Geography Matters for Veterans Patients

Dr. Pauline Chen, writing for the New York Times, comments on a recent JAMA study that “not only confirms what critics have long feared but also reveals how even the most self-evident policy choices can have unforeseen and potentially devastating consequences.”

“The researchers combed through the records of the over 50,000 veterans administration patients who were classified as eligible for a liver transplant from 2003 to 2010 and found that almost 1,500 had been placed on the waiting list for transplant at one of the five transplant centers. But the farther those patients lived from a V.A. transplant center, the less likely they were to be on the waiting list. And if they did manage to get on the list, they were less likely to receive a transplant compared with patients who lived closer.”

“Furthermore, the farther they lived from the center, the more likely they were to die waiting for a transplant.”

Is Obama Too Passive Over Veterans Affairs Scandal?

Dana Milbank questions whether President Obama is truly “madder than hell” over the veterans affairs scandal.

“Like VA Secretary Eric Shinseki, Obama wasn’t entirely convinced something bad had happened.”

“But there are no ‘ifs’ about it: … Lawmakers in both parties have spoken of a systemic problem at the agency, and the American Legion, citing ‘poor oversight,’ has called for Shinseki’s resignation.”

Obama’s “response to the scandal has created an inherent contradiction: He can’t be ‘madder than hell’ about something if he won’t acknowledge that the thing actually occurred. This would be a good time for Obama to knock heads and to get in front of the story. But, frustratingly, he’s playing President Passive, insisting on waiting for the VA’s inspector general to complete yet another investigation, this one looking into the Phoenix deaths.”


The VA Debacle as a Reflection of American Health Care Problems

Jonathan Cohn, commenting on the VA scandal, notes: “Of course, it’s worth remembering that some of the problems veterans are having right now have very little to do with the VA and a whole lot to do with American health care. As Phil Longman, author of Best Care Anywhere, noted in his own congressional testimony last week, long waits for services are actually pretty common in the U.S.even for people with serious medical conditionsbecause the demand for services exceeds the supply of physicians.

“The difference is that the VA actually set guidelines for waiting times and monitors compliance, however poorly. That doesn’t happen in the private sector. The victims of those waits suffer, too. They just don’t get the same attention.”

Veterans Suffer in States That Refuse Medicaid Expansion

Vox: “The failure of some states to expand Medicaid is leaving a quarter-million veterans without health insurance.”

To be entitled to health care through the Veteran’s Administration, “a veteran must have served for two continuous years or the full period for which they were called to active duty in order to be eligible. There are some exceptions … but about 1.3 million veterans remain uninsured nationwide.”

“According to a report by Pew using analysis from the Urban Institute, approximately 258,600 of those veterans are living below the poverty line in states refusing to expand Medicaid. Without veteran’s benefits — and with incomes too low to qualify for subsidies to use on the state exchanges — these veterans are left without affordable coverage options.”



The Veterans Affairs Debacle: An Authentic Scandal

National Journal: “Looking for a lone villain in the VA debacle, however, is a fool’s errand. It’s true that—despite holding the world’s most powerful post for five years—Obama is yet to eliminate the long waiting times for veterans seeking help. Blaming him alone, however, is to ignore roots of the problem that stretch back decades before Obama took the Oval Office.”

“Instead, the sheen of shame over the VA’s failures spreads across time and party affiliation. It stains the legacies of presidents as far back as John F. Kennedy and condemns past Congresses whose poor oversight allowed the problem to fester.”

Eugene Robinson: “Finally, an authentic scandal: incompetence and deception at the Department of Veterans Affairs. Given what we know so far, more heads need to roll — and a criminal investigation should be launched.”

President Obama needs to “clean house.”

John Dickerson: “But does anyone have faith that this outrage will be answered by serious action? One primary reason to despair is that we’re already living at peak outrage. Fake umbrage taking and outrage production are our most plentiful political products, not legislation and certainly not interesting solutions to complicated issues.”

The VA scandal is “a failure of one of the most basic transactions government is supposed to perform: keeping a promise to those who were asked to protect our very form of government.”

A Way to Reduce Obamacare Premiums

Jason Millman: “With much of the focus on Obamacare now on how much individual premiums could increase next year, a new analysis suggests there’s one way to keep them in check — more competition. That’s the conclusion of a new report from economists Leemore Dafny, Christopher Ody and Obamacare architect Jonathan Gruber.”

“The new analysis finds that exchange premiums ‘are responsive to competition,’ but the economists caution that the really new exchanges need further study. If this new research published in the National Bureau of Economic Research is correct, then more insurers entering the exchanges in future years could serve as a check on rate increases.”

(National Bureau of Economic Research)

Poll: Government Healthcare Trumps Private Insurers

The Morning Consult: “Morning Consult polling shows clear public frustration over cost with the biggest sectors of the health industry. Words like “greedy” and “expensive” appear frequently when voters are asked to describe what comes to mind when they think of hospitals, health insurance companies, prescription drug companies and medical device companies.”

In a word or two, could you please tell me what comes to mind when you think of health insurance companies?



In contrast, those surveyed gave largely positive attributes to care providers and government healthcare programs.  Words likes “good” and “needed” are used throughout voter descriptions of what comes to mind when they think of physicians, nurses, Medicare, and Medicaid.

In a word or two, could you please tell me what comes to mind when you think of Medicaid?


Report Debunks Fears of Skyrocketing Premiums

The Hill: “Fears that insurance premiums will spike next year are premature, according to a new report [by the Robert Wood Johnson Foundation] that argues market competition will likely keep costs from rising.”

RWJF: “In competitive markets, unless all insurers behave similarly, those that increase premiums will suffer the loss of a market share to those that continue to price more aggressively.”

“The competitive pressures mean insurers are unlikely to risk raising their premiums too high for fear of losing customers, the report says.”

Market Competition Led to Surprisingly Low Monthly Premiums in 2014; Same Expected for 2015

Lower Insurance Premiums for 2015?

More insurers plan to join Obamacare exchanges in 2015, which may lower premiums.

Bloomberg: “new competition should mean lower premiums for consumers, or at least more moderate increases. In Washington state, Molina Healthcare Inc. (MOH), which offered relatively expensive plans this year, has proposed an average 6.8 percent reduction in its 2015 premiums.”

Karen Ignagni, president and chief executive officer of America’s Health Insurance Plans: “Consumers benefit from competition … The most important thing is getting folks on the playing field offering different products to consumers so they can make the decisions that are best for them.”

“Among all the plans selling to individuals in Washington state, the proposed rate increases average about 8.25 percent, said Mike Kreidler, the state’s insurance commissioner. That’s the lowest requested increase in seven years, he said; final rates may be lower.”

But: “There are some states where there’s no competition at all … For those states, it’s really important that we get competitors.”

The Consequences of Being Uninsured

Jason Millman examines some of the data from the recent National Center for Health Statistics report “that provided a wide-ranging checkup on how our country is performing on numerous health-care measures.”

“The results aren’t all that surprising, but the graphs are a helpful visualization of how people put off necessary care because they can’t afford it. And ultimately, delaying care could lead to poorer health and the use of even more services, the NCHS report points out.”

Millman highlights the correlation “between people’s income and their decision to skip medical and dental care because of cost.”

(National Center for Health Statistics)

What Happened to ‘Repeal and Replace’ Obamacare?

Despite Republicans’ mantra to “repeal and replace” Obamacare, Sahil Kapur notes that “since the health care law blew past its 7 million sign-ups target last month, Republican leaders have been noticeably more restrained in the way they talk about it, ratcheting down their public calls for repeal. Action has also slowed.”

“In the House, the GOP’s spring 2014 legislative agenda — as outlined in an April 25 memo by Majority Leader Eric Cantor (R-VA) — doesn’t include any action on Obamacare.”

“House committee hearings on Obamacare are scant, with none currently scheduled.”

“The GOP’s pivot comes amid growing intra-party tension over how to deal with the law. Independent conservative experts warn that Obamacare won’t collapse on its own and that repealing it is no longer feasible as it would strip benefits from millions of Americans. It also comes after some anti-Obamacare claims on the right turned out to be inaccurate or failed to stand up to scrutiny.”

Will Rising Medicaid Enrollment Affect State Budgets?

Jason Millman: “On Tuesday, I wrote about how states that have rejected Obamacare’s Medicaid expansion had seen their Medicaid enrollment grow anyway, thanks to what’s known as the ‘woodwork effect.'”

“States knew the woodwork effect was coming and had time to prepare for it, since the ACA was passed more than four years ago. The big question is just how accurately were they able to predict its impact.”

“This graph from a December 2012 NASBO report shows how Medicaid has been taking a greater portion of state general funds, while education spending has decreased.”

(National Association of State Budget Officers)

Scott Pattison, executive director of the National Association of State Budget Officers, “said he’s heard anecdotally that the woodwork effect is a bigger issue in states that expanded Medicaid. That’s not  surprising, since those states generally have more resources — and more enthusiasm — to sign people up for coverage.”

Obamacare Scare Tactics Undermine Enrollment

Commenting on a new McKinsey Obamacare report, Jonathan Cohn concludes:

“Truth is, it’s going to be a while before we have a good sense of just how deeply Obamacare is reducing the ranks of the uninsured.”

“But the McKinsey report had one other finding that … ought to start some discussion right now.”

“About half of the people who McKinsey surveyed did not end up buying insuranceeither because they shopped and found nothing they liked, or because they didn’t shop at all … But two-thirds of these people said they didn’t know they could get financial assistance. In other words, they assumed they would have to pay the sticker price for coverage, even though federal tax credits would have lowered the price by hundreds or thousands of dollars a year.’

“And if the administration deserves some blame for this shortfall, its adversaries deserve more. Republicans and their allies did their best to taint the lawand, where possible, to undermine efforts to promote it. Without such obstruction, even more uninsured people would probably be getting coverage right now.”