Universal health care is far from the plan Republican leaders are proposing, but it’s getting some love in Southern Arizona.
Advocates cite various factors fueling single-payer popularity.
These include fear about recent Republican efforts to repeal and replace the Affordable Care Act (ACA, also called Obamacare), a public that’s more well-versed in health care and a repackaged “Medicare for All” message that they say makes the single-payer concept more understandable and palatable.
Nowhere was local support for that kind of system more obvious than at a standing-room-only health forum hosted by Tucson Medical Center June 26. A question about single-payer health care drew cheers, not from one or two lone voices, but from a chorus across the room of 700 people.
While the response from expert panelists at the forum was tempered, the audience’s enthusiasm was clear. Signs saying “Healthcare not Wealthcare” and “No More Pay Up Or Die Plans!” dotted the entrance to the event. The crowd was energized.
July 14, 20171:18 PM ET
Heard on All Things Considered
For Heather Gijanto, going to the doctor means taking a day off work and driving at least 60 miles round trip from her home in McNeal, Ariz., to the town of Bisbee. And that is assuming there is a primary care doctor available in Bisbee to get her in.
"You select one doctor and then you find out a few months later that that doctor is no longer going to be available," Gijanto says. "So then you have to start the whole process over again. And then you find that doctor and, for whatever reason, that doctor leaves as well."
Gijanto is frustrated and says she and her husband and their two young kids have had to change family doctors four times recently. Ideally, she says, the family would have one doctor who knew each member's medical history, so "I didn't have to explain my chart every single time or have to go over medications all the time with each new physician."
Arizona Public Media | Andrea Kelly | June 30, 2017
Health Care: Judy Rich, president and CEO of Tucson Medical Center discusses the impact of the proposed U.S. Senate changes to health care policy. Dr. Daniel Derksen, of the University of Arizona's College of Public Health, says it could raise health care costs for all Arizonans.
TUCSON (KGUN9-TV) - Senate Republicans postponed the vote on the Better Care Reconciliation Act Tuesday.
"The good part of the discussion going on right now is the people are starting to ask a lot of questions about what will happen to me what will happen to my family," said Daniel Derksen, a University of Arizona College of Public Health professor.
Derksen says 70 million Americans are currently covered by Medicaid and two million of those are in Arizona.
"The estimate is either of these bills would cause about 400,000 Arizonans to lose their Medicaid coverage and be uninsured," he explained.
He says in rural communities, health infrastructure depends on small rural hospitals known as critical access hospitals and these would have a hard time providing services if funding was cut.
"In Arizona we have 14 critical access hospitals and they would be particularly hard hit by these drastic cuts," he said.
Derksen says over the next 10 years, $7.3 billion in Arizona's federal Medicaid funding would be cut and with the loss of funding, nearly 25,000 jobs will be cut from Arizona.
U.S. Senator John McCain says Arizona has been nationally recognized for running one of the most efficient and cost-effective Medicaid programs in the country.
He stated this type of legislation should reward the state, rather than penalize it.
Senator McCain stated he supports repealing and replacing Obamacare, but quote, "I will be working hard to include important measures that address the concerns raised by Governor Ducey and other leaders across our state about the bill's impact on Arizona's Medicaid system."
TUCSON.COM | By Stephanie Innes Arizona Daily Star
Jun 26, 2017
The turnout at Tucson Medical Center’s forum about federal health reform Monday night underscored local concern about the issue — there were 700 people, twice what organizers expected.
A livestream of the event on Facebook drew 1,900, organizers added.
“I’m floored,” TMC spokesman Jim Marten said of the attendance numbers. “With the heat and everything. ... We had to keep adding chairs.”
Here are five takeaways from the event:
1. The sentiment at the forum was against both the Senate and House bills.
Judy Rich, CEO of TMC, made it clear at the beginning of the program that she thinks the American Health Care Act (House bill) and the Better Care Reconciliation Act (Senate bill) should be set aside, and that efforts should be made to move to a bipartisan solution that will be better for communities.
The audience members were also predominantly either concerned about both bills or had made up their minds against them. A group greeted attendees with information about a single-payer “Medicare for All” alternative. One woman held a sign that said “Healthcare Not Wealthcare.”
2. The opposition was not solely partisan.
Dr. Dan Derksen, a health-policy expert and professor at the University of Arizona’s Mel & Enid Zuckerman College of Public Health, pointed out impacts that both bills could have, particularly on Arizona’s rural and low-income populations. He said they would be devastating and, after the event, called the proposals “too vindictive.”
But he also disclosed to audience members that he is a lifelong registered Republican.
3. The Senate bill is not too different from the House bill.
Under both bills, Medicaid as we know it could end. And congressional budget reports on both bills predict that under their provisions, more Americans will be uninsured.
THE SUNDAY HERALD (Glasgow, Scotland) | Exclusive by Andrew Purcell
June 24, 2017
WITHIN five days, Trumpcare could well be on the US statute books. It hasn't taken long to get there. The journey began on May 4, when the Republican caucus in the House of Representatives gathered to vote on the American Health Care Act (AHCA). For seven years, they had promised to repeal Barack Obama’s signature legislative achievement, but now they had control of both houses of Congress and the White House, they couldn’t agree on a replacement. To conservative hardliners, the bill was too timid. Moderates worried that supporting it could cost them their seats.
Whips played Eye Of The Tiger on the stereo to harden their resolve, and projected an image of General George Patton urging them to "accept the challenge so that you can feel the exhilaration of victory.” Later, once the bill had scraped through 217-213, Republican Congresswoman Ann Wagner said: “The line of the day was out of Braveheart: ‘Freedom!’”
In their minds, these privileged few were Rocky entering the ring, William Wallace leading the charge at Stirling Bridge. Republican Congressman Jason Chaffetz rode in on a scooter, fresh from foot surgery covered by his subsidised government health insurance, to vote for a bill that will make the same operation unthinkably expensive for tens of millions of Americans. If it becomes law, thousands more will die each year because they cannot afford to see a doctor.
After working weeks behind closed doors, Senate Majority Leader Mitch McConnell (R-Ky.) unveiled another GOP bill to repeal and replace Obamacare, which follows the House version in many respects but differs in others. In this exclusive video, Michael Morrissey, PhD, a health policy expert from Texas A&M University, says the GOP bill is a good start on preparing people for needed cuts in entitlement programs. But taking an opposing view, Daniel Derksen, MD, of the University of Arizona School of Public Health, says the GOP Senate plan is a disaster in the making.
The Christian Science Monitor| by Francine Kiefer | Staff writer
June 22, 2017
WASHINGTON—Republican senators unveiled their long-anticipated healthcare plan to replace Obamacare on Thursday, and it includes significant changes to Medicaid, the joint federal-state program for the poor, elderly, and disabled.
The bill, which does not yet have the support of enough senators to pass, reflects the ongoing tussle of costs vs. social benefits that sharply divides the two parties as well as Republicans themselves.
Like the Republican legislation that passed the House in May, the draft bill put forward by Senate Republican leaders aims to rein in federal spending on the burgeoning program – a move they say will strengthen it in the long term. But over time, that will mean substantial cuts to some of the country’s highest-need populations, say advocates – though the full scope of those cuts won’t be known until the independent Congressional Budget Office releases its report on the Senate bill early next week.
“Medicaid is fiscally unsustainable,” says Steve Kelly, spokesman for Sen. Pat Toomey (R) of Pennsylvania, the senator who represented the GOP conservative viewpoint on Medicaid as the bill took shape behind closed doors.
Thirty years ago, Medicaid accounted for less than 3 percent of federal spending. Today, it’s nearly 10 percent. About one fifth of the US population is enrolled in it, according to a Congressional Research Service 2015 report. It pays for almost half of all births. It’s the single biggest payer for substance abuse treatment. It helps rural hospitals stay afloat and supports jobs in the health sector. It covers nursing homes for the elderly and long-term care for the disabled.
Even if the governor vetoed it, Nevada's plan to allow anyone to buy Medicaid coverage may be the way forward for Arizona and the nation.
Last week, the Nevada state Legislature handed Gov. Brian Sandoval an innovative opportunity to replace the Affordable Care Act at the state level. Unfortunately, he didn’t take advantage of the opportunity.
The Nevada Legislature sent Sandoval a bill that would have allowed any Nevadan to “buy in” to their state’s Medicaid program. On Friday, he vetoed the legislation. Had he signed it, and the Centers for Medicare and Medicaid Services approved the plan, any Nevadan could buy Medicaid coverage — regardless of income.
Why we need 'Medicaid for Many'
Assembly Bill 374 would have directed the Nevada Department of Health and Human Services to ask for a CMS Waiver (called an 1115 waiver) to allow any Nevadan to buy a Medicaid managed care plan. Nevadans eligible for an Affordable Care Act tax credit (called an advance premium tax credit) or cost-sharing reductions based on income could have used them to help pay their share of the premium.
Polling shows that most Americans want reasonably priced health insurance regardless of having a pre-existing condition. Nevada’s Medicaid plan would have done that, avoided a complicated health-system overhaul and could be tailored to fit other state programs.
“Medicare for All” is getting a lot of national attention again these days. Perhaps it’s time to add “Medicaid for Many” to the discussion, as the U.S. Senate is poised to vote on a bill in the next few weeks. Medicaid infrastructure exists in all states.
How it could work in Arizona
Arizona’s Medicaid program, called AHCCCS, operates through a CMS-approved 1115 Medicaid waiver. Medicaid is re-channeled through private health insurers through a multiyear bid process. Insurers compete for the Medicaid business, and are assured of enrollees for several years. Consumers are not subjected to the yearly volatility of changes in price, plans and benefits.
Insurers have time to build a contractual network with participating clinics, physicians, hospitals and other health providers; consumers can make sure their provider is participating. Arizona’s Medicaid program has the eighth lowest per-person expenditures of the 50 states, with two million AHCCCS enrollees among our population of seven million.
To make Nevada’s approach work in Arizona, our Medicaid 1115 Waiver needs amendment and CMS approval. With ACA tax subsidies and cost-sharing reductions, the out-of-pocket costs per person would be less than plans currently offered in Arizona’s Marketplace, with far less year-to-year volatility in pricing.
Let's take this debate nationally
Medicaid payment to hospitals and physicians tends to be lower than even what Medicare pays. To assure that there are enough hospitals, clinics, physicians, dentists and other health providers in the network, insurance vendors offering Medicaid plans would have to negotiate more reasonable payment rates with providers.
PHOENIX (AP) — The only two insurance companies offering individual health plans on federal exchanges in Arizona have filed paperwork to continue selling coverage in 2018, raising hopes that the state can avoid a repeat of last year’s crisis when one county was briefly left without a health insurance provider.
Officials with Blue Cross Blue Shield Arizona and Centene Corp’s Ambetter by Health Net confirmed this week that they have filed with the state Department of Insurance to continue offering insurance.
The companies have until July 1 to notify current customers if they change their plans and decide to pull out of the market. But if they follow through, the situation that developed last August when Aetna pulled out of Pinal County, leaving it without a plan for 2017, will be avoided. Blue Cross stepped in and offered coverage in Pinal County, sparing an estimated 8,000 to 10,000 customers from being left without individual insurance.
Blue Cross sells in 13 mainly rural counties and will maintain a similar set of plans next year as it currently offers. Health Net filed to again sell plans in Pima and Maricopa County.
Whether the two remaining Arizona providers would stick it out has been an open question, closely watched by health care insiders. Tara Plese, a spokeswoman for Arizona Alliance for Community Health Centers, said her group spoke regularly with the insurers and believed they would stay.
“We had some assurances that they would do so,” Plese said Tuesday.
Losing either of the companies would have been catastrophic for the insurance exchanges created under the Affordable Care Act. Iowa is scrambling to come up with a way to keep the only remaining provider selling in that state after three other insurers decided they would leave that market. Several counties in Missouri, Ohio and Washington state have no insurer for next year.
Pricing information hasn’t been released by the companies or the Department of Insurance, which will release proposed increases above 10 percent next month and all pricing by early-October. This year, the average premium in Arizona before subsidies nearly doubled, from $324 a month last year to $611 a month.
Those price boosts had varying effects, mainly because many people were shielded from them because of tax subsidies that increase with rates. But the number of people who signed up for insurance this year in Arizona who don't qualify for subsidies that can cover much of the cost of insurance plunged by 23 percent, according to an analysis of federal data released in March done by the University of Arizona health insurance expert Dr. Daniel Derksen. Meanwhile, signups by people who get subsidies went up by 3 percent.
The total number of Arizonans who received subsidies went up from 75 percent last year to 86 percent this year, according to data released by the federal Centers for Medicare and Medicaid Services on Monday.
The fate of those subsidies and of cost-sharing payments to insurers to help offset costs for lower-income customers is in doubt because of an effort to replace the Obama-era law with a new Republican-backed health plan. A proposal that passed the House is now being reworked in the Senate.
The agency said in a news release that affordability was effecting enrollment, pointing to the number of consumers who chose insurance plans during the most recent open enrollment period and then didn't pay the premiums. About 16 percent of the people who chose plans nationally didn't "effectuate" that coverage by paying the needed premiums.
In Arizona, the number was much higher. At the close of open enrollment, 196,000 people had chosen a plan in Arizona. But numbers released by the government show only about 140,000 paid the premium, a drop-off of 28 percent. State enrollment topped out at about 171,000 early last year.
Grants to allow first responders and members of other key community sectors to administer a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose.
Geographic coverage: Nationwide
Application Deadline: Jul 31, 2017
The Georgetown University Center for Children and Families (CCF) Rural Health Policy Project released Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities. This report resulted from analysis by researchers from Georgetown and the University of North Carolina Rural Health Research Program and examined "how the role of Medicaid has changed over time in 46 states with small-town and rural populations."