Category Archives: Medicaid

Health Reform and Spudnutz

I stood in line at 6:45 Sunday morning to purchase donuts at a very popular local donut shop — Spudnutz — at Lake Okoboji. The line of donut-seekers stretched far out the door. I did not receive donuts until 7:50 a.m. I waited more than an hour for donuts. (Yes, very good donuts). Nine people were working in that donut shop that once housed an auto mechanic shop.

If either the Senate bill or the House bill that was intended to repeal and replace the Affordable Care Act (ACA) became law, I fear none of those nine hardworking people would have health-care coverage in the future. For many of my patients and for, I believe, the employees of Spudnutz, I give thanks for the defeat of the Senate “skinny” repeal legislation.

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Health Reform and Blood Money

In 2003, Iowa used part of its portion of the 1998 Tobacco Settlement monies to help build a new Supreme Court Building. During those years and later, Iowa Republican legislators sought to reduce the funding and scope of the Iowa Tobacco Use Prevention and Control Commission, which was created to use the settlement monies to help Iowans to either quit smoking or not start. I said at that time that using the Tobacco Settlement monies for any use other than health care was wrong. As a former chair of the Tobacco Commission, I viewed this money as blood money because it was being paid out to partially compensate for the death and disease that cigarettes had caused Iowans for many decades.

Similarly, I use the same term, blood money, today regarding the U.S. Republican House and Senate efforts to repeal and replace the Affordable Care Act with a plan that will reduce wealthy individuals’ taxes by more than $600 billion over 10 years by taking a similar amount of money from the Medicaid program and from subsidies used to supplement poor and low-income individuals’ effort to pay for premiums in the individual health-insurance market.

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Health Reform and Nick Bath

Nick Bath is the senior health-policy aide to Senator Pat Murray (D) of Washington. I met Nick several times when he was a health-policy aide to now retired Senator Tom Harkin (D) of Iowa.

Nick is a Harvard law graduate and a classical pianist (according to his bio), and he reminds me in both looks and mannerism of British actor Hugh Grant when Grant was a younger man.

Senator Murray is one of the primary health-care advocates and strategists in the Senate. Because of my previous association with Nick and Senator Murray’s important health-care advocacy, I compose the following letter to Nick regarding the current health-care crisis and unknown future of health care, which evolved from the recently failed partisan attempt to repeal and replace the Affordable Care Act (ACA).

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Health Reform and “Yuge”

Former Vermont Governor Howard Dean speaking this week at the 2016 Democratic National Convention quoted Donald Trump. According to Governor Dean, Donald Trump said that he’s going to replace the Affordable Care Act (ACA) with “something so much better” — something “‘Yuge,’ no doubt.”

In researching this “something so much better,” I could find only a mismatched set of random ideas such as buying health insurance across state lines, establishing Medicaid block grants for each state to administer, allowing Americans to import medications, eliminating the individual mandate but still preventing insurance companies from excluding patients based on pre-existing conditions, and expanding tax exemptions for corporate health insurance to individuals.

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Health Reform and ACO Incentives – Getting It Right

We need to get this right. As I have said last month, I continue to be dismayed by the evidence that health-care costs are not being controlled. For example, in Minnesota, one of nation’s top health-care managed states, Blue Cross and Blue Shield announced that it would not sell individual insurance policies next year due to concerns over cost. Skyrocketing health-care costs will affect the affordability of private insurance and the existence of public health-care programs such as Medicare, Medicaid, and subsidized insurance sold under the Exchanges.

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Health Reform and Medicare for All … Seniors

One of my favorite movies is White Christmas, which starred Bing Crosby and Rose Mary Clooney. In one scene, Rose Mary Clooney’s character sings a song in a nightclub about her unhappiness with Bing Crosby’s character. She sings, “Love, you didn’t do right by me … you planned romance that just hadn’t a chance, and I am through.”

In a fashion similar to that Irving Berlin song, after years of touting private health insurance by helping to create the Healthy and Well Kids in Iowa (HAWK-I) — Iowa’s CHIP program, and working with CoOportunity Health — Iowa’s health-care co-op that went bankrupt, I have come to the conclusion that the private health-insurance market under the Affordable Care Act (known as the ACA or Obamacare) has not done “right by me.” More importantly, it has not “done right”  the citizens of the country. For reasons that I will clarify later, I now support expanding Medicare to individuals 55 years of age in a graduated, voluntary enrollment process.

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Health Reform and Confusion

It should be so easy: A patient should receive his or her needed and entitled health care.  Medicaid should be the conduit that connects the patient and the physician and then pays the physician or other health-care provider for services rendered.

Furthermore, if Medicaid contracts with a for-profit managed-care organization (MCO) to provide care to patients, there should be adequate state oversight to ensure the safety and well-being of these patients. As the 2016 Conference Report for the Health and Human Services, passed this week by the Iowa House and Senate, states, “The primary focus of the general assembly in moving to Medicaid managed care is to improve the quality of care and outcomes for Medicaid members.”

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Health Reform and the “Vulnerables”

In the health insurance industry, young adults are known as the “invincibles.” Like the superheroes that inhabit movies and TV now, these young men and women believe they are impervious to illness, disease, and injury. Therefore, they do not acquire health-care coverage, believing they are invincible. It is human nature to create groupings of individuals and name that grouping. We commonly talk about “baby boomers” and “millennials.” Tennessee Williams said that he wrote about the “incomplete.” Studs Terkel, in his book, Working, said he interviewed and wrote about the “uncelebrated.” Today for this blog, I create my own grouping. Here’s why.

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Health Reform and Oversight, Ombudsmen, and Obfuscation

“Iowa has two ombudsmen to investigate and advocate for the 560,000 poor or disabled recipients on the (Medicaid) program.”

— The Des Moines Register, February 28, 2016

I salute Jason Clayworth, the reporter who wrote the Des Moines Register article from which the above quote is taken, as well as Tony Leys, another Register reporter, and the Des Moines Register editorial staff. Their tireless efforts to investigate and comment on the upcoming transformation of the Iowa Medicaid program to a for-profit managed-care model has brought some clarity to the issue, as well as exposed some potential flaws. Iowa is only the fourth state in the country to completely adopt this new model across its various Medicaid programs.

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