Our Common Good

tartantambourine:

The Obama administration gave conditional approval on Monday to health insurance marketplaces being set up by six states led by Democratic governors eager to carry out President Obama’s health care overhaul. The six are Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington.

OK, these states are now my favorites as the best in the U.S. They actually care about their citizens.

By the way, I’ve only lived in one of them but have had happy moments in each of them. I encourage everyone to visit and enjoy and also to stay away from states that are dragging their feet or not willing to participate in increased access to health care for all.

Federally-funded community health centers (CHCs) are a significant part of the safety net. They provide care to low-income Americans, most of whom either have no health insurance or rely on Medicaid. The G.W. Bush Administration expanded CHCs dramatically, and the Affordable Care Act signed by President Obama does so even further, to the point they may serve as many as 30 million Americans a year in the near future. While seeing CHCs as laudable, many progressive health care policy analysts have fretted that the care provided in these centers is not at the same level of quality as that received by privately insured patients in other settings. A new study published in the American Journal of Preventive Medicine shows that this is indeed the case.

The research team examined over 30,000 ambulatory care visits to assess quality measures such as providing adequate medications for chronic illnesses, screening for high blood pressure, counselling patients about the need for exercise and the like. The quality of care provided in CHCs was compared to that provided by primary care doctors in private practice.

The difference in health care quality across the two settings was profound: CHCs provide much better primary care than do private practice doctors. Of the 18 quality measures examined, CHCs were superior on 11, equal on 6 and inferior on 1. When the researchers adjusted the findings for difference in patient characteristics, private sector care was not superior in any respect, and was on most indexes significantly worse.

Consumers saved nearly $1.5 billion in 2011 as a result of rules in President Obama's healthcare law that limit what insurance companies can spend on expenses unrelated to medical care, including profit, a new analysis shows.

Much of those savings — an estimated $1.1 billion — came in rebates to consumers required because insurers had exceeded the required limits.

The study by the New York-based Commonwealth Fund also suggests that the Affordable Care Act forced insurers to become more efficient by limiting their administrative expenses, a key goal of the 2010 law.

In some cases, insurers passed savings on to consumers in the form of lower premiums and higher spending on medical care, the researchers found. This was primarily true in the individual market, where consumers buy health insurance on their own.

The rules “appear to be producing important consumer benefits,” concluded the report’s authors, Michael McCue, a professor of health administration at Virginia Commonwealth University, and Mark Hall, a healthcare law professor at Wake Forest University.

Off The Cliff And Into Deep Water? Cutting Clean Air And Clean Water Programs Could Incur Heavy Costs By Climate Guest BloggerDec 2012

barrywone-blog:

by Peter Lehner, via NRDC’s Switchboard

The health cost of power plant pollution is an estimated $100 billion each year, nationwide, when people get sick or die from breathing dirty air. When polluted water makes swimmers sick, the additional public health costs in just two southern California counties has been estimated at$21 to $51 million each year.

In addition to being harmful to our health, pollution is a serious drag on the economy. As Congress attempts to negotiate this country off the edge of the fiscal cliff, it needs to maintain and strengthen the programs that protect our health by keeping pollution out of our air and water. Gutting programs that cut power plant pollution and keep sewage out of our waters will only end up imposing bigger costs down the road.

Congress has already cut programs that help keep our water clean; deeper cuts to these programs would deal a serious blow to the health and prosperity of communities where clean water is not only a source of recreation but a means of economic sustenance. When a beach on Lake Michigan is closed because the water is too polluted for swimmers, it can cost the local economy as much as $37,000 each day.

If your local beach doesn’t have the funding to monitor bacteria levels, and the local sewage plant can’t get a loan to upgrade its facilities, and climate change is inducing more frequent and heavier rainstorms that overload sewer systems, you have a recipe for an outbreak of waterborne illness–and untold health costs. When federal support for certain clean water programs falls short, municipalities have to rely on local sources of funding to meet their clean water obligations. The burden falls on local taxpayers instead.

Entire story.

brosephstalin:

Walmart, the nation’s largest private employer, plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week, according to a copy of the company’s policy obtained by The Huffington Post.

Under the policy, slated to take effect in January, Walmart also reserves the right to eliminate health care coverage for certain workers if their average workweek dips below 30 hours — something that happens with regularity and at the direction of company managers.

Walmart declined to disclose how many of its roughly 1.4 million U.S. workers are vulnerable to losing medical insurance under its new policy. In an emailed statement, company spokesman David Tovar said Walmart had “made a business decision” not to respond to questions from The Huffington Post and accused the publication of unfair coverage.

Labor and health care experts portrayed Walmart’s decision to exclude workers from its medical plans as an attempt to limit costs while taking advantage of the national health care reform known as Obamacare. Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.

“Walmart is effectively shifting the costs of paying for its employees onto the federal government with this new plan, which is one of the problems with the way the law is structured,” said Ken Jacobs, chairman of the Labor Research Center at the University of California, Berkeley.

For Walmart, this latest policy represents a step back in time. Almost seven years ago, as Walmart confronted public criticism that its employees couldn’t afford its benefits, the company announced with much fanfare that it would expand health coverage for part-time workers.

But last year, the company eliminated coverage for some part-time workers — those new hires working 24 hours a week or less. Now, Walmart is going further.

(Read More)

Even after adjusting for these factors, all of which are known to influence heart attack risk, Peterson and his colleagues found that unemployment remained strongly associated with higher heart attack rates. And while the effect is generally biggest in the first year after a job loss, that excess risk does not go away entirely once a person returns to work. The more times a person loses a job during his or her career, it seems, the higher the risk of heart attack. In fact, the difference between a person who has never lost his job and someone who has been unemployed four or more times is as big as the difference between a nonsmoker and a smoker, or between a non-diabetic and a diabetic, when it comes to heart problems.

What remains unclear, however, is what factors are contributing to the increased heart risk. Stress is certainly a factor, but the cumulative effect of unemployment suggests something more complicated may be contributing to the trend. No one thinks it’s pleasant to get fired or laid off. But, as the authors of an editorial accompanying the research say, the precise mechanism linking joblessness to heart attacks remains unknown.

The Centers for Disease Control and Prevention is considering examining a potential link between hydraulic fracturing, or fracking, and drinking water contamination.

The lawmakers sent a letter to Sebelius Friday stating that such a study could stymie job growth if not properly executed. They expressed concern in the letter that naturally occurring substances in groundwater could be improperly labeled as contaminants.

“Despite the significant growth of natural gas development, we are greatly concerned that the scientific objectivity of the Department of Health and Human Services is being subverted and countless jobs could be in jeopardy,” the lawmakers said.

Signatories included House Energy and Commerce Committee Chairman Fred Upton (Mich.); Rep. Ed Whitfield (Ky.), the committee’s Energy and Power subcommittee chairman; Rep. Joe Pitts (Pa.), the committee’s Health subcommittee chairman; Rep. John Shimkus (Ill.), the committee’s Environment and the Economy subcommittee chairman; and past committee chairman Rep. Joe Barton (Texas).

Guess we shouldn’t study cancers because curing them could hurt cancer treatment jobs.

No need to study how people have gotten sick from contaminated foods because that might cost someone a job.

What else should we stop studying because discovering a health risk could cost jobs?

earthfix:

EarthFix has also covered this issue in the Pacific Northwest, as well as a variety of other water quality issues as part of the Clean Water: The Next Act series.

Many years ago I worked on a civil litigation matter involving a waste water treatment plant for a large city.  A new technology failed and the plant was dumping almost raw sewage back into a lake - and facing steep EPA fines while they tried to figure out how to fix the problem. 

I will never forget an afternoon spent with some of the engineers and science folks where I first heard about their nightmares revolving around how to remove all the different drugs people were taking and then pissing into the system.  It was before some of the anomalies in fish and frogs were reported as possibly tied to sewage plant discharge and the first time I had actually considered that situation and realized that like it or not, we are probably all on drugs. 

January 11th is when American women in one American state will lose access to what is supposedly their constitutionally protected right, because Republicans in that state decided that for them

Maddow rips Mississippi Republicans over abortion crack down  (via The Raw Story)

As the state attempts to implement a rule barring Planned Parenthood clinics from participating in the government-funded Women’s Health Program, the health commission has directed low-income women­ to use its online database to search for a new provider.

Nearly half of the women served by the program currently rely on Planned Parenthood. The commission says that more than 3,000 providers are available to serve these women, but many experts are skeptical that these facilities will be able to accommodate the women displaced by the new rule.

The database has garnered complaints from health care providers and patients for producing what they see as inflated and “misleading” search results. It includes a number of duplicate entries, facilities that do not provide reproductive health services (such as children’s clinics), and listings for clinics that are unable to see new program clients.

When confronted about the issue by The American Independent at an event hosted by The Texas Tribune, Janek insisted that the “3,000 providers” figure was accurate and that the error-prone database is “a separate list.”

“When we say that we’ve got 3,000 providers out there ready to participate in this program, there’s no duplicates,” he said.

Still, Janek admitted the inaccurate database is “a real problem.”

[…]

A study by George Washington University’s School of Public Health and Health Services found the state’s estimates of the impact of the rule to exclude Planned Parenthood appear to “contain numerous methodological flaws” and cautioned that the projections “may overstate remaining provider capacity in communities” where program participants live. The study added that the state might be counting reference laboratories “as sources of direct patient care.”

As detailed by TAI, the database also includes multiple listings of the same providers, lending the appearance of more options than actually available. On Wednesday, Janek addressed this concern as well.

[…]

Despite the database problems and questions of provider capacity, the commissioner reassured the audience he is “confident” the Texas Women’s Health Program will be ready for implementation by Nov. 1 if needed.

Yet, shortly after Janek gave this assurance, the commission announced that it would continue accepting federal funds for the time being, allowing Planned Parenthood to remain in the program for now.

Last week, a state judge issued a temporary restraining order barring Texas from excluding Planned Parenthood as long as the state continued accepting federal funds. A court hearing set for Nov. 8 may provide more clarity about the legal controversy surrounding the rule.

Part of the problem, experts say, is that people who will be affected don’t realize the urgency because the subsidies won’t begin for another year. But policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved. Low enrollment could lead to higher premiums, health policy experts say. Hospitals worry that, without widespread participation, they will continue getting stuck with patients’ unpaid medical bills. And advocates say the major purpose of the Affordable Care Act – extending health insurance to more Americans – will go unmet if large numbers of vulnerable people don’t take advantage of it.

But because “Obamacare” has been so controversial, and its fate caught up in the presidential campaign, there has been little public discussion about the specifics of putting it into action. States such as Texas and Florida, where opposition to the legislation was strong, have been slow to embrace the law and critics have been loath to promote it.

Initial White House efforts at outreach caused congressional Republicans to accuse the administration of using taxpayer money for political gain. In mid-November, Ways and Means Committee Chairman Dave Camp (R-Mich.) subpoenaed Health and Human Services Secretary Kathleen Sebelius, demanding information about how her agency has used federal money to promote the Affordable Care Act. The administration is preparing a final budget for an outreach program focused on the opening of the exchanges in October.

[…]

Even as Congress was finishing the debate that led to the law, a coalition of health-care advocates formed to help promote it. Led by Families USA co-founder Ron Pollack, the group started Enroll America, a nonprofit largely funded by health-care industry and philanthropy groups.

In the coming months, the group will begin an advertising campaign meant to encourage Americans to sign up for the health-care law’s subsidized insurance coverage. Still in its planning stages, it is likely to start in the summer or fall of 2013, just before the state-based insurance marketplaces open for enrollment.

The still-unnamed campaign is likely to put more intensive resources toward a handful of key states. Those could include Florida and Texas, which have a combined 10 million uninsured residents, and have made little effort to do such outreach.

The group has raised $6 million from a coalition that includes the American Hospital Association, pharmacy chain CVS-Caremark, physician groups and individual health insurance companies. Although that initial funding has covered survey research and the hiring of seven staff members, board chairman Pollack said the group hopes to raise “tens of millions” more for the outreach campaign.

“We know now that the Affordable Care Act has to be implemented,” said Rachel Klein, Enroll America’s executive director. “It’s imperative that the people who will benefit hear about the new coverage available and learn how to sign up.”

Currently, 48.6 million U.S. residents lack health insurance. The Congressional Budget Office estimates that 30 million will gain coverage. That would leave nearly 19 million uninsured.

About a quarter of those are illegal immigrants, who aren’t eligible for the reform law’s subsidies. Two million, the CBO projects, live in states that will opt out of the Medicaid expansion.

The rest, however, probably are eligible for new benefits. The CBO, for example, expects that nearly 6 million of those newly eligible for Medicaid just won’t sign up for the program.

Even though the subsidies for currently uninsured people won’t go out until Jan. 1, 2014, the state exchanges that will offer health plans are being set up now, and participants will need to start signing up next Oct. 1. Supporters of the health-care law say the plan won’t be a success without a massive public relations campaign to build awareness.

Add Texas Gov. Rick Perry, Maine Gov. Paul LePage, Ohio Gov. John Kasich, Kansas Gov. Sam Brownback and Wisconsin Gov. Scott Walker to the list of Republican governors who are continuing to protest Obamacare by refusing to establish health insurance exchanges, in the process forcing the federal government to step in and create the exchanges itself. Starting in Oct. 2013, the exchanges will be the marketplace for individuals to obtain insurance if they do not have coverage through their employer, Medicare, or Medicaid. Beginning Jan. 2014, the new insurance plans will take effect, giving nearly every American citizen health care coverage.

I may be wrong, but it seems to me that these Governors are essentially helping create the “public option” the Republicans in Congress fought so hard against.