Chase Brexton took exception with me calling them a Hopkins affiliate even as they received all their money from Hopkins advocacy and had Hopkins people on the Board, Hopkins' students and health grads working the clinic turned health institution. You see how that works now with Beilenson, a Hopkins employee now taking the reins of this new health adventure and now the copious amounts of taxpayer money that will come into it building and operation.
WHY IS ALL OF THIS IMPORTANT? HOPKINS IS AN EXAMPLE OF THE QUASI-GOVERNMENTAL PARALLEL THAT TAKES ALL PUBLIC POLICY AND MAKES IT THEIR OWN. WE WANT PUBLIC OPTION.....WE DON'T GET IT. WE WANT HEALTH CARE THAT IS NOT CORPORATE AND WE GET SENIOR CARE OWNED BY HEDGE FUNDS. WE WANT HEALTH FRAUD BACK AND WE GET NOT EVEN AN ACKNOWLEDGEMENT FRAUD EXISTS.....BECAUSE THE PUBLIC DOESN'T CONTROL HEALTH CARE EVEN AS WE THROW TRILLIONS OF TAXPAYER MONEY INTO IT.
First I would like to say to Dr. Beilenson that the number one problem in cost in health care is health fraud..it costs entitlements $200-400 billion each year..billions in MD each year alone. I have never once heard Beilenson or Health Care for All under his directorship ever shout that loudly which shows he is not working to make health insurance affordable. The largest sector for this fraud is in the Medicaid drug/mental health area that thrives here in Baltimore.
What Beilenson appears to be trying to do is cash in on this 'gap' in coverage just as Medigap was created to cover seniors who wanted to close the Medicare gap created by the shortfall of coverage. Those Medigap companies have made billions in profits covering for coverage that should have just happened..as with this Medicaid coverage being created by the insurance mandate. As with Medigap with seniors there was no savings brought in this coverage, in fact it is attributed with inflating the costs. We also want to look at the system Belenson's employer Johns Hopkins is trying to build for the Medicaid patients...it is all preventive care that looks a lot like third world clinic care. With no health fraud laws in Maryland and no oversight against fraud, this Medicaid industry will be rife with entitlement fraud.
So, I suggest that Beilenson start his campaign to lower costs by shouting out against the fraud!
Peter Beilenson's next great adventure in health care One of Maryland's visionary leaders starts Evergreen insurance cooperative
Peter Beilenson (Jeff Brush/Baltimore Sun File Photo / February 16, 2013)
Dan Rodricks 2:44 p.m. EST, February 16, 2013
Peter Beilenson — doctor and public health visionary, Baltimore health commissioner, Howard County health officer, quick-study scholar and decoder of federal regulations — remains one of our most interesting men.
A person whose leadership has certainly improved the lives of thousands of Marylanders over the last 20 years, from Baltimore heroin addicts to young families in Columbia, Beilenson is now trying to establish a nonprofit health insurance cooperative — that is, Obamacare as progressives envisioned it from the start.
Beilenson left his post in Howard County last fall, having helped establish Healthy Howard, a pre-Obamacare initiative that provided medical care at modest premiums to individuals and working-class families who fell into a gap: They earned too much to be eligible for Medicaid but not enough to be able to afford private insurance. With the support of his boss, Howard County Executive Ken Ulman, Beilenson cobbled together an array of primary-care and specialist services, some of them pro bono, and offered them for modest monthly fees.
During Beilenson's tenure, about 2,000 individuals and families enrolled in Healthy Howard and several thousand more took advantage of the county's effort to introduce people to health benefits — such as subsidies for prescriptions — that they didn't know they could get.
There's a lot of that in health care, Beilenson discovered, and even more with the passage of the voluminous Affordable Care Act and its affirmation by the Supreme Court.
"Section 1322," Beilenson says, when I ask about his next great undertaking: the establishment of Evergreen Health Cooperative. Section 1322 of the ACA, he discovered, provides millions of dollars in financing for the startup of nonprofit cooperatives to compete with for-profit insurance companies. Each state is eligible for up to two such entities. Maryland has one, and it's Evergreen.
The cooperative received a $65 million federal loan in late September, and Beilenson left his post in Howard County to oversee the research, development, regulatory compliance and fundraising that will be needed to get Evergreen up and running by Jan. 1.
The mission of Beilenson's brainchild is along the lines of Healthy Howard: provide health care to thousands of Marylanders in the gap between Medicaid and private insurance, though anyone can apply for membership in the cooperative.
Evergreen's centerpiece is service: primary-care "medical homes" at four locations in Maryland shopping centers or malls (probably in White Marsh, Baltimore, Howard County and Prince George's County); staffs of salaried doctors, nurses, health coaches and social workers; smart use of telemedicine and Skype to consult with specialists, avoid unnecessary procedures and visits to emergency rooms; and emphasis on prevention by getting members to develop healthier lifestyles.
"A lot of this has been done before," Beilenson says. "We're trying to put it all together; that's the difference."
The goal is to bundle the best practices and save money.
"Obamacare does a lot to expand health care coverage," Beilenson says, "but it doesn't do enough to reduce costs."
Of course, profit remains in health care delivery. President Obama pretty much declared a single-payer system modeled after Medicare dead on arrival when he handed off his health care reforms to Congress. But despite all the trade offs and compromises that were made in 2010, Section 1322 of Obamacare remains. In the case of Beilenson's Evergreen, that means millions of dollars of credit to establish his plan's solvency and cover its startup costs.
But he and his board will still have to raise money. None of the Obamacare loan can be used for the marketing of Evergreen to Marylanders. Up against the established insurance providers, that will be take gobs of dough.
So Beilenson is running.
Evergreen has already been presenting ideas to focus groups, he says, sampling opinions of men and women, from 24 to 64 years of age, from the city and from the suburbs. So far, so good, he says. People like the convenience of an insurance plan that has its own teams of health care professionals, and focus group participants have been surprisingly receptive to the use of their smartphones to consult with doctors and nurse practitioners.
Something else: Beilenson, who has Parkinson's disease, doesn't want his new customers — excuse me, fellow members of his cooperative — to encounter what he does when he calls his present insurance company. He's adamant that they not spend a lot of time pushing buttons on a telephone to find help when they need it. Evergreen promises a live human being (in Maryland and not Malaysia) who will answer within 30 seconds when someone calls for help. Imagine that.
"That was the single piece that got the biggest response from the focus group," Beilenson says. "When we described that, people said, 'Yes, absolutely!'"
Evergreen is no doubt a risky venture, with a big loan to repay. Beilenson and his collaborators have to get people to buy into a new plan. But he has confidence he'll find takers, including those who see in Evergreen's promise Obamacare as it should have been done in the first place.
For those thinking that your Third Way corporate democrat was not aware of this 'murky' wording in the Affordable Care Act you need to consider that the goal here is creating global health systems and corporate profits, not patient access to care. So, making a supermajority of people unable to afford health insurance will push these families into a Medicaid-level of care. Remember, Medicaid has been drastically cut since being sent to the states by Obama and is now being made a public health service....not so much actual hospital care, mostly preventative care. When these Third Way corporate pols were toting patient coverage including children to 27 on parent's plan and pre-existing condition coverage, they were talking of those who could afford private insurance. As you can see those families are becoming few and far between.
RUN AND VOTE FOR LABOR AND JUSTICE CANDIDATES IN NEXT ELECTIONS SO WE CAN REVERSE ALL OF THESE POLICIES!!!!
Editorial A Cruel Blow to American Families
Published: February 2, 2013 New York Times
The Internal Revenue Service has issued a hugely disappointing ruling on how to calculate the affordability of health insurance offered by employers. Its needlessly strict interpretation of the Affordable Care Act could leave millions of Americans with modest incomes unable to afford family coverage under their employers’ health insurance but ineligible for subsidies to buy coverage elsewhere.
The problem arises from murky language in the law. It says a worker cannot get taxpayer-subsidized coverage on the new health insurance exchanges, starting in 2014, unless the cost of employer-based health coverage for that worker exceeds 9.5 percent of the worker’s household income.
Both the I.R.S. and the Congressional Joint Committee on Taxation have interpreted the law to consider only the cost of covering the individual employee in calculating the 9.5 percent, not the much higher cost for a family plan.
Although some analysts had offered persuasive legal and social arguments for adopting a more expansive and generous interpretation of what the law requires, the strict interpretation prevailed in a final rule issued by the I.R.S. last week.
There is no doubt that this pinched approach will put a significant number of workers and their dependents in a bind. A Kaiser Family Foundation survey found that in 2012, employees’ annual share of insurance premiums averaged $951 for individual coverage and $4,316 for family coverage. Under the I.R.S. rule, such costs would be considered affordable for an employee with a household income of $35,000 a year — making the employee’s spouse and children ineligible for a public subsidy on a health exchange, even though that family would have to spend 12 percent of its income for the employer’s family plan.
Estimates made in 2011 by respected research organizations suggested that some 2 million to 3.9 million non-working spouses and dependents would be harmed by the strict ruling. Looking only at children who were uninsured but supposed to gain coverage under health care reform, the Government Accountability Office estimated last June that 460,000 might remain uninsured because of the affordability definition, and that 1.9 million might stay uninsured if an existing children’s health insurance program is phased out as currently planned. This outcome is exactly the opposite of what health care reform is supposed to achieve.
It is hard to see what might be done to reverse this deplorable result. The ideal solution would be for Congress to clarify that the 9.5 percent calculation is based on a family plan, and that dependents can get subsidies on the exchanges if there is no affordable coverage at work. But House Republicans, who are bent on obstructing the health reform law, would never agree to helpful changes, especially one that would increase federal spending.
This problem increases the need to retain the children’s health insurance program, which is financed only through 2015. And it will be crucial to assess the impact that this misguided provision has on coverage, access to care, and the financial burdens on families of modest means.
WE SAW HEALTH COSTS SOAR AFTER THE ADDITION OF MEDIGAP. SOME PEOPLE WILL SAY THAT THIS WAS BECAUSE PATIENTS STARTED TO ABUSE THE SYSTEM AND CAUSED THE SOARING COSTS FROM THIS ABUSE.
WHAT REALLY HAPPENED IS THAT DOCTORS AND THE HEALTH INDUSTRY TOOK THIS PRIVATE HEALTH INSURANCE PROGRAM TO THE CLEANERS AS THEY MADE BILLIONS/TRILLIONS ON HEALTH CARE COSTS BY ORDERING EVER MANY TESTS ALL PAID FOR BY THIS PRIVATE INSURANCE. IT FUELED THE COSTS AND THE PATIENTS PAID FOR IT THROUGH THESE MEDIGAP INSURANCE PREMIUMS.
WAS THIS A GOOD IDEA? OF COURSE IT WAS.....PEOPLE NEEDED HELP WITH THAT 20% GAP IN PAYMENT. IF WE HAD HAD OVERSIGHT IN MEDICARE THERE WOULDN'T HAVE BEEN THE EXPLOSION IN CARE AND COST. THAT IS THE POINT WITH THESE HEALTH INSURANCE CO-OPS.....IF YOU DO NOT PUT UP PROTECTIONS AGAINST FRAUD AND OVERSIGHT IN USE WE ALL KNOW THERE WILL BE ABUSE......AND THERE WILL BE!!!!!
Medigap Reforms: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs
As part of several debt-reduction and Medicare-reform proposals, some policymakers propose to prohibit Medicare supplemental insurance policies (known as Medigap) from covering all of enrollee's out-of-pocket Medicare costs, which some believe leads to higher use of services and higher Medicare spending. Such changes would expose Medigap enrollees – currently about one in six Medicare beneficiaries – to a larger share of Medicare's cost-sharing requirements.
This analysis commissioned by the Kaiser Family Foundation examines three potential Medigap reforms, including one that is similar to a recommendation of the National Commission on Fiscal Responsibility and Reform (known as the Bowles-Simpson Commission).
The analysis estimates that the three options could save between $1.5 billion and $4.6 billion in Medicare spending in a single year. Under each of the options, enrollees would see an increase in average out-of-pocket spending for Medicare-covered services, as their Medigap policies become less generous. As a result of higher cost-sharing requirements, beneficiaries with Medigap could be expected to use fewer Medicare-covered services, leading to a decrease in average Medigap premiums.
The analysis finds that most Medicare beneficiaries with Medigap policies would be expected to pay less for their health care overall. However, Medigap reforms that prohibit first dollar coverage and charge additional coinsurance for hospital, home health and other services would have a disproportionately negative impact on Medigap enrollees who are in relatively poor health, those who require inpatient hospital care, and those with modest incomes – as these groups are more likely to face higher overall health care costs as a result of the changes.
The analysis does not attempt to estimate how much of this reduction in the use of Medicare services would be attributable to enrollees foregoing needed care or how it would affect enrollees' health and future medical needs – which potentially could have both health and spending implications over the long term.
The study was authored by Mark Merlis. It is part of a series of Kaiser Family Foundation studies examining the effects of proposed Medicare changes on the program's beneficiaries, the federal budget and other stakeholders, as part of the Kaiser Project on Medicare's Future.
Information provided by the Program on Medicare Policy
Publication Number: 8208
Publish Date: 2011-07-20
HERE IS MY QUESTION....BEILENSON IS JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH. JOHNS HOPKINS IS THE LEADING LOBBYIST AGAINST PUBLIC/UNIVERSAL CARE SO WHY WOULD YOU GIVE MONEY FOR THIS COMPETITIVE APPROACH TO HEALTH CARE AS NON-PROFIT TO THE PEOPLE FIGHTING IT?
REMEMBER MY COMMENTS THAT IN MARYLAND IF THE 1% WANT TO FIGHT AN ISSUE THEY SIMPLY CREATE A NON-PROFIT THAT BECOMES THE ISSUE AND THEN CONTROLS THE POLICY? THERE YOU HAVE IT....
SO, YOU HAVE A PRIVATE NON-PROFIT THAT IS JOHNS HOPKINS THAT SUCKED TRILLIONS OF TAXPAYER MONEY INTO THE HEALTH CARE DIVISION OF ITS UNIVERSITY TO GIVE US THE GLOBAL PRESENCE WE HAVE TODAY. THE NEXT STEP WOULD BE TO CREATE A PRIVATE NON-PROFIT THAT WILL SUCK BILLIONS OF TAXPAYER MONEY INTO THE HEALTH INSURANCE DIVISION TO GIVE US THE COMPLETE HEALTH SYSTEM PACKAGE.......ALL THAT IS HOPKINS.
Fiscal Deal Kills New Funding for Health Co-ops
By Phil Galewitz, Kaiser Health NewsPublished: January 03, 2013
Going, going, gone.
The fiscal cliff deal, approved by Congress on New Year's Day, eliminates most of the more than $1.4 billion in remaining funding from the federal health law for new nonprofit, customer-owned health plans designed to compete against the major for-profit insurers.
That means the Obama administration won't be able to approve loans to any additional co-ops. In the past 2 years, the Department of Health and Human Services has awarded nearly $2 billion in loans to 24 proposed state co-ops. Those loans won't be affected by the cut.
"We were blindsided by the elimination of funds," said John Morrison, president of the National Alliance of State Health Cooperatives. "The health insurance industry is getting its way here by torpedoing co-ops in the 26 remaining states. This is not about budgets; it is about those health insurance giants killing competition at the expense of millions of Americans who will pay higher premiums because of it."
But some House Republicans have said the co-ops were a way for the administration to reward its political friends. Sponsors of the co-op plans already under way include the Freelancers Union in New York, a farmers' union in Colorado and the Connecticut State Medical Society.
Critics also have been skeptical the co-ops could compete with more established insurers, such as Aetna and UnitedHealthcare.
"Starting a new health plan is a risky proposition," said Peter Kongstvedt, a McLean, Va.- based health care consultant. He said consumers already have sufficient choice of plans in most markets and won't miss having the additional co-ops.
Proponents of the co-ops say such plans could offer lower premiums because they don't have to generate profits for shareholders. Under the law, co-op plans must apply any surpluses to lowering rates or improving benefits or quality for their members. The co-ops are scheduled to open by next year.
In testimony before Congress last year, Morrison called skepticism about co-ops' ability to compete "naive," noting, "The large carriers are saddled with stockholder demands for profit, large overheads, antiquated legacy processing systems, and other inefficiencies."
Initially, the health law allocated $6 billion to help co-ops start up and meet state insurance solvency requirements. In 2011, Congress reduced that funding to $3.4 billion as part of broader budget cuts.
More than two dozen applicants were applying for co-op funding when the money was eliminated, Morrison said. HHS officials did not return calls for comment.
The deal approved Tuesday leaves 10 percent of the remaining co-op funds to cover the administrative costs connected with the 24 plans already launched.
Evergreen Health Cooperative Inc.
Service Area: Maryland
Award Amount: $65,450,900
Award Date: September 28, 2012
Evergreen Health Cooperative, Inc. (Evergreen) plans to provide high quality, affordable care to Maryland residents while pioneering innovative forms of healthcare delivery. Evergreen intends to provide health insurance coverage statewide and in the Maryland Health Benefit Exchange