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Progressive Politics in Minnesota, the Nation, and the World

The ACA: More Than Helping The Uninsured

Category: Health Care
Posted: 04/02/15 10:41

by Dave Mindeman

When it comes to the Affordable Care Act, we tend to focus on the broader goal of the law - to get affordable insurance for those who do not have it.

But there are other aspects of the law that have improved health care and have not been brought to public attention.

This is one -

The Affordable Care Act is "a major reason why we've seen 50,000 fewer preventable patient deaths in hospitals." - President Obama (March 25, 2015)

That statement got some attention and a fact checker looked into it....

The 50,000-number is derived from a study, released on Dec. 2, 2014, by the Agency for Healthcare Research and Quality, an arm of the Department of Health and Human Services. The study looked at the impact of the Partnership for Patients, a $460-million program funded by the health law which ties together 3,800 hospitals in 27 "health engagement" networks, with the goal of reducing ten categories of "patient harms," such as adverse drug events, pressure ulcers and catheter-associated urinary tract infections. The networks work together to identify possible solutions to common problems and then circulate those ideas among the various hospitals, with the goal of reducing preventable hospital-acquired conditions (HACs) by 40 percent and 30-day hospital readmissions by 20 percent.

Preventable deaths in the hospital has been a problem for many years. And a lot of it is due to a lack of coordination among hospitals and the lack of information transfer. The ACA addressed that - and it looks like it did so successfully.

Largely relying on more than 30,000 medical records, the study looked at how many fewer patient-related problems had taken place in hospitals--the study calculated 1.3 million fewer incidents over three years-and then used that to determine how many lives might have been saved. In general, the researchers used mortality estimates from other research...."There is some uncertainty about these estimates," one official said. "In some cases, the literature [on excess mortality] is better than others. But it is quite conceivable that 1.3 million fewer people are being harmed."

That number (over 3 years) is an impressive improvement in health care. Hospitals have fewer adverse incidents and fewer uninsured patients. Not only is that improving health care in general but it has a positive effect on the hospital bottom line.

The ACA has been a controversial bill and the changes to health care in the United States have been extensive. But the improvements are real and tangible.

If the Republicans really want to return to pre-ACA health care, they will have to take away all of its benefits in the process.
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MNSure Critic And Non-Supporter, Rep. Mack Says She Will Fix It?

Category: Health Care
Posted: 03/22/15 01:14

by Dave Mindeman

Rep. Tara Mack voted against the creation of a health care exchange. She worked to delay its implementation. When the state hurried its way into making an exchange, she offered no suggestions or help. When MNSure had its rollout problems, she was quick to criticize but offered no solutions. When the exchange successfully enrolled 183,000 Minnesotans, she focused on the software issues and glitches. When studies showed that Minnesota's uninsured rate declined by 40%, she said nothing.

But now we are supposed to believe that Rep. Tary Mack is going to work on fixing the system and "make it better".

Rep. Tara Mack, R-Apple Valley....sponsors House File 5, which would direct the commerce commissioner to ask the federal government for a 1332 waiver under the Patient Protection and Affordable Care Act. The waiver would allow qualified health plans to be sold outside of MNsure -- but eligible consumers would still receive federal subsidies. We should expand choice without making insurance purchasing as "frustrating, awkward and inconvenient" as MNsure has made it, Mack said.

In other words, Mack is working to give the power back to the insurance companies.

If, as Mack suggests, we take enrollment outside of MNSure, then insurers would have to have access to eligibility data to allow for tax subsidies. That would require them to have IRS data. Some have suggested that MNSure could still determine eligibility, but that outside insurers could then offer the plans with the subsidies. If we just let insurers get access to our private financial data, how can our data be protected? And if we use MNSure to determine that eligibility, then why would we even need the fix? The determination of eligiblity has been the main problem for MNSure from the beginning. Once the eligibility has been verified, MNSure becomes a simple shopping exchange.

Frankly, we have already been working to fix the initial problems that plagued MNSure - an IT nightmare. During the second enrollment, many of those problems went away. We still have things to fix, but what Rep. Mack is proposing is to make another major change in how this system operates....and what guarantee do we have that more software and data privacy issues don't occur?

Having our own state exchange has increased importance as the Supreme Court makes its determination on the ACA language involving those exchanges. We need to protect the Minnesotans that now have health insurance that they couldn't get before the ACA.

Rep. Mack is not going to give that protection. And her past record on MNSure has never been involved with support for the exchange - it has always been an effort to destroy it.

How can we trust someone like that to offer new legislation on this issue?
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Downey's "Fixes" for MNSure Are More Bunk

Category: Health Care
Posted: 03/01/15 17:36

by Dave Mindeman

I need to respond to an OP-ED in the Star Tribune by Keith Downy, chair of the Minnesota Republican Party and obvious MNsure critic.

It is a bit surprising that Downey and the MN GOP suddenly think of themselves as some kind of "savior" for MNsure - especially when they actively blocked its beginning, did nothing to work on the bill that brought it into being, have not bothered with helping in its evolution, and are still actively seeking to kill it with every opportunity.

So the idea of having the "cure" has to be viewed somewhat skeptically.

But at least, for once, Downey puts forward some actual remedies. Let's take a look....

1. Only 9 percent of MNsure enrollees actually bought the private coverages, and these enrollees don't need MNsure's failed technology to find their insurance. H.F. 5, authored by Rep. Tara Mack, R-Apple Valley, proposes waivers allowing enrollees to take their government subsidy to private-sector insurance exchanges, which already offer Obamacare-compliant private coverages and work perfectly. We should free these MNsure-locked customers to shop wherever they want! Using the federal exchange could also be evaluated.

Private plans have been key to MNsure's viability. And the horrible website has chased away most of the people that wanted to buy a private plan. But there is a flaw in the Mack bill. If we allow the federal subsidies to be used by the private sector, we will have a gigantic privacy issue. The exchanges and Fed website were designed to use data gathered from the IRS to determine those subsidies. One of the problems in forming these exchanges is how to keep that data safe and private. What the Mack bill does is potentially open that income data to insurance carriers, which to me would be a bigger disaster than software problems.

2. The 91 percent enrolled in government's MinnesotaCare and Medicaid programs, which have been available for years, were enrolled through the regular process and systems at the Minnesota Department of Human Services (DHS). They can continue to be. These enrollees do not need MNsure to get their coverage either!

Yes, many of them were eligible before. And many more became eligible with the Medicaid expansion. Except why were they not getting that coverage before? One of the reasons is that they didn't know about the programs or know that they were eligible. The MNsure exchange has been a valuable tool for determining all of that. Granted, the software has still made part of that journey into coverage a little tedious, but the overwhelming numbers of new MNCare and Medicaid recipients means that our overall uninsured rate has dropped by 40%. Would that have happened without MNsure? Maybe some of it - but it is hard to imagine Republicans signing onto new outreach programs to find them.

3.  Shut down the unnecessary MNsure bureaucracy and operations. S.F. 810, authored by Sen. Michelle Benson, R-Ham Lake, proposes an alternative nonprofit structure to manage Obamacare coverages, much like the Minnesota Comprehensive Health Association operated successfully.

I'm not sure how this is worded, but it is hard to imagine that we actually know what is unnecessary at this time. The MN Comprehensive Health Association is a favorite of Republicans because it only provided catastrophic coverage - few prescriptions or any preventive medicine. It was cheap insurance because it covered only the extreme health event. The MN GOP would love to bring that back.

4. Evaluate whether any components of MNsure's technology or operations could be salvaged by the DHS to improve the enrollment process for MinnesotaCare and Medicaid. If not, shut them down altogether.

We do have serious problems coordinating MNsure to our state health programs. Lots of improvement is needed here and they need to "talk" to each other much more efficiently. It might be better to have MNsure determine eligiblity for these plans and then turn over the files to MNCare or Medicaid from there. MNsure seems to have complicated matters with state recipients and that does need to be fixed.

Downey is good at listing complaints about MNsure - GOPers in general have made it a political sport. But his idea of "real" fixes is pretty shallow at best - and will make things more complicated at worst.

I am sure we would all like the MN GOP to be a partner in solving the MNsure problems, but Downey's words are no evidence of that.

Not in the least.
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