Ag and Rural Caucus for January
Better Practices
6:30 pm Thursday 2 January
Is it OK for a Democrat to run as Independent?
What do you think about Democrats running – and winning - as Independents? At our meeting in early December several of us celebrated local candidates who were elected while running as Independents. We welcomed local champions. I think I used the term “white knights.” We were challenged. Several thought that running as Independent even while successful did not build the brand.
What do you think? (Day after New Year's)
https://us02web.zoom.us/j/85907982157?pwd=MU4vV3E3VGZ5VU02dnhvZjg2b3hKZz09
Policy Briefing
6:30 pm Thursday 16 January
Harold Miller, Center for Healthcare Quality and Payment Reform
Shane McGuire, CEO, Columbia County Health System
Stopping the Loss of Rural Health Care Services
https://us02web.zoom.us/j/85907982157?pwd=MU4vV3E3VGZ5VU02dnhvZjg2b3hKZz09
Paste link into browser.
Follow up on Rural Hospitals and Health Care
This is the link to the recording. Harold’s slides are here. I have Shane’s Power Point slides as well. I would be pleased to forward them upon request. (I have lost confidence in linking to files on my computer.)
Harold followed up with materials about “global budget” concept. Search the recording link for “global budget” to learn about how important it is when evaluating universal health care reform.
Rural hospital viability is not a new topic. Washington’s Health Care Authority a decade ago convened WRHAP (Washington Rural Health Access Preservation). Harold recommends several pieces from that effort here and here and here.
At the Federal level, Harold made suggestions just a year ago about “how to fix payments for small rural hospitals.”
Just in case you had thought we had covered the health care bases last evening, Harold wanted to alert us to the “problem of high beneficiary cost-sharing at Critical Access Hospitals for people on Traditional Medicare. People with supplemental insurance plans are shielded from this, but it’s another problematic incentive for people to sign up for MA plans.” The Medicare Payment Advisory Commission (MedPAC) is meeting today. I have a copy of a paper being presented. Just let me know.
I want to thank Shane and Harold again for their work last evening. No one left the meeting thinking that they had the answers. “It’s complicated” could have been the slogan for the evening, but do not back off from following up on the details. Advocates for health care reform (most of us, I suspect) have a responsibility to listen and learn.
Don
17 January 2025
Whole Washington – SB 5233
This is about situational awareness. This roughly means that we need to be aware about how policies interrelate. Our topic for tomorrow evening is how we keep rural health care viable. We are talking about how we keep rural hospitals alive. Already, we may have complicated the question by writing about how the incentives driving private insurance and Medical Advantage threaten our rural hospitals. This is appropriate.
It is appropriate also to ask about how universal health insurance would affect rural hospitals. This week, for example, Senator Bob Hasegawa introduced SB 5233 in response to Whole Washington’s proposal for universal health . By this evening SB 5233 has earned eleven co-sponsors. And Whole Washington has plans for a voter initiative if SB 5233 falls short.
The language of SB 5233 is directed to the consumer: “to provide stable coverage from time of birth and maintained as a legal guarantee to all residents”. How about the suppliers, the hospitals? The situational awareness part of this is to ask if universal health care would make a difference to rural health care providers as well as to rural health consumers.
Universal health care is not precisely our topic tomorrow evening. But it may play a role.
Don
15 January 2025
Prequels
Harold is getting us prepped for Thursday. And he has data…some of which strike embarrassingly close to home. Click here for Rural Hospitals at Risk in Washington State, and here for Medicare Advantage uptake by WA county.
Take a look and see you Thursday.
Don
14 January 2025
Myth Busting…The problem is not Medicare/Medicaid
Harold Miller calls out a myth about why rural hospitals are under threat: “A common myth about small rural hospitals is that almost all of their revenues come from Medicare or Medicaid, but the fact is, on average, more than half of the services at small rural hospitals are delivered to patients with private insurance” (underlining added).
Not good. Earlier this month I passed on the observation that Medicare Advantage plans made “expense recovery difficult for small hospitals.” The bad guy in this story is not just UnitedHealthcare and Medicare Advantage. It turns out that private insurance administrators are in the same business. Should we be surprised? UnitedHealth group, UnitedHealthcare’s family, is the largest writer of private health insurance.
Putting names on villains makes moral outrage easier. Before we get too engaged in painting UnitedHealth black, though, let us remember that UnitedHealth is just the most success of a class of actors in how we deliver health care in this country.
Shane and Harold have to work within this framework. Join them in learning how to win in health care delivery and some of the counter-tactics that we have some chance of influencing. Learn the details. Then, we can talk about changing the rules.
Don
13 January 2025
UnitedHealthcare, Medicare Advantage and Rural Hospitals
Shane and Harold agreed to present on rural health care in early December…before the assassination of the UnitedHealthcare CEO.
Well OK, but what does UnitedHealthcare have to do with rural hospitals? The link is Medicare Advantage. UnitedHeathcare is our largest Medicare Advantage provider. One way they make money is by denying claims and generally making expense recovery difficult for small hospitals.
Cartridges found by Brian Thompson’s body had the words “deny,” “defend” and “depose” inscribed. The words mirrored Jay Feinman’s 2010 book title, Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims: “Insurance companies now often try to delay payment of justified claims, deny payment altogether, and defend these actions by forcing claimants to enter litigation.”
Shane joined our “politics” session Thursday evening in error but graciously polled us on what we might want to learn on the 16th. We mentioned Medicare Advantage plans, their consequences and their politics. He eagerly took notes.
Learn the details on the 16th. Details are important.
Don
3 January 2025
Our Better Practices roundtable is on the first Thursday of each month at 6:30 pm.. Use the link above for 2025.
Our Policy Series is on the third Thursday of each month at 6:30 pm. Use the link above for 2025.
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Ag and Rural Caucus of State Democratic Central Committee
Our mailing address is: Ag and Rural Caucus 2921 Mud Creek Rd Waitsburg, WA 99361