Repeal health care law? Forget about it

 By Joel Ario and Lawrence R. Jacobs, Special to CNN
updated 8:14 AM EDT, Wed July 25, 2012
Politicians should stop fighting and get to work on the health care reform, say Joel Ario and Lawrence Jacobs.

STORY HIGHLIGHTS
  • Joel Ario, Lawrence Jacobs: Cost of repealing health care reform will increase deficits
  • Key stakeholders are starting to build the new health market place, they say
  • States, medical providers, businesses, insurers and consumers embrace reform
  • Ario, Jacobs: It’s time to put aside politics and embrace the new health care system

Editor’s note: Joel Ario, a managing director of Manatt Health Solutions, previously served as director of the Office of Health Insurance Exchanges at the Department of Health and Human Services. Lawrence R. Jacobs is professor and director of the Center for the Study of Politics and Governance in the Hubert H. Humphrey School at the University of Minnesota.

(CNN) — On Tuesday, the Congressional Budget Office added another reason to drop the politics and get down to the hard work of health care reform. The nonpartisan organization released a report that finds the cost of repealing the reform will balloon government deficits by $109 billion between 2013 and 2022.

The CBO’s report reveals the practical hurdles to repeal and underscores a growing pattern in which the key stakeholders — states, medical providers, businesses, insurers and consumer groups — are moving beyond the partisan squabble to the no-nonsense work of building the market place of 2014, where everyone will be able to purchase affordable insurance regardless of pre-existing conditions.

Doctors, hospitals, insurers and employers are, of course, bargaining to improve their specific stakes. They harbor reservations and uncertainties, but their general approach is “mend it, not end it.”

The medical providers welcome relief from the crushing burden of uncompensated care and from the immorality of leaving the ill without adequate care owing to patients’ inability to pay.

Insurers look forward to new customers and to a new public conversation that spotlights the broader causes of high medical costs rather than blaming insurers alone.

Large employers are nervous about rising costs but are generally more concerned about moderating the rate of growth and ending a system that often shifts costs to them in the financial burden of caring for the uninsured.

A series of developments reveals the growing gap between the new reality on the ground and the lingering efforts of those who want to refight battles and repeal the law that the Supreme Court declared constitutional in June

Texas Gov. Rick Perry called Medicaid — the program for the indigent — the “Titanic” because he didn’t believe it was feasible or would prove seaworthy. Meanwhile, private business checked their bottom line and readily saw the new opportunities.

Our nation’s second-largest insurer, WellPoint, paid $4.9 billion in cash to purchase another insurance company, Amerigroup, to dramatically expand its ability to service the expanding number of people in Medicaid. Wall Street is doubling down on insurers who do Medicaid business because of their confidence in the Medicaid expansion.

As repealers complain, the marketplace created 89 new accountable care organizations, which were formed in 40 states to deliver more cost-effective care to more than 1 million people by July 1.

With great fanfare, House Republicans held a hearing earlier this month to profile how health reform interferes with patient care. There’s one problem: They are unable to feature the leading voices of patient care — the American Medical Association and American Hospital Association — because those organizations support reform as good for patients.

And then, of course, we have the voters. Only about a fifth push for full repeal. And many Americans, including rank-and-file Republicans, support new protections against insurers who turn away customers with pre-existing conditions or terminate policies when the costs of care pass annual limits.

Even if Republicans won the White House and congressional majorities in November, the frustrating legislative trapdoors that slowed and nearly killed health reform in 2009 and 2010 will likely remain hurdles to repeal. The reluctance of stakeholders, states and voters will stir consternation, delay and deadlock. The growing talk among Republicans of what would replace “repeal” is an early indicator of the changes afoot.

Republican Senate Majority Leader Mitch McConnell recently offered a dose of reality to calm repeal fever when he counseled that “it’s a lot harder to undo something than it is to stop it in the first place.”

Mitt Romney’s position may be the most revealing.

Against driving hailstorms from those favoring repeal, he has continued to support his reform in Massachusetts because he knows where stakeholders stand. While he won’t force states to implement his or the national reforms (he says he’d like to repeal the Affordable Care Act), his continued support for the Massachusetts reform will make it very difficult for him to deny other states the same opportunity that President George W. Bush gave him.

Reform of America’s health care system is under way, reconfiguring how care is provided and paid for. It is time to shift from symbolism and theatrics to the details of improving the transition that is occurring.

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Arrests over Capital Medicaid Protest

76 arrested in Capitol protest over Medicaid cuts

By Paul Courson, CNN
 
STORY HIGHLIGHTS
  • The demonstration is held in the Cannon House Office Building
  • Disability activists are worried about proposed cuts by House Republicans
  • Actor Noah Wyle is among those arrested

Washington (CNN) — Seventy-six people, including actor Noah Wyle, were arrested Monday at a demonstration protesting cuts in Medicaid proposed by the House Republican leadership, authorities said.

Hundreds of demonstrators filled the ornate rotunda of the Cannon House Office Building for the protests. The 76 were arrested on suspicion of unlawful conduct and demonstrating in a Capitol building, police said.

Wyle, formerly of “ER” and current star of “Falling Skies,” was among those handcuffed and taken away. Police said he and most of the others would face a misdemeanor fine and be released after processing.

The rally against the proposed cuts in Medicaid was organized by ADAPT, the Americans with Disabilities for Attendant Programs Today. A statement handed out during the event called for “accountability,” against the House’s proposed one-third cut to federal Medicaid spending.

“Today, I took part in an effort by ADAPT to bring attention to the Medicaid cuts that have been made by many states and are threatened to be made on a federal level,” Wyle said in a statement.

“To institutionalize a disabled American costs four times as much than to give assistance for independent living. This issue is about civil rights, not about medicine. People who have the ability to live in integrated, affordable and accessible housing should have the right to do so.”

The group wants House Budget Committee chairman Rep. Paul Ryan (R-Wisconsin) to require states to provide long-term alternatives to nursing homes and institutions that are often mandated by Medicaid rules.

Instead of home and community support when she’s older and unable to live on her own, protester Madeleine McMahan of Pennsylvania told CNN, “My generation? The Baby Boomers? we’re looking at nursing homes if we don’t do something about it.”

She spoke in handcuffs, waiting for police to escort her to an elevator for arrest processing.

Also in handcuffs and a wheelchair, Denise McMullin-Powell of Delaware said lawmakers proposing the Medicaid cuts are “completely ignoring that we even exist in the stupid budget that they have.”

She said “it’s worth getting arrested, it’s worth dying for, but they’re gonna kill us first because of the cuts. If we can’t stay in our home, if we can’t get the things we need through Medicaid, we will die in the streets without that type of thing.”

Wyle said, “This effort is to end the longstanding bias of the Medicaid system toward institutions and away from community care. The real shame is to see so many productive, intelligent people expending their energy on the fight for basic services to ensure their survival.”

Analysis – Health Care Costs more than Income

Take a close look at the chart up above. It’s taken from a new paper, in the Annals of Family Medicine. If you believe the doctors who put it together, it tells one of the scariest stories you’ll ever hear.

The gentle upward slope represents the median income for an American family, projected through 2035. The lighter colored curve is projected average spending on health care – insurance premiums, and out of pocket costs.

With current trends, the authors say, in less than 20 years the average family will face medical costs that are higher than their total income. All of it.

Dr. Jennifer DeVoe, one of the authors, says she already sees the strain in her practice at the Oregon Health Sciences University in Portland.

“I see people who don’t eat, or don’t pay rent, so they can pay medical bills,” she says. “They can’t afford their medication, or in some cases, even a mammogram.”

The basic facts aren’t new. Health care costs have been growing faster than inflation since the government began to track them in the 1960s. Between 2000 and 2009, the paper says, the average annual increase in insurance premiums was 8%, while household income rose an average of 2.1%.

But some experts say the doom and gloom is overblown. J.D. Kleinke, who last month wrote a Wall Street Journal op-ed titled “The Myth of Runaway Spending,” points out that growth in health spending has been moving closer to the overall inflation rate, for the past decade.  He says the slowdown came because insurers and private companies introduced plans with higher deductibles and bigger co-pays at the same time the government introduced health savings accounts, where individuals can get a tax break to help pay for medical expenses.

“In the old days, people never questioned cost because they were basically given a blank check,” says Kleinke. “Industry figured it out and said, ‘This is madness.’ ”

DeVoe acknowledges the trend, but says what strikes her first, “is that these costs are still increasing.”

Whether you see health spending as a crisis, depends, in part, on your focus.

In 2009 and 2010, total spending on health care grew at a slower rate – 3.8% and 3.9%, respectively – than at any time on record. But even that outstripped inflation –  1.6% in 2010, and a negative 0.3% the year before.

At the same time, a larger share of the cost is being borne by individual families. According to a survey last year by the Kaiser Family Foundation, premiums for family health insurance plans rose 9%.

To Kleinke, a resident fellow at the American Enterprise Institute, shifting the burden is good and necessary.

“Because people feel the economic pain directly, they’ve actually changed behavior, and spending did start to come down.”

A wild card in all this is the Affordable Care Act, often called “Obamacare.” Critics say expanding health insurance to cover another 30 million people will send costs through the roof. But ACA supporters point to provisions meant to slow or reverse the growth in spending – especially an emphasis on preventive care, which is supposed to reduce the need for expensive hospitalizations and emergency room visits.

DeVoe says the ACA is a “great first step, but it’s not enough to get us where we need to go in terms of sustainability.”

Co-author Dr. Richard Young, who runs the country’s largest family practice training program, at John Peter Smith Hospital in Fort Worth, Texas, points out that the new federal “comparative effectiveness” program – meant to compare the benefits of different treatments – is explicitly forbidden from considering cost, just as Medicare is forbidden from denying any “medically necessary” treatment, no matter how high the cost, or how small the medical benefit.

Young put it bluntly in an interview: “Until we’re willing to say ‘no’ to somebody, anybody, there is nothing to stop this inflationary pressure.”

Asked if the analysis isn’t deeply pessimistic, he said: “That’s right.”

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