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Still confused about the new health care law? MIT economics professor Jonathan Gruber tries a different way to communicate major elements of the law; he’s doing it light and through a comic book.
In Health Care Reform: What It Is, Why It’s Necessary, How It Works, Gruber guides readers through complex policy details, including the individual mandate to buy insurance, the health insurance exchanges and controlling health care costs.
Gruber was involved in developing Governor Mitt Romney’s universal health care plan in Massachusetts as well as in President Obama’s Patient Protection and Affordable Care Act.
He believes that people don’t approve of the law because they don’t understand it, which is why he wanted to write a book about it. Coming up with the graphic novel that explains the health care overhaul in a light way was his publisher’s idea. While not totally enthusiastic of the idea at the start, Gruber was later convinced that a graphic novel will be best if they want to effectively communicate their point to a wider group.
While the book is generally positive about the law, Gruber, who is a supporter of the healthcare reform law, takes a more cautious tone when discussing cost control. He said: “I wanted to be intellectually honest. I believe that cost control is too hard for us to know what to do right now.” He added: “I want to explain to that set of voters and readers who are really critical of this bill because it doesn’t do enough on cost control that that is really an unfair criticism. We’re not really at a place where we could address that problem.”
Pushing comprehensive smoking cessation programs may benefit Medicaid in the form of substantial savings, according to a recent study published in the journal PLoS ONE.
According to study leader Leighton Ku of the George Washington University School of Public Health and Health Services, their research demonstrates that spending for smoking cessation programs could be a good investment. The programs could lead to lower levels of smoking, which could mean reduced number of hospital admissions for smoking-related problems, translating to significant savings for Medicaid.
The study found that for every dollar spent in smoking cessations programs could generate a $2.12 return on investment. Their estimates were based on data from the 2002 to 2008 Medical Expenditure Survey and the Behavioral Risk Factor Surveillance Surveys.
“Smoking is the leading cause of preventable death in the United States. Millions of low-income smokers in the United States are insured by Medicaid. In 2004, smoking-related Medicaid expenditures for all states combined was $22 billion, which represented 11 percent of all Medicaid spending,” Ku explained.
Ku also cited the case of Massachusetts, which launched a massive smoking cessation campaign through medications and counseling of its Medicaid recipients. The state reportedly saved an average of $388 per user per year.
According to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, healthcare reform standards for electronic funds transfers and how health providers determine a patient’s eligibility will significantly reduce administrative costs for doctors and hospitals, private health plans, states and other government health plans. How significant? More than $16 billion during the next 10 years.
Sebelius said: “Thanks to the Affordable Care Act, healthcare professionals will spend less time filling out paperwork and more time focusing on delivering the best care for patients.”
U.S. physicians spend nearly 12 percent of fees for the costs of filling out forms and performing complex administrative tasks, according to a study published in the journal Health Affairs in 2010. Eliminating inefficient manual processes and simplifying the systems could save money and time — about 4 hours of professional time per physician and 5 hours of support staff time per week, and prove beneficial for both health care service providers and patients.
While there is increasing public support for research and innovation in the ocountry, majority of Americans don’t believe our progress in medical research is sufficient. Also, most Americans are not convinced about the US having the best health care system in the world.
Nearly 60% of Americans don’t see much progress in the field of medical research in the country, while 54% think other countries have better health care systems. This was revealed in the new edition of America Speaks, a compilation of public opinion polls commissioned by Research!America.
Many Americans also think that the US is falling behind in global competitiveness, with 77% thinking that the the country is losing its competitive edge in science, technology and innovation.
The good news is that a great majority (91%) believe that research and development are important to their state’s economy, and that it helps to improve health, create jobs and boost the economy.
Research!America Chair and former Illinois Congressman John Porter shared: “Americans support further investment in health research and have indicated that the federal government must do more to sustain and build our economy. Scientific research has proven to be an emerging, economic driver in cities that have committed to building their life sciences industry. To secure our position as a leader in science and innovation, we need to elect officials that will support a robust investment in research. That is why the 2012 elections are critical to our nation’s well-being.”
The poll also revealed that 87% of Americans think elected officials should listen to health care experts and professionals regarding health threats.
Since it the Patient Protection and Affordable Care Act became law in 2010, it has been the subject of many discussions. While some talks about why it should not be, the health care reform continues to implement its plans to better the country’s health care system. Here are the 5 major reforms we can expect in 2012:
1. Accountable Care Organizations
There will be financial incentive for physicians, hospitals and health care providers that voluntarily join the Accountable Care Organizations or ACOs and coordinate care for patients with original Medicare. It is expected that ACOs will save Medicare $960 million over three years.
2. Addressing Health Care Disparities
Although closing disparities in health care may be a tough challenge, the law will at least try by accelerating collection of data, funding community health centers, increasing racial and ethnic diversity in the health care professions and in 2014, providing affordable health insurance for all through insurance exchanges.
3. Insurance Rebates
With the medical loss ratio, health insurance companies must spend at least 80 percent of their premiums (85 percent for large group-based plans) on direct medical care or quality improvement. Not meeting the mark means they have to issue rebates.
Laurie Sobel, senior attorney for Consumers Union, shared: “The rebates start June 1, and they have to have them issued no later than August 1. The National Association of Insurance Commissioners estimates that Americans would have received nearly $2 billion if MLR had been in effect in 2010.”
4. Electronic Records
Currently still on paper records, the health care industry will be shifting to electronic records this year.
Dr. Glen Stream, president of the American Academy of Family Physicians, says that one of the advantages of this shift is the savings from nonduplication of services. He explained: “Say a patient comes to me with a painful knee, and I take an X-ray. And tomorrow, their knee is worse, and they go to the emergency room. If the ER physician can’t see the X-ray I did yesterday, they’re going to do another X-ray. The patient is going to get double X-ray exposure and double expense.”
5. Value-Based Purchasing
Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said: “For instance, in defined situations like a knee replacement, instead of paying a doctor for every service they provide to replace a knee, they get paid a lump sum to replace somebody’s knee. So there’s an incentive for them to do it as efficiently as possible while also providing high-quality care, as opposed to a fee-for-service arrangement where there is an incentive to do more tests and procedures because there is more money involved.”
The new Deloitte study “Physician Perspectives about Health Care Reform and the Future of the Medical Profession” reveals that physicians are not so excited about the future of health care in relation to the promises brought by the Patient Protection and Affordable Care Act.
Only 27 percent of physicians surveyed think that the new health care law will reduce costs by improving efficiency, while only 33 percent think the law will be able to decrease disparities. Half of the respondents say access to health care will decrease due to hospital closures as an effect of the implementation of the provisions of the law.
Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report, said: “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession. Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery.”
Physicians are concerned over the pressure that will be imposed on primary care doctors from millions of newly-insured consumers and its impact on the entire system. There are also concerns on the possibility that the health care reform could lead to a loss of autonomy and additional costs in adopting new processes.
Keckley added: “Effective reform has to consider the physician’s view as a starting point. We not only have to design the right model, but we have to create the right incentives and processes for implementing that model. The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.”
A study in the journal Medicare and Medicaid Research Review, published by the federal Centers for Medicare and Medicaid Services, revealed that Massachusetts spent more per person than any other state on healthcare. Massachusetts also has a higher percentage of the population with health insurance.
In 2009, Massachusetts spent about $9,278 per person on health care, putting it as the top healthcare spender in the US. Found at the bottom is Utah, which spent the least at about $5,031 per person. The national average is $6,815.
Massachusetts is one of only two states with functioning health-insurance exchanges. It has also passed a law in 2006 that required most residents to have insurance. Utah, on the other hand, also has a functioning health-insurance exchange but does not require residents to carry insurance. The federal healthcare law passed in 2010 will require most Americans to have insurance.
Reasearchers found that states on the higher end of the list of healthcare spending tended to have higher incomes and a higher percentage of people covered by insurance. The report also shared that states with relatively low incomes and high rates of uninsured, such as Utah, “would be most likely to have the greatest potential number of people eligible for the Medicaid expansion or exchange coverage.”
Healthcare spending in California is among the lowest in the US, well below the national average, according to new federal data.
New data from the federal government show that total spending by insurers, government agencies and individuals amounted to $6,238 per resident in 2009. The national average is $6,815.
It means California spends less per person on healthcare than all but eight states — Arkansas, Georgia, Texas, Utah, Nevada, Arizona, Colorado and Idaho.
With more than 7 million people uninsured in the state, most Californians seek medical treatment only when severely ill or injured. Low reimbursement rates paid to doctors and hospitals by the Medi-Cal insurance program has also been named a factor in the low healthcare spending in California.
Larry Levitt, a healthcare and insurance analyst, sees this as a point of concern. “The state is essentially under-investing in healthcare and ending up with an unhealthier population as a result. If people aren’t healthy, they are not able to work or to be as productive as they otherwise would be,” he said.
On the other hand, other possible factors for the low healthcare spending is that California has a relatively young and healthy population, who generally don’t need to seek medical treatment that much. Also, the state has many residents covered by health maintenance organizations than most other states.
The White House released a report showing that discounts on brand-name drugs for qualified recipients have saved 2.7 million Medicare recipients more than $1.5-billion nationwide. Under the Affordable Care Act, drug makers were required to offer 50 percent discount on all drugs in the donut hole.
The health care reform law has saved Michigan Medicare recipients, in particular, more than $33-million total on prescription drugs, according to the White House. Considering 60,904 recipients in the state, the amount equates to an average of about $556 per person.
Marilyn Tavenner, the interim administrator of the Center for Medicare and Medicaid Services, said: “Thanks to the Affordable Care Act, millions of Americans are receiving free preventive services and getting cheaper prescription drugs.”
Critics are not quicky to change their minds regarding the health care law passed early 2010, though. Joseph Antos, a health-care economist at the libertarian think tank the American Enterprise Institute, said: “The savings comes from requiring drug manufacturers to give a substantial discount. This discount is going to encourage people to stay on the name-brand drug instead of generics, which costs money. Eventually, the price of some drugs somewhere is going to go up somewhere in reaction to this.”
The report also revealed that more than 24.2 million Medicare recipients had used their free annual preventive visit to a physician; some 930,000 had availed this free visit in Michigan. This benefit is part of the health care reform act.
A House committee voted 33-17 to repeal the Community Living Assistance Services and Supports Act (CLASS) Act. The CLASS Act is part of the new health care law created to help disabled and elderly patients receive home healthcare rather than institutional healthcare.
The White House opposes the repeal. Republicans wanted it to be scrapped entirely while some Democrats pushed for restructuring.
Rep. Fred Upton, Michigan Republican and chairman of the House Energy and Commerce Committee, said: “I believe we have to start over on long-term care reform – an issue that will affect millions of Americans as they or a loved one need care. But first, we must erase a program that we know will not work; a program that was never structured to work, and that we could never afford.”
Secretary of Health and Human Services Kathleen Sebelius has earlier revealed that she couldn’t find a way to make the program self-sustaining and has suspended it indefinitely.
Sen. John D. Rockefeller IV, however, still do not see it right to repeal it. He said: “The CLASS Act may not be perfect, but it’s critical that we find another way to provide long-term care to the 21 million Americans who need it before we repeal this law.”
