Woodruff did not mention the individual mandate—a surprise, since it’s the sine qua non of the law and its most controversial provision. Instead she threw Lungren a softball, asking him to name “a few pieces of this that you want to see survive,” and failed to challenge him on what he said. Lungren blabbered about “patient-centered health care” and making sure that the “bureaucracy is not involved in this process,” and then got to that Republican hobby horse:
We have talked about preexisting conditions. In fact, we came forward with a much more vigorous program for having those pooled programs around the country for people with preexisting conditions. We ought to build on that.
Congressman: That’s exactly what the health reform law did. It provided expanded risk pools for hard-to-insure people by giving a bunch of money to the states to ramp up their insurance offerings for sick people. There is just one problem—the expanded pools have yet to score a win. The same affliction that has historically plagued all state risk pools plagues the new ones as well. The premiums they must charge are too damn expensive for most people. Medicare’s chief actuary predicted that about 375,000 people would sign up for the new pools; in early November only 8000 had. Your staff needs to do some homework, and so do researchers and producers at the NewsHour. Your constituents and their viewers deserve better.
The uninsured are not the culprits in emergency rooms usage. A few years ago, a solid study from the Kaiser Family Foundation and the Actuarial Research Corp. found that those without insurance were no more likely to use the ERs than those with coverage.
That may be well and good - but the issue isn't merely frequency of use - it's who pays for that use.
Even if insured and uninsured persons went to the ER at identical rates with identical expenses - the bill for the insured visits would be paid by private insurance (or by the individuals as out of pocket)
The relevant questions are
1) What is the total expense of those uninsured ER visits?
2) What % of that expense is passed on to bills paid by other patients and their insurance? and
3) Do either of those numbers change under the new health law?
#1 Posted by Sotto Voce, CJR on Fri 21 Jan 2011 at 02:37 PM
Sotto Voce,
Taxpayers will foot the bill for Obamacare under which Medicaid has been expanded to 133 percent FPL and subsidized plans will be available for those citizens who are found eligible to shop at the Exchange.
So no matter how you slice it - ER usage, insured, uninsured - taxpayers, both state and federal, will pay for all of it AND will also be required to purchase plans that the gov't (health benefits commissioner) has decided are affordable based on a person's prior year income. Many probably won't be able to use the insurance b/c of the skimpy coverage (will be underinsured) OR they will be forced by the IRS to pay a costly penalty and will end up in the E.R. when they need medical care. See Trudy's ten-part series on the MA plan in the cjr archives. (The MA plan was the marketing tool and model for Obamacare.)
It's a myth that insuers are passing these costs onto policyholders. Insurers use all kinds of spin to cover their greedy habits. The biggest of all is "cutting health care costs." This really means cutting out the costs they have to pay out that impair their bottomline. They try to sell this concept as the reason your premiums continue to rise.
Obamacare is not going to change this, and it also has no cost containment. Neither does the MA plan.
If the federal (and MA) gov't were truly concerned about providing access to care and cutting health care costs, both would have gotten rid of the insurance companies and implemented a single-payer system which works quite well in all other industrialized countries.
I attended a presentation made by former CEO of the MA Connector Authority Jon Kingsdale (Connector = Exchange in Obamacare) in August 2007 or 2008 (don't recall the year) at our local hospital during which he tried to sell the "great success" of the MA plan (model for Obamacare) to docs and nurses and those from the community who stopped by to hear this. Someone asked him who is paying for the subsidized plans that are available for residents whose income is up to 300 percent FPL (Obamacare = 400 percent FPL for a subsidized plan), and the answer was: state and federal taxpayers will have to pony up.
As Trudy points out in her story above, ER usage increased in MA when this plan was implemented. Why? I know of two reasons. People couldn't find doctors who would take subsidized patients because the reimbursement rates were too low, so overhead wasn't covered nor was expanding their practices to accommodate the newly insured. So, if you are sick, have insurance but can't find a doctor in the one and only network available in your area, where do you go? The E.R.
And, there are residents in MA who couldn't afford the affordable, subsidized, plans the state told them that they could afford or couldn't afford employer insurance and weren't eligible for a subsidized plan, so these health care criminals did not purchase coverage because they chose to buy food and pay the mortgage, rent or property taxes OR they signed up but found they couldn't afford the insurance or couldn't afford to use it b/c of the copays during months when they had to pay for a car repair or food prices were high so ended up having to go to the E.R. in spite of the MA mandated health insurance law.
MA powerbrokers tried to pawn off this increased use of the E.R. as: the newly insured need to be taught how to use their insurance.
Four years into this scheme, and the local hospital in my county sent out a letter to docs to inform patients that there's a program available to help pay the deductibles and copays for a colonoscopy for residents who are up to 400 percent FPL and can't afford to use their insurance. The letter points out that it is a known fact that many in western MA are underinsured and can't afford a colonoscopy, one of the most important . . .
This is not about use of the E.R. but does say that the MA plan with it's subsidized insura
#2 Posted by dianne, CJR on Tue 25 Jan 2011 at 04:37 AM