dr. Mary Bassett, who reminds us that Valentine’s Day was also National Condom Day. “Did you know the NYC condom comes in two sizes? Get some.”
— PROTEIN PROBLEM — Researchers from Cold Spring Harbor Laboratory, writing in The Journal of Cell Biology, say Importin-11, a protein, protects the anti-cancer protein PTEN from destruction by transporting it to the cell nucleus. Read the story here.
— STRONG WOMEN — Researchers from the Mailman School of Public Health found that 48 percent of career military women who were deployed to Vietnam for either military or civilian service are very happy, compared to 38 percent of women in the general population. The study, published in the journal Social Science & Medicine — Population Health, also found that women who served less than 10 years in the military were more likely to report their Vietnam experience as “highly stressful” (28 percent) compared to career military women who served more than 20 years (12 percent) and civilian women (13 percent).
MISSED A ROUNDUP? Get caught up here.
February 13, 2017
|D’Urso, Anthony||D||19||Long Island||Was Schimel, who was Yes vote + sponsor|
|Amato, Stacy||D||23||Queens||Was Goldfeder, who was Yes vote but not sponsor|
|Vanel, Clyde||D||33||Long Island||Was Kaminsky, who was Yes vote but not sponsor|
|Carroll, Robert||D||44||Brooklyn||Was Brennan, who Yes vote + sponsor|
|Wright, Tremaine||D||56||Brooklyn||Was Robinson, who was Yes vote + sponsor|
|Niou, Yuh-Line||D||65||Manhattan||Was Silver then Cancel, who were both Yes votes but not sponsors|
|Dickens, Inez||D||70||Manhattan||Was Wright, who was Yes vote + sponsor|
|de la Rosa, Carmen||D||72||Manhattan||Was Linares, who was Yes vote + sponsor|
|Jones, Billy||D||115||North Country||Was GOP Janet Dupree|
|Wallace, Monica||D||143||Buffalo||Was GOP Angela Wozniak|
|Kaminsky||9||D||Newly elected Senator, Voted for bill in Assembly in 2015||Long Island|
|Stewart-Cousins||35||D||Pledged to vote for it, but won’t officially cosponsor “because of her leadership position”||Westchester|
|Brookes||8||D||close race||Long Island|
|Bailey||36||D||newly elected Senator||Bronx|
|Felder||17||D||Caucuses with Republicans;||NYC (Brooklyn)|
|Savino||23||D/IDC||NYC (Staten Island/BK)|
|Carlucci||38||D/IDC||Seems very sympathetic. Verbal pledge to vote for bill if it comes to floor||Hudson Valley|