On Jan. 1, UPMC will achieve its long-sought divorce from Highmark. The separation will undoubtedly disrupt care, add untold stress and potentially harm thousands. UPMC, in refusing even to negotiate a renewed contract, has plainly driven the breakup.
UPMC’s grounds for divorcing Highmark are tenuous. In testimony to the Legislature, UPMC complained that Highmark threatens to injure UPMC by “steering” patients to the “now-struggling” Allegheny Health Network, which Highmark has supported to serve as competitive foil to UPMC.
UPMC further explained, “Western Pennsylvania simply has too many hospital beds, and any gain in admissions at one hospital must come at the expense of other hospitals.”
In brief, UPMC believes competition against Highmark is good, but competition against UPMC is bad. UPMC touts creation of the UPMC Health Plan as “a competitive thorn in Highmark’s side,” but derides its own competitors as malevolent meddlers. As once explained by its CEO, UPMC’s goal is to create a “benevolent monopoly.” Unfortunately, monopolies are rarely benevolent, and there is nothing suggesting that UPMC would forgo (untaxed) profits for the public good.
Category: Pennsylvania
What Has PAMED Done to Improve Tort Reform in Pennsylvania?
Pennsylvania has made amazing strides in medical liability reform WITHOUT CAPS! Follow the link to see the summary of opportunities that other states can pursue without damaging victims’ rights.
What Has PAMED Done to Improve Tort Reform in Pennsylvania?
Most Pennsylvania physicians — more than 93 percent according to a 2009 study published in the Journal of the American Medical Association —report that they continue to engage in defensive medicine as a result of the state’s hostile medical liability environment.
Physicians often ask us, “What has the Pennsylvania Medical Society [PAMED] done to address this problem in the past and what are you doing now to achieve meaningful tort reform in Pennsylvania?”
Hospitals wounded by politics – Opinion – The Times-Tribune
Scranton’s three hospitals are among more than one-third of hospitals statewide that lost money in 2013. More than half of the state’s hospitals had profit margins lower than 4 percent for the year, the threshold for sustainability according to the Pennsylvania Health Care Cost Containment Council.
It’s a trend that likely will continue statewide through 2014 and beyond unless the Corbett administration abandons its politically inspired resistance to the Affordable Care Act’s expansion of Medicaid.
The losses have multiple causes, but one key driver is the rising cost of uncompensated care — treatment for patients who have no private or public insurance and cannot pay.
According to the council, known as PHC4, Pennsylvania hospitals provided more than $1 billion in uncompensated care in 2013, a 5 percent increase over 2012.
Gov. Tom Corbett foolishly has rejected a portion of the federal health care law which, in other states that have accepted it, has begun to diminish levels of uncompensated care and provide hospitals with much-needed revenue.
Under the ACA, the federal government pays 100 percent of the cost of Medicaid expansion to cover uninsured low-income workers in the first two years and covers 90 percent of the cost thereafter.
It’s an extraordinary deal for states. In Pennsylvania, it would have pumped about $17 billion into the health care economy through 2019, including about a $1.6 billion direct reduction in the amount of uncompensated care. That reduction likely would be higher because many people now receiving treatment at hospitals would have insurance enabling them to see other providers first.
Paper: Gov. Tom Corbett health plan would need 700 workers
HARRISBURG (AP) — Gov. Tom Corbett’s Healthy PA, an alternative to expanding Medicaid, will require the state to hire more than 700 new employees, a newspaper reported Monday.
The figure was far higher than most states have experienced and came as a surprise to some experts in public policy, The Philadelphia Inquirer said.
Most of the new hires would be caseworkers in offices scattered around the state, said Bev Mackereth, Corbett’s public welfare secretary. She said that under Pennsylvania’s system, the caseworkers do more than in some other states, including evaluating those who sign up for potential eligibility for other benefits as well.
She said in an interview Monday that Pennsylvania also trails some other states in automation, which adds to the cost.
“We’re getting there, and we’re not where other states are,” she said. “Some states have everything automated — it’s very easy for them to do.”
The newspaper said the state has estimated about 605,000 people would be newly eligible under Healthy PA. The first-year cost of the 700-plus new hires will be just over $30 million, much of it subsidized by the federal government.
Mackereth said the additional personnel costs would be more than covered by the estimated Healthy PA savings of $125 million.
The Department of Public Welfare estimates it would require even more new workers — about 1,200 of them — to expand Medicaid under the President Barack Obama’s landmark health care law.
Corbett, a Republican seeking a second term this year, is waiting to hear back from federal regulators about Healthy PA. It would use Medicaid expansion money to provide private insurance coverage for the same group of people. Those private insurers would be able to operate without some of Medicaid’s coverage rules.
Geisinger Health Plan enrolls more than 20,000 through Obamacare – themorningcall.com
Geisinger Health Plan, a health insurance company serving Lehigh, Northampton and 39 other Pennsylvania counties, added more than 20,000 members during the first open-enrollment period under the federal Affordable Care Act, the company announced Monday.
"We are extremely happy with the number of individuals who selected Geisinger Health Plan for their health insurance coverage," says David Brady, vice president of health care reform and commercial business development. "We felt it was important to offer individuals who were shopping on the marketplace a choice of coverage options that focused on quality and customer service. Based on our results, Pennsylvanians agreed."
Geisinger Health Plan offered 26 plans on the federal marketplace and GeisingerMarketplace.com, its private site, the company said in a statement.
Geisinger Health Plan enrolls more than 20,000 through Obamacare – themorningcall.com
Pennsylvania isn’t serious about expanding Medicaid. How do we know? – latimes.com
Pennsylvania Gov. Tom Corbett has lately been getting credit in the political press for being one of those Republican governors coming around on the expansion of Medicaid under the Affordable Care Act. Advocates for the underprivileged can’t understand why.
They’re right to wonder. Corbett’s "Healthy Pennsylvania" plan, which was released for public comment this week, is a sham. It would reduce health benefits for many of his neediest citizens and impose punitive conditions on their coverage. It requires waiver approval from the federal government that’s almost certain to be refused, because some of its provisions are in flagrant violation of federal law. And even if it were approved, Corbett waited so long to put his plan together that it probably couldn’t be implemented until 2015. In the meantime, 500,000 of his citizens will be medically uncovered.
"He’s being very disingenuous," says Joan Alker, executive director of the Center for Children and Families at Georgetown University. "He knows a lot of this proposal is not approvable" under federal law.
Corbett’s proposal shows that many Republicans still aren’t done posturing with their citizens’ lives, even as some have done the right thing–among them Gov. John Kasich of Ohio and Jan Brewer of Arizona. Some GOP governors, like Rick Perry of Texas and Bobby Jindal of Louisiana, seem determined to take their neediest citizens all the way down–they’re not budging on their refusal to expand Medicaid coverage.
Corbett wants to have it both ways. He intends to masquerade as a feeling governor intent on bringing healthcare to the masses at practical cost. But beneath the fancy dress lies a cynical politician who knows his plan isn’t practical. If it gets rejected he’ll blame the Obama administration. "We tried," he’ll say. "But they blocked us." Don’t be taken in.
Pennsylvania isn’t serious about expanding Medicaid. How do we know? – latimes.com
Uninsured in Pennsylvania reaches record high – Pittsburgh Post-Gazette
Overall the number of uninsured Pennsylvanians increased by 11 percent from 2011 to 2012, while nationally the number decreased by 1.4 percent.
The numbers, based on data from the U.S. Census Bureau and the Centers for Medicare and Medicaid Services, reflect a troubling trend in health care insurance, which people traditionally received through their employer.
"We continue to see a dangerous erosion of employer-based coverage," said Andy Carter, president and CEO of the Hospital and Healthsystem Association that represents the interests of nearly 240 health facilities.
"The number of Pennsylvanians covered by private, employer-based plans hit an all-time low of 59.5 percent in 2012," he said.
And that’s not solely because people are out of work, he added.
"Three out of every 4 uninsured Pennsylvanians live in a household with at least one working adult, and nearly 4 out of 5 live in Pennsylvania’s suburban and rural regions," Mr. Carter said.
The association has advocated for the expansion of Medicaid as outlined under the Patient Protection and Affordable Care Act.
Uninsured in Pennsylvania reaches record high – Pittsburgh Post-Gazette
APPRISE: Older Adult Health Insurance Counseling, Allegheny County, Pennsylvania
Older Adult Health Insurance Counseling
APPRISE
APPRISE 412-661-1438 or APPRISE@fswp.org.
APPRISE offices are open Monday through Friday from 9:00 a.m. to 4:00 p.m.
SeniorLine 412-350-5460, toll-free 1-800-344-4319, TTY 412-350-2727 or SeniorLine@alleghenycounty.us
APPRISE is a free health insurance counseling program designed to help Pennsylvanians, age 60 years and older. APPRISE volunteer counselors are specially trained to answer consumer questions and offer education about Medicare, HMOs, long-term care insurance, supplemental insurance, and Medicaid benefits. APPRISE services are free, objective and completely confidential.
APPRISE counselors are available to assist an individual in the following ways:
- Determine if a Medicare HMO is right for the individual by explaining the way Medicare HMOs work.
- Understand Medicare benefits by explaining what services are covered under Medicare Parts A and B and the Medicare Summary Notice.
- Select a Medigap insurance policy by explaining the benefits in each plan and providing a list of companies that sell these plans.
- Obtain assistance to pay for prescription drugs through government and private programs that offer this service, and explain the eligibility requirements and how to apply.
- Find government programs that will pay Medicare deductibles, co-payments, and Part B premiums and assist consumers with the paperwork.
- Understand long-term care by explaining eligibility requirements for government long-term care programs and explaining private long-term care insurance and how to select the best policy.
APPRISE services are free and all information is kept completely confidential. To contact a counselor, contact the APPRISE coordinator at 412-661-1438 or APPRISE@fswp.org. For general information on this and other services for older adults, you may contact the DHS AAA SeniorLine at 412-350-5460, toll-free 1-800-344-4319, TTY 412-350-2727 or SeniorLine@alleghenycounty.us.
Pennsylvania Health Law Project (PHLP)
PHLP 1-800-274-3258 works to overcome barriers to accessing health care coverage and services. They provide:
Health Insurance Coverage, Department of Human Services, Allegheny County
PAFP/F: Access to Primary Care in Pennsylvania
Survey findings from the Pennsylvania Academy of Family Physicians, January 2013
Report says Pennsylvania lags in public health spending – mcall.com
Pennsylvania’s public health spending ranks in the lowest tier of states, according to a new survey released Thursday.
Public health officials said the study released by Trust for America’s Health and the Robert Wood Johnson Foundation may not present a full apples-to-apples comparison with other states, but that shouldn’t detract from the main finding that the federal and state governments are failing to keep up with public health needs.
The findings in the report, "Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts," showed that Pennsylvania ranks 43rd for per-capita state public health spending.
The state also gets a relatively small piece of federal public health spending, ranking 47th for state spending by the U.S. Centers for Disease Control and Prevention and 32nd for per-capita spending by the U.S. Health Resources and Services Administration.
Report says Pennsylvania lags in public health spending – mcall.com