Category Archives: Health Care

North Carolina Medicaid Reform

Medicaid

The new governor of North Carolina is out reform how Medicaid is paid for in the state:

 RALEIGH, N.C. — North Carolina’s $13 billion Medicaid program needs a big dose of private competition that will come from paying a handful of statewide managed-care providers to deliver medical, mental, and dental care to the elderly and disabled for a stable cost, Gov. Pat McCrory said Wednesday.

McCrory and state Health and Human Services Secretary Aldona Wos unveiled a proposal that would largely privatize management of Medicaid while keeping ultimate responsibility in state hands.

McCrory said reshaping Medicaid was the first and most pressing long-term task his three-month-old administration was tackling.

The problem today is that the program continually runs over budget and programs that had money allocated to them have to be adjusted to accommodate the overrun.

The idea is to remove the risk from the state and give it to the private sector in exchange for the chance to earn profits in the space.

Medical Innovation

innovation

I suspect that innovation in health care comes along in the same way that innovation in, say, TVs comes along.  Very expensive breakthroughs that eventually come down in price to the point that they become common place.

Consider this technology:

A team of scientists at Ecole Polytechnique Fédérale de Lausanne (EPFL) in Switzerland have developed the world’s smallest medical implant to monitor critical chemicals in the blood. The 14mm device measures up to five indicators, including proteins like troponin, that show if and when a heart attack has occurred. Using Bluetooth, the device can then transmit the data to a smartphone for tracking. The device can also track levels of glucose, lactate, and ATP, providing valuable data for physiologic monitoring during activity, or in possible disease conditions like diabetes. As far as tricorders go, this device may be the one you have been waiting for, provided you are on board for the implant.

I think this is cool; way cool.  And even if the cost is such that I can’t afford it for 10 years, I STILL think it’s cool.  In fact, I hope that rich people pay for the device and the service so that the price comes down to a level that allows for market penetration similar to HD TVs:

Last time the Giants played in the Super Bowl, in 2008, 41 percent of American households had at least one high-definition television.

That number has more than doubled, and now 87 percent of households have an HDTV, according to the Consumer Electronics Association.

Think of it.  Are we willing to “suffer” through only 41% of households having the best technology if it means that just 4 years later more than double that number will have the same access?

Let’s let people make profits off of cool things so that we can watch Super Bowls in HD.  And so that we can all have access to life saving technology.

Obamacare and Cost Savings

health care

Remember when proponents of Obamacare told us that government run health care models were better than private ones because they wouldn’t have to spend money on things like profit?

Or marketing?

So far California has received $910 million in federal grants to launch its new health insurance exchange under the Affordable Care Act (“Obamacare”).

The California exchange, “Covered California,” has so far awarded a $183 million contract to Accenture to build the website, enrollment, and eligibility system and another $174 million to operate the exchange for four years.

The state will also spend $250 million on a two-year marketing campaign.

Two hundred fifty million on marketing.

Not to mention the $143 million extra to start the thing:

Privately funded Esurance began its multi-product national web business in 1998 with an initial $5.5 million round of venture fund investment in 1999 and a second round of $34 million a few months later.

I’m not sure that we’ll ever be able to fix this thing we call Obamacare.  But it sure is gonna cost us if we don’t.

Where Are All The Doctors Going?

Doctor

There’s going to be some problems in Minnesota in the next 10 years:

Doctors are getting older in Minnesota.

In the next 10 years one in three will retire, and there aren’t enough future physicians to replace them. That could threaten your access to health care.

Combine this with a demand problem:

The Minnesota Health Insurance Exchange will give access to health care to an estimated 300,000 currently un-insured Minnesotans, meaning more patients, more overtime, and fewer doctors to treat them.

Now, I happen to think that as we increase our demand for doctors, the market should correct and supply us with more.  However, this can only happen if the market is free enough to allow corrections in price.

It’ll be interesting to watch as this unfolds across the country.

 

Obamacare Is Here

health care

I saw an article that democrats no longer feel that Obamacare can effectively be used against them as a weapon.  In essence, the law is here to stay and it is what it is.

I wonder if folks working at CVS knew what was in store:

In the wake of the implementation of the Affordable Care Act, CVS is telling its employees they need to reveal their height, weight, body fat percent and other personal information for health insurance purposes.

The Rhode Island-based company, which employs around 200,000 individuals, is telling workers who use its health insurance they need to have a wellness review done — or pay up.

The idea is to incentivize healthy living. CVS says the idea is nothing new.

“The idea of an employee wellness plan is perfectly legal under the ADA. Courts held up these plans,” said Joshua Kersey, a Tampa labor attorney. He says with “Obamacare” looming in 2014, practices like this wellness review are likely to become more common, because a lot of employers are expecting to pay more for their workers’ health insurance.

“The more money it’s going to save the employer, the more incentive the employer has to affect these types of programs,” he said.

In CVS’s case, workers not comfortable getting the review done will have to pay a $600 annual penalty.

Subject yourself to the wellness plan or face $600 in penalties.

This is the face of “free” healthcare.

Strange But True: Elements Of Obamacare Cost Most Than Originally Expected

Imagine my shock when I heard that portions of Obamacare are running into financial difficulty:

WASHINGTON (Reuters) – The Obama administration on Friday said it would stop enrolling new beneficiaries in a special $5 billion insurance program for people with pre-existing medical conditions, because of rising costs and limited funding.

The news comes a day after a top U.S. healthcare official told lawmakers on Capitol Hill that the administration is grappling with financial difficulties but determined to keep the Pre-Existing Condition Insurance Plan (PCIP) operating in 23 states and the District of Columbia through 2013.

PCIP was established in 2010 under President Barack Obama’s healthcare reform law to provide coverage for sick people unable to find it in the private insurance market. The program is designed as a bridge to January 1, 2014, when legal restrictions barring discrimination over medical conditions come into force.

The U.S. Department of Health and Human Services issued a notice on Friday saying it would suspend new enrollments beginning on Saturday to “help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.”

And what happens to government agencies that find they are short on money?  Why, they ration:

Gary Cohen, the HHS official responsible for overseeing implementation of Obama’s healthcare reforms, including PCIP, told the Senate Finance Committee on Thursday that the administration had begun to alter program benefits while grappling with funding restrictions.

It’s not very difficult to see where this whole thing is going to go.

We’re Gonna Ration

The allocation of scare resources: Rationing.

There are a lot of ways of doing it; time, money, connections even luck.

Some of us think that rationing by money optimizes quality and supply.  Others think that rationing by time does the same thing.  I disagree:

SACRAMENTO — As the state moves to expand healthcare coverage to millions of Californians under President Obama’s healthcare law, it faces a major obstacle: There aren’t enough doctors to treat a crush of newly insured patients.

So, California is going to ration on time.  And one of the metrics that time based rationing optimizes is – low quality:

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

Now, to be sure, allowing non-doctor health care providers could very well be positive; after all – why do we need an MD to refill a prescription for blood pressure medication?  However, I’m sure that California isn’t embracing this is an open-market mindset.  Rather, docs are just fleeing the medicaid business.  In fact, in California, only 57% of doctors are accepting new medicaid patients.

 

Another Company Cuts Hours

Yesterday I posted about an IT firm cutting hours as a result of the economic conditions ahead.

Hours were going to be cut.  Instead of a 5-day work week the schedule would now be built around a 4-day work week.

My suspicion is that the firm is targeting a work week that comes in under 30 hours a week.

Well, there is a company that is making no bones about it:

A fast-food chain is slashing employee hours so franchise owners don’t have to pay health benefits. Around 100 local Wendy’s workers have learned their hours are being cut. A spokesperson says a new health care law is to blame.

The penalty for failure to offer insurance is $2,000 per employee.  In this case, $200,000 is a lot of money:

The company has announced that all non-management positions will have their hours reduced to 28 a week. Gary Burdette, Vice President of Operations for the local franchise, says the cuts are coming because the new Affordable Health Care Act requires employers to offer health insurance to employees working 32-38 hours a week. Under the current law they are not considered full time and that as a small business owner, he can’t afford to stay in operation and pay for everyone’s health insurance.

The irony, of course, is that fast food chains typically employ the younger worker.  Folks who might be entering the job market for the first time and are learning valuable work skills.   Skills that they may not otherwise acquire.  And the reason they are being impacted is a law that attempts to help provide medical care to the population.  Well, these kids are the healthiest segment OF that population.

 

Elections Have Consequences

It’s simple, really.  When there is an incentive to save money, there should be no surprise that incentives will drive behavior.  Consider Community College of Allegheny County:

To Community College of Allegheny County’s president, Alex Johnson, cutting hours for some 400 temporary part-time workers to avoid providing health insurance coverage for them under the impending Affordable Health Care Act is purely a cost-saving measure at a time the college faces a funding reduction.

But to some of the employees affected, including 200 adjunct faculty members, the decision smacks of an attempt to circumvent the national health care legislation that goes into effect in January 2014.

“It’s kind of a double whammy for us because we are facing a legal requirement [under the new law] to get health care and if the college is reducing our hours, we don’t have the money to pay for it,” said Adam Davis, an adjunct professor who has taught biology at CCAC since 2005.

Temporary part-time employees received an email notice from Mr. Johnson on Tuesday informing them that the new health care act defines full-time employees as those working 30 hours or more per week.

As a result, the college as of Dec. 31 will reduce temporary part-time employee hours to 25 per week. For adjuncts, the workload limit will be reduced from 12 to 10 credits per semester.

The decision affects only temporary part-time employees and not permanent part-time employees who already are eligible to participate in the college’s health care plan.

My hope is that the folks impacted voted for Obama; you should reap the rewards of the decisions you make.

But that’s not all:

Darden Restaurants Inc. — parent of the Red Lobster, Olive Garden and Capital Grille eateries in Colorado and elsewhere — is cutting back hours of workers at some of its locations in an apparent effort to reduce insurance costs related to the new health-care reform law.

The Orlando, Fla., Sentinel newspaper reports that the Orlando-based company (NYSE: DRI) “has stopped offering full-time schedules to many hourly workers in at least a few” of its locations.

The Sentinel quotes the company as saying it plans to limit employees at some restaurants in four unidentified markets to 28 hours a week. Darden said the move is intended “to help us address the cost implications health care reform will have on our business.”

Under the federal Affordable Care Act, the health-reform law that some call Obamacare, companies with at least 50 employees must provide health insurance, starting in 2014, to all those who work at least 30 hours a week. Those that don’t will pay a penalty.

I suspect that this will play out across America more and more.  As the ramifications of electing Obama continue to see the light of day, more and more we are going to see this reaction by business.  Fewer people hired, higher ratios hired as part time employees, more efforts to drive productivity by more and more automation.

It really is important to understand that there really aren’t solutions; only tradeoffs.

Want healthcare?  Lose jobs.  Sacrifice growth, accept higher unemployment.

If you voted for Obama, this is on you.  This is what you wanted, this is what you explicitly put into motion.

We warned you.

 

Basic High School Math Fail

Again, I’m reading a bunch of stuff for an upcoming post and I see this:

Lucia Harkenreader’s check landed in her mailbox last week: a rebate of $456.15 from her health insurance company, with a letter dryly explaining that the money came courtesy of the federal health care law.

For Ms. Harkenreader, 53, who is putting a son through college, the rebate helps soothe the frustration she feels toward her insurer, Golden Rule, which is owned by UnitedHealthcare.

“It seems like the health insurance companies really just don’t have any consideration for the cost out here,” said Ms. Harkenreader, who pays about $480 a month for a high-deductible plan, up from $400 last year. “What costs have gone up to justify that rise in premium? I’d love to know. Did you give your people a raise? I guess your light bill went up?”

How is it possible that she can ask “What costs have gone up?” as she clutches a $456.00 check?  How can she ask “What costs have gone up?” as insurance companies are required to “insure” people who knock on the door with a broken arm?

People wonder why this country is in trouble.