Heartfelt – March 2011

Posted on March 2, 2011 by Tim B

When last we chatted there were some pretty pressing issues that had surfaced related to our advocacy work.   Dr. David Feinwachs was in the news as a staunch supporter of healthcare spending transparency and had offered testimony in a committee setting.  Since that time Feinwachs has again been called on for his expert testimony in another committee hearing, and has been in great demand at healthcare educational forums and gatherings around the state.  It’s not an understatement to say that fiscal responsibility is foremost on the minds of most all members of the Minnesota legislature and, if it’s not, it should be.  That’s what makes the accountability issue even more crucial to push for and one to watch as we gauge the personal sincerity of our elected representatives in St. Paul.

The focus of Seven County and our GMHCC members has always been about improving healthcare access, quality and affordability.   Research and history has shown that there is significant waste that has been allowed to continue unchecked in the state funded and HMO delivered healthcare programs.  Current estimates, using historical calculations,  indicate that there is at least $150 million dollars per year in tax dollars spent on healthcare that are not subject to common sense review.   This does not make good fiscal sense and it does not make for good stewardship of dwindling resources.  You wouldn’t allow this to happen in your home budget by having a contractor charge you anywhere from 10-13% extra on your bill without telling you what it was for.   Why this is allowed to continue is almost beyond belief, especially when legislators trumpet the fact that they are the watchdogs of our tax dollars.

The good news is that some legislative responses to this lack of accountability have surfaced, finally.  There are currently two bills, one in the House and one in the Senate,  that are aimed at answering  the question(s) of “…where DO our healthcare tax dollars go?”  A telling piece will be what kind of broad based interest and support these bills will garner in the legislature.  It will be a litmus test for who “talks about” reform and who is actually willing to “do something” about it.  Keep your eyes open for how involved or committed your reps are during this process.

Further news on the healthcare front involves our meeting with newly appointed Minnesota Dept. of Health (MDH) commissioner Dr. Ed Ehlinger and Assistant Ellen Benavides.  GMHCC reps, including six (6) from Seven County, met for over an hour with the MDH reps.  It was a very open and frank discussion of the state of healthcare in Minnesota and an exchange of ideas about how to improve the system.  Our CBP (County Based Purchasing) efforts really caught the attention of the commissioners.  They asked for details about our involvement and how they might help in making the application process simpler and smoother for counties that wish to either form new CBP groups or join existing CBP organizations.  As a background story to the application process, three years ago a group had been ready to move ahead with forming a new CBP group in the Rochester area and had done all of the necessary groundwork and received near unanimous favorable marks from everyone during the application process.   All was a “go” until it reached the governor’s desk where it was vetoed and tossed aside.   Nearly two years of bipartisan work and planning went for naught.  To say it was disappointing to those who put in the work doesn’t do it justice… it was devastating.  The process needs to be changed and simplified.

GMHCC currently has a $40K grant to do education and outreach in promoting CBP around the state and is currently focusing efforts in central Minnesota in and around St. Cloud.  The goal is to make sure that the process becomes simpler and less political for groups to be part of a CBP because of the physical value they provide to the people they serve, and to the fiscal health of the counties who make use of it.  It is the ultimate win-win proposition in healthcare.

On the healthcare horizon is an upcoming  meeting with MN Dept. of Human Services Commissioner Lucinda Jesson in a joint meeting that will also include Dr. Ed Ehlinger (MDH Commissioner).  GMHCC will be well represented as will Seven County at that meeting.  A full report on the outcome of the meeting will be ready for the next issue of ECHOES.

Finally, there has been a lot of talk about revolts and insurrection and it’s become an unavoidable everyday conversation.   There is a message in the uprisings in Tunisia, Egypt, Yemen and now in Libya, and on the home front a massive demonstration in Wisconsin, as well as slightly smaller ones in Ohio, Indiana and Michigan.  Is it the wave of things to come?  It should be a given that anytime a group of people feels ignored, overlooked, abused or taken for granted, sooner or later there will be a backlash.  It’s not a matter of “if” but a matter of “when.”  I think, to the amazement of most people in this country, the tremendous rebellion and overthrow of the Egyptian government was done in a manner more civil than could possibly be imagined, especially given the scope (millions of people) of the protest.   Strange as it may be to most, there is something that we can learn from how that change was accomplished.  Civility and orderly rebellion can win out and restore sanity and fairness to unfair systems.  Case made.

Peace… and good, affordable, accessible healthcare to all!

******************

Answer to QUIZ Question from February ECHOES:  The president in 1965 was LBJ and the response to his State of the Union address was co-delivered by Senator Everett Dirksen (IL) and Representative Gerald Ford (MI).

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Heartfelt – February 2011

Posted on February 2, 2011 by Tim B

I’ve seriously pondered how to approach this month’s commentary.  So many things have happened over the past 30-45 days it’s hard to feature just one, so I won’t.

Let’s start with one of the most recent events, namely the state of the union address delivered by President Barack Obama on Tuesday, January 25th.  My schedule was open that evening following my Hinckley City Planning Commission meeting.  I arrived in time to see the president enter the chamber and move to the podium.  His opening greeting to members in attendance, as well as “…my fellow Americans” was all I listened to before heading to my little home office to begin writing this message.

This is a departure for me, intentionally avoiding listening to the state of the union.  I’ve listen made it a point to listen to all or most of these addresses for at least fifteen straight years, because I wanted to hear what the President had to say about “our” country.

My purpose in avoiding the speech was not to advocate that everyone else follow my lead on this, but rather it was a deliberate attempt at gauging the impact of a speech from a broad perspective after the fact.  Monitoring Facebook and Twitter and a variety of blogs were my chosen social media sources, and I tuned in to Fox, MSNBC, CNN, KARE11 and Public Television to get a sense of the more traditional electronic news sources and their “take.”  I also sampled the New York Times, St. Paul Pioneer Press, Minneapolis Star Tribune, Wall Street Journal, St. Cloud Times and the Duluth News Tribune.  All of these news sources have their own news accounts, and most have their own spin as well, either through commentary or letters from readers, depending on the outlet.

If you’re now waiting for a mind blowing, game changing revelation based on what I’ve found, don’t hold your breath.  What I found was interesting, but not a whole lot different from what you might expect.  Bloggers have their own idealized slant, Twitter and Facebook folks are your Tweeps or Friends and you know where they’re at, and the various news outlets behaved in typical fashion.  As an aside, it’s become very difficult to find news accounts that don’t have a discernible slant in their news… that’s a blurred line that shows me that the news departments are either lazy, or they just don’t realize the importance of separating news from opinion.  That bothers me and it should bother you too, as it does a disservice to people that are looking for news.

This low-tech experiment was done in hopes that I could find a way of explaining how we got to where we are in this country politically.  It shouldn’t matter who is delivering the state of the union, be it Ronald Reagan, Bill Clinton, Dwight Eisenhower, George W. Bush, Gerald Ford, Barack Obama or Franklin Delano Roosevelt.  The person at the podium is the president of the United States, and is not the president of the Republican or Democratic Party.  We seem to be moving farther and farther away from that ideal.  Increasingly it seems that pressure is brought to bear to immediately rebut anything that is said in a public political context.   For you historians, 1966 was the first year of a response to the president’s state of the union address from the Party not occupying the White House at the time.   QUIZ Questions:  Who was the president in 1966, and, who delivered the opposition party’s response to the speech?

Part of the blame for the aforementioned pressure are the advances in technology that now make it possible to get a response sent worldwide within minutes of the event itself.  Many times that forces people (apparently) to offer a response or rebuttal to something which they often seem to do it without giving it any thought whatsoever.  There seems to be little or no time given to contemplation, or personal reflection, or big picture thinking, just blurt something out just because it can be done.  It’s easy to see the vicious circle that’s created by this phenomena – noise generated for the sake of noise.  My Dad and my Grandfather always used to say that “some people talk just because they like to hear their head rattle.”  Now I know exactly what they meant.  Let me add a somewhat modified Twain quote for the times: “News travels all the way around the world before reflection has pulled its boots on.”

Moving on to an issue a bit closer to home, the subject of accountability by the HMOs in Minnesota has continued to gain support and momentum in many advocacy networks, including ours.  Meetings and strategy sessions with allies and legislators are being arranged every day as we move ahead with our plans to bring fiscal responsibility to healthcare in Minnesota.  We have had extended conversations with legislators, both new and not-as-new, about bringing them up to speed on our work as well as to find out where there is support for accountability and transparency in spending our tax dollars.

David Feinwachs, who was the general counsel for the MN Hospital Association (MHA) for 30 years, has offered his insight and expertise to us. His story was featured in last month’s ECHOES and it gives a snapshot as to why he was relieved of duties, and why his assistance will prove invaluable in making the case for accountability for the billions of tax dollars spent on healthcare.  We welcome his input and look forward to a strong working relationship.  Shining the light of truth on HMO healthcare delivery in Minnesota is long overdue, but it’s not for lack of trying.

More good news comes from the communications we have had with the newly appointed head of the MN Department of Human Services, Lucinda Jesson, and the new head of the MN Department of Health, Dr. Ed Ehlinger.  Both commissioners have agreed to meet with us (Seven County and GMHCC reps) in the next week or so to talk about what needs to be done to improve healthcare in the state.  As healthcare advocates, there is good reason for us to be optimistic about what can be accomplished this year in the way of reform.

Peace… and good, affordable, accessible healthcare to all!

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Echoes – December 2010

Posted on December 2, 2010 by Tim B

Whistleblower Fired…

In a move that caught many people by surprise, the attorney for almost 30 years for the MHA (Minnesota Hospital Association) was abruptly terminated in response to a video that he helped produce.

The video was authored and produced by Dr. David Feinwachs who has been the corporate attorney for  the MHA since 1980.  Feinwachs was “released” from responsibilities in late November in apparent response to vehement objections to its content by various HMOs in Minnesota.  Minnesota’s HMOs were the subject of the video along with the state healthcare programs that they have been allowed to run since 1983.

At issue in the video is the double-standard and lack of accountability that is now the rule for the non-profit HMOs in Minnesota (by law, all Minnesota HMOs are required to be organized as non-profit entities).  Feinwachs describes the accountability problem as a “black box.”  State “tax dollars go into the black box” of HMO accounting in the form of $3 billion dollars in tax money every biennium, and they are “never accounted for” in any meaningful way, according to Feinwachs.

Feinwachs considers the current system of handing over healthcare tax dollars to the HMOs fiscally irresponsible and something that needs fixing.

The video illustrates the lack of oversight in a simple and understandable fashion and asks viewers to consider  the question of why no accounting of funds has been demanded for these tax dollars, and why this *demonstration project has been allowed to continue unmonitored.

The response to the video’s content from the HMOs through the MN Council of Health Plans (MCHP), the organization which is made up of HMOs in the state, has been that they are monitored and are accountable to the state.

Feinwachs addresses that by saying they (the HMOs) are allowed to self report their expenditures and they don’t follow the same standard as any other group receiving state tax dollars.  He goes on to say that they are also not subject to any competitive bidding process, which is also unique to organizations receive state money.

As a well known and highly respected member of the healthcare industry as part of the MHA, Feinwach’s firing has generated a huge amount of interest.  Related to that, KSTP-TV reporter Jay Kolls has done an investigative piece on the story and plans to follow legislative activity related to the issue of HMO accountability.

Seven County and the Greater Minnesota Health Care Coalition (GMHCC) has contended for years that turning over state run programs without regulations or accountable standards has always been a huge waste of state resources.  Efforts to urge accountability hearings have been an ongoing priority with GMHCC and its coalition partners for years.

————

State “tax dollars go into the black box” of HMO accounting in the form of $3 billion dollars in tax money every biennium, and they are “never accounted for…”

—————

* (the original legislation that created the system of allowing HMOs to handle all state-run programs was called a “demonstration project”)

********

To watch the video:

http://www.vimeo.com/17156418

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Heartfelt – December 2010/January 2011

Posted on December 2, 2010 by Tim B
~ by Tim Burkhardt

In order to fulfill my seasonal obligation (in case I haven’t mailed out cards) I would like to offer:  Happy Holidays!  Merry Christmas! Happy Hanukkah! Season’s Greetings!   If I could I would give everyone a Heartfelt Holiday Hug, but I can’t get to everyone in time, sorry.  Hopefully, now, nobody feels left out, at least those of you who faithfully read ECHOES.

Surprisingly, it has been a very busy end of year, more so than expected.  In November I mentioned that things were winding down and, except for a few random meetings, the bulk of our advocacy efforts were slated for 2011.  A couple of things have crept onto the scene recently which has changed all that.

The first item is the recent deluge of advertisements from the insurance companies, that seems significantly heavier than years past, promoting their Medicare Part D (and C) products to an ever enlarging client base (Baby Boomers).  I watch some TV and, of course, I’m hyper-sensitive to all ads that are senior related like glucose monitors, and scooter stores and Medicare insurance products.  This deluge (of Medicare commercials) has translated into an increasingly larger volume of calls to our office with questions and requests for counseling appointments/advice.  This is a good thing in that people recognize that Seven County offers a valuable service to the region as an unbiased, trusted and reliable source of information.

In checking with the folks at East Central Senior Resource Center, who also offers some insurance/Medicare counseling, they also have been inundated with an ever burgeoning volume of requests for information.  It has made us scramble a bit to keep up with the demand but I feel we have been doing an excellent job at keeping up with our inquiries.  Kudos on that front to Lisa for adjusting her schedule and being flexible, as well as to Shannon for professionally handling the task of fielding initial and follow up requests for information and appointments.

The second item came right out of the blue. It was the recent firing of Dr. David Feinwachs, who has been the corporate attorney for the Minnesota Hospital Association (MHA) for 30 years.  The short version of why he was fired involves the unexpectedly heavy hand of the HMOs in engineering his termination from MHA.  Feinwachs knows the topic of healthcare in Minnesota inside and out and he created a very revealing video that highlighted a disturbing lack of accountability in the HMO administration of state run programs, not to mention a likely significant waste of taxpayer money.  As it turns out, the telltale video piece is what prompted his termination from MHA, thanks entirely to the pressure brought to bear from Minnesota HMOs collectively.

Feinwachs has never hidden the fact that he was uncomfortable with the lack of accountability with the way that HMOs were given kid-glove treatment, to put it mildly, when it had to do with fiscal responsibility for tax dollars.  Most of you are aware that the biggest reason non-profit HMOs in Minnesota are so profitable (go figure) is their total control of the state healthcare programs; to the tune of $3 billion dollars per biennium.  That’s $3 billion in YOUR tax dollars, by the way.  In Minnesota, HMOs are allowed (?) a different set of accounting/reporting standards.  There is zero transparency, none.

We should all be uncomfortable and outraged with this lack of accountability.  There have been some attempts, since the system was created in 1983, to measure the fiscal soundness of giving away the state healthcare programs and the dollars that go with it, all of which have been thwarted.   Nobody is blameless here, Democrats or Republicans.  It was signed into law by Governor Al Quie and has survived every subsequent legislative body since then.  What was created as a demonstration project has turned permanent, and quite profitable, and has never been measured since its inception.  That’s a huge waste of tax dollars and a black eye to everyone in state government who has allowed this to continue unabated.

It seems that Mr. Feinwachs was doing his job in his capacity as attorney for the MN Hospital Association in making sure there was financial transparency and fiscal accountability.  For his actions, he was fired.  View for yourself the Feinwachs video at: http://www.vimeo.com/17156418

Oh, and by the way, Happy Holidays, Merry Christmas, Happy Hanukkah, and Season’s Greetings!   Peace and good, affordable accessible healthcare to all… and to all a fulfilling New Year.

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Echoes – November 2010

Posted on November 2, 2010 by Tim B

Legislation To Extend Veteran’s Education

http://chronicle.com/article/Bill-to-Expand-Veterans/123789/

A major expansion of the Post-9/11 GI Bill benefits was approved in the Senate Veterans’ Affairs Committee in late summer, about one year after the latest changes to veterans’ educational aid took effect.

S. 3447, sponsored by Sen. Daniel K. Akaka (Hawaii), would increase the number of people who could receive benefits and expand the list of programs or training for which veterans could use the aid. It would also change the way housing and textbook allowances are calculated and provide in-state tuition and fees at public colleges, or up to $20,000, adjusted annually and based on the national average cost.

Advocates of the legislation are optimistic about its chances of making it through the full Senate, but without a cost analysis having been prepared yet, expanding the aid could be a challenge. If the bill were to pass, the Department of Veterans Affairs recommended that it become effective no sooner than August 1, 2011, which would allow more time to plan for its implementation. In the House, Rep. Walt C. Minnick (Idaho), proposed similar legislation, HR 5933, which is scheduled to be the subject of a committee hearing on September 16.

The new G.I. Bill, which Congress passed in 2008 and took effect last August, extended benefits beyond what the previous Montgomery GI Bill provided, giving new allowances for housing and textbooks, and making it easier to transfer benefits to a child or spouse. The proposed changes to the Post-9/11 GI Bill would largely keep the bill’s provisions intact, but the revisions seek to improve benefits so they are delivered in a “timely, accurate, and equitable way,” according to bill sponsors.

The biggest change would be in how tuition benefits are calculated. The bill the committee passed would base the amount veterans could be eligible for on a national average, instead of giving veterans up to the full amount of tuition and fees at the most expensive public college in their state. That shift could help streamline the way the department processes benefits requests. Last year—the first time veterans were eligible for the new G.I. Bill benefits—many payments to veterans were delayed. The veterans affairs department also is having to issue one-time checks to veterans who received a living stipend since January 1, because the department didn’t update its benefits after military housing allowances increased. About 153,000 veterans will receive those housing checks; more than 270,000 people received G.I. benefits in the 2009-10 academic year.

The Department of Veterans Affairs improved its efficiency in processing requests from fall 2009 to the spring, working at more than three times the rate it did in the fall, according to Keith M. Wilson, director of education service for Veterans Affairs. This past summer the department allowed colleges to begin submitting proof of veterans’ enrollment on June 1, even if tuition and fees weren’t in place. Thus, 50,000 requests for benefits have already been processed for the fall.

“We underestimated the complexity of what we needed to do last fall, and there were unacceptable delays,” Mr. Wilson said during a committee hearing last month. “We now have more resources to put toward it to better handle the implementation.”

Among other changes the bill that passed the Senate committee would make are those that would extend benefits to all members of the National Guard and Active Guard Reserve; some are now ineligible for aid. The committee legislation would also allow veterans to receive aid for a wider array of educational programs, including vocational and on-the-job training, and change the ways housing and textbook allowances are calculated, providing funds for distance-learning students and basing the amount of payment for housing on the number of credit hours.

More Veteran’s Legislation

Recently signed into law was the the Veterans’ Benefits Act of 2010, which paves the way for changes to many Veterans’ Affairs programs and benefits, including insurance, healthcare, employment and education.  The bill is an amendment to Title 38 of the United States Code and 2003′s Servicemembers Civil Relief Act.

Introduced and passed in the U.S. House of Representatives in July 2009, H.R. 3219 was then sent to the Senate, which it passed on Sept. 28 this year. With the president’s signature on Oct. 13, the bill became Public Law 111-275.

The Veterans’ Benefit Act of 2010 will “ensure that those who were willing to lay down their lives for our country, and their families and survivors, receive meaningful, world-class, 21st century benefits,” said Rep. Bob Filner (California), who sponsored the bill.

Among other benefits, the bill works to enhance employment opportunities for veterans by reauthorizing the expired VA work-study program (and permitting students to work in congressional offices and state veteran agencies) and creating a Veterans Energy Related Employment Program.  It also allows the U.S. Office of Special Counsel to investigate Uniformed Services Employment and Reemployment Rights Act, or USERRA, claims. USERRA protects service members from employment discrimination and is especially important for members of the Guard and Reserve who are called to active duty. Other benefits of the bill include:

  • Reauthorizes the Homeless Veterans Reintegration Program through fiscal year 2011, and provides an additional $1 million to services for homeless women veterans and homeless vets with children
  • Allows 100-percent disabled veterans to receive Servicemembers Group Life Insurance, or SGLI, coverage for two years following separation at no charge (retroactive to those separated on or after June 15, 2005) and allows veterans under age 60 to increase Veterans’ Group Life Insurance coverage
  • Increases the maximum loan guarantee amount under the Veterans’ Mortgage Life Insurance from $90,000 to $150,000. On Jan. 1, 2012, this will increase to $200,000
  • Extends the life of the Veterans’ Advisory Committee on education and authorizes the Secretary of the VA to grant up to $200,000 per year to address housing needs of disabled veterans
  • Prohibits cell phone services to charge termination fees if a service member receives orders to an area that does not support the company’s contract
  • Allows parents of a child who died in service to the country to be buried in a national cemetery with their child (if the veteran child has no living spouse or children)
  • Increases burial and funeral benefits and plot allowances (for veterans who are eligible for burial at a national cemetery or die at a VA facility) from $300 to $700
  • Prohibits the VA from collecting co-payments or other fees for VA hospital care or medical services from catastrophically disabled veterans

The Veterans’ Benefit Act of 2010 also addresses health care issues for veterans of all ages. For instance, it allows the VA authority for care permanently for Vietnam-era herbicide-exposed veterans and Persian Gulf War veterans who have insufficient medical evidence to establish a service-connected disability and creates a Committee on Care of Veterans with Traumatic Brain Injury within the Veterans Health Administration. It also establishes a priority level for Medal of Honor recipients to equal that of former prisoners of war and Purple Heart recipients in regard to VA care.  To read the full text of the bill, visit  http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h3219.

 

Transform 2010 Workshop

A contingent of Seven County members attended an all day work session designed to share information about the coming “wave” of Baby Boomer retirees that will arrive in force over the next 7-10 years.

A variety of perspectives were included as part of the breakout sessions, as information gathered from a survey of over 3,400 respondents was shared with those in attendance.  The MN Board on Aging, MN Dept. of Human Services and the MN Dept. of Health were the sponsors of this event held at the spacious Earle Brown Heritage Center in Brooklyn Center.

Five related topics were explored and shared with over 500 registered conference goers.

Redefining Work and Retirement

Minnesota should encourage individuals to continue working in both paid and nonpaid roles, and prepare for their retirement and old age.

1. Transform public and private retirement and employment policies to better reflect demographic realities and support continued work.

2. Transform Minnesota’s post-secondary education system and employer-based training to meet the education and training needs of an aging workforce.

3. Encourage individuals to plan and “self-invest” in financial planning for a lifetime.

4. Engage Minnesotans in vital aging opportunities as they age.

5. Expand the options available to individuals to pay for long-term care costs.

6. Strengthen federal income and health programs that provide the foundation for individual retirement security.

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Heartfelt – November 2010

Posted on November 1, 2010 by Tim B
~ by Tim Burkhardt

As I write this the ink isn’t yet dry on all the ballots cast in the 2010 elections. There were a goodly number of surprising results (to some) that took pollsters and voters by surprise.

I’ve been asked for my opinion on the outcomes of the election and the overall impact on our advocacy work here at Seven County. My answer is simple… the change will be that we will be talking to a few different faces for the next couple of legislative sessions. Seeing as how we only endorse policy and do not endorse candidates, our work remains very straightforward; help advance the cause(s) of senior citizens and especially work on advancing affordable, accessible healthcare for all. The work remains the same regardless of who is sitting in those elected offices in Washington, D.C., St. Paul and in our Seven Counties.

We also will be mindful of the recently passed priority of our GMHCC membership to make Campaign Finance Reform our highest concern at the national level in 2011. This seems to be even more important with the enormous amounts of money that were spent on the just completed elections. An obvious case in point was the race for the Sixth Congressional District seat between incumbent Michelle Bachmann and challenger Tarryl Clark. In excess of $15 million dollars was spent on that race! It always strikes me as terribly odd that people spend all that money to acquire a job that pays a little over $100,000 per year… seems out of balance regardless of who wins.

The last number I heard was that around $4 billion dollars was spent nationally during the election cycle. Let me just think about this for a second… we’re in tough economic times, people are out of work, healthcare costs are soaring way past affordable, jobs are hard to come by, people are losing their homes in record numbers, our deficit continues to grow each year, but somehow… we can come up with $4 billion dollars for an election? I guess the logic or the humanity of that escapes me. There just should be no reason to devote those kinds of resources to elect officials to represent our needs in this country. None. If we can clean that up we’ll be well on our way to making life better for all of us. Plus, it will be interesting work as we dig deeper into Campaign Finance Reform and make new friends and allies to advance the cause; a cause that will benefit all of us regardless of age.

Politics, it seems, for years, or all too long, has been concerned with right or left, instead of right or wrong. That needs to change and the good news is that many more people have come to recognize that fact and, hopefully, will be willing to work to change it and clean up the toxic atmosphere of current politics. The sooner that happens the better off we’ll be. I’m ready. How about you?

Peace and good affordable, accessible healthcare for all!

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Echoes – October 2010

Posted on October 2, 2010 by Tim B

Health Care Law

Parts of the new Patient Protection and Affordable  Care Act (PPACA) law went into effect on September 23, 2010.  A select number of people will see immediate benefit from the new law (see box below), while other provisions will gradually be phased in over the next six years.  The new law couldn’t have come into effect at a more opportune time.

A record rise in the number of people without health insurance across the nation is fueling renewed debate over a health care law that could work better at boosting coverage than controlling costs.

According to Census Bureau data released in September, more than 50 million (50.7 million) people were uninsured last year, almost one in six U.S. residents. The percentage of those with private insurance was the lowest since the government began keeping data in 1987.

The reasons for the rise to 50.7 million, or 16.7%, from 46.3 million uninsured, or 15.4%, were many; workers losing their jobs in the recession, companies dropping employee health insurance benefits, families going without coverage to cut costs. Driving much of the increase, however, was the rising cost of medical care; a Kaiser Family Foundation (June 2010) report shows workers now pay 47% more than they did in 2005 for family health coverage, while employers pay 20% more.

Although the health care law signed into law in March is designed to insure an additional 32 million people in public and private programs, it doesn’t fully kick in until 2014. For the next few years, experts say, the problem could get worse. The average cost to insure a family of four is already about $14,000.

The increase in the uninsured population had been expected as employers continue to shed jobs.  Low-income households were three times as likely to be uninsured as those with incomes above $75,000. Workers ages 18-64 were the primary losers, as public programs such as Medicare, Medicaid and the Children’s Health Insurance Program protected the young and aged.

President Obama picked up on that glimmer of hope in his response to the Census report. He said the new health care law, which is designed to insure more poor and middle-income Americans, “will build on that success by expanding health insurance coverage to more families.”

Proponents of the law say the sharp rise in the number of uninsured in 2009 only makes their case stronger.  Opponents say the Census report exposes the fallacy of the new law — its reliance on government insurance programs to shield low-income families from soaring medical costs. The government’s health care actuary projected last week that overall health care spending would rise slightly over the next decade.

Since its passage, the law has struggled to win public support. The latest USA TODAY/Gallup Poll found Americans disapprove of the new law 56% to 39%, though the Kaiser Family Foundation has found that many individual provisions are more popular.

Interestingly enough though, well over 70% of those responding also said they didn’t feel that the law that was passed went far enough in reforming healthcare.

Fact vs Fiction

Concern: Medical insurance benefits will be taxed as income.

Reality: False. Taxing medical benefits was discussed as a cost-saving option during reform negotiations, but in the end the idea was dropped. The myth, however, lives on.

Caveats: The cost of health-care benefits must be listed on the W-2 forms business owners issue to their employees, starting in 2011. This will probably further the confusion. Want to read relevant portions of the health-care law itself? The Henry J. Kaiser Family Foundation has a site (http://www.kff.org/healthreform/sidebyside.cfm) where you can call up specific portions of the law (just “employer requirements,” for instance) that may apply to your company.

Concern: Small companies get tax credits to provide insurance.

Reality: True for mom-and-pop shops, which are currently the least likely to offer coverage. Not true if you have more than 25 full-time employees (50 part-time) or pay average annual salaries of more than $50,000 per employee.

Caveats: The full credit, which starts at 35 percent this year, and jumps to 50 percent in 2014, is given to companies with fewer than 10 full-time workers and average salaries under $25,000. Employers must pay at least half the cost of the insurance provided.  The credit gets reduced gradually for companies that have 10 to 25 full-time employees with average salaries between $25,000 and $50,000. It phases out entirely for companies with 25 full-timers. Companies with 25 to 50 full-time employees fall into a kind of limbo: You won’t get a tax credit if you offer insurance, but you won’t be penalized for not offering it, either.

Concern: Businesses will be fined if they don’t provide medical insurance.

Reality: Not true, if you have fewer than 50 full-time employees. True, for companies employing 50 or more full-time workers. (Part-time employees’ annual hours are calculated, so that 100 half-time employees equal 50 full-timers.)

Caveats: Business owners with 50 employees need not panic just yet. This provision of the law doesn’t go into full effect until 2014.  More than 95 percent of companies with 50 or more employees currently offer coverage, according to the Health and Human Services website (www.healthcare.gov).  In 2014, those who don’t offer it, and have at least one full-time employee who receives a premium tax credit (which will be offered to low-income individuals) to buy coverage on his own, will be fined $2,000 per full-time employee, excluding the first 30 employees. Companies that offer coverage but have at least one full-time employee receiving a premium tax credit (presumably because company coverage is too expensive) will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, again excluding the first 30 employees.

 

Concern: Small businesses will be required to issue 1099s to all vendors.

Reality: True. In an effort to close the tax gap, all companies will be required to issue 1099 tax forms to any vendor upon whom they spend $600 or more annually. This includes the deli catering your company meetings and the stationery store where you buy envelopes. It is likely to double accounting costs at some small companies, Hanley says.

True. In an effort to close the tax gap, all companies will be required to issue 1099 tax forms to any vendor upon whom they spend $600 or more annually. This includes the deli catering your company meetings and the stationery store where you buy envelopes. It is likely to double accounting costs at some small companies, Hanley says.

Caveats: This provision goes into effect in 2012 and may be overturned or limited before then.

Currently, 1099s are issued mainly to independent contractors and service providers. Broadly extending the requirement will mean that entrepreneurs who have never issued 1099s will likely have to send out 15 or 20 a year, Hanley says. Larger companies may have to mail out thousands of forms, undercutting government paperwork reduction efforts.

~

Sources used:  Bloomberg Business Week of July 13, 2010 and www.healthcare.gov

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Heartfelt – October 2010

Posted on October 1, 2010 by Tim B
~ by Tim Burkhardt

In case you missed it there is a “new” movement to change, actually do away with, Medicare and Social Security by groups who never wanted those programs in the first place, mainly Wall Street banks/brokerage firms and insurance companies.  Coincidentally, those aforementioned industries were recipients of some of the gigantic TARP (Troubled Asset Relief Program) bailouts passed by the previous andcurrent administrations.  Wall Street bankers and insurers stand to gain much if Medicare and Social Security are dismantled and/or privatized. As it is, Wall Street banks and investment firms are getting quite healthy thanks in large part to the government’s intervention.   Ironic isn’t it that supporting them has now emboldenedthem?

Not surprisingly, now that they are feeling their oats again, banks and insurance companies are backing efforts to get an even larger piece of the pie related to Social Security and Medicare through privatization.  Apparently it doesn’t matter that the government (you and me) stepped in and saved them from collapse, for now they want more… and more. They are a hungry animal with little or no social conscience and certainly an unbridled appetite for amassing wealth beyond compare, all the while ignoring those who are footing the bill.

It’s really hard to imagine what this country would look like if Medicare were not around.  A likely scenario would be that many seniors would be uninsured, would have lost their homes and retirement savings, and either be homeless or living with their children or relatives, or they would have died prematurely for lack of affordable healthcare.  The protection afforded seniors, both for their health and lifestyle, by Medicare has been nothing short of miraculous.  Of course the rest of that “non-Medicare” scenario would mean an unimaginable accumulation of strength, wealth and power by the insurance companies, as if they didn’t have enough already.  That begs the question, “How much is enough?”

Be mindful that those scary Medicare/medical buzzwords have resurfaced again as the discussion heats up.  Words like “voucher,” and “choice,” are at the middle of the change talk being proposed by those interested in “real healthcare reform.”  In simple terms, voucher means that seniors would get a set “credit” that they could redeem at selected health providers and once it’s used up for the year (?) everything else would be out-of-pocket expense to the individual owning the voucher.   Choice would only refer to a choice of insurance companies, not a choice of doctors for the individual.  The bottom line is that choice of insurance companies is no choice at all.

As most everyone knows, the concept of Medicare Part D (prescription drug benefit) had one giant flaw; it left the insurance companies in the mix and rewarded them handsomely for “participating” in the program to help seniors with their drug costs.  You’ve all seen the satisfaction numbers relating to part D and they are abysmal, based on what was spent on the program.  That’s due in large part to allowing/inviting the drug and insurance companies to write the prescription drug bill.  What did you think would happen when you plopped a blank check down in front of those groups?  Two guesses who’s being asked for advice on how to “reform” Medicare.

Likewise, seniors should be on alert and remember the Part D creation debacle when the talk shifts to “how to reform” Social Security.  The industry leaders (banks and brokerage firms) need to be miles away from the reform table when there’s any discussion of how to make Social Security stronger and more durable.  Any plans to place the lion’s share of Social Security dollars into the stock market should be “off the table” (much like any talk of single-payer healthcare was taken off the table early last year).    Let’s learn from failed history, not repeat it.

Peace and affordable, accessible healthcare for all!

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Echoes – September 2010

Posted on September 2, 2010 by Tim B

GMHCC Annual Meeting Will Focus On CBP

The Greater Minnesota Health Care Coalition (GMHCC), of which Seven County is a founding member, will continue to focus their attention on County Based Purchasing (CBP) of healthcare.

Scandrett-Przybilla

Special guest speakers and panelists will be on hand for the October 12th Annual Meeting of GMHCC members.

Panelists for the event will include Michael Scandrett, who will be able to report on the Association of Minnesota Counties position on CBP, and also on hand will be Jim Przybilla the CEO of Prime West Health.

Almost 1/3 of all Minnesota counties now participate in some type of county based purchasing of healthcare, saving their taxpayers a good deal of money while delivering better healthcare access to the participants who are enrolled.

Until recently, those who were eligible for healthcare services were those enrolled in MNCare or in the GAMC or Medical Assistance programs in Minnesota.

That may be changing as one of the current CBP groups, PrimeWest Health, will be able to expand its program to cover even more people as it prepares to launch their Values Health program. This new program is modeled with the same basic county based purchasing of healthcare and relies on partnerships with thirteen (13) county units of government along with dozens of healthcare service providers. A number of school districts in the region are also part of the initial partner group that will be eligible for services.

The target group to be served is individuals who make just a bit too much to qualify for state subsidized programs, but also don’t earn enough to be able to afford private coverage on their own.

The financing will be done through a “multi-share” model utilizing individuals, employers, community and state or federal government funds. Persons in the program will contribute to the cost of their health care by means of a sliding fee scale based on their income. Likewise, employer’s contribution will be on a sliding fee scale based on the size an financial position of the company.

Participating employers’ financial contribution also will be on a sliding fee scale based on the size and audited financial position of the company.

The state and/or federal portion would come through funds available for advancing health care reform and health care coverage for all residents.

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Heartfelt – September 2010

Posted on September 1, 2010 by Tim B
~ by Tim Burkhardt

There are seasons… and then there are seasons. For me fall is THE season for a number of reasons.

First of all, the search for “cool” ends… folks are not in constant search mode for heat relief. After the summer we’ve had (it’s not officially over yet) many people will probably come round to naming fall as their favorite, if they haven’t already done so. No more ninety (90) degree days with 60-70% humidity (it’s not the heat, it’s the humidity!) and no more melting like a popsicle in the great out-of-doors.

Moderate temperatures will be the “norm” for the next 60 days or so (moderate to me, I suppose) and the likelihood of mosquito attacks drops dramatically as well, always sufficient reason to rejoice. Daytime highs in the 45-70 degree range with overnight lows in the 20-50 degree range are more to my liking. Sadly, we’ll have to give up most of the glorious rainbow explosion of colors, brought to us courtesy of summer-flowering plants, but they are replaced with an equally vibrant assortment of fall splendor as our trees and shrubs give us a leafy visual concert worthy of Rembrandt, Picasso or Monet.

The business of Seven County takes off in a slightly different direction too, as the seasons change. The parades, county fairs and expos are done, for the most part, and the business of planning for the Customer Appreciation Day at One More Time (September 17th, 9-12 noon), the GMHCC Annual Meeting (October 12th 9:30-11:30) as well as our regularly scheduled monthly delegate meetings keeps us plenty busy around here. Ongoing planning for next year’s 2011 Seven County Convention (April 14th in Aitkin), and all that comes with it, continues in addition to those seasonal promotions for our stores (Halloween, Thanksgiving, Christmas, New Year’s). And, we certainly don’t want to overlook our volunteer Christmas Party coming up in December… that’s going to take a bit of time to pull together, too.

On the subject of volunteers and before I forget, there’s a quick recap and some thanks that need to be passed along regarding our recent volunteer road trip. In August a busload of us headed down to take in a St. Paul Saints game at Midway Stadium in St. Paul. As luck would have it, it was one of the hotter days of a hot summer. But, we survived and had a great time tailgating and sitting in the sun watching America’s favorite pastime. Thanks to all the volunteers that made it a memorable day and special thanks to Shannon Jackson who took care of all of the trip details… it was a fun day for all.

In other Seven County news, we are talking with some local groups in putting together a candidate forum. The Kanabec Chamber and KBEK and maybe one other group have expressed a willingness to put one or two forums together. Stay tuned for details as we work on the details of such an event. And, for those of you that want to learn more about developments in healthcare that likely will affect all Minnesotans in the future, check out the GMHCC event on October 12th starting at 1 p.m. (see front page story on CBP). There’s some perceptible tremors in the field of healthcare delivery in Minnesota, and CBP (county based purchasing) is sitting squarely on the fault line.

Peace and good, affordable, accessible healthcare to all!

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