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    The health care status quo is not good enough

    by: desmoinesdem

    Sat Jun 27, 2009 at 17:20:42 PM CDT


    Health and Human Services Secretary Kathleen Sebelius issued reports on Friday detailing the problems with the "health care status quo" across the country. You can find the reports at HealthReform.gov. The report for Iowa is here, and I've also posted it after the jump. Among other things, it shows the percent increase in family health insurance premiums since 2000 and the percentage of uninsured Iowans.

    A couple of points jumped out at me:

    • Choice of health insurance is limited in Iowa. Wellmark BC and BS alone constitutes 71 percent of the health insurance market share in Iowa, with the top two insurance providers accounting for 80 percent.11

    Iowa is not unusual in this regard. Most insurance markets in the United States are dominated by one or two companies. My family's Wellmark premiums went up 10 percent this year alone. Speaking of which, the annual salary of Wellmark's CEO has "nearly doubled" in the past five years to about $2.5 million.

    • Choice is even more limited for people with pre-existing conditions. In Iowa, premiums can vary, within limits, based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.

    I know a family in Des Moines who were unable to purchase health insurance at any price because the mother has a thyroid condition. They are now covered through the father's employer, but if he loses his job they will have no health insurance options.

    Two more reasons why we cannot settle for health care reform without a public option, or with a fake public option. I was glad to see several House Democratic caucuses affirm that they will fight any health care bill lacking "a real and robust public option that lives up to our criteria".

    Click "there's more" to read the whole report, with supporting footnotes.

    desmoinesdem :: The health care status quo is not good enough
    THE HEALTH CARE STATUS QUO: Why Iowa Needs Health Reform

    Congress and the President are working to enact health care reform legislation that protects what works about health care and fixes what is broken. Iowans know that inaction is not an option. Sky-rocketing health care costs are hurting families, forcing businesses to cut or drop health benefits, and straining state budgets. Millions are paying more for less. Families and businesses in Iowa deserve better.  
    IOWANS CAN'T AFFORD THE STATUS QUO
    - Roughly 1.9 million people in Iowa get health insurance on the job(1), where family premiums average $12,206, about the annual earning of a full-time minimum wage job.(2)
    - Since 2000 alone, average family premiums have increased by 88 percent in Iowa.(3)
    - Household budgets are strained by high costs: 19 percent of middle-income Iowa families spend more than 10 percent of their income on health care.(4)
    - High costs block access to care: 8 percent of people in Iowa report not visiting a doctor due to high costs.(5)
    - Iowa businesses and families shoulder a hidden health tax of roughly $600 per year on premiums as a direct result of subsidizing the costs of the uninsured.(6)
    AFFORDABLE HEALTH COVERAGE IS INCREASINGLY OUT OF REACH IN IOWA
    - 10 percent of people in Iowa are uninsured, and 71 percent of them are in families with at least one full-time worker.(7)
    - The percent of Iowans with employer coverage is declining: from 71 to 65 percent between 2000 and 2007.(8)
    - Much of the decline is among workers in small businesses. While small businesses make up 76 percent of Iowa businesses,(9) only 39 percent of them offered health coverage benefits in 2006 -- down 2 percent since 2000.(10)
    - Choice of health insurance is limited in Iowa. Wellmark BC and BS alone constitutes 71 percent of the health insurance market share in Iowa, with the top two insurance providers accounting for 80 percent.(11)
    - Choice is even more limited for people with pre-existing conditions. In Iowa, premiums can vary, within limits, based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.
    IOWANS NEED HIGHER QUALITY, GREATER VALUE, AND MORE PREVENTATIVE CARE
    - The overall quality of care in Iowa is rated as "Average."(12)
    - Preventative measures that could keep Iowans healthier and out of the hospital are deficient, leading to problems across the age spectrum:
    - 11 percent of children in Iowa are obese.(13)
    - 21 percent of women over the age of 50 in Iowa have not received a mammogram in the past two years.
    - 36 percent of men over the age of 50 in Iowa have never had a colorectal cancer screening.
    - 74 percent of adults over the age of 65 in Iowa have received a flu vaccine in the past year.(14)
    The need for reform in Iowa and across the country is clear. Iowa families simply can't afford the status quo and deserve better. President Obama is committed to working with Congress to pass health reform this year that reduces costs for families, businesses and government; protects people's choice of doctors, hospitals and health plans; and assures affordable, quality health care for all Americans.

    1 U.S. Census Bureau, Current Population Survey. HIA-4 Health Insurance Coverage Status and Type of Coverage by State--All Persons: 1999 to 2007, 2007.
    2 Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2006, Table X.D.
    Projected 2009 premiums based on Centers for Medicare and Medicaid Services, "National Health Expenditure Data," available at http://www.cms.hhs.gov/nationa...
    3 Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2000, Table II.D.1.
    Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2006, Table X.D.
    Projected 2009 premiums based on Centers for Medicare and Medicaid Services, "National Health Expenditure Data," available at http://www.cms.hhs.gov/nationa...
    4 Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2006.
    5 Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2007.
    6 Furnas, B., Harbage, P. (2009). "The Cost Shift from the Uninsured." Center for American Progress.
    7 U.S. Census Bureau, Current Population Survey. Annual Social and Economic Supplements, March 2007 and 2008.
    8 U.S. Census Bureau, Current Population Survey. HIA-4 Health Insurance Coverage Status and Type of Coverage by State--All Persons: 1999 to 2007, 2007.
    9 Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2006, Table II.A.1a.
    10 Center for Financing, Access and Cost Trends, AHRQ, Medical Expenditure Panel Survey - Insurance Component, 2001, 2006, Table II.A.2.
    11 Health Care for America Now. (2009). "Premiums Soaring in Consolidated Health Insurance Market." Health Care for America Now.
    12 Agency for Health Care Research and Quality. 2008 State Snapshots. Available http://statesnapshots.ahrq.gov/.
    13 Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health, Data Resource Center for Child and Adolescent Health.
    14 Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2007.

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    well, (0.00 / 0)
    Two more reasons why we cannot settle for health care reform without a public option, or with a fake public option. I was glad to see several House Democratic caucuses affirm that they will fight any health care bill lacking "a real and robust public option that lives up to our criteria"

    We're in trouble if that's "available nationwide, on day 1, and accountable to Congress and the Peee-Pul."



    the four House caucuses (0.00 / 0)
    want the public option to be government-run and open to every American on day one.

    Invite other Iowa political junkies to join us at Bleeding Heartland.

    [ Parent ]
    available nationwide (0.00 / 0)
    is not the same thing as open to every American.

    [ Parent ]
    true (0.00 / 0)
    but previous statements I've seen from the four caucuses suggest that they are talking about a Medicare-type plan that any American could buy into.

    We'll have to see what emerges from the Senate. Obama probably would accept anything that gets the votes in the Senate. I believe he will only lean on the Senate to do better if House Dems prove they are ready to kill a bad health care reform bill.

    Invite other Iowa political junkies to join us at Bleeding Heartland.


    [ Parent ]
    you are correct (4.00 / 1)
    The four caucuses have a detailed platform. They cut through the fluff, and put down their markers on a Medicare model to ensure cost-cutting and fairness to disadvantaged citizens.

    The 'nationwide, available on day 1, etc' is a loser, which was my original point. This really goes back to whether the start point should have been 'public option.'

    If you're defining your plank according to what it can't be: regional, trigger, privately-run, you've already lost the battle.

    My friend Len Nichols of the NAF is back in the news today:


    "All this is complicated," Nichols said. "All this is hard to show."

    Americans who are going to pay a lot of the bill for covering the uninsured are being asked to believe in a different kind of payoff - one that is appealing but more difficult to quantify than the subsidies needed to help cover poorer people. Look past the price tag of legislation, Obama is saying, to a future of smaller premium increases and guaranteed coverage even if you lose your job or become sick.

    I'm asking you to believe ... The future of lower premiums is based on health IT, provider incentives for health outcomes, etc, not by a public plan driving down costs. Yes, it's hard to show, because as I've mentioned many times, and as Nichols himself notes in the recent paper cited below: "We admit there are few real-world examples that prove this kind of system would function as anticipated." I agree. The CBO agrees.

    If you read his paper: A Modest Proposal for a Competing Public Health Plan Nichols makes clear that 1) he thinks  a public plan is a waste -- he thinks private-only can be successful and points to the MA model, 2) that any public plan included is purely for political sake, and I quote:


    The political purpose of a public plan is to create a haven for individuals who are skeptical of private health insureres at the outset of a newly reformed marketplace.

    but that this can only take place under certain conditions:


    The disagreement over the potential uses of the public plan to rein in system costs could not be more profound. Our vision would not use the public plan's potential market power over provider payment.

    ...

    and avoid an inevitable drift to a single-payer system.

    I am certain that if there's a 'public plan' at the end of the day, it will not serve the function we intend it to serve. This will have been accomplished by ensuring that any of that nasty 'single payer' talk didn't see the light of day in the first place. And at this point, banging spoons on tables demanding 'nationwide, etc' simply helps this process along.



    [ Parent ]
    did you see this? (0.00 / 0)

    Despite data she released showing that fewer Iowans have health coverage through their employer, Sebelius downplayed the risk that employers would drop coverage altogether if a public option was available. The public option, she said, would be available only to those now without health insurance coverage.

    link


    I don't think anyone knows (0.00 / 0)
    what the public option will look like. Some of Obama's comments at the ABC forum made it sound like he envisions a public option that private insurers would have to compete directly against--if they can't compete, too bad.

    That said, I am not counting on the White House to hang tough on this. If a fake public option got through Congress, Obama would sign it and declare victory.

    We may need the Progressive Caucus and their allies to vote down whatever compromise emerges from the Senate. Then if Obama really wants health care reform to pass, he will have to get on the side of a real government-run public option open to everyone, and twist enough arms in the Senate to get to 51 votes.

    Invite other Iowa political junkies to join us at Bleeding Heartland.


    [ Parent ]
    I've been meaning to ask you about this (0.00 / 0)
    who were unable to purchase health insurance at any price

    Most states have a high-risk pool. MN's is one of the better ones. MD's is ok. Iowa's -- I'd rank below MN/MD, but still --  did your friends get turned down by HIPIOWA? It's supposed to be the insurer of last resort.

     


    I will ask them (0.00 / 0)
    They told me that they tried everywhere and no one would even give them a quote. I don't know whether they tried HIPIOWA, though.

    Invite other Iowa political junkies to join us at Bleeding Heartland.

    [ Parent ]
    they may (0.00 / 0)
    have been turned off by the 6-month wait period. In MD, it's one month.

     


    [ Parent ]
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