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BEWARE......MARYLAND HEALTH CARE FOR ALL IS SIMPLY A JOHNS HOPKINS ORGANIZATION CREATED TO CO-OPT THIS ISSUE.....HOPKINS FIGHTS FOR PRIVATE HEALTH SYSTEMS AND AGAINST UNIVERSAL/PUBLIC HEALTH CARE.!!!!!
Posted on: Thursday, March 1, 2012 Financing a single payer system in Maryland Financing the Maryland Health Security Act By Gerald Friedman, Professor of Economics, The University of Massachusetts at Amherst
This policy memo explores the economic implications of enacting the Maryland Health Security Act (MHSA) and establishing the Maryland Health System Trust (MHST) a single-payer system to finance health care in Maryland. The proposed trust would finance virtually all necessary medical care including hospital care, doctor visits, dental care, mental health, prescribed occupational and physical therapy, prescription drugs, medical devices as well as medically necessary nursing home care and home health care. Medical care would be financed through the MHST without co-payments or deductibles.
The MHST will finance medical care with substantial savings compared with the existing multi-payer system of public and private insurers. Some of these savings would be used to extend coverage to the 15 percent of nonelderly adults in Maryland without insurance and to improve coverage for the growing number with inadequate coverage. In addition to improving access to health care, the MHST would reduce economic inequality by replacing the current regressive system of health insurance finance with progressive and proportional taxes. By reducing administrative and other waste, the MHST would increase real disposable income for most Maryland residents while reducing the burden of health care on Maryland businesses.
Financing the Maryland Health Security Act (31 pages):
House Bill 1035 - Maryland Health Security Act of 2011:
Comment: By Don McCanne, MD
Many proposals have been advanced and bills introduced for single payer programs. Perhaps the most frequent question asked is, "How would you pay for it?" The general answer is easy. You simply use progressive tax policies to fund a universal risk pool that pays for all appropriate care for everyone. Most people want specifics. In this report, Professor Gerald Friedman describes a financing proposal for the Maryland Health Security Act of 2011, a single payer model of reform.
As with all other single payer proposals, he reaches the conclusion that the substantial savings of the single payer model could be used to extend coverage to the uninsured and to improve coverage for the growing number with inadequate coverage. This would increase disposable income for most residents and reduce the burden of health care costs on Maryland businesses.
Friedman also provides a graph projecting three scenarios for Maryland health expenditures for the next decade: 1) the existing health care finance system, which we all know is terribly inflationary, 2) growth under the Affordable Care Act, which is much worse (since this is the most expensive model of reform), and 3) growth under single payer, which is dramatically reduced - bringing cost escalation down to tolerable levels - truly "bending the curve."
One important footnote in his report should be mentioned: "We assume that all necessary federal waivers are granted and legislation is enacted to allow the incorporation of existing federal programs into the MHST (Maryland Health System Trust), including Medicare, Medicaid, and the Veteran’s Administration." We might add to that legislation addressing the preemption clause for self-insured, employer-sponsored plans under the federal Employee Retirement and Income Security Act of 1974 (mentioned in the fiscal and policy note for HB 1035).
Activists should continue to support state efforts for single payer reform while simultaneously supporting enabling federal legislation, for the reasons mentioned. The former is not possible without the latter. A far better option would be to enact a national single payer program, but until we can bring sanity to our political process, state single payer reform should be pursued.
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Is the Basic Health Program option a good idea?
Posted by Don McCanne MD on Thursday, Apr 19, 2012 This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.
The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks and Considerations for States By Deborah Bachrach, Melinda Dutton, Jennifer Tolbert and Julia Harris
Kaiser Family Foundation, March 2012
The Basic Health Program (BHP) is an optional coverage program under the Patient Protection and Affordable Care Act (ACA) that allows states to use federal tax subsidy dollars to offer subsidized coverage for individuals with incomes between 139-200% of the federal poverty level (FPL) who would otherwise be eligible to purchase coverage through state Health Insurance Exchanges. States can use the BHP to reduce the cost of health insurance coverage for these low-income consumers, a highly price-sensitive population with high rates of uninsurance. Depending on how it is designed, the BHP also can help consumers to maintain continuity among plans and providers as their income fluctuates above and below Medicaid levels.
As states weigh whether to implement a BHP, they face significant questions and challenges. Critical among these are how to design the BHP to enhance continuity of coverage as people move among Medicaid, the BHP, and coverage through qualified health plans (QHPs) in the Exchange; how to assess the BHP’s impact on the viability and effectiveness of state Exchanges; and how to estimate revenues and costs to evaluate the financial feasibility of the BHP.
Federal officials have yet to provide details about how the program will be financed, administered and certified, and states are struggling to evaluate the BHP’s impact on the viability and effectiveness of state Exchanges. Federal regulations will inform state deliberations, but are unlikely to fully resolve the complexity or eliminate the risk. Ultimately, states that opt for a BHP will want to design BHP programs so as to minimize the state’s financial exposure and address any negative impacts on the Exchange. States in which a BHP is not a viable option may want to consider alternative strategies to advance affordability and continuity goals.
The Basic Health Program is designed for individuals with incomes between 139-200% of the federal poverty level – a population that otherwise would be very vulnerable to cost sharing provisions of purchasing and using plans in the state insurance exchanges.
This report explains the moving levers that are required to construct such plans while being sure that benefits are adequate while costs are controlled for both the beneficiaries and the state and federal governments. With eligibility frequently shifting between Medicaid, the Basic Health Program, and the state exchange plans, it is clear that stability cannot be achieved. It is highly unlikely that plans can even be constructed that would meet the various goals for the patients, providers and state and federal governments, and, regardless, they would create an administrative nightmare.
Since the purpose of the Basic Health Program is to remove financial barriers to care for this vulnerable group, it only seems logical that this highly flawed plan should be discarded and replaced with an administratively simplified plan that removes access barriers not just for them, but for everyone – an improved Medicare for all.