Submitted by kgmeiner on Tue, 02/04/2014 – 2:56pm
By: Kathleen Gmeiner, Project Director, OCHC
Three Republican Senators – Orrin Hatch, Tom Coburn and Richard Burr – introduced on January 27, 2014 the Republican replacement plan to go with their party’s call to “repeal and replace Obamacare.” It’s called the “Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE Act).” It would be a very poor replacement for the ACA. It makes health care affordable for far fewer people and at the expense of comprehensive benefits and covering those excluded from the market by pre-existing conditions. Here is what it does:
People would have protection from insurance company discrimination based on pre-existing conditions ONLY IF they were continuously insured. Otherwise their option would be state high risk pools that the law would aid. [Note: State-run high risk pools have never been effective in covering the millions with pre-existing conditions].
Young adults could still remain on their parents’ insurance policies.
Prohibition on lifetime limits in what an insurance company will pay out remains.
People who fail to choose a health plan would be passively enrolled in a plan at the subsidy to which they are entitled; they could drop it.
It would encourage malpractice reform.
It would give states Medicaid dollars based on the number of people enrolled in Medicaid, not based on what the state spent on Medicaid. The ACA provision that subsidizes states at 100% and then down to 90% would be gone. Persons eligible for Medicaid could take Medicaid or buy private insurance instead with a subsidy.
It would keep the changes to Medicare in the ACA.
It would prevent insurance companies from canceling insurance policies except for fraud or misrepresentation.
What’s missing from the Republican plan?
The mandated set of benefits (The ACA requires policies to have ten essential health benefits)
The prohibition against gender discrimination
Protection for pre-Medicare age older adults –Under the ACA, a 60-year-old cannot be charged more than 3 times what a 20–year-old is charged. Under the Republican plan, the older person could be charged 5 times as much. And, states could even opt out and charge greater than five to one.
Tax subsidies are cut off at 300% of the federal poverty level, not 400% as under the ACA
Financing – the insurance, hospital and medical device provider taxes that support the ACA are gone; the replacement is a reduction on what employers who provide insurance can deduct from their taxes.
The Center for Health and Economy, a newly-created think tank by former Congressional Budget Office and Republican Douglas Holtz-Eakin, issued a fiscal analysis of the plan January 30th. Of note, the Center says that “there will be a significant increase in individual market participation, but that is “expected to be offset by large reductions in the Medicaid population.” (emphasis added)
And that’s the rub. While the plan would provide subsidies, it would greatly reduce Medicaid. And it leaves all of the people with pre-existing conditions who are unable to maintain continuous coverage at the mercy of state high risk pools, which have a terrible track record for helping large numbers of those with pre-existing conditions. Those who could maintain coverage would likely do so with higher deductible plans that would not be required to provide mental health and substance use disorder services, maternity coverage, women’s health benefits and the preventive services – all now firmly established in the ACA.
Let’s take a look at the subsidy in the ACA and the CARE Act by looking at a hypothetical.
Tricia is 26-year-old single adult living in Franklin County with annual income of $22,000, or 191% of the federal poverty level. Under the newly proposed “CARE” Act she would get a subsidy of $1,560 for a year. Applied to the lowest cost silver plan in the current Ohio Marketplace, she would pay $125 per month under CARE, while under the ACA she is paying $105. But, under the ACA she can receive, without co-pay or deductible, an annual well woman visit and a routine Pap test. Under the ACA, if she gets pregnant she’s covered. If she is diagnosed with a mental illness, she’s covered. Under Tricia’s silver plan she can see her doctor for a $10 co-pay. None of these benefits is guaranteed in the CARE plan. And without the ACA, she may be paying more for her insurance than a 26 year old male living in her same city.
There is one silver lining in the introduction of this new plan. It shows that Republicans recognize that they can’t keep calling for the ACA’s repeal without an alternative and that to have a chance at passing a “replacement” bill, they cannot totally roll back the ACA. But that is about the only positive that can be said about it.
Submitted by achenault on Wed, 04/23/2014 – 4:35pm
If you know anything about UHCAN Ohio, you may be puzzled about the seemingly odd assortment of work we do. ACA implementation makes sense, but why are we engaged in a dental access campaign, a report on community health workers, building the voice of Medicare/Medicaid beneficiaries in a new managed care model? There’s a method to our seeming madness.
Even with the achievement of the Affordable Care Act, there is still much to be done. We still have too many people without insurance, and others with insurance but unaffordable out-of-pocket costs. We have people with chronic conditions and disabilities, including mental illness and addiction, who do not receive the right services at the right time and place. Too many people end up in the hospital and nursing homes because they don’t have the care they need to stay healthy and at home. Health care spending is growing too fast for individuals and the economy. And 30% of that spending either provides no value or actual harm. Because the problems are so complex, we need to have a multi-layered approach to solutions.
In its earlier years, UHCAN Ohio, understandably, focused largely on fighting for coverage and access to affordable care for uninsured and under-insured people – expanding Medicaid coverage for working parents, strengthening hospitals’ “charity care” policies, and immigrant access to interpreters and health care, to name a few
In 2008 Governor Strickland’s administration convened a multi-stakeholder “State Coverage Initiative.” UHCAN Ohio was at the table, along with Ohio Consumers for Health Coverage. From the start, participants raised the need to address skyrocketing health care costs, waste in the system, uneven quality of care received, and racial/ethnic health disparities. Otherwise the rising cost of health care would make coverage expansions impossible to sustain, Both the Strickland and Kasich administrations, in different ways, organized initiatives to develop strategies to reform how we deliver and pay for health care.. UHCAN Ohio, aware that system change could be very good – or very bad – for consumers, organized consumer participation all along the way. After all, shouldn’t consumers have a voice in reshaping the system?
The goal of health reform is often defined as the “triple aim:” Better care, better health, and lower costs for everyone. We recognize that “better health” means investing more in prevention and health improvement. Furthermore, much of what determines a person’s health – especially for people of color and people with low incomes – occurs outside the medical system, such as where you live and work, access to nutritious food, and time to exercise. Plus, profound racial and ethnic health disparities, the legacy of historic discrimination in employment, housing and criminal justice, won’t go away without deliberate policy decisions.
Here are some core understandings that UHCAN Ohio has about its work.
There’s a lot wrong with our present health care coverage, quality and cost. That’s why we have to tackle change from several angles at once – and demand a seat at the table for the users of the system. In future newsletters, you will see articles exploring how we are tackling the various parts and how you can get involved in reshaping health care.
Submitted by achenault on Wed, 10/22/2014 – 12:00pm
Three Ohio dentists who are leaders in providing quality dental care to all Ohioans have traveled to Alaska to review the education program for the Dental Health Aid Therapists.
We asked them recently to reflect on their experience and help paint the picture of how Dental Therapists can be part of the solution to solve Ohio’s oral health crisis.
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Dr Hill is the retired dental director of the Cincinnati Health Department and is the Executive Director of the American Association for Community Dental Programs |
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Dr. Ed Sterling, DDS, was the director of The Ohio State University Nisonger Center IDD Dental Program for 39 years. While leading the dental program, he served more than 10,000 children and adults with intellectual and developmental disabilities, and taught thousands of dental students and dental hygiene students; general practice dental residents in Ohio State’s College of Dentistry and pediatric dental residents from Nationwide Children’s Hospital how to provide best practice dental care to children and adults with disabilities |
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Dr. Barry Gibberman has been helping patients have the smile of their dreams for over 30 years. He was recruited to Cincinnati from his native New York City by Procter and Gamble where he helped manage clinical trials for Crest toothpaste. He left P&G to pursue a career in Family dental practice. |
Why were you interested in going on the trip?
Dr. Gibberman: Through a longtime friendship with a public health dentist in Cincinnati, I was introduced to the DHAT concept at several lectures and meetings over the past 2 years. It seemed very intriguing to me and I did not completely understand the resistance to the concept by organized dentistry. Seeing the program first hand would give me a much better appreciation of the issues surrounding the DHAT controversy. So I decided to go!
Dr. Hill: My first trip to Alaska was in 2007. I had first heard about the New Zealand program and those in other countries and their success in 1976. Being a public health dentist, I was aware that every attempt made in the US to pilot similar models had been thwarted by the American Dental Association. My career has been devoted to creating access to oral health care for low income, uninsured and underinsured folks. At the time I went to Alaska, at the invitation of two Alaska foundations, along with representatives of the American Dental Association, the American Public Health Association and others, the Alaska Dental Association and the American Dental Association had filed a law suit against the Alaska Native Tribal Health Consortium in an attempt to once again stop any attempts to implement this model.
Dr. Sterling: l was interested in the trip in order to see the program “up close.” I had read about it and we have had discussions but to see it adds another dimension.
What were your expectations before you went on the trip?
Dr. Gibberman: I expected to see competent, well trained, young para-professionals treating young and adult patients. I expected to see basic dental services performed well–
Dr. Hill: My expectation was to be able to see the curriculum and teaching/training facilities, observe students and therapists at work, examine the quality of their work and speak with residents of Alaska to get a sense of the attitudes of the general population. I went with an open mind, without preconceptions of any of the above. I have now been to Alaska three times to make my observations, each time with a different group of dentists, some more skeptical than others, who were going for the first time. Each time, I wondered what their response would be.
Dr. Sterling: My expectations were that there was a training and a clinical program – beyond that, I didn’t have much in mind.
How was the reality of the program different from your expectations?
Dr. Gibberman: The reality of the program exceeded my expectations. The DHATs were mature young to middle age adults who took the jobs very seriously. They were well trained, had excellent supervision, spent a great proportion of their time building relationships in the communities in which they worked and managed to inspire other young villagers to consider entering training programs which could improve their future livelihood.
Dr. Hill: The reality was extremely gratifying. I found the training to be exemplary, the students to be both passionate and compassionate. The quality of the treatment being provided was at least comparable to that provided by young dentists I had hired as dental director for the Cincinnati Health Department. The facilities were almost exact duplicates of those we had in our public health system, with excellent equipment and ADA approved materials.
And interestingly, I had opportunities to speak with residents who found the program extremely helpful and couldn’t understand all the controversy. One mother told me that before therapists she couldn’t afford dental care for her whole family. She had to pick and choose, depending on her personal resources and who she thought was the highest priority, who could get dental care. She always fell to the bottom of the family list and had been in great need of care until her community got therapists. On each of my second and third trips, every dentist left Alaska convinced of the quality of care, appropriateness of care and the value therapists would have in the Lower 48.
Dr. Sterling: I was quite impressed with the DHATs. Their commitment and their sacrifices to participate in the program – and there were significant sacrifices; the length of the training time, the distance from family – were readily apparent. They were mature beyond their ages and quite sophisticated, not only in their presentations, but in their manner. They were younger than most of the dental students I have dealt with yet, far more mature. The technology in use is impressive and their equipment is newer than in my office – certainly newer than I anticipated. The organization is outstanding. The didactic materials are very well organized and I was quite pleasantly surprised to greet two former OSU students who are the primary didactic instructors (Dr. Mary Williard and Dr. Sarah Shofstall).
The supervising dentist determines what procedures the DHAT is permitted; it is individualized based on the supervising dentist’s assessment of the individual DHAT. The quality of the care provided was excellent and the level of caring for their patients was obvious. I would have liked to have observed some of the restorative care provided.
The student selection process is quite rigorous, as it should be. The supervising dentists I encountered were committed to their roles as a teacher, a mentor and the responsible party for what was done. I was surprised at the number of patients who have been served by the program – it is impressive.
The recertification process is also quite rigorous with 80 hours of direct supervision every two years; this is in addition to continuing education requirements. That is far more rigorous than any dental health professional faces in Ohio.
What would having dental therapists in Ohio mean for Ohioans?
Dr. Gibberman: DHATs in Ohio could seriously improve access to care. One dentist supervising multiple DHATs could serve many patients needing care at a potentially lower cost than individual dentists- in remote as well as inner city areas which are currently underserved.
Dr. Hill: Dental programs that are currently threatened with staff reductions and reductions in capacity as costs continue to rise and Medicaid rates remain stagnant (no increase in almost 15 years), will have an opportunity to restructure delivery of services in a less expensive, more cost effective manner. Other programs will be able to consider expanding services. I can think of community health centers that have facilities that would allow for more staff, but currently more staff means bigger financial losses for the center. Therapists would make program expansions possible.
It would mean that care could be accessible to those living in rural and geographically isolated areas, as in southwest Ohio. And, by recruiting dental therapy students from these communities, with some incentives to return, it would assure these communities that dental care was accessible and continuous
Dr. Sterling: Dental therapists would certainly be an asset in Ohio. Dental therapists are competent, capable professionals. They can augment community programs that have great difficulty meeting the salary requirements of the dentists they employ. It is hard to locate dentists and harder to keep them. Medicaid fees have not changed since 2000. This is a de facto decrease since all other costs; e.g. materials, staff, equipment and utilities have all increased.
I view dental therapists as potential practice extenders. They would be an asset to private practices, as well. They can be a parallel provider within a defined scope of practice. Dental therapists would certainly make it possible for significantly more people to receive needed dental care. They would provide continuity and consistency to the delivery of dental care, including health guidance – something that is not available to many Ohioans today.
Dental care should not depend on a feel good one day a year program. Certainly there can be acute situations in dentistry but, for the most part, we are dealing with chronic conditions and chronic needs; these require continuity. One day a year, one month a year, sealants and fluoride varnishes will not meet the need. With the use of technology, supervision can be “direct” even when distant.
Submitted by achenault on Wed, 10/22/2014 – 12:41pm
By: Cathy Levine, Executive Director, UHCAN Ohio.
Ten years ago, my mother was readmitted to a suburban New York hospital after shoulder surgery, for a urinary tract infection caused by the catheter used during surgery – considered a preventable infection (they then made her very sick from a test she probably didn’t need). That was my introduction to hospital readmissions for Medicare patients.
A recent Columbus Dispatch article reported that Central Ohio hospitals are paying higher penalties to Medicare, because their readmission rates are not improving at the rate Medicare wants. What’s going on and what do consumers need to know?
Nationally, almost 20% of Medicare patients who are hospitalized are readmitted to the hospital within thirty days for reasons connected to the original admission. Hospital readmissions cost Medicare $17 billion per year – spending that’s largely preventable with better care. But hospital readmissions brought increased revenues to hospitals and taking steps to prevent readmissions cost hospitals money. So, hospitals had financial incentives to maintain the status quo of – until now.
Readmissions happen for several reasons besides hospital-caused complications. A big culprit is inadequate transition planning – for instance, sending a frail older adult home without making sure home care is provided to support recovery. To prevent readmissions, hospitals have to look out for patients after they leave the hospital – either by providing follow-up care or coordinating that care with community-based providers or nursing homes.
To reduce readmissions rates among older adults, Ohio’s Area Agencies on Aging in several regions have established transitions programs using a national model with demonstrated effectiveness.
Another tool for reducing readmissions is the model of enhanced primary care – the so-called “Patient Centered Medical Home,” which is a medical practice that coordinates patient care across settings. PCMH patients who are discharged home from the hospital should expect their doctor’s office to coordinate the patient’s home care.
Medicare’s system of penalties based on unacceptable readmission rates is spurring improvements in patient care and saving money. Why not do the same for Medicaid and privately insured patients? Community Catalyst created model legislation that adjusts payments based on rates of readmissions and other preventable harm. Versions of this legislation is in effect in several states to improve patient safety while saving money.
UHCAN Ohio and Ohio Consumers for Health Coverage have recommended to the Kasich administration that they adopt a similar reimbursement system to reduce readmissions. They received legislative authority to implement it in Medicaid. How much longer must consumers wait?
FOR IMMEDIATE RELEASE: CONTACT: John Arnold, 614-456-0060 ext. 237
December 15, 2014
Advocates Concerned About Confusion as MyCare Ohio Kicks In on January 1
Nearly 100,000 Ohioans who are dually eligible for Medicare and Medicaid are currently enrolled in managed care plans of MyCare Ohio, the demonstration to integrate and coordinate their care, for their Medicaid services.
On January 1, 2015, MyCare Ohio enrollees will begin also receiving their Medicare services through their MyCare plan, unless they choose to opt out. Enrollees who have not made a choice have already been assigned. Ohio Consumer Voice for Integrated Care (OCVIC) is extremely concerned about widespread confusion among many enrollees about their choices with respect to their Medicare services.
In the past 2 months, enrollees received notices from the state explaining their options. But these notices are way too complicated for the average person to understand – let alone older adults with cognitive impairments. OCVIC is fearful that enrollees will realize what’s happened only if they encounter interruptions of current Medicare services, including doctor visits and prescription drugs. MyCare Ohio Enrollees Need to Understand Their Choices and that Help is Available
MyCare Ohio enrollees can choose to continue receiving their Medicare services through the traditional program or a Medicare Advantage plan. But, to avoid having their Medicare automatically switched into their MyCare Ohio plan, enrollees have to take active steps to “opt out.” The problem is, many enrollees are confused.
In order to make a good decision about MyCare Ohio for themselves, people need to know:
Consumers must also understand that MyCare Ohio plans are managed care organizations. That means that in order to receive the most benefit,
These requirements may be very different for people who participate in the traditional Medicare fee-for-service program.
Certainly the coordination of all medical and home and community based services offered by MyCare Ohio is a benefit that may help a lot of people as well as having one insurance plan and member ID card that covers everything. But, making MyCare work is an individual decision. In this case, one size does not fit all.
For help in understanding your choices, enrollees can contact:
Your Local Area Agency on Aging
OSHIIP
Talk to Your Providers:
MyCare Ohio beneficiaries should talk with their doctors and other providers to make sure that they will still be able to serve them after January 2015. For more information about their plans and services they should call their MyCare insurance plan. The telephone numbers for each plan is listed below.
Providers who have additional questions about reimbursement, becoming a contracted provider, or how MyCare Ohio will work for their patients or clients should contact each plan’s provider service. These numbers are listed below.
Understanding MyCare Ohio is a challenge for most people and if this new demonstration is going to work in Ohio, we must make sure that it does no harm to our most vulnerable populations that are mandated to participate.
Consumers Need to Know:
1. MyCare Ohio members can add or remove coordination of their Medicare services every month. They must continue to have their Medicaid services coordinated by their MyCare plan.
2. There are benefits and potential drawbacks to having MyCare Ohio coordinate your Medicare services.
3. Free help is available in your community to help you to understand your choices. Contact your local Area Agency on Aging or OSHIIP.
Your doctors and other providers may be confused about whether they can treat you, if you are in MyCare Ohio. Talk to your providers and have them call your plan’s Provider Services to resolve whether they can continue as your provider.
Submitted by achenault on Wed, 01/14/2015 – 2:08pm
We are grateful for your generous gifts in the last weeks of 2014. Thanks to your support, UHCAN Ohio will continue, in 2015, to build the consumer voice to shape health care polices and develop solutions to meet Ohioans’ needs.
In 2015, we will:
From the bottom of our hearts, we thank you for taking your commitment to make health care work for all Ohioans to the next level by donating to UHCAN Ohio.
