April 2018 meet-up: PHAN briefing

April 6, 2018

By: Leon Reed

Erin Ninehouser of the Pennsylvania Health Access Network (PHAN) presented a briefing on healthcare in Pennsylvania. This summarizes some of her key points.

Big picture questions

  1. What would make healthcare better?

  2.  What shared goals can we agree upon?

  3.  Where do we start?

 

Healthcare and the Affordable Care Act (ACA)

  1.  According to Senator Casey, “Real stories are what saved the ACA.”

  2. 22 million people got coverage under the ACA. In Pennsylvania, the uninsured rate is down to 5%

  3.  Minimum coverages – before ACA, insurers were allowed to sell “junk insurance,” high deductibles, limited coverages

    1. “Race to the bottom” – if there are no standards, plans will leave coverages out (mental health, maternity) 

    2. Administration is allowing junk coverage back in, little by little

Healthcare costs and aging

  1. 2.6M on Medicare (PA)

  2.  865K Medicaid (395K both)

  3. Average cost of a semi-private nursing home room is $111,325

  4. Medicare doesn’t pay for longterm care

  5. Medicaid waiver programs can be used to deliver services at home (help with daily tasks, transportation, etc.)

  6. “Services My Way” patient directed 

    1.  Hire personal care giver; Medicaid pays; anyone but spouse

    2.  Approval is a complex process: finances, medical needs (PC doctor, divisional office of aging; must have someone in your corner)

Medicaid

  1.  Block grants often discussed: states woukd be forced to reduce benefits or raise taxes

  2. Medicaid (PA)

    1.  78% of Medicaid goes for seniors and people with disabilities

    2.  12% older (27% of the money)

    3.  18% disabilities (51% of money)

    4.  35% children (13% of money)

  3.  Medicaid work requirements

    1.  Unnecessary administrative burdens

    2.  Awful lot of non-elderly, non-disabled people (freelancers, in school, caregivers)

 Key questions (home-hospital-facility matrix)

  1.  Where do we want to live?

  2. What do we need to live well?

  3. Who helps us do that?

  4. What puts us in the hospital?

  5. What helps us stay out of it?

  6. Who helps us get home?

Questions

Drug costs– Senator Warren has a bill to let Medicare negotiate drug costs

 

Is UPMC purchase limiting choice?

  1. Consolidation is a national trend; there are no easy answers

  2. “Non-profits” like UPMC need t have community advisory boards – community gets some voice

  3. Also have to do a community health needs assessment

PHAN is not working on Medicare for all– “we work on issues where we can win victories”