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Good news, bad news on health care

Posted on 06/26/15 by Wendy Patton

by the U.S. Supreme Court upholds provisions of the Affordable Care Act that help people pay for health insurance. But some onerous provisions in the state’s Medicaid program cleared the state’s budget conference committee and appear headed for the governor’s signature. Here’s a quick overview of yesterday’s good news for health on the national level, bad news on the state front.

Good news: The Affordable Care Act is the law of the land. A lawsuit challenged the ability of the federal government to help people afford insurance in states like Ohio, where the state declined to administer its own health insurance marketplace. The Supreme Court denied the challenge. Chief Justice Roberts, writing for the court, stated: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

The ruling clarified that federal tax credits can be used to help people afford health insurance in all states. More than 161,000 Ohioans can continue to afford health insurance without worry. Thousands of Ohio families continue to benefit from health reform’s promise of quality, affordable health care.

The Affordable Care Act has provided health coverage for more than 16 million Americans, reducing the cost of uncompensated care last year by more than $7 billion nationally.

Bad news: The new state budget would ask the federal government’s Centers for Medicare and Medicaid Services (CMS) to waive a number of Medicaid rules in a manner that could create barriers to care.

The state extended Medicaid in 2014 to low-income adults. A half million people signed up. Hospitals started to see their bottom lines strengthen as more patients had insurance. Health-care costs declined as the health of participants improved in one pilot project at Cleveland's MetroHealth System, which began earlier than the statewide expansion and where such results are available.

It’s a good thing that the new budget still includes adults in Medicaid. But if CMS waives Medicaid rules as outlined in the budget bill, new costs and penalties will prevent some people from getting the health care they need. That defeats – for those individuals – the purpose of health reform. Some of the elements of the proposed plan in the fiscal year 2016-17 budget include:

• Premiums: Monthly premiums of the lesser of 2 percent of annual family income or $99 per year per participant. This is less onerous than the original House plan, but research shows such payments reduce health-care usage among the poor – because income is so limited and choices are hard.


• Monthly payments: Premiums may be paid in monthly installments. This can be hard for families who lack bank accounts, transportation, stable housing or face other barriers to completing a task like mailing a payment.


• Incentives: Each participant would receive an electronic benefits swipe care, loaded with “points,” which represent amount of care available to that participant. Extra points are to be given based on participant’s meeting health-care goals or achieving physician-set benchmarks. This could discriminate against those who lack access to health basics: Transit to get to stores with healthy food, for example, or whose neighborhoods are too unsafe to permit healthy exercise.


• Preferences: Those with bank accounts and computers who arrange electronic funds transfer for their monthly premium payment are automatically given additional health-care points. This discriminates against those who live in places without Internet access and those too poor to have a bank account.


• Penalties: Missing payments or required paperwork for more than 60 days results in loss of care. Debt must be cleared or paperwork submitted before readmission. This is far less onerous than the 12-month lockout of the House plan, but if the goal is to provide care, any barrier defeats the purpose.


• Care “caps:” If care for a patient costs more than $300,000 a year or $1 million in a lifetime, they are to be transferred to other programs, raising concern about changes in treatment for the sickest of patients.