Massachusetts Health Stats

Obama Defunding RomneyCare According to Globe, Herald

I find it hard to believe but according to both the Globe and the Herald today, October 31, the federal waiver that underlies (or is it underlays?) RomneyCare is in serious trouble.  Supposedly the Obama administration seriously wants to cut back on the federal money with which the state of Massachusetts pays for much of the incremental insurance that everyone from Mitt Romney to Deval Patrick to President Obama himself wets their pants over on a daily basis.

This recent post explains the waiver in wonk talk. But the nickle version is as follows: 

•  
  • (Which has always been almost everyone of us here in Massachusetts.  Healthcare insurance was invented here in 1850. We love it.)
• If you're familiar with the proven business concept of eliminating the middleman, RomneyCare works just the opposite.
• Massachusetts used to pay mostly public charity hospitals to take care of the needy using mostly a tax on those of us that used the Massachusetts-based non-profit healthcare insurers.
• A large group of religous charity hospitals in Massachusetts also helped the needy the old fashioned way
  • (You probably think I mean via charitable giving. There was some of that but the basic method of the religous approach to helping the needy was to pay workers poorly, ironically making them 'needy.')
• So the state went hat in hand to Bill Clinton and a Medicaid waiver was granted in 1997 to use some Medicaid money to help the charity hospitals to help the needy. 
• The 'outside the box' thinking behind RomneyCare in 2006 -- the second time the waiver came up for renewal -- was to take that Federal money and
  • give it to politically connected insurance companies instead
  • they, in turn, would give it to politically connected teaching hospitals to take care of the needy.
• But no one told the needy.  They keep going to the public charity hospitals.
  • (The needy can't go to the religous charity hospitals any more because they were put out of business by this so-called reform. That puts more stress on the remaining public charity hospitals.)

Last week, the proponents of single payer healthcare insurance for Massachusetts, a group called Mass-Care, spelled all this out in great detail in a 100-page document. 

Or you can work your way back through my blog posts, reading every other post (in the posts not about the failure of RomneyCare, I tend to write about the failure of Medicare).

-- Dennis Byron

Massachusetts Blue Cross: Please Pass a Law to Make Us Stop Wasting Money... and Beat Wellpoint

Blue Cross of Massachusetts will hold a conference October 21

• at an expensive Boston hotel
• to present expensive Harvard research findings
• paid for by Blue Cross 

The research finds that Massachusetts residents want the state

• to pass laws
• to stop Blue Cross from spending money
  • at expensive Boston hotels
  • for expensive and obvious Harvard research (link pending release of research results by Blue Cross).

The canned research by some Harvard professor in the bag to Blue Cross finds that Massachusetts residents want the state rather than payers or providers to control costs.  The research is part of the fourth wave of propaganda -- which included the Tuesday October 18 New York Times article -- to try to jumpstart Governor Deval Patrick's failed proposal to force Massachusetts state employees into HMOs.

Those would mostly be Blue Cross HMOs, of course.  Today, most state employee health insurance is fee for service and administered by Wellpoint (WLP). Deval Patrick passed a law in summer 2011 to force many munincipal employees to Wellpoint as well (by abrogating collective bargaining rights but you never read that in the liberal media).

-- Dennis Byron

Feds Screw Seniors with 2012 Social Security Increase

Headline after headline today screams some variation of:

"Feds Screw Seniors with 2012 Social Security Increase...

At least that's the impression I get from hundreds and hundreds of news articles October 20 that couple the breathless news that the first Social Security increase in three years will be accompanied by the first Medicare Part B premium increase in three years. 

Duh!. That's the way it's supposed to work.

An exception to the cockeyed media twist is this MSNBC headline: "Social Security goes up, but so do Medicare premiums." That's accurate. And the story behind it is accurate.

But I saw one website that linked to the MSNBC story with a lede that said the social security increase will be "largely taken up" by Medicare Part B premium increases. I don't see anything in the linked article that even implies that. Because I respect the blogger who wrote it -- who is probably neither Social Security (SS) or Medicare age -- he must have just assumed from all the media twisting of this news that "largely taken up" was the case. Otherwise I can't imagine where he got the idea.

Simplistically the average person on SS is going to get a $35 raise in income a month and a $10 raise in part B premium. Depending on the Part C or D choices they make over the next 6 weeks of Medicare Open Enrollment, they could "cut their loss," which is how the cockeyed press seems to be looking at this news.

It does look like about 3% of the SS population may have it all "taken up" but -- assuming the rumored $10 montly increase is accurate for those that have been paying $96.xx the last three years for Medicare Part B -- such a SS recipient would be someone only receiving $300 a month currently (as opposed to the average of around $1100). I think that would mean they put very little into SS over the years. Maybe they're mostly retirees on a government pension back when -- still true some places maybe? -- government employees didn't contribute to SS.  

But there's also 2,000,000 of us baby boomers that are apparently going to get a Part B premium decrease.  Because -- as noted above -- while everyone that signed up for Medicare in 2009 or before has had their premium frozen at $96.xx a month for the last three years, those of us that signed up in 2010 and 2011 have been paying $110.xx and $115.xx a month, respectively, to make up for the difference. Our premiums will go down to the new rumored $106 (or whatever it turns out to be). 

Seniors that make over $85,000 a year have also been paying more than $96.xx, a lot more, and their premiums will go down as well.

Thanks for the inflation, Barry, especially for the environmental regulations and wars that have driven up oil prices.

-- Dennis Byron

DukakaCare... RomneyCare... Obamacare... PatrickCare? What the Left Up to?

What's with all the old news this week?

• The NPR and Politifact stories about the 2006 RomneyCare Massachusetts health insurance law being like the 2010 Patient Protection and Affordable Care Act (PPACA), known as Obamacare, are getting tiring.
• And the New York Times' breathless October 18, 2011 report that Governor Deval Patrick of Massachusetts is going to put the people whose healthcare Massachusetts directly funds (25% of the state's population -- those on Commonwealth Care -- AKA RomneyCare, Medicaid, and state employees but not retirees) into HMOs was old news on March 18, 2011. (Oh by the way, about half of them are already in HMOs.)

So what this left's angle? I can only assume it has something to do with Republican presidential politics. I think it's some backasswards way of attacking Romney. I can't believe we have to put up with another year of this crap. But -- whatever -- the left is just as wrong on this subject as the Mittmaniac Romney supporters I wrote about back in August. 

Using NPR and Politifact's logic, except for the late lamented CLASS Act, there is no difference at all between PPACA and RomneyCare:

• 1st So-called Difference: Yes, RomneyCare WAS about containing costs. It is no different than PPACA on those grounds. See Romney's letter to the Boston Globe dated November 21, 2004 (but get it fast; everything in the Globe's archives, costs money starting October 19) and many similar articles and presentations about/by Romney at the time. To say RomneyCare was not about containing costs is a Deval Patrick lie to introduce socialized medicine in Massachusetts as described above. Romney now plays along because it helps his current political persona).
• 2cnd So-called Difference: Despite what Politifact and NPR say, RomneyCare contained no patient bill of rights because Massachusetts effectively already had one, after DukakaCare
• 4th So-called Difference: NPR and Politifact says PPACA covers more types of people whereas RomneyCare only covered children. No idea where the lefties came up with that one. RomneyCare covered all these people.  That was what RomneyCare was all about. 
  • If a person does not qualify for Medicaid but is below 150% of FPL they get free $450 a month Cadillac insurance. 
  • From 150% to 300% of FPL they get a $450/month Cadillac policy for from $45 to $115 a month depending on where they fall on the FPL-Plus scale (this information is an average individual situation; similar deals for families with up to $88K in income depending on size of family).
  • Strangely, although this is supposedly a huge problem both in Massachusetts and throughout the U.S., only 44,000 people (out of 6,500,000 people) are covered by the subsidized insurance and only about 100,000 (out of 6,500,000 people) are covered by the free insurance
• 5th So-called Difference: NPR claims RomneyCare did not raise taxes. RomneyCare dramatically raised Massachusetts taxes.  It introduced - of course  - a tax for not buying insurance... plus a tax on smokers, increased the taxes on healthcare insurers, added many more fees and most dramatically forced the legislature to raise sales taxes 20%.  The latter happened after Romney jetted out of town but is just as much a part of RomneyCare because it is part and parcel of all the budget cuts on city, town and school aid, parks, cops and courts and even public health that the state has faced because of RomneyCare 

It's hard to believe either the left, with the convicted felon ex-House Speaker always smiling down on Romney in those photos the left loves to run, or Romney himself is proud of this disaster.  But that's politics, I guess.

-- Dennis Byron

Obama Administration Realizes RomneyCare Did Not Work.

Poltico writes on October 11:

"Medicaid waiver entangled in safety net in Massachusetts – The extension of the Medicaid waiver that allows Massachusetts to operate its landmark health care reform has hit a roadblock over funding for “safety net” providers, who are facing a growing demand for care even though the state’s coverage expansion was supposed to limit their burden of caring for the poor."

There is no entaglement here. The headline would be clearer and more revealing IF the Politico headline simply stated the reality. 

"Even Obama Administration Realizes RomneyCare Did Not Work."

Depending on your politics or perspective, maybe it seemed like a good idea at the time to take away the free care pool money from the charity hospitals (now cutely called "heatlh safety net" hospitals) and give it to the politically connected insurance companies who could give it back to the charity hospitals (and maybe to the politically connected teaching hospitals too?). And that was all that RomneyCare was about, an accounting gimmick. All the Massachusetts Medicaid waiver information on HHS.gov explains how it is supposed to be revenue neutral.
 
But it didn't work. The free care pool was supposed to go virtually to zero but instead it's back over a half a billion and is still not fully funded by the legislature. 

The Massachusetts lefties do not want to accept the fact of RomneyCare's failure when they see data that all the newly insured are getting free or highly subsidized insurance. So they blame the failure on George Bush's recession. They don't want to face the failure when some politically correct place finds increasing use of ERs and CHCs. So they blame it on lack of public transportation. The lefties don't want to accept failure even when the left-wing Blue Cross Foundation shows how RomneyCare has eaten away at other state programs, including public health. So they blame it on Scott Brown.

Maybe the Massachusetts left will accept the failure of RomneyCare now that the left-wing Obama administration is finding RomneyCare a failure and holding up Massachusetts' Medicaid waiver extension.

-- Dennis Byron

 

Romney Tells the Big Lie about RomneyCare

The Manchester Union Leader on October 8 quotes Mitt Romney as follows:

He said his own Massachusetts health care plan “dealt with the 8 percent of our population that didn't have insurance. We wanted to get those people insured. It wasn't fair for everyone else to have to pay for that.

“We were spending hundreds of millions of dollars giving out free care to people, many of whom were perfectly capable to care for themselves,” he said. “There's a federal law that requires hospitals to care for people regardless of whether they have insurance.”

Romney keeps repeating this 8%/perfectly-capable-to-pay rubbish so there can be no doubt that Romney is in Big Lie mode.  These statements can no longer be considered slips of the tongue or poorly worded contemporanous phrasing at a campaign event.

1. On the 8% statement: Realistically RomneyCare affected everyone in Massachusetts negatively.  But even by the narrow way Romney wants to parse it to fool people outside Massachusetts, RomneyCare affected not only the 8% that were then uninsured (his number) but also the 10% that were then buying insurance individually or via small groups.

2. On the "perfectly capable of taking care of themselves" statement: RomneyCare was never intended to find people capable of taking care of themselves and bring them to justice.  RomneyCare was a pretty simple concept.  It took 200,000 or so people who were eligible for Medicaid but who had never signed up, and signed them up, sometimes without their knowing it.  It took another 200,000 or so people that didn't have insurance but who did not qualify for Medicaid and gave them free -- around 150,000 -- or highly subsidized -- around 50,000 -- insurance (e.g., at 300% of FPL, a single person gets a $450/month Cadillac policy for $115).   

The people -- maybe a few tens of thousands out of 6,500,000 -- who could afford insurance but chose not to, simply get waivers. And they still go to the ERs and the community health centers and get free care.  The free care pool, which was supposed to approach zero to fund this great experiment, is now at "hundreds of millions of dollars" ($500 million) and growing.

-- Dennis Byron

Wellpoint Runs Medicare in Illinois, Minnesota and Wisconsin

In the 2010 and ongoing healthcare-insurance reform debate over the Patient Protection and Affordable Care Act (PPACA), better known as Obamacare, one of the biggest hoaxes perpetrated by politicians -- particularly former Illinois Senator Barack Obama --  is that Original Medicare, Parts A and B, are run by the government. 

This is usually followed by an attack by politicians like Obama on George Bush for improving Medicare Parts C and creating Medicare Part D in 2003. They say in contrast that the "inefficient" Parts C (now called Medicare Advantage) and D are run by "greedy for-profit private" insurance companies. Left wing academics, newspaper columnists and editorials constantly pile on to this lie. Advocates of single-payer healthcare and/or healthcare insurance pick up the meme.

 

On October 6 the for-profit and much maligned by Obama insurer, Wellpoint, announced that it will run Medicare in Illinois, Wisconsin and Minnesotta. Wellpoint noted in the press release that it:

"will process claims and administer benefits."

Isn't that what a private insurance company does? Elsewhere in the country, private insurance companies such as Blue Cross, Hewlett Packard's insurance subsidiary and Cigna hold similar contracts to run Medicare Parts A and B. That sure doesn't sound like Medicare is run by the government to me. Prior to Hewlett Packard being awarded the original contract that was renewed August 22 in the northeast U.S., Blue Cross of Massachusetts ran Medicare in Massachusetts.

I can understand that the academics in their ivory towers and the stooge journalists might not realize the lie they are perpetrating on the nation. But certainly the politicians that award these contracts and take the political donations from Wellpoint and Wellpoint affiliated individuals and organizations realize it.

Do not confuse who pays for insurance vs. who runs it. All Medicare -- Parts A through D -- is paid for by you: roughly 75% by the government with tax money (meaning you) and 25% by you directly via premiums. But Medicare is run by private insurance companies just like all other health care insurance. It works exactly the same way if your non-Medicare insurance is through a self-insured employer such as Catepillar or Kohl.

-- Dennis Byron

How Badly Has RomneyCare Hurt Private Health Care Insurance In Massachusetts?

I have started to take a look at just how badly Massachusetts' private health care  insurance market has been hurt under RomneyCare.  The impetus was the October 3 "discovery" by the leftie media in Massachusetts that RomneyCare free and subsidized insurance has crowded out new private insurance in Massachusetts completely in the last four years.

It turns out that studying the issue is going to be hard to do because the state Department of Healthcare Finance and Policy (DHCFP) apparently keeps two sets of books for "private insurance." Here is what its most recent Quarterly Key Indicators Report says the numbers were in 2007-2009 (most recent comparable data): But here's supposedly the same data from the DHCFP's report of May 2011 on Premium Trends:

There seems to be about a 500,000 yearly difference in each of the three years.

This is very interesting to market research because as the charts show, the trend lines are not all the same.  For example, private individual insurance actually increased back to its level before the merged market as people came back into the market in response to lower premiums.  Once I get one rational set of data, I think we'll find many more instructive such factoids (which someone told me recently actually means "not a fact).  For example, most likely insurance in total did not increase 400,000 in Massachusetts, as the media simplistically reports, but instead private insurance decreased 100,000 and 500,000 people were added to free and subsidized policies. 

Whichever set of data and whatever factoid means, the trends lines are the same: big- time "crowdout" of the private market by RomneyCare. I'm really surprised no one on the right is on to this yet because of the implication for the Patient Protection and Affordable Care Act.

-- Dennis Byron

RomneyCare "Crowd Out" Approaches 100%; It's Bush's Fault

In his latest report on "Key Indicators..." of the "progress" of RomneyCare, Governor Deval Patrick shows that the "crowd out" of "private insurance" by "public insurance" for the "newly insured" in Massachusetts has reached close to 100%. It had looked to me like the percentage was in the mid 90s after the previous Key Indicators report but the Patrick administration is not transparent -- or timely -- about the numbers so it was hard to tell.

Well "now" the number is 98% according to a graph put together by -- I think -- someone at Harvard as reported on by Martha Bebbinger at WBUR, a Massachusetts National Public Radio affiliate.

 

Whoever put the chart together has done some digging to try to cut through the lack of Patrick-administration transparency. In particular, they attempt to estimate how much of the private insurance market in Massachusetts -- as reported by Patrick's propagandists -- is really public insurance.  I question the estimate but I applaud the attempt.

I've beaten this horse to within an inch of its life over the six months of this blog's existence.  Now that left wingers like NPR are finally on to the story, my work here is done. But the bigger picture of understanding the healthcare insurance market in Massachusetts requires that some definitions be laid out now that both sides (I'm assuming some enterprising right winger will pick up on this) are engaged:

• "Now" -- The data only covers through December 2010.  Patrick administration data about RomneyCare is always months late making almost all discussions about the data moot by the time they happen. For example, the May 2011 Key Indicators report was released in early October and covers year-old data. Carey Goldberg of CommonHealth says on her blog that the state bureaucrats are circulating the August Key Indicators report now among themselves (and that it includes statistics that will change whomever's interpretation). But us peons can't see that August 2011 report until 2012.
• "Crowd Out" -- The technical definition is covered pretty well here.  The implication is simply that the government will take over the market (health care in this example) and/or that the needy will not get what the program was intended to deliver, depending on your perspective. 
• "Private Insurance" -- Patrick himself has muddied this water distrurbingly as described above but the meaning should be that it is insurance where the payer of a claim is a private company using money solicited from private entities, including companies and individuals.  In reality, this term breaks down in the discussion of RomneyCare because almost all the money described under public insurance in RomneyCare discussions is at least administered by private companies such as Blue Cross (and don't mix up private and profit vs. non-profit but that's grist for another blog post)
• "Public Insurance" -- You would think this would be insurance where the policy is issued by and claims adjudicated and paid by the government.  Maybe some of MassHealth/Medicaid works that way, I don't know. Despite public perception, none of Medicare works that way. The Massachusetts state employee fund is administered primarily by Wellpoint of California and secondarily by in-state insurers if state employees chose HMOs. Whether the state writes the check to the insured, the provider or to the administrator probably is different in each situation.
• "Newly Insured" -- This is probably the next area I'll dig into.  The 400,000 "newly insured" in Massachusetts are not really individually newly insured.  Most used to be on other plans or other people's policies or took a few years off because of the high premiums for individual insurance before the "merged market," or... One beauty of looking at the Massachusetts health care insurance market is that the state is so static in terms of population and economic activity that it is easy to see what is really happening.

All of this mattered to me six months ago because RomneyCare is a financial disaster from a fiscal conservative's perspective and the Patrick administratrion's lies and deceptions about RomneyCare are a moral disaster from any honest person's perspective. But this matters to left wing groups like NPR because the same sort of "crowd out" is what's predicted for the Patient Protection and Affordable Care Act (PPACA) as well. So, naturally, rather than admitting that economic theory has proven out, the left is saying "it's George Bush's fault." That is, the recession is causing the crowd out.

-- Dennis Byron