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Philadelphia Case Exposes Deep Rift In Abortion Debate

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Beyond Obamacare

How a Single-Payer System Can Save US Health Care

As Minnesota�s physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.

What if there were a simple, streamlined solution that would guarantee health coverage for every Minnesotan while saving the state billions of dollars? A growing number of Minnesota physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans� administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.

Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every Minnesotan could have comprehensive coverage while the state would save billions annually.

A deeply flawed system

The desire for meaningful reform comes in the face of the U.S. health care system�s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation�s economy�twice that of other wealthy democracies�48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.

At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.

Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans�which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.

The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans (including 262,000 Minnesotans) will remain uninsured after its full implementation.

The solution

The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.

Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.

Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate �job lock,� in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.

A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system�up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.

The Minnesota model

Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for �state innovation waivers� to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont�s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.

In Minnesota, two advocacy organizations�Health Care for All Minnesota and the Minnesota chapter of Physicians for a National Health Program�are garnering public support for a single-payer system. Gov. Mark Dayton has expressed support for single payer, and Sen. John Marty (DFL-Roseville) has authored legislation to establish such a system in Minnesota. Known as the Minnesota Health Plan, it would replace the current inefficient patchwork of private and public health plans with a single statewide fund that would cover the health needs of all Minnesotans�inpatient and outpatient services, preventive care, prescription drugs, medical equipment and mental health and dental care. A 2012 study by the Lewin Group confirmed the feasibility of single payer in Minnesota. It concluded that adoption of a single-payer system would provide coverage to every Minnesotan, including the 262,000 left uncovered by the ACA, while saving the state $4 billion in the first year alone. The average Minnesota family would save $1,362 annually in health costs, while the average Minnesota employer that currently provides insurance would realize savings of $1,214 per employee per year. The analysis showed these savings came primarily from administrative simplification; provider compensation remained unchanged.

Conclusion

With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.

This article originally appeared in the April 2013 issue of Minnesota Medicine.

Scammers Find Fertile Ground In Health Law

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Rate of employer-based health insurance keeps dropping

From USA Today –

The availability of employer-sponsored insurance has fallen by about 10% over the past decade, which has spurred an increase in the overall number of Americans without health insurance, according to a report released today.

“This documents that in virtually every state across the country, there has been a steady decline in employers that provide coverage over the past 10 years,” said Andrew Hyman, director of the Robert Wood Johnson Foundation’s health care coverage team. “It would be a real stretch to say this was caused by anticipation of the Affordable Care Act,” President Obama’s 2010 health care law.

The universal coverage requirement and the state health insurance exchanges needed to make it work will start Jan. 1. Some employers have said they may drop health insurance because it would be cheaper to pay a $2,000 fine and have employees buy insurance through the exchanges instead of paying an average of $15,000 to buy that employee health insurance.

Other employers have said they will drop employees’ hours below 30 a week to avoid the requirement to provide insurance or pay a fee.

If so, employers would be following a trend that started before the health care law passed in 2010. The new study found that employer-sponsored coverage dropped from 69% to 60% between 1999 and 2010. The amount each employee paid annually for insurance more than doubled in that period from $435 to $1,056 for an individual and from $1,526 to $3,842 for a family.

The Johnson foundation’s State Health Access Data Assistance Center conducted the research.

Coverage also varied from state to state, based on state law, regional employment rates and average employer size.

Hyman said the steady decline in coverage has come in spite of changes in the economy and employment rates throughout the decade.

“So now we’re all wondering how it will change with the implementation of the ACA,” he said. The “silver lining,” he said, is that with the new law, even those who don’t receive coverage through their employer will be able to get a plan through the health exchange system.

Predictions vary on the law’s effects. The Congressional Budget Office says between 3 million and 5 million fewer people will have employer-subsidized insurance. A Towers Watson survey of more than 500 companies with more than 1,000 employees found none of the companies plan to drop insurance because of the law. A House Ways and Means Committee study found that 71 Fortune 100 companies said they could save $28.6 billion by dropping health insurance and paying the $2,000-per-employee fine.

However, health insurance brokers say their business clients are “staying the course” on their current health plans, said John Torinus, co-founder of Successful Entrepreneur Investors and who has served on several health care reform task forces. As a former CEO, he said he considered health coverage a benefit not just to the employee, but also to the employer.

In a presentation to the World Health Care Congress Wednesday, Torinus said corporations have the power to turn the tide of rising health care costs. Consumer-driven plans, as well as employers who help employees make good decisions about spending and lifestyle, are a better answer than dropping employees’ insurance. Healthy employees are more productive, take less time off and are happier.

He said more employers are offering health care at the workplace so they can ensure employees receive preventive checks to keep them healthy, the employer isn’t saddled with unnecessary referrals and procedures and the employee goes to a less-expensive, better-quality specialist when there are several options from which to choose.

Kent Bradley, senior vice president and chief medical officer of grocery store giant Safeway, proposed that employers could address the rising costs of Medicare by pushing back the time in a person’s life that he or she starts being unhealthy.

Employers are better able to provide incentives � employees at Safeway pay premiums based on their behaviors, and they can save up to $760 per person � as well as a supportive workplace to help people make healthy lifestyle choices. So rather than having a population of seniors dealing with chronic disease from obesity, such programs could stave off illness until a population turns 75 or older, he said.

Hyman said he expects employers to continue to offer insurance.

“I think, frequently, employers are thinking and projecting based on one or two factors,” he said. “But it will be interesting to see what they do with a range of considerations.”

A Healthy Choice For America’s Small Businesses

Ed. note: This post was first published on the official blog of sba.gov. You can see the original post here.

Small businesses are the backbone of our communities. And, in an economy where small businesses create two-thirds of jobs, owners and employees deserve a health insurance market with fairer prices, better choices, and greater certainty. With the implementation of the Affordable Care Act, that market is on its way.

In recent years, the number one concern for millions of small business owners has been health care. Because they had less bargaining power, small businesses paid an average of 18% more for the same health insurance plan offered to their bigger competitors.

As America�s economy continues to get stronger, small businesses across the country are playing a critical role in creating jobs, driving innovation and fostering economic growth.� Now, more than ever, they need every tool available to help their businesses grow and thrive�including a way to give their employees access to quality, affordable health insurance.

In 2014, employers will be able to choose a plan through a new Health Insurance Marketplace and in 2015 and beyond, employers will be able to let their employees choose from a number of plans.

Marketplaces

Beginning in 2014, small business owners will have access to a Marketplace�which opens for enrollment on October 1st�that will allow them to make side-by-side comparisons to find a plan that fits their budget and that�s right for their businesses and employees.

Each Marketplace will operate a Small Business Health Options Program, or SHOP, focused just on small businesses, where employers will be able to choose from a range of affordable plans to offer their employees.� In 2014, employers will be able to choose a plan, from a variety of Marketplace options, to offer their employees.� In States like California in 2014 and in all States starting in 2015, employers will be able to choose a variety of plans to offer to their employees�empowering each employee to choose the plan that best suits his or her needs.

Although we have heard some claims that the opening of our SHOP marketplaces will be delayed, this is not the case�these marketplaces will open for enrollment, as planned, on the first of October. �

With SHOP, every small business owner will be able to:

Access a single place to learn about health insurance and get accurate information on different plans;Make apples-to-apples comparisons of the prices and benefits of private insurance plans for their employees; and,Use their existing insurance broker to access the SHOP, or shop for plans themselves, without a broker�choosing a plan that works for their budget, their business, and their employees.

You can learn more about the Marketplaces by visiting www.healthcare.gov/marketplace.

Tax Credits

Small businesses are also seeing savings thanks to new tax credits available to help them cover their employees.

Many small businesses with fewer than 25 employees have already received a tax credit of up to 35% of their health insurance costs. And beginning in 2014, this tax credit will go up to 50%.�

Increased Transparency

Insurance companies must now publicly justify every rate increase of 10% or more, which has led to a sharp decline in double-digit rate hikes. The proportion of double-digit rate hike requests plummeted from 75% in 2010 to 14% so far in 2013.� Starting in 2014, insurers will have to transparently report every proposed rate increase, even if it�s a 1% bump.

Additional rules require insurers to spend at least 80% of small employer premium dollars on employees� actual health benefits, instead of the insurer�s own administrative costs.� These limits, along with those in the individual market, have already resulted in more than $1 billion being returned to business owners and other consumers.

By making the health insurance market work better for America�s small businesses, the Affordable Care Act will help our small business owners and entrepreneurs get back to the business of being in business, and focus on what they do best: delivering great products and services, creating jobs, and growing our economy.

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A Healthy Choice For America’s Small Businesses

Ed. note: This post was first published on the official blog of sba.gov. You can see the original post here.

Small businesses are the backbone of our communities. And, in an economy where small businesses create two-thirds of jobs, owners and employees deserve a health insurance market with fairer prices, better choices, and greater certainty. With the implementation of the Affordable Care Act, that market is on its way.

In recent years, the number one concern for millions of small business owners has been health care. Because they had less bargaining power, small businesses paid an average of 18% more for the same health insurance plan offered to their bigger competitors.

As America�s economy continues to get stronger, small businesses across the country are playing a critical role in creating jobs, driving innovation and fostering economic growth.� Now, more than ever, they need every tool available to help their businesses grow and thrive�including a way to give their employees access to quality, affordable health insurance.

In 2014, employers will be able to choose a plan through a new Health Insurance Marketplace and in 2015 and beyond, employers will be able to let their employees choose from a number of plans.

Marketplaces

Beginning in 2014, small business owners will have access to a Marketplace�which opens for enrollment on October 1st�that will allow them to make side-by-side comparisons to find a plan that fits their budget and that�s right for their businesses and employees.

Each Marketplace will operate a Small Business Health Options Program, or SHOP, focused just on small businesses, where employers will be able to choose from a range of affordable plans to offer their employees.� In 2014, employers will be able to choose a plan, from a variety of Marketplace options, to offer their employees.� In States like California in 2014 and in all States starting in 2015, employers will be able to choose a variety of plans to offer to their employees�empowering each employee to choose the plan that best suits his or her needs.

Although we have heard some claims that the opening of our SHOP marketplaces will be delayed, this is not the case�these marketplaces will open for enrollment, as planned, on the first of October. �

With SHOP, every small business owner will be able to:

Access a single place to learn about health insurance and get accurate information on different plans;Make apples-to-apples comparisons of the prices and benefits of private insurance plans for their employees; and,Use their existing insurance broker to access the SHOP, or shop for plans themselves, without a broker�choosing a plan that works for their budget, their business, and their employees.

You can learn more about the Marketplaces by visiting www.healthcare.gov/marketplace.

Tax Credits

Small businesses are also seeing savings thanks to new tax credits available to help them cover their employees.

Many small businesses with fewer than 25 employees have already received a tax credit of up to 35% of their health insurance costs. And beginning in 2014, this tax credit will go up to 50%.�

Increased Transparency

Insurance companies must now publicly justify every rate increase of 10% or more, which has led to a sharp decline in double-digit rate hikes. The proportion of double-digit rate hike requests plummeted from 75% in 2010 to 14% so far in 2013.� Starting in 2014, insurers will have to transparently report every proposed rate increase, even if it�s a 1% bump.

Additional rules require insurers to spend at least 80% of small employer premium dollars on employees� actual health benefits, instead of the insurer�s own administrative costs.� These limits, along with those in the individual market, have already resulted in more than $1 billion being returned to business owners and other consumers.

By making the health insurance market work better for America�s small businesses, the Affordable Care Act will help our small business owners and entrepreneurs get back to the business of being in business, and focus on what they do best: delivering great products and services, creating jobs, and growing our economy.

Sweeping Anti-Abortion Bill Expected To Become Kan. Law

Kansas legislators gave final passage to a sweeping anti-abortion measure Friday night, sending Gov. Sam Brownback a bill that declares life begins "at fertilization" while blocking tax breaks for abortion providers and banning abortions performed solely because of the baby's sex.

The House voted 90-30 for a compromise version of the bill reconciling differences between the two chambers, only hours after the Senate approved it, 28-10. The Republican governor is a strong abortion opponent, and supporters of the measure expect him to sign it into law so that the new restrictions take effect July 1.

In addition to the bans on tax breaks and sex-selection abortions, the bill prohibits abortion providers from being involved in public school sex education classes and spells out in more detail what information doctors must provide to patients seeking abortions.

The measure's language that life begins "at fertilization" had some abortion-rights supporters worrying that it could be used to legally harass providers. Abortion opponents call it a statement of principle and not an outright ban on terminating pregnancies.

"The human is a magnificent piece of work at all stages of development, wondrous in every regard, from the microscopic until full development," said Sen. Steve Fitzgerald, a Leavenworth Republican who supported the bill.

Abortion opponents argue the full measure lessens the state's entanglement with terminating pregnancies, but abortion-rights advocates say it threatens access to abortion services.

The declaration that life begins at fertilization is embodied in "personhood" measures in other states. Such measures are aimed at revising their constitutions to ban all abortions, and none have been enacted, though North Dakota voters will have one on the ballot in 2014.

But Kansas lawmakers aren't trying to change the state constitution, and the measure notes that any rights suggested by the language are limited by decisions of the U.S. Supreme Court. It declared in its historic Roe v. Wade decision in 1973 that women have a right to obtain abortions in some circumstances, and has upheld that decision while allowing increasing restrictions by states.

Thirteen states, including Missouri, have such language in their laws, according to the National Right to Life Committee.

Sen. David Haley, a Kansas Democrat who opposed the bill, zeroed in on the statement, saying that supporters of the bill were pursuing a "Taliban-esque" course of letting religious views dictate policy limiting women's ability to make decisions about health care and whether they'll have children.

And in the House, Rep. John Wilson, a Lawrence Democrat, complained that the bill was "about politics, not medicine."

"It's the very definition of government intrusion in a woman's personal medical decisions," he said.

Brownback has signed multiple anti-abortion measures into law, and the number of pregnancies terminated in the state has declined 11 percent since he took office in January 2011.

The governor said he still has to review this year's bill thoroughly but added, "I am pro-life."

This year's legislation is less restrictive than a new North Dakota law that bans abortions as early as the sixth week of pregnancy and a new Arkansas law prohibiting most abortions after the 12th week. But many abortion opponents still see it as a significant step.

"There is a clear statement from Kansas with respect to the judgment on the inherent value of human life," said Senate Public Health and Welfare Committee Chairwoman Mary Pilcher-Cook, a Shawnee Republican and leading advocate for the measure.

The bill passed despite any solid data on how many sex-selection abortions are performed in Kansas. A 2008 study by two Columbia University economists suggested the practice of aborting female fetuses � widespread in some nations where parents traditionally prefer sons � is done in the U.S. on a limited basis.

But legislators on both sides of the issue said the practice should be banned, however frequent it is.

The bill also would require physicians to give women information that addresses breast cancer as a potential risk of abortion. Advocates on both sides acknowledge there's medical evidence that carrying a fetus to term can lower a woman's risk for breast cancer, but doctors convened by the National Cancer Institute a decade ago concluded that abortion does not raise the risk for developing the disease.

The provisions dealing with tax breaks are designed to prevent the state from subsidizing abortions, even indirectly. For example, health care providers don't have the pay the state sales tax on items they purchase, but the bill would deny that break to abortion providers. Also, a woman could not include abortion costs if she deducts medical expenses on her income taxes.

"Every taxpayer will be able to know with certainty that their money is not being used for abortion," Pilcher-Cook said.

But Jordan Goldberg, state advocacy counsel for the New York City-based Center for Reproductive Rights, called the tax provisions "appalling and discriminatory."

"It's probably, if not definitely unconstitutional, and it's incredibly mean-spirited," she said.

___

The anti-abortion legislation is HB 2253.

___

Associated Press Writer Maria Fisher in Kansas City, Mo., also contributed to this report. Follow John Hanna on Twitter at www.twitter.com/apjdhanna

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