We start with the always brilliant Dr. Pauline Chen , this time talking about what happens when insurers put profits before people. She's talking about a new book by former CIGNA PR guru turned insurance company critic Wendell Potter called Deadly Spin. It's what I face every day as I try to help patients get the care they need. This is well worth reading.
In that context, we view the GOP plan for repeal . Assuming that complete repeal will not pass the Senate, a bunch of piecemeal repeal bills have been introduced to eliminate the individual mandate that people buy insurance, and to de-fund reform implementation efforts.
But the GOP has some obstacles.
Although the nonprofit Congressional Budget Office says repeal of health reform would cost $230 billion over 10 years, the GOP says they disagree. The CBO also says repeal would leave 32 million people without insurance in 2019. The GOP plans to release its own figures at some point showing that health reform is costly and repeal will save money. The problem with this is that the parties have always agreed to use CBO estimates so they're not talking past each other. It's going to be hard to get any sort of agreement on anything if the Dems and GOP refuse to rely on the CBO.
Meanwhile, Dems are coming together on repeal of reform -- even those who voted against reform are likely to vote against repeal because of the positive consumer protections that already have taken effect. Tweak the law, make changes? Sure. But wholesale repeal? No way.
And President Obama has now official said he would veto the total repeal bill.
Thirty-three State Governors are sending a letter to the feds asking them not to expand Medicaid enrollment as part of health reform. Starting in 2014, Medicaid is supposed to cover all adults up to 133% of the federal poverty level. The feds will pay 90% of the cost of this expansion, but that federal share phases out over time, leaving the states to pick up more of the tab for this expansion. So the states are unhappy. Meanwhile, not a day goes by when I don't get a call from an adult in some state who's broke but not on Social Security disability, and they can't get Medicaid or afford any other alternative. So I ask the States what they plan to do for these folks instead of expanding Medicaid?
Meanwhile, both Federal and California officials pledge to push back against California Blue Shield's 59% rate increases. The Insurance Commissioner has asked Blue Shield to hold off for 60 days so he can look into the matter.
Disability rights advocates in Texas have been trying to get institutional settings shut down. That may now happen due to budget cuts. The hope is that this would lead to more community based care.