Cox Promotes HSAs As Partial Solution To Health Care Crisis – And Further Analysis

Received some information from the Cox campaign.  While some of this is already known, its worth considering further..  Also, I would encourage you to read all the way through to my own thoughts on this issue.

Reiterating his position on the forced insurance mandate of the Federal government (something our current governor endorses) Cox suggests options for choice and personal control over your health care:

“Creative tools like health savings accounts enable job makers to provide quality health care options to Michigan workers while driving down prices and giving families greater control over their health care, Michigan families deserve more quality options and to have the final say about their health care. Unfortunately, all they’ve gotten from Governor Granholm, President Obama and Congress is an unconstitutional mandate that they purchase insurance- or else.”

With the rising cost of health care, health savings accounts represent one way for small businesses and individuals to acquire quality health care at an affordable price. Mike Cox would like to create tax incentives for businesses that provide HSAs to their employees and will assist self-employed residents who want to create HSAs.

Cox also wants to examine transferring a pilot group of Medicaid clients, such as 19-20-year-old Medicaid recipients and Caretaker Relative populations, from traditional Medicaid coverage and provide those individuals with HSAs. The move will improve wellness, drive down the cost of health care and trim government spending.

In March, Cox filed a lawsuit to stop President Obama and House Speaker Pelosi’s massive federal health care bill because it oversteps Congress’s Constitutional authority and for the first time ever forces Michigan residents to purchase a product as the price of citizenship. The bill also includes trillions of dollars in federal spending, at least 88 new government programs and nearly 1,700 new sets of regulations.

“Never before in our history have you had to buy something as the price of citizenship,” Cox said recently. “This is an unprecedented overreach by Congress and the President. There are constitutional limits to what Congress can force individuals and the state to do and I am fighting this bill because it exceeds those limits.”

As Attorney General, Cox has saved Michigan residents hundreds of millions of dollars in higher premiums and costs by fighting Blue Cross rate hikes, and stopping anti-consumer bills in the state legislature.  Also,  Cox has recovered a record $162 million in Medicaid Fraud and led the fight to create an Office of Medicaid Inspector General, while also fighting drug companies that fraudulently billed the State of Michigan or put consumers at risk.   He also outlined a set of ten guiding principles for building a foundation for constitutional, long-term healthcare reform in Michigan.

From Cox’s site with my own notes in red below:

29. Expand the Drug Website to Include Pricing Information on 300 Most Commonly Used Prescription Drugs and Generics

Right now, www.michigandrugprices.com, the website which allows Michigan seniors and consumers anywhere in Michigan to compare prices on commonly prescribed drugs, is a first step in helping seniors and the uninsured save thousands of dollars. Mike Cox has always been a proponent of providing more information, but has faced resistance from the Granholm-Cherry administration. As Governor, Mike Cox will double the amount of prescription drugs on the website and include generic drug pricing on the website. Mike Cox is committed to providing consumers with as much information as possible.

Mike Cox will explore opportunities for more primary care by Physician Assistants and Nurse Practitioners especially in rural or underserved areas. These practices enable greater access to care and lower costs. Any program implemented using treatment by physician assistants or nurse practitioners will need assistance and oversight from the Michigan State Medical Society and licensed physicians.

This may actually help spur on real competitive efforts and does not mandate anything. Win win

30. Expand Health Insurance Pooling Options for Citizens in the Private Sector

Mike Cox supports the expansion of health insurance pooling options for those Michiganders who are covered by small employers or buying their own insurance. As outlined in his January letter to the Legislature, Cox supports studying changes in the health insurance market to potentially pool those individuals who now buy their own insurance with so-called “small group” businesses. Creating larger pools of these private sector citizens may provide them – and their employers – the ability to buy health care insurance at rates that traditionally have only been available to “big” businesses. This concept parallels the MEWA legislation passed by the Legislature for the public sector, as well as the pooling of public sector employees advocated by Cox, Senate Republicans, and Speaker Dillon.

With the rising cost of health care, health savings accounts are a way for small businesses and individuals to provide quality health care at an affordable price. As Governor, Mike Cox will create tax incentives for businesses that provide Health Savings Accounts (HSAs) to their employees as well assist self- employed individuals in creating HSAs. Mike Cox will target incentives for those businesses that currently do not offer health insurance to their employees.

HSAs for businesses do carry some complications, but as an option will likely expand overall coverage being provided to workers.

31. Expand Availability of Health Savings Accounts for Individuals and Small Businesses To Increase Affordability and Accessibility

With the rising cost of health care, health savings accounts are a way for small businesses and individuals to provide quality health care at an affordable price. As Governor, Mike Cox will create tax incentives for businesses that provide Health Savings Accounts (HSAs) to their employees as well assist self- employed individuals in creating HSAs. Mike Cox will target incentives for those businesses that currently do not offer health insurance to their employees.

See above.

32. Pilot Health Savings Accounts for Optional Medicaid Populations To Increase Wellness and Contain Costs

Medicaid cost-growth is out of control; Medicaid spending in Michigan has grown over 88% since 2002 and now totals over $9.9 billion. One way to control the costs of Medicaid and health care for all is to provide alternative coverage for Medicaid populations that currently receive other forms of coverage. As one initial step toward healthy utilization of health care services and as a way to lower costs, Mike Cox will examine transferring a pilot group of Medicaid clients, such as 19-20 year old Medicaid recipients and Caretaker Relative populations, from traditional Medicaid coverage and provide those individuals with an affordable, high-deductible health insurance and a Health Savings Accounts.

Recipients will receive an ATM-style card attached to a pre-funded account for the amount or portion of the deductible. Medicaid administered in this way will give each recipient greater control and understanding of the value of his or her health care – and its costs. This pilot will incentivize parents to meet specific wellness benchmarks (inoculations, well baby visits, etc) for their children and allow the roll-over of “savings” from year to year. Likewise, the indigent who are chronically ill (those with diseases such as diabetes or heart problems) will similarly be incented to properly utilize health care and stay out of Emergency Rooms. (Currently, the average Medicaid recipient is four times more likely to use the ER than the average citizen). The goal is to encourage wellness and health while containing rapidly escalating Medicaid costs.

Indeed we need to consider the high load on medicaid in Michigan.  Nearly $10 Billion is an insane amount and could be cut drastically by placing a certain amount of the responsibility on the recipient.  This will reduce ER visits in cases where an ER visit is not necessary.  Skin in the game..  good call.

33. Expand Electronic Medical Records Utilization

Some of Michigan’s hospitals now practice extensive use of electronic medical records. As a result, the use of technology provides the potential for increasing savings and efficiencies in health care. Electronic medical records and e-prescribing provide the promise of increasingly accurate diagnosis, treatment, and prescribing. Electronic medical records and prescribing also saves the consumer and health care provider time and costs. As Governor, Mike Cox will create incentives to expand the use of e-prescriptions and electronic medical records. These technological advances create savings and improve quality of care while lessening the chances of misdiagnosis, mistreatment, inaccurate prescriptions and dangerous consequences resulting from erroneous drug interactions.

As long as there is adequate safeguards for the privacy of patients.. I can foresee abuses without the implementation of proper procedural compliance with the use of such a system. Otherwise if it prevents misdiagnosis or mistakes adding to the cost of care, then it will help

34. Encourage Innovative Savings Ideas Like Tele-pharmacy For Outstate and Rural Communities

As Governor, Mike Cox will support innovative methods like tele-pharmacies to increase health care accessibility and contain costs in smaller and rural communities.

For rural areas, access to pharmacy services will be expanded by encouraging tele-pharmacy efforts. Upper Peninsula hospitals will be encouraged to work together to share pharmacist costs and hours of service.

Interesting..  Innovative servicing of those who don’t have the density of population

35. Incentivize Home Health Care: Keeping People Out of the Hospital and Healing At Home

Modern advances in technology allow greater expansion of home health care due to the increased ability of health care providers to monitor patient’s care by telephone and electronic medium. Caring for a patient at home can be cost-effective, reducing patient exposure to other diseases in the hospital setting, and allowing a patient to stay at home with family and friends while healing.

According to the National Association for Home Care and Hospice and Medicare data from 2007, home health care costs $132 per visit; much lower than $544 per day costs at an average nursing home; and dramatically lower than $5,765 for an overnight stay at a hospital.

NAHC also detailed results from a series of studies comparing at-home care for specific conditions versus costs in a hospital for the same conditions. Home care was the more cost-efficient option in a variety of cases ranging from a savings of $153/per patient/month for congestive heart failure care to $25,860 per patient per month for low-birth weight infant care.

Novel idea.  We have seen outpatient technology advances in recent years.  This is a natural extension, and makes sense.

36. Office of Medicaid Inspector General

Medicaid costs the State of Michigan $9.9 billion this year and is growing. National studies estimate that Medicaid fraud and waste may range from 3% to 10% in any state. As Attorney General, Mike Cox has collected a record $162 million in Medicaid fraud. Currently most of these recoveries occur as a result of “tips” as opposed to referrals from the Department of Community Health or regular audits by Community Health. Invariably, it is hard for a bureaucracy like the Department of Community Health to audit itself. As a result, very few cases are referred for investigation or prosecution. States such as New York and Texas have created an office of Medicaid inspector general to increase fraud recoveries and break the cycle of bureaucratic sluggishness in departments like the Department of Community Health.

Based upon the experience of New York and Texas, states can expect to increase Medicaid recoveries once they adopt an office of Medicaid inspector general by 400%. If Michigan were to create an inspector general, we could expect to collect at least $80 million more per year. Mike Cox will create an Office of Medicaid Inspector General to save Michigan taxpayers – and Medicaid patients – $80 million annually. By transferring existing auditors in the Department of Community Health to a Medicaid Inspector General’s office, Michigan will intensify efforts and create more successful collection of fraudulent funds.

Though not a big fan of a new government office..  If fraud is costing taxpayers money, its worth considering.  Also worth considering whether compliance to new government entity would drive up costs at the local levels (doctor’s office) significant enough to offset the presumed gains.

37. Reduce Health Care Cost Growth by Rewarding Quality of Care Over Quantity of Care

As Governor, Mike Cox will reduce costs in health care by finding ways to reward quality of care over quantity of care. Mike Cox will provide support for expansion of efforts like the Michigan Hospital Association Patient Safety Organization and the research being done by the Michigan Hospital Association’s Keystone Center for Patient Safety and Quality – developing best practices that hospitals and providers can utilize to reduce infections and re-hospitalizations.

Mike Cox will also have the Department of Community Health partner with provider groups to provide reimbursement incentives for quality of care approaches like the Patient-Centered Medical Home.

Mike Cox will require Medicaid providers to detail efforts to follow evidence-based, best practices to receive payment from the state.

Rewarding positive advances in the treatment of humans?   I would have to see how such things are quantified.

38. Explore Opportunities to Expand Access to Care by Providing Treatments by Physician Assistants and Nurses Under Supervision of Physician

Mike Cox will explore opportunities for more primary care by Physician Assistants and Nurse Practitioners especially in rural or underserved areas. These practices enable greater access to care and lower costs. Any program implemented using treatment by physician assistants or nurse practitioners will need assistance and oversight from the Michigan State Medical Society and licensed physicians.

We are going to have a shortage of doctors going forward..  This is a must.  See below..

The doctor shortage issue is something that threatens our general welfare.  Stepping outside my normally  (quite conservative) restrictive posture on government spending, I would suggest an effort by state government to educate doctors with a contract tied to the education.  If not a pre-contractual obligation at least one that rewards the medical school efforts afterward, tie-barred to a term of service in community health for a period of a couple years.

the effects?

It would provide a greater amount of health coverage in communities that are somewhat served by only an “emergency room” only model now, and would encourage a greater number of doctor candidates to enter the profession.

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