Thursday, April 06, 2006

Multiple States Work Toward Universal Health Insurance in Non-Partisan Ways, While Federal Government Pushes More Off Health Care

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The above map represents nation-wide coordination for universal health care for the 2000 election. It's pretty much everybody. Meanwhile, Democrats and the Republicans ignore their citizens and increasingly repress their health, ecological soundness, and destroy their economies in the name of corporate welfare.

Below is an interesting article on how such health care concerns are bubbling up to force the issue for more affirmitive situtions in local states. The different local strategies popping up across the United States for universal health care--and the mechanisms in which the Democrat-Republicans attempt to shove the pressure into existing corporate sponsorship forms are a nice window into the politics of gatekeeping and power. The Massachusetts style "solution" to health care--PENALIZING people for NOT buying private insurance (i.e., for NOT subsidizing corporate insurance) is a poor method for attempting to aid people and provide health insurance encouragements. It sounds like just more corporate subsidization instead of really providing for a concern of universal health coverage. However, as the article states:
"This is probably about as close as you can get to universal [in Massachusetts, in current political frameworks]," said Paul Ginsburg, an economist who is president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."

However, when polls show that no one supports the policies of the Republicans or Democrats in the United States, what if you would like to see both these parties wither away, because they have lost their electoral basis entirely? [1] [2] [3]

Since no one supports these gatekeeping parties in practice, citizens and physicians have been organizing by local state instead.

For instance, there is the The Consumers for Affordable Health Care Coalition which advocates for a single-payer health care system within the state of Maine. "It is one of hundreds of state-wide organizations seeking universal health care." A second is the Public Campaign, "a grassroots campaign trying to inform communities of the benefits of Universal Health Care. Its objectives extend beyond promoting the universal health care system, as well, but the success of a universal health care system is among the organization's top priorities." A third is the The National Labor Party, which
"believes that the United States' current health care system is a poorly regulated, corporate-dominated system that eliminates choice, erodes care, and inflates administrative costs while boosting profits and CEO compensation. According to the Labor Party, health care is a critical social good that demands collective interests prevail over private gain. This interest group is committed to a single payer system to achieve universal and effective health care for all. Members are currently circulating petitions and mobilizing voters is its main purpose. They are trying to get voters to support the Health Care Trust Bill."

A fourth groups is Physicians for a National Health Program (PNHP), with

"over 9,000 members in chapters across the United States. Members of this non-profit volunteer organization believe that access to high quality health care is a right of all people and should be provided as a public service, rather than bought as a commodity. According to the PNHP, this single-payer system is the only solution to solving the United States' health care problems. The PHNP also believes that too much profits are going to insurance companies and believes savings from a universal health care program could amount to 13 to 30 percent. The PNHP published the first major single payer proposal in the New England Journal of Medicine in 1989." [*]

The tragic irony is that this was a move on the local level in response to the Bush Administration kicking people off Medicare--while it was recently reported that multiple more billions are being given to Halliburton's war machine. It was estimated that 52% of all Iraq spending has gone to enrich Halliburton.)

Interesting, nonetheless that they are working together on the local level to take care of issues of health, something that typically is more approriately addressed locally than federally in the bioregional state. That is particularly clear when the Bush Administration has moved to kick more people off health care federally, while of course putting more and more corporations on life support... (I have nothing against Republicans: I just ask them to be actual conservative Republicans supporting local democracy like they say they are--instead of federal one-party-state police state theocrats. A simple glance at why the remaining small support of Bush--only around 33-34%--should abandon him like the plague is very clear with these ten points why the Right should leave Bush).

Certainly one bioregional state solution would be more germane toward all this widely popular organizing for protecting health care: institutionalize a watershed based districting for elections. This will remove the gatekeeping political parties and their gerrymandered districts (the only way Democratic and Republican party dominance is maintained instead of by clean elections). It would make elections more competitive, allow for voters to have more choices, and in doing that, it forces all parties to be more representative of the local intermixed health, ecological, and economic interest in a particular area. Health care--the true will of the people--will follow more smoothly with a changed formal institutional appratus removes the gatekeeping will of the uncompetitively elected (and unauditably elected, like they prefer) Democrats and Republicans.

Massachusetts Set to Offer Universal Health Insurance
(New York Times)
April 4, 2006

BOSTON, April 4 — Massachusetts is poised to become the first state to provide nearly universal health care coverage after the state legislature overwhelmingly passed a bill today that Gov. Mitt Romney says he will sign.

The bill does what health experts say no other state has yet been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines several different methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government.

"This is probably about as close as you can get to universal," said Paul Ginsburg, an economist who is president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."

The bill, which resulted after months of wrangling between legislators and the governor, requires all Massachusetts residents to obtain health coverage by July 1, 2007.

Individuals who can afford private insurance will be penalized on their state income taxes if they do not buy it. Government subsidies to private insurance plans will enable more of the working poor to be able to afford insurance and will expand the number of children who are eligible for free coverage. And businesses with more than 10 workers that do not provide insurance will be assessed a fee of up to $295 per employee per year.

All told, the plan is projected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said.

"It is not a typical Massachusetts-Taxachusetts, oh just crazy liberal plan," said Stuart H. Altman, dean of the Heller Graduate School for Social Policy and Management at Brandeis University. "It isn't that at all. It is a pretty moderate approach and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."

Many states, including Massachusetts, have been wrestling for years with how to cover the uninsured, and several states have come close, according to the National Conference of State Legislatures. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but 3 percent of people remain uncovered. Attempts at covering all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat a few years later when, in the mid-1990's, [even] the language in the bills concerning universal coverage was repealed. [The U.S. is still very much a corporate state hurting its people instead of aiding it.]

In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004.

The Massachusetts bill approved today was hammered out from proposals and input from Democratic legislators, Mr. Romney, a Republican, Senator Edward M. Kennedy, a Democrat, insurers, academics, businesses, hospitals, and advocates for the poor, including religious leaders.

They were motivated in part by a threat by the federal government to eliminate $385 million in federal Medicaid money unless the state reduced the number of uninsured people. The state was supposed to have the bill completed last January, but state officials said they were confident that the federal government would approve of the bill approved today.

"It's a balanced bill," said State Senator Robert E. Travaglini, the majority leader. "Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise. This is going to be a template for the rest of the nation to follow."

Governor Romney, who is considering running for president in 2008, said in an interview today that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed."

He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone."

In particular, Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford health insurance to buy it, in the same way that drivers are required to have auto insurance. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more.

One element that Mr. Romney and some legislators did not want was the fee for employers who do not provide health insurance. For several months the bill seemed stalled because the state House and Senate leaders could not agree on the issue of charging businesses or on how much to charge them. One proposal of an $800-per-employee charge was reduced to a maximum of $295 that will be reduced as more and more people become insured, Mr. Travaglini said.

Because the bill is part of a budget bill, Mr. Romney has line-item veto power and he said today that he would likely change the business fee provision in some way or veto it before signing the bill. Still, he did not seem that concerned about it, saying he had been most concerned that the fee not be a payroll tax, as had been originally proposed. [i.e., he was mad more money was not being sucked from the working poor, who were then punished for not supporting exorbitant corporate insurance! His 'electorate' so called is obviously the immortal beings called corporations, instead of citizens.]

Mr. Travaglini said that if Mr. Romney vetoed the business fee, the legislature would override it.


Blogger Mark said...

Here's a 2003 Universal Health Care Poll by ABC News:


This ABCNEWS/Washington Post poll was conducted by telephone Oct. 9-13, 2003, among a random national sample of 1,000 adults. The results have a three-point error margin. Fieldwork was conducted by TNS Intersearch of Horsham, Pa.

lots of nuggets there, this is just the introduction:

Americans express broad, and in some cases growing, discontent with the U.S. health care system, based on its costs, structure and direction alike — fueling cautious support for a government-run, taxpayer-funded universal health system modeled on Medicare.

In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments.

Support for change is based largely on unease with the current system's costs. Seventy-eight percent are dissatisfied with the cost of the nation's health care system, including 54 percent "very" dissatisfied.

Indeed, most Americans, or 54 percent, are now dissatisfied with the overall quality of health care in the United States — the first majority in three polls since 1993, and up 10 points since 2000.

4/06/2006 4:39 AM  
Blogger Mark said...

Healthcare for All?

Commentary: What Americans think about universal coverage.
By Ruy Teixeira
September 27, 2005

Article created by The Century Foundation

To the extent one can rank people's personal economic worries, rising health care costs are frequently at the top of the list.

For example, in a June 2005 Lake Snell Perry Mermin survey, 27 percent picked rising health care costs, 18 percent wages not keeping up with costs, 14 percent a secure retirement, 12 percent higher taxes, and 9 percent rising gas prices as their chief economic worry. Just 5 percent picked losing their job.

One way to control health care costs, of course, is in the context of a system that would provide universal health insurance coverage to Americans.

Would Americans support government action to create such a system?

They say they would, though there are nuances to that support which suggest mobilizing the public to move in that direction remains tricky. Here's what we know and what we don’t about public opinion on universal health care, based on available data.

What We Know

1. Rising health care costs, not health coverage, is people’s chief health care concern. For example, in a June, 2005 Kaiser Family Foundation survey, the top worry was “having to pay more for your health care or health insurance” (45 percent said they were very worried), followed by “not being able to pay medical costs when you are elderly” (42 percent), “your income not keeping up with rising prices” (40 percent), not being able to afford the health care you think you need (34 percent), losing your health insurance (30 percent), and not being able to change jobs because you’re afraid of losing your health insurance (18 percent).

2. The public wants the government to play a leading role in providing health care for all. For example, in an October, 2003 Washington Post/ABC poll, by almost a two-to-one margin (62 percent to 33 percent), Americans said that they preferred a universal system that would provide coverage to everyone under a government program, as opposed to the current employer-based system. Similarly, in Kaiser polls from 1992 to 2000, a large majority of the public agreed that the federal government should guarantee medical care for people who don’t have health insurance. In a slightly different question asked more recently by Kaiser in June 2003, more than seven in ten adults (72 percent) agreed that the government should guarantee health insurance for all citizens, even if it means repealing most of the tax cuts passed under President George W. Bush, while less than one-quarter (24 percent) disagreed with this statement. Finally, the last time Gallup asked whether the federal government should make sure all Americans have health coverage, they agreed that was a federal government responsibility by 62 percent to 35 percent (November 2002).

3. American overwhelmingly agree that access to health care should be a right. In 2000 just as in 1993, eight in ten agreed that health care should be provided equally to everyone, and over half agreed “strongly” or “completely.” In addition, in 2004, about three-quarters (76 percent) agreed strongly or somewhat that access health care should be a right.

4. The public says it is willing to pay more in taxes to provide every American with health care coverage. In August 2003, Pew found Americans favoring, by 67 percent to 26 percent, the U.S. government guaranteeing “health insurance for all citizens,” even if that meant repealing most of “recent tax cuts.” And the majority was scarcely diminished (67 percent to 29 percent) by referring not to repealing tax cuts but more directly to “raising taxes.” Similarly, Greenberg Quinlan Rosner/Public Opinion Strategies (GQR/POS) found, in January 2004, a 69 percent to 28 percent majority saying that they would be willing to pay more per year in federal taxes to assure every American citizen received health care coverage.

5. But support for universal coverage drops significantly if such a program would mean limitations on access to medical care. For example, while 62 percent in the October 2003 Washington Post/ABC poll said they wanted universal health care system run by the government, rather than the current system, that support dropped to 35 percent if that limited choice of doctors and to 38 percent if that meant longer waits for nonemergency treatment.

6. Moreover, willingness to pay more in taxes for universal coverage is a “soft” commitment. For example, when phrased as whether the respondent would be “willing to pay more—either in higher insurance premiums or higher taxes—in order to increase the number of insured Americans,” 51 percent say that they would not, compared to 45 percent who say they would. And, in the GQR/POS survey, when asked how much they’d be willing to pay in additional taxes to assure universal coverage for American citizens, 40 percent would not name a dollar figure at all and 16 percent named a figure under $100.

7. The public also is not completely clear on whether the federal government actually has to lead the way on universal coverage. When asked specifically about responsibility for covering the uninsured, four in ten people (43 percent) do say that the federal government should have the most responsibility for providing health insurance coverage to the uninsured, but two in ten (20 percent) say that state governments should be most responsible, and about one in ten (11 percent) say that employers should be most responsible. Another two in ten (18 percent) think that the responsibility belongs to none of these or to another group (June 2003 Kaiser poll).

8. And the public is not sure whether the government should make a major or a limited effort to provide health insurance to the uninsured. The last time this question was asked by Kaiser in May 2003, 42 percent said that there should be a major effort, 37 percent said that there should be a limited effort, and 13 percent said that things should be kept the way they are.

9. The public generally wants to build on, rather than eliminate, the current employer-based private health insurance system. In a January, 2000 Kaiser poll, they preferred building on the current system to switching to a system of individual responsibility (54 percent to 39 percent) and in a November 2003 Kaiser poll, they preferred keeping the current system to replacing it with a government-run system (57 percent to 38 percent).

10. In that context, the public supports a wide variety of options for expanding health insurance to cover more Americans. In a June, 2005 Kaiser poll, the public said they favored tax deductions or credits for businesses (88 percent); expanding state government programs like Medicaid (80 percent); expanding Medicare to cover people ages 55–64 (74 percent); tax credits for uninsured individuals (73 percent); and requiring business to offer employees health insurance (70 percent). In a December 2003 Harvard School of Public Health/Robert Wood Johnson/ICR poll, 80 percent supported expanding Medicaid/SCHIP; 76 percent supported employers being required to offer a health plan; and 71 percent supported a tax credit plan. Trailing these options, but still garnering majority support, were a universal Medicare plan (55 percent) and an individual coverage mandate plan (54 percent). Finally, the 2004 GQR/POS poll found 74 percent favoring guaranteed health care coverage for all American children under 18 and 62 percent favoring catastrophic health insurance coverage for all Americans. (Note: one of the only options that didn’t garner majority support in these polls was a single or national health plan financed by tax payers that would provide insurance for all Americans [37 percent to 47 percent].)

What We Don’t Know

So, it appears that the public is very open to a government-supported system of universal coverage, but not sure about how (and how fast) to get there and what kind of system it really wants. This is a challenging environment for advocates of universal coverage. To be effective, they will need to resolve a number of unanswered questions about public responsiveness to a universal coverage message.

1. Does the public see a connection between universal coverage and containing health care costs? If so, what kind and how can that connection be strengthened? If not, what can be done to create that connection?

2. The public says it favors a government role in guaranteeing health insurance coverage for all. But how does the public envision that role? And what does the public really hear when terms like “universal coverage” and “guaranteed health insurance” are used? Do advocates know what kind of terminology would actually work the best when talking about these goals with the public?

3. If the public believes access health care is a “right,” is that the best way to talk about the goal of universal coverage? If not, what is the best way to connect to Americans’ values in and around the health care issue?

4. We need to know much more about the sensitivity of the American public to the costs involved in extending health insurance coverage. How seriously should we take the surface commitment to pay more in taxes? How would the issue have to be framed to make that surface commitment into a more durable one? How important might the issue of containing health care costs be to getting the public to accept the costs of universal coverage?

5. How can advocates avoid the restricted choice counterattack that will inevitably be raised to any universal coverage plan? Should consumer choice be a central element of any universal coverage plan? If so, what is the best way to frame that?

6. The public appears to support the general goal of universal coverage but seems shaky on the scale of the effort need to meet that goal. What is the best and most effective way of making clear the scale of effort needed to actually attain universal coverage?

7. The public appears to support a wide range of possible ways to increase coverage, but it is unclear which, if any, of these approaches the public identifies as particularly effective. Can the public be led to identify progress toward universal coverage with a few key reforms that would stand out from the rest? If so, which ones and how should advocates talk about them?

Ruy Teixeira is a senior fellow at The Century Foundation and the Center for American Progress.

4/06/2006 4:45 AM  
Blogger Mark said...

More on Massachusetts attempt use the phrase "insure everyone" as mislaid.

Massachusettes version seems innately designed to triage away those most requiring health assistance.

More below on bizarre "solutions" of Massachusetts for Orwellian named "state universal health care" (which above seems instead to be a form of forced support of corporate exorbitant health care instead of really about health.

This secondary rub about it requiring ID citizenship cards increasingly leans my interpretation of its "universality" as more of a propoganda statement than reality.

I'm torn of course--torn between all the undocumented illegals that could prostrate themselves on the American public dole thus, which is a sensitive topic presently. However, one should keep in mind that additionally this would ostracize undocumented REAL citizens without any purpose.

US rule demands proof of citizenship for healthcare
Law could hurt the state's poorest

By Scott Helman, Globe Staff | April 11, 2006

Almost all of the state's poorest residents will have to show proof of US citizenship to continue getting medical care by July 1, under a little-noticed federal law that could endanger coverage for many, as Massachusetts is trying to expand access to healthcare.

Born out of ongoing efforts in Washington to clamp down on illegal immigration, the new federal requirement compels anyone seeking Medicaid coverage to provide a birth certificate, a passport, or another form of identification in order to sign up for benefits or renew them.

No such proof is required now.

The requirement was tucked into the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year.

The measure was part of an effort to limit the skyrocketing growth of federal entitlement programs. It has surfaced as Massachusetts begins to implement its sweeping healthcare plan, which aims to bring health coverage to almost all of the state's uninsured, in part by enrolling those in Medicaid who are eligible but who have not signed up.

Healthcare specialists voiced fear that because many Medicaid recipients -- including the homeless and the mentally disabled -- won't be able to easily produce documentation of their citizenship, they will have difficultly receiving care at community health centers, hospitals, or anywhere else.

''So we've got people in nursing homes, people in the [state Department of Mental Retardation] institutions, we've got the homeless, we've got the . . . mentally ill who now will have to come up with some verification to prove that they're citizens," said Victoria Pulos, health law attorney at the Massachusetts Law Reform Institute. ''It's ironic that this is happening in the state where part of the health reform plan is to make sure that everyone who's eligible for Medicaid is enrolled."

The new federal requirement, which all states have to comply with, would apply to the vast majority of the more than 1 million people on MassHealth, the Massachusetts Medicaid program.

The intent is to prevent undocumented immigrants from posing as citizens and taking advantage of taxpayer-funded healthcare benefits that are afforded only to legal residents. (Under federal law, undocumented immigrants can receive only emergency Medicaid care; Massachusetts has 40,000 on such a program, which is called MassHealth Limited.)

Less than three months before the new citizenship requirement takes effect, though, Massachusetts and other states are waiting for guidance from the federal government on how it will work.

Mary Kahn, a spokeswoman for the federal Centers for Medicare & Medicaid Services, said that the agency is writing the regulations, but that there is no indication of a delay.

Massachusetts already compels Medicaid recipients to verify their incomes, usually through W-2 forms, to ensure that the figure is low enough to qualify for the program. The state Medicaid director, Beth Waldman, played down the difficulty of adding another requirement.

''This shouldn't take away from people's access to healthcare," Waldman said. ''All you need to do is show that you're a citizen."

Waldman said that many of the state's 1,033,000 MassHealth recipients are not likely to have trouble proving citizenship, because they have already had to do so in registering with some other federal program, such as Social Security. (About 478,000 MassHealth members, for example, also get Medicare, Social Security, or welfare benefits, the state says.)

Some healthcare advocates, though, described the new rules as onerous on community health centers and other healthcare providers, but more so on Medicaid recipients, many of whom, they said, may not continue getting care if they cannot provide the paperwork or may have to wait to get treatment until they can locate the right documents.

''We're in the business of trying to make central Dorchester and parts of Mattapan a healthier place," said Bill Walczak, chief executive officer of Dorchester's Codman Square Health Center. ''We didn't create the healthcare centers to become citizenship enforcement centers."

The provision was added to the Deficit Reduction Act by two Republican representatives from Georgia, Charles Norwood and Nathan Deal, who have been outspoken against illegal immigration. Bush signed the legislation two months ago, saying, ''The bill I sign today restrains spending for entitlement programs while ensuring that Americans who rely on Medicare and Medicaid continue to get the care they need."

Chris Riley, Deal's chief of staff, said yesterday that the citizenship provision was simply about ''enforcing the law."

''The intent was to verify that US citizens are getting Medicaid," Riley said.

Norwood issued a statement in February saying, ''After years of listening to 'advocates' whine about compassion for those who intentionally break our laws for financial gain, I'm glad to see us finally showing some compassion for our own poor and sick who abide by the law."

State Representative Marie J. Parente, a Milford Democrat who speaks often about restricting illegal immigration, said she agreed with Norwood's statement. Parente said she was at an event in Peabody yesterday at which someone asked her about healthcare for illegal immigrants.

''I said, 'Why don't you have the same compassion for the American people who don't have a good healthcare plan?' " said Parente, who hosted a meeting on immigration last week at the State House that she said drew more than 1,000 people.

The Center on Budget and Policy Priorities in Washington, D.C., issued a report this year saying that the rule would affect nearly 50 million people nationwide.

It would, the report said, ''almost certainly create significant enrollment barriers for millions of low-income citizens who meet all Medicaid eligibility requirements."

An evaluation of the Medicaid program by the inspector general of the US Department of Health and Human Services in July 2005 recommended the agency strengthen quality control to prevent abuse by noncitizens.

It did not, however, recommend requiring recipients to provide proof of citizenship.

Healthcare providers said it was too early to know how the federal requirement would affect Massachusetts, but they say they would always treat people who need care, no matter their ability to pay nor their documentation. They said it could, however, create complications for them in qualifying for federal reimbursement.

''We know that this will create some potential problems for folks in traditional Medicaid programs," said a Massachusetts Hospital Association spokesman, Paul Wingle. ''What this comes down to for hospitals is really not . . . whether folks get urgently needed care. It comes down to whether or not that care will be reimbursed."


4/13/2006 3:33 PM  
Anonymous Anonymous said...

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3/14/2008 12:56 AM  
Blogger Unknown said...

As a long-time Massachusetts resident I truly hope that our government will move towards universal health insurance for all. I've spent a long time in the insurance industry, my company provides car insurance in Brookline MA and the surrounding areas. That being said, I understand both sides of the insurance question and can see the push back that private entities would have. However, when it comes to health care I think we all have a right... Just look at Canada, and some of the leading European nations, Germany, France, Scandinavia. These people do it right and are guaranteed health care as a birth right!

- Sash

7/22/2016 6:27 AM  

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