Trump’s mine safety nominee defends MSHA inspectors, calls silicosis “unacceptable”

President Trump’s nominee to head the Labor Department’s Mine Safety and Health Administration (MSHA) appeared today before a Senate committee for a confirmation hearing. David Zatezalo answered questions about the epidemic of black lung cases, an increase in mine worker fatalities, the need for safety assistance for small mine operators, and more. Zatezalo began his career in 1974 as a UMWA coal miner and most recently served as chairman of Rhino Resources.

I watched the webcast of Zatezalo’s confirmation hearing. The nominee noted his experience managing 39 different coal mines in the U.S. and Australia. I suspect he has more years of experience managing coal mines than any previous MSHA chief.

Here are some of the exchanges between Senators and the nominee:

On Don Blankenship:

Senator Tim Kaine (D-VA): “The CEO of Massey Energy, Don Blankenship, who served a one year sentence for conspiracy to violate mine safety laws has asked President Trump and MSHA to reopen the investigation into the Upper Big Branch incident, in which 29 miners were killed. Would you honor that request should you be confirmed?”

Mr. Zatezalo: “Senator, absent any new evidence I don’t see any reason why it should be reopened.”

Zatezalo gets two thumbs up for his response.

On the very poor safety record at one of his mines:

Senator Tim Kaine (D-VA): “When you were CEO of Rhino Resources the Eagle #1 mine was put on [MSHA’s] proposed pattern of violation notice in November 2010 and then again August 2011. A pattern of violation notice is issued when safety violations are extensive and enforcement action is not immediately addressing the problems. Do you think those sanctions…were fair and appropriate?”

Mr. Zatezalo: “I was not proud of the fact that we got designated as a PPOV mine. I did not try to lawyer up and stop anything from happening. You know, if you haven’t done your job, we should be big kids and deal with it as such.”

Senator Tim Kaine (D-VA): “Do you think you would have any challenge working with the senior career staff at MSHA given that some of them were involved in taking enforcement action against your company?”

Mr. Zatezalo: “No sir, I don’t. They [MSHA] did what they were supposed to do.”

Another thumbs up for Zatezalo. I liked hearing him support MSHA officials for doing their job—a job that requires putting miners’ safety above all else.

On the number of MSHA inspectors

Senator Bob Casey (D-PA): “Do you have any sense of the adequacy of the number of inspectors at MSHA.”

Mr. Zatezalo: “It seems to me that the number of inspectors today is pretty good. From the data that I see, MSHA has been making  all of the required inspections, which is four per year [in underground mines.] We certainly don’t want to let that fall down. Just as I wouldn’t want to drive on the highways without police or constables to take control of speeders and drunk drivers, inspections in mines in U.S. are a necessity. Inspections have to continue and I don’t think they should continue at a diminished rate either.”

Senator Bob Casey (D-PA): “I hope Mr. Zatezalo that if you were to be confirmed and you did not see the level of inspectors that you would expect, you would advocate for more funding, and more support, and make that clear to Congress.”

Mr. Zatezalo: Absolutely would sir.

Zatezalo was emphatic when he said “absolutely” and I give him a thumbs up. I take him at his word that he will stand up to Secretary Acosta’s and the White House’s bean counters. Otherwise, it will be on his shoulders if MSHA fails to fulfill its statutory responsibility to conduct the required mandatory inspections at every U.S. mining operation.

On black lung and silicosis: 

Senator Tim Kaine (D-VA): “In southwest Virginia, there has been an epidemic of progressive massive fibrosis—that’s the most severe form of black lung disease. …The largest cluster of this disease ever documented is found in southwest Virginia and more are being uncovered every week in a clinic in St. Charles, Virginia.

“..It’s been reported to me that some of this severe lung damage is caused by mining rock mixed with thinner coal seams causing miners to then inhale crystalline silica, which is far more toxic than coal dust. … It’s been reported to me, that you said the technology to monitor silica dust in real time does not exist. Talk to me a little bit about that. Is there the possibility, technological possibility of getting to the point were we can more effectively monitor? Can you elaborate on that?”

Zatezalo politely answered the Senator’s question about the limitations of the current dust monitoring system. Specifically that it may take a couple of weeks before sampling results are analyzed at a laboratory and reported back to the mine. But, Zatezalo gets a special thumbs up for redirecting his answer to controlling silica dust as the first line of defense. The solution to the national disgrace of miners with silica-related disease is not better sampling—it’s controlling miners’ exposure to respirable dust.

Mr. Zatezalo: …I understand the National Academy of Sciences, as well as NIOSH and MSHA, are putting together a report that should be available in January to delineate and hopefully offer suggestions on how to address this. Silicosis is not an acceptable thing for our [miners.]

“…Coal dust is something at this point that we think we can handle fairly well. Silica is much more difficult to handle. I figure we’re going to have to go some engineering type controls, and really increase ventilation, and really increase water to be able to control it.”

Like Senator Kaine, Senator Casey also had questions about coal miners being diagnosed with black lung and silicosis. He referred to the regulations adopted by MSHA in 2014 to address coal mine dust.

Senator Bob Casey (D-PA): “Tell me about how you would approach enforcement of [the rules adopted by the Obama administration on coal mine dust.]”

Mr. Zatezalo: Sir, that enforcement is ongoing today… and would have to continue. I would not propose any reduction in the enforcement of [those rules.] …I would not see that diminish  in any way. The only things that remains, that needs to be investigated further is silicosis and the silica issues.

I wrote last week about West Virginia Senator Joe Manchin’s announcement that he would not support Zatezalo’s confirmation. Prior to that Senators Murray (D-WA), Casey (D-PA) and Whitehouse (D-RI) sent a letter to the Labor Department asking questions about the nominee’s previous dealings with MSHA. None of those Senators, however, raised those concerns at today’s hearing.

It will be a few weeks before we find out whether David Zatezalo gets a thumbs up from a majority of Senators.


Article source:Science Blogs


It’s October. What’s Congress doing about healthcare?

We made it to October without letting Congressional Republicans ravage our healthcare system, so that’s a relief. However, the fact that it’s October also means funding for the Children’s Health Insurance Program and federally qualified health centers has expired … and Congress has been putting so much energy into trying to gut Medicaid and further restricting women’s access to abortions that they neglected to renew funding for these two immensely popular bipartisan programs.

Instead of funding these programs because they’re crucial sources of coverage and care for large portions of our population, House Republicans are trying to use them as leverage to weaken other aspects of public health. Vox’s Dylan Scott reports:

Republicans want to pay for CHIP and health center funding by cutting Obamacare and cutting entitlement spending.

The House GOP plan would:

  • Cut Obamacare’s public health fund by $6.4 billion over 10 years

  • Cut the grace period for Obamacare enrollees who fail to make premium payments. Under current law, enrollees can miss three months of payments without losing their coverage. The House bill would shorten that grace period to one month or allow states to set their own.

  • Repeal Obamacare’s Independent Payment Advisory Board, the controversial panel created by the law tasked with reducing Medicare’s costs if the program’s spending grows at too fast a rate.

  • Increase Medicare premiums for high earners (individuals making $500,000 annually)

  • Aim to cut Medicaid payments for prenatal care and preventive services for children in circumstances when another insurer could instead be liable for the costs

Let’s all remember what this says about the values of current members of Congress when the next election arrives.


Article source:Science Blogs

Watch out for “innovation”

In any very mature industry – and workers’ comp is certainly that, certain truths are immutable. Scale, margin compression, consolidation are all inevitable – or at least two out of three are.

Innovation – mostly “small i” innovation – can and will help smaller entities compete with goliaths, and large companies maintain and even grow margins.

The innovations I’m speaking of are the tweaks, efficiencies, streamlined processes and smoother customer interactions that make vendors easier to work with. Front-line customers benefit from these small innovations, sometimes almost without noticing them.

  • What used to take two phone calls now is done automatically.
  • Medical services are scheduled, visits conducted, and progress reports prepared and delivered with no action by front-line customers needed
  • Bills that had to be reviewed line-by-line are now auto-qdjudicated, with only those lines or bills that qualify via a rules engine hitting the front-line person’s queue.
  • Medical services are automatically authorized, with relevant guideline language attached.
  • Medical service reports are auto-uploaded to the claim file, with only those issues needing attention highlighted for review.

What’s easy to lose track of is the purpose of automation and innovation. The primary purpose is NOT to make the vendor more efficient and reduce vendor costs; it should be to deliver better service to the end user, be they provider, patient, front-line customer.

Therein lies the trap. In a mad dash to strip out cost and improve “efficiency”, many service companiess don’t pay near enough attention – if they pay any attention at all – to how those changes affect the end-user.

For a while, those “improvements” will reduce costs and add to profits. Then, as front-line users suffer in voice-mail hell, or can’t find anyone to answer their questions, or have to ask for another password to enter a “portal” for the umpteenth time, revenues will start to decrease.

Instead, focus your innovation efforts on those that will make your end users happier, less stressed, and less busy.

Take work off their desk/workstand and put it on yours.

That’s innovation that delivers long-term results.




Article source:Managed Care Matters

WV Senator says “thanks, but no thanks” to Trump’s nominee for mine safety agency

West Virginia’s senior U.S. senator will not be supporting President Trump’s nominee to head the Mine Safety and Health Administration (MSHA). Senator Joe Manchin (D-WV) issued a statement on Wednesday which said:

“While I appreciate Mr. Zatezalo’s willingness to serve, I cannot support his confirmation to lead MSHA. After reviewing his qualifications and record of safety during his time in the coal industry, I am not convinced that Mr. Zatezalo is suited to oversee the federal agency that implements and enforces mine safety laws and standards.”

Ken Ward at the Charleston (WV) Gazette was first to report on David Zatezalo’s nomination. It was made public on Saturday, September 2 (Labor Day weekend) on the White House website. The announcement indicated that Zatezalo most recently served as chairman of Rhino Resources. It’s a publicly-traded coal mining and oil/gas extraction firm with operations in CO, IL, KY, UT, and WV.

As he does so well, Ward put the nominee’s background in proper context. In his September 2 story, the Gazette reporter described some of the mine safety happenings while Zatezalo was with Rhino Resources.

  • The company had a “series of run-ins with MSHA” over serious safety violations. In 2010 and 2011, Rhino’s Eagle #1 coal mine in Raleigh County, WV was on track— not once, but twice—for stepped up enforcement under MSHA’s “pattern of violations” authority.
  • In the midst of MSHA warnings over a “pattern of violations” at the Eagle #1 mine, Joseph Cassell, 33, was fatally injured while working there.
  • At the firm’s CAM Mine #28 in Pike County, KY, MSHA had evidence of a manager giving miners advance notice that an inspector was at the mine (which is illegal under the Mine Act.)  In 2011, MSHA took the matter to court. A federal judge ruled in favor of MSHA and granted an injunction against the mine operator.

Those troubling matters and more appeared in a letter sent last week to Labor Secretary Alex Acosta from three of Senator Manchin’s colleagues. Senators Patty Murray, Sheldon Whitehouse, and Robert Casey requested letters and other documents from MSHA which may help to characterize Zatezalo’s perspective on worker safety and health. The Senators are members of the Committee on Health, Education, Labor and Pension, which is considering Zatezalo’s nomination for MSHA chief.

The lawmakers’ inquiry also extends to time periods when the nominee served as vice president for mining operations at AEP (2001 – 2004) and in leadership positions with the Ohio Coal Association (2004 – 2014). The Senators note that the trade group sued MSHA over its “pattern of violations” authority. They asked Labor Secretary Acosta to provide the requested documents at least three days before David Zatezalo’s confirmation hearing which is scheduled for Tuesday October 3.

A “smoking gun” document is hard to come by and I doubt MSHA has one. What Senators do have is their West Virginia colleague’s “thanks, but no thanks” rejection of President Trump’s nominee to lead MSHA. Senator Manchin was Governor of West Virginia during the 2006 disaster at the Sago mine that killed 12 coal miners and the 2010 coal dust explosion at the Upper Big Branch mine that killed 29 men.

“I have comforted too many families who have lost loved ones serving our nation in the mines.

Investigations into those disasters revealed the consequences of lax enforcement and inadequate regulations (here, here.) No one, including Manchin, wants that repeated. No doubt that was on the Senator’s mind when he wrote:

“After reviewing his qualifications and record of safety during his time in the coal industry, I am not convinced that Mr. Zatezalo is suited to oversee the federal agency that implements and enforces mine safety laws and standards.”

Will Senator Manchin’s decision convince any Republican Senators to also say “thanks, but no thanks” to President Trump’s MSHA nominee?  Tuesday’s confirmation hearing may provide a hint.





Article source:Science Blogs

Why the Foresight deal is different.

There are two big takeaways – the price, and why Paradigm paid so much.

Sources indicate Paradigm has bought Foresight for around $150 million, a huge multiple for a relatively small company with trailing earnings of less than $5 million.

Foresight’s niche is narrow but important – the company’s core business is negotiating prices for implantable surgical devices. More recently the company entered the surgical services business with Encompass, a network of surgeons and facilities.

The announcement was pretty much what you’d expect, but the real news is why Paradigm paid what it did. First, a little history.

I’ll admit to wavering between being impressed with Paradigm and thinking it won’t ever become a significant force in the industry. As noted previously, the company has been around for the better part of three decades, and throughout that time has seemed to be just a year or so away from really breaking out.

Today’s no different.

That’s not to say Paradigm doesn’t have deep expertise and hasn’t produced excellent results for some clients – it most certainly has. The problem is two-fold; the original marketing message is tough – we can manage the really tough claims better than your claims staff can. Hard to see how a claims exec would jump at the chance to show a third party is better at a critical core skill than her or his staff.

The second is what Paradigm missed back then, and I’d suggest still doesn’t understand., Payers don’t like vendors that only solve part of their problem. What I mean is this – Paradigm asks a payer to give them data on claims that meet specific criteria. Then, Paradigm winnows thru those claims, picking the ones it can fix, and sending the rest back.

Wrong approach.

If a payer sends you a big bunch of problems, you should figure out a way to help with ALL OF THEM.

That may be one reason Paradigm recently bought a couple of case management companies; in addition to diversifying revenue sources and adding customers, the deals bring more ownership of nurses who will likely be used to service the cat claims that are Paradigm’s core business. That said, case management is a declining business under strong price pressure – just what you’d expect in a very mature industry.

Which brings us to Foresight.

Diversification, technology, and data on surgeries are all going to help Paradigm diversify even more.  And, the surgical network may provide a consistent and growing revenue stream to complement the case management and somewhat-less-predictable catastrophic case business.  It’s likely margins in the implant and surgical businesses are going to be much higher than case management and more in keeping with Paradigm’s cat case business.

From this outside perspective, this is the reason Paradigm’s owner Summit paid what it did. They’ve owned Paradigm for almost 2.5 years, and it’s time to get things ramped up for another equity event in the next few years.

What does this mean for you?

Good news indeed for anyone looking to sell their workers’ comp business!


Article source:Managed Care Matters

Occupational Health News Roundup

At the Toronto Star, reporter Sara Mojtehedzadeh went undercover as a temp worker at Fiera Foods, an industrial bakery, to investigate why temp workers are more likely to get hurt on the job. Earlier this year, Canadian occupational health and safety officials brought charges against the company, whose clients include Dunkin’ Donuts, Costco and Walmart, for the death of 23-year-old Amina Diaby, who was strangled to death after her hijab got caught in a machine.

Mojtehedzadeh, along with Brendan Kennedy, write:

I get about five minutes of training in a factory packed with industrial equipment.

I am paid in cash with no deductions or pay stubs. I pick up my wages from a payday lender, a 35-minute bus ride from the factory.

Fiera has been slapped with 191 orders for health and safety violations over the past two decades, for everything from lack of proper guarding on machines to unsafely stored gas cylinders.

At least a dozen of the women I meet on my assembly line at Fiera, a multimillion-dollar company, are hired through temp agencies.

Temp agency workers are changing the face of labour in Ontario.

In workplaces around the province, the use of temp agencies limits companies’ liability for accidents on the job, reduces their responsibility for employees’ rights, and cuts costs.

When I walk into the factory, I see mostly people of colour. Many are new Canadians. Many told me they have taken this job for one reason: to survive.

The story describes the speed of the production line as “crushing” — Mojtehedzadeh reports:

Work that is too slow elicits shouting. Work that is too sloppy elicits more shouting. Our lead hand fires out a salvo of shrill commands to push the tempo.

The pinching continues for seven hours and 15 minutes. We receive one half-hour lunch break, as required by law. It is unpaid. We also receive a paid 15-minute break.

I feel overwhelming relief when it’s finally my turn for lunch. My shoulders are on fire. I shuffle to the break room and look eagerly at the THINK SAFETY clock. Only three hours have passed. A co-worker watches me collapse onto a bench.

“It gets harder,” she calls out.

Read the full story at the Toronto Star.

In other news:

Charleston Gazette-Mail: Ken Ward Jr. reports that Sen. Joe Manchin, D-W.Va., will oppose Trump’s nominee to head the U.S. Mine Safety and Health Administration. Trump has nominated former coal executive David Zatezalo, who served as chairman of Rhino Resources. While Zatezalo was an executive at Rhino, the mining company received more than one letter from MSHA regarding a “pattern of violations”; another Rhino mine was the target of an MSHA lawsuit for undermining inspections. Manchin said in his statement: “I have comforted too many families who have lost loved ones serving our nation in the mines. Strong leadership at the Mine Safety and Health Administration is non-negotiable.”

Arizona Daily Star: Emily Bregel reports that about 160 members of the Southwest Regional Council of Carpenters showed up at a meeting of the Industrial Commission of Arizona to confront officials about being too lenient with employers who violate health and safety standards. The also confronted the commission for not aggressively going after wage theft allegations and fraud within the construction industry. (An OSHA investigation found the commission arbitrarily reduced penalties for safety violations.) Bregel reported that during the meeting, union President Fabian Sandez said: “In our industry, dishonest businesses commit on a continuing basis acts of wage theft, fraud and willful safety violations, putting the physical safety and financial well-being of our state’s workers at risk. Yet this commission has chosen to side with lawbreakers by reducing fines, watering down violations, rather than taking the appropriate actions demanded by law.”

CNBC: Lauren Thomas reports that Target will be raising its minimum wage from $10 to $11 and is committed to raising it to $15 by 2020. The move comes amid a “quiet wage war” between Target and Walmart, which had previously announced a raise to $10 an hour by 2016. Target said the wage increase will start in October and will apply to the 100,000 temp workers it plans to hire for the holidays. In a commentary, Peter Sonn, general counsel for the National Employment Law Project, writes that Target’s decision “blows up the claims of corporate lobbyists who argue it’s simply not possible for industries like retail and restaurants to pay a $15 minimum wage.” He goes on to write: “Target’s plan to raise pay to $15 an hour over the next 30 months is smart business strategy, and what our nation’s workforce and economy need. There’s now a bullseye on the back of employers like Amazon, Walmart and McDonalds. They should follow Target’s lead.”

NBC Philadelphia: Alicia Victoria Lozano writes that the Philly-area International Brotherhood of Electrical Workers Local Union 98 is preparing to file suit against pharmaceutical companies that have contributed to the opioid epidemic. The union has lost eight members in 11 months to the drug. The union recently changed its opioid prescription policy to help prevent addiction, with members using the union’s health provider now limited to five days of opioids for injury or pain. The old policy allowed for unlimited opioid prescribing. Lozano quoted John Dougherty, business manager for the union, who said of fellow workers: “They don’t want to miss any work time, so they work through injuries, which compounds the pain and leads to the use and abuse of opioids. I’m sick of seeing our members working themselves into an early grave.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

Article source:Science Blogs

Susan Collins saves the GOP

With her announcement that she won’t vote for the Graham-Cassidy bill, Sen. Susan Collins (R ME) has ended GOP efforts to kill the ACA.

She also saved her party from the disaster that would befall it if the bill had become law.

here’s why.

  • millions of core Republicans would have lost health insurance coverage,
  • states that went for Trump in the presidential election would have lost billions in federal funds,
  • many of the people covered in the individual market in Trump states have pre-existing conditions; Cassidy-Graham would have allowed insurers to drastically limit their coverage
  • Key GOP states such as Arkansas and Kentucky would lose billions in Medicaid dollars over the long term

This doesn’t mean future efforts won’t seek to slash coverage for kids via cutbacks in the Child Health Insurance program (CHIP), limits on Medicaid, or thru budget machinations. But these will be much lower-impact, subtler moves that won’t be as potentially devastating to the Republican brand as Cassidy-Graham. CG would have shown core supporters the GOP’s “solution” to the healthcare mess was far worse than the current one.

So, what now?

Nothing much is going to happen with healthcare in Congress for some time.  That’s too bad, as ACA needs fixing – namely:

This would go a long way to giving certainty to insurers, certainty that would lower premiums and stabilize markets.

What does this mean?

While the result may be a failure to deliver on a core campaign promise, what’s really happened is the GOP didn’t do deeper and broader damage to itself.



Article source:Managed Care Matters

Graham-Cassidy isn’t a health care solution. It’s a blueprint for less access, less value and less coverage.

In yet another attempt to repeal and replace the Affordable Care Act, much of the GOP justification boils down to one argument: that the ACA isn’t working. Never mind that we don’t really know what constitutes a “working” health care system for Republicans.

For a while, Republicans said the ACA wasn’t working because some U.S. counties didn’t have an insurer. Today, no county is without an insurer. Then there’s the argument that ACA premiums are too high. However, the research shows that while premiums have gone up, the rise in premiums has been slower under the ACA than it was before the ACA. Other health policy experts have pointed out that average premiums dropped fairly significantly early in the ACA’s implementation, even as many people were receiving much more comprehensive and valuable health coverage.

It’s true that premiums did rise — sometimes dramatically and it’s an issue that lawmakers in both parties agree needs to be addressed. But on the other hand, policy experts and lawmakers knew it would take insurers time to adjust to the ACA’s new rules and protections and settle on premium rates that matched the new marketplace. That’s why ACA designers included measures like the “risk corridor” program to protect insurers from too much loss and ensure their continued participation in the ACA. Plus, ACA subsides generally shield marketplace customers from premium hikes.

Now, the GOP argument is that block granting the health care system and handing over (dramatically reduced) funds to states is a magic panacea for all of our health care woes. It’s an argument that falls apart once you remember that 19 states chose not to expand their Medicaid programs, even though nearly all of the costs of expansion were picked up by the federal government. That decision — made by state lawmakers — left millions of Americans in a completely preventable health insurance gap.

The Graham-Cassidy bill isn’t a new health care system — it’s the old health care system. (Except likely even worse since it devastates Medicaid funding.) The Graham-Cassidy plan strips American consumers of guaranteed health protections and puts coverage decisions back in the hands of the free market and the political whims of ever-changing state governments. We already did that — before the ACA. That old system delivered higher and higher uninsurance rates every year, higher premiums every year, no guarantee to basic health services, discrimination based on pre-existing conditions and bankruptcy-inducing lifetime limits. Graham-Cassidy threatens to do the same thing. It isn’t innovative; it’s a relic of the past.

The real story is that the ACA isn’t perfect, but it’s ushered in some extremely positive changes that deserve more attention and credit in the health care debate. Premium rates can’t be the only way we define success or failure in a health care system. We should also be focused on how well a health care system is working to broaden access to care, create affordability and improve health metrics. In that vein, let’s take a look at just a few recent studies on the impacts of the ACA — gains we risk losing under the GOP plan as well as under pressure of constant uncertainty coming from the White House.

  • In a study published this month in Health Affairs, researchers examined data from the Urban Institute’s 2017 Health Reform Monitoring Survey to assess recent gains in coverage, access and affordability under the ACA. They found that the gains made in the early days of ACA implementation have persisted into 2017, with adults in all parts of the country, of all ages and of all income groups benefiting from gains in the U.S. insurance rate. In particular, just 10.2 percent of nonelderly U.S. adults are now uninsured, compared to nearly 41 percent before ACA implementation. Adults with low and moderate incomes experienced the greatest reductions in uninsurance. For example, among adults with family incomes at or below 138 percent of federal poverty, uninsurance decreased by more than 42 percent following ACA implementation; among adults between 139 and 399 percent of poverty, uninsurance decreased by more than 49 percent. The study also found that the share of adults without a usual source of care decreased, the share without a routine check-up in the last year decreased, and fewer adults reported unmet medical needs due to cost.
  • This study, recently published in Medical Care Research and Review, analyzed credit bureau data to get a clearer picture of how the ACA Medicaid expansion impacted people’s finances. In states that decided to expand Medicaid, researchers found financial improvements as measured by: improved credit scores; reduced balances past due as a percent of total debt; reduced probability of a medical collection balance of $1,000 or more; reduced probability of having one or more recent medical bills go to a collection agency; reduction in the probability of experiencing a new negative balance of any type; and a reduced probability of a new bankruptcy filing. The study states: “This work demonstrates how the ACA Medicaid expansions have improved economic well-being of low-income Americans, which at the same time has implications for providers and payers of medical services.”
  • A new study published in the journal Drug and Alcohol Dependence examined the impact of the ACA on opioid addiction treatment. (FYI: Another recent study found that the opioid overdose epidemic has become so bad in the U.S. that it’s contributed to a decline in overall life expectancy.) The ACA study analyzed data from the National Survey on Drug Use and Health on more than 4,000 people with an opioid use disorder between 2008 and 2004. The researcher found that the odds of insurance coverage increased by 72 percent for people with an opioid use disorder between 2008 and 2014. In addition, the odds of not receiving addiction treatment due to financial concerns dropped by 50 percent. After ACA implementation, the study found, the odds of receiving opioid addiction treatment increased by 158 percent, with the odds of a person’s insurance paying for the care going up by 213 percent. (The Graham-Cassidy bill would allow states to waive essential health benefits, such as substance abuse treatment.)
  • A 2017 study from the Commonwealth Fund, based on data from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System, found that ACA expansions decreased the probability of not receiving medical care by between 21 percent and 25 percent. It also found that gaining insurance coverage increased the probability of having a usual source of care by up to 86 percent. Before the ACA, about 47 percent of uninsured people reported they were unable to get medical care because of cost. Gaining health insurance cut that number by half.

Graham-Cassidy isn’t the future of health care — it’s not a bill informed by evidence-based ways of improving people’s health and lives. It’s a bill based on political calculations, not medical ones.

Yes, the ACA isn’t perfect. But it’s making real progress that lawmakers should be working to improve upon, not tear down. If you’d like to voice your opinion on Graham-Cassidy, the American Public Health Association has an easy-to-use template to help you reach your representatives in Congress.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

Article source:Science Blogs

More reasons to oppose the latest awful iteration of GOPcare

Many of us were cheered by Senator John McCain’s announcement of his opposition to the horrible Graham-Cassidy bill that would gut Medicaid and wreck the individual insurance market. But Senate Republicans could still pass this bill, and will keep trying until the clock runs out at midnight September 30th.

Last week I explained why the bill is so damaging to public health, and Kim Krisberg rounded up opposition statements from major organizations that work on healthcare. Two items that have come out since then are also worth considering.

Senate Republicans are rushing to vote before the Congressional Budget Office can complete its analyses on how many people will lose insurance coverage or how premiums might respond to the destabilization of the individual market. In the absence of a CBO score, Matthew Fiedler and Loren Adler of the USC-Brookings Schaeffer Initiative for Innovation in Health Policy have used CBO’s estimates for prior legislation to analyze Graham-Cassidy’s likely impacts. They calculate that, compared to the status quo, the legislation would lead to 21 million more uninsured by 2026, and 32 million uninsured after 2026 (unless Congress acts before then to authorize additional funding to replace the block grants that will expire in 2026).

Another important point comes from the New York Times’s Margot Sanger-Katz, who dug into the details of how states might use the block grants that Graham-Cassidy offers. Senators Lindsey Graham and Bill Cassidy are promoting these block grants as a way to allow states rather than the federal government to decide how to assist the portions of their populations that don’t have employer-sponsored insurance — though they’re not mentioning that the total federal transfer to states will be about $160 billion less than it would have been for 2020-2026. The idea of local solutions to local issues might sound good in theory, but it also means states will have to devote a lot of resources to identifying and setting up those local solutions. Sanger-Katz writes:

In 2003, health care policy makers in Massachusetts agreed that the state should build a system to expand coverage to its uninsured residents.

It took four years before Romneycare was fully up and running.

In between, politicians had to think hard about how they wanted the system to work: how money would be raised and spent, what benefits would be offered, whether and how markets should be used to distribute coverage, whether people who didn’t buy coverage should be penalized. They had to build a computer system to help people check their eligibility and understand their options. They had to recruit insurers to participate. And they needed to find uninsured residents and persuade them to enroll.

A new health care bill before the Senate would require all the states in the country to make a similar soup-to-nuts evaluation of how they’d like their health care systems to work, to build such a system and be ready to open their doors in substantially less time — just over two years. That may not be realistic.

As the National Association of Medicaid Directors noted in a letter opposing Graham-Cassidy, the bill would “constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.” States would have to do far more than they currently do, but with far less money.

For Graham-Cassidy to fail, three Republicans would need to vote against it. So far, Senator Rand Paul of Kentucky and Senator John McCain of Arizona have come out against it. Senator Lisa Murkowski of Alaska voted against the previous GOPcare bill; this time, Graham-Cassidy would allow Alaska and up to four other states with low-density populations to put off the Medicaid rollback. Senator Susan Collins of Maine is “leaning against” it but hasn’t publicly committed to voting against it. The American Public Health Association is still urging public health supporters to ask their members of Congress to vote against Graham-Cassidy.

Article source:Science Blogs