Month: July 2017

Buyer Beware: Ted Cruz Goes Pro-Choice

  

The concept of the Trojan horse is familiar to us all. After a 10 year siege of Troy, the invading Greeks pretended to sail away—but left behind the infamous horse with a group of elite soldiers hidden away inside of it. The Trojans pulled the horse into the city as their victory trophy, and the rest, as they say, is history.

But to understand why the Cruz amendment to the Senate healthcare bill is a Trojan horse that will wreak havoc on the individual insurance market, it’s necessary to understand a more complicated concept: adverse selection.

For health insurance markets to function normally there must be a mix of healthy and sick people that purchase any given product. Adverse selection occurs when purchasers of insurance recognize that they are healthier or sicker than the average consumer, and therefore buy either more or less health insurance.

This becomes a problem when sicker consumers all self-select into one health insurance product, and healthy consumers all self-select into another health insurance product. In that instance, an adverse selection problem has occurred, and the product purchased by the sicker consumers is destined for a turbulent ride as premiums skyrocket and only the sickest of the sick continue to pay them. This is the ominous “death spiral” we so often hear about.

Put in this context, it’s easy to see why the Cruz amendment to the healthcare bill presents an adverse selection problem. The Cruz amendment, as you know, will allow insurers to sell non-compliant health insurance plans alongside compliant plans. These skimpier non-compliant plans will cover fewer maladies, have higher deductibles and copays, will be exempt from requirements to provide preventative care at no out of pocket cost, and will undoubtedly be much cheaper than compliant health insurance plans.

Those who are not yet sick will flock to these plans. And the sick will stick to those that actually provide coverage. But without the benefit of a healthy mix of consumers in the compliant plans, they will be in for a turbulent ride.

If you’re healthy, this may seem like a great deal. The only change you’ll notice at first will be an increase in the number of go-fund me pages you see on Facebook for those who purchased non-compliant plans and made the mistake of getting sick, having a heart attack, or coming down with cancer. But sooner or later, we all make the change from healthy to sick, from subsidizer to subsidized—that’s life, and that’s health insurance. And when we do, we’ll all be a lot better off if we don’t fall for the Trojan horse of the Cruz amendment to the healthcare bill.

Senate Healthcare Bill Threatens to Reduce Care for Older Americans

  

Medicaid has grown into one of the largest and most critical payers of healthcare services in the country. It covers more than 70 million Americans annually and accounts for roughly one-sixth of all U.S. healthcare expenditures. It provides millions of children and pregnant women, aged, blind, and disabled individuals, and other low-income and vulnerable populations with the ability to receive crucial healthcare services. One group which benefits the most from Medicaid is the elderly. Medicaid pays for services such as care in skilled nursing facilities, home- and community-based services, and other services on which many elderly Americans rely. Medicaid is the largest payer of long-term services and supports in the country; it pays for nearly half of all nursing home costs and represents a disproportionate share of all Medicaid spending. As the population ages and more Baby Boomers reach retirement age and beyond, the demand for these long-term services and supports will continue to increase. Older Americans with fixed incomes will require more assistance paying medical bills even as their age makes it more likely that they will face complex medical issues such as heart disease, dementia, Alzheimer’s, and diabetes.

Instead of investing in this critical population for the future, the Republican-controlled Congress’s and the Trump administration’s actions demonstrate that they do not place a priority on the healthcare and well-being of older Americans. The Senate’s Better Care Reconciliation Act of 2017 (BCRA) would phase out Medicaid expansion over three years and would allow states to cap Medicaid spending through either a per capita cap mechanism or through a block grant (read ANA’s policy primer on Medicaid block grants here).  According to the non-partisan Congressional Budget Office, the Senate bill would result in a 26 percent reduction in Medicaid spending by 2026 (a total reduction in spending of roughly $800 billion over the same time period) and a 35% reduction in Medicaid spending by 2036. The Trump administration’s budget proposal would also cut over $600 billion in Medicaid funding, not including changes made through the effort to repeal and replace the Affordable Care Act. Such cuts would squeeze state Medicaid budgets, forcing them to make tough decisions about the provision of care and likely resulting in restricted access and lower quality of care for the nation’s seniors.

It is clear that the Senate’s BCRA is more intent on saving money and providing tax cuts to the wealthy than they are with ensuring that Americans’ parents and grandparents receive the critical care that they need just as they confront complex medical needs and limited incomes. It is critical that nurses make their voices heard through ANA’s call campaign. Let your senator know that this bill is unacceptable and will negatively impact the lives and healthcare of millions of older Americans!

Protect Your Practice: Healthcare Bill will have Profound Impact on Nursing, Nurses, Patient Care

  

To many nurses around the country, the talk about healthcare reform in the nation’s capital is just that: a whole lot of talk. But if the current healthcare bill being considered by the Senate passes, are you ready for how it will impact your practice and the nursing profession as a whole?

Take hospital funding, for example. Love it or hate it, it’s a fact that “Obamacare” (or the  Affordable Care Act, “ACA”) drastically reduced the amount of money hospitals spend annually on uncompensated, or “charitable,” care.

In one state alone, Minnesota, hospitals have seen their uncompensated care costs decline by 17% since the implementation of the ACA, saving hospitals in the state about $53 million annually.

Such numbers are far from uncommon, and are probably similar where you live. The reason is simple: when more people have insurance, more people are able to pay their hospital bills. Unfortunately, the healthcare changes being considered by the Senate would leave 49 million people across the US without health insurance, once again increasing the need for hospitals to provide enormous (and enormously expensive) amounts of charitable and otherwise uncompensated care.

These increased costs will need to be accounted for in hospital budgets and will likely impact nurse staffing and care delivery—a critical issue which ANA recently addressed in a widely co-signed letter to the Center for Medicare Services.

But the healthcare bill will also impact nurses outside of the hospital setting. According to a recent survey of school administrators, over seventy percent of school districts turn to Medicaid to pay for the health professionals and school nurses needed to care for special education students. Since the senate healthcare bill would cut Medicaid spending by almost $800 billion and impose a cap on the amount of Medicaid-funded services any child could receive, school nurses and administrators are staunchly opposed to the bill.

Even if you don’t work in a hospital setting, and even if you don’t have children in school, it’s likely you will still be impacted by the healthcare bill being considered by the Senate. For example, we all have a vested interest in the health of our nation’s veterans. But of concern to veterans, VA nurses, and Veterans groups, 1.75 million vets stand to lose their Medicaid coverage under the healthcare bill, which in turn would impact the VA as more veterans seek care in that already overloaded and underfunded system.

Since Medicaid pays for most of the 1.4 million Americans in nursing homes, elderly Americans and nursing home nurses are also gravely concerned by the impact of the healthcare bill. The same goes for rural nurses and citizens, whose safety-net hospitals are projected to lose eighty-three percent of their net income by 2026 under the new bill.

The list goes on: whether or not you realize it, this healthcare bill will impact you and your practice, perhaps in ways that are unforeseen or unintended. That’s why the American Nurses Association is calling for a more thorough, nuanced, and bipartisan process for healthcare reform.

We urge the Senate to step back and approach this herculean task in a way that works for all Americans. For the sake of nurses and their patients, we can’t afford to get this one wrong.