Lt. Governor Will Ainsworth’s appointments: Healthcare related (January 2019 – July 2019)
We are please to present Lt. Governor Will Ainsworth’s healthcare related appointments from January to July 2019. Additional appointments in judicial and criminal justice, education and child welfare, IT/infrastructure and agriculture and natural resources are to follow. Steering Committee on Women’s Health (Made February 04) · Dr. Alicia Ewing Medicaid, Joint Committee (Made February 20) · Senator Jim McClendon · Senator Greg Reed Alabama Head and Spinal Cord Injury Trust Fund Advisory (Made March 04) · Senator Tom Butler Alabama Family Practice Rural Health Board (Made May 08) · Senator Greg Reed
Daniel Sutter: Two paths forward for healthcare
Numerous prominent Democrats now support Medicare for All, the most recent proposal for a single-payer healthcare system. A recent Trump Administration report, Reforming America’s Healthcare System Through Choice and Competition, offers a different path forward, detailing the numerous ways government restricts competition and increases costs. Medicare for All suggests that we would be turning away from markets and private insurance to government healthcare. In truth, government rules have dominated the industry for over fifty years. A handful of economists have argued for more competition. These arguments have been largely ignored. Until now. Market proponent and economist John Goodman describes the new report as “astonishingly bold,” and “the first time any administration has explicitly acknowledged” government as the source of our most serious problems in healthcare. Competition for profits in markets controls costs. Let doctors and hospitals compete and we can see who offers patients the best service for the best price. Yet we do not truly use markets for healthcare. For instance, doctors rarely quote prices for treatments or procedures ahead of time. People seem to fear that profitable medicine must involve cutting costs and offering low quality care. Yet luxury thrives under competition. Luxury hotels succeed because they deliver high quality, albeit costly, service. Examples like the Mayo Clinic demonstrate that reputations for excellence in medicine can be maintained. Concierge doctors provide high quality care for paying customers. Reforming America’s Healthcare System’s list of how government inhibits competition is too long to thoroughly examine. I will consider some highlights. Scope of practice laws often prevent medical professionals like physician assistants, advanced practice nurses, and pharmacists from offering services consistent with their training. These professionals can competently diagnose many routine conditions or prescribe standard drugs but are restricted by law. A Mercatus Center study estimated that eliminating state scope of practice laws would save over $800 million annually. Such restrictions particularly hurt rural areas facing a shortage of physicians. Certificate of Need laws require government-appointed boards to approve new or expanded healthcare facilities. Alabama’s law covers hospitals, nursing homes, and out-patient surgery centers, among others. Executives from hospitals and clinics often staff these boards, letting existing providers deny entry to would-be challengers. This is a dubious idea. Sears would have loved to keep Walmart and Amazon out of retail. Telemedicine promises considerable cost savings. Smart phones can already transmit a significant amount of information to a medical professional. The barriers to telemedicine today are primarily regulatory. And the benefits extend beyond dollars: patients with limited mobility can avoid painful trips to a doctor’s office. America arguably needs more doctors. We have fewer doctors per capita than most other developed nations despite spending a larger percentage of our GDP on healthcare. Medical doctors must be smart and spend years in intensive training, so the supply will always be limited. But the restrictions are artificial, not natural. Medical organizations run by physicians – who benefit from restricted supply – determine the number of slots in America’s medical schools. The report proposes redirecting Federal medical education dollars to gradually increase enrollment in U.S. medical schools. Simplifying the process for approving foreign-trained doctors to practice in the U.S. offers more immediate relief. Residency and licensure burdens could be waived for doctors completing foreign medical training judged comparable to American programs. The alternative to markets and competition is governance by experts. State Certificate of Need laws resulted from one such Federal planning effort in the 1970s. Government experts would avoid investments in unneeded hospitals and facilities to help control costs. Yet the healthcare costs have outpaced inflation since the 1970s. Experts never seem to outperform competition in controlling cost. Government control and markets provide alternative ways to organize our economy. We rely on markets to supply us with food, which is as much a necessity as medical care, with ever-declining prices and an incredible array of options as a result. Perhaps we should give a healthcare market a chance before turning to Medicare for All. ••• Daniel Sutter is the Charles G. Koch Professor of Economics with the Manuel H. Johnson Center for Political Economy at Troy University and host of Econversations on TrojanVision. The opinions expressed in this column are the author’s and do not necessarily reflect the views of Troy University.
Democrats will try forcing Senate vote against Donald Trump health plan
Democrats will try forcing a campaign-season vote on blocking a Trump administration rule allowing insurers to sell short-term plans that are cheaper but skimpier than allowed under the Obama health care law, party leaders said Thursday. Though the effort has a chance of passing the narrowly divided Senate, it is certain to die in the Republican-controlled House. Even so, Democrats believe a pre-election Senate vote would put GOP senators in a difficult spot because the new plans won’t necessarily contain popular features like covering people with pre-existing medical conditions or certain benefits like prescription drugs. “This is an issue the American people should know where everyone stands,” Senate Minority Leader Chuck Schumer, D-N.Y., said in a conference call with reporters. With many Republicans saying they back covering people with pre-existing medical problems, Schumer added, “Let them instead of saying they’re for it actually do something to preserve pre-existing conditions.” Democrats said they will use the seldom-utilized Congressional Review Act, which under some circumstances lets any senator force a vote on overturning recent actions taken by federal agencies. Sen. Tammy Baldwin, D-Wis., who faces a potentially competitive re-election contest in November, will lead the effort. Republicans control the Senate 51-49, but Sen. John McCain, R-Ariz., has been gone since December battling brain cancer. Democrats would need at least one GOP lawmaker to side with them to prevail in the Senate. They are viewed as having a chance of capturing Senate control in this fall’s elections. Republished with the permission of the Associated Press.
“Are ‘useless’ exams raising the cost of healthcare in Alabama?
Every year, across the nation, physicians are required to participate in the Continuing medical education program, advertised as a way to keep doctors up to date on new findings and treatments for various healthcare needs. Although these requirements sound like a good idea; many doctors find that some of the tests add no value to themselves or their patients, and some believe they are contributing to the rise of healthcare costs. One test that has come under fire lately is the Maintenance of Certification or MOC test. According to the Modern Medicine Network, “New York-based internist Jonathan Weiss, MD, says that until he and others pushed back, the American Board of Internal Medicine (ABIM) was adding more requirements for MOC and reducing the time intervals between them ‘every time I turned around.’ Not only that, but ‘at no point did I feel the material being asked of me was terribly germane to what I did on a day-to-day basis,’ he says. “The process is fatally and fundamentally flawed.”M In Alabama, physicians are required to complete 25 AMA PRA Category 1 Credits or their equivalent every calendar year, in which the MOC tests are included. But according to Niran Al-Agba and Meg Edison, both pediatricians and members of the Practicing Physicians of America board, MOC tests are not educative at all. “It is credentialization, not education. The tests don’t mirror real-world scenarios.They provide no educational value,” they told Fortune Magazine. Not only do the tests provide no real world experience or education, but they are costly, and time consuming. According to The Hospitalist, the MOC program could cost “$5.7 billion in physicians’ time and fees over the next decade. “We estimate that physicians will spend 33 million hours over 10 years to fulfill MOC requirements,” said Dr. Dhruv S. Kazi in the same report. According to Al-Agba and Edison, limiting MOC requirements would help alleviate the growing physician shortage and save millions of physicians hours each year; time that should be spent on patients, not a board certification.
Affordable Care Act enrollment deadline looms; December 15 last day for rolling signup
Another deadline looms in the battle to decrease the number of uninsured Americans via the landmark Affordable Care Act. The last day to enroll in health insurance through the federal Marketplace for January is December 15. Those who wait cannot be covered until February 1 at the earliest. Two Birmingham area hospitals are doing their part to help people enroll, assisters will be on-site at St. Vincent’s East and Princeton Baptist Medical Center on Saturday, Dec. 12 from from 10 a.m. to 2 p.m. Assistance will take place in Classroom 3 at St. Vincent’s East and at the Haynes Auditorium at Princeton Baptist. The assistance is free, and no appointment is necessary. A handful of organizations are participating to promote the event, during which so-called “navigators” who are trained to penetrate the law’s associated paperwork. The groups include Birmingham Health Care, The Dannon Project and Enroll Alabama. The federal Marketplace was created by the federal healthcare law in 2009, known to detractors and supporters alike as Obamacare. People who qualify based on their income and family size can receive significant savings on health insurance through the Marketplace. Nationally, the average monthly cost for insurance for one person in the Marketplace is $76.
Tim Melson: Improving Alabama healthcare starts with funding Alabama Medicaid
I am deeply concerned about the future of healthcare in this state as a result of the ripple effects of proposed cuts to Alabama Medicaid. If we want to improve and grow as a state and have job opportunities for our citizens, we cannot afford to let this happen. Healthcare is a multi-billion dollar business in this state, employing hundreds of thousands of Alabamians. And I am among the many that believe Medicaid helps secure the foundation of our state healthcare ecosystem. While Governor Bentley’s original 2016 budget included a 20% increase for Medicaid funding, the one passed in the regular session and vetoed by the governor cut Medicaid funding by roughly 5%. During the special session cuts of anywhere from 5% to 25% were proposed, and even after a special legislative session we still do not have a General Fund budget. Worse, the actual cuts would be much greater, considering that for every dollar in state funding that is cut we lose roughly $3 in federal matching funds. A $156 million cut then really means $600 million less injected into our healthcare system. So why does this potential loss matter? Because many of Alabama’s rural hospitals, pediatrician offices, and other healthcare professionals are already teetering on the edge of closure. In 1980, 85% of hospitals in rural counties delivered babies (over half of all deliveries are paid for by Medicaid). Now only 17 rural counties have a hospital with delivery services or an OB/GYN. Because over 1 million people are covered by Alabama Medicaid right now, and more than half of those are children. That represents nearly 21% of the state’s population. It is a cross-section of our state’s population that affects rural, suburban, and urban. Because Children’s Hospital in Birmingham, one of the finest medical facilities of its kind in the country, recently issued a statement revealing that over 60% of its patients are covered by Alabama Medicaid. If you cut funding for those children, what is the likelihood that the hospital can continue to serve non-Medicaid patients? Pretty slim. Because at the other end of the age spectrum, Medicaid also forms the backbone of the nursing home system in this state. If funding is lost there, everyone in a nursing home, not just Medicaid patients, will be harmed. Two out of every three residents are there because of the coverage from Alabama Medicaid. In other words, cutting Medicaid means cuts to every medical practice and every healthcare facility. That means a lack of access to quality care for all citizens, not just those covered by Medicaid. This is all compounded by the fact that the agency is in the middle of a massive structural reform that will save taxpayers hundreds of millions of dollars…assuming funding is granted by the legislature. With these changes, care will be based on outcomes. That means funding crucial preventative and maintenance services that will cut costs by reducing the need for emergency services. Medicaid is at a turning point in Alabama. We can choose to reform and improve the system or continue harsh cuts that will perpetuate the degradation of healthcare across the state. So I call on my fellow Alabamians to talk to their state representatives and state senators. Urge them to find a solution that does not include dismantling our healthcare system. Cutting Medicaid means cutting healthcare. For everybody. Tim Melson represents District Six in the Alabama Senate, which is comprised of all or parts of Madison, Limestone, and Lauderdale counties. He is a retired anesthesiologist and deeply involved in community service.
State Senate leader files plan to check Medicaid, prison spending
Senate President Pro Tem Del Marsh has introduced a plan to address what he sees as the deeper issue in the current budget dilemma: growth in state spending on Medicaid and corrections. Late last week, Marsh filed Senate Bill 476 to limit the Alabama Medicaid Agency to no more than 10 percent Alabama’s total discretionary spending and to keep funding for the Alabama Department of Corrections below 5.5 percent. According to a Yellowhammer News report, Medicaid now accounts for about 9 percent of Alabama’s appropriations and corrections makes up 5.1 percent. Marsh told Yellowhammer News that he brought the bill because of his concerns over how the two programs have expanded in recent years. Here’s a quote from that interview: “Because of the budget situation, we have been forced to take a deep dive into the issues with the General Fund and look at ways to make deliverable changes in the way we spend taxpayer money,” Marsh said. “This bill gives both Medicaid and corrections room to grow from their current allocation but caps the amount so we can begin to control spending within those two programs.” Appropriations for both programs come from the state general fund: the Alabama Medicaid Agency absorbs about 35 percent of the general fund and corrections accounts for another 20 percent. However, Alabama’s healthiest revenue streams – personal income and sales taxes – are earmarked for the Education Trust Fund, not the general fund. The governor has cited lack of revenue in the general fund as the basis for his plan to increase taxes by $541 million. So far, lawmakers have failed to come to consensus on how to address the shortfall.
