Archive for the 'Single-Payer Healthcare' Category

Why Organized Labor Is Organizing Against Obamacare

This significant article shows a potential new source of support for winning Single-Payer healthcare: organized labor. Unions which had held back from embracing Single-Payer because they had their own health plans are now realizing that Obamacare does not just encourage employers to cut back full-time jobs to un-benefited part-time jobs. Obamacare also damages hard-won union-based health plans.

2013-09-17-GP_meeting-detail

Click to enlarge image.

The Fiscal Times, August 30, 2013

Why Organized Labor Is Organizing Against Obamacare
(Read this article on-line at http://tinyurl.com/pchnggr )

By ERIC PIANIN, The Fiscal Times

Now look who’s making a fuss about Obamacare.

President Obama has had his hands full fending off Republican assaults against Obamacare. Sen. Ted Cruz of Texas and a handful of other GOP lawmakers even favor shutting down the government, if necessary, to prevent the new law from fully taking effect.

But Obama is also getting blasted these days from an unexpected quarter: Major labor groups instrumental in helping the president win a critical second term are charging that Obamacare is undercutting existing union-sponsored health insurance programs and even encouraging employers to cut workers’ hours.

This is the latest bizarre wrinkle in the unfolding political drama over Obama’s signature program for extending health insurance coverage to millions of uninsured Americans.

Last month, leaders of three of the largest labor unions sent a scathing letter to Senate Majority Leader Harry Reid (D-NV) and House Minority Leader Nancy Pelosi (D-CA), warning that if the problems with the insurance program are not addressed, the new health care law will “shatter not only our hard-earned health benefits, but destroy the foundation of the 40-hour work week that is the backbone of the American middle class.”

The letter was written by James Hoffa, president of the International Brotherhood of Teamsters, Joseph Hansen, president of the United Food and Commercial Workers International Union, and Donald Taylor, president of UNITE-HERE, a union that represents hotel, airport and food service workers. It stressed the unions’ displeasure with a law they all had previously supported and helped to pass.

“When you and the president sought our support for the Affordable Care Act, you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat,” said the letter. “We have been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision. Now this vision has come back to haunt us.”

AFL-CIO president Richard Trumka echoed those concerns Thursday, telling reporters during a breakfast event that the administration and Congress made some serious blunders in drafting the legislation that must be fixed to quiet the growing union discontent.

“We’ve been working with the administration to find solutions to what I think are inad-vertent holes in the act,” said Trumka. “When the act was put together, it wasn’t thought completely through. So we work on a daily basis. I’m hopeful we get something done in the very near future.”

PERVERSE INCENTIVE?

From labor’s perspective, arguably the biggest problem is that the law – when fully implemented – will create an incentive for employers to keep their workers’ hours below 30 hours a week.

The Affordable Care Act will eventually penalize firms employing 50 or more people that don’t offer health insurance – or that offer coverage below minimum standards. This is the so-called “employer mandate.” The White House this summer put that provision on hold until 2015 to give medium and large employers the opportunity to better prepare and plan for the changes and reporting requirements. But once that provision finally takes hold, union leaders say that companies will cut the hours of workers below 30 hours per week to get under the 50-worker threshold for providing health care coverage.

With salaries remaining relatively static during this tepid economic recovery, a cutback in hours would be tantamount to a substantial pay cut for many union and other workers who are struggling to make ends meet.

“Employers are trying to plan their future by creating a work force that gets 29-and-a-half hours or less a week, so that they don’t have to pay health care,” Trumka said yesterday. “That is obviously something that no one intended….Is that an issue? Yeah, that’s an issue.”

Labor leaders also fear that Obamacare may end up “destroying” the union’s multi-employer health plans unless it is changed.

At issue are “Taft-Hartley plans” – the non-profit health care plans long used by union-ized workers in the building trades and service industries and jointly administered by participating companies and unions. Those plans have traditionally allowed workers in transient industries to move between employers while still preserving the same quality of health care. Because union leaders have helped negotiate those plans, they typically offer strong coverage at a low out-of-pocket cost to workers.

Under the Affordable Care Act as currently interpreted by the administration, union members with this form of health insurance coverage would not be entitled to federal tax subsidies available to others who purchase policies from private companies in the new insurance exchange, according to labor leaders. Moreover, many union members who hold these “non-profit” policies may get hit with federal taxes to help offset the cost of the subsidies offered in the new state exchanges.

“Taken together, these restrictions will make non-profit plans like ours unsustainable, and will undermine the health-care market of viable alternatives to the big health insurance companies,” according to the letter sent to Reid and Pelosi by the labor chiefs.

The Treasury Department has signaled it views the Taft-Hartley plans as equivalent to other employer-based plans, which aren’t eligible for subsidies. And the Congressional Research Service, a nonprofit legislative analysis group, published a paper saying Taft-Hartley plans likely wouldn’t be eligible for subsidies based on the way the law is written.

The health care law is likely to be a prime topic of conversation when Obama addresses the AFL-CIO’s Quadrennial Convention next month in Los Angeles. Obama’s relations with labor have been rocky at times, for sure. Yet while he’ll talk about his plans to create jobs, provide better pay and strengthen workplace protections, the president’s speech on Sept. 9 may not include every reassuring word that labor leaders are right now longing to hear.

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Spaniards Protest Health Care Reforms: privatization, closures of public facilities

Spaniards Protest Health Care Reforms

By HAROLD HECKLE
Associated Press

Protestors march as they carry a banner reading, “Public health care” and “24 hours strike” during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

MADRID — Thousands of people marched in Madrid on Sunday to protest plans to privatize parts of their public health care system, with some questioning the motives behind the government’s actions.

The march by employees and users of the system is the year’s second large “white tide” demonstration, named after the color of the medical scrubs many protesters wear. Several similar marches took place last year.

Demonstrators thronged main boulevards in the center of the Spanish capital, carrying banners saying, “Public health care should be defended, not sold off.”

The Madrid region has proposed selling the management of six of 20 large public hospitals in its jurisdiction and 10 percent of its 268 public health centers. It says these reforms are needed to secure health services during Spain’s economic crisis.

A protestor carries a banner reading, “Spanish Prime Minister Mariano Rajoy, serial fraudster” during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

But protesters were skeptical.

“This measure is politically inspired and not financial,” said mechanical engineer Mario Sola, 47. “If public hospitals were unsustainably loss-making as we’re being told, private enterprise wouldn’t be interested.”

Health care and education are administered by Spain’s 17 semi-autonomous regions rather than by the central government.

Many regions are struggling financially as Spain’s economy has shrunk due to a double-dip recession following the 2008 implosion of the once-prosperous real estate and construction sectors.

Some regions overspent during boom years, but are now excluded from borrowing on the financial markets to repay their accumulated debts, forcing them to seek savings and even request rescue aid from the central government.

Regional health councilor Javier Fernandez-Lasquetty called the protests irresponsible and said that “everyone has their point of view, but we are all fighting to defend the same thing.”

Jose Gabriel Gonzalez Martin, president of Spain’s Independent Civil Service Trade Union Center, said many people’s suspicions were aroused when former government health officials acquired jobs with private companies lining up to take over medical analysis functions.

“It might be purely coincidental, but some coincidences are surprising,” Gonzalez said.

Protestors shout slogans during a demonstration against regional government imposed austerity plans to restructure and part privatize health care sector in Madrid, Spain, Sunday, Jan. 13, 2013. Madrid proposes selling off the management of six of 20 public hospitals and 27 of 268 health centers. Spain’s regions are struggling with a combined debt of 145 billion euro ($190 billion) as the country’s economy contracts into a double dip recession triggered by a 2008 real estate crash. Andres Kudacki / AP Photo

 

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Healthcare Crisis: Not Enough Specialists For The Poor, but Calif to Cut Medi-Cal Spending

Healthcare Crisis: Not Enough Specialists For The Poor

LA Times, December 15, 2012

With months-long waits for Medi-Cal patients to see specialists, some turn to emergency rooms — exactly what healthcare reform is banking on avoiding.

By Anna Gorman, Los Angeles Times

The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor.

He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery.

Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. His vision has deteriorated so much he is considered legally blind.

PHOTOS: Waiting in vain to be seen

“I want to see again,” he said. “I’ve been waiting a long time.”

Lawrence, 49, and patients like him are posing a critical challenge for the planned overhaul of the nation’s healthcare system. Federal officials are investing billions in community health centers like the To Help Everyone (T.H.E.) Clinic, where Lawrence’s problem was diagnosed, with the hope that they can keep more patients out of high-cost emergency rooms.

But a dearth of specialists available to low-income patients presents one of the bigger hurdles facing the country as it tries to bring spiraling healthcare costs under control. Doctors say meeting new government mandates to keep patients healthy and out of hospitals — a linchpin in reducing medical spending — will be virtually impossible without the ability to make timely patient appointments with specialists.

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

The healthcare overhaul includes initiatives aimed at reducing shortages of general medicine professionals but does little to increase the availability of specialists.

In Los Angeles County, the sheer volume of poor or uninsured patients needing specialist services has long overwhelmed the public health system, creating costly inefficiencies and appointment delays that can stretch as long as a year and half.

Patients’ conditions often must be dire for them to see a neurologist, cardiologist or other specialist quickly. Community clinics try to bypass the backed-up formal government referral system by pleading, cajoling and negotiating to get less critically ill patients like Lawrence moved up on waiting lists.

“Where needs are absolutely critical, we are able to work out special arrangements,” said Rise Phillips, chief executive of T.H.E. Clinic. “That is not the norm. That is, rather, the exception.”

At times, clinic staff members are forced to work against one of their key missions by sending patients to emergency rooms to increase the odds of their seeing a specialist more quickly.

The challenge can be seen in Belinda De Leon’s cubicle in a small, windowless back corner of T.H.E. Clinic. A referral specialist, De Leon spends her days trying to speed up appointments for the center’s clients — and fielding calls from patients wanting to know how much longer they have to wait. At any given time, she’s juggling more than 1,000 pending referrals.

One involves uninsured housekeeper Juana Barrera. Barrera, 45, has been waiting since April 2011 to see a gastroenterologist and get a colonoscopy. She has had bleeding off and on and recently started having pain in her stomach.

On a recent visit, she told De Leon she is scared to wait any longer. But she can’t afford to pay for the test out of pocket. “I’m hoping it’s not anything like cancer,” she said.

De Leon promised to update Barrera’s referral paperwork to indicate she is experiencing pain. “Hopefully that will help,” she said.

Waits for specialist appointments vary dramatically, depending on the type of specialist needed. Patients willing and able to travel across L.A. County to specialty clinics may be able to see a doctor within a month or two. Others who lack transportation and must go to a nearby facility can wait up to a year for a dermatologist or neurologist and up to 18 months for a cardiologist or ophthalmologist.

The county is trying to make the system more efficient, reduce wait times and ensure that those who don’t need more advanced care don’t overburden the system, said Mitch Katz, head of the L.A. County Department of Health Services. County officials risk losing newly insured patients, along with government funding, if they can’t find ways to reduce the bottleneck.

One focus is using technology to improve communication and better screen patients. A pilot program, for example, is allowing primary care doctors at community and public clinics to quickly transmit patients’ medical information via computer to a public health specialist for a consultation.

The electronic consults are streamlining referrals and helping clinic doctors make better treatment choices, said Louise McCarthy, executive director of the Community Clinic Assn. of Los Angeles County.

During an August visit to T.H.E. Clinic, Lawrence saw nurse practitioner Sandeep Lehil for the first time. He told her he was controlling his diabetes with medication and a modified diet. But his vision wasn’t getting any better.

“My eyes are really bad,” he told Lehil. “I can barely see.”

Lawrence’s medical record showed that he wouldn’t be seeing an ophthalmologist for many months.

“That’s a long time to live with blurry vision,” Lehil said.

“By that time, I’ll be blind maybe,” Lawrence responded.

Lawrence, who has a soft voice, an accent and a lanky frame, arrived in the U.S. nearly 20 years ago to pick apples, and overstayed his visa. He can’t work or drive, and he relies on others to cook meals to avoid burning himself. His immigration status prevents him from getting health insurance or unemployment benefits. He lives with a friend, spending most days listening to a television he can barely see. When the phone rings, he lifts it almost to his nose to see who is calling.

In mid-October, Lawrence was back at the clinic and saw a different, fill-in doctor who knew nothing about his situation, nor when his surgery would be scheduled. “You haven’t received any notice?” asked physician David Hwang. “No, not yet,” Lawrence answered, adding that he checks his mailbox every day.

De Leon, the referral clerk, later gave Lawrence unwelcome news: The wait to see an ophthalmologist at the county’s Harbor-UCLA Medical Center was still about a year. She said she was trying to get him an appointment elsewhere sooner.

Weeks later, Lawrence took matters into his own hands. With the help of a friend, he took three buses to reach the emergency room at Los Angeles County/USC Medical Center northeast of downtown. He waited several hours but finally saw an emergency room physician, who managed to get him an appointment the next day with an eye doctor.

“You have to do what you have to do,” Lawrence said.

At the medical center’s specialty clinic, ophthalmologist Simon Bababeygy told Lawrence his cataracts probably were caused by his diabetes, high blood pressure and high cholesterol.

He described the surgery he would perform, on one eye at a time. And he spoke the words Lawrence had been waiting for: He should be seeing much more clearly by the end of the year.

Preparing for the surgery, doctors got an abnormal result on a heart test. Now, Lawrence has to wait to see a county cardiologist before going back to Bababeygy to schedule the eye operation. He has no idea how long that could take.

“Every time, it’s something else,” he said. “My eyes are getting worse. And now it’s my heart.”

anna.gorman@latimes.com

Times staff writer Anna Gorman reported aspects of this story while participating in the California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism.

Copyright © 2012, Los Angeles Times

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LA Times, December 13, 2012

Court Ruling Could Cut California Spending On Medi-Cal

A 9th Circuit appeals panel decides California can reduce its Medi-Cal reimbursements to doctors, pharmacies and others. Providers say the doctor shortage will worsen.

By Maura Dolan and Chris Megerian, Los Angeles Times

SAN FRANCISCO — In a potential windfall for the state, a federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.

The ruling could make it harder to find doctors for as many as 2 million new patients who could become eligible for Medi-Cal under President Obama’s healthcare law — a possible 25% expansion of the program. California already provides one of the lowest rates of reimbursement in the nation for medical services to the poor, and there is a shortage of doctors to serve those patients.

Lynn S. Carman, an attorney for a group of pharmacies, said the decision would be costly for providers, worsen the doctor shortage and would be appealed.

“If this decision stands it will not only destroy the Medicaid program in California, but it will destroy the Obamacare program for millions of Americans who are now being shoved into the Medicaid program under the Affordable Care Act,” Carman said.

“They will not be able to obtain quality healthcare or access to services because providers cannot provide services at less than what it costs to furnish them,” Carman said.

The ruling could make it considerably easier for the state to close its budget gap.

The state is facing a $1.9-billion deficit next year, although Proposition 30’s temporary tax hike and an improving economy are projected to shift the state back into surpluses in the near future.

Medical providers said Thursday that the cutback should be lifted now that the state’s fiscal outlook has improved. The ruling can be applied retroactively to June 1, 2011.

“Now that the state has money, it would be like Scrooge for Gov. Brown not to pass a bill to eliminate at least the retroactivity part of it,” Carman said.

For the governor, Medi-Cal cuts could serve one policy aim at the expense of another.

Balancing the budget has been Brown’s first priority since taking office, and cutting healthcare — the state’s second-biggest cost after education — has been key to his fiscal goal.

But at the same time, he has wanted California to be out front in healthcare reform, and lead the country in efforts to put the federal law into place.

A spokesman for Gov. Brown released a statement Thursday that implied that Brown was inclined to put his budget priorities first, and was not likely to rescind the cuts.

“Today’s decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs,” the spokesman wrote.

In a ruling written by Judge Stephen S. Trott, appointed by President Reagan, the panel said the lower court injunctions were unwarranted because the federal government had approved the cuts.

“Neither the State nor the federal government ‘promised, explicitly or implicitly,’ that provider reimbursement rates would never change,” Trott wrote.

California has estimated that the 10% cut to medical providers and pharmacies would save the state $50 million a month.

Medi-Cal typically covers families and disabled Californians. The federal law will extend its coverage to single, childless adults beginning in 2014.

The California Medical Assn., which joined dentists, pharmacists, medical suppliers and medical response companies in trying to block the cutbacks, urged Brown to repeal them.

Dr. Paul R. Phinney, president of the doctors’ association, said the cuts shrink the number of providers who could afford to serve both existing Medi-Cal patients and the new ones who could become eligible for coverage in 2014.

“We need to ensure that health insurance isn’t just an empty promise for these patients,” Phinney said.

According to the California HealthCare Foundation, Medi-Cal patients already have difficulty finding doctors.

A foundation study published in July 2010 said 25% of physicians provided care to 80% of Medi-Cal patients.

Although 90% of physicians told the foundation they were accepting new patients, only 57% said they were taking on new Medi-Cal patients.

Dr. Ted Mazer, a San Diego ear, nose and throat surgeon, said he had to stop taking fee-for-service Medi-Cal patients several years ago because the reimbursements didn’t cover his costs and Medi-Cal patients were inundating his practice.

“So few doctors will see Medi-Cal patients that I was seeing them from the Mexican border to Riverside County to Orange County,” said Mazer, an officer of the California Medical Assn. “The reimbursement costs are so poor they don’t even cover costs, let alone pay for the administrative hassle. I can only see so many until I go under.”

Chris Perrone, deputy director of the foundation, said Thursday’s ruling will make it harder to block rate cuts in the future.

“The hurdles for people who want to block these rate cuts are little higher,” said Perrone.

maura.dolan@latimes.com

chris.megerian@latimes.com

Dolan reported from San Francisco and Megerian from Sacramento.

Times staff writer Anna Gorman contributed to this report.

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CARA Flash Mob: Hands Off Social Security, Medicare, Medicaid! Tax the Top 2%!

The nation’s richest banks and corporations have rung up billions in deficits with wars, tax cuts for the richest, bank bailouts, and reckless speculation, and now they want us to pay by sacrificing Social Security, Medicare, Medicaid, and every other part of the Safety Net!

Democrats and Republicans alike are burning the midnight oil in search of a bi-partisan Grand Bargain to screw seniors, people with disabilities, kids, and low-income workers.

No Way! Join our Flash Mob for social justice: We demand:

* No cuts to Social Security, Medicare, Medicaid, or services to low-income people.

* End the tax cuts for the rich

* Create millions of jobs

Our goal is to video our flash mob and have it go VIRAL – so the whole country puts pressure on Congress to demand that we do not cut our essential programs in order to make the Grand Bargain on the deficit and avoid sequestration before the end of the year.

Sponsored by the California Alliance for Retired Americans (CARA) and Jobs With Justice (JwJ).

See the Resolution on Social Security, Medicare, and Medicaid written by SF Gray Panthers and passed by the SF Central Labor Council.

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Bipartisan plan to gut Medicare: Vouchers, Premium Support, and Competition

Bipartisan plan to gut Medicare: Vouchers, Premium Support, and Competition

Democrat Ron Weiden and Republican Paul Ryan are pushing a plan to send the Medicare we know into a death spiral.  Medicare would become voucher system, with recipients receiving checks based on the premiums of the second-cheapest Medicare-HMO in an area.  Annual voucher increases would be limited to Gross National Product  growth plus one percent, far less than the historical growth rates of Medicare costs.  Medicare’s premiums would be higher than HMOs premiums, because Medicare would be forced to accept sicker, more expensive patients, who would not survive under HMOs managed care.  Medicare recipients would have to pay the difference between Medicare’s higher premiums and the vouchers based on the 2nd-cheapest-HMO plan, out of their own pockets, which would steadily drive healthier patients out of Medicare.  Medicare would fall into a death spiral of higher premiums, fewer, sicker patients, and less funding.  This plan was also promoted in the 2003 Medicare Modernization Act.  See http://tinyurl.com/7enm8eo .

New York Times, December 14, 2011

Lawmakers Offer Bipartisan Plan to Overhaul Medicare

By ROBERT PEAR

WASHINGTON — A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary.

The lawmakers aim to reshape the debate over the giant health insurance program by addressing concerns that have provoked fierce opposition to similar ideas in the past.

Just as important as the details of their proposal was the fact that the two were working together on an issue that both parties have exploited for political advantage.

In 2010, many Republicans won House seats — and the support of older voters — by arguing that President Obama’s health care law would damage Medicare. Democrats are hoping to retake the House by arguing that Mr. Ryan and other House Republicans are pushing for the privatization of Medicare, which they say could greatly increase costs for beneficiaries.

The new Wyden-Ryan proposal, by blurring the contrast between the parties on this issue, could make it more difficult for Democrats to win the argument.

The proposal would make major structural changes in Medicare and limit the government’s open-ended financial commitment to the program.

Under the proposal, known as premium support, Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government.

Congress would establish an insurance exchange for Medicare beneficiaries. Private plans would compete with the traditional Medicare program and would have to provide benefits of the same or greater value. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare.

In addition, the growth of Medicare would be capped. In general, spending would not be allowed to increase more than the growth of the economy, plus one percentage point — a slower rate of increase than Medicare has historically experienced.

To stay under the limit, Congress could cut payments to providers and suppliers responsible for the overspending and could increase Medicare premiums for high-income beneficiaries, the lawmakers said.

The proposal is sure to come under fire from beneficiaries and Democratic lawmakers who see themselves as the pre-eminent defenders of Medicare.

For his part, Mr. Wyden said: “Medicare is the most important fiber in the social safety net. I would never do anything to shred it, weaken it or harm it in any way. Our proposal places traditional Medicare, long supported by progressives, alongside a menu of private alternatives that provide the choice and competition long supported by conservatives.”

Unlike the Ryan budget blueprint approved by the House in April, Mr. Ryan said, the new proposal would preserve the traditional fee-for-service Medicare program as an option for all beneficiaries. “Our proposal harnesses the power of competition to address the root cause of medical inflation,” said Mr. Ryan, the chairman of the House Budget Committee.

Democrats expressed concerns about the proposal based on policy and politics. A senior Democratic Congressional aide said, “This plan gives bipartisan political cover to Ryan and other Republicans against whom we have been waging a very successful political offensive.”

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Severe, Long-Term Medicare and Medicaid Cuts Planned Will Impact Jobs Picture

The New York Times says cutbacks in healthcare planned in future years are so severe that the resulting layoffs and hiring freezes will  worsen the nation’s unemployment.   We need to take this very seriously. Half the Obama’s health plan is funded by scaling back $575 billion in planned increases in Medicare spending over the next decade, money intended to care for baby-boomers as they age into Medicare. Democrats and Republicans alike are calling for hundreds of billions in additional Medicare cuts.  All of these Medicare cuts are aimed at the doctors, hospitals, nursing homes, rehab facilities serving Medicare patients.  The cuts will result in many of these providers either dropping out of Medicare or giving dangerous care because of short-staffing.  Read more at http://wp.me/p3xLR-pJ . Proposed cuts to Medicaid providers, and cuts in Medicaid enrollment and services are even worse.

Capping and even cutting Medicaid and Medicare spending while allowing costs to rise to accommodate insurance, drug, and hospital profits means that government and its corporate partners are tossing away the notion of equal care for seniors, children, people with disabilities, and low-income workers.

New York Times, Thursday, August 18, 2011

Cuts in Health Care May Undermine Role in Labor Market

By REED ABELSON and KATIE THOMAS

Even during months of stubborn unemployment, the health care industry has provided a solid underpinning, reliably adding jobs in an otherwise dismal environment.

For example, hospitals, nursing homes and the like added about 430,000 jobs during the recession, as the country shed 7.5 million jobs. With the latest government reports showing a meager overall gain of 117,000 jobs in July, health care remained a significant contributor with an additional 31,000 jobs for the month, a tad higher than an average monthly addition of 25,000 health jobs in the last year. Hospitals, which had a slight decline in June, added 14,000 jobs in July.

While few experts can predict how the stock market’s gyrations and government cutbacks this month will affect the health industry, several health industry analysts warn that the sector is showing signs of economic sluggishness that has long kept other business sectors beleaguered.

The situation has led many in the health industry to caution that it cannot be relied upon to keep hiring workers. “It’s not realistic to believe that we’re going to continue to generate job growth when you’re speaking about Medicare and Medicaid reductions in the hundreds of billions of dollars over the next few years,” said Daniel Sisto, president of the Healthcare Association of New York, which represents the state’s hospitals and health systems.

Companies that rely on government spending have been bracing for deeper reductions, and President Obama recently alluded to another round of belt-tightening from one of the industry’s bedrock payers — Medicare.

Signs of a gloomier outlook have been surfacing in various spots, from a slowing in new construction plans to falling share prices of nursing home companies to announced layoffs among hospital support staff.“Nobody is sure what will happen,” said Alan M. Garber, a physician and health policy expert at Stanford. The cuts in government programs like Medicare and Medicaid, and pressure to reduce costs, are thwarting health care employers in trying to meet the rising demand for their services.

“The health care industry is facing greater uncertainty than in any time in memory,” Dr. Garber said.

Yet even though economists and other experts still predict increasing demand for health care as the population ages, with an accompanying demand for job growth, health care officials and executives cite a daunting cascade of recent events as reasons to reassess any expansions.

They point to Congress’ intent to reduce spending, economically depressed states struggling to deal with a rash of cuts in Medicaid programs and the continued uncertainty of financial costs that will be imposed by the federal health care law, including contradictory lower court decisions about the constitutionality of various provisions.

A survey by the Conference Board, a business research group, found that help-wanted ads for health care providers and technicians fell by 61,200 listings in July.

In Florida, for example, health care led the state in job gains during the recession — it was the only industry that did not lose jobs during that time. But since September of last year, the leisure and hospitality industry has been adding more jobs, according to a state economist.

The Palo Alto Medical Foundation, a large physician group in Northern California that employs 5,500 people, including 1,000 doctors, says it has no plans to add many more people in the near future. “Really our focus these days is to do more with the assets we have,” said Cecilia Montalvo, the vice president for strategic development for the medical group.

Hospitals also appear to be slowing the pace of building, as projects begun before the recession started are now being completed. The volume of tax-exempt debt for hospitals in the first half of the year has fallen by nearly half from a year ago, said David Johnson, a managing director at BMO Capital Markets. “We’re overinvested in hospitals and hospital beds,” he said.

The University of Michigan Health System, for example, is adding some 560 jobs as a result of new children’s and women’s hospitals it plans to open soon and an expansion of its emergency department. But Doug Strong, who heads the system’s hospitals, said his overall goal is to shrink his work force in future years as he tries to make the system more efficient.

While he expects the demand for health care services to rise, he believes he needs to deliver that care with fewer people at less cost. “I think that is what the nation is asking of all of us,” he said.

The impact of state cuts in Medicaid are already being felt in doctor’s offices, hospitals, nursing homes and home health agencies around the country. Hospitals experienced reductions in Medicaid reimbursement in 37 states for next year’s budgets, according to Lisa Goldstein, an analyst at Moody’s, who predicts further cuts.

At the Elliot Health System in Manchester, N.H., the seemingly abrupt decision by state lawmakers to sharply reduce hospital reimbursements led the hospital to recently lay off 182 people.

“For the last 10 years, we’ve been pretty stable and we’ve been able to grow,” said Elliot’s chief executive, Doug Dean. But faced with the loss of millions of dollars in Medicaid revenue that would wreak havoc on the coming hospital budget, Mr. Dean said he had no choice but to cut jobs. “It was simply because of the economics of Medicaid,” he said. Elliot is among a group of hospitals filing a lawsuit to stop the cuts.

Health care employers are also confronting cuts to the federal Medicare program. In July, nursing home operators learned their reimbursements would be cut by 11 percent in October, and hospitals expect further reductions in what they are paid under the new health care law as well as in future efforts to reduce the federal deficit.

Still, these continue to be boom times in many corners of the industry. Partners in Care, a New York nonprofit provider of home health care services, is hiring so many home health aides that it recently opened a second training center to handle the flood of new employees.

Its staff of aides has grown from close to 5,800 in 2006 to about 9,200 today. In June, the group, which is part of the Visiting Nurse Service of New York, hired 374 new people, the second-biggest month in its history.

Jay Conolly, vice president of human resources at Partners in Care, said his group is benefiting, not just from the growing elderly population, but also from the consolidation of nursing homes and hospitals in the New York area and a heightened interest in low-cost alternatives to inpatient care. The Bureau of Labor Statistics has predicted that jobs will grow faster in the home health care area than in any other section of the health care industry.

“There’s never been enough home health aides, and there never will be,” Mr. Conolly said.

And many expect that when the economy finally does rebound, hiring will, again, take off, especially when more people are expected to be insured under the federal health care law. Geraldine Bednash, chief executive of the American Association of Colleges of Nursing, expects there is pent-up demand for their services, especially for nurse practitioners and nurse midwives, who would work in primary care. “We are going to see this huge onslaught of need for nurses,” she said. “So we’re in a blip, that’s all.”

There are some who wonder whether the country should continue to rely on health care as a stalwart supplier of new jobs. If spending on health care continues at its current pace, it will choke out other vital sectors and end up hurting the rest of the economy, said Joshua Shapiro, chief United States economist at MFR Inc. “I think the path that we’re on now is clearly unsustainable,” he said.

Tom Torok contributed reporting.

Short link to this post:  http://wp.me/p3xLR-sm

Obama! HANDS OFF SOCIAL SECURITY, MEDICARE, AND MEDICAID

On July 24, President Obama was twisting arms to get Congress to agree to huge debt reductions that would cripple Social Security, Medicare, and Medicaid.

Angry defenders of these programs responded by staging a noisy demonstration outside the Obama Campaign’s Oakland California headquarters, where a training session was under way to organize volunteers into the 2012 campaign machine.

We tried to get inside to speak to the volunteers and explain that 80% of the people say they don’t want our programs cut, and that corporations and the rich should be taxed to solve the debt.  During the standoff, we got many leaflets inside. You can read the leaflet here. After we went outside and began our demonstration, one volunteer came out and said we were right, that she’d tried to talk with the people inside, and she was disgusted that the Campaign was determined to go ahead with their agenda and wasn’t willing to listen to why our programs need to be saved.

Fighting to save Social Security has been much harder this year than in 2005 when Bush tried to privatize it. A big reason is that now the proposed cuts, which are much worse, are being pushed by a Democratic president, causing many to be reluctant to fight back. We need to get over this hesitation, not only in word, but also in deed. Today’s small demonstration was a start.

short link to this post:  http://wp.me/p3xLR-sc


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