Johns Hopkins Medicine CEO: Obamacare Will Have “Catastrophic Effects” on Health-Care

[spursncowboys]

Johns Hopkins Medicine CEO: Obamacare Will Have “Catastrophic Effects” on Health-Care Safety-Net
Posted December 7th, 2009 at 2.40pm in Health Care.
Dean and CEO of Johns Hopkins Medicine Edward Miller writes in the Wall Street Journal (http://online.wsj.com/article/SB10001424052748703939404574567981549184844.html):

"Both the House and Senate health-care reform bills call for a large increase in Medicaid—about 18 million more people will begin enrolling in Medicaid under the House bill starting in 2013, Centers for Medicare and Medicaid Services (CMS) Actuary Richard Foster estimates.
…
A flood of new patients will be seeking health services, many of whom have never seen a doctor on more than a sporadic basis. Some will also have multiple and costly chronic conditions. And almost all of them will come from poor or disadvantaged backgrounds.
…
We’ll meet the demands placed on us because serving poor and disadvantaged populations is part of our century-old mission. But without an understanding by policy makers of what a large Medicaid expansion actually means, and without delivery-system reform and adequate risk-adjusted reimbursement the current health-care legislation will have catastrophic effects on those of us who provide society’s health-care safety-net. In time, those effects will be felt by all of us."

Read Miller’s entire op-ed here - http://online.wsj.com/article/SB10001424052748703939404574567981549184844.html.

Abortion, the public option, and the individual and employer mandates are all important issues in the health care debate. But Miller’s op-ed reminds us that not enough attention has been paid to the fact that in both the House (http://blog.heritage.org/2009/10/30/the-house-health-bill-a-welfare-spending-explosion/) and Senate bills (http://blog.heritage.org/2009/11/19/the-senate-health-bill-medicaid-and-class-act-provisions/), almost half of all new insurance coverage gained through “reform” is actually accomplished through expansion of Medicaid eligibility requirements. The only reason Medicaid carries such a heavy load under Obamacare (http://www.heritage.org/Research/HealthCare/wm2662.cfm) is because the Congressional Budget Office scores it as an inexpensive way too expand health insurance coverage. But Medicaid does not provide ideal health care (http://www.heritage.org/Research/HealthCare/bg2183.cfm). That is why single payer advocates push for “Medicare for All” (http://www.medicareforall.net/) not “Medicaid for All” … which is what Obamacare may actually deliver.

http://blog.heritage.org/wp-content/uploads/2009/11/medicaidfifth.jpg

Go here to see a larger, printable PDF of the chart.

[ChumpDumper]

“Medicaid for All” … which is what Obamacare may actually deliver.Since when does 20% mean "all"?

[George Gervin's Afro]

Since when does 20% mean "all"?

He has to go back to the Heritage Foundation to answer that one.

[George Gervin's Afro]

The Senate Health Bill: Medicaid and CLASS Act Provisions
Posted November 19th, 2009 at 5.20pm in Ongoing Priorities.
The 2074 page Reid Health Bill (H.R. 3590) generally follows the Senate Finance and HELP versions on Medicaid and in the creation of a new health care program, the Community Living Assistance Services and Supports (CLASS) Act.

Curiously, in the short term (2010-2013), the Reid bill helps fewer people gain coverage than the Senate Finance bill. The Congressional Budget Office (CBO) estimates 2 million will lose Medicaid/SCHIP coverage each year in this period compared to current law. But, by 2019, Medicaid/SCHIP enrollment will increase by 15 million, accounting for nearly half of all individuals who will gain coverage.

More Welfare. The Reid bill expands Medicaid eligibility for people below 133 percent of the Federal Poverty Level (FPL), significantly changing it to a pure income based federal entitlement. It also raises, then lowers, the federal matching rates for different populations and states. In a provision aimed at Louisiana, the Reid bill provides a special “disaster recovery” match rate for states that have had a major disaster declared (Section 2006). CBO estimates that state spending under the Medicaid provisions will still increase by $25 billion.

Of course, there are millions of persons at or below 133 percent of the federal poverty level who get private health insurance. The Reid bill would, based on all previous experience, guarantee a further crowding out of private health care coverage.


From one of the blogs the sissy used to document his nice picture. What experience is this blogger relying on to make the claim that people will get crowed out of private insurance? Can I just substitue my experience to refute this?

[TeyshaBlue]

From one of the blogs the sissy used to document his nice picture. What experience is this blogger relying on to make the claim that people will get crowed out of private insurance? Can I just substitue my experience to refute this?

If the blogger you are refering to is Dennis G. Smith, then I'd say he's got a little cred as the former Director of Medicaid and State Operations at the U.S. Department of Health and Human Services. The crowding out effect he's talking about is, I think, the effect that eligibility expansions, ie pre-existing conditions, would have on premium prices. They would inevitably rise creating a heavier pricing pressure that could squeeze some consumers out of the market.

[MannyIsGod]

Wait, so Miller is proposing keeing the same system in due to cost?

How is this not hte rationing you guys so often use as a scare tactic?

[MannyIsGod]

I'd say the idea that private insurers are getting crowded out of markets they aren't in to begin with is fairly funny. Why do you think we have so many uninsured?

[TeyshaBlue]

I'd say the idea that private insurers are getting crowded out of markets they aren't in to begin with is fairly funny. Why do you think we have so many uninsured?

I don't think that was what Dennis Smith was concerned with. I think he was refering specifically to those that were at or just above the poverty line that currently had insurance. Of course, that might only be 12 people, but the point stands.

I think we have so many uninsured for a myriad of reasons ranging from choice to the codependent relationship between pharma, insurance and gpos, to the undeniable opacity of pricing. Why do you think we have so many uninsured?

[spursncowboys]

I smoked pot with Johnny Hopkins.

[MannyIsGod]

I don't think that was what Dennis Smith was concerned with. I think he was refering specifically to those that were at or just above the poverty line that currently had insurance. Of course, that might only be 12 people, but the point stands.

I think we have so many uninsured for a myriad of reasons ranging from choice to the codependent relationship between pharma, insurance and gpos, to the undeniable opacity of pricing. Why do you think we have so many uninsured?

Price. By and large it all comes down to cost. I used to sell insurance about 7 years ago and I sold skimpy plans that were good for huge medical emergencies but that was it. The amount people I spoke to were paying was sometimes astronomical.

People at 133% above the poverty line are not getting private insurance unless it is provided through an employer. I don't have figures to back this up right now (and frankly I'm too tired this evening to search for them - maybe after finals) but I fail to see how a single person making 13,000 (roughly) a year is going to go out and spend about 10% of that on health insurance (assuming they are healthy).

[George Gervin's Afro]

If the blogger you are refering to is Dennis G. Smith, then I'd say he's got a little cred as the former Director of Medicaid and State Operations at the U.S. Department of Health and Human Services. The crowding out effect he's talking about is, I think, the effect that eligibility expansions, ie pre-existing conditions, would have on premium prices. They would inevitably rise creating a heavier pricing pressure that could squeeze some consumers out of the market.

I can't reconcile the notion that the raising poverty level will force those who have insurance to lose it.

[Nbadan]

Recenty released CBO estimates project that employer based health insurance could see up to a 3% drop in premiums under the Senate plan...

Employment-Based Coverage


The legislation would have much smaller effects on premiums for employment-based coverage, which would account for about five-sixths of the total health insurance market. In the small group market, which is defined in this analysis as consisting of employers with 50 or fewer workers, CBO and JCT estimate that the change in the average premium per person resulting from the legislation could range from an increase of 1 percent to a reduction of 2 percent in 2016 (relative to current law).6 In the large group market, which is defined here as consisting of employers with more than 50 workers,the legislation would yield an average premium per person that is zero to 3 percent lower in 2016 (relative to current law). Those overall effects reflect the net impact of many relatively small changes, some of which would tend to increase premiums and some of which would tend to reduce them (as shown in Table 1).7

CBO (http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf)

Bet Joe 'the truth' Paggs won't tell you that on his show

[TeyshaBlue]

Price. By and large it all comes down to cost. I used to sell insurance about 7 years ago and I sold skimpy plans that were good for huge medical emergencies but that was it. The amount people I spoke to were paying was sometimes astronomical.

People at 133% above the poverty line are not getting private insurance unless it is provided through an employer. I don't have figures to back this up right now (and frankly I'm too tired this evening to search for them - maybe after finals) but I fail to see how a single person making 13,000 (roughly) a year is going to go out and spend about 10% of that on health insurance (assuming they are healthy).
I agree. I'd bet that those at the 133% threshold that held insurance do so only due to employment bennies. Cost, and by extension pricing transparency are the major players in the healthcare fiasco. That's where Id like to see reform.

[TeyshaBlue]

I can't reconcile the notion that the raising poverty level will force those who have insurance to lose it.

That opinion of mine was predicated upon the belief that revamping the pre-existing clause would cause insurance premiums to increase. Strictly a gut feel...I don't really have any data to support that. In my many years in the healthcare field tho, it just seems almost intuitive that costs would rise. I see nbadan has addressed this. I've got to read up on what he's got to say.

[TeyshaBlue]

Recenty released CBO estimates project that employer based health insurance could see up to a 3% drop in premiums under the Senate plan...

Employment-Based Coverage



CBO (http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf)

Bet Joe 'the truth' Paggs won't tell you that on his show

An important caveat to this: "However, current policies that had been purchased in any of those markets or that were offered by self-insured firms would be exempt from all of those changes if they were maintained continuously—that is, policies held since the date of enactment of the legislation would be “grandfathered.”

That's a big chunk of coverage that the CBO gets to basically ignore in their figures. I generally like the analysis done by the CBO as it's usually very straight forward and pretty transparent. This appears to be the case here as well, although their analysis is predicated on a great many unqualified and unquantified savings and costs. It's a pretty strong guess, but a guess nonetheless. This is how the CBO tells you they're guessing in some areas:
"The analysis does not incorporate potential effects of the proposal on the level or growth rate of spending for health care that might stem from increased demand for services brought about by the insurance expansion or from the development and dissemination of less costly ways to deliver care that would be encouraged by the proposal. The impact of such “spillover” effects on health care spending and health insurance premiums is difficult to quantify precisely, but the effect on premiums in 2016 would probably be small."

There's also an excise tax component to their analysis that they don't really nail down. I can't tell if they don't have a way to speculate on the effects or they just can't quantify them enough to even weigh them.
I'll have to spend some time with this paper. Thanks, dan. It's a good read.:toast

[jacobdrj]

I agree. I'd bet that those at the 133% threshold that held insurance do so only due to employment bennies. Cost, and by extension pricing transparency are the major players in the healthcare fiasco. That's where Id like to see reform.

I would agree with this point.