Long-Term Care System LEAN Process starts up

The work stemming from LD 1078 started up on Tuesday, Sept. 15th, with the Department of Health and Human Services. DHHS has been instructed to revamp the current home and community based care part of the long-term care system. The current system in place, the current eligibility and intake, and then the way the decision is made as to what care someone needs, and then the way the care is delivered is all under consideration. The eligibility, based on medical and financial information, is currently undergoing a lean process. One thing that has come out of it is the reduction of paperwork used in the process. RN's now have 3 to 6 pages of paperwork to deal with, instead of the 30 or so they had before. The LEAN core team has been selected. This group is mapping the current system, then mapping a future system, then developing an improvement action plan. This core team is made up of consumers, workers, advocates, providers, and members from DHHS. There is also a consumer group meeting. This group is made up of the folks that rely upon the system for the services and care they receive. This group is meeting before the core team starts its work. The people relying on care and services will get to tell DHHS what it is like being in the system, what works for them and what does not. I'm so glad that the people receiving care and services are part of this process. This is so important, they are the ones with the experience, good and bad, in the system. DHHS also put together a worker focus group made up of workers. This group will discuss worker issues raised in the legislation that was worked on this past legislative session. This is also another victory for workers. Workers get the chance to address issues and problems with DHHS. Ted Rippy, Dee Dee Strout from 771 are members of the worker group. Julie Moulton, and Cathy Bouchard from Maine PASA are in the worker group. I am too, representing Maine PASA, KVO, Local 771 and the Direct Care Alliance. This group is diverse in the work they do, thereby providing a wide range of worker insight. A comment was made in this first Lean meeting that more funding needs to be available to providers. DHHS and Jay Hardy from Alpha One both responded that this lean process is working with the current system, with the current funding that is in place. The purpose of the process is to make the system work for the People of Maine. The intent is to look at a complex process and find ways to save time, make the system more efficient. By making it more efficient, we stand to save money. That money can be turned over to workers in the forms of better wages and benefits. This work is very important. I am very pleased and honored to be a part of it. The documents pertaining to the Long-Term Care System Lean Process can be found by clicking the link. Thanks to Cheryl Ring and David Perkins of DHHS for making this information available online.

Health care insurers often dominate market

Little competition among private companies in many regions, studies show Associated Press Sunday, Aug 23, 2009 WASHINGTON - One of the most widely accepted arguments against a government medical plan for the middle class is that it would quash competition — just what private insurers seem to be doing themselves in many parts of the U.S. Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals. For Democrats, the answer is a public plan that would compete with private insurers. Republicans see that as a government power grab. President Barack Obama looks to be trapped in the middle of an argument that could sink his effort to overhaul the health care system. Even lawmakers opposed to a government plan have problems with the growing clout of the big private companies. "There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant." Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association. Overhaul supporters tout savings Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit. A study by the Urban Institute public policy center estimated that a public plan could save taxpayers from $224 billion to $400 billion over 10 years by lowering the cost of proposed subsidies for the uninsured, while preserving private coverage for most people. "Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates." "The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan,'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate." Insurers contend their industry is extremely competitive, and a public plan is unnecessary. About 1,300 carriers operate across the country, although many only have a small share of the market in their states. "You can have a very competitive market and still have companies with a high market share," said Alissa Fox, a top Washington lobbyist for the Blue Cross Blue Shield Association. Fox points to the federal employee health program, which also covers members of Congress. It offers a total of more than 260 options and 10 nationwide plans. Despite all the choices, about 60 percent of federal workers pick a Blue Cross plan. "Insurers need to be of a significant size to best serve their customers and make sure that people get the best value," Fox said. Nonetheless, lawmakers are concerned. Big insurers are getting bigger. Small businesses in particular have fewer and fewer options for getting coverage. Congressional investigators this year looked at insurers catering to small employers around the country. The Government Accountability Office found that the median — or midpoint — market share of the largest carrier increased to 47 percent in 2008 from 33 percent in 2002. The basic framework lawmakers are looking at for a health care overhaul would encourage competition, even without a government plan. It calls for setting up a big insurance purchasing pool called an exchange. It would be open, at least initially, to individuals and small businesses. The government would offer subsidies to make premiums more affordable. Consumers would find it much easier to shop for a plan through the exchange. For one thing, they would be able to readily compare benefits and premiums in different plans. Also, participating insurers would have to take all applicants and not charge higher premiums to those in poor health. Offering the option of a public plan would supercharge the competition, supporters say. Plan could rival giants Blumberg envisions a plan that pays medical providers more than Medicare, but less than private insurance. Her study estimated it could grow to 47 million members, leaving 161 million with private insurance. Even so, that would make the new public plan one of the largest insurers in the country, rivaling Medicare, Medicaid and big private companies such as Wellpoint and UnitedHealthcare. It's a scenario that gives pause even to traditional adversaries of the insurance companies. "The fear and concern is that the public plan could become the market-dominant plan," said Dr. James Rohack, president of the American Medical Association. "When you've got the federal government involved, it can infuse money into a plan to keep it solvent even if the premiums are lower than its actual costs." Snowe, among the few Republican senators still trying to come up with a bipartisan compromise, wants to hold back on creating a public plan for now and give insurers one last chance to show if they can keep costs in check. That's doesn't go far enough for liberals, who are loath to give the insurance industry tens of millions of new customers supported by taxpayer subsidies. "It would give the industry a windfall without any countervailing force to require them to lower their costs," said Richard Kirsch, national campaign manager for the advocacy group Health Care for America Now. "The insurance companies could continue to jack up premiums while getting a whole new market."

Snowe Meets with President to Discuss Overhaul of the American Health Care System

July 16, 2009 Washington, D.C. U.S. Senator Olympia J. Snowe (R-Maine), a senior member of the Senate Finance Committee, which has jurisdiction over health care, and part of a select working group of senior committee members meeting daily with Committee Chairman Baucus and Ranking Member Grassley to find common ground on health care reform, released the following statement today after being asked to the White House by President Obama for a meeting to discuss congressional efforts to provide high-quality, affordable health care coverage: "With one in four Americans suffering from a lack of affordable coverage, I told the President today that I am committed to the goal of providing universal, affordable health care this year, and I am convinced the President shares my goal. The impact of this bill – on both health and the economy – demands we get this right. So I also said that the process for reforming the system must match the enormity of the task at hand. We must calibrate the speed of our action on this monumental issue to the necessity to get this right. It took nearly a year and a half for the Johnson Administration to create Medicare to cover 20 million seniors – versus the nearly 70 million who today lack substantive coverage. "One of the areas on which we can find common ground and ensure affordable health care for all people is through my ‘safety net plan’ as a fall back option. This option would be available from day one in any state where – after market and insurance reforms are implemented – affordable, competitive plans still do not exist. And finally, I told the President that we appreciate and are anxious for his support as we tackle one of the most difficult aspects of any major legislation – finding the means to pay for it. Ultimately, the Finance Committee has the responsibility to pay for this proposal but we certainly welcome the President’s leadership in overcoming these obstacles."

HealthCare United - Maine

Yesterday, Grant Schott, HealthCare United's Maine organizer, held a meeting to get ideas on how to start moving this campaign forward in Maine. There were four interested individuals there, myself included. One was a social worker from southern Maine and another was a former union sister who used to work through Alpha One. Grant asked us if we'd be willing to help out with this campaign in Maine. We all made suggestions of groups to contact and try to work with. Grant specifically asked for help with canvassing and making phone calls. SEIU is working on this campaign across the nation. Please see the post of July 18th about HealthCare United. If there are any members of 771 who are interested in working on this campaign, please contact me helen.hnsn@gmail.com or Grant grant@healthcareunited.org for more information. This is a great way to meet other health care workers in Maine and share ideas on reform and work towards making those reforms a reality.