Winning Medicare for All? “I Like Our Chances”

Despite insights, Time magazine’s cover story falls short on remedy

In his recent Time magazine article, Steven Brill paints a vivid and rather depressing picture of the perverse malfunctioning of our health care system � overpriced and technology-addicted � and he acknowledges some of the advantages of Medicare.

Sadly, however, he shies away from an endorsement of the obvious solution: an improved Medicare for all, i.e. single-payer national health insurance.

I�ll come back to that a little later. However, let me first say that Brill masterfully illuminates much of what�s wrong with U.S. health care.

Take, for example, the �chargemaster� list: an archival, bizarrely hyper-inflated price list in each hospital based on some long-lost secret formulas and automatically inflated over time.

As a physician and health policy researcher, I�ve long known about the massive charges offered to non-contract payers (read: individuals not covered by a public or private insurer), charges that are completely meaningless for costing studies because they�re almost never paid in full and don�t represent the real resources used to provide care. However, what Brill lays out brilliantly (pun intended) is the following:

Some very poor (lower-middle income) people actually do pay the sky-high chargemaster rates. There is a cottage industry (growing, I�m sure, if nothing else due to this article) to help those hapless souls negotiate steep discounts on these ridiculous bills. Hospital administrators either refuse to discuss the chargemaster list or offer up the most heinous, transparently nonsensical justifications for using it. Perhaps worst of all, the CEOs of large not-for-profit providers are paid literally millions of dollars (OK, not tens of millions like big for-profit companies, but still �), thereby introducing into a supposedly public-good-oriented setting the compensation (and marketing) tone of for-profit industry. When these not-for-profits list their �charity� care they value it at the price levels in the chargemaster, even though the cost to produce those services is less than 10 percent of the chargemaster price.

In these and other instances, Brill performs an outstanding public service. However, he regrettably stops short (or his editors stopped him short) of explaining why a single-payer health care system is the only effective remedy for the mess we find ourselves in today. This despite the fact that much of what he says would lead you directly to that conclusion.

He goes so far as to quote others, including John Gunn, Sloan-Kettering�s chief operating officer, who says, �If you could figure out a way to pay doctors better and separately fund research � adequately, I could see where a single-payer approach would be the most logical solution. � It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.�

Yet Brill characterizes single payer, the most logical solution, as �unrealistic� and fraught with the danger of government overreach and intrusion, summarily dismissing it. Need we mention insurance-company overreach and intrusion in the doctor-patient relationship? Need we note the freedom of Medicare beneficiaries to choose their own doctor and hospital, something that would also characterize a single-payer system?

Incidentally, Brill sharply undervalues the government role in paying for health care. He says that the federal government pays $800 billion per year out of our $2.8 trillion health bill, with the remainder mainly picked up by private insurers and individuals.

The $800 billion federal spending on Medicare and the federal portion of Medicaid is right. However, when you add in other federal programs, the state portion of Medicaid, other state and local programs, health insurance for government employees, and tax subsidies, the total government contribution is over 60 percent of total health spending, and rising. Our government already spends enough to pay for universal single payer!

Single-payer health reform is clearly the answer. We need to create the meme and the momentum and the aura of inevitability to do the right thing � despite the opposition of individuals and organizations with massive vested financial interests in the private health industry. They can be overcome.

Think Lincoln and the 13th amendment. As he said (or at least Daniel Day-Lewis said in the movie), regarding prospects of passing the amendment out of Congress, despite doom-saying by his advisers � �I like our chances� (slight smile).

I like our chances on single payer because it�s now so obvious how irremediably broken our system is, and the house of cards will eventually fall. It�s all about perseverance and timing.

James G. Kahn, M.D., M.P.H., is a professor at the Philip R. Lee Institute for Health Policy Studies, Global Health Services, and the Department of Epidemiology and Biostatistics, all at the University of California, San Francisco. He is also past president of the California chapter of Physicians for a National Health Program.

Countdown to Affordable Health Insurance

January is the perfect month for looking forward to new and great things around the corner.

I�m feeling that way about the new Health Insurance Marketplace. Anticipation is building, and this month we start an important countdown, first to October 1, 2013, when open enrollment begins, and continuing on to January 1, 2014, the start of new health insurance coverage for millions of Americans. In October, many of you�ll be able to shop for health insurance that meets your needs at the new Marketplace at HealthCare.gov.

This is an historic time for those Americans who never had health insurance, who had to go without insurance after losing a job or becoming sick, or who had been turned down because of a pre-existing condition. Because of these new marketplaces established under the Affordable Care Act, millions of Americans will have new access to affordable health insurance coverage.

Over the last two years we�ve worked closely with states to begin building their health insurance marketplaces, also known as Exchanges, so that families and small-business owners will be able to get accurate information to make apples-to-apples comparisons of private insurance plans and, get financial help to make coverage more affordable if they�re eligible.

That is why we are so excited about launching the newly rebuilt HealthCare.gov website, where you�ll be able to buy insurance from qualified private health plans and check if you are eligible for financial assistance � all in one place, with a single application. Many individuals and families will be eligible for a new kind of tax credit to help lower their premium costs.�If your state is running its own Marketplace, HealthCare.gov will make sure you get to the right place.

The Marketplace will offer much more than any health insurance website you�ve used before. Insurers will compete for your business on a level playing field, with no hidden costs or misleading fine print.

It�s not too soon to check out HealthCare.gov for new information about the Marketplace and tips for things you can do now to prepare for enrollment.� And, make sure to sign up for emails or text message updates, so you don�t miss a thing when it�s time to enroll.

There is still work to be done to make sure the insurance market works for families and small businesses. But, for millions of Americans, the time for having the affordable, quality health care coverage, security, and peace of mind they need and deserve is finally within sight.

Giving Single-Payer a Second Look

As President Obama prepares to address the nation about his vision for health care reform, we should not overlook the last, best truly transformative change to our health care system: Medicare. We have been staring so intently at the lessons of 1993 that we may have forgotten the universal rule of successful lawmaking: “keep it simple.”

During the eleven town hall meetings I’ve held around my district, I’ve had some direct experience with the anxiety this debate has produced. Much of the fear comes from two groups: those who have Medicare and don’t want it changed and those who have never had a government-run reimbursement system like Medicare and are worried about the impact it will have on their quality of care.

In both cases, a calm, reasoned and vigorous defense of the American single-payer plan is just what the doctor ordered.

The truth is that the United States already uses single-payer systems to cover over 47% of all medical bills through Medicare, Medicaid, the Veterans Administration, the Department of Defense and the Bureau of Indian Affairs.

Understanding that these single-payer health programs are already a major part of our overall health care system should help us visualize what an actual public plan would look like. These institutions also provide health care to millions of satisfied customers in every community who would heartily agree that the government can build and run programs that work quite well.

Medicare also provides us with a case study in the hypocrisy of our Republican friends who have built their party on a 44-year record of undermining this popular program. And now their Chairman sees no irony in ripping “government run” healthcare while publishing an op-ed opposing changes to Medicare.

If Medicare has been such a success, why not extend it? Why not have single-payer plans for 55 year olds? Why not have one for young citizens who just left their parents or college coverage?

So far, the answers we hear to these questions have simply not been very convincing.

At one town meeting the President responded that that he was worried about its “destructiveness.”

Really? Americans would still go to the same doctor and the same neighborhood hospital. Sure, they would be able to delete the 1-800 number of their insurance company from their cell phones. And doctors would have to get rid of all those file cabinets full of paperwork while their assistants who spend time fighting with insurance companies would be able to actually speak to patients.

But everyone would adjust, I’m sure.

The real reason we haven’t seen the Democratic Party embrace the obvious and simpler idea is that it boils down to pure beltway politics.

We’ve been reluctant to tackle the real inefficiency in the current system, namely, the very presence of the private insurance companies. Too many in Washington would rather stay friends with the insurance and drug companies when real reform probably can’t be achieved in a way that makes these powerful institutions happy.

That’s not to say we should vilify the industry. When they pocket up to 30% in profits and overhead (compared to 4% for Medicare) or when their executives take multimillion dollar salaries, insurance companies are doing what their shareholders want them to do.

But let’s leave it to the Republicans to defend those actions. I, and most Democrats, should not join the chorus that sounds like we care more about insurance companies than taxpayers.

The same is true for Big Pharma. If Wal-Mart can pool its customers to be able to offer the $4 prescriptions, why shouldn’t the federal government drive the same hard bargain on behalf of the tax payers so they too get the best prices under Medicare? I pose this exact question at every town hall meeting I attend and if my colleagues and the President did the same on Wednesday night, they would mix good policy with good politics. Instead we have watched a puzzling dance as policymakers have effectively limited the savings we would find in the enormous drug expenditures that are a fixture in our current system. Is it any wonder citizens are confused?

I have no delusions about the muscle needed to overcome resistance from the insurance and pharmaceutical industries. But I believe that for every American we may lose to a slash-and-burn TV ad funded by these businesses, we will gain five among those who are looking for a clear rationale for what we are trying to accomplish and an example for what it may look like.

We also achieve something else: realignment of the political universe. Democrats understand the role of government and are proud of our signature achievement: Medicare. The Republicans care most about big business.

I’ll take that fight any day. And I’m hoping that the President will tell us on Wednesday that he is willing to do the same.

Anthony D. Weiner is a Democrat representing New York’s 9th Congressional District.

Both sides demonstrate in Grand Rapids over plan for single-payer national health system

As a local organizer of Single Payer Michigan, Chris Silva led a rally Saturday outside the Federal Building to build support for a single-payer national health system and dispel what he considers half-truths.

“(Opponents) kind of think what we’re talking about is socializing medicine, rationing healthcare, but that’s simply not true,” he said.

“We’re taking the best of both worlds: public funding … private delivery. ”

The rally, one of 50 planned nationwide, brought dozens, some from as far away as Detroit, but not all bought Silva’s message. As many as five groups showed up to support or protest a single-payer system, which supporters say would save $400 billion a year if for-profit health insurers are taken out of the equation — and everyone would have health care.

Across Michigan Street NW, The Tea Party of West Michigan said the idea of the federal government managing health care would be a disaster.

“I don’t think our founding fathers would ever dream this would fall under the umbrella of the federal government,” organizer Mark Petzold said.

President Barack Obama is working with insurers and medical groups in an effort to bring health insurance to all Americans.

John Gritter, a registered nurse at Lakeland HealthCare in St. Joseph, said the health-care system is in crisis, with patients delaying care until they require expensive emergency-room treatment, or going bankrupt if they require extended medical treatment. Hospitals are forced to write off unpaid bills, putting them at risk of financial collapse, which hurts everyone, he said.

The down poor economy has only made the situation worse.

“This is the real deal. It’s not hypothetical, it’s actual,” Gritter said.

Your Stories Of Being Sick Inside The U.S. Health Care System

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How the Insurer Knows You Just Stocked Up on Ice Cream and Beer

Your company already knows whether you have been taking your meds, getting your teeth cleaned and going for regular medical checkups. Now some employers or their insurance companies are tracking what staffers eat, where they shop and how much weight they are putting on�and taking action to keep them in line.

The goal, say employers, is to lower health-care and insurance costs while also helping workers. Last month, 1,600 employees at four U.S. workplaces, including the City of Houston, strapped on armbands that track exercise habits, calories burned and vital signs, part of a diabetes-prevention program run by insurer Cigna. Some diabetic AT&T employees also use mobile monitors; in September, AT&T also started selling to employers its blood-pressure cuffs and other devices to track wearers 24/7.

But companies also have started scrutinizing employees’ other behavior more discreetly. Blue Cross and Blue Shield of North Carolina recently began buying spending data on more than 3 million people in its employer group plans. If someone, say, purchases plus-size clothing, the health plan could flag him for potential obesity�and then call or send mailings offering weight-loss solutions.

Marketing firms have sold this data to retailers and credit-card companies for years, and health plans have recently discovered they can use it to augment claims data. “Everybody is using these databases to sell you stuff,” says Daryl Wansink, director of health economics for the Blue Cross unit. “We happen to be trying to sell you something that can get you healthier.”

Some critics worry that the methods cross the line between protective and invasive�and could lead to job discrimination. “It’s a slippery-slope deal,” says Dr. Deborah Peel, founder of Patient Privacy Rights, which advocates for medical-data confidentiality. She worries employers could conceivably make other conclusions about people who load up the cart with butter and sugar.

Analytics firms and health insurers say they obey medical-privacy regulations, and employers never see the staff’s personal health profiles but only an aggregate picture of their health needs and expected costs. And if the targeted approach feels too intrusive, employees can ask to be placed on the wellness program’s do-not-call list.

For their part, companies say tracking employees’ medical data saves money because they use it to make people healthier�and sometimes reward them in other ways, too.

Johnson & Johnson, for example, pays employees $500 to submit their biometrics and other health information; J&J then offers eligible employees an additional $250 if they get pregnancy counseling, enroll in a disease-management program or get their colonoscopy on time. The “tailored and targeted messages” paired with the monetary incentives are a “great way to bring people to participate in the program,” says Dr. Fikry Isaac, the company’s vice president of global health services.

With companies under more pressure than ever to reduce health-care spending, the so-called advanced analytics industry provides an opportunity to zero in on errant employees and alter their behavior. “As an employer, I want you on that medication that you need to be on,” says Julie Stone, a Towers Watson TW +0.09% benefits consultant.

Anesthesia Care And Web-Surfing May Not Mix, Nurses Say

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Nurses Union Will Keep Fighting for Medicare for All

Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter�s appeal to single payer advocates to �bury the hatchet,� recently published in The Nation, is both misdirected and shortsighted.

Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.

But there are some gaping holes in this thinking.

First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don�t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.

Second, let�s not have illusions about the history of the ACA.

Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.

So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It’s one reason so many people vote against their own interests.

To get any hearing from Sen. Max Baucus, who was running the Senate side of the debate, nurses, doctors, and single-payer healthcare activists had to get arrested in a Senate Finance Committee hearing. On the House side, Democrats who proposed single payer amendments endured heavy-handed threats from then-White House chief of staff Rahm Emanuel. Meanwhile, then-Press Secretary Robert Gibbs publicly attacked the �professional left� who will only �be satisfied when we have Canadian healthcare and we�ve eliminated the Pentagon.�

It should not come as a surprise that negotiating with your supporters before engaging political opposition, and lecturing, hectoring and seeking to silence healthcare activists who have worked for years for real reform, Obama and the Democrats ended up with a weaker bill. That bill lacked the public option HCAN and other liberals had claimed would be their bottom line, while HCAN and other liberals embraced the individual mandate � the brainchild of the right-wing Heritage Foundation � as high principle.

Even with its positive elements � yes, it does have some � the Affordable Care Act uses public money to pad insurance profits (the subsidies to buy private insurance), prevents the government from using its clout to limit price gouging by the pharmaceutical giants, does little to effectively control rising healthcare costs for individuals and families that have made medical bankruptcies and self-rationing of care a national disgrace, and falls far short of the goal of universal coverage.

We can, as Michael Moore has said, acknowledge that the Supreme Court decision was a defeat for the opponents of any reform of our healthcare system without pretending that our nation�s health care crisis is over.

For three weeks in June and July, the California Nurses Association/National Nurses United sponsored a tour that drew about 1,000 people to free basic health screenings and another 2,000 to town hall meetings in big cities and rural communities across California. We heard a lot of stories like this one, from Carolyn Travao of Fresno:

I worked for Aetna health insurance for 15 years. When I took early retirement, I thought my Cobra would be manageable. Then they sent me a bill in January for $1,300 a month and I couldn�t pay it.

Soon after,

I had a heart attack. I knew I didn�t have health insurance. I have a mortgage. I had a 401(k) that I knew would get wiped out, so I didn�t go to the hospital. I stayed at home for 16 hours, suffering chest pains, praying that I would die because my son would be left homeless and I do have insurance to pay off my mortgage so if I die he would at least have a home. I couldn�t take the pain any longer and I kept passing out, and he kept saying “Mom, you�re going to die.”

�OK,” I said, “take me to emergency.” So we went to emergency. But when I got home, my bill was $135,000. I have $13,000 left in my 401k. I don�t think I can even start [paying]. I never thought I would lay there and want to die. But I would have rather died knowing that my son would be left homeless with no job.

Since the ACA�s cost control mechanisms for insurance companies are so weak � for example permitting insurers to charge far more based on age and where you live � and hospitals will still largely have free reign to impose un-payable bills, will Carolyn and millions like her really have guaranteed healthcare under the ACA?

Sadly, nurses who have seen far too many patients like Carolyn know the answer all too well. That is why nurses and our organization will never stop fighting for guaranteed healthcare based on a single standard of quality care for all that is not based on ability to pay and is not premised on protecting the profits of healthcare corporations that long ago wrote off patients like Carolyn Travao.

Unlike Wendell Potter and many of the liberals, nurses see the ACA as a floor, not a ceiling. It�s time now for those who say they recognize its limitations and believe in genuinely universal healthcare to join us in pushing for an improved and expanded Medicare for all.

Nurses respect the president. But they love their patients far too much not to go the distance for their patients� health and survival.

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Conyers Reintroduces National Single-Payer Health Care Bill

Today, Representative John Conyers, Jr. (D-Mich.) reintroduced H.R. 676, �The Expanded And Improved Medicare For All Act.� This bill would establish a privately-delivered, publicly-financed universal health care system, where physicians and non-profit health care providers would be in charge of medical decisions — not insurance companies.

H.R. 676 would expand and improve the highly popular Medicare program and provide universal access to care to all Americans. The program would be primarily funded by a modest payroll tax on employers and employees, a financial transaction tax, and higher taxes on the wealthiest Americans.

H.R.676 has been introduced in Congress since 2003, and has a broad base of support among universal health care activists, organized labor, physicians, nurses, and social justice organizations across the nation. The bill has been endorsed by 26 international unions, Physicians For A National Health Program, two former editors of the New England Journal of Medicine, National Nurses United, the American Medical Students Association, Progressive Democrats of America, and the NAACP. Last Congress, 77 other Members in the House of Representatives signed on as cosponsors of the legislation. In 2011, the Vermont legislature passed legislation that lays the foundation for a single-payer health care system in the state.

Representative Conyers issued this statement following the release of the bill:

�I am pleased to announce the reintroduction of H.R. 676, �The Expanded And Improved Medicare For All Act,� in the 113th Congress. I have introduced the bill in each Congress since 2003 and I will continue to do so until the bill is passed,� said Conyers.

�Many Americans are frustrated with high out-of-pocket costs, skyrocketing premiums, and many other serious problems that are part and parcel of a health care system dependent on private health insurance plans. H.R. 676 would reform this broken system.

�Passage of the Patient Protection and Affordable Care Act was an important initial reform, which will provide health insurance to millions of our nation�s uninsured and eliminate many of the worst practices of the private health insurance industry.

�However, it is my opinion, and the belief of many leading health care practitioners and experts, that establishing a non-profit universal single-payer health care system would be the best way to effectively contain health care costs and provide quality care for all Americans. It is time for Members of Congress, health policy scholars, economists, and the medical community to begin a serious discussion of the merits of a universal single-payer health care system.�

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Holding Insurance Companies Accountable for High Premium Increases

The Affordable Care Act prohibits some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.� It provides families and individuals with new protections against discriminatory rates due to pre-existing conditions, holds insurance companies accountable for how they spend your premium dollars, and prevents insurance companies from raising your insurance premium rates without accountability or transparency.

For more than a decade before the Affordable Care Act health insurance premiums had risen rapidly, straining the pocketbooks of American families and businesses. �Oftentimes, insurance companies were able to raise rates without explanation to consumers or public justification of their actions.

Rate Review in Action
The Affordable Care Act brought an unprecedented level of scrutiny and transparency to health insurance rate increases by requiring insurance companies in every state to publicly justify their actions if they want to raise rates by 10% or more. �Insurance companies are required to provide easy to understand information to their customers about their reasons for significant rate increases, and any unreasonable rate increases are posted online. �

And it�s working. �A new report released today shows that the health care law is helping to moderate premium hikes. �Since this rule was implemented, the number of requests for insurance premium increases of 10% or more has dropped dramatically, from 75% to 14%.� The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggest that this slowdown in rate increases has continued into 2013.�

Moreover, when an insurer does decide to increase rates, consumers are seeing lower rate increases than what the insurers initially requested.� In the review of rate requests for 10% or more, over 50% resulted in customers receiving either a lower rate increase than requested or no increase at all. ���

States have received $250 million in Health Insurance Rate Review Grants to help strengthen and improve their rate review processes thanks to the Affordable Care Act. �Of the 44 states that received rate review grants, 40 have reported enhancements to their rate review websites.� These website enhancements include searchable rate filings, new public comment options, live streaming of rate hearings, and plain language explanations of rate review and rate filings.

The Effective Rate Review program is one of many in the health care law aimed at protecting consumers.� The rate review program works in conjunction with the 80/20 rule, which requires insurance companies to generally spend 80% of premiums on health care or provide rebates to their customers. Insurance companies that did not meet the 80/20 rule have provided nearly 13 million Americans with more than $1.1 billion in rebates. Americans receiving the rebate will benefit from an average rebate of $151 per household.�

Additionally, today we issued a final rule that implements five key consumer protections from the Affordable Care Act, including protection against denial of health coverage because of a pre-existing condition.� This rule makes the health insurance market work better for individuals, families and small businesses, and it also increases the transparency brought to rate increases by directing insurance companies in every state to file all of their rate increase requests.

To learn more about the final rule issued today, visit: http://www.ofr.gov/inspection.aspx

To read today�s report on Rate Review, visit: http://aspe.hhs.gov/health/reports/2013/rateIncreaseIndvMkt/rb.cfm

Eyes On Election, Governors Hedge On Health Care

July 15, 2012

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As governors from around the country meet this weekend in Williamsburg, Va., health care is near the top of their agenda. Specifically, what to do about the federal health law, now that the Supreme Court has given states new options.

Republican governors in particular said they were genuinely surprised by the Supreme Court ruling. The justices declared the health law in general constitutional, but gave states the option of whether or not to dramatically expand their Medicaid programs. They'll now get to choose whether to put most people who earn more than about $15,000 a year on the program or not.

"I think a lot of us, certainly on the Republican side, believed it would be found unconstitutional. So I think it's just added more confusion to the issue rather than settling the issue," said Utah Gov. Gary Herbert, "and probably more impetus on the November election to really find out and sort out what the implications are going to be going forward."

Indeed, the meeting's host, Virginia Gov. Bob McDonnell, said he wasn't planning to say yet whether his state would expand its Medicaid program, even with the federal government picking up the vast majority of the costs.

"Honestly, I don't think it's responsible fully for my state to make a decision now because there's still more information we need," he said.

Many Democratic governors see things differently, however, including Delaware's Jack Markell, the incoming chairman of the National Governors Association.

"This is not political. This is a financial analysis of what does it mean to cover, in our case, an additional 30,000 people," he said, "and my view � and we're clarifying that we're understanding it all properly � ... is that this is absolutely a good deal for Delaware taxpayers."

Unlike Republicans, who say the Supreme Court decision confused matters, Democrats like Maryland's Martin O'Malley also insisted that it should have ended the debate.

"I think most governors understand that the Supreme Court's decision was a final and clear ruling," he said.

Other Democrats were less charitable. Vermont's Peter Shumlin said some of his Republican colleagues aren't being honest by calling for the repeal of the health law on the one hand, while declining to say whether they'll accept the federal Medicaid funding that flows from it on the other.

"Have a spine. The American people are sick and tired of spineless politicians. [Either] say, 'I believe the Affordable Care Act is the wrong thing, so I will not take the loot,' or say, 'I believe the Affordable Care Act will help my state cover uninsured Americans, grow jobs, economic opportunities, and I'm taking the loot,' " Shumlin said. "But to say, 'I'm gonna criticize the plan, but I won't tell you whether I'm taking the loot or not until after the election,' that's what breeds cynicism among the American people."

O'Malley of Maryland thinks most of those Republican governors will eventually come around and take the money for economic � if not political � reasons.

"Once the posturing of the election is past, I think that a lot of these governors are going to have a hard time going home to their doctors, nurses, hospitals and explaining to them why they are passing up an opportunity to transform these dollars into better economic uses for job creation in their states," he said.

But for many Republican governors, like Nebraska's Dave Heineman, it's about something bigger than parochial interests.

"They all say it's free federal money. No, it's not. That's our tax dollars," he says. "It's costing every one of us."

Behind the scenes at the meeting, however, governors did seem to agree on one thing. There are still lots of questions they want the federal government to answer about how they will all work together as the health law's implementation proceeds.

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Cancer Rehab Begins To Bridge A Gap To Reach Patients

More From Shots - Health News HealthHow The Sequester Could Affect Health CareHealthBritish Man Dies From SARS-Like Virus In U.K. HospitalHealthFew Public Family Planning Centers Accept Insurance, YetHealthCancer Rehab Begins To Bridge A Gap To Reach Patients

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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When Going Back To The Hospital Is Good News

More From Shots - Health News HealthWhat Nuclear Bombs Tell Us About Our TendonsHealthPopular Workout Booster Draws Safety ScrutinyHealthDon't Count On Extra Weight To Help You In Old AgeHealthDarkness Provides A Fix For Kittens With Bad Vision

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Health Spending Increases Remain At Record Lows

More From Shots - Health News HealthDarkness Provides A Fix For Kittens With Bad VisionHealthTraces Of Anxiety Drugs May Make Fish Act FunnyHealthMore Women Turn To Morning-After PillHealthScientists Pass The Hat For Research Funding

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Stressed Out Americans Want Help, But Many Don't Get It

More From Shots - Health News HealthNeed A Price For A Hip Operation? Good Luck With ThatHealthU.S. Fertility Rates Fall To All-Time LowHealthHow Parents Can Learn To Tame A Testy TeenagerHealthWhy Even Radiologists Can Miss A Gorilla Hiding In Plain Sight

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Gaps In Maternity Coverage For Some Women Could Grow Under Health Law

More From Shots - Health News HealthWidely Used Stroke Treatment Doesn't Help PatientsHealthFeds Reject Mississippi's Plan For Insurance ExchangeHealthStressed Out Americans Want Help, But Many Don't Get ItHealthCatholic Bishops Reject Compromise On Contraceptives

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Teaming Up with WebMD to Take Your Questions

Starting August 1st, and for the first time ever, women will have access to potentially life-saving preventive care free of charge.� Thanks to the health care law, services including well-woman visits, gestational diabetes screening, breastfeeding support and supplies, contraception, domestic violence screening, and more will be covered without cost sharing in new health plans starting August 2012 � giving women more control over their own health.

To talk about these new benefits becoming available for women, we are teaming up with WebMD to take your questions on what this means for women and their families. Please join HHS Secretary Kathleen Sebelius and Annic Jobin, WebMD�s Director of News and Partnerships, for a live online discussion on Wednesday, August 1st at 1:30pm EST.

You can watch the conversation live at www.healthcare.gov/live, and submit questions on Facebook at www.facebook.com/healthcaregov or on Twitter using the hashtag #womenshealth. You can also join the conversation here on WebMD.

To learn more about the preventive benefits that many insurers are required to cover, visit www.healthcare.gov/prevention. We hope you can join us for this important discussion.

Vermont Single-Payer Financing Plan Released

The Shumlin administration released two financing plans Thursday evening: one for funding a publicly financed health care system and another to pay for portions of the state�s new health benefit exchange.

The much-anticipated single-payer financing plan provides more of a map of the state�s health care finance landscape than it does a course of action through it. The document itself alludes to the need for a plan with substantive revenue-generating measures.

�A future financing plan will likely feature a substantial and regular individual and employer contribution, similar to current law, albeit one paid through a public system,� the plan says.

The plan � which was drawn up by the University of Massachusetts for a price tag of $300,000 � estimates that the total savings of reforming the system would be about $35 million in 2017. The total $5.91 billion cost of the system would place a burden of $1.61 billion on taxpayers, after federal funding, and a $332 million chunk would be placed on employers who continued to enroll their employees on their insurance plans after the system takes effect.

While the plan points to a slate of tax bases for raising such revenues, the architects of the plan acknowledge the lack of information they had to work with � and, therefore, the potential inadequacy of their findings.

�Many details regarding the structure of a single payer system in Vermont have not been determined,� they write. �These details may significantly affect the assumptions underlying our models and therefore the results of our models.�

When Gov. Peter Shumlin and the Legislature approved Act 48 in 2011, they set the state on a track towards a publicly financed health care system. Part of that legislation called for a financing plan to be submitted to the Legislature by Jan. 15, 2013, that �shall recommend the amounts and necessary mechanisms to finance Green Mountain Care and any systems improvements needed to achieve a public-private universal health care system.�

On Thursday, Director of Health Care Reform Robin Lunge said the plan met the statutory goal.

�It has amounts, and it has necessary mechanisms included; it just doesn�t have one,� she said. Furthermore, she added, the plan seeds the Statehouse for constructive debate over how to pursue and implement such a health care system.

Jeffrey Wennberg, who runs the anti-single payer group Vermonters for Health Care Freedom, panned the report for its lack of substance.

�The report � contains surprisingly little information within its 91 pages,� he said in a public statement. �There is no multi-year budget or projection, and the Act 48-required recommendation for a funding source is completely absent.�