April 2018 meet-up: PHAN briefing
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
What would make healthcare better?
What shared goals can we agree upon?
Where do we start?
Healthcare and the Affordable Care Act (ACA)
According to Senator Casey, “Real stories are what saved the ACA.”
22 million people got coverage under the ACA. In Pennsylvania, the uninsured rate is down to 5%
Minimum coverages – before ACA, insurers were allowed to sell “junk insurance,” high deductibles, limited coverages
“Race to the bottom” – if there are no standards, plans will leave coverages out (mental health, maternity)
Administration is allowing junk coverage back in, little by little
Healthcare costs and aging
2.6M on Medicare (PA)
865K Medicaid (395K both)
Average cost of a semi-private nursing home room is $111,325
Medicare doesn’t pay for longterm care
Medicaid waiver programs can be used to deliver services at home (help with daily tasks, transportation, etc.)
“Services My Way” patient directed
Hire personal care giver; Medicaid pays; anyone but spouse
Approval is a complex process: finances, medical needs (PC doctor, divisional office of aging; must have someone in your corner)
Medicaid
Block grants often discussed: states woukd be forced to reduce benefits or raise taxes
Medicaid (PA)
78% of Medicaid goes for seniors and people with disabilities
12% older (27% of the money)
18% disabilities (51% of money)
35% children (13% of money)
Medicaid work requirements
Unnecessary administrative burdens
Awful lot of non-elderly, non-disabled people (freelancers, in school, caregivers)
Key questions (home-hospital-facility matrix)
Where do we want to live?
What do we need to live well?
Who helps us do that?
What puts us in the hospital?
What helps us stay out of it?
Who helps us get home?
Questions
Drug costs– Senator Warren has a bill to let Medicare negotiate drug costs
Is UPMC purchase limiting choice?
Consolidation is a national trend; there are no easy answers
“Non-profits” like UPMC need t have community advisory boards – community gets some voice
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”