What I learned at Health Action 2018

Below, a few notes from Health Action 2018, Families USA's annual conference -- things I learned, or learned in more detail, or was forcefully reminded of. [Update: my report about what the conference suggested about where Democrats may be headed on the healthcare front is up at Crooked Media.]

         Re Medicare:

• Many low income sixtysomethings face a "Medicare cliff" at age 65. They've had all their medical expenses paid by Medicaid;  now, suddenly, they're faced with Medicare's 20% copays, drug costs, etc. (Leslie Fried, National Council on Aging)


• Medicare Savings Programs (MSPs), a variety of programs through which low-income Medicare enrollees' premiums or out-of--pocket costs are picked up by Medicaid, are all underutilized. Only about half of those eligible are enrolled. Funding for State Health Insurance Assistance Programs (SHIP), which provide enrollment assistance to seniors, is grossly inadequate and at risk. Susan Collins has stood up for SHIP. (Leslie Fried).  I plan to learn more/post more about the Medicaid-->Medicare cliff.


• Come time to enroll, even Medicare experts have a hard time sorting through Medicare Advantage and Medigap options.


• Seema Verma's CMS is steering Medicare enrollees toward Medicare Advantage programs "through incomplete and biased information in public outreach materials"  David Lipschutz, Center for Medicare Advocacy).

Re states and territories:


• New Mexico 's Medicaid program enjoys the highest federal match rate (80%) and the lowest cost per member $297) in the fifty states. 42% of people in the state are on Medicaid. Activists are pushing for a Medicaid buy-in option.  (Colin Baillo, Health Access New Mexico)


• Puerto Rico  - far poorer than New Mexico, has a federal match rate of just 55% (as do all the territories) -- and an annual cap on top of that. Absent a new cash infusion, 500,000 enrollees will lose coverage in 2019, when a temporary allotment included in the ACA runs out.  The dystopian block-granted future Republican lawmakers have in store for the 50 states is current reality in PR. 

Re activists, politicians and social workers:


• The Little Lobbyists -- parents of children with complex medical needs -- enacted a miracle of high impact "accidental activism" by showing up, and showing up, and showing up, on Capitol Hill. They were uniquely equipped to learn on the fly because, as co-founder Elena Fung put it, we had become experts in our  kids' diagnoses and symptoms and therapies, and we saw this activism as a natural transition to political activism. If we can go toe-to-toe with the head of surgery to save our baby's life, we can go toe-to-toe with our member of Congress to save our healthcare. 


• Activists in Maine effected a slower, more meticulous miracle of high-impact activism by planting a ballot initiative bomb under Paul LePage's five vetoes of Medicaid expansion bills. The successful effort demonstrates that "offense is the best defense," according to Jennie Pirkl of the Maine People's Alliance, who was honored for her roll in the initiative. The referendum drive not only mandated the expansion,  Pirkl noted, but increased the pressure on Senator Susan Collins to reject legislation capping Medicaid funding -- in a state ravaged by opioid addiction. 


• Elizabeth Warren thinks that blaming unsustainable U.S. healthcare costs entirely on insurers is still a winning political strategy.


• ACA enrollment counselors -- and Medicare/Medicaid enrollment counselors, and social workers generally who help people access government services for which they're eligible - are awesome, intrepid people.

And apropos of nothing: almost every time I start to type "Health Action" I type "Health Access" instead -- which would actually be a good name for the conference. Update: I even did it in the title of this post (corrected...).