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Here is a great place to get information on Healthcare Reform. The DOL's FAQ page located at http://www.dol.gov/ebsa/healthreform/. There are over 13 FAQ's coverage a wide range of topics. Did you know as an employer you were required to notify employees of the federal exchanges before March 01, 2013? Good news if you didn't that requirement has been pushed back to later this year before the open enrollment period beginning October 1. Read more online.
Survey Finds Majority Of Small Business Owners Confused About ACA.
The Insurance and Financial Advisor (3/28) reports that, according to a new survey conducted by eHealth, Inc., the parent company of eHealthInsurance.com, an online health insurance marketplace, a majority of small business owners "incorrectly believe health care reform requires them to provide health insurance for employees in 2014, or that they'll be taxed if they don't offer health insurance next year." The survey found "that only 18% of small employers believe they can confidently define or explain health insurance exchanges. Nearly two-thirds, 62%, admit to not understanding exchanges at all, while 20% say they have only a vague understanding of the role exchanges are expected to play."
Possible Premium Growth Under ACA Garnering More Attention.
Coverage continues Thursday of a new study which predicts premiums will rise for individuals purchasing health insurance next year because of the Affordable Care Act. Many sources focus specifically on the acknowledgment of this reality by HHS Secretary Kathleen Sebelius, made Tuesday. The White House pushed back Wednesday, but still several cable news programs took the opportunity to skewer the Administration and its healthcare law.
In continuing coverage, The Hill (3/28, Viebeck) "Healthwatch" blog reports that in a new study, "the Society of Actuaries predicted Wednesday that insurers will pay 32 percent more on average for medical claims under healthcare reform, as more patients enter the insurance market and take up higher-value benefits." This could "potentially rais[e] premiums for some consumers."
Similarly, Modern Healthcare (3/28, Block, Subscription Publication) reports, "As health insurers prepare to submit 2014 premium rates to state regulators next month, some stakeholders are questioning whether the Patient Protection and Affordable Care Act will be affordable after all." The "worry is that some of the mandates in the law could drive up the cost of coverage so much that many consumers may choose to pay a penalty for failing to get coverage rather than pay steep insurance premiums." As the article explains, some of these concerns "highlighted in a study released Tuesday by the Society of Actuaries," which found "that the cost of medical claims, one of the key factors driving insurance premiums, will rise an average of 32% nationwide by 2017 as a result of an expected change in the individual market composition."
In a related account, The Hill (3/28, Viebeck) "Healthwatch" blog reports that the Obama Administration "acknowledged Tuesday that some people could see their premiums rise under the healthcare reform law." HHS Secretary Kathleen Sebelius "told reporters that 'there may be a higher cost associated with getting into that market' where 'folks will be moving into a really fully insured product for the first time.'" The Hill notes that Sebelius' comment "was among the first from the Obama administration to reveal a degree of uncertainty about the impact of the law on insurance premiums." Sebelius' "concession on premiums put the White House on the defensive. When asked about Sebelius's remarks, a spokesman for President Obama said healthcare costs are falling thanks to the reform law."
Offering state specific accounts are the Deseret (UT) News (3/28, Schulzke), Albuquerque (NM) Business First (3/28, Domrzalski), the Kansas City (MO) Business Journal (3/28, Pfannenstiel, Subscription Publication), and the Minneapolis/St. Paul (MN) Business Journal (3/28, Grayson).
White Pushes Back Against SOA Report On Health Premiums Under ACA. Meanwhile, the Christian Science Monitor (3/27, Feldmann) reports that Sebelius "says it's too soon to talk specifics about premiums until the insurance companies submit their bids this summer. But she predicts that the online exchanges will encourage competition among insurers and bring premium prices down." The Monitor also notes that the white House is "pushing back" against a study from the Society of Actuaries which says that "implementation of Obamacare will mean an average increase of 32 percent in the cost of medical claims per person by 2017," arguing that the study had been "conducted by a health insurance company."
The Hill (3/28, Sink) "Healthwatch" blog echoes this, saying that "the White House insisted on Wednesday that healthcare costs are falling after a member of President Obama's Cabinet said some people could see their insurance premiums rise under the Affordable Care Act." Deputy press secretary Josh Earnest said Wednesday, "I would actually point to the results that we're already seeing from the Affordable Care Act, which is a savings of $2.1 billion, and the analysis from the [Congressional Budget Office] that actually says, in the future, we're gonna see rates that are lower for higher benefits."
October 1 may be one of the most anticipated deadlines of the year as it marks the beginning of open enrollment in health insurance exchanges. Finally, by the fall of 2013 we expect to have a better idea of how much health reform will really cost. As employers who offer coverage and for those who sell coverage begin setting their 2014 rates, we will truly have a clearer understanding of how much health reform will cost and impact employers
2014 Tax Costs Hit 2013 Premiums
We are all too familiar with double-digit rate increases. Unfortunately, we are seeing increases today which are higher than normal, as it appears many carriers are beginning to fold the cost of the new health insurance premium tax into their 2013 rates.
The healthcare reform law imposes a massive new sales tax on all fully insured health insurance products which will increase the cost of coverage for all individuals, businesses and public program beneficiaries with private insurance. The tax begins at $8 billion in 2014 and rises to $14.3 billion in 2018, increasing annually thereafter based on premium growth. The Joint Committee on Taxation projects that between 2013 and 2022 the new tax will total $101.7 billion. Additionally, there is nothing in the law that prevents health insurance carriers from passing this tax dollar-for-dollar to consumers.
HHS Clarifies ACA Multistate Plan Rules.
The Wall Street Journal (3/2, Radnofsky, Mathews, Subscription Publication) reported that HHS said Friday in new rules for the Affordable Care Act that insurers who win contracts to offer multistate plans through healthcare exchanges will have to meet most state insurance requirements but still may be able to use a package of benefits approved by the Federal government. The Journal says HHS rejected the idea of adding requirements to multistate plans in favor of offering broad, affordable access. HHS also issued rules about fees that insurers will face and about compensation for insurers who accept more sick people in their plans. The Journal says major insurers are being choosy about entering the state marketplaces and are likely to sample those markets before offering plans on a broader scale.
The Washington Examiner (3/4, Conger) reports that of the "more than 700 pages of new regulations to implement portions of the Affordable Care Act" that HHS released Friday, "Three of the regulations are final and roll out the multistate healthcare exchanges and reforms to the insurance market, including provisions to encourage cost-sharing, stabilize health insurance premiums and prevent providers from denying coverage."
The Hill (3/2, Wilson) "Regwatch" blog reported that HHS said in a statement that the new rules would "help to ensure that every American has access to high-quality, affordable health insurance."
CQ (3/2, Reichard, Subscription Publication) reported further, "The regulations are part of a final rule and interim final rule dryly titled 'notice of benefit and payment parameters.' The regulations govern: the so-called Three R program to cushion insurers against possible early financial losses in the unfamiliar insurance exchange market, creation of 'SHOP' exchanges to serve small businesses, and premium tax credits to help the uninsured pay for insurance and lower their cost-sharing expenses and changes to medical loss ratios."
CMS Regulations Finalize SHOP Exchanges. In a specific report on the SHOP exchanges, CQ (3/4, Subscription Publication) explained, "CMS proposed that for plan years beginning on or after Jan. 1, 2014, and before Jan. 1, 2015, it will delay an "employee choice" model as a requirement for the SHOPs in the exchanges run by the federal Department of Health and Human Services in those states that do not create their own marketplace. That means just one qualified health plan would have to be offered by a small employer to workers in those exchanges."
Modern Healthcare (3/2, Daly, Subscription Publication) reported, "The Small Business Health Options Program, created under the healthcare reform law, will offer a marketplace of insurance plan options for small businesses beginning in 2014. States will have the option to allow businesses with more than 100 employees to purchase coverage through the SHOP Exchanges beginning in 2017."
ACA Glitch Could Mean Some Families Will Be "Priced Out" Of Coverage.
The AP (1/30, Alonso-Zaldivar) reports that a "glitch" in the Affordable Care Act could mean that some families will be "priced out of health insurance." According to the AP, "IRS regulations issued Wednesday failed to fix the problem as liberal backers of the president's plan had hoped," and as a result, "some families that can't afford the employer coverage that they are offered on the job will not be able to get financial assistance from the government to buy private health insurance on their own." The Administration "says its hands were tied by the way Congress wrote the law," noting that the "affordability glitch is one of a series of problems coming into sharper focus as the law moves to full implementation."
For its part, Bloomberg News (1/31, Wayne, Rubin) reports that "an effort to allow looser rules for calculating whether workers will be eligible for U.S. subsidies to buy health insurance was rejected today by the Internal Revenue Service." The article describes that "employees can receive government tax credits to buy insurance for their families if the coverage their employers offer would cost more than 9.5 percent of their income, the IRS said today in final regulations," but "that calculation will be based on the cost of self-only coverage, not family coverage, which is more expensive and would give more people access to the credits." Democratic lawmakers, "including U.S. Representatives Sander Levin of Michigan and Henry Waxman of California, had called for the IRS to use the more generous calculation to give families more access to policies on the insurance exchange, or marketplace."
Meanwhile, the Wall Street Journal (1/31, Radnofsky, Subscription Publication) reports that a spokesman for the Treasury Department said the regulations are based on the language in the healthcare law.
The NPR (1/30, Appleby) "Shots" blog, in partnership with the Kaiser Health News "Capsules" blog, reports that "consumer groups had hoped to sway the IRS to base the affordability threshold on the cost of a family plan, saying the rules could prevent some children and spouses from getting coverage." Joe Touschner, senior health policy analyst at Georgetown University's Center for Children and Families, said, "It doesn't make sense to test the affordability of children's coverage by looking at the cost of covering one person, the employee." However, "supporters of the rule, among them employer groups and insurance brokers, say it closely follows the wording in the law and will be easier to administer."
The New York Times (1/31, A11, Pear, Subscription Publication) notes that HHS Secretary Sebelius "said Wednesday that she wanted to use her discretion to prevent the imposition of tax penalties on certain uninsured low-income people in states that choose not to expand Medicaid. A rule proposed by her department would guarantee an exemption from the penalties for anyone found ineligible for Medicaid solely because of a state's decision not to expand the program.'"
HHS Releases New ACA Regulations On Medicaid, Exchanges.
Modern Healthcare (1/15, Daly, Subscription Publication) reports that CMS "issued proposed operational rules Monday (PDF) for health insurance exchanges and Medicaid programs, which included an increase in allowable beneficiary cost-sharing in the latter." HHS Secretary Kathleen Sebelius said in a news release, "Today, we are proposing a rule to provide Americans with access to affordable, high quality health coverage and give states more flexibility to implement the law in a way that works for them."
The Hill (1/15, Baker) "Healthwatch" blog reports that HHS released rules surrounding the implementation of the Affordable Care Act, specifically the provisions governing the Medicaid expansion and state exchanges. The "472-page regulation aims to streamline the process for determining who is eligible for the expanded Medicaid program, as well as the system for notifying applicants of eligibility decisions."
The Washington Post (1/15, Kliff) "Wonkblog" reports that, under the new ACA regulations proposed Monday, "states may soon have the authority to charge Medicaid patients higher co-payments." The rule "would set a maximum $4 co-pay for any outpatient services used by Medicaid patients who live below the poverty line ($11,170 for an individual)." Currently, "the maximum co-payments" ranges "between $1.30 and $3.90, depending on the actual cost of the service." HHS "contends that, since most procedures already cost enough to land in the range of a $3.90 co-payment," saying, "a flat $4 cost sharing maximum is reasonable." Medicaid director Cindy Mann explained to reporters, "It's not triggered by the Affordable Care Act itself and is not a change to the law. It's prompted by the context of states expanding Medicaid."
Also reporting on the new proposed regulations are CQ (1/15, Subscription Publication), LifeHealthPro (1/15, Bell), and the Orlando (FL) Business Journal (1/15, Aboraya, Subscription Publication) "Buzz" blog.
Conference Panelists Predict "Rate Shock" As HHS Implements ACA.
CQ (12/20, Subscription Publication) reports that at the annual Wall Street Comes To Washington Conference, sponsored by the nonpartisan Center for Studying Health System Change, analysts warned that HHS will have to "creatively use their regulatory powers to lessen rate shock in the new health insurance exchanges set to begin enrolling people next fall." The panelists suggested "ways to forestall such increases," including "postponing the movement of enrollees in the state Preexisting Condition Insurance Plan into the exchanges and slowing the implementation of a 'rating band' requirement that will sharply increase prices for the young."
Most Governors Opt Out Of State-Based Exchanges.
The New York Times (12/15, A13, Pear, Subscription Publication) reported that the Obama Administration "said Friday that more than half the states had rejected its pleas to set up their own health insurance exchanges," in what it says is "a setback to President Obama's hopes that Republicans would join a White House campaign to provide health insurance to all Americans." Friday was the deadline to announce plans, and "Federal officials said they knew of 17 states that intended to run their own exchanges, as Congress intended." HHS Secretary Sebelius gave "conditional federal approval" Friday to Kentucky and New York and "approved an application from the District of Columbia." The Times examined some of the reasons states gave for not running their exchanges.
The Los Angeles Times (12/15, Levey) reported "But what was once viewed as a setback for the Affordable Care Act is increasingly seen as a blessing by consumer advocates, many of whom doubt that officials in some Republican-controlled states are committed to implementing a law they fervently oppose."
The Wall Street Journal (12/15, Radnofsky, Subscription Publication) noted that HHS has said they will be prepared to run the exchanges in all the states that opted out of setting up their own. Spokeswoman Erin Shields Britt said, "Consumers in every state will absolutely have access to an exchange come January of 2014."
However, the AP (12/15) reported, "drafters of the law did not anticipate that so many states would remain on the sidelines at this late stage. Federal control of the new state markets where individuals, families and small businesses will shop for taxpayer-subsidized private coverage was seen as a failsafe, not the standard for nearly half the country. Critics predict delays."
HHS Issues Two Rules For Insurance Exchanges.
The AP (11/30) reported that "the Health and Human Services department is proposing a 'user fee' amounting to 3.5 percent of premiums for health insurers who want to offer policies in new federal exchanges coming in 2014." According to HHS, "the fee is to cover administrative costs of the new markets, which were designed to be self-supporting." According to the article, "The proposed administrative fee in the new exchanges would be higher than the 2 percent to 3 percent overhead commonly cited for running Medicare, a disparity that critics of the law were quick to point out."
The New York Times (12/1, A17, Pear, Subscription Publication) reported that in addition to the announcement of the 3.5 percent user fee, "federal officials said that consumers would soon have access to nationwide health plans similar to those available to members of Congress and other federal employees." According to the Times, the two announcements "show the White House rushing to carry out the health care law" and "also illustrate the rapidly growing role of the federal government in the nation's health care system." The Times added that HHS Secretary Sebelius "said that fees...would be 'sufficient to cover the majority of costs'" for the Federal role in the exchanges, although "she did not say how the remainder of the money would be raised."
Bloomberg News (11/30, Wayne) noted that "the total amount of the fee announced [Friday] won't be known until all states have made their decisions," regarding whether to set up a federally or state-run exchange.
The Hill (12/1, Baker) "Healthwatch" blog added, "HHS said it might change the amount of its user fee in later years, as more people enroll coverage through the exchanges. It will also monitor states' fees."
CQ (12/1, Adams, Subscription Publication) reported that in response, America's Health Insurance Plans spokesman Robert Zirkelbach said Friday that "any new fees to pay for the administration of exchanges will add to the cost of coverage, which is why it is important to focus on reducing these costs by streamlining operations, avoiding regulatory duplication, and utilizing the experience and expertise of health plans."
In a separate report, CQ (12/1, Adams, Subscription Publication) reported further on the new "multistate rule," issued by the Office of Personnel Management, under which "insurers that want to offer a national multistate plan would be allowed to phase in their participation in all 50 states over four years. In the first year, the plans would only have to operate in 31 states." The new program would be run by OPM, "which currently covers about 8 million workers and their families through the Federal Employee Health Benefit Program."
Obama Administration Unveils New ACA Regulations.
Much of the coverage of newly-released ACA rules casts them as giving states greater flexibility even as they require insurers to cover people with pre-existing conditions.
USA Today (11/20, Kennedy) reports that "the Obama administration released new health care regulations Tuesday that preclude insurers from adjusting premiums based on pre-existing or chronic health conditions, tell states what benefits must be included in health exchange plans, and allow employers to reward employees who work to remain healthy." The rules give guidance on how to implement provisions within the 2010 healthcare law. After noting that the regulations are not final, the article says that "there is a 90-day comment period during which the government and participants can negotiate to adjust the regulations."
The Wall Street Journal (11/21, Radnofsky, Subscription Publication) reports that the new rules issued Tuesday gives states additional discretion over their plans. Kathleen Sebelius, secretary of the Department of Health and Human Services, remarked, "I'm confident states will have what they need to move forward with creating these critical new insurance markets."
Reuters (11/21, Morgan) quotes HHS Secretary Kathleen Sebelius, who said during a conference call with reporters, "The information we're putting out today will answer many of the states' remaining questions, as will additional guidance to be issued in the days and weeks ahead." She added that she plans to "sit down" with governors to talk with them about their concerns.
CQ (11/21, Adams, Subscription Publication) reports that "after months of delay, the Centers for Medicare and Medicaid Services [CMS] on Tuesday released a proposed rule that establishes the essential benefits that health insurance plans must offer under the health care law." Separately, the CMS "issued a guidance to states on the types of benefits that Medicaid programs must include if they expand coverage under the health care law." The article details that "under the essential benefits proposed rule, health plans in the individual and small-group markets - both in and outside of the new exchanges - would have to provide coverage in the 10 categories of services that the health care law requires."
The Los Angeles Times (11/21, Levey, Bureau) reports that the "Obama administration reaffirmed key requirements of the new healthcare law Tuesday, setting out how insurance companies will cover nearly all Americans, even if they are already ill, and provide plans with minimum benefits." The article says that "in state and federally run exchanges, insurance companies will be prohibited from denying coverage to sick Americans." According to the Times, "insurers will no longer be able to charge more from women or customers with medical conditions."
NPR (11/20, Rovner) reports in its "Shots" blog that under the new rules, "premiums are allowed to vary according to certain factors, including age, smoking status, location and family size. But, and it's an important but, coverage can't be cancelled because of an illness." HHS Secretary Kathleen Sebelius told health reporters on a conference call, "The proposed rules and guidance we're releasing today would make it illegal for insurance companies to discriminate against the approximately 129 million Americans with pre-existing health conditions."
In its "Healthwatch" blog, The Hill (11/21, Baker) reports that the new regulations "require insurance companies to cover people with preexisting medical conditions - one of the most popular provisions of President Obama's healthcare law." However, the article notes that "the regulations still leave key questions unanswered, including the structure of a federally run insurance exchange in the roughly 30 states that won't set up their own." According to the blog, "HHS officials said more information on the federal exchange will be coming soon."
An article in CQ (11/21, Reichard, Subscription Publication) observes that "missing from Tuesday's massive release of hundreds of pages of proposed rules filling in the details of the sweeping redesign of the insurance market, set in motion 32 months ago by passage of the health care law, were details on an entity looming ever larger in delivering the fruits of that legislation: the federally facilitated exchange." CQ later mentions that "during a press call about the rules that are ushering in unprecedented changes in the cost and components of health coverage, Gary Cohen, a senior official at the Centers for Medicare and Medicaid Services, said that 'we will be putting out additional guidance on the federally facilitated exchange in the near future.'"
The New York Times (11/21, A17, Pear, Subscription Publication) reports that "the proposed rules, issued more than two and a half years after President Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign." According to the article, "insurance companies are rushing to devise health benefit plans that comply with the federal standards." Beginning in October, "people can enroll in the new plans, for coverage that begins on Jan. 1, 2014."
Bloomberg News (11/20) reports that "UnitedHealth Group Inc. (UNH) and other health insurers would be able to vary their premiums based only on age, tobacco use, family size or geography under proposed U.S. rules meant to protect people with pre-existing illnesses." Additionally, "the Department of Health and Human Services outlined conditions and services insurers must cover, and laid out rules to let companies expand employee wellness programs, according to proposed regulations posted online today." The article details that "the first rule targets 50 million to 129 million Americans who have conditions such as diabetes and cancer that insurers have cited to deny coverage or increase premiums, the department said in its filing."
The Washington Post (11/21, Aizenman) reports that the new rules "would loosen some of the 2010 health-care law's mandates on insurers while tightening others." For instance, the article points out that "the law permits insurers to set their premiums for tobacco users 1.5 times higher than those for non-smokers," but "insurers wouldn't be allowed to impose the surcharge on smokers enrolled in smoking-cessation programs."
Also covering the story are: McClatchy (11/21, Pugh), the Washington (DC) Post's (11/21, Kliff) "Wonkblog," the National Journal (11/21, Sanger-katz, Subscription Publication), Modern Healthcare (11/20, Zigmond, Subscription Publication), Kaiser Health News (11/20, Appleby, Hancock, Carey), MedPage Today (11/21, Pittman), the Huffington Post (11/20, Young), the Jacksonville (FL) Business Journal (11/20, Aboraya, Subscription Publication), and the Seattle Times (11/21).
Rules Expand Prescription Medication Coverage. The AP (11/21, Murphy) reports that "the Obama administration has strengthened" the prescription medication coverage "that will be available to the millions of people who will get insurance through the nation's new health care overhaul starting late next year." According to the report, Dan Mendelson, CEO of the market analysis firm Avalere Health, saw one crucial change in the rules released Tuesday: "Health insurance plans will now have to cover the same number" of prescription medications "as the benchmark plan in their states." Essentially, this requirement "means there will be a higher number" of prescription medications "covered in each class, such as antipsychotics or antidepressants, than had previously been required."
Analysis: Public Largely Unaware Of Healthcare Law Changes. The Washington Post (11/21, Kliff) reports that "after surviving a Supreme Court decision and a presidential election, the Obama administration's health-care law faces another challenge: a public largely unaware of major changes that will roll out in the coming months." While "states are rushing to decide whether to build their own health exchanges and the administration is readying final regulations," an increasing "body of research suggests that most low-income Americans who will become eligible for subsidized insurance have no idea what's coming." The Post says that "policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved."
New Rules Encourage Wellness Programs. In its "Healthwatch" blog, The Hill (11/21, Viebeck) reports that the new regulations "encourage participation in employer-based wellness programs as a way to drive down healthcare costs." According to the article, "wellness rules will increase the maximum permissible reward for workers who participate in programs that encourage certain health outcomes, such as smoking cessation or weight loss."
CQ (11/21, Reichard, Subscription Publication) reports that "as is proscribed in the health law (PL 111-148, PL 111-152), the maximum permissible rewards would increase in 2014 from the current ceiling of 20 percent of the cost of health coverage to 30 percent." However, the article adds that "the proposed regulation says that when it comes to programs designed to prevent or decrease tobacco use, the maximum reward could be increased to as much as 50 percent." According to CQ, "Federal officials say this proposal also would protect individuals from unfair underwriting practices that could otherwise reduce benefits based on someone's health status."
However, NBC News (11/20, Fox) notes in its "Vitals" blog that "the rules do not specify the types of wellness programs employers can offer."
Insurance Industry Reacts To New Rules. CQ (11/21, Norman, Subscription Publication) reports that the "reaction from the insurance industry" on the new rules "was not overly critical." Karen Ignagni, president and CEO of America's Health Insurance Plans, which represents the industry, said in a statement, "We appreciate that the proposed rules issued today seek to minimize coverage disruption, and we look forward to working with the department to achieve this goal."
In its "Healthwatch" blog, The Hill (11/21, Baker) reports that the rules "provide much-needed specifics for insurance companies that must prepare for new mandates set to take effect in 2014." In a statement, the Blue Cross Blue Shield Association said, "We welcome the release of the proposed regulations on exchanges, essential health benefits and insurance reforms, which are critical to implementing the healthcare reform law." BCBS went on to state, "With open enrollment less than a year away, having final rules is critical."
New Rules Address Some Of Florida Lawmakers' Questions About Exchange. The Palm Beach (FL) Post (11/21, Green) reports that "Florida's next Senate President Don Gaetz and House Speaker Will Weatherford wrote last week to Sebelius, saying leaders could not yet make a decision" on whether the state will open an exchange. They wrote, "The state lacks sufficient information to fully evaluate the potential impact of choosing one exchange model over another." The Post says that "the rules released Tuesday address some of the legislators' questions including a query about minimum benefits," but "it's unclear whether that information will speed a decision."
Two "Pay-For-Performance" ACA Provisions Go Into Effect Monday.
In a piece carried by dozens of major print outlets, including Bloomberg News, the Salt Lake Tribune, the Denver Post, and the Arizona Daily Star, the AP (10/1, Alonso-Zaldivar) reports, "As of Monday, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications." This is "part of a broader push under President Barack Obama's health care law to improve quality while also trying to save taxpayers money." According to the AP, in response to this new penalty system, hospitals "are working on ways to improve communication with rehabilitation centers and doctors who follow patients after they're released, as well as connecting individually with patients."
Politico (10/1, Norman) reports that two "major" provisions of the ACA go into effect Monday. The Hospital Value-Based Purchasing Program, in which "the government will pay hospitals according to how well they perform on a set of standard clinical quality measures and on surveys of patients' experience," and the second program which targets hospital readmissions, are "the largest efforts to date to nudge hospital payments away from paying for quantity toward so-called pay for performance."
Modern Healthcare (9/30, McKinney, Subscription Publication) (9/30, McKinney, Subscription Publication) reported further on the Hospital Value-Based Purchasing Program, which "was devised to compel hospitals to improve the quality and continuity of care beyond the acute events that put patients in their beds." However, "many hospital officials and industry experts say the program could force the nation's independent, community-based hospitals to make hard choices about whether they can stay that way." More hospitals are looking into joining systems to "help absorb the impact of financial cuts and more effectively treat patients across different settings of care."
Medicare Changes To Take Toll On Hospitals In Virginia, Washington, DC. The Washington Post (10/1, Sun) (10/1, Sun) reports, "Hospitals in the District and Northern Virginia will lose millions of dollars in Medicare funding over the next year because too many of their patients were readmitted to a hospital within weeks of being released, according to Medicare data and interviews with hospital officials." Of 16 hospitals in the District and Northern Virginia, the reductions over the course of a year "will vary from $1.2 million for MedStar Washington Hospital Center in Northwest Washington, the region's largest private hospital, to about $12,000 for Reston Hospital Center in Virginia." According to the Post, "some of the hardest-hit facilities are inner-city hospitals that tend to treat sicker, poorer patients."
Texas Hospitals Fined For High Readmissions. Fort Worth (TX) Star-Telegram (10/1, Mitchell) reports, "Ten Tarrant County hospitals, including Medical Center of Arlington and Texas Health Harris Methodist Fort Worth, are being penalized by Medicare for the number of patients who were readmitted soon after being discharged." The Texas hospitals are "among 2,200 nationwide whose Medicare reimbursements are being cut by as much as 1 percent," starting Monday
Essential Benefit Benchmark Plans Due Monday.
CQ (9/28, Norman, Subscription Publication) reported that ahead of Monday's deadline for states to submit their "benchmark plans for essential health benefits" to HHS, 16 states have "identified their proposed benchmark plans" and another 17 have "identified their potential benchmarks" as of Friday. HHS officials have pointed out that this deadline is a "soft" one, "since it was not sent out as a formal regulation." Further, HHS will soon "begin reaching out to states that haven't submitted benchmarks to discuss a default plan."
Illinois Approves "Lean" Essential Health Benefits Benchmark. The AP (9/28, Johnson) reported that on Friday, Illinois chose its benchmark essential health benefits plan, marking "another milepost" in implementation of the ACA. The state's healthcare council, appointed by Governor Pat Quinn, "approved Blue Cross Blue Shield's Blue Advantage plan," which the AP characterized as "a relatively lean small-group policy." Eventually, this benchmark plan "will determine the cost of future premiums and how broad coverage will be for many Illinois patients."
Maryland Approves Essential Health Benefits. In continuing coverage, the Baltimore Business Journal (9/28, Gantz, Subscription Publication) reported that Maryland approved its essential health benefits Thursday, to be based on the plan received by the state's employees.
Aetna Expands Prostate Cancer-Treatment Coverage.
Reuters (9/29, Clarke) reported Seattle-based Dendreon Corp's shares escalated Friday after health insurer Aetna announced it would expand coverage of the pharmaceutical company's prostate cancer drug, Provenge (sipuleucel-T), to include hormone treatment-resistant metastatic prostate cancer patients, who cancer has spread to the brain or lungs.
Bloomberg News (9/28, Flinn) added that Aetna spokesperson Susan Millerick explained that previously, the Hartford, Connecticut-based insurer "didn't cover the drug for patients whose cancer had expanded to the brain or lungs."
The AP (9/29) reported Aetna "posted a memo Friday saying it considers Provenge 'medically necessary' for men with late-stage prostate cancer that has not responded to other therapies" but the insurer stipulated that patients "must have cancer that has not reached the liver and a life expectancy greater than six months" to receive the coverage. Dendreon subsequently, released a statement saying it views Aetna's move "as a positive policy update for patients with advanced prostate cancer who may be eligible for Provenge and reflects Dendreon's continued efforts to ensure eligible patients have access." At present, Dendreon "has no other drugs on the market."
HHS Awards Grants For Six More Health Insurance Exchanges.
The Hill (9/28, Baker) "Healthwatch" blog reports, "The Health and Human Services Department awarded another $223 million in grants Thursday to help states build new insurance exchanges under the Affordable Care Act." The grants were given to five states and Washington, D.C. In total so far, "34 states have gotten federal money to begin building their exchanges."
CQ (9/28, Subscription Publication) adds that of the six recipients, Arkansas is the only which will not operate a state-based exchange. Instead, Arkansas received $18.6 million to apply toward the operation of the "federally facilitated exchange," or FFE. In addition to Arkansas and DC, Colorado, Massachusetts, Minnesota, and Kentucky received grants Thursday.
Modern Healthcare (9/28, Daly, Subscription Publication) reports that in a news release, HHS Secretary Kathleen Sebelius said, "The resources announced today will ensure states have the assistance they need to continue moving forward."
Colorado Receives $43 Million. The Denver Post (9/28, Booth) reports that Colorado received $43 million from HHS Thursday. The Denver Business Journal (9/28, Harden, Subscription Publication) adds that this "follows an early grant of $17.9 million from HHS in February."
Minnesota Receives $42.5 Million. The Minneapolis Star Tribune (9/28, Crosby) reports that Minnesota "received $42.5 million in its third federal grant to help design and develop a health insurance exchange." This brings the total so far to $70.3 million.
LifeHealthPro Evaluates Exchange Programs Across Country. In response to Thursday's grant announcements, LifeHealthPro (9/28, Festa) evaluates how, and if, insurance exchanges are being established across the country. They write that states that "passed legislation early and are constantly working on the build out, like California...still acknowledge exchange-building is a formidable task." And, "feuds and confusion in other states, coupled with Republican skepticism...collide as governors figure out whether they should wait until after the general elections." The piece then looks in depth at several states, including Kentucky, which received a grant Thursday, Wyoming, Minnesota, and Pennsylvania.
Kaiser Poll Finds Obama Has The Edge In Medicare Debate, ACA More Popular.
The Hill (9/28, Viebeck) reports that President Obama "maintains a 20-point advantage over Mitt Romney on Medicare, and his signature healthcare law is more popular than it has been in years," according to September's Kaiser Health Tracking Poll, which "had mostly good news for Obama, but this was tempered by one finding - that two in three seniors believe the healthcare law directly cuts Medicare benefits. ... Overall, the poll found that 45 percent of U.S. adults have a favorable view of the healthcare law, while 40 percent have an unfavorable view." The Hill adds, "Fifty-five percent of U.S. adults believe Medicare should stay as it is today, while 37 percent back the GOP's idea of partially privatizing the program with a voucher system, the poll found."
The Washington Post (9/28, Aizenman, Cohen, Craighill) reports that new polls from the Post and the Kaiser Family Foundation have found that voters in Florida, Ohio and Virginia "broadly oppose the sweeping changes to Medicare proposed by...Paul Ryan and, by big margins, favor President Obama over Mitt Romney on the issue." The Post adds, "Among seniors, the issue rivals the economy as a top voting issue, undercutting Romney's appeal in Florida, Ohio and Virginia. Generally, the more voters focus on Medicare, the more likely they are to support the president's bid for reelection."
The AP (9/28, Lederman) reports, "Seniors, like just about everyone else, have money on their minds." The AP adds, "More seniors say the economy is extremely important to their vote than Medicare, says a poll released Thursday by the nonpartisan Kaiser Family Foundation. A recent Associated Press-GfK poll shows 7 in 10 seniors say taxes and the federal deficit are important to them."
Poll Highlights Importance Of Medicare To Election. CQ (9/28, Subscription Publication) reports that the Kaiser Family Foundation poll , released Thursday, found that "36 percent of Americans said Medicare issues are 'extremely' important to their vote in the November election," the third highest share, behind just the economy and the deficit.
Politico Looks Into Obama's Changing Views On Medicare. Jonathan Martin, in a post for Politico (9/28, Martin) titled, "What Obama Isn't Saying About Medicare," says the President "better hope his audience hadn't thumbed through Bob Woodward's latest book." Martin adds, "As Woodward explains in 'The Price of Politics,' Obama was willing to make significant changes to the cherished federal health care plan for seniors last year as part of a grand bargain with congressional Republicans. And 2011 was hardly the first time Obama considered confronting the costly and popular program; it's also highly likely it won't be the last if he's reelected."
New Study Finds Romney's Healthcare Plan Would Cost Americans Millions.
CQ (9/28, Bunis, Subscription Publication) reports that left-leaning think tank Families USA released a study Thursday which found that "tens of millions more people would be uninsured and Americans would pay thousands of dollars more each year for their coverage under Mitt Romney's health proposals than under President Obama's health care law." The report explains that because Romney's plan would help people pay for insurance with tax deductions as opposed to tax credits, those who make more would benefit to a greater degree. The report also looks into how repealing the Affordable Care Act, which Romney vows to do, will affect seniors, via the Medicare Part D "donut hole."
The Hill (9/28, Viebeck) "Healthwatch" blog provides precise numbers from the study. It found that non-employer health insurance would cost a family an average of $11,481 in 2016 under Romney's plan, versus $5,985 if Obama stays in office.
The Business Courier of Cincinnati (9/28, Ritchie, Subscription Publication) "CincyBizBlog" reports on the specifics for families in Ohio, which the report says will pay about $5000 more a year under Romney's plan than Obama's.
Report: Private Insurance Through Employers Decreasing.
CQ (9/28, Norman, Subscription Publication) reports that new research shows "traditional private insurance through employers is contracting." Further, this study , by the nonpartisan Employee Benefits Research Institute, found that "those Americans who still have employer-based insurance are far more likely to earn more than $75,000 a year, work in a managerial or professional occupation, be employed by a big firm - and be white." This trend in private insurance coincides with a parallel trend, in which enrollment in public coverage is increasing.
Modern Healthcare (9/28, Zigmond, Subscription Publication) adds, "As the nation's unemployment rate hovers around 8%, employment-based coverage is likely to continue a downward trend for 2012."
Studies Show Rising Care Costs, Dropping Insurance Rate In US.
Bloomberg News (9/26, Wayne) reports that two studies released this week show that "medical prices accelerated faster than some projections last year and the number of uninsured is rising." First, the Health Care Cost Institute study released Monday found that "costs for people with employer-sponsored insurance plans jumped 4.6 percent in 2011, more than the government's 3.9 percent estimate for the entire health system." Then, a CDC report said that "the number of people without insurance climbed 1.7 percent in the first quarter of 2012." Together, Bloomberg says these data "show the U.S. goal of expanding health care is veering onto a more difficult road." The piece quotes a representative from HHS responding, "In recent years, overall health-care cost growth has reached record lows and the health-care law drives costs down."
The ABC News (9/26, Tapper, Dwyer) "Political Punch" blog reports on the Health Care Cost Institute study, and adds that a recent Kaiser Family Foundation report showed that "health insurance premiums for individuals and families also climbed" from 2010 to 2011, up three percent for an individual, and four percent for a family. The blog characterizes the two studies as counter to "President Obama's 2008 promise to contain" healthcare spending.
Looking further into the Health Care Cost Institute Study, CQ (9/26, Subscription Publication) calls it "the first broad look at 2011 health care spending for those with employer-sponsored health insurance." The study attributes the "uptick in spending" it found to "increases for all major categories of care: hospital stays, outpatient care, medical procedures and prescription drugs."
Republicans Use Study To Disparage ACA. The Hill (9/26, Baker) "Healthwatch" blog reports that Republicans used the Health Care Cost Institute study Tuesday "to argue that President Obama's healthcare law hasn't lived up to expectations." Republicans on the House Ways and Means Committee said, "The verdict is in, and it is clear that President Obama has failed to deliver."
Insurance Premiums Expected To Rise About 5.3% In 2013. NPR (9/26, Andrews) reports in its "Shots" blog, "the good news for this open enrollment season is that premiums aren't expected to increase quite as much for 2013 as they did this year." The blog says that "the increase looks to be about 5.3 percent instead of an average 5.9 percent rise for 2012, according to Towers Watson's annual health care survey of mid- to large-size employers." However, it points out that "the bad news" is that "employers will ask workers to shoulder more of the burden - again."
Poll: Most Believe ACA Will Be Implemented, Many Anticipate Changes.
The AP (9/26) reports, "About 7 in 10 Americans think President Barack Obama's health care law will go fully into effect with some changes, ranging from minor to major alterations, an Associated Press-GfK poll finds." Just 12 percent expect the ACA to be completely repealed, and a similar amount, 11 percent, believe it will be "implemented as passed." Summarizing the results, the AP writes, "Americans are converging on the idea that the overhaul will be part of their lives in some form, although probably not down to its last clause and comma."
Doctor Argues ACA Is "Destined To Fail."
In an op-ed for the Bangor (ME) Daily News (9/26), New York City doctor and medical professor Richard Amerling argues that the Affordable Care Act will make healthcare less efficient and more expensive. He writes, "It is destined to fail and will be expensive beyond belief, in dollars, lost opportunity and in misery. If only the free market were given a chance to deliver quality care at reasonable cost."
Op-Ed: ACA Improves Health Care. In an opposing op-ed for the Bangor (ME) Daily News (9/26), arborist Rufus Wanning contends that the Individual Mandate was in fact the "most politically conservative plan" available to Obama and Congress when devising the Affordable Care Act. He questions Republicans, notably Mitt Romney, who have pledged to repeal the entire law, and runs through the various negative effects this would have. Wanning concludes, "The Affordable Care Act represents a real health care improvement, not just according to Democrats, but according to wiser Republicans of the past."
HHS Launches Plan Summary Requirement For Insurers.
Reuters (9/25) reports that on Monday, a provision of the Affordable Care Act kicked in, requiring health insurance companies to offer a short, easy-to-understand summary of the benefits included their plans to potential buyers. These guides are intended to allow for side-by-side comparison of insurance plans much like a consumer would use nutrition facts on food packaging. The new rule is timed to coincide with the onset of the open enrollment season for most private health insurance plans.
The CQ (9/25, Adams, Subscription Publication) adds, "Some patients who buy their coverage on their own in the individual market can find the summaries on the federal website www.healthcare.gov. Others can request it or will be sent summaries when enrolling in a health plan." HHS Secretary Sebelius said of the new requirement, "Choosing a health plan is one of the biggest decisions any of us can make," and that these forms should make that decision easier.
Modern Healthcare (9/25, Zigmond, Subscription Publication) adds that the summary will include "information about covered health benefits, out-of-pocket costs and the network of providers." It will also have a "comparison tool called 'Coverage Examples,'" used to "compare options of what different health plans offer for two common medical conditions: managing Type 2 diabetes and having a baby."
Sebelius: New Form Makes Choosing A Health Plan Easier. In an op-ed for USA Today (9/25, Sebelius), Health and Human Services Secretary Kathleen Sebelius notes that as the open enrollment season for many health plans draws near, "Americans have an important new tool to help them pick the right coverage thanks to the Affordable Care Act." She explains that the "Summary of Benefits and Coverage" is a "simple, standardized form" that tells consumers "what a given health plan covers and how much it costs. As a result, comparing health insurance options to find the best one for your family has never been easier." Sebelius notes that thanks to the new form, Americans will no longer be "forced to take their chances, buying a policy without all the facts." She concludes, "Choosing a health plan is one of the biggest decisions any of us make. Starting today, that decision will be a lot easier."
WPost Discusses What Consumers Should "Expect" This Open Enrollment Season. The Washington Post (9/25, Andrews) reports that in addition to having an "easier" time comparing plans, workers can expect a few other changes as the health insurance open enrollment seasons begins. Premiums "are expected to rise 5.3 percent in 2013," which is a smaller increase that this year. Dependents are also expected to cost more. In more consumer-friendly news, wellness programs will "get more muscle."
ACA Allows States To Choose "Essential Health Benefits."
The Washington Post (9/22, Kliff) "Wonkblog" reported, "Policy experts expected the Affordable Care Act to establish a basic set of health benefits for the nation, but the Obama administration instead empowered each state to devise its own list." Various proposals states have made include permitting coverage of acupuncture in California, and chiropractic services in Michigan. According to Wonkblog, "That nationwide patchwork highlights the difficulty of agreeing on what constitutes good basic health care, as well as the tricky balances that states face in weighing coverage vs. cost."
Obama Administration Considering New System To Report Medical Mistakes.
The New York Times (9/23, A20, Pear, Subscription Publication) reported that the Obama Administration is considering a system for the public to report "medical mistakes and unsafe practices" in healthcare. Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, said of the proposed system, "Patient reports could complement and enhance reports from providers and thus produce a more complete and accurate understanding" medical mistakes. Draft materials include an informational flier and a questionnaire; results "would be analyzed by researchers from the RAND Corporation and the ECRI Institute, a nonprofit organization that has been investigating medical errors for four decades." The Times said consumer groups like the American Hospital Association are receptive, while the AMA had no immediate reaction but said it would study the idea.
Sequester Cuts To Medicare Will Result In "Massive" Job Loss.
In continuing coverage, American Medical News (9/24, Fiegl) reports that the "mandatory, across-the-board spending cuts to Medicare" included in the Federal budget sequester "will lead to large job losses at physician offices and throughout the rest of the health care system." This is according to a study by the Pittsburgh-based consulting firm Tripp Umbach, commissioned by the American Hospital Association.
Reps Introduce Bill To Alter CBO Scoring Of Preventive Health Programs.
Modern Healthcare (9/24, Lee, Subscription Publication) reports that "Reps. Michael Burgess (R-Texas), a physician, and Donna Christensen (D-Virgin Islands) introduced legislation that would change how the Congressional Budget Office looks at budget savings from wellness programs." Their bill, the Preventive Health Savings Act, "calls for the CBO to analyze scientific data to gather information on budget savings achieved through disease prevention and wellness programs beyond the 10-year budget-scoring period." According to Healthcare Leadership Council President Mary Grealy, this legislation "will encourage more federal investment in prevention of chronic diseases."
Lobbying Groups Making Their Case Against Sequester In Washington.
The National Journal (9/21, McCarthy, Subscription Publication) reports that ahead of the sequester, armed with the "ammunition" from last week's CBO report, lobbying groups are doubling down on efforts to make lawmakers aware of the effects the automatic cuts would have on their various industries. Among those lobbying are Medicare providers, like hospitals, doctors, and nursing homes. American Health Care Association (AHCA), "released a television ad that features Beverly McKinney, an elderly woman who was hit by a car and recovered from a broken pelvis at a long-term care facility." The ad is running on cable channels throughout Washington, DC, and is "specifically targeted at Capitol Hill staffers and lawmakers." AHCA President Mark Parkinson said in a statement, "We're running these ads to remind policymakers that cuts have consequences and [could] potentially jeopardize the tens of thousands of residents we care for every day."
Sequester Could Cost Maryland 13,000 Jobs. The Baltimore Business Journal (9/21, Gantz, Subscription Publication) reports that Maryland could lose 13,000 jobs by 2021 if the sequester is not avoided, according to a report by consulting firm Tripp Umbach. The figure is based on the 2% reduction in Medicare reimbursements included in the "Budget Control Act of 2011."
Some Patients Receive Colonoscopy Bill Due To Coding Variations.
MedPage Today (9/21, Pittman) reports, "Although most patients expect colonoscopies to be provided free of charge, patients sometimes receive a bill because of coding variations among physician offices," according to a report. While colonoscopy, "as a recommended preventative service...is supposed to be provided without a copay or deductible under the" health reform law, "differences in billing codes from insurer to insurer, state regulations, and whether or not a colonoscopy is considered preventative complicate matters." According to MedPage Today, "The Kaiser Family Foundation, American Cancer Society, and the National Colorectal Cancer Roundtable identified three situations in which patients encountered unexpected cost sharing for colonoscopies: when a polyp is detected and removed during screening, when a screening is done following a positive stool blood test, and when the patient is at increased risk for colon cancer."
Kaiser Looks Into Effect Of Competition On Healthcare Market.
A feature for Kaiser Health News (9/21, Appleby, Serafini), in collaboration with The Atlantic, looks into whether offering more competition in a healthcare market actually "tames costs" in the way that many Republican lawmakers contend. The article cites the Federal Employee Health Benefits Program, which "is often touted as holding down the increase in premium prices more successfully than private workplace plans or government-run programs." The article concludes, based on data analysis and interviews with experts, that "it has not held down costs per enrollee as efficiently as Medicare during the past decade." The piece compares tenets and outcomes of the two programs extensively.
NPR Blog: ACA Faces Two More Challenges.
In continuing coverage, the NPR (9/21) "Shots" blog reports on two of the latest challenges to the Affordable Care Act. The first came from the Congressional Budget Office, which Wednesday "issued a report that increases by 50 percent its estimate of how many people will ultimately pay a fine rather than purchase health insurance as required." The second comes from Oklahoma Attorney General Scott Pruitt, who has "filed an amended lawsuit in federal court charging that an IRS rule to implement the law's subsidies exceeds its authority under the measure."
CMS Has Yet To Release Essential Benefits Proposal.
CQ (9/20, Reichard, Subscription Publication) reports, "Despite indications that it might be out by now, a proposed rule setting minimum standards for the benefits that insurers must provide under the health care law has yet to emerge – and the Obama administration may be skittish about releasing it before the approaching election." With insurance exchanges set to begin next year, "insurers, states and health care law supporters all say that...having a proposed rule is key." According to CQ, the CMS has "issued a 'bulletin' to guide states on putting together an essential benefits standard," but "that's not the same as a proposed regulation."
CBO Says Nearly Six Million Will Pay Tax Penalty Under Healthcare Law.
The CBO said Wednesday that nearly 6 million people, most of whom are in the middle class, will face a tax penalty under the Affordable Care Act for not getting health insurance. The AP (9/20, Alonso-Zaldivar) reports that the new CBO numbers are "50 percent higher than a previous projection by the same office in 2010, shortly after the law passed. The earlier estimate found 4 million people would be affected in 2016, when the penalty is fully in effect." The AP adds that the new estimate, which is "significantly" higher than original estimates, "amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises."
The Washington Times (9/20, Cunningham) reports that the CBO "said the government will collect about $7 billion from the tax in 2016, and $8 billion a year thereafter." The Times also notes that the "six million expected to pay the penalty is a relatively small percentage of the 30 million non-elderly residents who will be uninsured in 2016."
CQ (9/20, Ethridge, Subscription Publication) explains that "about 85 percent of that increase is due to changes resulting from higher unemployment rates, lower wages and salaries, and the effects from laws passed since 2010."
The Hill (9/20, Baker) "Healthwatch" blog adds that another reason for the estimate's increase is the Supreme Court ruling that states could opt out of Medicaid expansion. In states that opt out, "millions of people will lose Medicaid as an option. Most will be poor enough to be exempt from the individual mandate, but a small percentage will have to buy private coverage or pay the fine."
Census Data Show Uninsured Rate Has Dropped In Twenty States.
Kaiser Health News (9/20, Galewitz) reports that the Census Bureau has released state-level data on health insurance, which shows that "the percentage of people without health insurance fell in 20 states last year with Oregon, Rhode Island and Vermont seeing the biggest declines." Still, "two states had a statistically significant increase in the uninsured rate, Missouri and Montana." This Census Bureau release comes after last week's heavily reported news that, nationally, the number of uninsured had dropped for the first time since 2007. Kaiser looks farther into these new numbers, and runs a chart with the uninsured rate for every state.
More North Texans Insured. The Dallas Morning News (9/20, Michaels) reports that the latest Census Bureau data show that "the share of North Texans without health insurance fell for the second straight year in 2011, largely because of higher numbers of children on public insurance and gains in the number of young adults on private policies." In 2011, 22.3% of North Texans had no health insurance, as compared to 23.5% in 2008. The progress comes mostly from gains among young adults and young children.
House Bill Aims To Alter Popular Medical Loss Ratio.
The Hill (9/19, Viebeck) "Healthwatch" blog reports that the medical loss ratio, a popular provision of the Affordable Care Act, "would change under a House bill now ready for mark-up." The measure, sponsored by Representative Mike Rogers (R-MI), would exclude "insurance brokers' fees from counting as administrative costs under the requirement." According to Healthwatch, the bill is seeking to "placate" brokers. It is expected to pass the Energy and Commerce Committee Thursday.
Law Professor Urges Congress To Protect Medical Loss Ratio. In an op-ed for Politico (9/19), Washington and Lee University School of Law professor Timothy Stoltzfus Jost writes that Congress "seems poised to throw out one of the most popular and effective provisions of the Affordable Care Act," the medical-loss ratio. He argues that the move is "intended to protect the income of a special interest group," and, "some Democratic House members are helping Republicans do it." After discussing the merits of the so-called "80/20 rule," he concludes that it is in everyone's best interest to keep this provision standing.
Former IRS Commissioner Lists Challenges Stemming From ACA.
In a post for The Hill (9/19) "Congress Blog," former IRS Commissioner Mark W. Everson argues that the agency is not prepared for the new duties foisted upon it by the Affordable Care Act. He runs through a list of challenges the Administration faces due to the new law, including updating major information services, informing practitioners like CPAs and individuals of intricacies to ensure compliance, and greater reliance on the White House and other government agencies. On top of this, the IRS is already facing a tough season because "of delayed congressional action on numerous tax provisions and the exploding problem of identity theft." He concludes that if all doesn't go perfectly, "the damage to tax administration would be serious and lasting."
Kaiser Questions Effect Of ACA On HIV Treatment.
CQ (9/19, Norman, Subscription Publication) reports on a Kaiser Family Foundation brief , released Tuesday, which questions how HIV treatment will be affected under the Affordable Care Act. The main concern is with Medicaid, and whether allowing states to opt out of the expansion will leave many patients with HIV without coverage. The brief also "asks whether the benefit packages that will be available through Medicaid and state-based exchanges will be sufficient for people with HIV." And third, Kaiser expressed worry that the Ryan White program, "which in the past has been key in helping people with HIV and AIDS get care, might be changed or restructured when it comes up for reauthorization next year."
Study: Off-Label Use Of Antipsychotics Has Increased Among Kids On Medicaid.
HealthDay (9/19, Dallas) reports that over the past 10 years, the use of antipsychotic medications off-label "has increased among children enrolled in Medicaid," according to a study published Sept. 10 in the journal Health Services Research. "In the study, researchers from the Children's Hospital of Philadelphia found a 62 percent jump in the number of publicly insured children between the ages of three and 18 taking antipsychotics. In 2007 alone, 65 percent of the 354,000 children on these drugs were taking them for uses that have not been approved by the FDA, the investigators pointed out."
Last week both the Obama Administration and the Kaiser Family Foundation issued very different reports about the cost of health insurance in 2011. The one from the Obama Administration claims over $2 billion in health insurance premium savings in the past year, while the Kaiser Family Foundation report shows the average American covered by employer-sponsored insurance paid $700 more in premiums in 2011. Now, we at the Washington Update readily admit that the only math we can be trusted to perform accurately in our head is calculating discount percentages while shopping. But even with our weak math skills, we were pretty sure those numbers didn't add up. When we broke out our trusty calculator app and multiplied the number of Americans with employer coverage (170 million) by $700 we got $119 billion. Then we went to the newly released census report and divided the number of privately insured Americans (197,323,000) by $2.1 billion and got nine cents. After that we put our phone down and went in search of our migraine medication.
Once revived, we did a little bit of digging (a skill at which we excel) to find out what exactly constitutes the administration's $2.1 billion in "savings." It turns out that $1.1 billion was attributed to the health reform law's MLR rebates, which are dubious savings at best. The remaining $1 billion was attributed to the new law's rate review provisions. However, when we looked into it we found that the report did not take into consideration any of the many state rate review systems that were in place long before the health reform law was enacted. Furthermore, savings percentages were not weighted by enrollment, so while rate review may have resulted in a lower premium amount than what a carrier originally proposed for a given product, that doesn't mean anyone actually bought the product which wound up with an adjusted rate.
The folks at the Congressional Joint Economic Committee (JEC), who likely have much stronger math skills than we do, were also a little concerned about the discrepancies between the two reports. In response they updated an earlier JEC report about the cost of coverage and found that the average family has paid $12,791 more in health insurance premiums over the past four years, which has cost the economy as a whole more than $843 billion. Again, those are numbers that are a little bit different than what then candidate Obama promised in 2008--that the cost of coverage would go down by $2500 per family
Obama Administration Says No Insurance For Young Immigrants.
In a front-page story, the New York Times (9/18, A1, Pear, Subscription Publication) reports, "The White House has ruled that young immigrants who will be allowed to stay in the United States as part of a new federal policy will not be eligible for health insurance coverage under President Obama's health care overhaul. The decision - disclosed last month, to little notice - has infuriated many advocates for Hispanic Americans and immigrants. They say the restrictions are at odds with Mr. Obama's recent praise of the young immigrants." Despite the President's recent announcement "that hundreds of thousands of illegal immigrants who came to the United States as children, attended school here and met other requirements would be allowed to remain in the country without fear of deportation," HHS told state health officials that "young immigrants granted a reprieve from deportation 'shall not be eligible' for Medicaid or the Children's Health Insurance Program."
Sequestration Could Lead To $11 Billion Reduction In Medicare Payments.
McKnight's Long Term Care News (9/18) reports that "failed budget deficit negotiations in Congress could result in an $11- billion reduction in payments to Medicare providers, a government analysis released Friday predicts." According to the article, "under the terms of the Budget Control Act of 2011, if Congress cannot agree on a plan to reduce government spending by $1 trillion, a set of 'triggered' or 'sequestered' cuts will be enacted on Jan. 1." It notes that "if a stalemate occurs, the Obama Administration favors a 2% reduction in payments to Medicare providers, rather than cutting beneficiary benefits, according to a report released by the White House's Office of Management and Budget."
Poll: More People Forgo Filling Prescriptions Due To Cost.
WebMD (9/14, Mann) reports that "more than 80% of Americans who don't have prescription drug coverage are not filling their prescriptions, skipping medical tests, passing on doctor's appointments because of cost, or cutting corners elsewhere, a new Consumer Reports poll shows." The article points out that "nearly half of the adults polled did not fill a prescription because of cost in the past year, compared with 27% last year." Lisa Gill, the editor of prescription drugs for Consumer Reports, remarked, "the jump from one year to the next was massive, bordering on a crisis."
The New York Daily News (9/14, Furman) reports that the poll found that "overall, a whopping 81% said that over the past 12 months they have been trying to cut corners to cope. That's up from 65% last year." According to the article, "problems paying for medical bills and medications is the No.1 financial woe Americans face today - more than meeting mortgage payments or paying big household bills, Consumer Reports said."
AHIP Leader Asks Congress To Lower ACA Benefit Threshold.
CQ (9/14, Reichard, Subscription Publication) reports, "A spokesman for the nation's biggest health insurance lobby testified in Congress this week that the health care law should be changed to require less generous benefits than it does now." Said Daniel T. Durham, executive vice president of the trade group America's Health Insurance Plans (AHIP), "Consideration should be given to lowering the minimum actuarial value for coverage sold in the exchanges to ensure the availability of affordable coverage options and to allow smoother transitions to new benefits packages." The article explains Durham's views in more detail.
Census Data Indicate Fewer Americans Uninsured.
New Census Bureau data released Wednesday indicating that fewer Americans lacked health insurance coverage last year received a significant amount of coverage, particularly online. Many sources point to a provision in the Affordable Care Act allowing young adults to remain on their parents' policies as one potential reason for the decline.
The Census data say that "the rate of Americans without health insurance decreased to 15.7 percent last year, down from 16.3 percent in 2010," Politico (9/13, Millman) reports. The data also indicate that the "number of people without coverage also decreased to 48.6 million in 2011, down from 50 million in 2010." Politico points out that "in a White House blog post, the Obama administration said the new figures prove the Affordable Care Act is working."
The Washington Post (9/13, Aizenman) reports that one "major factor was an influx of newly insured young adults, many of whom benefitted from a provision in the 2010 health-care law requiring insurers to let parents keep adult children on their plans up to age 26." However, "for most other age groups, the numbers largely reflected the continuation of a long-running shift away from private insurance toward government coverage - with Medicare and Medicaid picking up much of the slack left by the steady erosion of employment-based insurance." The Post also points out that "for the fifth straight year, the portion of Americans on Medicaid, the joint federal-state program for the poor and disabled, increased, reaching 16.5 percent in 2011."
Bloomberg News (9/13, Wayne) reports that altogether, "48.6 million people were uninsured last year, compared with 49.9 million in 2010, the largest numerical drop since at least 1999, according to Census data." The Obama "administration had estimated that 3.1 million people who would otherwise lack insurance this year took advantage of the health law to join their parents' coverage." Bloomberg News adds, "The Census data showing increased coverage of young adults 'is a clear signal that the Affordable Care Act is working,' said Ron Pollack, executive director of Families USA, a nonprofit consumer advocacy group in Washington that supports the law."
The Hill (9/13, Baker) "Healthwatch" blog reports that "2011 was also the first time in 10 years that the number of people with private health insurance did not fall, according to the Census Bureau." Approximately "55 percent of the population has private coverage, and 32.2 percent are on government programs - up from 31.2 percent in 2010."
The NBC News (9/13, Fox) "Vitals" blog reports, "Liberal groups said the data showed that fears health care reform would cause employers to stop offering health care coverage are unfounded."
CQ (9/13, Norman, Subscription Publication) reports, "David Johnson, chief of the social, economic and housing statistics division at the census, estimated that about 40 percent of the decline in the uninsured could be tracked to the health care law," although he "wouldn't tie the entire change directly to the law, saying that some of the newly insured may have found coverage through other means."
CNN Money (9/13, Fox) reports, "The rate of private health coverage ticked higher for all age groups between 18 and 54, but for those in the 55- to 64-year old bracket, the rate edged slightly lower."
The Huffington Post (9/13, Young) reports, "Fewer Americans may be without health insurance compared with 2009 and 2010, but the 48.6 million uninsured people last year still stands as the third-highest number ever and is 4.5 million more than in 2007. The share of the US population that was uninsured last year is tied for the fourth-highest on record." The Affordable Care Act "will extend health insurance coverage to about 30 million people starting in 2014, the Congressional Budget Office projects."
Also covering the story are: Kaiser Health News (9/13, Galewitz), the St. Paul Pioneer-Press (9/13, Snowbeck), the Connecticut Post (9/13, Cuda), the New Orleans Times-Picayune (9/13, Adelson), the Salt Lake (UT) Tribune (9/13, Stewart), the Providence (RI) Journal (9/13, Freyer), the Greater Binghamton (NY) Press & Sun-Bulletin (9/13, Spector), the Sacramento (CA) Bee (9/13, Walters) "Capitol Alert" blog, the Orlando (FL) Business Journal (9/13, Aboraya, Subscription Publication), the Phoenix Business Journal (9/13, Gonzalez, Subscription Publication), the New Mexico Business Weekly (9/13, Domrzalski, Subscription Publication), the Houston Business Journal (9/13, Raji, Subscription Publication), and Modern Healthcare (9/13, Blesch, Evans, Subscription Publication).
NYTimes Credits Healthcare Reforms For Decline In Uninsured. In an editorial, the New York Times (9/13, A30, Subscription Publication) says the decline in the number of uninsured Americans is "in large part, the result of the health care reform law and better coverage under public programs like Medicaid," and adds that the decline "shows why repealing the health care law or revamping and shrinking Medicaid, as many Republicans want to do, would be disastrous moves." According to the Times, the census data "underscore the importance of retaining the health care reforms, which will increasingly make insurance more affordable for middle-class families."
Study: Insurance Premiums See Moderate Increase.
New research on trends in US health insurance costs received heavy coverage in print and online, but was not mentioned during any of last night's national news broadcasts.
On the front page of its "Business Day" section, the New York Times (9/12, B1, Abelson, Subscription Publication) reports on a study released Tuesday by the Kaiser Family Foundation, which found that "a family with employer-provided health insurance now pays just under $16,000 in annual premiums, an increase of about four percent over a year ago," while "individual policies purchased through an employer rose even less, increasing just three percent from last year to an average of $5,615." According to Kaiser, "the lower premiums were a sign that the rise in health care costs continued to be modest," although "the study's authors were cautious about the explanation, wondering whether the smaller increases in recent years signaled the start of a long-term trend or were simply the result of a slow economy."
IRS Reports On Readiness To Handle New Tax Regulations From Healthcare Law.
The Hill (9/12, Baker) "Healthwatch" blog reports that Congressional Republicans from the House Ways and Means Committee "hammered the tax provisions of President Obama's healthcare law" at a hearing to gauge the IRS' readiness to handle new tax provisions included in the Affordable Care Act on Tuesday. According to the Hill, this "tax attack is the latest front in Republicans' three-year assault on Obama's healthcare plan." One accusation the Republicans levied was that "individuals and businesses will spend nearly 80 million hours complying with the law's new mandates and tax filing requirements."
The Washington Times (9/12) "Inside Politics" blog reports, "A top IRS official assured Congress on Tuesday that the agency will be prepared to dole out health insurance subsidies to millions of Americans 15 months from now." Deputy Commissioner Steven Miller replied, "Absolutely," when House Ways and Means Oversight Subcommittee Chairman Charles Boustany asked "whether the agency will be ready to implement a major part of President Obama's health care law in 2014." Miller continued, "Based on the planning and structures we've put in place, we will be ready on the exchange provisions." He also "denied a charge that the agency will need to hire up to 16,000 new agents, an estimate which has been circulated by Republicans."
Reuters (9/12, Dixon) reports that Miller assured the subcommittee that the IRS will not force Americans to buy health insurance, and that the new law should not create any negative interactions with the agency. He said, "In most cases, taxpayers will file their tax returns reporting their health insurance coverage, and-or making a payment, and there will be no need for further interactions with the IRS."
Poll: Obama Has Double-Digit Advantage On Issues Of Medicare, Healthcare.
The Politico (9/11, Schultheis) "Burns & Haberman" blog reported, "More from the new CNN poll out this afternoon: President Obama has a double-digit lead over Mitt Romney on both the issues of health care and Medicare." The CNN poll found that "54 percent of likely voters think Obama would better handle the issue of health care, compared with 45 percent for Romney." On Medicare, "Obama leads Romney by 11 points, 54 percent to 43 percent, compared with a 1-point lead back in the pre-convention August poll."
Center for American Progress Officials Defend Study Critical Of Romney Medicare plan. The Hill (9/11, Viebeck) "Healthwatch" blog reported, "Officials with the left-leaning Center for American Progress (CAP) backed up President Obama's claim that seniors will pay tens of thousands of dollars more for healthcare under Mitt Romney's plan." Obama's charge "came from a CAP Action Fund study released in" last month. "The study concluded that someone retiring at age 65 in 2023 would pay $59,500 more for healthcare after the reforms to Medicare advocated by Romney and Ryan. Someone retiring in 2030 would pay $124,600 more, the study found."
Poll Shows Concern Among Voters About Medicare.
The National Journal (9/11, Cooper, Subscription Publication) reports, "With less than two months to go before Election Day, Americans are expressing concern about the viability of the Medicare system, a leading Republican plan to reform it, and whether President Obama's health care plan will help them." According to the latest edition of the United Technologies/National Journal Congressional Connection Poll, "a full 68 percent of respondents strongly or somewhat agreed with the proposition that 'the Medicare program is running out of money and will have to change if it is to survive.'" And only half agreed with the statement "Medicare will pay enough benefits when I get older to cover all or most of my health care needs." Further, "Democrats were more supportive than Republicans of leaving Medicare as it is, although a slim majority of Republicans favored keeping it as is."
"Blue Button" To Provide Veterans Access To Personal Health Records.
Modern Healthcare (9/11, Conn, Subscription Publication) reports that "pushing the Blue Button was what a parade of government and private-sector health information technology leaders did-often and with gusto-during a series of panel discussions in Washington to kick off Health IT Week." The article describes that "the 'silly little ASCII file,' as Peter Levin, chief technology officer at the US Veterans Affairs Department described it, is now the format of copies of electronic medical records accessible by more than 1 million VA patients who have registered to use the VA-developed Blue Button system that launched" two years ago. "Named for a Blue Button on the VA's personal health-record system that activates the mechanism, it enables veterans to access their records [in] the VA's VistA EHR system and copy them in either the plain-text ASCII or PDF formats," the report adds.
Finally Some Guidance on Employer Issues
After promising new guidance for almost a month, the IRS finally released two notices last week to provide employers with much-needed guidance on how to count employees for the purposes of PPACA’s employer mandate and 90-day waiting period requirements. Notice 2012-58 covers the definition of a full-time employee for purposes of the assessment of employer penalties relative to the employer mandate requirements and Notice 2012-59, which was issued jointly with the Department of Health and Human Services (HHS) and the Department of Labor covers the law’s 90-day limitation on waiting periods. The notices state that employers can rely on the guidance in the documents at least through the end of 2014, which means don't hold your breath waiting for formal regulations on this topic.
Notice 2012-58 expands the safe harbor method described in previous notices to give employers the option to use a look-back measurement period of 3 to 12 months to determine whether newly hired, variable hour or seasonal employees are full-time employees. Employers can use the same method for ongoing employees. Employers will not be subject to tax penalties for these workers during the measurement period. Employers will be required to offer a corresponding stability period of up to 12 months during which coverage will be available to employees determined to be full time at the conclusion of the look-back period.
The notice also provides for an administrative period for ongoing employees and certain newly hired employees between the end of the look-back period and the effective date of coverage to permit employers to complete the enrollment process. Employers who offer coverage will not be subject to tax penalties for not offering coverage to full-time employees for the initial three months of employment (corresponding with the 90-day waiting period limitation). Furthermore, the notice is explicit that employers will not be subject to tax penalties if the employee’s contribution to employer-sponsored self-only coverage does not exceed 9.5% of an employee’s Form W-2 wages reported in Box 1 (the affordability safe harbor).
In addition to providing this guidance to employers, the employer responsibility notice specifically seeks comments on a variety of issues. The tax man would like these comments back by September 30, so guess what your Washington Update author will be doing next week? If you have any thoughts on the following points, please feel free to email them to firstname.lastname@example.org.
- Whether and, if so, what types of safe harbor methods should be available to employers for use in determining the full-time status of short-term assignment employees, temporary staffing employees, employees hired into high-turnover positions, and other categories of employees that may present special issues?
- Whether to develop additional guidance (such as relevant factors or safe harbors) to assist employers and employees in determining, as of an employee’s start date, whether the employee is reasonably expected to work an average of at least 30 hours per week, including whether the employee is a variable hour employee.
- What rules should be provided to address coordination of differing measurement and stability periods during the transition following a merger or acquisition?
- How the term “seasonal worker” should be defined for purposes of the ACA’s employer tax penalty provisions?
- Meanwhile, Notice 2012-59 specifically addresses how the 90-day waiting period limitation applies to variable hour employees where eligibility for an employer plan is determined using an hours of service requirement. The notice states that an employer who offers coverage will be considered in compliance with the limitation so long as coverage for an eligible employee is effective within 13 months of the employee’s start date (plus the fraction of a month to the first day of the next calendar month). The notice includes four examples, including one in which an employer offers coverage to part-time employees after 1,200 hours of service.
The Los Angeles Times (9/10, Zamosky) reports on future prospects for healthcare in the United States, writing, "With all the squabbling about healthcare, there's one fact on which all sides can agree: American medicine costs too much, especially when you consider what we're getting for our money. And as experts look toward the future, they don't see costs dropping dramatically any time soon." Explaining further, the Times writes, "Americans spent $2.6 trillion on medical care in 2010, or about $8,233 per person. That's more than any other country spends to keep its citizens healthy, dwarfing the per-person price tag of even the second-biggest spender on health, Switzerland, by nearly 60%. The price of healthcare in the U.S. is generally expected to remain high." The article explains the various causes of the continuing high costs, which will reach nearly 20% of GDP by 2020.
ACA To Bring In "New Age Of Consumerism." The Los Angeles Times (9/10, Zamosky) reports, "The Patient Protection and Affordable Care Act is changing the way insurers do business." However, writes the Times, "it's not all good news: Future employers are also expected to shift more costs to employees, and consumers will generally take on more of their healthcare expenses." Though its implications are yet to be seen, "the health reform law will bring millions of new potential customers to insurers' doorsteps starting in 2014, ushering in a new age of consumerism. New services, tools and communication strategies are being developed to attract and retain your business, much the way banks and retailers have for years."
The New York Times (9/10, Tavernise, Subscription Publication) reports, "The share of young adults without health insurance fell by one-sixth in 2011 from the previous year, the largest annual decline for any age group since the Centers for Disease Control and Prevention began collecting the data in 1997, according to a new report released on Monday." Specifically, "The share of people ages 19 to 25 who lacked health insurance fell to 27.9 percent, down from 33.9 percent in 2010, or about 1.6 million fewer uninsured people," An analyst from the Center on Budget and Policy Priorities said "the increased coverage for young people was almost certainly due to a provision in the Obama administration's Affordable Care Act that allows children to stay on their parents' insurance policies until their 26th birthday."
The National Journal (9/8, Sanger-Katz, Subscription Publication) reported, the "Health and Human Services Department is launching a pilot program that would shift up to 2 million of the poorest and most-vulnerable seniors out of the federal Medicare program and into private health insurance plans overseen by the states. The administration has accepted applications from 18 states to participate in the program, which would give states money to purchase managed-care plans for people who are either disabled or poor enough to qualify for both Medicare and Medicaid. HHS approved the first state plan, one for Massachusetts, last month." This move stems from provisions in the ACA which "allow experimentation in delivering health care at lower cost through demonstration projects." The Journal focuses on the "irony" of the Administration's support for this pilot, because of campaign rhetoric.
In Newsweek (9/10, Klaidman), Daniel Klaidman writes, "For many Democrats, [Chief Justice] Roberts's Obamacare ruling was an act of judicial statesmanship that saved the Supreme Court from becoming a virtual arm of the Republican Party," while "for the right...it was an ideological stab in the back," but, according to Klaidman, "for Roberts himself, it was arguably the apotheosis of a jurisprudential and personal struggle years in the making-between his staunch conservatism and his attachment to predictability, social harmony, decorum, and propriety." Klaidman adds, "In voting to uphold health-care reform, Roberts showed deference to the elected branches of government, averted a direct clash with a president from an opposing party in the heat of a national election, and strengthened the court's institutional legitimacy as a neutral arbiter of the law," and now he "presides over a court awash in recriminations and leaks: just the kind of disorder and unseemliness that John Roberts has spent his whole life avoiding."
Bloomberg News (9/10, Tiron) reports that on NBC's Meet The Press (9/9, Gregory), Mitt Romney "said he would keep health insurance coverage for people with pre-existing conditions even as he vows to replace President Barack Obama's signature health-care law on the first day of his presidency. 'I'm not getting rid of all of health-care reform. Of course there are a number of things that I like in health-care reform that I'm going to put in place,' Romney said. 'One is to make sure that those with pre-existing conditions can get coverage.'"
NBC Nightly News (9/9, lead story, 4:15, Holt) also noted that Romney "disclosed he would preserve the most popular parts of the President's healthcare plan, something he said before, but went into more detail today."
In an editorial, Bloomberg News (9/10)writes that now that both conventions have ended, "one issue important to the health care of older Americans is rising into the sunlight and finally getting some of the attention it needs." They are referring not to Medicare, but Medicaid, which dedicates one-third of its funding to "long-term care for the disabled and frail elderly." The piece outlines both candidates' plans for the program: Obama's would continue the program as is, Romney's would ostensibly turn funding into a block grant. Though the editorial board sees Obama's plan as "preferable" to Romney's, they find neither adequate to best serve seniors.
Reuters (9/7, Dixon) reported on a recent trend of tax specialists helping wealthy clients, individuals who make over $200,000, avoid paying new taxes stemming from the healthcare law. Experts told Reuters about several methods for shielding income from the new taxes, or otherwise avoiding them. The article characterized this trend as demonstrating the complex and confusing nature of the law.
The AP (9/7, Alonso-Zaldivar) reports that yesterday the Institute of Medicine issued a report finding that "the U.S. health care system squanders $750 billion a year - roughly 30 cents of every medical dollar - through unneeded care, Byzantine paperwork, fraud and other waste." The conclusion drawn is that while both "President Obama and Republican Mitt Romney are accusing each other of trying to slash Medicare and put seniors at risk ... deep cuts are possible without rationing, and a leaner system may even produce better quality." That's because the IOM's "one-year estimate of health care waste is equal to more than 10 years of Medicare cuts" under the ACA and "more than enough to care for the uninsured." The report also "identifies six major areas of waste: unnecessary services ($210 billion annually), inefficient delivery of care ($130 billion), excess administrative costs ($190 billion), inflated prices ($105 billion), prevention failures ($55 billion) and fraud ($75 billion)."
The Washington Times (9/7, Cunningham) reports in its "Inside Politics" blog, "The report highlighted flaws that have long plagued the U.S. health care system, which is relatively slow to adopt new technologies, lacks incentives for doctors and hospitals to keep costs down and doesn't encourage all of a patient's providers to coordinate care."
ABC (9/7, Wong) in its "Medical Unit" blog says that "the money squandered on services that failed to improve Americans' health could have provided health insurance for more than 150 million workers or covered the salaries of all of the nation's first responders for more than 12 years." Author Dr. Mark Smith, president of the California HealthCare Foundation, said, "We're spending money in ways that don't seem to improve people's health."
Improvement Available With Existing Technologies, Tools. Bloomberg News (9/7, Wayne) says the report finds that healthcare "needs stronger government leadership to coordinate practices as the Affordable Care Act increases burdens on caregivers." Recommendations include "fully adopting electronic medical records, ushering drug discoveries into use faster and improving physician training," which Bloomberg sums up as "better training and sharing of information."
The San Francisco Chronicle (9/7, Colliver) says the report also found that "tens of thousands of deaths could be averted through better care," and that "improving quality and lowering costs are not only possible but could be done with tools and technologies that exist."
CQ (9/7, Reichard, Subscription Publication) reports, "Wasted money isn't the only issue. 'By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state,' the IoM said." It also said that "achieving higher quality at a lower cost requires no less than transforming all of U.S. health care into a 'learning' system." Also, "IoM officials pointed to concrete examples of systems that are doing what they recommend, such as Denver Health in Denver Colorado and the Virginia Mason health system in Seattle Washington."
The Business Courier of Cincinnati (9/7, Ritchie, Subscription Publication) in its "CincyBiz" blog says, "To fix the system, the report prescribed: better use of data; payment systems that reward quality and value; adoption of electronic health records and mobile technologies; and transparency about the costs and outcomes of care."
The Daily Mail (UK) (9/7) reports, "The report's main message for government is to accelerate payment reforms, said panel chair Dr. Mark Smith."
Modern Healthcare (9/7, McKinney, Subscription Publication) reports, "In the 382-page report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, an 18-member expert panel argues for a set of improvement strategies that panel members say will make information more accessible, engage patients and their families and make care more equitable."
The Washington Post (9/7, Somashekhar) reports, "Democrats assembled in Charlotte try to solidify their advantage with female voters and cast as positively as possible President Obama's signature health-care law." They took "advantage of an engaged prime-time audience to push their talking points about women and the health-care law."
And Politico (9/7, Raju, Kenen) reports, "From the podium at the national convention, Democrats keep doing what would have been unthinkable three months ago: they're taking credit for 'Obamacare.'" The reason is that "the campaign believes there's been a shift in momentum since the Supreme Court upheld the law in June," and they "think it makes for an appealing contrast to Paul Ryan's plan to overhaul Medicare and Medicaid." But "moderate Democrats in the party are wary of leaning too heavily into the law."
Yet after the president spoke, Politico (9/7, Kenen) said, "Barack Obama's health care law consumed much of his presidency and much of the Democratic National Convention, but you wouldn't have known it Thursday night. In back-to-back speeches, Obama and Vice President Joe Biden all but ignored the Affordable Care Act." The president made only "a passing, oblique reference." In another posting, Politico (9/7, Samuelsohn) commented, "Obama's been embracing 'Obamacare' on the campaign stump in recent weeks," but "Obama made only passing reference to the health care law. And he certainly didn't give it a shout out by name."
CQ (9/6, Ethridge, Subscription Publication) reports on efforts during this week's Democratic National Convention to "promote President Obama's signature health care law." On Tuesday, "speaker after speaker touted the benefits of the 2010 law and warned of the consequences if Republicans were able to repeal it." And Wednesday, "Democratic lawmakers joined others at a Families USA event intended to rally support for the law." Two key speakers the article mentions are Iowa Senator Tom Harkin, chairman of the Health, Education, Labor and Pensions Committee, and Nancy-Anne DeParle, deputy White House chief of staff.
The Hill (9/6, Berman, Bolton) reports, "Democrats at the podium of the party's national convention are fully - and finally - embracing President Obama's signature healthcare law, and liberal lawmakers are applauding the move," carrying remarks from HHS Secretary Kathleen Sebelius, First Lady Michelle Obama, former Sebelius adviser Neera Tanden, former Pennsylvania Governor Ed Rendell, Connecticut Representative Rosa DeLauro, Iowa Senator Tom Harkin, and House Minority Whip Steny Hoyer.
DNC Healthcare Forum Features Patrick, Pelosi. The AP (9/6) reports, "Massachusetts Gov. Deval Patrick will be speaking about the effects the Affordable Care Act has had on American families during a health care forum" as part of the DNC in Charlotte Wednesday morning. Governor Patrick will be joined by Victoria Kennedy and House Minority Leader Nancy Pelosi.
MedPage Today (9/6, Pittman) reports that at the DNC healthcare panel Wednesday, "party leaders spoke for nearly 2 hours on the benefits of the Affordable Care Act (ACA). ...They cited coverage of preexisting conditions for children, closing the Medicare Part D "doughnut hole," free preventive services, and the ability to keep children on their parent's health plan until age 26 as examples of ACA benefits that have already gone into effect." The panel "featured key players in the battle to pass the ACA including Nancy Pelosi (D-Calif.), Speaker of the House of Representatives at the time; Nancy-Ann DeParle, then director of the White House's Office of Health Reform; and Vicki Kennedy, widow of former Sen. Ted Kennedy."
Physician Delegates To DNC Support Healthcare Reform. MedPage Today (9/6, Pittman) reports on Julie Meyers, a pediatrician from Rhode Island, and Michael Reddix, an internist from Mississippi, two physician delegates to the Democratic National Convention this week. Both are "strong advocates" of the Affordable Care Act, and believe "there is a lot of misunderstanding within the law and what it has to offer." The doctors told MedPage Today that "they'd hate to see the ACA repealed, a staple of the Republican platform this election year."
Republicans Respond To DNC Healthcare Claims. Modern Healthcare (9/6, Daly, Subscription Publication) reports on responses to "Democratic criticisms unleashed this week at the Democratic National Convention regarding Republican plans to overhaul Medicare." Wednesday, in a call with reports, "conservative health policy experts sought to boost the plans by Republican presidential candidate Mitt Romney to repeal the Patient Protection and Affordable Care Act and replace it with a variety of health policy changes, including controversial plans to add a subsidized private insurance option to Medicare." The experts also attempted to brand Romney's plan as that which would allow for "innovation" and "fine-tuning adjustments."
CQ (9/6, Reichard, Subscription Publication) seeks to determine if recent attempts by the Democrats "to call the Medicare overhaul approach Romney and Paul D. Ryan favor a voucher system" is accurate. The answer "appears to be no," but, "there's a big if." Indeed, "analysts say that to get premium support right and keep traditional Medicare affordable, Republican administrations in the future would have to be willing to abide by a rigorous regulatory approach they may not be philosophically inclined to follow." CQ determines that in order to "preserve Medicare," a large amount of regulation would be necessary.
The CQ (9/5, Subscription Publication) reports that Tuesday, CDC Director Tom Frieden told reporters that "health care systems should use electronic records to identify and more closely monitor patients with high blood pressure. " He said that "controlling hypertension is the 'single most important thing the health care system can do.'" According to Frieden, after tobacco, hypertension poses the biggest danger to the health of Americans. He also said that "if hospitals and health care professionals were to focus on" this problem, "about 10 million Americans' blood pressure could be under control within the next five years."
The Washington Post (9/5, Kliff) "Wonkblog" reports that the healthcare section of the 2012 Democrat party platform "focuses on all the things Democrats have done, with little vision for what happens next." It touts the passage of the Affordable Care Act, "boast[ing] about the 'landmark reforms that are already helping millions of Americans.'" Wonkblog concludes, though the "platform acknowledges Obamacare is not the final act...there is not much in the platform in explaining what, exactly, the next effort ought to look like."
Similarly, CQ (9/5, Norman, Subscription Publication) reports, "The Democratic Party platform, released Tuesday, asserts that Republicans would repeal the health care law while Democrats are committed to 'moving forward.' But it offers only generalities as to what would lie ahead for health care in a second Obama term."
The American Medical News (9/4, Berry) reports, "Health insurers believe that going big will give them an advantage in the post-health system reform marketplace and expect to continue to consolidate beyond two major acquisitions announced this summer." Analysts say Aetna's acquisition of Coventry Health Care and WellPoint's acquisition of Amerigroup "make 2012 the busiest in at least five years" for health plan mergers and acquisitions. According to the American Medical News, "the result for physicians could be even less leverage in fee schedule negotiations and pressure to participate in health plans' Medicaid managed care and Medicare Advantage networks to be part of commercial networks."
The Houston Chronicle (9/4, Fikac) reports, "Texas officials express confidence that thousands of low-income women will be able to find new providers should Planned Parenthood be excluded from the state's Women's Health Program," but many across the state are not pleased with the state's decision to forgo federal funding for political reasons. According the Chronicle, clinics across Texas have already been affected by the actions, but the Health and Human Services Commission remains "confident that the state will continue to provide women with the services covered by the Women's Health Program."
The New York Times (9/1, A12, Goodnough, Subscription Publication) reported, "The way Mitt Romney and Representative Paul D. Ryan frame it, the debate over social programs that has become a dominant theme of the presidential race is all about the future of Medicare, the government health insurance program for retirees." However, as the Times noted, "The outcome of the election will probably have a more immediate and profound effect on Medicaid, the joint state-federal program that provides health care to poor and disabled people." The story notes that "few other issues present a starker difference between the Republican and Democratic tickets" and proceeds to describe the proposals offered by both sides.
In continuing coverage, the Obama Administration this week "quietly issued a rule" declaring that the 800,000 young undocumented illegal immigrants who can remain in the US under the President's new immigration policy, "can't benefit from the healthcare reform law," the Miami Herald (8/31, Dorschner) reports. HHS "released a rule amendment to clarify that the Affordable Care Act, which offers coverage to those 'lawfully present' in the United States, did not apply to those mentioned in Obama's June declaration."
Reuters (8/31, Morgan) reports that Medicare will continue to dominate the presidential campaign this fall. According to recent Quinnipiac/CBS/New York Times polls, the issue is important not just to current recipients, today's seniors, but baby boomers who are looking ahead to retirement. The polls show that eight out of ten voters 50-65 in Wisconsin, Florida, and Ohio say Medicare is "important" or "very important" to them; high interest among respondents in swing states like these make it key to both candidates, Still, Reuters notes that Mitt Romney's acceptance speech at the RNC Thursday only afforded Medicare one cursory mention, and that neither he nor running mate Paul Ryan have made their plan for the program explicit.
In RNC Speech, Romney Makes Only Passing Reference To Healthcare, Medicare. Politico (8/31, Haberkorn) reports, "Mitt Romney's most significant political speech of the 2012 campaign made only a passing reference to two of the biggest issues in the entire election: Medicare and the future of President Barack Obama's health care law." In the 45 minute speech, "there were exactly two lines about health care. One was the same attack on Obama's Medicare cuts that Paul Ryan made last night. The other was the standard pledge to repeal 'Obamacare.'" Indeed, "on the night when he had the biggest national audience he's had since the first days of the campaign, Romney didn't talk about what he'd put in place of Obama's health care law - even though it could have been a prime opportunity to win public support for the market-oriented, state-based reforms he says he wants. And he didn't say a word about the Medicare overhaul he and Ryan have proposed - even though he could have explained how the new system would work, building public support for his plan to provide subsidies to help seniors buy private health insurance or traditional Medicare coverage."
AP Fact Check: Romney's Plan To Balance Budget Lacks Specifics. The AP (8/31, Woodward, Raum) reports, "Mitt Romney promised voters Thursday night that he would cut deficits and put America on track to a balanced budget as president, but he left voters to take it on faith - or not - that he could deliver. The details behind that pledge, and the painful spending choices involved, are conspicuously lacking in his agenda." To fill this void, the piece looks into Romney's speech closing the Republican National Convention, noting that "no one would expect a presidential nominee's acceptance speech...to march through the nitty gritty of a budget." But, it continues, "the specifics don't exist anywhere else and, without them, there's no telling how he could increase military spending, cut taxes, restore over $700 billion to Medicare, meet the government's core obligations - and bring down deficits."
MedPage Today (8/31, Frieden) reports that physicians attending the Republican National Convention "are working to get various healthcare messages - mostly related to the Affordable Care Act (ACA) - across to convention delegates." Many physicians groups have gathered in Tampa to get their messages across, including Physicians for Romney Victory, American Academy of Family Physicians and Doctors for America. Their viewpoints vary; all have a vested interest in improving the country's healthcare system, but disagree on how to accomplish it. One physician in attendance, Michael Burgess, MD (R-TX), "wants to educate convention-goers about the many healthcare issues which still need to be ironed out no matter who is elected president." Rep. Burgess is "particularly concerned" about the effects on healthcare of the upcoming "sequestration."
New Group Seeks Physician Support, Input For Romney Campaign. MedPage Today (8/31, Pittman) reports on the newly established "Physicians for Romney Victory," which "is targeting doctors who are against the Affordable Care Act." According to MedPage, Romney's campaign is using the group to "mak[e] a push for physician donors, telling them they could have a bigger voice in health reform if the party is elected in November." Greggory DeVore, MD, national co-chair of the group, told MedPage that the ACA "wasn't crafted with physician input." Aiming to change this, Dr. DeVore says "Physicians for Romney Victory is targeting doctors in Kansas City, Los Angeles, San Antonio, San Diego, St. Louis, and Tampa," though "he couldn't give specifics on the amount of money raised so far."
Modern Healthcare (8/30, Daly, Subscription Publication) reports that "the satisfaction of enrollees with so-called consumer-driven health insurance plans has matched support that traditional insurance plans receive from their beneficiaries, according a recent survey." The article says that "the Employee Benefit Research Institute, a Washington-based health policy research organization, has tracked the satisfaction of enrollees in high-deductible insurance plans paired with various types of savings accounts since 2006." Enrollees in these plans have generally reported lower levels of satisfaction as compared with enrollees in traditional insurance plans. However, the article points out that "the group's online survey of enrollees reported this week that 71% of enrollees in both types of plans were either 'extremely satisfied' or 'very satisfied' with their plans."
MedPage Today (8/30, Frieden) reports from the Republican National Convention in Tampa that "a bipartisan approach to health reform is possible, several speakers said here Tuesday at a forum sponsored by the Galen Institute, a conservative think tank." The forum moderator summed it up, "The American people know there are real problems in our health sector that need to be fixed, and that really can have bipartisan solutions." Panelists included Tom Price, MD, an orthopedic surgeon and Republican Congressman from Georgia, who said, "We agree that healthcare needs to be affordable for everybody, accessible for everybody, it needs to be of the highest quality and there absolutely must be choices for patients. That's the common ground."
Information Week (8/30) reports that "electronic health record adoption by physicians is growing, to judge by the results of a recent survey sponsored by Medscape, a leading website for continuing medical education." According to the article, "the survey of 21,200 physicians across 25 specialties, conducted last spring, found that 74% of them already were using an EHR and that another 8% of them were currently installing or implementing systems." The report adds that "the rapid increase in physician adoption of EHRs this year is directly related to the government's incentives for Meaningful Use of qualified EHRs and the penalties for not showing Meaningful Use, said Leslie Kane, executive editor of Medscape's Business of Medicine division, in an interview with InformationWeek Healthcare."
The National Journal (8/30, Barnes, Subscription Publication) reports that a poll they conducted "found that the majority of both GOP and Democratic operatives sense their respective standard-bearers can win on the Medicare issue." The poll, "an anonymous survey of Democratic and Republican elected and party officials, grassroots activists, consultants, fundraisers, lobbyists, and allied interest-group leaders," asked, "Which candidate is helped more by a campaign debate over Medicare?" The Journal writes that it "is no surprise" that 92% of 134 Democrats polled said Obama, but that it is "somewhat surprising" that more than half of the 160 Republicans replied Romney.
CNN Blog Looks Into Romney's Plan For Medicare "Donut Hole." The CNN (8/30, Cohen) "The Chart" blog explores the implications of Mitt Romney's health policies on the Medicare "donut hole," a "coverage gap for seniors who take prescription drugs." A provision in the Affordable Care Act closed the donut hole in 2009, making "it so seniors will get discounts on drugs while they're in the donut hole," or spending between $896 and $4,350 on prescriptions. However, because "Romney has vowed to repeal Obamacare," this gap would "re-open." According to Romney spokeswoman Andrea Saul, "reversing the Affordable Care Act would help seniors in a way that is much bigger than the donut hole."
Republican Doctors Have Positive View Of Ryan's Medicare Proposal. MedPage Today (8/30, Frieden) reports that Vice Presidential nominee Rep. Paul Ryan "has the attention of all doctors when it comes to his proposal to turn Medicare into a 'premium support' program." Ryan's Medicare proposal, applicable to those who turn 65 after 2022, "would provide an average of $8,000 to help offset the cost of buying private health insurance. Those eligible would still have a choice to enroll in the traditional fee-for-service Medicare program - but would receive premium support for that option just as those using private plans would." His plan would also "raise the age of eligibility from 65 to 67 and reopen Medicare Part D's 'doughnut hole.'" According to MedPage, "Republican physician congressmen attending the party's national convention say they like the Ryan proposal," though "some physicians attending the convention are not fans of premium support."
The Washington Post (8/29, Kliff) "Wonkblog" reports on the recent Towers-Watson survey , which found that none of the 512 companies they polled were "very likely" to drop insurance coverage after the Affordable Care Act goes into effect in 2014. Indeed, "The vast majority - 77 percent said - it was 'not likely' that they would stop offering health insurance." Wonkblog characterizes the results as "surprising," because of how expensive health insurance already is, and "it should be a lot easier for a worker to access coverage when the law is fully implemented than it is right now."
Healthcare IT News (8/29, Monegain) reports, "Healthcare insurer Aetna has created Aetna Innovation Labs to focus on ways to improve patient outcomes by leveraging data and best practices." Under Innovation Labs, a dedicated team will "make it possible for Aetna to test specific initiatives such as those related to disease prediction and intervention, rapidly determine success rates and impact across populations of members and quickly expand programs that show promise."
Bloomberg News (8/29, Wayne) reports, "With a shortage of doctors in the US already and millions of new patients set to gain coverage" under President Obama's healthcare reform law, "American medical schools are struggling to close the gap." One "major reason" for this is "the residency programs to train new doctors are largely paid for by the federal government, and the number of students accepted into such programs has been capped at the same level for 15 years." Notably, the ACA's "insurance expansion takes effect at a time when the US has 15,230 fewer primary-care doctors than it needs," according to an HHS assessment released Aug. 28. Meanwhile, the Association of American Medical Colleges "predicts the shortage, including specialists, will climb to 130,000 by 2025."
The New York Times (8/29, A16, Goodnough, Subscription Publication) reports, "Banned from tightening Medicaid eligibility in recent years, many states have instead slashed optional benefits for millions of poor adults in the program. Teeth have suffered disproportionately." Today, half the states' Medicaid programs cover only emergency dental care, and many more have "stopped paying private Medicaid providers for fillings, root canals, crowns and dentures." However, one such state, Massachusetts, "recently decided to restore part of that coverage." Writes the Times, "Starting in January, Massachusetts Medicaid will pay for fillings - but only for those in the front of the mouth. The reasoning was that healthy front teeth were more important for getting and keeping jobs."
New York Moves Dental Services For Poor To Managed Care. The Albany (NY) Times-Union (8/29, Crowley) reports, "Dental services for the state's poor moved into managed care on July 1. Whether the move makes it easier or harder to find an upstate dentist is open to debate." The piece explains, in July, "the state required all private health insurers that offer Medicaid medical plans to also provide dental care. The new policy primarily affects upstate Medicaid enrollees because downstate enrollees are already in managed plans." The move is intended to address the fact that "historically, few upstate dentists accept Medicaid, making it difficult for patients to find care." However, "leaders of the New York State Dental Association believe many dentists won't join the networks because of the complexities of dealing with each one."
In his column for Reuters (8/29), Mark Miller asserts that the Affordable Care Act's plan to cut $716 billion from Medicare over the next decade is as a necessary first step toward improving the efficiency and outcomes of the program. After explaining the reasons Medicare needs major changes, he outlines several ways to bring them about, drawing from a study by the Institute of Medicine in 2009. These strategies include pay-for-performance, coordinated care, better preventive services, and reducing fraud.
Among extensive coverage of the GOP convention and the platform the party voted on Tuesday, Modern Healthcare (8/29, Zigmond, Subscription Publication) reports that the official Republican platform "includes repealing the Patient Protection and Affordable Care Act, while restoring Medicare payment cuts that the 2010 law authorized."
The Hill (8/29, Baker) "Healthwatch" blog explains, "The party platform, adopted Tuesday at the Republican National Convention in Tampa, Fla., further ties the party to Ryan's sweeping healthcare reforms, particularly his plans for Medicare." The platform states, "This is the only way to limit costs and restore consumer choice for patients and introduce competition; for in healthcare, as in any other sector of the economy, genuine competition is the best guarantee of better care at lower cost."
MedPage Today (8/29, Pittman) reports that the Republican platform states, in part, "We seek to increase healthcare choice and options, contain costs and reduce mandates, simplify the system for patients and providers, restore cuts made to Medicare, and equalize tax treatment of group and individual health insurance plans." Among the specifics, the party is calling for block-grants, "alternatives to fee-for-service models and government-sponsored health savings accounts."
Democrats Respond To GOP Platform In a separate report, Modern Healthcare (8/29, Zigmond, Subscription Publication) writes that "President Barack Obama's senior campaign adviser on Tuesday touted the benefits of the Patient Protection and Affordable Care Act and questioned the effects of Mitt Romney's campaign promise to restore the more than $700 billion in Medicare payment cuts included in the 2010 law."
Boehner: Republicans Not Committed To Passing Ryan's Medicare Plan. USA Today (8/29, Davis) reports that Republicans have "rallied around Paul Ryan's proposal to overhaul the Medicare system in its proposed budget, on the campaign trail and in the party's 2012 platform approved Tuesday, but top House and Senate leaders will not commit to enacting the proposal if the GOP takes control of Congress and the White House next year." On Monday, Speaker Boehner "declined to say whether Republicans would have a mandate from voters to enact the Ryan proposal if Mitt Romney defeats President Obama." According to USA Today, Boehner "said Ryan's proposal was one plan that would play a role in the broader entitlement debate."
USA Today (8/28, Dugas) reports, "As health care costs continue to increase, employers are looking for ways to cut costs," according to a new Towers Watson study of 440 midsize and large companies. Among the survey's findings: "13% of companies say they will increase workers' premiums by 5% in 2013," 38% "will reduce spouse and dependent coverage," and "nine percent firms are planning to offer telemedicine consultations next year." The study also notes that "most employers, 88%, are committed to offering health care benefits." Says Towers Watson, "They know it's needed to attract and retain the best employees."
The San Francisco Chronicle (8/28, Colliver) reports on a "new breed of health care consumer[s] - people who pay such a large portion of their health costs that they're questioning the value of insurance." With insurers and employers shifting more share of healthcare costs to consumers, some people are opting to negotiate their health services on their own. However, many consumers encounter challenges in determining the costs associated with health services. The Chronicle notes that "some companies offer services to help consumers figure out how much doctors, labs and hospitals charge for their services."
A poll released Monday by Resurgent Republic found that "more Americans favor the Medicare reform outlined in Rep. Paul Ryan's budget than want to keep Medicare as it," the Daily Caller (8/28) reports. When asked to choose between two statements, one of which "echoed the Democratic campaign line on Medicare and the other echoed Ryan's conception," 45 percent of likely voters agreed with the statement that echoed Ryan's plan. Forty percent favored the other statement. Independents "leaned heavily" toward the Ryan statement, "53 percent to 34 percent, as did swing state voters – 46 percent to 39 percent." The Daily Caller notes that the numbers "appear to undermine the Democratic assumption that Romney hurt his chances by selecting Ryan as his running mate."
Boehner Says Republicans Welcome Debate Over Medicare. ABC World News (8/27, story 5, 2:15, Sawyer) interviewed House Speaker and Republican Convention Chairman John Boehner. Asked about opposition to Rep. Paul Ryan's Medicare plan, Boehner said, "I think what people are saying, they want to make sure that Medicare's going to exist. ... If the system doesn't change, it will go broke. Republicans have been forthright about the needs of fixed Medicare. And our colleagues across the aisle they want to be critical of us, but they have no plan. They've put nothing on the table to help fix Medicare. So they want to have this debate, let's have it."
Robinson: Seniors Won't Buy GOP Claims On Medicare. In his column for the Washington Post (8/28) Eugene Robinson argues that Republicans are trying to steal the Medicare issue from Democrats. Their argument "centers on $716 billion that Obama, through the Affordable Care Act, has shifted away from Medicare providers." Robinson notes that while there would be no reduction in benefits to seniors under the healthcare law, Republicans are "charging Obama with 'gutting' Medicare and promising that not a penny would be cut under a Romney administration." Robinson adds, "We're supposed to forget that Obamacare preserves Medicare as a guarantee - a promise that all Americans will have health care in their golden years - while the Romney-Ryan plan would subject seniors to the vagaries of the private insurance market and potentially cost them an extra $6,400 a year." He concludes, "Republicans may tell themselves that the GOP is the party of Medicare. But I doubt seniors will be convinced."
On the front page of its Business Section, the Wall Street Journal (8/27, B1, Mathews, Subscription Publication) reports that it is becoming increasingly more common for hospitals to acquire private physician practices, and this may be contributing to higher costs for routine healthcare. In many cases, a service can increase in price after an acquisition, despite no change in procedure or location. This is due to the structure of insurance reimbursements, which are often more generous to hospitals than independent practices. Though the hospital industry says the growing rate of private-practice acquisitions will increase efficiency and improve quality, health insurance companies say that for now, it is just costs that are rising.
The New York Times (8/26, A14, Pear, Subscription Publication) reported, "Even as President Obama accuses Mitt Romney and Representative Paul D. Ryan of trying to privatize and 'voucherize' Medicare, his Administration crows about the success of private health plans in delivering prescription drug benefits and other services to Medicare beneficiaries." Private plans include Medicare Advantage, typically delivered by HMOs, and drug benefits for Medicare, "delivered exclusively by private insurers, subsidized by the government." In the results for 2013's competitive bidding, the Administration noted Medicare Advantage premiums dropped an average of 7 percent, while Medicare prescription premiums were "steady," although Federal spending is down about 30 percent from earlier CBO estimates. The Times looked at some of the reasons behind the numbers.
The New York Times (8/26, SR10, Subscription Publication) editorialized that "confusing language in the health care reform law has raised the possibility that millions of Americans living on modest incomes may be unable to afford their employers' family policies and yet fail to qualify for government subsidies to buy their own insurance." The Times gave background of the issue, which has to do with IRS interpretations of affordability, and calls the "glitch" a "bizarre development." The Times concluded that the Treasury Department out to "allow...a compromise" recommended by some "that would allow workers' dependents to buy subsidized coverage, without penalizing the employers. The worker would simply remain covered through the employer, while the rest of the family could get subsidies to buy separate coverage on the exchanges."
On Thursday, the Department of Health and Human Services announced new Federal grants "giving 34 states the ability to create insurance exchanges under the healthcare law," The Hill (8/24, Viebeck) "Healthwatch" blog reports. According to the blog, HHS "is preparing for 2014, when much of the divisive law will take effect." Said Secretary Kathleen Sebelius, "Thanks to the healthcare law, Americans will have more health insurance choices and the ability to compare insurance plans. We continue to support states as they move forward building an exchange that works for them." Modern Healthcare (8/24, Zigmond, Subscription Publication) reports that according to an HHS Fact Sheet , the Department has dispersed more that $765 million worth of grants.
The Wall Street Journal (8/23, Banjo, Subscription Publication) reports that beginning on Monday, August 27, Wal-Mart will offer vaccinations recommended by the CDC for 10 infectious diseases other than the flu and pneumonia, including shingles, meningitis, hepatitis and HPV. The Journal notes that Mollen Immunization Clinics will be operating the vaccination kiosks in front of Wal-Mart stores, and the Journal says that the program is part of Wal-Mart's larger effort to increase its healthcare-related market share. Wal-Mart said that by using a network of nurses, instead of pharmacists, it will be able to administer a larger variety of shots to more people. Though the Journal quotes US Health Department national vaccine program office director Bruce Gellin as praising the initiative, it also notes he cautioned that Wal-Mart's and other similar programs also should inform individuals' primary-care physicians about the vaccinations to avoid duplication.
The AP (8/23, Carpenter) reports, "It's inevitable that something will be forgotten in the excitement of sending a child off to college, and insurance is "often overlooked," though the "don't need to buy all kinds of additional insurance." Still, parents had better at least review their coverage to know whether they're prepared for that stolen iPad, trip to the emergency room or worse." The AP goes on to offer specific tips for parents on health, auto, personal property, tuition, life and travel insurance. On health insurance, the AP notes for example, that parents generally can keep "their children on their plan, which federal health reform allows until age 26," though "it's important to check your plan's network of preferred doctors and hospitals extends there. Otherwise the highest level of coverage may not be available."
CNN Money (8/23, Luhby) reports on its website that while Mitt Romney and Paul Ryan would turn Medicare over to the private market, insurers "can't always provide health coverage for seniors for less than the federal government." Private insurers "already cover more than a quarter of Medicare participants in a little-known, but rapidly growing program called Medicare Advantage. ... Medicare Advantage, however, hasn't lowered the tab of providing health care to the nation's seniors. That's because the federal government pays insurers a lot more than they bid under a complex formula that was designed in part to encourage them to expand access. In 2011, insurers were paid a total of $124 billion, 110% of what it would have cost under traditional Medicare."
Reuters (8/23, Morgan) reports that Wednesday, the CBO released a report (pdf) that lowered the projected cost of Medicare over the next ten years. The figures, revised from estimates CBO published earlier this year, reduced forecasts by $19 billion for fiscal year 2012 and by $169 billion through 2022. Still, the government is expected to spend $7.7 trillion on the program in the coming decade. According to Reuters, the lower figures are due to slower rates of growth in medical expenditures, in part due to the recession and the healthcare overhaul.
Modern Healthcare (8/23, Daly, Subscription Publication) adds that because of the large portion of spending Medicare represents, this downward revision "helped slow somewhat the federal government's expected accumulation of debt over the coming decade."
Medicare Spending Still Growing. Politico (8/23, Nather) presents the CBO report differently, reporting that despite the decreased projections, the CBO estimates that Medicare spending will "grow from 3.7 percent of the Gross Domestic Product next year to 4.3 percent in 2022."
CMS Moves Forward With Initiative To Improve Medicare Services. The Hill (8/23, Viebeck) "Healthwatch" blog reports, "Federal health officials are moving forward with a plan to reward healthcare providers that improve services for Medicare patients." The four-year project, known as the Comprehensive Primary Care Initiative, "will be administered by the Medicare agency's Innovation Center, a creation of the 2010 healthcare law that seeks to reduce costs and improve healthcare delivery." According to Healthwatch, the goal of this effort is "to foster well coordinated primary care within Medicare." Said Marilyn Tavenner, acting administrator of CMS, "Primary care practices play a vital role in our healthcare system. We are looking at ways to better support them in their efforts to coordinate care for their patients."
Chris Matthews, on MSNBC's Hardball (8/21), said, "The President's message on Medicare [is] apparently scoring higher than Romney's" in the newest NBC News/Wall Street Journal poll, which "showed half of registered voter agreed with" him "that changing Medicare the way Paul Ryan has suggested is a bad idea. Only 34% agreed with what Romney has said on Medicare."
National Journal's Major Garrett, also appearing on MSNBC's Hardball (8/21), added, "This was what Romney bought when he brought on" Ryan, who "injects into this race an entire debate about Medicare," and, "on balance, when you talk about entitlements, people are, at least initially, resistant to change." Garrett added, "Let's be honest...three week ago, the Romney campaign was not eager to spend three, four, five weeks slogging through a Medicare debate...because it takes away from the economic message, which they believe is so much more lethal against President Obama, but can't get do it because Medicare stands in the way."
Pew Poll: Americans Don't Approve Of Ryan's Medicare Proposal. A Pew Research Center poll released Tuesday found that 72 percent of Americans have heard of Rep. Paul Ryan's Medicare proposal. Of those, 49 percent oppose it and 34 percent support it. Bloomberg News (8/22, Salant) reports, "While current Medicare recipients wouldn't be affected by the change to a voucher system, senior citizens were the strongest opponents of the Ryan proposal, according to the Pew poll. Among respondents 65 years of age and older, 55 percent opposed ending traditional Medicare, while 24 percent favored it. Those between 50 and 64 disapproved of it, 49 percent to 35 percent, and those between 18 and 49 were against it, 46 percent to 38 percent." The poll "of 1,005 adults was taken Aug. 16-19 and has a margin of error for its entire sample of plus or minus 3.6 percentage points."
Politico (8/22, Burns) reports in its "Burns Haberman" blog, "At this point, most Americans do not associate Ryan with the proposal to change Medicare. Just 23% of those who have heard about the idea of shifting Medicare to a system of credits to buy private insurance identify it as Ryan's. Nearly as many (17%) say Barack Obama proposed this, while 44% do not know who proposed it."
USA Today (8/21, Szabo) reports, "Studies have long shown an increased risk of breast cancer in women whose breasts are considered 'dense,' or less fatty." However, "new research [is] showing that breast cancer patients with dense breasts were no more likely to die than other patients," though they "were more likely to die of their breast cancers if they also were obese, according to the study, involving more than 9,000 women, in today's Journal of the National Cancer Institute. " In response, "Barbara Monsees, chairwoman of the American College of Radiology's breast imaging commission, who wasn't involved in the new study," said, "It shows we have a lot to learn about dense breast tissue and its implications for screening, diagnosis and treatment."
The AP (8/21, Neergaard) reports, "More women are getting the word that they may have breasts too dense for mammograms to give a good picture. What's not so clear is what to make of that information." The NCI study "tracked more than 9,000 breast cancer patients and concluded those with very dense breasts were no more likely to die than similar patients whose breasts weren't as dense." NCI lead researcher Dr. Gretchen Gierach commented that the result is "definitely reassuring." The story notes that "according to the American College of Radiology, about 10 percent of women have almost completely fatty breasts. Another 10 percent have extremely dense breasts," and "the rest are in between."
Planned Parenthood Announces $3-Million Breast Cancer Initiative. The Los Angeles Times (8/21, Healy) reports, "Planned Parenthood has launched a $3-million package of breast health programs designed to identify women at elevated risk of breast cancer, increase access to specialty healthcare for women with apparent breast abnormalities, and expand a breast health educational program aimed at Latinas." The initiative is being funded by "money donated in the wake of the Susan G. Komen Foundation's decision to withdraw its support for the organization - a step that was reversed after it ignited a firestorm of controversy in February." The Chicago Tribune (8/21) and Reuters (8/21, Morgan) also report on the initiative.
The Austin (TX) American Statesman (8/21, Roser) reports that 12 hospitals in Austin, Texas, on Oct.1 will see their Medicare reimbursement rates reduced because of too-early readmissions. Explains the Statesman, "The penalties are the first wave of reductions in payments for Medicare, the federal program that covers the elderly and disabled, under the 2010 federal health care law." CMS spokesman Bob Moos said, "This is part of a larger effort to pay for quality and pay for performance, rather than pay for procedures."
USA Today (8/21, Dugas) reports, "As the open-enrollment season for health benefits approaches, many workers will be making some bad choices," according to "the Aflac WorkForces Report, a July survey of more than 2,000 consumers released today." The survey found that "the majority of American workers -- 56% -- estimate that they waste up to $750 each year because of costly mistakes they have made with their health insurance benefits." Some of the common errors found by the survey include electing the same benefits packages year after year, "rarely or never" exceeding deductible costs, and not contributing the correct amount of money to flexible spending accounts.
In a 2,260-word story, the AP (8/21, Johnson) focuses on a growing trend among drug manufacturers to offer coupons when their brand-name patents expire. Commercial insurers say the coupons "throw a wrench" into their efforts to "get as many patients as possible to take generic drugs, which account for about 80 percent of all prescriptions filled in the US." Some insurers are "fighting back": According to Express Scripts Holding Co., "more than half the insurance plans its services have policies requiring patients to pay an extra fee for staying on the brand-name drug," and the fee is high enough to "make use of coupons unattractive." But brand-name drug makers say coupons "give loyal patients savings of as much as $100 a month." For example, under Pfizer's "Lipitor For You" coupon program, Pfizer "absorbs up to $75 of the patient's out-of-pocket cost." Insured patients pay around "$4 a month" and uninsured patients "get the $75 off each prescription."
The Los Angeles Times (8/21, Terhune) reports, "Health insurance giant Aetna Inc., trying to capitalize on growing enrollment in Medicare and Medicaid, has agreed to acquire Coventry Health Care Inc. for about $5.7 billion in cash and stock." According to the Hartford, Conn., insurer, "the Coventry deal will allow it to add more than 5 million new members, many of them in faster-growing Medicare Advantage and Medicaid managed-care plans." The $7.3 billion deal is expected to boost Aetna's "share of revenue from government health plans to more than 30%, from 23% now."
Bloomberg News (8/21, Nussbaum) reports, "The deal will add more than 5 million customers to Aetna's 36.7 million members, including 250,000 people on Medicare health plans and 930,000 on Medicaid. Coventry provides prescription drug coverage to 1.5 million more Medicare enrollees as well." Bloomberg notes that employer-backed plans which "make up the bulk of Aetna's business" are under pressure "amid the weak US economy and new regulations in the health law."
The New York Times (8/20, B1, Brustein, Subscription Publication) reports on the front-page of its business section that smartphones soon "may also act as medical devices, helping patients monitor their heart rate or manage their diabetes, and be paid for by insurance," though "first, a range of issues - around vetting, paying for and monitoring the proper use of such apps - needs to be worked out." The Times notes, "If smartphone-based systems can reduce the amount of other medical care that patients need, the potential benefit to the health care system would be enormous," but "apps dealing directly with medical care cannot be introduced to the public with bugs that will be fixed later. The industry is still grappling with how to ensure quality and safety." The Times goes on to examine the case of WellDoc -- "one of the pioneers in the prescription-app field" – and its DiabetesManager system.
The Boston Globe (8/20, Conaboy) reports, "Programs that reward doctors and hospitals for hitting certain quality targets are being rolled out in Massachusetts and across the country," but "several recent publications question whether pay-for-performance systems actually lead to better care for patients. A review of seven studies of primary care programs that paid doctors extra for meeting certain targets, published by the Cochrane Collaboration in September, was inconclusive about the effect on quality of care," while another "study published in March in the New England Journal of Medicine found that a large Medicare pilot program that paid providers more if they met certain process targets - and docked those who did poorly - did not reduce short-term patient mortality rates."
New recommendations from the Centers for Disease Control and Prevention regarding hepatitis C testing received a significant amount of coverage, mostly online, as well as on one of last night's national news broadcasts. CDC Director Dr. Thomas Frieden and Dr. John Ward, who runs the CDC's viral hepatitis division, were quoted in multiple articles. NBC Nightly News (8/16, story 5, 1:30, Williams) reported that the government has a "health warning...for an entire American generation" regarding hepatitis C.
The AP (8/17, Stobbe) reports, "All baby boomers should get a one-time blood test to learn if they have the liver-destroying hepatitis C virus, US health officials said." Dr. Frieden, during a call with reporters, said, "Unless we take action, we project deaths will increase substantially."
CQ (8/17, Reichard, Subscription Publication) reports, "CDC says such testing could identify more than 800,000 additional people with hepatitis C, the leading cause of liver transplants in the US and can lead to liver cancer, the fastest-rising cause of cancer-related deaths. The new round of testing could also prevent 200,000 cases of cirrhosis of the liver." According to Frieden, "A one-time blood test for hepatitis C should be a on every baby boomer's medical checklist."
The NPR (7/31, Hamilton) "Shots" blog reports, "One reason so many boomers are infected is that more than a few used injected drugs much earlier in their lives, says...Ward." According to Ward, "We had an epidemic of hepatitis C transmission in the '70s and '80s, and we're now seeing an epidemic of hepatitis C disease."
Reuters (8/16, Beasley) quoted Dr. Ward as saying, "Hepatitis C is particularly dangerous because it is a silent killer. It can live for decades in a person's body, slowly destroying the liver, while causing few symptoms."
Forbes (8/17, Haiken) points out that "CDC screening guidelines are extremely important because they strongly influence what insurance companies decide to cover. In all likelihood, very soon doctors will no longer need to specify that you're at risk for Hep C to send you to the lab for a blood test."
HealthDay (8/17, Reinberg) reports, "The final recommendations were published in the Aug. 17 issue the CDC's Morbidity and Mortality Weekly Report. They were also published online Aug. 17 in the Annals of Internal Medicine."
WebMD (8/17, Mann) reports that the recommendations' "release dovetails with a new phase in the CDC's 'No More Hepatitis' campaign."
The Hill (8/17, Viebeck) "Healthwatch" blog reports that a poll commissioned by the Kaiser Family Foundation found that Medicare "ranks first in voters' minds and considerably above President Obama's healthcare overhaul as Americans decide who they will support for president." The Affordable Care Act "came in fifth on a list of healthcare issues...with about six in 10 calling the divisive 2010 law important to their vote," while Medicare "received top billing...with 73 percent saying it is either 'extremely' or 'very' important as they make their choice for president."
Time (8/16, Bachmann) reports, "Switzerland's healthcare model successfully delivers much of what the US is trying to achieve: universal coverage through mandatory private insurance." Time explains the tenets of the Swiss system, in which "the government regulates the insurance industry and defines what health services must be offered." Additionally, the law mandates that insurance "can't exceed 8% of personal income; if it does, the government subsidizes the cost." The law has been in effect since 1996; and Time notes that thus far, the "system is running as smoothly as a Swiss watch and the patient satisfaction rate is high." Still, the article cautions that although the system could serve as a model for the US, there are critical differences between the two countries.
CQ (8/16, Reichard, Subscription Publication) reports, "On the heels of a new blitz by Republican candidates to depict the health care overhaul as a threat to the Medicare program, the Obama administration on Wednesday announced a collaboration with major pharmacy chains to tell seniors about the benefits of the law." HHS Secretary Kathleen Sebelius, who announced the plan, explained, "These partnerships will help people with Medicare learn more about new preventive services such as mammograms and the new Annual Wellness visit that are available at no charge for everyone with Medicare."
The Hill (8/16, Viebeck) "Healthwatch" blog adds that Secretary Sebelius announced the "the joint effort" at a CVS in Jacksonville, Florida. Healthwatch explained that this partnership "means Medicare beneficiaries will have better access to details about the administration's health law."
The Florida Times-Union (8/16, Cravey), Modern Healthcare (8/16, Daly, Subscription Publication), the Kansas City (MO) Business Journal (8/16, Subscription Publication) and Law 360 (8/16, Slajda) also report on the story.
The Houston Chronicle (8/14, Kever) reports that "1.5 million Texans [benefitted] from a provision of the Affordable Care Act that requires insurance companies to return a portion of the premiums if they spend less than 80 percent on medical care." Overall, residents in the state of Texas "received $166.9 million in rebates, more than residents of any other state"; and the bulk of the rebates ($134.2 million) "went to people who...bought individual policies." On average, the "rebate per Texas family was $187," according to the Department of Health and Human Services.
In an op-ed for the Harrisburg (PA) Patriot-News (8/14), Donald J. Palmisano, M.D. J.D., the former president of the American Medical Association, editorializes about the failings of the Affordable Care Act. He writes, "As Americans learn more about ACA, many are finding it to be more and more unsound." Dr. Palmisano lists several provisions he expects won't work, and then offers proposals to improve upon the law. He concludes, "To fashion a health care system that works best for patients, lawmakers on both sides of the aisle must work together to pass reforms that help make high-quality care more accessible and less costly overall."
CQ (8/14, Reichard, Subscription Publication) reports, "The consumer representatives to the National Association of Insurance Commissioners released a 51-page report (pdf) Monday loaded with technical recommendations for how state and federal officials should write regulations to implement key consumer protections under the health care law." According to the advocates, "At issue are health law protections governing the regulation of insurance. ... The way regulators write the regulations putting these protections in place in 2014 will determine whether they work for consumers or tilt toward the interests of insurers." Said Beth Abbot of Health Access California, "We want to make sure that, as they implement these reforms, they're putting consumers front and center."
The Pittsburgh Post-Gazette (8/14, Toland) reports on "stop-loss" insurance, which "pays out in the event that a company's health claims exceed what has been set aside to pay for benefits in a given year." Currently, "most small businesses -- those with 50 or fewer employees -- don't directly pay the health care expenses of their employees," but insurance companies are "wooing smaller companies...into the universe of 'self-insured' businesses by offering ancillary stop-loss policies." Critics say this "is meant to sidestep federal health care reform measures and could result in higher health care premiums."
New York Times (8/12, Pear) reported that the IRS-proposed definition of "affordable" health insurance threatens to leave some families unable to afford employer-provided insurance plans, yet with no access to subsidies to buy it. The IRS maintains that affordable employer-provided insurance is for the employee only and should be, as the law requires, no more than 9.5 percent of the employee's overall household income. Yet, "critics say the Administration should also take account of the costs of covering a spouse and children because family coverage typically costs much more." As an example, one survey found that the employee's portion of healthcare premiums "averaged $920 for individual coverage and more than four times as much, $4,130, for family coverage." Yet, the employee portion of family-coverage premiums "would be deemed affordable for a family making $35,000 a year, even though the family would have to spend 12 percent of its income for full coverage under the employer's plan."
The Wall Street Journal (8/13, Mathews, Subscription Publication) reports that starting September 23, insurance companies will be required to provide consumers searching for healthcare with a four-page document detailing their options. The document, intended to streamline the process and allow for consistent comparisons between insurers, is mandated in the Affordable Care Act. Says Michael Hash, interim director of the HHS Center for Consumer Information and Insurance Oversight, "It provides a tool to help people with comparison-shopping."
The Hill (8/10, Baker) reported in its "Healthwatch" blog, "Single adults without children would benefit significantly from the Medicaid expansion in President Obama's healthcare law," according to a report "written by the Urban Institute and the Robert Wood Johnson Foundation," finding that "roughly 82 percent of the people newly eligible for Medicaid do not have a dependent child." Under the Affordable Care Act Medicaid eligibility would be boosted "to 138 percent of the federal poverty level."
CQ (8/1, Reichard, Subscription Publication) reported that of those eligible, "slightly more than half are under the age of 35" and "most are white, and most are not living with dependent children."
Fallin Considers Medicaid Expansion. The Tulsa (OK) World (8/10, Greene) reported on Oklahoma Gov. Mary Fallin's considering whether to sign on to the expansion of Medicaid eligibility under the Affordable Care Act. The story notes that Fallin, when in Congress, spoke out repeatedly against the act. Yet, while "several GOP governors quickly stepped forward to reject the expansion on ideological, political and fiscal grounds. Fallin has not." Meanwhile, "hospitals and business interests [have been] lobbying her to accept the money."
Former New Hampshire Gubernatorial Candidate Defends Medicaid Expansion. 2002 Democratic nominee for New Hampshire governor Mark Fernald writes in the Concord Monitor (8/13), "The primary goal of the Affordable Care Act is to reduce the number of people without health insurance." Yet "many New Hampshire Republicans, including gubernatorial candidates Ovide Lamontagne and Kevin Smith, and House Speaker William O'Brien, have lined up to oppose any expansion of Medicaid." Fernald calls that "the triumph of ideology over common sense." He says the question is "should New Hampshire spend about $5 million a year from 2018-2020, and $10 million a year thereafter, in order to receive about $90 million in federal dollars," adding, "to ask the question, you know the answer is 'yes.'"
USA Today (8/13, Wolf) reports that Rep. Paul Ryan, Mitt Romney's choice to be his running mate, authored "the most sweeping effort ever to reduce the explosive growth in Medicare and Medicaid." Under Ryan's plan, Medicare "would be run largely by private insurers and would cost beneficiaries more or offer them less. Traditional Medicare would remain as an option. The plan would start in 2023, effectively exempting those 55 and over." USA Today adds, "Under the plan, starting in 2023 new Medicare beneficiaries could choose a private health plan, and the U.S. government would subsidize the cost. Low-income recipients and those with greater health risks would get extra help. The approach is modeled after Medicare's prescription drug program, passed in 2003." USA Today notes that while Democrats and the President have criticized the plan, "Ryan reasons that Medicare's exponential growth requires revolutionary solutions."
Bloomberg News (8/12, Faler) reports that Ryan "wants to replace the traditional system with a plan to give seniors a fixed amount of money to buy private coverage. The theory is that competition among health insurers for their business will bring down spiraling costs." Democrats "say it won't work, predicting that seniors will be left to either shoulder bigger bills or forgo care - or both."
NPR (8/13) reports on its website that the changes Ryan proposes for Medicare are "dramatic," noting that under his plan, "seniors would get a set amount of money rather than automatic coverage. They could use that to choose from a range of health plans. ... The amount of money the senior gets, however, wouldn't necessarily go up as fast as medical costs. Ryan and those who support his idea say that choice and competition would maintain the benefits. Others, including President Obama, aren't so sure."
The Wall Street Journal (8/13, Paletta, Subscription Publication) says that by selecting Ryan as his running mate, Romney has made the future of Medicare a key issue in the campaign and will have to decide fairly quickly whether to embrace Ryan's plan or offer an alternative of his own.
The National Journal (8/13, Sanger-katz, Subscription Publication) says both Romney and Ryan "now support a kinder, gentler version of Ryan's original, polarizing plan, which would have eliminated the government-run insurance program in favor of a fixed-value voucher plan for seniors. The refined proposal would preserve traditional Medicare as a choice, but encourage seniors to shift to private plans that offer lower premiums by forcing traditional Medicare to compete on price." National Journal notes that Romney and Ryan "agree on the key points: beginning in 10 years, seniors will be able to choose between private plans and traditional Medicare; the voucher value will be based on competitive bidding between insurers; and richer seniors will pay a bigger portion of the tab than their less wealthy peers. Indeed, Romney's website says that Ryan's latest plan 'almost precisely mirrors Mitt's ideas.'"
The AP (8/13) reports that Romney says he and Ryan "have talked about providing people more Medicare choices and making sure the program doesn't change for current seniors or those nearing retirement." Romney and Ryan discussed the issue during an interview on CBS' "60 Minutes."
USA Today (8/13, Camia) reports that in the CBS interview, Romney and Ryan "defended their stance on Medicare, saying Ryan's plan to overhaul the health insurance program for seniors won't hurt them in Florida." Romney "said the plan would not make any changes for seniors currently enrolled in the government-run health insurance program." Ryan "cited the example of his mother, who now lives in Florida and is a Medicare beneficiary," saying, "Our point is we need to preserve their benefits, because government made promises to them that they've organized their retirements around. ... In order to make sure we can do that, you must reform it for those of us who are younger. And we think these reforms are good reforms, that have bipartisan origins."
Romney Says Obamacare Cuts Medicare. The National Journal (8/13, Subscription Publication) reports that Romney "is ready with a counterattack to the charge that the budget plan offered by his new running mate would 'end Medicare as we know it.'" For months, Romney has been saying, that the President's healthcare plan "'cuts Medicare by $500 billion' - even though fact-checking media outlets have raised red flags about the accuracy of that claim." Romney adviser Stuart Stevens repeated the charge, saying, "here's only one person is this race who is cutting Medicare by $500 billion and that's President Obama. ... That's a conversation we welcome, about who is endangering the fiscal solvency of the country and endangering Medicare.'"
Modern Healthcare (8/10, Dunning, Subscription Publication) reports, "While the majority of employee wellness incentives offered in 2012 were aimed at boosting participation rates, a growing number of companies are linking rewards and penalties to measurable results among program participants," according to a survey of over 2,000 US employers released this week. The survey "revealed that one-quarter of employers offering incentivized wellness initiatives in 2012 have attached rewards to progress made toward meeting healthy blood pressure and cholesterol levels, body-mass ratios and other biometric measurements, compared with just 4% the prior year."
The Austin (TX) American Statesman (8/10, Roser) reports, "At a time when consumers are being discouraged from using expensive hospital" EDs "for non-emergencies, St. David's HealthCare has opened four urgent care centers in the past three years that bill patients more like emergency rooms do." The facilities "are an extension of a hospital-based" ED "and are classified as Type B emergency departments, said St. David's Senior Vice President Mark Clayton." According to the American-Statesman, "Some patients who complained about the centers on Yelp wrote that they thought they were going to a less expensive urgent care center only to learn they were being billed for an ER visit."
A new Medicare pilot program will test whether it can "relax hospital-payment rules to help the growing number of seniors who are shelling out thousands of dollars for follow-up nursing-home care," the Washington Post (8/10, Jaffe) reports, noting that the issue "involves what should be an easy question: Is the Medicare beneficiary an inpatient or an observation patient?" Current Medicare rules require that a patient have "at least three days in the hospital as an inpatient - not just for observation - to qualify for follow-up care in a nursing home. ... Under the pilot program, the 380 hospitals participating will be able to rebill Medicare for observation services if claims for inpatient care are rejected. Medicare officials want to see if that takes some of the pressure off hospitals."
The AP (8/10, Cass) examines who "gets thumped by higher taxes in President Barack Obama's health care law," noting, "Some 4 million individuals without insurance are expected to pay about $55 billion over eight years, according to the Congressional Budget Office's estimates. Employers could be dinged an estimated $106 billion for failing to meet the mandate, which starts in 2014. But that mandate money, whether it's called taxes or penalties, is overwhelmed by other taxes, fees and shrunken tax breaks in the law. These other levies could top $675 billion over the next 10 years, under the CBO's projections of how much revenue the government would lose if the law were repealed." The AP notes that "roughly 20 million people eventually will benefit from tax credits that start in 2014 to help them pay insurance premiums."
The Los Angeles Times (8/9, Terhune) reports on a new survey of 1,203 employers conducted by Mercer, which found that "more than 60%...anticipate some increase in their health benefit costs due to the federal Affordable Care Act." Further, "20% of those businesses expect an increase of 5% or more." In addition, 6% of the employers in the survey indicated they "were likely to stop providing health benefits after government-run insurance exchanges open in 2014."
The Wall Street Journal (8/9, Radnofsky, Subscription Publication) adds that the Mercer survey indicated that that the firms that will be most affected by the ACA are in the retail and restaurant industries. Modern Healthcare (8/9, Geisel, Subscription Publication) also reports on this survey.
Employers Expect Costs To Increase 7%. The Washington Business Journal (8/9, Subscription Publication) reports that a survey conducted by the National Business Group on Health found that "large employers expect their health insurance costs will increase 7 percent next year." The Louisville (KY) Business First (8/9, Subscription Publication) "Morning Call" blog also reports on this survey.
USA Today (8/9, Kennedy) reports that records and interviews with healthcare experts indicated that the Affordable Care Act "gives Medicare and Medicaid more authority to track and reject payments for medical procedures believed to be overused." The law and 2009 stimulus act will also "change payment incentives and allow physicians to use electronic records to limit unnecessary medical testing. Private insurers will also be able to work with government agencies to combine billing data to spot trends in overused procedures." Medicare spokesman Brian Cook remarked, "The health care law is helping us implement new incentives for doctors, hospitals and health care providers to provide better quality care, and not just a greater quantity of services."
The Washington Times (8/9) editorializes, "America simply can't afford Obamacare." The Times adds, "The scary fact is the bureaucrats with the green eyeshades haven't realistically added up all the indirect but real costs of Obamacare such as the burden on consumers and the impact of higher taxes on economic growth and employment. It's a mistake to throw more money into a national-health scheme that will leave almost 30 million Americans without insurance and many more with worse access to care."
In a New York Times (8/8, Mandelbaum) "You're the Boss" blog post, Robb Mandelbaum writes about how much of the ACA-mandated health insurance rebate employers must pass on to employees, saying that attorneys "who specialize in employee benefits law disagree on the implications for small businesses." Recounting the details of the rebates, Mandelbaum notes, "Small businesses in 38 states, the District of Columbia and three United States territories are receiving checks on behalf of their employees, according to the Department of Health and Human Services." Mandelbaum presents the differing views on the issue from the attorneys he questioned about it, concluding the post with an observation by Chris Rylands, of the Atlanta-based firm Bryan Cave, who "said that he expected the government to tighten the rules eventually." Rylands told Mandelbaum, "I think the Department of Labor will issue clearer parameters about what you can and can't do with the money."
The Washington Post (8/7, Andrews) reports that although healthcare reform law "provides a safety net for young adult children, who can now stay on their parents' health plans until they reach age 26," it does not "guarantee that their parents' plan will cover" pregnancy. Under the Pregnancy Discrimination Act of 1978, "group health plans with 15 or more workers are required to provide maternity benefits for employees and their spouses," but the law doesn't require maternity coverage for employees' other dependents. Notably, in "2008, an estimated 2.8 million women ages 15 through 25 got pregnant, 12 percent of all those in this age group," according to the most recent estimates available from the National Center for Health Statistics.
The Hill (8/7, Baker) "Healthwatch" blog reports, "Businesses expect their healthcare costs to grow by about 7 percent next year -- a bigger jump than they've seen in the past three years," according to a survey by the National Business Group on Health. Although the group "did not directly attribute the expected jump" to healthcare reform law, it "noted that employers are changing their health plans to comply" with the new legislation. The survey also found that 60 percent of respondents "plan to shift more healthcare costs to employees, but most said their workers' costs would rise by less than 5 percent next year." In addition, many companies are "trying to cut costs by beefing up programs that reward workers for healthy behavior."
CQ (8/7, Reichard, Subscription Publication) adds that National Business Group President Helen Darling said the survey also revealed "growth in the use of 'reference pricing'" system in which employers "pay a certain amount for a particular health service and employees who want to see a doctor or get a procedure that costs more than the reference point must pay the difference out of their pockets. 'This is going to become very common I think,' Darling said at a news briefing on the survey."
WPost Wonkblog Points Out That Premium Growth Is Slowing. The Washington Post (8/7) "Wonkblog" also reports on the survey, but took a different perspective. The blog writes, "Dig a bit deeper into the numbers, and there's actually a slight slowdown in health insurance premium growth - but one that may not necessarily trickle down to the consumer." Explains Wonkblog, "Some of this has to do with a lower cost of health care: During the recession, people have used fewer health care services, which has translated into lower cost growth. But it also has to do with how employers are designing their health insurance plans."
A study conducted by the National Center for Health Statistics has found that one in three US doctors does not accept new Medicaid patients. According to the Wall Street Journal (8/7, Radnofsky, Subscription Publication) around 31% of doctors from a sample of 4.326 said they would not accept Medicaid recipients. Meanwhile, 18% said they would not take new patients with private insurance and 17% said they would not accept new Medicare patients.
Kaiser Health News (8/7, Galewitz) reports that "New Jersey had the nation's lowest rate at 40 percent, while Wyoming had the highest, at 99 percent," while "Pennsylvania and Delaware closely track the national average of approximately seven out of 10 doctors accepting new Medicaid patients."
The Washington Post (8/7, Kliff) reports in its "Wonkblog" that CDC economist Sandra Decker's research "is the first that has ever given a state-by-state look at doctors' willingness to accept Medicaid," which "makes it a helpful report to understand the factors that influence doctors' participation in Medicaid, alongside the public policy levers that could encourage them to join up."
CQ (8/7, Adams, Subscription Publication) adds that primary care physicians were "11 percent less likely than other physicians to agree to see new Medicaid patients," and doctors in the "Midwest were 12 percent more likely to accept new Medicaid patients than those in the Northeast."
The Hill (8/3, Kasperowicz) reported in its "Floor Action" blog, "Rep. Michael Burgess (R-Texas) and three other senior House Republicans have introduced a bill that would repeal the 2010 healthcare law's establishment of an insurance program for people with pre-existing conditions, and replace it with federal funding that would let states handle this problem on their own. ... Burgess said his proposal is an improvement because it would not require people to wait for coverage until 2014, and would also allow states to try their own solutions to the problem."
In the "Plumb Line" blog of the Washington Post (8/3), Greg Sargent writes a new Hofstra University poll found that suburban voters "are inclined against" government spending and regulations "in the abstract, but are adamantly opposed to cutting them when the talk turns to specifics." According to the poll, "87 percent oppose cutting Social Security and Medicare benefits." Sargent concludes, "If Obama can steer this into a debate over who Americans should trust to approach entitlement and regulatory reform in a balanced way, one that defends middle class interests - him, or Romney and a bunch of Tea-boiling-mad right-wing Congressmen - then perhaps he can begin turning the argument over government to his advantage."
ABC World News (8/1, story 6, 0:35, Sawyer) reported, "Today is an important day for women's health. ... Starting today most of your private health plans must offer women eight different services and tests for free, including the yearly doctor's visit, routine breast and pelvic exams, prenatal care, and the most controversial provision: birth control. But religious employers like Catholic charities and hospitals do not have to directly include free birth control under their health plans."
NBC Nightly News (8/1, story 3, 2:00, O'Donnell) reported, "Domestically another piece of President Obama's signature healthcare law went into effect today and includes preventative care for as many as 47 million women including access to contraceptives at no charge and by going into effect started the healthcare fight all over again." NBC (O'Donnell) added, "From free birth control to annual check-ups millions of American women with private health insurance could begin to save money and that means no out of pocket co-pays for many preventive services." Kathleen Sebelius, Secretary of Health and Human Services, was shown saying, "No woman should have to choose between seeing her doctor and putting food on her table for her family." O'Donnell continued, "The new rules take effect when employer-based policies renew or when individuals buy new coverage so many women will wait a while longer."
The AP (8/2) reports Sebelius said, "President Obama is moving our country forward by giving women control over their health care."
On the front of its Marketplace section, the Wall Street Journal (8/2, B1, Mathews, Subscription Publication) reports that some of the country's largest health insurance companies are putting up more barriers for individuals who are trying to receive medical care. For instance, some companies are offering plans that restrict patients' choices with regard to physicians or hospitals. Other companies are now requiring physicians to obtain pre-authorization before they perform certain procedures or tests. American Medical Association President Jeremy A. Lazarus is quoted as saying, "There seems to be a return we're hearing about to some of the old practices that have been very frustrating to physicians."
ABC World News (7/31, story 6, 0:40, Sawyer) reported, "The new Obama healthcare law requires insurers to hand out rebates tomorrow. If they haven't spent enough of your premium money up to 85% on healthcare itself. If you buy direct coverage, you could get a check possibly for hundreds of dollars. If you work for a company that provides your insurance, your boss gets the rebate and can decide whether to pass it on to you."
The CBS Evening News (7/31, story 7, 2:30, Pelley) reported, "There is a little known part of the healthcare reform law that requires insurance companies to spend 80% of their premiums on healthcare, or reimburse the customer." CBS (Tracy) added, "It requires insurance companies to spend at least 80% of the money they collect in premiums on actual medical care. No more than 20% of premiums can be spent on salaries, bonuses and advertising. ... The idea was to force insurers to get rising costs under control." Tracy continued, "Overall 14% of insurance companies owe rebates, including some of the largest, Aetna, Cigna, Humana and United Health Care."
On the Daily Caller (8/1), Michael Bastasch writes a Kaiser Family Foundation poll found the 54% of Americans "are 'tired of hearing lawmakers debate the health care law and would like them to move on to other issues.'" The poll also found "that 46 percent of Americans admit they can still be persuaded to change their opinion of the" Affordable Care Act, with 36% of the law's supporters saying "there's a chance someone could change their opinion of the law" while "only 19 percent of opponents said that they were open to changing their mind." While respondents are still divided 46 to 45% for repealing the law, 56 to 35% oppose stopping it by not funding it and "half of those who support repeal want to see the law replaced with a Republican alternative."
Under the headline "Insurance Rebates Seen As Selling Point For Health Law," the New York Times (7/30, Goodnough, Subscription Publication) reports in a front-page story that under Affordable Care Act-mandated rebates, "insurers will pay out $1.1 billion this year, according to the Department of Health and Human Services," which "President Obama is highlighting...as a tangible early benefit of the controversial legislation." Though "only about 17 percent...will see a rebate this year," the Times notes, Washington and Lee University law professor Timothy S. Jost "and others say the rebate provision could prove a potent selling point for a law that remains unpopular with many Americans, not to mention a well-timed tool for the Obama re-election campaign." Still, the Times adds, insurers "say the rebate requirement does not address swiftly rising medical costs" and that "the rule could drive insurers with high administrative costs out of some markets if they are not given more time to meet the 80/20 standard."
Health Insurance Refunds "Refocus Debate" On ACA. The Augusta (GA) Chronicle (7/31, Corwin) reports that health insurance companies that spent over 20 percent of premium dollars "on items not related to paying actual medical claims will have to send out a notice and potentially a refund check by Wednesday" in what "could be the first tangible sign for some families that health care reform is more than a contentious debate in Washington." Additionally, "the refunds refocus debate on how the insurance market is regulated and where the new regulations might provide some disincentives for companies
The Washington Post (7/31) offers advice from Consumer Reports "on how to avoid unwelcome surprises" from your health insurance company. Tips include: "Understand your health insurance," as well as "don't pay until all bills are in," and "stay in network if you can."
Reuters (7/28, Morgan) reported Mike Hash, the senior official overseeing the Administration's health exchange effort at HHS, said, "We are on track to set up the federally facilitated exchange in those states" that don't create their own health insurance exchanges by 2014. Additionally, HHS is planning to issue before the fall guidance on how Federal exchanges would operate.
CQ (7/28, Reichard, Subscription Publication) reports that at a forum on health insurance exchanges, Federal and state officials were "peppered" with "questions about the nitty gritty of creating the new insurance marketplaces." Michael Hash, acting head of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, said that guidance on the essential benefits proposal will be released "shortly," while a supplemental guidance document on the exchanges' operational details will be out in the "summer." When asked if exchange plans will "pay Medicaid level payment rates, which are relatively low," Hash responded, "That's a matter between the health plans and the providers and I don't believe there are provisions in the Affordable Care Act that actually speak to that."
The Arizona Republic (7/29, Wiles, 322K) reported, "Several key tax rules are scheduled to change in 2013" under the Affordable Care Act. They include higher payroll withholding and a new tax on investment income. Meanwhile, the threshold for deducting medical expenses will rise from 7.5 to 10 percent of adjusted gross income. Meanwhile, people should "look for the Internal Revenue Service to issue regulations in coming months."
Bloomberg News (7/27, Wayne) reports that health insurers continue to press the Obama Administration to count fraud-fighting costs as medical costs to escape the 20 percent profit and administrative cost limit in the Affordable Care Act. Insurance executives raised the subject at the White House this week, with representatives from UnitedHealth Group and Blue Cross Blue Shield Association saying the limitation on the costs is a disincentive. HHS Secretary Sebelius said, "We know that fraud's taking place across the health care system with many private insurance companies facing the same challenges that we do." DOJ estimates that some $60 billion in fraudulent charges plague Medicare and Medicaid annually.
The Star-Telegram /Texas Tribune (7/30, Aaronson) reports, "While Texas works to fix a system that allowed dental clinics to charge the state millions of dollars in questionable Medicaid bills, dental providers say many impoverished Texas children have been left without adequate access to care." Both "dentists and orthodontists agree that the fraud and abuse of children at some corporate dental clinics is a serious problem that the state is addressing," although they contend that the state's manner of addressing the issue is leading to an environment in which it is difficult to "treat Medicaid patients. They say providers are often forced to refile reimbursement claims and wait months for payments as managed care organizations determine whether the claims meet their stricter determination of 'medically necessary' dental care
The Kansas City (MO) Star (7/29, Bavley, Adler) reported that with the Supreme Court's overturning the Affordable Care Act's mandate on expanding Medicaid, for some states "Medicaid expansion is in doubt," as "there are serious concerns about the costs and complexity of a larger Medicaid, as well as ideological opposition to any government growth." Because the ACA doesn't provide tax credits for buying insurance to those under the poverty line, assuming they will be covered by the expanded Medicaid, "these very poor people will be shut out." Also, the law assumes that with the additional millions insured, "hospitals will no longer need all the subsidies they receive through Medicare to cover the costs of uninsured patients," so not expanding Medicaid could hit hospitals financially. As hospitals have to treat emergency patients, they will seek to raise rates for the privately insured to make up the losses
Texas Governor's Decision To Forgo Medicaid Expansion Stirs Debate. The Houston Chronicle (7/30, Ackerman) reports, "Gov. Rick Perry's announcement this month that Texas won't participate in the Affordable Care Act Medicaid expansion...launched a debate about whether expanded Medicaid or the status quo is the least costly path." Texas hospitals charge $17.3 billion annually to treat the uninsured, and it is passed on to all Texans. According to Kathleen Stoll, the author of Family USA's 2009 report on the phenomenon, "the extra amount Texans pay in employer-based coverage is close to double the national average because so many Texans are uninsured."
CQ (7/27, Norman, Subscription Publication) reports that a survey of 1,545 workers released by the National Business Group on Health, which represents 350 large employers, found that "employer-provided health benefits remain crucially important to workers as an aspect of their jobs, and a majority is satisfied with the health plans offered despite rising premiums and out-of-pocket costs." Under ACA, "the issue is key," because "some employers may be faced with the choice of whether to keep their current plans or drop insurance and pay a penalty instead."
Modern Healthcare (7/27, Daly, Subscription Publication) notes that the survey "came two days after the release of a Deloitte survey of large- and medium-sized employers that found 9% anticipate dropping coverage within three years"
The New York Times (7/27, Carrns) in its "Bucks" blog sums up the implications of the survey, "Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection." The blog concludes, "No wonder older people object so strongly to any changes in Medicare."
In a column in the Washington Post (7/27), J.D. Harrison writes, "No one fought harder against the health-care reform law than the National Federation of Independent Business," and now that the Supreme Court upheld the healthcare reform law, its "team of lawyers and lobbyists has pinpointed three particularly onerous elements they believe can be made less burdensome for small business owners, either through legislative or regulatory action." The group seeks to eliminate the health insurance tax (HIT) provision, the costs of which they believe will be passed on by insurers. Next, the NFIB is urging the Department of Health and Human Services "to limit the full-time equivalence of" part-time and seasonal workers under the employer mandate. The group also "hopes to strip down the minimum benefits package that businesses are required to provide for employees," even though HHS hasn't determined the requirements yet.
The San Antonio Business Journal (7/27, Thomas, Subscription Publication) reports, "Insured Texans are due to receive more than $166 million in rebates this month from insurance companies under the federal Affordable Care Act." Mark McKinnon, a political consultant and former media strategist for George W. Bush, said, "These rebates will be a welcome surprise to a lot of consumers and help reduce angst about (the health care reform law)."
The New York Times (7/27, Bernard) blog "Bucks" reports that "a proposed rule would extend health insurance to the children of gay people who are partnered with federal employees. But the domestic partners themselves would still be blocked from coverage because of the federal law that defines marriage as between one man and one woman." The blog adds that "the proposal is significant because same-sex couples often have trouble establishing legal ties to their children," but it "still wouldn't put these families on an entirely even footing with their heterosexual married peers."
Dev Patnaik of Jump Associates, a strategy firm, writes in Forbes (7/27) that due to the recent Supreme Court ruling on the Affordable Care Act, "approximately 35 million Americans...will have to go shopping for a health plan on so-called health exchanges." For insurers, "that's both a tremendous opportunity and a serious threat." The opportunity, of course, lies in the millions of new customers, but the threat is that "insurance companies have very little idea who these people actually are, what their needs are, what their purchasing behavior will look like, and what kind of customers they'll turn out to be." To predict how insurers may respond to this change, the article draws upon the business practices of Walmart, Target, and Apple.
USA Today (7/27, Kennedy) reports the Obama Administration announced Thursday that "insurance companies, local governments and the federal government will trade health care billing information to help spot fraud trends." HHS Secretary Kathleen Sebelius said that "previously, neither the government nor insurers chased the money until it was 'out the door' in what has been called a pay-and-chase model," adding, "Now, we're taking away crooks' head start." USA Today adds, "Attorney General Eric Holder called it another step in a buildup of fraud-fighting." Previously, "privacy laws have prevented such a partnership, but the Department of Health and Human Services and the insurers will scrub out patients' personal information from the bills to address privacy concerns."
The AP (7/27, Smith, Alonso-zaldivar) reports, "Health and Human Services Secretary Kathleen Sebelius said the new public-private partnership will allow government programs and the insurance industry to take the high ground against scam artists constantly poking the system for weaknesses." She said, "By sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped." The program seeks "to start producing results in six months to a year," although "extensive sharing of claims data will take longer because difficult legal and technical issues have to be worked out." Additionally, "many of the details of the new partnership have yet to be worked out."
The New York Times (7/26, A13, Belluck, Subscription Publication) reports on a new study by Harvard researchers, published online Wednesday in the New England Journal of Medicine, which "found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died." The study "analyzed data from three states that had expanded their programs in the last decade to cover a population not normally eligible for Medicaid: low-income adults without children or disabilities."
The AP (7/26) reports, "The study found that for every 176 adults covered under expanded Medicaid, one death per year would be prevented."
The Kaiser Health News (7/26, Fleming) "Capsules" blog reports, "The decline in mortality...was especially pronounced among older individuals, minorities and residents of the poorest counties."
The Los Angeles Times (7/26, Levey) reports that the researchers also found that "residents of those states" that had expanded their programs "were also far less likely to delay needed care because of cost and more likely to report that they were in good health."
The Wall Street Journal (7/26, Dooren, Subscription Publication) reports that according to the study's authors, the research does not prove that Medicaid was the reason for the lowered rates, although they wrote, "The fact that mortality changes were largest in expected subpopulations offers some reassurance that we have isolated the effect of Medicaid expansion."
The Denton (TX) Record-Chronicle (7/26, Ramirez) reports, "A federal directive may impact how local hospitals get funding for uninsured patients and Medicaid beneficiaries. Representatives from Texas Health Presbyterian Hospital Denton, Denton Regional Medical Center and Baylor Health Care System asked Denton County commissioners to consider having the county join the Regional Health Partnership 9 to ensure future Medicaid funding. ... Earlier this year, the commission received federal approval of a Medicaid 1115 waiver to allow the state to expand its Medicaid managed care program."
The Hill (7/26, Baker)'s "Healthwatch" blog reports, "Businesses and employees are increasingly choosing insurance plans with high up-front costs and low premiums," according to new research from America's Health Insurance Plans (AHIP). The research found that "roughly 13.5 million people are covered by high-deductible insurance policies," which is "an 18 percent increase from 2011." This trend may be "a prime example of 'consumer-driven' healthcare," because these plans "offer a relatively inexpensive option for people who don't expect to rack up large medical bills."
Politico (7/26, Norman) reports, "The expansion of the Medicaid program - or the lack thereof - has emerged as a major focus of U.S. AIDS advocates at the 2012 International AIDS Conference this week." Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, remarked, "The extension of Medicaid coverage to all people up to 133 percent of poverty without discrimination is perhaps the single-biggest thing that can be done to push the National HIV/AIDS Strategy forward." Carl Schmid, deputy executive director of The AIDS Institute, added, "The Medicaid expansion is probably the biggest focus for us. It's huge."
New data from the Congressional Budget Office (CBO) regarding the costs of federal health law, as well as how many individuals will ultimately remain uninsured, received heavy coverage, both online and in print. The findings were also covered on one of last night's national news broadcasts.
The CBS Evening News (7/24, story 9, 0:35, Pelley) reported, "The nonpartisan Congressional Budget Office has done the math on the President's healthcare law for the first time since the Supreme Court upheld it. The CBO said today that the Court's ruling, which allows states to opt out of expanding Medicaid, will save the Federal government $84 billion over the next 11 years, but if Republicans make good on their vow to repeal the law, the CBO said that will increase the deficit by $109 billion because the law raises revenues and cuts spending."
McClatchy (7/24, Levey) reports that the CBO has concluded that "fewer Americans will likely get health insurance over the next decade under" the Affordable Care Act "as a result of the Supreme Court's decision to limit it," but "at the same time, the court's decision to allow states to opt out of a major expansion of the government Medicaid insurance program for the poor could also save taxpayers $84 billion by 2022." According to McClatchy, "The new projections confirm that the court's ruling will not fundamentally alter the law," which will "still... reduce the number of Americans without health coverage by some 30 million over the next decade."
According to the New York Times (7/25, A16, Pear, Subscription Publication), the CBO "now predicts that six million fewer people will be insured by Medicaid," but "half of them, it said, will probably gain private insurance coverage through health insurance exchanges to be established in all states. On balance, the budget office said... 'about three million more people will be uninsured' in 2022." CBO director Douglas Elmendorf said, "For the average person who does not enroll in Medicaid as a result of the court's decision and becomes uninsured, federal spending will decline by roughly an estimated $6,000 in 2022," but "for the average person who does not enroll in Medicaid as a result of the court's decision and enrolls in an exchange instead, estimated federal spending will rise by roughly $3,000 in 2022 -- the difference between estimated additional exchange subsidies of about $9,000 and estimated Medicaid savings of roughly $6,000."
The Washington Post (7/24, Montgomery) reports that "as a result of the court's decision," the CBO "now expects that some states will refuse to fully expand their Medicaid programs or will not do so immediately when most provisions of the law take effect in 2014. In those states, people who earn 100 percent to 138 percent of the federal poverty level will be eligible to receive government subsidies to obtain private insurance on newly created insurance exchanges. But people who earn less than the full poverty level could be left in the cold, the CBO said." The Post adds that the CBO "did not attempt to predict how each state would respond to the court ruling."
The Los Angeles Times (7/25, Levey) notes that the CBO "estimated that by 2022, about a sixth of Americans who would have been eligible for Medicaid will be living in states that do not expand their programs. Despite being barred from Medicaid by their state, some of these people will nonetheless qualify for federal subsidies to buy private health insurance on their own."
The AP (7/25, Alonso-Zaldivar, Taylor), CQ (7/25, Reichard, Subscription Publication), Roll Call (7/24, Dennis, Subscription Publication), the Washington Times (7/25, Cunningham), the Huffington Post (7/25, Young), Bloomberg News (7/25, Faler), Politico (7/25, Allen, Dobias), the Washington Post (7/25) "Wonkblog," the Wall Street Journal (7/25, A4, Radnofsky, Subscription Publication), The Hill (7/24, Wasson) "On the Money" blog, the USA Today (7/25) "The Oval" blog," the Washington Post (7/25, Bernstein) "Plum Line" blog, the Kaiser Health News (7/25, Appleby) "Capsules" blog, the Boston Globe (7/25, Borchers), Reuters (7/25, Smith), the NPR (7/25, Peralta) "The Two-Way" blog, Modern Healthcare (7/25, Daly, Subscription Publication), CNNMoney (7/25, Fox), and the National Journal (7/25, McCarthy, Subscription Publication) all covered the story.
Analysts Conclude The ACA Could Limit Seniors' Access To Care. In a segment for Fox News' Special Report (7/24) on the CBO report, correspondent Jim Angle reported that the Affordable Care Act "will raise revenue, in part, by cutting Medicare by $500 billion," and "the chief actuary of Medicare said that would eventually reduce payments for Medicare recipients to less than those on Medicaid." John Goodman, president and CEO of the National Center for Policy Analysis, said, "That means the senior citizen will be less attractive to doctors, from a financial point of view, than welfare mothers. How long do you think that can go on before seniors start complaining to their members of Congress?"
Health Leaders Media (7/25, Commins) reports, "The federal government is making available to states $275 million to design and test cost-effective care delivery and multi-payer coordination models." In a press release, HHS Secretary Kathleen Sebelius remarked, "As a former governor, I've seen states in action and know what great laboratories they are for innovations we can put into practice nationwide." Neva Kaye, managing director for health system performance at the National Academy for State Health Policy, added, "They want to give states the room to innovate and find ways to address the quality and cost issues."
The Wall Street Journal (7/24, Radnofsky, Subscription Publication) reports that a study by consulting company Deloitte released Tuesday predicts that about one in ten employers in the US will drop health coverage for their employees over the next few years, as the Affordable Care Act goes into effect. The report also predicted even more would in the future. Deloitte's findings are less than those released last year by McKinsey, which said up to 30% of employers would drop coverage.
The Washington Post (7/24) reports that the ACA provision which allows young adults under 26 to stay on their parents' health insurance plans "gives employers new options too: They can encourage their young employees to join Mom and Dad's plan rather than sign up for the company policy." The article discusses the benefits and costs of the options available to both employers and their employees, before concluding, "Young workers have to do their homework" to decide which option to take.
The Wall Street Journal (7/24, Murphy) reports in its "CFO Report" blog that Peter Benson, chief financial officer at McDonald's, said yesterday that the Affordable Care Act could cost his company over $400 million a year in additional healthcare costs, and that the restaurant chain has been "increasing our conversations and disclosures with franchisees" about the law's possible impact. However, noting that other factors, such as fluctuations in commodities prices, can produce similar challenges, Benson said that while the ACA "is a significant item, and it's gaining a lot of attention, as a [profit and loss] item we have managed through items of this magnitude in the past and I'm hopeful we can do that in the future."
Politico (7/21, Millman) reported, "On Friday, the administration published a proposed rule that would extend one of the health care law's best-known provisions - allowing children to stay on their parents' health plans until age 26 - to same-sex partners of federal workers." The piece notes that "the rule would extend eligibility in the Federal Employee Health Benefits Program to the children of an enrollee's same-sex partner."
The Los Angeles Times (7/21, Savage) quotes Brian Moulton, legal director for the Human Rights Campaign, who said, "These are small but important steps in the direction of equality." The Washington Post (7/20, Davidson) also reported this story.
The AP (7/23) reports, "Nowhere did Obama's health care law hold more promise than in Texas, which leads the nation in the portion of its population that is uninsured," and "without a Medicaid expansion, the state's working poor will continue relying on emergency rooms - the most costly treatment option - instead of primary care doctors." The piece notes, "Perry has said no Texan is going without health care because emergency rooms cannot turn away patients in urgent need. But the system to pay for chronic health problems is underfunded, difficult to navigate and as a result can shorten life expectancies."
The Dallas Morning News (7/20) editorializes, "This newspaper didn't think the Affordable Care Act was the best health care overhaul for America, but for the life of us we can't figure out why Gov. Rick Perry is so rock-solid against implementing sensible parts of the legislation." The piece argues, "At the very least, Austin should submit a plan to Washington before the law takes effect. Washington may tweak it, but the state can then start negotiating. Standing still won't help Texans who could gain from a marketplace that informs them about the quality, cost and services of health plans."
Texas Has Completed No Reviews Of Health Insurance Rate Hikes. In its "Shots" blog and on its "All Things Considered" program, NPR /KUHF (7/21, Feibel) reported, "Texas Gov. Rick Perry has opposed the expansion of Medicaid under the Accountable Care Act, and his administration has yet to review big health insurance rate hikes under the law," according to consumer advocates in that state. To date, "the Texas Department of Insurance hasn't completed any reviews. Officially, they're all pending." Meanwhile, "the insurance companies can go ahead and raise the rates anyway."
MedPage Today (7/22, Frieden) reported, "Medicare beneficiaries seem to be happier with their coverage than those with employer-sponsored private health insurance, according to a survey by the Commonwealth Fund" published online in the journal Health Affairs. "One-fifth of those covered by employer-sponsored health insurance and 33% of those with policies from the individual market rated their coverage as 'fair or poor' compared with only 8% of Medicare beneficiaries, fund president Karen Davis, PhD, of New York City, and colleagues wrote." Within the Medicare program itself, "15% of those in Medicare Advantage plans, which are run by private insurers, gave their plan a 'fair or poor' rating, compared with 6% of those with traditional Medicare coverage."
The Washington Post (7/20, Rau) reports Medicare data released Thursday indicate hospitals "are making little headway in reducing the frequency at which patients are readmitted despite a government campaign and the threat of financial penalties." Frequent readmissions are seen as "a sign of the shortcomings of the nation's healthcare system, with more than one in five Medicare patients returning to the hospital within a month of discharge." In October, Medicare "will begin to penalize hospitals with higher than expected readmission rates as required" by the Affordable Care Act.
The Hill (7/20, Viebeck) reports in its "Healthwatch" blog that HHS Secretary Kathleen Sebelius "said a new project under the Affordable Care Act will improve care and cut spending in three major federal health programs." The announcement said that "the initiatives will reward states for working with healthcare stakeholders to better coordinate care and cut 'unnecessary spending' in Medicare, Medicaid and the Children's Health Insurance Program." Sebelius remarked, "As a former governor, I've seen states in action and know what great laboratories they are for innovations we can put into practice nationwide." Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, added, "These awards are an incentive for states to recruit partners and accelerate the work that many of them are already doing to improve healthcare and lower costs." CQ (7/20, Norman) and Modern Healthcare (7/20, Zigmond, Subscription Publication) also report this story.
CQ (7/20, Norman, Subscription Publication) reports that "the Obama administration on Wednesday disclosed the contents of a final rule dealing with information that insurers must provide as part of the health law's standard health benefit package, less than two weeks after the comment period for the proposed regulation ended." CQ writes that "while the rule is not a major piece of how essential health benefits will be administered...it nonetheless stirred objections among insurers who said it went too far by asking them to describe not only the services they cover, but how they plan to limit access to covered services."
The Christian Science Monitor (7/20) reports, "Vermont plans to become the first state to adopt a single-payer health-care system. Its backers say it will cut costs and create jobs, but critics say the centralized control will drive away doctors." The state said "if all goes well, by 2017 or even earlier, the state of 626,000 plans to become the first in the country to adopt a single-payer system." The program will cost the state up to $9.5 billion.
Modern Healthcare (7/20, Evans, Subscription Publication) reports that "small employers with fewer than 100 workers could see incentives to self-insure under the healthcare reform law, a paper by the Center for Studying Health System Change says." Employers that self-insure "are exempt from new rules under health reform for fully insured products, including state review of premium rate increases, community rating for premiums and essential health benefits." The reports authors believe this "could lead to a shift in the market."
The New York Times /Texas Tribune (7/20, A17A, Ramshaw, Subscription Publication) reports, "When it comes to finding cost savings in the state's unwieldy Medicaid program, the Office of Inspector General at the Health and Human Services Commission gets high marks. ... But O.I.G.'s dollar-recovery strategy - which includes an increased reliance on a rule that allows investigators to freeze financing for any health care provider accused of overbilling - has enraged doctors, dentists and other providers who treat Medicaid patients," who "say an anonymous call to a fraud hot line or a computer-generated analysis of a handful of billing codes is enough to halt their financing without even a hearing, jeopardizing their practices and employees and leaving thousands of needy patients in a lurch while the state works to prove - or rule out - abuse."
The New York Times (7/19, A14, Goodnough, Pear, Subscription Publication) reports, "In what could lead to a direct confrontation with the Obama administration," Maine Gov. Paul LePage (R) "is planning to cut thousands of people from Maine's Medicaid rolls, arguing that the recent Supreme Court ruling on the law gives him license to do so." LePage "says the ruling gave states leeway to tighten eligibility for Medicaid," although "Federal officials insist that while the ruling allowed states to opt out of a planned expansion of Medicaid, it left intact all other aspects of the law affecting the program." The Times notes that "the debate here may presage political and legal conflicts between the federal government and other states as they grapple with implications of the Supreme Court decision.
The Hill (7/19, Lillis) reports in its "Healthwatch" blog, "Former GOP Sen. Bill Frist (TN) urged fellow Republicans Wednesday to embrace the insurance exchanges that are central to President Obama's signature healthcare reform law." In an op-ed in The Week magazine, Frist wrote that the exchanges are "perhaps the most innovative, market-driven, and ultimately constructive part of the law." He argued, "Helping more Americans find and compare the private insurance they need and can afford should be an easy principle both political parties agree on." Kaiser Health News (7/19, Serafini) "Capsules" blog also reports this story.
The Hill (7/19, Viebeck) reports in its "Healthwatch" blog that former Centers for Medicare and Medicaid Services chief Don Berwick "blasted critics of the healthcare law for 'irresponsible, cruel, baseless rhetoric' and said Washington leaders 'bend the truth and rewrite facts' out of convenience." Berwick recently addressed Harvard graduates, where he "condemned Washington for 'careless games' when it comes to healthcare."
In an op-ed for the Washington Times (7/19), Kathryn Nix, policy analyst in the Heritage Foundation's Center for Health Policy Studies, writes that "rules and restrictions in Obamacare undercut" the ability of health insurance companies to use "consumer-directed health plans." She says these plans curb healthcare costs by letting "families and individuals manage their own accounts." For this and many other reasons, she believes that, "if Washington truly wants to 'bend the health cost curve down,' the smart move is to repeal Obamacare."
The New York Times (7/19, Carrns) reports in its "Bucks" blog on a report by the Commonwealth Fund finding that "women in the United States have more trouble paying for medical care than women in other countries, even if they have health insurance." The report found that "women in the United States said they had problems paying medical bills at double the rate of women in 10 other countries – all of which had universal health coverage" so that "about a fourth of women in the United States 19 to 64 years old had medical bill problems, compared with 12 percent in France and 4 percent in Germany."
The Wall Street Journal (7/18, A3, Corkery, Subscription Publication) reports on a study from the State Budget Crisis Task Force, which found that states' abilities to offer basic government services are threatened by increasing Medicaid costs and pension expenses for public employees. Richard Ravitch, a one-time lieutenant governor of New York who co-chairs the task force, remarked, "Our goal was not to say that the apocalypse is around the corner. But it will be a hell of a lot more expensive to deal with these problems in five or ten years than to deal with them now."
The AP (7/18, Rugaber) reports, "The states' financial problems aren't just a result of the recession and slow recovery, the report said. They have built up over years." For example, Ravitch said that "increased spending on health care and pensions are crowding out other funding. Many states have already cut spending on public universities and infrastructure, such as roads and public transit."
The New York Times (7/18, A18, Fernandez, Subscription Publication) reports, "Several local leaders, health policy analysts and officials at urban hospitals across the state said Mr. Perry's decision to reject billions of federal dollars that Texas would receive in a Medicaid expansion would hurt county taxpayers and the hospitals they support, forcing them to continue to pick up much of the tab for treatment of the uninsured." The Times notes that "community health advocates and others criticized the governor's decision as long on talk but short on solutions or alternatives."
The Washington Post (7/18)'s "Wonkblog" reports on the "financial decision employers face" when choosing whether to "keep offering health insurance in 2014, or send employees to the new health insurance marketplaces." The blog relies on recent analysis (7/18) by Truven Health Analytics to detail four scenarios that could take place. All scenarios that involve employers dropping coverage lead to greater costs to the employee, which may not be balanced out by the benefits to the employer.
USA Today (7/17, Kennedy, Wolf) offers an analysis of federal data, which showed that "President Obama's health care law is constitutional as a tax - but only a small percentage of Americans will pay more." Donald Marron, director of the non-partisan Tax Policy Center, acknowledged that "the law's impact on middle-income taxpayers 'is on average going to be relatively small. The bulk of the taxes are aimed at corporations and high-income folks.'" Furthermore, "about 18 million people will get tax credits if they buy health insurance plans through new federal or state exchanges."
The Fort Worth (TX) Star-Telegram (7/17, Walker) reports that expanding Texas' Medicaid program "'would threaten even Texas with financial ruin,' [Texas Governor Rick] Perry wrote in a letter to Kathleen Sebelius, secretary of the Health and Human Services Department." The decision to expand Medicaid "will fall to the Republican-controlled Legislature, which convenes in January. Democrats vowed to fight for expansion, but legislators first must plug a $4 billion to $5 billion shortfall in the 2011-12 Medicaid budget."
CQ (7/17, Reichard, Subscription Publication) reports that "insurers responding to a recent proposal governing the information they must provide to help federal officials set standards for minimum health benefits say they are worried the government will do it in a way that makes coverage unaffordable." The issue "is the process of establishing the 'essential health benefits' plans," which the insurers must start offering in the fall of 2013. Insurers are afraid that a lack of "flexibility" will make their costs harder to control.
The AP (7/17, Taylor) reports that a healthcare law repeal "won't be as easy as some Republicans portend, and it certainly won't be quick" because "any realistic effort to repeal the Affordable Care Act - as opposed to last week's quixotic vote in the GOP-controlled House - is sure to get jumbled together with lots of other issues, including Medicare, taxes, food stamps and defense spending." The piece notes that "Republicans have to first pass a budget," and they "have a problem in that there's a lot more on their agenda than just repealing the health care law, and it's all going to have to be crammed into a budget resolution and follow-up reconciliation bill, too."
Politico (7/17, Robillard) reports on a poll released by Gallup on Monday, which found that "most Americans think President Barack Obama's health care reform law will harm taxpayers and businesses, while helping those directly threatened by a lack of health care." Specifically, "Sixty percent believe the law will make things worse for taxpayers, 57 percent think it will do so for businesses, 51 percent think it will do so for doctors and 46 percent think people with health insurance will be worse off." Furthermore, "For those without health insurance, 59 percent think the law will help, with just under a third thinking it will hurt."
The Kaiser Health News (7/17, Rau) "Capsules" blog reports that a new study appearing in the Archives of Internal Medicine has determined that safety-net hospitals may face financial difficulties in October when Medicare begins adjusting hospital payments based on quality. The study notes that safety net hospitals typically receive "poorer marks from patients," and that "the gap between how their patients rate them and the scores that other hospitals get has widened" over the past four years. If the trend continues, "it means safety net hospitals will be at a disadvantage when the Centers for Medicare & Medicaid Services uses the scores to dole out bonuses and penalties that will ultimately amount to 2 percent of regular Medicare payments."
Reuters (7/17, Pittman) quotes study author Dr. Ashish Jha of the Harvard School of Public Health in Boston, who says the effect on safety-net hospitals remains unclear. "They're the one set of hospitals that will take care of anyone who comes through their door no matter what their ability to pay," he said. "When safety-net hospitals shut down, it has huge effects on the entire marketplace." Dr. Jha suggests that Medicare officials reach out to safety-net hospitals and give them the resources to improve their patient care.
The Indianapolis Business Journal (7/17, Wall) quoted Sheryl Skolnick, co-head of research at CRT Capital Group LLC, who believes all hospitals face as much or more financial risk as health insurers under the Affordable Care Act. "The hospitals may end up paying for the poorest and sickest of today's uninsured anyway AND see cuts in Medicare and Medicaid on top of that," Skolnick wrote in a note to investors last month. She added, "While not immune, health plans, who have already been whacked by nasty regulations imposed by reform, have generally shown the ability to generate strong cash flows in spite of those new limits on margins and profits, while the worst may be yet to come for the hospitals."
The Charleston (WV) Daily Mail (7/17, Rivard) notes that the West Virginia Hospital Association "backs the Medicaid expansion even though the program's reimbursement rates are notoriously low. That's because West Virginia hospitals currently provide $740 million in charity care to the uninsured. Many of those uninsured people will be eligible for Medicaid if the state decides to expand the program."
The Washington Post (7/16, Aizenman) reports on the many Republican state leaders who are "balking" over the Affordable Care Act's Medicaid expansion. The leaders "speak of two experiences that, they charge, raise questions about whether the federal government can be counted on to hold up its end of the bargain: Congress's decision not to fund a mandated increase in Medicaid pay rates for doctors beyond two years and Obama's recent willingness to consider cutting the federal contribution to Medicaid."
Iowa Gov. Terry Branstad (R) said on Fox News Sunday (7/15, Hume), "The Federal government has a $16 trillion national debt, 40 cents of every dollar they're spending is borrowed money, and what do they want to do? Add another 15 million to 17 million people to the Medicaid rolls. It's unaffordable, unsustainable at even the federal or state level, and if we buy into it, then we have a maintenance effort requirement and when the federal government can't afford to do it, the burden gets dumped on the taxpayers of our state."
Florida Gov. Rick Scott (R) said on Fox News Sunday (7/15, Hume), "The Federal government can't afford this. We can't afford it. It doesn't make sense to do this expansion. What they ought to be doing is creating more choice, creating more competition; give individuals the same tax breaks as employers so you own your own policy and reward people for taking care of yourself." The Hill (7/16, Yager), in its "Healthwatch" blog, also reports on the Fox News interviews.
The Hill (7/16, Baker) reports in its "Healthwatch" blog, "In the two weeks since the court issued its decision, the Health and Human Services Department has pushed out new grants, new policies and a new rhetorical standby: It's time to get onboard." In a letter sent to governors last Tuesday, HHS Secretary Kathleen Sebelius wrote, "Now that the Supreme Court has issued a decision, we want to work with you to achieve our ultimate shared goal of ensuring that every American has access to affordable, quality healthcare." The Hill notes that "she has echoed that message several times since the court issued its historic 5-4 decision upholding most of the Affordable Care Act, and Obama sounded a similar theme when the ruling was announced."
Tavenner Offers Medicaid Expansion Help. The Wall Street Journal (7/13, Radnofsky) reported in its "WashWire" blog that Marilyn Tavenner, acting administrator for the Centers for Medicare and Medicaid Services, sent a letter to Republican governors on Friday offering assistance in expanding Medicaid programs. She wrote, "We expect that, as states study their options, they will recognize that this is a good deal ... We hope that states will not turn down the resources and flexibility offered in the Affordable Care Act and will put aside old political battles to move forward with implementation. We stand ready to help."
CQ (7/13, Subscription Publication) reported, "The letter from Tavenner begins to answer some of the many questions that states, the health care industry and policy experts have been raising since the June 28 Supreme Court decision."
The Hill (7/13, Viebeck) writes in its "Healthwatch" blog that the Commonwealth Fund, a nonprofit research organization, says in a new study that President Obama's "healthcare law will bring the United States in line with Europe by insuring more women and reducing their healthcare cost burden," but only if it is "fully implemented." The study said women in the US and Europe now have vastly different experiences with healthcare, with US women paying more, having more trouble paying their healthcare bills, and sometimes going without medical care because of the cost. The Commonwealth Fund urged states to fully adopt the Medicaid expansion portion of the law as part of "near-universal health insurance coverage for women."
American Medical News (7/16) reports on the Centers for Medicare & Medicaid Services (CMS) proposed 2013 physician fee schedule, in which "the Medicare program would pay doctors to coordinate patient care following a discharge from a hospital starting in 2013." The service would also "include payments for phone calls and other related care management activities that currently are not compensated." However, the proposal also "outlined a series of cuts to pay rates next year."
Modern Healthcare (7/13, Zigmond, Subscription Publication) reported that "the number of uninsured women in America rose by more than 30% between 2000 and 2010, according to a new Commonwealth Fund report that studies differences in healthcare costs for women in the US and 10 other countries." According to the story, "in 2010, 20% of US women, or about 18.7 million females between the ages of 19 and 64, were uninsured, compared with 15%, or about 12.8 million in 2000."
HealthDay (7/13, Reinberg) noted that "in addition to the nearly 19 million uninsured women, another 17 million women were underinsured in 2010." Also, "while uninsured women in the United States were likely to have problems paying medical bills and getting health care, many insured American women also face these problems, compared with women in other countries."
Medscape (7/13) reported that the study authors found that "uninsured women in the United States were the most likely to have difficulty with medical bills and getting necessary healthcare, but even insured women in the United States were more likely to have these problems than women in the other 10 countries."
In its "Health" blog, NPR (7/16, Aguirre) reports, "In the absence of a cure or vaccine for HIV/AIDS, drug treatment has at least helped lower the pandemic's toll." NPR says that the US Food and Drug Administration has played a key role in bringing the cost of drug treatment "down from $1,100 per person annually in 2004 to $335 per person in 2012" through the President's Emergency Plan For AIDS Relief, or PEPFAR. Starting in 2004, the FDA began expediting the tentative approval of generic drugs, "allowing production of more than 140 generic versions of common antiretrovirals, or ARVs, to be offered through PEPFAR." This change allowed nearly 70 percent of the medications being used to receive ARV treatment with generic versions.July 13-2012
The Dallas Morning News (7/13, Garrett) reports, "Texas taxpayers will absorb $15.6 billion of additional costs if President Barack Obama's health law is fully implemented in the Lone Star state through 2013, not the $27 billion that the state's Medicaid program managers estimated more than two years ago. The Texas Health and Human Services Commission's new estimate represents a 42-percent reduction in the figure it released soon after Obama signed the law in March 2010."
The Houston Chronicle (7/13, Fikac) reports that Executive Commissioner Thomas Suehs told a Texas House subcommittee that "the state would get an additional $100.1 billion in federal money over that time," which he "acknowledged would be attractive to local entities grappling with the cost of caring for the quarter of the state's population that currently is uninsured." Suehs added that "he agrees with Perry that Medicaid should not be expanded because it has too many problems that should be fixed first."
The AP (7/13, Johnson) reports that global spending on medications will "slow markedly" in the next four years "due to a slew of new low-cost generic drugs coming to pharmacies in the US and other developed countries." Analysts say at the same time, pharmaceutical companies will "boost its sales in emerging markets including China, India and Russia." Michael Kleinrock, head of research development at the IMS Institute for Healthcare Informatics, said, "We're going to see the cost of medicines drop dramatically in the US because of all the new generic drugs." Kleinrock added, "About 80 percent of the prescriptions filled in the US now are generics" and he predicts that number will be closer to 85 percent by 2016.July 12-2012
USA Today (7/12) editorializes that "in a pointless piece of political theater, the House voted yet again on Wednesday to repeal President Obama's health care law," but "not so meaningless...are recent decisions of several states to resist what ought to be some of the less controversial aspects of ObamaCare," such as the establishment of insurance exchanges and a Medicaid expansion. The piece argues, "The balky governors and legislators, overwhelmingly Republicans, complain about cost and state sovereignty, but for the citizens all that matters is what they'll get or what they'll lose, and they'll lose a lot." USA Today concludes that in this case, "a little common sense would go a long way."
Perry: ACA Programs Are "Misguided." In a USA Today (7/12) op-ed, Texas Gov. Rick Perry (R) writes, "Setting aside the brazen intrusion into state sovereignty and the gross federal overreach, the practical problem with ObamaCare's Medicaid expansion is that the product the administration is selling is broken. State and federal budgets are simply unable to handle an expansion of this magnitude." Furthermore, "When it comes to ObamaCare's insurance exchanges, they aren't the free-market solution they're advertised to be." Perry concludes, "ObamaCare is one long-term contract nobody should sign, and I'm proud to stand with other governors in opposition to these costly and misguided programs."
The Washington Times (7/12, Dinan) reports that the Government Accountability Office "said Wednesday President Obama is stretching the law to give bonuses to mediocre private Medicare plans - an $8 billion program the auditors had already urged the administration to cancel." While "the administration counters that it's trying to learn what kinds of incentives can spur private companies to offer better coverage," the GAO "said that's a stretch, since the demonstration seems designed to produce little useful data and could even reduce incentives for private plans to provide better care." The Times notes that HHS Secretary Kathleen Sebelius "had previously rejected GAO's findings and said her department would move ahead with the demonstration project."
The AP (7/12) reports, "Medicare's assertion that the program is fully legal 'does not resolve our concerns,' the GAO's Gibson wrote to Health and Human Services Secretary Kathleen Sebelius." Meanwhile, "In a statement, Medicare spokesman Brian Cook said there is 'longstanding precedent' for such programs 'with Republican and Democratic administrations using this authority in this way.'" CQ (7/12, Bunis, Subscription Publication) and Modern Healthcare (7/12, Daly, Subscription Publication) also report this story.
The Hill (7/12, Baker) reports in its "Healthwatch" blog, "Health and Human Services (HHS) Secretary Kathleen Sebelius on Tuesday urged governors to participate in the Affordable Care Act's (ACA) Medicaid expansion, which the Supreme Court said must be optional for states." In addition, she "announced a new round of meetings for state and federal officials to discuss implementation of President Obama's healthcare law." In a letter to governors, Sebelius wrote, "Now that the Supreme Court has issued a decision, we want to work with you to achieve our ultimate shared goal of ensuring that every American has access to affordable, quality healthcare."
Bloomberg News (7/12, Wayne) reports, "The ruling doesn't allow states to cut people from their Medicaid rolls, Health and Human Services Secretary Kathleen Sebelius said in a letter to governors yesterday. One passage of the law, called 'maintenance of effort,' prevents states from reducing eligibility or benefits in Medicaid before new online insurance exchanges are to be available in 2014."
The Washington Post (7/12, Kliff) reports in its "Wonkblog" that "Sebelius is exploring how to make the health law workable without a Medicaid expansion." In her letter to governors, she "acknowledged that some states may not. To that end, Sebelius hinted that the Obama administration has been looking at how to make the law work best in recalcitrant states." Sebelius wrote, "As to the very small number of affected individuals who would not qualify for the statutory exemption. Congress provided additional authority, which we intend to exercise as appropriate, to establish any hardship exemption that may be needed."
Amerigroup CEO: States Should Expand Medicaid. The Kansas Health Institute (7/12) reports that Amerigroup CEO James Carlson, who "recently signed Medicaid managed care contracts with the state of Kansas said today that states shouldn't refuse the offer of additional federal money to expand their programs." He remarked, "When you step back from this, there are billions of dollars of federal money that are going to flow into states. We think the states are going to need to take it."
A front-page story in the New York Times (7/11, A1, Meier, Thomas, Subscription Publication) reports, "At a time of soaring health care bills, experts say that doctors, middlemen and drug distributors are adding hundreds of millions of dollars annually to the costs borne by insurance companies, employers and taxpayers through the practice of physician dispensing," which is described as doctors' "own in-office pharmacies." According to the Times, "The practice has become so profitable that private equity firms are buying stakes in the businesses, and political lobbying over the issue is fierce." States such as California and Oklahoma are "alarmed by the costs," and "have clamped down on the practice," while "legislative and regulatory battles over it are playing out in other states like Florida, Hawaii and Maryland."July 11-2012
The AP (7/11) reports that "the Obama administration says low-income residents in states that decide to opt out of a big Medicaid expansion in the new health care law will not risk federal penalties as an unintended consequence." The article notes that in a letter to governors Tuesday, HHS secretary Kathleen Sebelius said that those residents "will not face the individual insurance mandate."
Southern Governors Reject Medicaid Expansion. Politico (7/11, Allen, Smith) reports that Republican governors in the South "have a real plan to gut" the Affordable Care Act. Texas and Florida "are among five hell-no states, meaning three million of the potential Medicaid beneficiaries -- or about one in five nationwide -- won't get coverage through President Barack Obama's health care law, according to a Politico analysis of data compiled by the Urban Institute. The governors of Mississippi, Louisiana and South Carolina also have said Washington can keep its Medicaid money and the new requirements that come with it." Politico notes that some GOP governors "have taken a more measured approach," suggesting "they're not at all sure that rejecting a big infusion of Medicaid cash makes for good policy or good politics. In fact, they're trying to recast the problem as one that Obama must solve."
Arizona Takes Time To Weigh Medicaid Expansion. The AP (7/11, Davenport) reports that Arizona Governor Jan Brewer's administration will take months "to get enough information to make an informed decision on the Medicaid expansion," despite vocal opposition in the past. Don Hughes, Brewer's health policy adviser, said the administration "will consult legislators, care providers, business leaders and others as it considers the state's options."
Virginia Governor Undecided On Medicaid Expansion. The Washington Post (7/11, Kumar) reports in its "Virginia Politics" blog, "Gov. Bob McDonnell sent a letter to legislators Tuesday saying that he is considering whether Virginia should opt out of the federal health law's Medicaid expansion, but needs more information. ... In a seven-page letter to members of the General Assembly, McDonnell said he was weighing ramifications following the Supreme Court's health-care decision. But he reiterated that he would not call a special legislative session to deal with the issues."
The Washington Times (7/11, Sherfinski) reports that McDonnell "wrote a separate letter to Mr. Obama on behalf of fellow GOP governors, noting that if states opt out of the Medicaid expansion, there likely will be a significant gap in coverage for low-income people who don't qualify for tax credits. He also questioned how the government could afford to even implement the law 'with deficits already over $1 trillion in every year of your presidency, and the debt growing $5 trillion in the past three years to an outrageous record of nearly $16 trillion.'"
The AP (7/11) reports that McDonnell wrote, "This is an unsustainable trajectory that demands improvement and greater efficiency. A great expansion of Medicaid, without significant reform of the current so-called, 'federal-state partnership' is not responsible. Before an expansion decision is made, we must discuss with (US Health and Human Services Secretary Kathleen Sebelius) the necessity of including clear and fair rules and state flexibility in decision making for the Medicaid program."
Idaho Governor To Examine Medicaid Expansion, Insurance Exchange Options. NPR (7/11, Messick) reports, "Gov. C.L. 'Butch' Otter will form working groups to 'research and carefully examine' Idaho's options in the wake of the recent Supreme Court decision upholding the main components of President Obama's health care law. That's according to an opinion piece distributed to media by the governor's office this afternoon." Jon Hanian, the governor's press secretary, "said there are many questions the federal government still must answer. 'Things like the list of regulations,' Hanian elaborated. 'There's been some discussion about whether there's going to be a fee for connecting to a federal data hub. There are quite a few questions that we still need some clarification on, which is why the governor wanted to look at this very cautiously and carefully.'"
Minnesota Governor Continues Developing Health Insurance Exchange. The AP (7/11) reports that Minnesota Governor Mark Dayton wrote a letter Tuesday to HHS Secretary Kathleen Sebelius confirming his plans to "continue developing a health insurance exchange for Minnesota." Dayton wants to win Federal approval of his plan by January 1 "to avoid getting a one-size-fits-all federal model."
Rejection Of Medicaid Expansion Creates Financial Problems For Hospitals. The Financial Times (7/11, Kirchgaessner, Subscription Publication) reports that some US hospitals are facing financial problems in the wake of some Republican governors' decisions to reject am expansion of Medicaid in their states. Those decisions create a financial problem for hospitals who for hospitals who are legally required to treat those patients.
Former CMS Administrators Offer Advice For Medicaid Expansion Efforts. Politico (7/11, Norman) reports, "Three former administrators of the Centers for Medicare & Medicaid Services who served Republican presidents have a bit of advice for Democrats trying to get conservative governors to go ahead with Medicaid expansion: Be flexible. Don't make it a political litmus test. And try not to pour fuel on what's already a hot-burning fire." Mark McClellan, who served under President George W. Bush, remarked, "The big point is that states are going to get something as a result of the shift in the negotiating power with the federal government. That's going to mean something, but we don't know exactly what." Tom Scully, who also served under President George W. Bush, added, "What you don't want to do is make rejection of the Medicaid expansion a litmus test for Republicans."
Wall Street Expects Increase In Medicaid Spending. Politico (7/11, Reis) reports, "There are clear signs that Wall Street is anticipating a spike in Medicaid spending that would come from the expansion. Among them: Insurance giant WellPoint announced Monday it has agreed to spend $4.9 billion in cash to purchase Amerigroup, a smaller health insurance firm whose business focuses on Medicaid administration."
Studies Show Medicaid Money Sparks Economic Activity. The Washington Post (7/11, Kliff) reports in its "Wonkblog" that "study after study has found that federal Medicaid dollars spur economic activity beyond the initial investment." Robin Rudowitz, associate director for the Kaiser Commission on Medicaid and the Uninsured, commented, "For every dollar that a state spends, federal funding filters through the state economies. That tends to go both into health service vendors as well as other sectors."
Orszag: States Will Find It Hard To Resist Subsidies. In Bloomberg News (7/11), Peter Orszag, vice chairman of global banking at Citigroup, writes that while "many states seem likely to opt out at first," as time passes "most states will find it hard to resist the substantial subsidies for new enrollees. ... The bottom line is that given the steep federal subsidies being offered, it seems likely that states will eventually take up the additional coverage, even if they resist at first."
The Washington Post (7/10, Somashekhar) notes that while Mitt Romney has vowed to repeal the President's healthcare law if he is elected, unless Republicans "gain huge numbers in Congress," he "likely would not have the votes to simply repeal the entire law." As President, Romney "could instruct the Department of Health and Human Services to drag its feet, pushing back deadlines and turning to an army of lawyers and consultants to figure out how to exploit the law's weaknesses. But that kind of administrative muscle flexing could bring its own political problems." Many predict Romney "would move decisively and aggressively to make good" on his promise if he is elected, but "doing so would carry political pitfalls, because millions of Americans not only support the law but already are benefiting from some of its provisions."
The US News and World Report (7/11, Bennett) "DOTMIL" blog reports a new Center for Strategic and Budgetary Assessments report due out Thursday has concluded that "US military personnel and their dependents believe lifetime healthcare coverage isn't worth the high price the Pentagon pays for it, preferring instead pay hikes over other potential benefits changes." According to the CSBA study, the majority of troops "do not value free TRICARE for Life commensurate with what it costs DOD to provide." Instead, the troops surveyed "place the highest value ... on their ability to choose where they next will serve and for how long."
In his bi-weekly column for the Los Angeles Times (7/11), Michael Hiltzik highlights two lawsuits filed by Aetna and United Healthcare earlier this year, "alleging that a Northern California chain of small surgical clinics fraudulently overcharged them tens of millions of dollars by counting on the insurers being asleep at the cost-control switch." Hiltzik says the heart of the issue "is whether unnecessary medical utilization increases, driving up costs, when doctors refer patients to clinics they own." This trend, he adds, is "especially troubling in California, where physician-owned clinics are subject to such lax regulation that state authorities have almost no idea how their surgical outcomes match up to hospitals and other better-regulated facilities."
NBC Nightly News (7/10, story 5, 0:35, Williams) reported that President Obama is "ready to issue an executive order that will allow" firefighters fighting the Colorado wildfires "to buy into a Federal health insurance plan. A bill has also been introduced in the House in Washington that would cover them as US Forest Service employees."
In his "Federal Diary" column for the Washington Post (7/11), Joe Davidson writes that the US government is "finally closing a loophole" in which it avoided "offering health insurance for some federal employees who risk their lives to save the lives and property of others." Many Federal firefighters are "allowed to work only 1,039 hours, just under six months, not including overtime," which "makes them part-timers who are not eligible to secure health insurance through the Federal Employees Health Benefits Program (FEHBP)." But following a trip to Colorado and meeting with firefighters, President Obama announced plans to "issue interim regulations allowing them to buy health insurance just like other employees."
The AP (7/11) reports that even though many healthy young people may not like the idea of buying thousands of dollars worth of medical insurance under the Affordable Care Act, "that doesn't necessarily make blowing off the mandate a good idea for the fit and frugal. Millions of young people will qualify for good deals on health care if they take time to sort through the complicated law." The AP goes on to explore ways in which young people can get good deals on health coverage.July 10-2012
The Los Angeles Times (7/10, Muskal) reports, "Texas turned down an expansion of Medicaid coverage and said it will not create a state-run healthcare insurance exchange, joining the chorus of states that are rejecting two key proposals of the Obama administration's healthcare overhaul measure." Texas Gov. Rick Perry (R) announced the rejections in a letter to HHS Secretary Kathleen Sebelius, and the move is said to have "been widely expected." Perry remarked, "I stand proudly with the growing chorus of governors who reject the Obamacare power grab. Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to health care."
USA Today (7/10, Camia) reports that "Texas joins states such as Florida, Louisiana, Mississippi and South Carolina in flouting the US government on the Medicaid provision in the national health care law." The piece notes, "In response to Perry's letter, HHS department spokesman Keith Maley told the Associated Press that consumers in all 50 states would have access to an exchange by 2014, and he said the federal department would ensure states have the 'flexibility and resources they need' to implement the new law."
The New York Times (7/10, A10, Fernandez, Subscription Publication) reports, "Mr. Perry's opposition to the provisions, while not surprising, angered Democrats and community health advocates in Texas." In a statement, Rebecca Acuña, a spokeswoman for the state Democratic Party, said, "Rick Perry could've brought billions in federal dollars to Texas, reduced the rate of the uninsured and improved the quality of life for Texans. Rick Perry's Texas solution is to let Texans stay ill and uninsured."
The AP (7/10, Stengle) reports, "Texas Hospital Association President and CEO Dan Stultz said hospitals agree with Perry that the Medicaid program is 'severely flawed,' but he added that 'without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured and increasing uncompensated care to health care providers.' ... US Rep. Lloyd Doggett, among the Texas Democrats criticizing Perry's announcement, called the governor's decision 'disgraceful.'"
The Dallas Morning News (7/10, Wilonsky) reports, "Perry also dismissed a recent report by the federal Agency for Health Care Research and Quality that ranked Texas worst in the country in healthcare services and delivery. He said that Texas has 'some of the finest healthcare in the world,' and offered the influx of people moving to the state as proof." Perry remarked, "The idea that this federal government, which doesn't like Texas to begin with, can pick and choose and come up with some data to say Texas has the worst healthcare system in the world is just fake and false on its face."
Rick Ungar writes in Forbes (7/10), "Given that Texas has, to date, operated one of the skimpier Medicaid programs in the nation, the state actually stands to benefit more than any other as a result of the Affordable Care Act's Medicaid expansion." In addition, "Perry's letter to the HHS Secretary further highlights his complete disdain for the ruling of the United States Supreme Court by pointing out that the law is in 'direct contradiction to our Constitution'-a real brain teaser when the Supreme Court has ruled that the law is, indeed, constitutional."
The Washington Post (7/10, Kliff) reports in its "Wonkblog" that "while the stakes are high for the White House, the territory is by no means uncharted. Washington has twice faced off with states over federal health care expansions, when Medicaid initially launched in 1965 and with the Children's Health Insurance Program in 1997. In both cases, all 50 states ultimately signed up – but not without some wrangling."
Also reporting this story are the Dallas Business Journal (7/10, Hethcock, Subscription Publication), the Dallas Observer (7/10, Minora), the Houston Business Journal (7/10, Wilkinson, Subscription Publication), the Houston Chronicle (7/10) "Texas Politics" blog, the San Antonio Business Journal (7/10, Bailey, Subscription Publication), Bloomberg News (7/10, Chang), Reuters (7/10, MacLaggan), ABC News (7/10), CBS (7/10) "Political Hotsheet," Politico (7/10, Smith), The Hill (7/10, Baker) "Healthwatch" blog, CQ (7/10, Norman, Subscription Publication), NPR (7/10, Hensley) "Shots" blog, and the Huffington Post (7/10, Johnson).
South Carolina's HHS Head: "We Simply Can't Support This." Bloomberg News (7/10, Newkirk, Selway) reports, "Caught between poverty and pressure to curb government's power, South Carolina illustrates the forces at play in the nation's capitals amid the broadest changes to the health care system since 1965." Tony Keck, head of South Carolina's HHS department, remarked, "We simply can't support this. We are not going to jam more South Carolinians into a broken program, a program that stifles innovation, discourages personal responsibility, and encourages fraud, abuse and overuse of services -- and that, by the way, costs us billions of dollars."
The Rock Hill (SC) Herald (7/10) editorializes that "if the state does turn down federal help in covering these low-income people, we hope the governor and state lawmakers have an affordable alternative in mind. ... Haley and Keck insist that South Carolina can find more efficient ways to deliver health care to the poor, and they may be right. But it is doubtful that they could find enough waste and inefficiency to come close to euqaling the money the federal government would provide through Medicaid."
Arizona Governor "Still Gathering Information" On Medicaid Expansion. The Arizona Republic (7/10, Alltucker, Reinhart) reports, "As Texas Gov. Rick Perry becomes the sixth GOP governor to say his state will opt out of the federal health-care law's Medicaid expansion, health-care providers, patients and business owners in Arizona are anxiously waiting to see whether Gov. Jan Brewer will follow suit." Brewer is said to be "still gathering information about the scope, expense and federal requirements that would accompany an expansion of Medicaid in Arizona," and she "plans to meet with health-care leaders, including hospitals, doctors and insurers, before deciding whether to accept, reject or request a modified Medicaid expansion."
Iowa Governor Says Medicaid Expansion Would Be "Big Mistake." The Sioux City Journal (7/10) reports, "Gov. Terry Branstad on Monday reinforced his opposition to the Affordable Care Act, even as his critics continued to ramp up pressure on him to change his mind." He "said it would be 'a big mistake' for the state to expand Medicaid coverage to an estimated 150,000 Iowans after the US Supreme Court ruling that allowed states to choose if they want to expand services."
Delaware Governor "Remains Uncommitted" To Medicaid Expansion. The Wilmington (DE) News Journal (7/10, Starkey) reports, "In Delaware, Democratic Gov. Jack Markell remains uncommitted to widening eligibility up to 133 percent of poverty, as envisioned in the health law." Markell remarked, "The court decision made clear that what was mandatory is now optional. Before we decide whether to choose that option, it seems prudent to get greater clarity and certainty from the federal government."
The Hill (7/10, Baker) reports in its "Healthwatch" blog that "most businesses waited for the Supreme Court before making plans to comply with President Obama's healthcare law - but most aren't waiting for November to see whether the law might be repealed." According to a "survey from the consulting firm Mercer found that most businesses have not begun planning for requirements that will take effect in 2014, including the mandate requiring employers to provide health benefits to most workers."
The Houston Chronicle (7/9, Kever) reports, "Between 1.5 million and 2 million people in Texas would be covered by the Medicaid expansion, but the Supreme Court allowed states to opt out without jeopardizing their funding for the traditional Medicaid program." The rules "for traditional Medicaid vary from state to state; in Texas, children, pregnant women, disabled adults and the elderly are covered." With "the expansion, anyone with an income no greater than 133 percent of the federal poverty level would qualify" and "advocates say that would improve public health." The story offers a few personal stories of those held in limbo while waiting for the state's decision on whether to expand Medicaid.
New Indiana Governor To Make Medicaid Expansion Decision. The AP (7/8, LoBianco) reports, "The first major test for Indiana's next governor will likely be deciding whether to expand the state's Medicaid rolls." The piece notes that "Republican gubernatorial candidate Mike Pence has not said definitively that he would oppose the Medicaid expansion, but he has been pretty clear on his opposition to the federal health care law. A spokesman for Democrat John Gregg, meanwhile, says he is sticking to Daniels' wait-and-see approach before making any decisions."
Tennessee Governor Has Not Made Medicaid Expansion Decision. The Memphis Commercial Appeal (7/9) reports, "Although Tennessee's governor has said he opposed the Affordable Care Act...he hasn't signaled whether he would block an expansion of TennCare, the state's Medicaid program." The piece notes, "Gordon Bonnyman, executive director of the Tennessee Justice Center, said the state doesn't really have any choice but to expand TennCare. Should the state fail to expand the program, Tennesseans will, in effect, see their federal taxes used to subsidize expanded Medicaid programs in other states, he said."
The AP (7/9) reports that Craig Becker, "the head of the Tennessee Hospital Association says hospitals across the state are going to suffer if TennCare is not expanded under the new federal health care law. ... Becker said hospitals are worried because the health care law would drastically reduce special payments to hospitals that treat large numbers of Medicaid or uninsured patients."
Georgia Hospitals Depending On Medicaid Expansion. The Atlanta Journal-Constitution (7/9, Williams, Teegardin) reports, "Georgia hospitals were depending on the health care law to ease the burden of treating hundreds of thousands of uninsured patients each year for free. But that relief may never come. ... For hospitals, not expanding the health program for poor and low-income Georgians would mean having to treat almost as many uninsured patients as ever while facing significant cuts to their reimbursements." The piece notes, "The Medicaid curveball comes at a time when Georgia hospitals are already in the throes of a massive industry transformation to improve quality and efficiency driven by market forces as well as the new law."
The New York Times (7/8, A14, Pear, Subscription Publication) examines the next battleground for the Affordable Care Act: whether insurance subsidies will be part of the healthcare exchanges that the Federal government runs in states that refuse to run their own. "Critics say the law allows subsidies only for people who obtain coverage through state-run exchanges," while "the White House says the law can be read to allow subsidies for people who get coverage in Federal exchanges as well." According to the Times, "The dispute has huge practical implications" for costs, with the CBO estimating that "23 million uninsured people will gain coverage through exchanges and that all but five million of them will qualify for subsidies, averaging more than $6,000 a year per person."
Politico (7/9, Millman, Dobias) reports that health analysts are uncertain whether the new insurance rules including the requirement that insurance companies cover people with pre-existing conditions, can remain if congressional Republicans repeal aspects of the Affordable Care Act using budget reconciliation. There is "broad agreement Republicans could use the legislative maneuver to go after the law's individual mandate. ... Also likely on the chopping block are the suspended CLASS Act and the much-maligned Medicare Independent Payment Advisory Board, both of which got repeal votes in the House." Politico adds, "What's tougher to game out, however, is whether Congress could pair all that with repeal of the law's insurance market reforms, including a requirement for insurers to offer coverage to anyone who seeks it and a ban on charging customers based on their medical histories."
The Hill (7/9, Berman) reports that despite Republican claims that the individual mandate in the Affordable Care Act is "the 'largest tax in America's history.'" in reality it is "not even the largest tax increase in the 2010 healthcare law, much less in the history of the republic." The Hill notes that according to the CBO, the "penalty, or tax, for not buying health insurance will bring in just about $4 billion a year and a total of $17 billion by the end of the decade. Taken either as a whole or as a percentage of the overall economy, that pales in comparison to many tax increases in recent decades. And according to findings by Republicans on the House Ways and Means Committee, there are nine different revenue increases that are larger within the healthcare law itself."
George Skelton writes in the Los Angeles Times (7/9), "In Washington, it's called the Affordable Care Act. In Sacramento, it could be become known as another budget buster. Obamacare - as it's pugnaciously tagged by the political right - may not be affordable at all for California state government." Len Finocchio, associate director of the Department of Health Care Services, "acknowledges that the federal act will result in a heavier state financial load."
The AP (7/9, Tomlinson) reports that in Texas, the number of physicians "willing to accept government-funded health insurance plans for the poor and the elderly is dropping dramatically amid complaints about low pay and red tape, according to a survey by the Texas Medical Association." Just "31 percent of Texas doctors said they were accepting new patients who rely on Medicaid, the health insurance program for the poor and disabled, in the survey provided to the Associated Press on Sunday. In 2010, the last time the survey was taken, 42 percent of doctors accepted new Medicaid patients."
The Washington Post (7/6, Sargent) reports in its "Plum Line" blog, "Republican governors who are threatening to opt out of the Medicaid expansion - which could deprive millions of insurance - have justified it by claiming that opting in could crush their state budgets. ... But what if opting in to the Medicaid expansion could actually save states money over the long term?" The piece notes that it is "very possible," as shown in "an Urban Institute study that was conducted in 2011 but is newly relevant in light of the GOP governors' threats."
Carroll: Few States Will Ultimately Refuse Medicaid Expansion Money. At CNN (7/6), Dr. Aaron E. Carroll, an associate professor and vice chairman of health policy and outcomes research in the department of pediatrics at the Indiana University School of Medicine, writes about the Medicaid expansion. He notes, "I still believe that few states will choose to refuse the expansion money. It's hard to say no to a full funding of insurance for millions of constituents when it will cost you nothing." He adds that "it will be politically difficult to say no when so many other states are saying yes. There will also be enormous pressure from physicians, hospitals and other providers, who stand to lose a ton of money if people aren't insured."
Kentucky Encouraged To Not Expand Medicaid. The Louisville (KY) Courier-Journal (7/6, Loftus) reports, "Kentucky House Minority Leader Jeff Hoover on Thursday urged Gov. Steve Beshear not to expand Kentucky's Medicaid program." Hoover remarked, "We have repeatedly had problems budgeting for the financial needs of our Medicaid system already."
Reid: Nevada "Foolish" Not To Get Reimbursement. The Las Vegas Review-Journal (7/6, Tetreault) reports that according to Sen. Harry Reid (D-NV), Nevada Gov. Brian Sandoval should expand Medicaid. Reid remarked, "Brian Sandoval has said he is going to look at it to see how it would work. Once he looks at it, he will have to take it." He added, "As far as Medicaid, the state of Nevada and other states, they would be foolish not to get this money. It's a hundred percent reimbursement for the first few years."
Louisiana Hospital Officials Cautious About Governor's Refusal To Expand Medicaid. The New Orleans Times-Picayune (7/6, Alpert) reports, "Louisiana hospital officials are taking a wait-and-see attitude toward Gov. Bobby Jindal's refusal to expand Medicaid eligibility as called for in" the federal health reform law. While hospital officials in "other states...are lobbying their governors and legislatures to move forward with the Medicaid expansion, Louisiana hospital administrators and representatives are being cautious." According to the Times-Picayune, "hospitals are worried the expanded Medicaid participation authorized under the health overhaul law...would lead the federal government to significantly reduce compensation to hospitals for providing care to the uninsured."
The AP (7/6) reports, "Texas ranks worst in the nation in health care services and delivery, according to an annual scorecard issued by the federal Agency for Health Care Research and Quality." According to the AP, "The Texas Medicaid law for the disabled and poor offers one of the most limited health care programs in the nation, and more than 25 percent of Texans do not have health insurance of any kind, which is the highest uninsured rate in the nation."
The Houston Chronicle (7/6, Ackerman, Walczak) reports, "Texas scored 31.61 -- less than half of top-ranked Minnesota's 67.31 - out of a possible 100 points in the Agency for Healthcare Research and Quality annual rankings." The state, "rated 'weak' or 'very weak' in nine of 12 health delivery categories...dropped from 47th place in 2010 to 51st in 2011, behind all other states and Washington, D.C."
The Austin (TX) American-Statesman (7/6, Roser) reports, "Texas rated below the average of all other states on treating women under 70 with breast cancer who received breast-conserving surgery and radiation within a year of diagnosis, as well as four factors involving management of home health care patients: those who got better at getting in and out of bed and those having shortness of breath, pain when moving around and urinary incontinence." The state "scored best on preventing weight loss among long-term nursing home residents; controlling pain among shorter-term nursing home residents; children who received the Haemophilus influenzae type B, or Hib, vaccine; small children who received all recommended vaccines; and the number of prostate cancer deaths."
Politico (7/6, Bergstrom) reports on a Gallup poll released Thursday, which found that 46 percent of "Americans believe that the Affordable Care Act will hurt rather than help the US economy," while 37 percent felt the opposite. Furthermore, "Republicans were far more likely than Democrats to say the law will hurt - 78 percent to 20 percent, respectively - while 47 percent of independents believe the same, versus 34 percent who think the law will help." The Wall Street Journal (7/6, Nicholas) "WashWire" blog also reports this story.
Politico (7/4, Haberkorn) reports that additional legal challenges to the President's healthcare law are likely, "and the next ones just might help Republicans keep pushing their favorite political hot buttons." The next wave of suits are "going after pieces of the law that happen to be red meat for many conservative voters - like the law's contraception mandate and a new Medicare panel that Republicans call a 'rationing board.'" Another possible challenge, which "would try to block the feds from offering subsidies in a federal health insurance exchange, is meant to exploit a loophole in the law. But it could also be a good 'messaging hit' -- allowing them to attack the subsidies they see as a budget-busting new entitlement."
NYTimes: Administration Should Be Aggressive In Pushing Healthcare Law. An editorial in the New York Times (7/4, Subscription Publication) criticizes the White House for being "halfhearted in its sales pitch" on the healthcare bill. The Times notes that while business groups "allied with Republicans have spent $235 million on television ads attacking the law with false accusations, with the vigorous aid of Mitt Romney and his campaign" Democrats and the Obama campaign "have been amazingly reluctant to speak up for the president's biggest accomplishment and tell voters what's in it." The Times concludes, "It's past time for the White House and the Obama campaign to set aside their diffidence and begin playing an equally aggressive offense."
The Washington Post (7/4, Aizenman, Somashekhar) reports on the growing number of Republican state leaders who are "revolting against the major Medicaid expansion called for under President Obama's health-care overhaul, threatening to undermine one of the law's most fundamental goals: insuring millions of poor Americans." The governors of Florida, Iowa, Louisiana and South Carolina have indicated that they will seek to opt out of expanding the program. Governors "of half a dozen other states - including Texas, home to one of the largest concentrations of uninsured people - are considering following suit. The governors argue that expanding their Medicaid programs, which are jointly funded with state and federal money, would crush state budgets."
The Hill (7/5, Viebeck) reports in its "Healthwatch" blog, "At least 15 governors have indicated they will not participate in the expansion of Medicaid under the healthcare law, striking a blow to President Obama's promise of broader insurance coverage." The piece notes that "the decision is...loaded with politics, particularly for Republican governors who are adamantly opposed to 'ObamaCare.'"
The AP (7/4, Alonso-Zaldivar) reports, "Officials at the Health and Human Services department say they are not particularly concerned. They may have lost the stick, but they still have carrots." Mike Hash, director of the HHS office responsible for the health overhaul, remarked, "We believe that states will in fact take advantage of the coverage for these individuals because of many factors. One is the available federal funding." He noted that "not every state took part when the Children's Health Insurance Program was launched in the 1990s," although "within two years they were all aboard." The Kansas City (MO) Star (7/4, Helling) and the Waterville (ME) Morning Sentinel (7/4, Mistler) reported on their states' plans.
Five States Have Already Extended Medicaid Over Past Two Years. The Washington Post (7/4, Kliff) reported in its "Wonkblog" that "over the past two years, five states have quietly executed the Affordable Care Act's largest coverage expansion to date, extending benefits to more than 500,000 Americans. ... Five states – California, Connecticut, Minnesota, New Jersey and Washington - as well as the District of Columbia took the Obama administration up on the offer."
NYTimes Urges States To Expand Their Medicaid Rolls. An editorial in the New York Times (7/5, Subscription Publication) argues that the Supreme Court's decision to strike down the Affordable Care Act's requirement that states "expand their Medicaid programs to cover virtually everyone earning up to 133 percent of the federal poverty level" could "harm some of the nation's poorest citizens." The Times says that because some states will opt out of expanding Medicaid, "substantial numbers of the very poor could be left out of coverage." The Times urges states to accept "the very generous federal subsidies to expand Medicaid rolls."
Texas Hospital Association CEO Supports Medicaid Expansion. In the San Antonio Express-News (7/5), Dan Stultz, president and CEO of the Texas Hospital Association, writes, "Texas hospitals recognize there are concerns with expanding the Medicaid program, but given the state's high number of uninsured, all options for increasing coverage must be closely considered. .. State government can provide access to health care for low-income Texans through the appropriate funding of the Medicaid program
The Washington Post (7/5, Kliff) "Wonkblog" reports, "Health care spending for 14- to 18-year-olds has grown faster than any other age group with private coverage." The blog post explains that according to a report from the Health Care Cost Institute, one of the factors driving up health spending for teenagers is "the increased use of mental health services. In 2010, the average teenager was prescribed 1.2 central nervous system drugs, which treat conditions like depression and attention-deficit hyperactivity disorder."
In an op-ed for the Wall Street Journal (7/3, Hennessey, Subscription Publication) , Keith Hennessey, a fellow at Stanford's Hoover Institution who served as director of the National Economic Council for President George W. Bush, writes that a Republican sweep in the fall elections is necessary to repeal the Affordable Care Act, but 60 Republican senators are needed to repeal key elements of the law. Hennessey notes that Senate Democrats used reconciliation, which applies only to legislative changes to taxes, to get around a Republican filibuster and pass part of the law and suggests that with a GOP majority, the same process could be used to repeal the law.
The Christian Science Monitor (7/3, Loria) examines the impact of Massachusetts' healthcare reform law, noting that the state "is doing pretty well" under the law, according to "those who have studied its effects upon residents, businesses, and state coffers." The Monitor reports that "about 400,000 additional people are newly covered by health insurance, bringing down the share of uninsured residents from 7.4 percent in 2004 to 1.9 percent by 2010, according to the Massachusetts Division of Health Care Finance and Policy. Massachusetts now has the highest percentage of insured residents among all the states. Costs to the state are also within original estimates, according to the Massachusetts Taxpayers Foundation." Noting that the Massachusetts law is funded differently than the federal law, The Monitor points out that it "isn't a perfect demonstration lab for national reform."
The Los Angeles Times (7/3, Little) reports, "Americans remain sharply divided on President Obama's healthcare reform law following the affirmation of most of its provisions by the Supreme Court. But, a new CNN/ORC poll reveals that there have been some positive, if slight, gains for the Affordable Care Act since its contentious passage into law." The CNN poll finds that "fifty percent of Americans side with the Supreme Court in its ruling Thursday, with 49% disagreeing," but "opposition" to the law's "provisions has dropped since 2011, the last time CNN asked the same question. More Americans now narrowly favor at least most of its elements (52%), rather than opposing most (47%). That's a 7-percentage-point swing in favor" of the ACA.
Politico (7/3, Tau) reports that according to the poll, "Americans are just as split about the controversial individual mandate within the law. The survey finds that 48 percent favor the mandate, while 51 percent oppose."
The Washington Post (6/30, Aizenman) says the Supreme Court's ruling "that states can opt out of the 2010 healthcare law's expansion of Medicaid without losing current federal funding has raised some thorny questions about the practical and financial ramifications. ... Because of a quirk in the law," those "with incomes between the federal poverty level and 133 percent of that level" would "become eligible for federal subsidies to purchase private insurance plans on the state-based marketplaces, or exchanges, created by the law," meaning that they "might cost the government more than if they had gotten Medicaid."
Hospitals Urge States To Expand Medicaid. The Wall Street Journal (6/30, Burton, Dooren, Lippman, Subscription Publication) says hospitals are urging states to expand Medicaid. The Washington Post (6/30, Kliff, Yang) says "expanding health insurance to about 30 million more Americans will mean hospitals won't have to shoulder as much cost caring for uninsured individuals. But all those added patients will need thousands more physicians than are working now."
Republican-Controlled Missouri Legislature Plans To Reject Medicaid Expansion. The St. Louis Post-Dispatch (7/1, Crisp) reported, "If conservative Republicans who control the Missouri Legislature follow through on plans to reject an expansion of the Medicaid health care program for the poor, they will be turning down an estimated $8.4 billion windfall from the federal government." The Post-Dispatch added, "The problem Republican leaders say, is that to get that money, the state would have to pony up $431 million of its own -- money they say Missouri doesn't have." The state's "Republican Lt. Gov. Peter Kinder, calling the expansion a 'break-the-bank' scenario, said the Legislature is unlikely to approve it."
Mississippi Governor Says Deep Cuts Required To Allow For Medicaid Expansion. The AP (6/30, Pettus) reported that "top Republicans in Mississippi say the state can't afford to expand its Medicaid program to cover more people under the federal health care overhaul." But, "some Democrats...say the state should jump at the chance to provide coverage for its more than half million uninsured residents." The state's "Republican Gov. Phil Bryant said Thursday that Mississippi would have to make deep cuts to education and transportation to cover expenses for an estimated 400,000 new people on Medicaid."
Nebraska Governor Promises To Block Efforts To Expand State's Medicaid Program. The AP (6/29) reported that Nebraska's Republican "Gov. Dave Heineman promised Thursday to block any effort to expand Nebraska's Medicaid program, a key provision of the federal health care overhaul that the US Supreme Court deemed optional for states while upholding most of the law." Heineman "told reporters that expanding coverage to at least 100,000 more Nebraskans would drain money from other priorities, such as education, or require a tax increase." The governor "said he has no plans to call a special session to more quickly comply with the requirements of the landmark law signed by President Barack Obama."
Alaska Governor To Consider Whether To Opt Out Of Expanding State's Medicaid Program. The Alaska Dispatch (7/2, Coyne) reports that Alaska's Republican governor Sean Parnell, "who has actively fought the Affordable Care Act, on Thursday said, among other things, that he would consider whether or not the state...would opt out of expanding Medicaid, a cornerstone of the law's efforts to expand health insurance access to most Americans." According to the Dispatch, "If Parnell opts out of expanding Medicaid -- and if the Legislature doesn't challenge him -- many of those who would qualify will remain uninsured."
Georgia Governor Still Undecided About Medicaid Expansion. The Atlanta Journal-Constitution (7/2, Teegardin, Williams) reports, "The US Supreme Court has upheld the health care overhaul, but Georgia's emergency rooms and free clinics may still be jammed with the uninsured years after that landmark ruling," because "without the Medicaid expansion...Georgia will not come close to extending insurance to most of the 1.9 million residents who do not have it now." Last week, "Gov. Nathan Deal said...he had not yet reached a decision on Medicaid and noted that the November elections may change the landscape yet."
Michigan Governor Seeks To Analyze Long-Term Costs Of Medicaid Expansion. The Detroit Free Press (6/30, Anstett) reported, "Michigan Gov. Rick Snyder on Friday put the brakes on moving too quickly to expand Michigan's Medicaid program, wanting to analyze the long-term costs to the state of extending the coverage to a half million more people." The governor "just wants to analyze the financial implications of expanding the program, said press secretary Geralyn Lasher." The Free Press points out, however, that "Snyder favors quick action on another provision of the law -- creating a largely Web-based health insurance shopping site, or exchange."
Last night, the three network newscasts devoted more than 34 minutes of combined coverage to the ruling and its implications, which is almost twice as much time as they spent on all the other day's news combined. All three networks portrayed the day's events as an unambiguous "victory" for President Obama.
On ABC World News (6/28, lead story, 3:45), Diane Sawyer reported, "The US Supreme Court has said the Obama healthcare law is constitutional and therefore the law of the land. It is a huge victory for the President." Brian Williams, on NBC Nightly News (6/28, lead story, 5:00), said Chief Justice John Roberts "gave the President the victory he wanted." Scott Pelley, on the CBS Evening News (6/28, lead story, 4:25), described Roberts as having "singlehandedly saved the most important domestic achievement of a liberal president." Editorials in most major papers, including the New York Times, the Washington Post and USA Today all hail the court's ruling.
While there was some mention of the possibility that employers will have an incentive to stop offering their employees healthcare benefits, the networks' coverage put much more of an emphasis on those uninsured Americans who stand to benefit from the full implementation of the legislation. NBC Nightly News (6/28, story 3, 2:25, Williams), in a segment on those impacted by the court's ruling, featured a woman named Kathy Watson, who has been diagnosed with cancer. Watson was shown saying the ruling "brought tears to my eyes," and "I'm not really sure what I would have done if the law was struck down." As an example of someone upset by the decision, NBC profiled "small business owner" Joe Alivo who "offers healthcare to his 48 workers," but, "if he goes to 50, he says the law would require him to provide more comprehensive and expensive care or pay a penalty." Alivo said he likely would stop offering health insurance to his employees because "the penalty is far below my premiums."
On ABC World News (6/28, story 2, 3:10, Sawyer) David Muir reported from the emergency room at USC Medical School that "five hundred patients come rushing through these doors every day, many of them uninsured, many of their visits here unnecessary because they don't have a regular doctor." Muir added that is "why the doctors saving lives here, also had an eye trained here on the Supreme Court today," and "because of the court's decision, doctors here believe there will be fewer coming in uninsured." The CBS Evening News (6/28, story 5, 2:40, Pelley) reported that "the Medicaid expansion was designed for people...who cannot afford to buy insurance."
The New York Times (6/29, A1, Liptak, Subscription Publication), under the front-page banner "Justices, By 5-4, Uphold Health Care Law; Roberts In Majority; Victory For Obama," reports, without qualification, "The decision was a victory for Mr. Obama and Congressional Democrats, affirming the central legislative achievement of Mr. Obama's presidency." According to the Times, "The court's ruling was the most significant federalism decision since the New Deal." Mark Landler, in another front-page article for the New York Times (6/29, A1, Subscription Publication), says that for the President, the ruling is not "just political vindication," but "a personal reprieve, leaving intact his hopes of joining the ranks of...presidents who fundamentally altered the course of the country."
Likewise, USA Today (6/29, A1, Wolf, Jackson), on its front page, says the court gave the President "a major election-year victory," and says Mitt Romney "vowed...to make repeal of the law a major part of his campaign, calling it too expensive, too much government, and too much of a burden for job creators."
The Washington Post (6/29, A1, Barnes, Aizenman, Branigin) also reports that "the court's historic compromise amounted to a major victory for the White House." The Los Angeles Times (6/29, Savage) says the President "had staked the success of his presidency on passage of the law," and reports that "some conservatives immediately branded [Roberts] a turncoat." The Detroit Free Press (6/29, Anstett, Spangler) also says the ruling "gave Obama an election-year victory."
Bloomberg News (6/29, Goldman, McCormick), in an article titled, "Obama's Supreme Court Win May Help Now More Than November," says "the court handed the president a victory, averting a rebuke of his defining legislative accomplishment." Historian Douglas Brinkley says, "He avoided disaster and in the end reminded people that this has not been a do-nothing presidency."
USA Today (6/29), in an editorial titled, "Supreme Court ObamaCare Ruling Benefits Millions," says, "Amid all the political spin about who won and who lost as a result of Thursday's Supreme Court decision to uphold the 2010 health reform law, it's worth noting up front that the landmark ruling will benefit millions of everyday Americans. Many of the people who will be helped already know exactly how: They have pre-existing medical conditions and can't get insurance. Or they have a desperately sick child, have blown through their insurance policy's lifetime limit and now have enormous bills they can't pay."
The New York Times (6/29, Subscription Publication), in an editorial, writes, "There is no underestimating the importance of the Supreme Court decision upholding most of the health reform law," and says it "was a huge victory for President Obama at a critical time."
Under the title "Vindication for 'Obamacare,'" the Los Angeles Times (6/29) editorializes, "Regardless of the paths taken to get there, the" Supreme Court "reached the right results. The individual mandate is a crucial part of the effort to make coverage available to more people by barring insurers from denying coverage to or gouging people with preexisting conditions. ... And, reducing the number of uninsured, in turn, helps the efforts to slow the growth of healthcare costs by enabling more people to get preventive care, manage chronic ailments more efficiently and reduce the demand for high-cost emergency room services." The Times concludes that "policymakers and healthcare leaders should continue to build on the foundation the law created for a more efficient, effective and affordable healthcare system focused on keeping people healthy, not treating them when they're sick."
After Ruling, States Scramble To Meet Federal Deadlines. The New York Times (6/29, Sack, Abelson, Subscription Publication) reports, "The Supreme Court's decision to uphold the Affordable Care Act shifts the focus from whether sweeping changes to the health insurance market should take place to a scramble to meet the law's rapidly approaching deadlines." As the Times explains, some states chose to delay the work to meet those deadlines in order to wait and see whether the Court would strike down the law, but now that the ACA has been upheld, those states "face the unsettling prospect that the federal government could take over their responsibilities, particularly in setting up the health insurance marketplaces known as exchanges, where people will be able to choose among policies for their coverage."
The AP (6/28) notes that under the ACA, "states play a key role in delivering new health insurance coverage to millions of lower-income and middle-class people." However, "Republican-led states have resisted, and the National Association of Insurance Commissioners expects only about half the states to be ready to set up new health insurance markets, slated to open for business in 2014." Another AP (6/28) story displays a list of all 50 states and details the status of each state in implementing the Affordable Care Act.
States Face Decisions On Expansion Of Medicaid. USA Today (6/29, Raasch) says "state leaders recoiled, rejoiced and reacted" to the upholding of the "requirement that everyone have health insurance but making state expansion of Medicaid a voluntary way to fulfill that mandate." USA Today says "a uniform pace in how the law is instituted across 50 states is unlikely." The Hill (6/28, Viebeck) says in its "Healthwatch" blog that the ruling "created a dilemma for states, which must decide whether to participate in the law's expansion of Medicaid."
The New York Times (6/29, Pear, Subscription Publication) says "experts disagreed" Thursday on whether states would choose "a huge expansion of Medicaid." Sen. Lamar Alexander (R-TN), "an opponent of the health law, predicted that many states would choose not to expand Medicaid." But National Association of Medicaid Directors Executive Director Matt Salo said "his initial sense was that many states would accept the expansion."
The Los Angeles Times (6/29, Levey) says the decision "may mean liberal states that have embraced the healthcare law such as California, Illinois and Maryland will effectively offer all of their residents health coverage in 2014," while "conservative states such as Florida and Texas, which have refused to implement the law while they challenged it in court, could reject federal aid, leaving hundreds of thousands of their residents without medical insurance." The Wall Street Journal (6/29, Burton, Radnofsky, Dooren, Subscription Publication) quotes a spokesman for South Carolina Gov. Nikki Haley as saying, "We're not going to shove more South Carolinians into a broken system that further ties our hands."
Ruling Expected To Benefit Most Healthcare Providers. The AP (6/28, Johnson) reports that the court's ruling "is expected to be a boon to most of the health care industry by making coverage more affordable for millions of uninsured Americans. The ruling could give the biggest boost to hospitals and health insurers, but drugmakers and biotech companies also will get additional customers because the law requires nearly everyone to have health insurance by 2014 or pay a fine." Meanwhile, "medical device makers will be hit with a tax on sales as a result of the law." In response to the decision, "shares jumped on Thursday for hospitals, but fell slightly for drug makers and most insurers."
USA Today (6/29, Mullaney) reports, "Insurance companies hailed the Supreme Court's ruling upholding the Affordable Care Act, saying it gives them certainty about the rules they'll face as they push to cut administrative costs and reward doctors who contain health care costs by emphasizing preventive care." As USA Today notes, "the law's requirement that most people buy insurance or pay a tax penalty if they fail to get coverage was the essential trade-off the industry sought in exchange for the law's requirement that coverage be offered to people with pre-existing health conditions. Now that the court has upheld the so-called individual mandate, the industry will move ahead quickly with new incentives to boost the quality of care."
Still, Fox News (6/29, Shawn) reports on its website that "the insurance industry reacted to the Supreme Court decision by saying that the ruling will actually end up raising rates even more than they have climbed since the law was enacted."
The Boston Herald (6/28, Van Sack) reports, "The local medical device industry vowed to keep up the fight against a proposed tax that was upheld" under the ACA. Tom Sommer, president of the Massachusetts Medical Device Industry Council, said, "We believe that the tax will result in work force reduction and decreased (research) activities at our companies." And "medical device industry stocks mostly fell after the Supreme Court ruling."
Forbes (6/28, Fontevecchia) reports the court's Medicaid ruling "should be negative for major health insurance companies, as it will drive more customers at lower margins, and positive for Medicaid companies." So "Medicaid companies should see a relief rally, as the federal government's ability to cut funding for Medicaid programs was limited by the law."
Reuters (6/28) reports on the decision regarding Medicaid. The changes in the ACA were expected to reach about 16 million people, but if states decide not to expand Medicaid eligibility rules, then far fewer would benefit. But administration officials said that they expect states to expand the rules because the federal government will pay the additional cost for three years and 90 percent after that. Several governors are quoted saying the cost is beyond the resources of their states.
Reuters (6/28) reports that Cigna Corp is planning to buy some Medicare Advantage plans in Texas and Arkansas from Humana Inc. According to the story, the new markets will allow Cigna's HealthSpring unit to expand its operations in Tecas and Arkansas. About 3,500 Humana or Arcadian members will be added to Healthspring's collection of customers.
On its front page, the New York Times (6/28, A1, Medina, Subscription Publication) reports, "As the United States approaches the climax of a fierce national debate over the Obama administration's health care law, which would significantly increase the number of people covered by medical insurance, thousands of people are crossing the [US-Mexico] border in search of care they either cannot afford or wish to get more cheaply. The influx has grown steadily over the last several years," increasingly attracting a "growing group of middle-class patients from all over the country looking for deals on elective surgeries that most medical insurance will not cover." Physicians in Mexicali, Mexico, "with strong support from the local government, are hoping to attract more Americans for elective procedures or more basic care that they may not be able to afford at home." The piece warns, however, that no hospital in Mexicali has received American medical accreditation
The Pittsburgh Post-Gazette (6/27, Toland) reports that "as many as one in 10 health insurance dependents, by some industry estimates, may be ineligible for the company health benefits they are receiving." For that reason, "more employers and health care buyers, looking to trim health costs where they can, are turning to dependent eligibility verification audits" in which insured persons with "dependents on their health plan -- that is, a spouse, children or both --...need to fill out verification forms and furnish some combination of tax returns, marriage certificates, mortgage statements, and copies of birth certificates so those dependents would be permitted to remain covered."
The San Angelo (TX) Standard-Times (6/27, Waller) reports that Medicaid expenses in Texas have "grown from 14 percent in 2001 (with public education at 44.9 percent and all other spending at 41.1 percent) to 20.2 percent in 2011 (with public education at 41.3 percent and all other spending at 38.5 percent)." Texas Comptroller Susan Combs said Medicaid costs are expected to "rise to 37.2 percent by 2023, with public education at 37.4 percent and all other spending at 25.4 percent." Some of this increase will depend on the outcome of the Supreme Court ruling on the Affordable Care Act
The AP (6/27, Stengle) reports, "The federal government may have to implement a major provision of President Barack Obama's health care overhaul in Texas since the state's conservative leaders are steadfastly opposed to it." However, "one state agency has fulfilled parts of the law and said it's prepared to move forward if the law is upheld by the US Supreme Court." The piece notes that "the Texas Health and Human Services Commission will be responsible for the Medicaid expansion under the law, and it says the federal government still needs to provide some necessary details." Department spokeswoman Stephanie Goodman remarked, "But assuming they get us that guidance ... we've been planning all this time for the various contingencies and will be ready to act, whatever the court decides."
NBC Nightly News (6/25, story 10, 0:20, Williams) reported, "A government panel is tonight urging doctors to conduct regular obesity screening during check-ups."
USA Today (6/26, Hellmich) reports, "Physicians should screen all adult patients for obesity during office visits and either refer obese patients to comprehensive weight-management programs or offer them one, says the US Preventive Services Task Force [USPSTF] in new recommendations announced Monday."
The Los Angeles Times (6/26, Healy) reports that the "move...could significantly expand insurance coverage of weight-loss treatments." Currently, "few private health insurers...reimburse physicians for weight-loss counseling or pay for programs that patients seek out on their own. A growing number, in fact, charge obese patients more for coverage -- a policy that some public health officials have denounced as punitive and ineffective."
The AP (6/26) reports, "The task force has recommended adult obesity screening previously, and similar guidelines urge tracking whether youngsters are putting on too many pounds." According to the AP, "Surveys show only about a third of obese patients recall their doctor counseling them about weight loss, even though people whose doctors discuss the problem are more likely to do something about it." Physicians "can struggle with the pounds, too, and Johns Hopkins University researchers recently reported that overweight physicians were less likely than skinnier ones to advise their patients about weight loss."
NBC Nightly News (6/24, story 5, 2:45, Holt) reported, "This week, the Supreme Court wraps up its current term, and that means we'll finally hear a decision of the blockbuster showdown over President Obama's healthcare law." NBC (Williams) added, "Some of the nation's largest insurance companies now say they will continue honoring a few of the law's requirements even if the court strikes it down. That would include letting parents keep children on their policies until age 26, covering preventative services such as blood pressure screenings and removing caps on the costs of lifetime patient spending. ... The big insurers have said nothing about keeping another popular provision of the law that keeps them from denying coverage because of pre-existing conditions. There's no way to be sure when the court will issue this widely anticipated decision, it could be as early as tomorrow or it could be as late as Thursday, which will probably be the last day of the term."
The Washington Post (6/25, Barnes) reports that the healthcare ruling, along with another on immigration, will mark a "finale that cannot come quickly enough for the administration, which has had a long year at the high court." The Post notes that in a string of cases, the Court has "rejected the administration's legal arguments with lopsided votes and sometimes biting commentary. The administration's win-loss record will sting a lot less, of course, if the court upholds the constitutionality of Obama's signature domestic achievement, the Affordable Care Act. That decision on health care, which will define the term, could come as early as Monday and almost certainly will be announced by Thursday."
CQ (6/23, Reichard, Subscription Publication) reported, "Three Republican senators have warned the Obama administration not to place new limits on the issuance of 'stop-loss' insurance, which employers purchase in order to operate self-insured health plans." According to CQ, Sens. Olympia J. Snowe (ME), Michael B. Enzi (WY) and Tom Coburn (OK) wrote in a letter to the heads of the Departments of Labor, Treasury, and Health and Human Services that a recent Federal Register notice suggests that the departments "may be considering actions to limit stop-loss coverage for small and medium plans, which would be outside the limits of the administration's existing authority."
Bloomberg News (6/22, Wayne) reports, "About 12.8 million Americans will get rebates averaging $151 from their health insurers, the US government said today in its latest announcement touting the 2010 health-care law." In a statement, HHS Secretary Kathleen Sebelius remarked that "the rule 'helps ensure consumers get fair value for their health care dollar.'"
The AP (6/22, Alonso-zaldivar) reports that "what the report didn't spell out clearly is that nearly two-thirds of the 12.8 million benefitting are only entitled to pro-rated rebates, because they are covered by employers who pay most of their premiums." When asked "how many households will get rebate checks in the mail," Mike Hash, head of the health reform office at the federal Health and Human Services department, said, "We wouldn't know that at this particular point."
The Hill (6/22, Viebeck) reports in its "Healthwatch" blog, "Materials from HHS said that consumers will likely see a rebate check in the mail, a lump sum reimbursement to the account they use to pay premiums or a reduction in their future payments. Insurers must issue checks by Aug. 1, unless the law is struck down in the next two weeks."
The New York Times (6/22, Tavernise, Subscription Publication) reports, "No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions." When a majority of the provisions of ACA go into effect next year, it will infuse the market with healthy people and wouldn't allow insurance companies to deny someone coverage for a pre-existing condition. Karen Ignagni, president of America's Health Insurance Plans, says, "When you have insurance reforms without requiring everyone to participate, it becomes a sickness fund, not an insurance system." Whether or not he individual mandate is struck down by the Supreme Court, states will still have regulatory powers to help those with pre-existing conditions get medical care.
Fate Of Prevention, Public Health Programs Questioned. In a front-page story, the New York Times (6/22, A1, Abelson, Subscription Publication) reports, "Exactly what happens to the money for" programs such as community health centers "if the Supreme Court decides to overturn the entire law is unclear." The Times notes that "if the court strikes down the entire law, many experts are skeptical that lawmakers will go ahead with funds for programs like the new Prevention and Public Health Fund, even if they are completely distinct from the controversial aspects of the law seeking to overhaul the insurance markets."
Healthcare Decision Will Have Impact On Young And Old. USA Today (6/22, Wolf) reports that the Supreme Court decision expected next week on healthcare reform will have effects on both young and old Americans throughout the country. Among the provisions that could be struck down are lifetime limits on medical benefits, insurance coverage for those will pre-existing conditions, and a provision that allows children to stay on their parent's coverage until age 26. While some of the largest insurance companies have said that they will keep some of these provisions intact, if the Supreme Court strikes down the law, theoretically the basis and funding for those programs will be lost.
Political Implications Of ACA Decision To Be More Apparent Next Year. The Washington Post (6/22, Tumulty) reports, "Though no one outside the Supreme Court has an inkling how it is going to rule on President Obama's health-care law, the political fallout - at least initially - is easy to predict. ... In the longer run, however, each of those scenarios raises a whole new set of political and policy questions for the two parties. That means the real implications of the decision are not likely to become apparent until next year."
Fate Of Consumer Protections Depend On Ruling. The Kansas Health Institute /Kaiser Health News (6/22, Appleby) reports, "Riding on the outcome are a host of popular consumer protections, many aimed at the estimated 18 million Americans who buy their own coverage and who face greater obstacles and costs than those who get coverage through their jobs. ... Insurers, too, have a lot at stake: While the law saddles them with new regulations and taxes, it also positions them to reap an additional $1 trillion in gross revenue over eight years, largely from new customers, according to one forecast by Bloomberg Government, a for-profit news and research firm."
States Plan To Expand Medicaid Coverage Regardless Of SCOTUS Decision. Politico (6/22, Millman) reports that even if the Supreme Court decides to throw out the Medicaid expansion in the Affordable Care Act, "some state Medicaid officials plan to move forward with reform plans that already are being put into place." Officials with Medicaid say they are already moving ahead with changes, "regardless of whatever the Supreme Court decides." Nathan Johnson, assistant director for healthcare policy at the Washington State Health Care Authority, says "We're proceeding with optimism, but acknowledging the uncertainty
The New York Times (6/21, A14, Goodnough, Subscription Publication) reports, "A Supreme Court ruling on the constitutionality of the health care law is expected any day now, but even if the Obama administration wins in the nation's highest court, most evidence suggests it has lost miserably in the court of public opinion." Noting Republicans' push to fight the law, the piece says "that success may stem in large part from more than $200 million in advertising spending by an array of conservative groups," while "in contrast, most advertising spending in support of the law has come from the Department of Health and Human Services." The Times interviewed about two dozen residents of Philadelphia suburbs "who were mostly opposed to the law," and found that "certain worries, resentments and dark predictions about it came up time and again."
AP-Gfk Poll: One-Third Of Americans Support Healthcare Law. The AP (6/21, Sherman) reports that according to an Associated Press-Gfk poll, "just a third of Americans back President Barack Obama's health care overhaul on which the Supreme Court is about to pass judgment," and while "the overall level of support for the law is relatively unchanged in recent months, with 47 percent opposing it," the "poll shows that only 21 percent of independents approve of the law, a new low in AP-GfK polling." The piece notes that "whatever people think of the law, they don't want a Supreme Court ruling against it to be the last word on health care reform. More than three-fourths of Americans want their political leaders to undertake a new effort, rather than leave the health care system alone if the court rules against the law, according to the poll."
Politico (6/21, Robillard) reports, "The AP poll shows opinion on Obama's handling of health care law to be remarkably consistent: 48 percent of Americans approve of the way Obama is handling the issue and 50 percent disapprove. Those numbers have barely budged over the AP's past three polls on the issue, dating back to January. Thirty-three percent of Americans have 'total support' for the legislation, compared to 47 percent who oppose the bill." The Hill (6/21, Viebeck) "Healthwatch" blog and the Washington Post (6/21, Sargent) "Plum Line" blog also report on the poll.
Professors Note Most Americans Support ACA's "Core Provisions." In the Los Angeles Times (6/21), Theda Skocpol, a professor at Harvard University, and Lawrence R. Jacobs, a professor at the University of Minnesota, write that "what many Americans don't realize is that the individual mandate would affect fewer than 2 of every 100 people, according to the best estimates." They highlight "three big things" the ACA does, noting that they "are the essence of the Affordable Care Act - and although we rarely hear about it, polling shows that 60% to 70% of Americans, including a majority of Republicans, favor these core provisions."
The Washington Post /Kaiser Health News (6/21, Galewitz) reports that the future of Medicaid "hangs in the balance of the Supreme Court's decision on the 2010 health-care reform law," as it "would be greatly expanded under the health-care reform law," although "if the entire law is struck down, states for the first time since 2009 would be free to tighten eligibility and make it more difficult for people to apply." Alan Weil, executive director of the National Academy for State Health Policy, remarked, "If the law survives, Medicaid will grow and look much different in 2014 than it does today. If the law goes, states would begin looking at rollbacks in eligibility."
The AP (6/20, Murphy) reports that if the Affordable Care Act "survives Supreme Court scrutiny, the landmark overhaul will expand coverage to about 30 million uninsured people, according to government figures. But an estimated 26 million US residents will remain without coverage - a population that's roughly the size of Texas and includes illegal immigrants and those who can't afford to pay out-of-pocket for health insurance." The piece explains, "To be sure, it's estimated that the Affordable Care Act would greatly increase the number of insured Americans," but "still, millions of illegal immigrants won't qualify for coverage," while "many legal US residents will go without insurance, too. About 36 percent of the population that remains uninsured will qualify for Medicaid but won't sign up for various reasons. Others likely will make too much money to qualify for assistance but be unable to afford coverage."
Analysts: Law Without Mandate Still Workable. The Christian Science Monitor (6/20, Feldmann) asks, "So if just the mandate goes, does the rest of the law fall apart? In a word, no." But the piece notes that "the real disconnect comes if the Supreme Court strikes down the individual mandate but lets stand the guarantees of coverage for people with preexisting conditions and the 'community rating' provision that bars plans from charging more on the basis of gender or health status." Larry Levitt, a senior vice president at the Kaiser Family Foundation in Menlo Park, California, remarked, "It's far from ideal, but it doesn't mean that the law is a failure or unworkable. People would still be getting benefits; there would still be lots of consumer protections going into effect. I don't think it cuts out the heart of the law. But it would be a challenge."
CQ (6/20, Reichard, Subscription Publication) reports that according to Kaiser analysts, "If the mandate goes, 'the consequences may not be as dire as some will undoubtedly claim. And, in addition to the subsidies and age-based premiums already included in the [health care law], there are other mechanisms being discussed that the federal government and states could pursue to even out the risk pool in the absence of a mandate.'"
The Hill (6/20, Viebeck) reports in its "Healthwatch" blog, "Rep. Jan Schakowsky (Ill.), the chief deputy whip for House Democrats, predicted during an interview on The Bill Press Show that the entire law would be upheld but said her party 'would absolutely move forward' with the remaining reforms even if the mandate is defeated."
California May Lose $15 Billion Annually If Supreme Court Scraps Healthcare Law. The Los Angeles Times (6/20, Terhune, Gorman, Loury) reports, "If the Supreme Court scraps the Affordable Care Act in the coming days, California will lose out on as much as $15 billion annually in new federal money slated to come its way, dealing what state officials say would be a critical blow to efforts to expand coverage to the poor and uninsured." California "is one of the biggest beneficiaries of the federal healthcare law because of its large number of uninsured residents - about 7 million people, or nearly 20% of California's population."
Maryland Prepared To Push For Reforms Even Without Affordable Care Act. The Baltimore Sun (6/20) reports that young adults who have been able to stay on their parents' health insurance plans are among those who are "already benefitting from the Affordable Care Act." As the Supreme Court's term nears its end, many await the decision on whether the act will be overturned. "In Maryland, where the law's implementation has been embraced, officials, advocates and providers already say they plan to push for reforms even without the law."
Illinois Small Businesses Support Affordable Care Act, Poll Finds. The Peoria (IL) Journal Star (6/20) reports, "More than 60 percent of Illinois' small employers want to see the US Supreme Court uphold the Affordable Care Act, although with at least minor changes, according to a survey released Tuesday by the Small Business Majority." According to the poll conducted via the Internet, "only 22 percent want it changed." Jim Duffett, executive director of Campaign for Better Healthcare, said, "Contrary to political spin, small businesses don't want the law overturned."
In his column in the New York Times (6/20, Subscription Publication), Eduardo Porter says that the individual mandate has become a point of contention for many in the healthcare debate. Porter uses the analogy of buying care insurance "once the car is lying in a ditch" to show how a health insurance system similar to that would crumble. However, the government can do little to enforce the fines, ranging from $695 to $12,500, other than withhold the tax return Americans may expect to receive. According to Porter, "Making the mandate work requires convincing Americans that the new healthcare law is not a plot to destroy the nation. Americans would have to embrace universal coverage as a desirable goal for a rich industrial society."
The Hartford (CT) Courant (6/20, Sturdevant) reports, "A new J.D. Power and Associates survey says nearly half of employers plan to change the way they provide health insurance to workers -- offering them a set amount of cash to buy their own plan rather than providing coverage and charging employees a portion of the premiums." This "change would happen as states set up health exchanges, which are marketplaces for individuals and small groups to buy coverage, required under federal health care reform." The Courant points out, however, that "health insurers...said Tuesday it's unlikely that employers will veer away from employer-based health care, and even J.D. Power's senior director for health care, Rick Millard, advised caution in interpreting the survey results."
Forbes (6/19, Japsen) reports that American Medical Association "board chair Dr. Robert Wah says the doctor group has been working with health insurers to improve claims processing to eliminate headaches for doctors and patients." While "health insurance companies are inaccurately processing one in 10 medical claims...the rate is much improved than in the past, meaning fewer delayed payments to doctors and less bureaucratic headaches for patients, the American Medical Association said."
According to the Chicago Tribune (6/19, Frost), "Still, the report said, claims errors contribute to about $7 billion in wasteful spending."
The Chicago Sun-Times (6/19, Thomas) reports, "The report card also shows that timeliness and transparency with medical claims improved this year, but the number of denials went up, from 2.10 percent in 2011 to 3.48 percent in 2012."
The Hill (6/19, Viebeck) "Healthwatch" blog reports, "UnitedHealthcare was found to be the most error-free of all health insurers measured, with an accuracy rate of 98.3 percent," according to "the AMA's fifth annual National Health Insurer Report Card." The blog added that "Wah called for a more streamlined billings process across the healthcare system in order to reduce the burden on" physicians.
MedPage Today (6/19, Walker) reports, "Anthem, the company with the lowest accuracy rate last year improved its accuracy rating drastically -- jumping from a 61% accuracy rating in 2011 to an 88.6% accurate rate in 2012."
The AP (6/19, Alonso-Zaldivar) reports, "Covering all the bases ahead of a momentous Supreme Court ruling, the Obama administration plans to move ahead with major parts of the president's health care law if its most controversial provision does not survive, according to veteran Democrats closely involved with the legislation." If the part of the bill that requires "that nearly every US resident have health insurance is declared unconstitutional, the remaining parts of the law would have far-reaching impact, putting coverage within reach of millions of uninsured people, laying new obligations on insurers and employers, and improving Medicare benefits even as payments to many service providers get scaled back." A senior White House advisor said, however, that "President Obama is confident the whole law will be upheld when the court issues its ruling in the next week or two, but officials will be ready for any outcome."
More Young People Covered By Parents' Medical Insurance Policies. USA Today (6/19, Kennedy) reports, "More than 3.1 million Americans ages 19 through 25 are covered by their parents' medical insurance policies because of a provision in the 2010 health care law, the Department of Health and Human Services is expected to announce today." The number is "up from 2.5 million in December." HHS Secretary Kathleen Sebelius said, "This policy doesn't just give young adults and their families peace of mind, it also gives them freedom."
ACA Strikedown Would Complicate Who Pays For Uninsured ED Care. The Los Angeles Times (6/19, Levey) reports that the "Emergency Medical Treatment and Active Labor Act, or EMTALA, has been a bedrock principle of American healthcare - passed by a bipartisan Congress, signed by a Republican president and largely unchallenged since by hospitals and doctors." However, one unresolved issue was who would pay for the care. That issue "helped shape President Obama's 2010 healthcare law and its requirement that Americans get health insurance." Now, according to the Times, "if the law, or just the insurance mandate, is struck down" by the Supreme Court, uninsured patients' "bills will be passed on to taxpayers, hospitals and privately insured patients, as they have been for the last quarter century."
The Washington Post (6/19, Torres) reports, "College students and their families will have better options for health insurance in the upcoming school year, but there will be higher costs, too." As the Post explains, many students choose to stay on a parent's health plan "now that plans are required by the 2010 health law to cover children up to age 26.... Insurers responded to this requirement by slightly raising their prices."
Modern Healthcare (6/19, Kutscher, Subscription Publication) reports, "Almost half of employers are anticipating a change to the type of health benefits they offer to their employees - with 47% saying they will 'definitely' or 'probably' switch to a defined-contribution model." The story adds, "A survey from market research firm J.D. Power and Associates found that employers are increasingly interested in alternatives to traditional health benefits, such as offering vouchers or directing employees to health insurance exchanges."
The Killeen (TX) Daily News (6/19, McGuinness) reports, "Data from the 2010 Census shows that of the 5.8 million Texans living without health insurance, more than 17 percent of them are under 18 years of age." Anne Dunkelberg, associate director for the Austin-based Center for Public Policy Priorities, remarked, "It's one of the most vulnerable parts of the population. Texas still has one of highest rates for uninsured people in the nation, and unfortunately, it does in many children." She "said the high rate of uninsured children was, in part, a reflection of the growing cost of private health insurance for their parents, who often have to pay higher premiums for adding their dependents on to their employer's health care plans."
The New York Times (6/19, Carrns) reports in its "Bucks" blog on a Kaiser Family Foundation May tracking poll , which found that "a quarter of Americans report problems paying medical bills in the past year, and about 60 percent say they've 'cut corners' to avoid health care costs." The piece notes, "The most common steps that people have taken to save money include relying on home remedies or over-the-counter drugs (38 percent) instead of going to the doctor, or skipping visits to the dentist (35 percent)."
The Christian Science Monitor (6/18, Feldmann) reports, "The political world is on pins and needles, waiting for the Supreme Court to hand down its ruling on President Obama's sweeping reform of the health-insurance system. A decision could come as early as Monday. ... Publicly, Mr. Obama and his surrogates express confidence that the court will uphold the Affordable Care Act. Implementation is proceeding on schedule, they say. Still, at the White House correspondents' dinner in April, the president joked: 'In my first term, we passed healthcare reform. In my second term, I guess I'll pass it again.'"
Ruling Could Impact Healthcare Reforms Made Independent Of ACA. The Washington Post (6/18, Rau) reports that "changes that hospitals, doctors and insurers had been moving toward even before" the Affordable Care Act could be "halted" or "hobbled" if the Supreme Court rules parts of the law unconstitutional. The changes "include increasing the role of primary care, especially for low-income patients; forcing hospitals and doctors to work together closely; and reducing pay to hospitals if they don't meet patients' expectations or outcome benchmarks set by the government."
Ruling Could Also Eliminate "Lucrative Pool Of Patients." The Washington Times (6/18, Cunningham) says "if the justices uphold the part of the Affordable Care Act requiring insurers to cover patients with pre-existing conditions, insurance companies would suffer a blow, but doctors, hospitals and drugmakers would find themselves with more insured, high-need patients." But if the reforms are struck down, "healthcare providers could lose out on a lucrative pool of patients they had been counting on under the original deal."
USA Today (6/16, Mullaney) reported, "From Wall Street, the decision's potential impact on health care - and the health care business - looks huge. Barclays Capital analyst Joshua Raskin says some health insurance stocks might drop 30% if the court throws out the entire law." The piece notes that "Medical inflation, while moderating, continues to outpace general inflation, driving fiscal problems for states and for Washington. At the same time, health care remains a tough business: Bond-rating agency Moody's says non-profit hospitals, which control most of the US market, have their lowest revenue growth in 50 years."
Reuters (6/15, Morgan) reports that the Medicare Payment Advisory Commission, in an effort to make beneficiaries more responsible for the growing costs of Medicare, released a report to Congress on Friday that recommended a 20% charge for the 90% of Medicare beneficiaries who purchase supplemental insurance to cover costs not covered under Medicare Part A and Part B. The commission also recommended a $5,000 upper limit for annual out-of-pocket expenses that aims to protect beneficiaries from the high cost of catastrophic illnesses.
CQ (6/15, Adams, Subscription Publication) quotes Diane Rowland, chair of the commission, who said, "Assuring appropriate access to care and prudent payment policies that promote access to high quality and effective care for Medicaid and CHIP beneficiaries are MACPAC priorities. Understanding whether access to necessary care needs to be improved – by how much, for which populations, for what services, in which delivery arrangements and under what payment approaches – helps to shape purchasing strategies and attain better health outcomes for beneficiaries and better value for the programs."
Modern Healthcare (6/16, Zigmond, Subscription Publication) quotes Dr. David Sundwall, MACPAC's vice chairman, who said, "It is important to evaulate what information exists for monitoring access in Medicaid and CHIP, both from within current programs and other data sources."
In a separate story, Modern Healthcare (6/15, Barr, Subscription Publication) reports, "The National Rural Health Association and the Medicare Dependent Rural Hospital Coalition, an informal collaboration of hospitals with Medicare-dependent hospital status, strongly dispute a new report from the Medicare Payment Advisory Commission, which suggests that certain Medicare rural hospital special payments may be too high or unnecessary. MedPAC found little difference in healthcare use between rural and urban beneficiaries, similar access and quality for the most part and questioned the need for extra payments."
The AP (6/15, Alonso-Zaldivar) reports Catholic Health Association, an important ally in President Obama's healthcare overhaul, sent HHS a letter Friday that rejected the compromise over Catholic hospitals providing birth control coverage to their women employees. The group said it "does not believe church-affiliated employers should have to provide birth control as a free preventive service, as the law now requires." The group's letter said the compromise "initially seemed to be 'a good first step' but that examination of the details proved disappointing. The plan would be 'unduly cumbersome' to carry out and 'unlikely to adequately meet the religious liberty concerns' of all its members, the group said."
The Huffington Post (6/18) quotes Sister Carol Keehan and leaders of the CHA, who wrote in a five-page letter to HHS, "The more we learn, the more it appears that the ... approaches for both insured and self-insured plans would be unduly cumbersome and would be unlikely to adequately meet the religious liberty concerns of all of our members and other Church ministries." USA Today (6/15) and CQ (6/15, Bunis, Subscription Publication) also reported on the letter.
The New York Times (6/15, Weisman, Shear, Subscription Publication) reports that House Republicans are planning their response to the coming Supreme Court ruling on President Obama's healthcare law. According to the Times, if the court does not strike down the law entirely, House leaders "plan to force a vote immediately to repeal the law to reinforce their deep opposition to the legislation, opposition that has become central to their political identity." The Times says the House GOP plan is "just one element of the coordinated planning by groups on both sides of the issue as the Supreme Court ruling approaches as early as next week." The Times notes that while White House officials remain confident "that the court will rule in its favor and that the administration will move on to put the law into force," supporters of the law "do not necessarily share that view and are gearing up in the event of an unfavorable decision."
An editorial in USA Today (6/15) says that while it contains "some good ideas," the healthcare plan Mitt Romney described on Orlando last week "is shaping up as an evolving grab bag of familiar bromides and policy ideas that constitute a profoundly inadequate follow-up to his initial effort" in Massachusetts. USA Today concludes, "If the goals are to expand coverage, help people with existing conditions get affordable insurance, and make sure you don't lose your coverage if you lose your job, RomneyCare II falls well short of what's needed."
Romney Plan Called "The Right Vision." In an opposing op-ed in USA Today (6/15), James C. Capretta, a visiting fellow at the American Enterprise Institute and a fellow at the Ethics and Public Policy Center, says Romney's plan is "the right vision, and it's very different from President Obama's." Capretta adds, "President Obama's plan is to shift enormous power and control in the health sector to the federal government. That's a recipe for inefficiency and low-quality care. Gov. Romney wants to harness the power of the marketplace to deliver better care at lower cost to all Americans. That's the choice in 2012."
The New York Times (6/15, Aaronson, A31A, Subscription Publication) reports many independent pharmacists "say the drastically reduced reimbursement rates set by" the Texas Medicaid "managed care plans to save the state money are forcing them out of business." Additionally, there are "suspicions among independent pharmacies that CVS Caremark is capitalizing on" having become one of the pharmacy benefit managers handling Medicaid recipients' claims "to expand its retail business at the expense of locally owned pharmacies." A memo by a CVS supervisor told CVS pharmacists the reduced dispensing fees could hurt independent pharmacy owners and offer "a huge opportunity for us to grow our company." Independent pharmacists argue that instead of adding pharmacy benefit managers, the state could save money "require patients to use less-expensive generic drugs, directly reduce reimbursement rates or set lower caps on patients' supplies."
The Los Angeles Times (6/15, Brown) "Booster Shots" blog reports, "Before 2010, nearly half of Americans did not receive routine clinical preventive services that are known to save lives, researchers at the US Centers for Disease Control and Prevention reported Thursday" in the Morbidity and Mortality Weekly Report. The "researchers said the purpose of their investigations was to establish a baseline for use of preventive services before implementation of the healthcare reforms in the Affordable Care Act." The ACA "could impact future prevention trends because it requires many health insurance plans to provide preventive services without cost-sharing, they reported." CDC director Dr. Thomas R. Frieden wrote, in the report's foreword, that "the findings of this report indicate that tens of millions of people in the United States have not been benefiting from key preventive clinical services, and that there are large disparities by demographics, geography, and health care coverage and access in the provision of these services."
Modern Healthcare (6/15, Barr, Subscription Publication) reports, "Among the findings were that slightly less than half of patients with diagnosed ischemic cardiovascular disease were prescribed aspirin or other anti-platelet drugs and that despite improvements in hypertension treatment and control, slightly less than half of those with high blood pressure had it under control, according to the report."
According to HealthDay (6/15, Preidt), the report also indicated that "fewer than one in 13 tobacco users were prescribed medications to help them quit their habit."
MedPage Today (6/15, Fiore) reports, "In terms of breast cancer screening, about 20% of women ages 50 to 74 hadn't had a mammogram in the past two years, and use was lower among American Indian/Alaska Native women, as well as those with less education, lower household income, and a lack of health insurance." Meanwhile, "despite large increases in colorectal cancer screening use in recent years, the researchers said, about a third of patients ages 50 to 75 weren't up-to-date with their screening." The researchers "also found that only 28% of adults under age 65 were vaccinated against influenza, and about 20% of people who have HIV remain undiagnosed."
Politico (6/14, Sherman, Allen) reports House Speaker Boehner "recently told Republicans in a private meeting to change their tone on healthcare and fast: stop using 'job-killing' to describe the Obama healthcare law," since "the job-killing message was polling poorly, sources said." Instead, Boehner told his caucus to emphasize cost increases and the law's impact on small businesses. Politico says the "episode underscores both the GOP's recognition that it needs to be ready to respond to the Supreme Court's looming decision on the healthcare law and the delicacy with which Republicans must fashion that response." GOP leaders "wanted to give their members a platform to frame their side of the political debate as the campaign season heats up -- with the added bonus of giving fuel to tea party Republicans as well as the tax-minded establishment."
Scalia Query Made Broccoli A Symbol Of SCOTUS Debate Over Law. The New York Times (6/14, Stewart, Subscription Publication) has a front-page feature on how "broccoli, of all things, came up in the Supreme Court during arguments" over the ACA, as Justice Scalia wondered if a Congress that can "require Americans to buy health insurance" could "force people to buy just about anything -- including a green vegetable that many find distasteful. ... Since then broccoli has captured the public imagination and become the defining symbol for what may be the most important Supreme Court ruling in decades."
Rove: Obama's Response To Overturn Would Mean Most Politically. Karl Rove writes in his Wall Street Journal (6/14, Subscription Publication) column that if part or all of the law is thrown out by the Court, it is President Obama's response, not that of the GOP, that will have the most political impact. The President will have the option of moving to the center and calling on Americans to respect the decision, then call for a more measured and bipartisan new law. However, Rove says the President is less likely to do this than he would be to double down with attacks on the Supreme Court, as in his April criticism of "an unelected group of people" overturning a law.
The Huffington Post (6/13, Stein) reports Mitt Romney, speaking in Florida Tuesday, "outlined once again what he would do to replace" the Affordable Care Act. His campaign later "clarified that he would not tackle one of the central issues" contained in the law: "the prohibition of discrimination against people with pre-existing conditions. The approach Romney described centers around proposals to return much of the decision-making to the states while allowing for greater portability of coverage."
The New York Times (6/14, Berg) reports in its "The Caucus" blog that on Wednesday, Congressional Budget Office director Douglas W. Elmendorf spoke to reporters at a Christian Science Monitor breakfast, where "he disputed the view pushed mostly by Republicans that the health care law has, to this point, hurt employment." Elmendorf said that under the law, "most job loss would be incurred by people exiting their jobs voluntarily because they would be able to obtain health insurance outside of work."
The Hill (6/14, Baker) reports in its "Healthwatch" blog, "Rep. Charles Boustany (R-La.) questioned Wednesday whether President Obama's healthcare law is wasting money with its efforts to create a more efficient healthcare system." In a letter to the HHS Secretary Kathleen Sebelius, Boustany wrote, "Healthcare innovation and expenditure reduction are important objectives, but recent reports on grant making activities at CMMI reveal a lack of transparency and suggest the possible waste of taxpayer dollars."
CQ (6/14, Ethridge, Subscription Publication) reports that in the letter, Boustany wrote, "The cost and opaqueness of CMMI requires thorough congressional oversight. There may be reasons for funding projects that promise a negative return on investments, but taxpayers deserve a public accounting for this use of their hard-earned dollars." He "requested several pieces of information about the grant awarding and review process, including copies of all applications reviewed, a list of all reviewers, information on how the review teams were assembled, the timeline for application reviews and how the CMMI determined estimated savings for each project."
Bloomberg BusinessWeek (6/14, Wayne) reports that the Government Accountability Office has determined that "a program to fight fraud in the Medicaid health system for the poor has cost the US at least $102 million in auditing fees since 2008 while identifying less than $20 million in overpayments." Peter Budetti, the director of program integrity at the Centers for Medicare and Medicaid Services, said that "three companies won't have their contracts renewed, and two others will be reassigned." He remarked, "The results were extremely disappointing, way below what the expectations had been."
The New York Times (6/14, Carrns) reports on a Commonwealth Fund study , which found that "despite recent gains in offering health coverage to young adults, many still do not have coverage and have had to make tradeoffs because of medical costs." Sara Collins, vice president of affordable health insurance at the Commonwealth Fund, commented, "I think the fact that so many young adults came onto their parents' policies indicates a need that was there. We think of them as a young healthy group, but the findings suggest they are in need of health care like other age groups."
The Wall Street Journal (6/13, Radnofsky, Subscription Publication) reports on a Centers for Medicare and Medicaid Services forecast of US healthcare spending published online yesterday in the journal Health Affairs. CMS says that spending will increase in 2014 as the Affordable Care Act is fully implemented and though the growth rate is expected to decline after that, it would remain higher than in recent years. While spending growth rates were under 4 percent in both 2009 and 2010 and are expected to stay at that level through 2013. In 2014, it is expected to rise to 7.4 percent due to increased coverage under the ACA. In the following years, the rate is expected to decline to an average of 6.2 percent. The report credits most of the growth in spending to an aging population and only 0.1 percent to the ACA.
The AP (6/13, Alonso-zaldivar) reports in a story appearing on over 240 news sites, "Despite a recent easing of medical costs, the nation's health care spending will keep outpacing economic growth for the foreseeable future." And "by the beginning of the next decade, health care spending will be growing roughly 2 percentage points faster than the overall economy, 'which is about the same differential experienced over the past 30 years,' said the report from Medicare's nonpartisan Office of the Actuary." But "Obama has argued that his overhaul would begin to 'bend the cost curve' to more affordable levels."
The Washington Times (6/13, Cunningham) reports, "The US will spend slightly more on health care over the next decade than it would have had President Obama's Affordable Care Act not passed." The law "is expected to add $478 billion to health care costs over the next decade, driving up average spending by one-10th of a percent faster than if the law had never been passed." In response, "Republicans said the data proves the health care law won't solve the problem of ballooning health care costs," but "the administration defended the law," with HHS Secretary Kathleen Sebelius saying that "Americans' out-of-pocket expenses will be less beginning," adding, "That's real money back in the pockets of millions of Americans."
The Washington Examiner (6/13, Klein) reports in its "Beltway Confidential" blog, "When President Obama began pushing national health care legislation in 2009, he argued that reform was needed to rein in the unsustainable growth in health care spending that was crippling the budgets of businesses, states and the federal government. But a new government actuarial study finds that as a result of the law, health care spending will be $478 billion higher over the next decade than it would have otherwise been had no law been passed." And "about 50 cents of every dollar of health care spending in the United States will be financed by government by 2021." In its defense, the ACA "would cover 30 million more Americans, while adding 0.1 percent to average annual health care spending growth."
Bloomberg News (6/13, Wayne) reports, "An aging population, improving economy and President Barack Obama's health-care overhaul will push spending on medical services to almost 20 percent of US gross domestic product by 2021." But "Health and Human Services Secretary Kathleen Sebelius said in a blog post that the law 'is helping control health costs and expand coverage, and ensure better health and better health care, for all Americans in the next decade and well beyond.'"
Politico (6/13, Dobias) reports the growth rate is "a tad slower - 0.1 percentage point slower - than it would have been without the controversial health care law." Yet the story quotes John Poisal, deputy director of the National Health Statistics Group at CMS saying, "The average growth rate over the entire projections is 5.7" percent while "our pre-ACA projection is 5.6."
CNN Money (6/13, Sahadi) reports, "Health reform provisions going into effect in 2014 include an expansion of eligibility for Medicaid; a mandate that all individuals be insured; and federal subsidies for low- and middle-income Americans purchasing policies on state-based insurance exchanges."
A study on the increase in imaging received a moderate amount of coverage in print and online, but was not covered on any of last night's national news broadcasts. Most sources point to the health risks associated with increased exposure to radiation from certain types of scans.
The Los Angeles Times (6/13, Bardin) reports, "The use of CTs, MRIs and other advanced medical imaging tests has soared over the last 15 years, according to new research that raises questions about whether the benefits of all these scans outweigh the potential risks from radiation exposure and costs to the healthcare system." Researchers looked at "data from patients enrolled in six large health maintenance organizations," and "found that doctors ordered CT scans at a rate of 149 tests per 1,000 patients in 2010, nearly triple the rate of 52 scans per 1,000 patients in 1996." Meanwhile, "MRI use nearly quadrupled during the period, jumping from 17 to 65 tests per 1,000 patients."
The New York Times (6/13, A18, Gee, Subscription Publication) reports, "The study , published online on Tuesday in the Journal of the American Medical Association, says that while advanced medical imaging has undoubted benefits, allowing problems to be diagnosed earlier and more accurately, its value needs to be weighed against potential harms, which include a small cancer risk from the radiation." Earlier this year, "a group of nine medical specialty boards recommended that doctors perform 45 common tests and procedures less often, with imaging prominent among them." One of these boards, "the American Academy of Allergy, Asthma and Immunology, said a CT scan was not needed for cases of uncomplicated acute rhinosinusitis, or sinus infection, while another board, the American Society of Clinical Oncology, said doctors should cut back on CT and PET scans for early prostate and breast cancers that are unlikely to metastasize."
The Huffington Post (6/13, Pearson) reports, meanwhile, that "the American College of Radiology, for example, has called for a stop in imaging among patients with uncomplicated headaches."
Bloomberg BusinessWeek (6/13, Ostrow) reports, "Paul Ellenbogen, chairman of the American College of Radiology Board of Chancellors, said in a statement that the group advises clinicians to prescribe advanced imaging only to those with a clear medical need. Those receiving the highest doses of radiation are most likely cancer patients or those with chronic conditions who required multiple scans, he said."
CQ (6/12, Subscription Publication) reports, "Provisions of the health care law will help stabilize health plans financially when their medical outlays for newly covered Americans are hard to predict, says a study released Monday by the Society of Actuaries." According to CQ, "Plans will be protected if they charge premiums that are too low to cover the medical costs of enrollees, the study notes."
The Los Angeles Times (6/12, Terhune) reports that in California, Aetna Inc., Anthem Blue Cross, and WellPoint Inc. "are proposing to raise small-business rates more than 10% next month, drawing scrutiny from state regulators." According to "Byron Tucker, a spokesman for the state Department of Insurance...the agency is having discussions with the three companies about whether the proposed rate hikes are too high." In a separate action, "the California Department of Managed Health Care said it is reviewing other proposed rate increases going into effect in July or August." Still, no matter what either agency decides, neither is empowered to deny rate increases. Instead, they can only ask the companies to reduce the rate increases or engage in public criticism of health insurers that do not lower rates.
The Washington Post (6/12, Fletcher) reports, "States are finally seeing a bit of revenue growth in a turnaround from the economic downturn that devastated budgets in fiscal 2009 and 2010, according to a survey by the National Governors Association (NGA) and the National Association of State Budget Officers (NASBO)." However, "the problem is that many states are contending with costs that are rising even faster, as help from the federal government dwindles." In particular, spending on Medicaid "surged by 20 percent this year, following a rise of 23 percent in fiscal 2011," placing great strain on state budgets across the US.
In the Washington Post "Wonkblog," Sarah Kliff writes, "The term 'young invincibles' came into common parlance (or, common wonk parlance) during the health reform debate. It describes twenty-something Americans who, believing themselves to be impervious to health risks, don't see the value in purchasing health insurance coverage." However, according to a new study conducted by the Commonwealth Fund, approximately 40% of young adults "reported having a cost-related problem accessing health care."
Poll: Despite Health Coverage, Some Sick Adults In Massachusetts Struggle With Costs. The Boston Globe (6/12, Conaboy) "White Coat Notes" blog reports, "Fourteen percent of sick adults in Massachusetts were unable to get health care they needed in the past year, according to a poll conducted by the Harvard School of Public Health" in conjunction with the WBUR, the Robert Wood Johnson Foundation, and the Blue Cross Blue Shield of Massachusetts Foundation. "Among them, more than seven in 10 cited financial reasons. They couldn't afford the out-of-pocket costs or their insurer refused to cover the test or treatment."
The Washington Post (6/11, Aizenman) reports, "The nation's largest health insurer will keep in place several key consumer provisions mandated by the 2010 health-care law regardless of whether the statute survives Supreme Court review." According to the Post, "officials at UnitedHealthcare will announce Monday that whatever the outcome of the court decision - expected this month - the company will continue to provide customers preventive health-care services without co-payments or other out-of-pocket charges, allow parents to keep adult children up to age 26 on their plans, and maintain the more streamlined appeals process required by the law."
The New York Times (6/11, Abelson, Subscription Publication) notes that "UnitedHealth declined to say what it planned to do regarding some of the more significant changes now required by the law in 2014, when insurers will no longer be able to deny coverage to someone with a pre-existing condition or ask those in poor health to pay more." The Los Angeles Times (6/11, Terhune) and Bloomberg News (6/11, Wayne) offer similar coverage.
In a news analysis for the New York Times (6/10, SR4, Subscription Publication), health reporter Pam Belluck examined what may happen to healthcare reform whether the Supreme Court strikes down the entire Affordable Care Act, parts of it, or leaves it in place. According to Belluck, policy experts "say the practical effect of the court's decision will probably be less earth-shattering than some people think," in part because the act's components have momentum. Moreover, "if the law is struck down entirely...many experts say that some changes the law has already set in motion will continue, probably more slowly, but possibly at a more urgent pace in reaction to the elimination of the federal law." The analysis continues through some specifics of the act and how they might be affected.
Supreme Court's ACA Ruling Could Have "Messy Ripple Effects." The AP (6/10, Alonso-Zaldivar) reports on "the messy potential ripple effects when the Supreme Court delivers its verdict on the Affordable Care Act this month. ... Because the legislation is so complicated, an orderly unwinding would prove difficult if it were overturned entirely or in part."
Former Head Of Medicare, Medicaid Warns Striking Down ACA Would Mean Chaos. Kaiser Health News (6/11) reports, "Bruce Vladeck, who ran Medicare and Medicaid for four years under President Clinton, forecasts 'chaos' in the health care delivery system and increased deaths if the Supreme Court strikes down the health law. Killing the law would 'save a fortune' for the government, but at the expense of 'gutting Medicaid,' says Vladeck, who is now a senior advisor for Nexera, a New York hospital consulting firm."
The New York Times (6/9, A1, Peter Baker) examines emails distributed Friday by House Republicans that detailed interactions between the drug industry and the Obama Administration that resulted in "a juncture where the heady idealism of the campaign trail collided with the messy reality of Washington policy making. A president who had promised to negotiate on C-Span cut a closed-door deal with a powerful lobby, signifying to disillusioned liberal supporters a loss of innocence, or perhaps even the triumph of cynicism." The Times provides some specifics, such as emails between lobbyists and Obama healthcare adviser Nancy-Ann DeParle, who once wrote that "she and other top officials had 'made decision, based on how constructive you guys have been, to oppose importation'" of medicines.
Bloomberg News (6/8, Armstrong) reports, "Eric Schultz, a White House spokesman, called the Republican accusations 'baseless' and 'politically driven.'" He remarked, "Republicans, who previously admitted this is not serious and merely a partisan effort to distract the President's re-election campaign, are now attempting to recycle an old story that was well covered during the original debate three years ago." The Wall Street Journal (6/8, Mundy) "WashWire" blog and Reuters (6/9, Morgan) also reported this story.
The Philadelphia Inquirer (6/11, Brubaker) reports on a provision in the Affordable Care Act "designed to eliminate, for some uninsured or underinsured patients at least, jaw-dropping bills...that are based on astronomical 'gross charges.' Instead, hospitals are supposed to charge the uninsured no more than they would receive from Medicare or commercial insurers." The act "also imposed new requirements on nonprofit hospitals' financial assistance policies and placed restrictions on billing and collections to protect consumers who are overwhelmed by medical expenses." For the story, "the Inquirer asked 25 Philadelphia-area hospitals and health systems for copies of their financial assistance policies." The hospitals varied in the income level at which they would provide "free care" to uninsured patients from $46,100 for a family of four, "the minimum recommended by Pennsylvania regulations and required by New Jersey's Hospital Care Assistance Program," to $69,108.
The Hill (6/8, Viebeck) reported in its "Healthwatch" blog on a new report by the conservative think tank American Action Forum, which found that "an annual fee to raise money for President Obama's healthcare law will increase insurance premiums by billions of dollars on the whole." The group "argued that the annual fee from insurers starting in 2014 amounts to a tax on the middle class."
The Financial Times (6/8, Fifield, Subscription Publication) reports that HHS Secretary Kathleen Sebelius told a town meeting on women's health on Thursday that the Obama Administration is preparing for every contingency ahead of the Supreme Court ruling on the ACA. Sebelius said that while the Administration is "confident and optimistic that this change within the law was well within the purview of Congress," it will "be ready for court contingencies." She also warned that if the Court strikes down the law, it would have a "pretty cataclysmic impact" and would negate the "incredible changes and improvements to Medicare" made over the last two years.
Politico (6/8, Smith) notes that Sebelius said that if the Court strikes down the law, "the new market without pre-existing conditions would cease to exist, lawmakers would have to establish new Medicare rates, and the money currently available to states to set up insurance exchanges would stop immediately."
Reuters (6/8, Morgan) quotes Sebelius, who said, "What we're doing right now, quite frankly, is just working as hard as we possibly can to get ready for 2014. We think it's the best preparation to anticipate that the law is fully constitutional."
The Hill (6/8, Viebeck) reports in its "Healthwatch" blog that "Sebelius called healthcare reform 'the most important women's health law in at least 50 years' - on par with Medicare." She remarked, "We've been talking to women throughout the country about the Affordable Care Act and about how this law is already impacting their lives. What the law meant for them is peace of mind." Sebelius added, "Whatever the circumstances ... care will be there. Affordable prices will be there. Coverage will be there that you need."
CQ (6/8, Ethridge, Subscription Publication) reports, "Sen. John Kerry introduced legislation Thursday that would expand access to Medicare Advantage and supplemental Medigap policies to all Medicare beneficiaries, including the disabled." Kerry remarked, "There is still some discrimination within Medicare that is preventing all beneficiaries from being treated equally. That's got to end, and I'll continue to push this bill forward until it does."
In remarks to reporters Thursday, House Minority Leader Nancy Pelosi "defended the healthcare reform law, tying it to the promises written in the Declaration of Independence," Politico (6/8, Haberkorn) reports. Pelosi said the law is "about life, liberty and the pursuit of happiness for the American people," adding that it "'unlocks' them from a job to pursue happiness without the threat of losing their health insurance." Pelosi said the law's weak public support is a result of "opponents who have misrepresented the legislation."
The San Francisco Chronicle (6/8, Lochhead), in its "Below the Beltway" blog, quotes Pelosi, who remarked, "The public doesn't generally know that, that children in America, over 80 million people in America have already benefited from the health care bill. Whether it is ending discrimination against children because of a preexisting medical condition, whether it was the wellness prevention, once-a-year checkups that now people, especially our seniors, are getting, whether it is lowering the cost of prescription drugs for seniors by closing the donut hole. And I bet you, if you went to a pharmacy right now and you saw a senior purchasing pharmaceuticals, prescription drugs, and those drugs are cheaper now because of the bill, they would not relate it to the Affordable Care Act."
Bloomberg BusinessWeek (6/8, Wayne) reports, "Fees that health insurers will be required to pay the US government starting in 2014 will give nonprofits such as Kaiser Permanente a market advantage over corporate competitors, said economist Douglas Holtz-Eakin." Those "fees -- starting at $8 billion and escalating each year based on the industry's premium revenue -- aren't tax deductible." Although "nonprofits don't have an income tax, companies such as UnitedHealth Group Inc. would effectively be paying taxes on the fees they're handing over to the government, said Holtz-Eakin." The fees were put in place by Democrats to help cover the costs of the ACA.
Politico (6/7, Allen) reports that the Supreme Court "will deliver their landmark ruling on the 2010 healthcare law this month," and the federal government "is in line to reap hundreds of billions of dollars in savings -- perhaps more than $1 trillion -- if certain parts of it are struck down. That money could be freed up just in time for a battle over whether automatic cuts to the Pentagon and social programs will kick in, and some members of Congress are already dreaming about the possibilities." According to Politico, "If the court kills just the parts of the law that cost money, while leaving in place new taxes and spending cuts, that would leave more cash on the government's books." Politico notes that the deficit would rise slightly if the court strikes down the entire law, and there would be no effect on the budget if the entire law is upheld.
The Hill (6/7, Baker) reports in its "Healthwatch" blog that according to an American Action Forum analysis, "the Health and Human Services Department has missed nearly half of its legal deadlines while implementing President Obama's healthcare law." The piece notes, "The highest-profile item on the list of missed deadlines is the CLASS, or Community Living Assistance Services and Supports, program, which would have provided insurance for long-term care such as nursing-home stays. But HHS decided not to implement the program, saying it simply couldn't work as it was written."
American Medical News (6/7, Berry) reports, "Young adults with health insurance coverage are more likely to have regular medical visits and are less likely to go without care, delay care or end up in the emergency department, according to survey (pdf) results released by the Centers for Disease Control and Prevention." This past December, "the US Dept. of Health and Human Services announced...that the coverage rate for 19- to 26-year-olds rose from 64% in September 2010 to 73% in June 2011, translating to an estimated 2.5 million additional insured young adults. The government credited the new rules for expanding coverage, because the rise in insurance coverage was largely due to an increase in the percentage of young adults who are privately insured, from 49% to 58%, rather than a rise in the number covered under Medicaid or other public plans."
The Hill (6/6, Viebeck) reports in its "Healthwatch" blog on a survey from the International Foundation of Employee Benefit Plans, which found that "most American employers believe that a Supreme Court decision rejecting the entire healthcare law would be the best option for their finances." For example, "Sixty-six percent of groups with 50 or fewer employees selected that outcome as the most favorable, compared to 46 percent of those with between 500 and 999 employees." In addition, the survey "found that the scenario employers see as most likely - an end to the mandate, but not the entire law - is also the one that would be the toughest on their books."
The Hill (6/6, Baker) reports in its "Healthwatch" blog, on a study published in Health Affairs finding that "states and the federal government will have to work hard to make sure that new insurance exchanges in President Obama's healthcare law actually create more competition." The study found that "rural areas with low populations tend to have less competition among insurance companies," and "people in those areas generally pay higher out-of-pocket costs than people in more populated areas with greater competition."
In The Hill (6/6) "Congress" blog, Rep. Dennis Kucinich (D-OH) writes, "When the Supreme Court issues its decision on the Affordable Care Act (ACA), the debate will not stop. The ACA brought about immediate relief from some of the worst outcomes of for-profit healthcare, but it is by no means sufficient to temper the rapacious conduct of insurance companies who are determined to make money by not providing healthcare." He argues, "There is only one solution: Medicare for All," which "would cover everyone in the United States for all medically necessary services with no co-payments, premiums or deductibles, for the same amount we currently pay for healthcare."
The Boston Globe (6/6, Conaboy) reports, "Using the model of letter grades posted in New York to steer diners away from the dirtiest restaurants, a prominent health quality group is grading US hospitals on safety, giving Massachusetts medical centers the highest overall scores in the nation." This morning, the Leapfrog Group plans "to post the assessments online Wednesday morning at hospitalsafetyscore.org." These "grades are meant to measure how well hospitals prevent errors that kill tens of thousands of patients each year and are designed as a deliberately simple tool for patients choosing where to get care, said Leah Binder, Leapfrog's chief executive."
On its front page, the Boston Globe (6/5, A1, Jan) reports on the potential aftermath of the Supreme Court's decision for the health reform law. For example, "the entire bill could be overturned," thus eliminating "the controversial mandate that most people purchase health insurance," as well as other "provisions allowing young adults to stay on their parents' insurance until age 26, making prescription drugs for seniors more affordable, and requiring insurers to cover those with pre-existing medical conditions without charging them more." The article points out that "both Democrats and Republicans in Congress have been reluctant to openly discuss contingency plans, or the possibility of compromise, in the event the court strikes down the law." However, "as the clock ticks towards decision time, the Legislature is doing what it can to preserve some of the national law's more popular elements in case the law is struck down."
Administration Considers Options If SCOTUS Strikes Down Individual Mandate. The Huffington Post (6/5) reports that several Democratic sources say the Obama Administration is growing increasingly confident that the Affordable Care Act can "remain viable even if the Supreme Court strikes down the provision that requires individual citizens to purchase health insurance." While the Administration has argued that the individual mandate "is intertwined with the rest of the law's reforms to insurance markets," as "the Supreme Court's ruling draws near, talk of the mandate's necessity has been replaced with conversations over the other options in the policy cupboard. Those include penalizing people who show up for emergency coverage after their surgery and tax incentives for buying insurance."
WSJournal: HHS Is Squandering Taxpayer Money. An editorial in the Wall Street Journal (6/5, Subscription Publication) criticizes grants made by HHS under the Affordable Care Act, noting that the Department is squandering taxpayer money. The Journal notes that Ernst & Young's annual audit of the HHS balance sheet found that the Department cannot accurately track its spending and is in violation of several federal accounting rules which were written for the bureaucracy.
Near Majority Wants Congress To Try Again If ACA Struck Down. National Journal (6/5, Cooper, Subscription Publication) reports on a United Technologies/National Journal Congressional Connection Poll, which found that "if the Supreme Court strikes down part or all of the Affordable Care Act, a strong plurality of the public wants Congress to try again to come up with a comprehensive health care law to guarantee insurance for all Americans." The piece notes, "The near majority-46 percent-that favored trying to come up with another law providing health insurance to all Americans shows a public that still has an ambitious agenda for Congress at the same time that it's wary of parts of the Obama legislation."
Study Estimates Hundreds In Savings From Individual Health Insurance Under ACA. The New York Times (6/5, Carrns) reports in its "Bucks" blog on a study from the journal Health Affairs, which predicted that "people who buy individual health insurance would likely save hundreds of dollars a year in out-of-pocket medical costs under the Affordable Care Act." The piece notes that "the study found that if the Act had been implemented from 2001 to 2008, the average adult with individual insurance would have saved at least $280 a year on out-of-pocket costs for medical care and prescription drugs," while "the savings were greater for those aged 44 to 64 ($589 a year) and for those with low incomes ($535)."
The Bangor (ME) Daily News (6/5, Hancock) reports, "Half of all workers at employer-sponsored health plans - including those working for the government - could be on high-deductible insurance within a decade, according to a new paper from Rand Corp." While "supporters say the plans can contain health costs," opponents "say high-deductible insurance is just a way for corporations to shift costs onto workers, especially those dealing with chronic illness such as diabetes and arthritis."
The Huffington Post (6/5, Akitunde) reports, "Once only something done by the incredibly wealthy, medical tourism is 'really turning into something people understand,' said Josef Woodman, CEO of Patients Beyond Borders, which produces guidebooks on medical travel." The organization "estimates that in 2012, 600,000 people traveled abroad for treatment -- a number anticipated to grow 15 to 20 percent annually as boomers age." According to Rajesh Rao, CEO of IndUSHealth, "80 percent or more of the people using medical tourism are baby boomers," and he suspects that "the bulk of utilization happens with baby boomers just because they're at an age where they need more intervention." Though the cost of a round-trip ticket and hotel accommodations add to the expense of treatments sought abroad and often paid for out-of-pocket, many experts, doctors, and patients agree that medical tourism is still more affordable than paying for procedures performed in the US.
Colleges Point To ACA In Announcing Higher Premiums Or End To Student Insurance.
The Wall Street Journal (6/4, A5, Radnofsky, Subscription Publication) reports that under the Affordable Care Act, some colleges are raising insurance premiums for students while others are dropping coverage due to ACA requirements for expanded coverage. A GAO study is cited finding that most students are on the parents' health insurance policies, though about seven percent of college students bought their own plans, mostly from schools. The ACA is said to have eliminated the possibility of low cost, low benefit plans.
Proposed HHS Rule To Outline Data Needed For Defining Essential Health Benefits.
Modern Healthcare (6/3, Daly, Subscription Publication) reports, "A proposed HHS rule outlines a data-collection process for determining the minimum scope of many future health insurance plans. ... No indication was given in the proposed rule about when HHS officials will issue highly anticipated rules outlining the essential health benefits, but the proposed rule stated that the department will follow the direction outlined in the December bulletin."
Appeals Court To Weigh Texas Planned Parenthood Ban.
The Wall Street Journal (6/4, Jones, Subscription Publication) reports that the 5th Circuit Court of Appeals in New Orleans will hear arguments this week over a rule banning Planned Parenthood clinics in Texas from participating in a program subsidizing health services for uninsured, low-income women. The rule, passed by the Texas Health and Human Services Commission in February, prohibits organizations linked to abortion providers from receiving funds under the Texas Women's Health Program, and bars the 49 Planned Parenthood clinics in the state that do not provide abortions from participating in the program because of their affiliation with the Planned Parenthood Foundation of America, which supports women's abortion rights.
Treating Routine Injuries With Opioids Increases Other Costs.
In a front-page report, the New York Times (6/3, A1, Meier, Subscription Publication) says the costs of treating "routine injuries" with opioids such as OxyContin, Percocet, and Duragesic are creating high costs in the US through insurance payouts and lost time on the job. The drugs are a "big and fast-growing cost" that leaves workers out longer, and sometimes permanently. One insurer's analysis in 2010 showed that "when medical care and disability payments are combined, the cost of a workplace injury is nine times higher when a strong narcotic like OxyContin is used." The drugs also are costing taxpayers, "who underwrite coverage for public employees like police officers and firefighters." The Times says insurers are partly to blame – "during the last decade, they readily reimbursed doctors for prescribing painkillers while eliminating payments for treatments that did not rely on drugs, like therapy."
Emails Reveal Healthcare Deals With Pharmaceutical Industry.
The Wall Street Journal (6/1, Mundy) says GOP leadership in the House Energy and Commerce Committee, which is investigating how the Affordable Care Act was crafted, released emails Thursday from the Pharmaceutical Research and Manufacturers of America that reveal how the White House struck a deal with the pharmaceutical industry to get the healthcare reform bill passed. According to the emails, the pharmaceutical lobby got a "good deal" by capitalizing on negative media coverage that focused on the rising costs of healthcare reform. White House concessions to industry included abandoning price controls for prescription drugs and abandoning Obama's campaign pledge to allow the reimportation of cheaper drugs. White House spokesman Eric Schultz called the release of the emails "a nakedly political, taxpayer-funded crusade to hurt the president's re-election campaign."
The Washington Times (6/1, Cunningham) says the emails reveal that former White House Chief of Staff Jim Messina and healthcare reform advisor Nancy-Ann DeParle "told drug company representatives in June 2009 that if they didn't cooperate on the initiative, Mr. Obama would demand a 15 percent rebate on Medicare drugs and push to remove the tax deduction for direct consumer advertising -- items that could cost the industry $100 billion over the next decade." Those threats apparently worked, since parties worked out a deal shortly thereafter. The drug companies "agreed to pay higher Medicaid rebates and a new healthcare reform fee to raise $80 billion for the legislation, and promised to run positive television ads about it. In exchange, the White House gave them direct input into the new policies and promised to let them continue to set their own drug prices."
The AP (6/1) adds Nancy-Ann DeParle "told PhRMA's chief lobbyist for negotiating the deal that the White House would oppose new drug importation policies because of 'how constructive' PhRMA had been. According to PhRMA's lobbyist, White House Deputy Chief of Staff Jim Messina told him that the 'WH is working on some very explicit language on importation to kill it in health reform.'"
Politico (6/1, Haberkorn) quotes White House spokesman Eric Schultz as saying of the House panel, "This is the same House committee that has spent, according to one report, over $1 million in taxpayer dollars for the past 15 months looking into baseless allegations on Solyndra -- but has done almost nothing to move legislation that would create jobs or grow the economy." Also covering this story are Roll Call (6/1, Strong, Subscription Publication), Bloomberg News (6/1, Armstrong), The Hill (6/1, Baker) "Healthwatch" blog, and CQ (6/1, Subscription Publication).
Proposed California Budget Would Hit Healthcare Safety-Net Hard.
The Contra Costa (CA) Times (6/1, Steinberg) reports that if California Gov. Jerry Brown's budget goes through, "the hits to California's health care safety net comes on three fronts, according to the California Association of Public Hospitals and Health Systems." The budget would "take $100 million in federal funding that would have in some cases reimbursed the state's public hospitals for services already provided." It would also eliminate "more than $60 million in fiscal year 2013-14 funding to public hospitals that was agreed to under a fee designed to maximize federal funding available to California for the Medi-Cal program" and "cut an additional $9 million in fiscal 2013-14 safety net pool funding used to help cover expenses incurred for care to the uninsured."
State Medicaid Directors Say ACA's Expansion Of Program Will Be Difficult.
CQ (6/1, Adams, Subscription Publication) reports, "With a year and a half to go before Medicaid is supposed to be expanded to cover an additional 16 million people under the health care law, on Thursday Medicaid directors said," at a panel sponsored by the National Medicaid Congress, "they are worried that they will not be ready to handle the surge in enrollment." The majority of "states face budget constraints that make it hard for them to expand enrollment in a phased-in way in preparation of the huge surge in the program in 2014 under the law." Additionally, "they face huge uncertainty about whether the expansion will actually take place or be derailed by a Supreme Court decision expected next month or a change in administrations after the November elections."
Consumer Reports Article Looks At Healthcare Price Variation.
The National Journal (6/1, Sanger-Katz, Subscription Publication) reports, "A new story from Consumer Reports highlights how extreme price variation and sketchy transparency can mean that even insured patients often end up on the hook for huge, unanticipated bills." The article "homes in on two big themes: The broad range of prices that various providers charge for the same procedures, even if they are all considered in the network of a particular insurer; and changes in how plans calculate 'usual and customary charges' mean that out-of-network reimbursements frequently cover a much smaller percentage of costs than patients typically realize."
The CNN (6/1, Young) "The Chart" blog reports, "Nancy Metcalf, the magazine's senior program editor and author of the article," said, "What we found was there's no such thing as a price for a health care service. Prices are all over the map and vary depending on where you have the service, and it's much more likely to be more expensive if you have it in a hospital versus a doctor's office." According to Metcalf, "The most consumer unfriendly thing is that it's often impossible to find out what the service will cost ahead of time."
Poll Indicates 16 Percent Of Americans Check Prices Before Getting Healthcare.
Under the headline "More Americans Are Checking Prices Before Getting Health Care," the NPR (6/1, Hensley) "Shots" blog reports, "In the latest NPR-Thomson Reuters Health Poll we asked people across the country whether they size up the prices for care before making decisions," and how those who did went about doing it. The poll found that "16 percent said they'd looked for prices beforehand, compared with 11 percent who'd answered that way in the previous poll." The poll indicated that "most commonly, people got the information in person -- at about 53 percent."
Report: US Healthcare Cost Increases May Be Slowing.
Bloomberg News (5/31, Wayne) reports, "Cheap walk-up health clinics, lower costs for drugs and medical supplies, and state laws requiring hospitals to publish prices may be helping to reduce the increase in US health costs," according to the PricewaterhouseCoopers annual report on trends in US medical costs. "Health-care costs are expected to rise 7.5 percent in 2013, or 5.5 percent when accounting for changes in insurance benefits, such as higher deductibles and co-payments," the report found. This "is the fourth year in a row the annual cost increase is less than eight percent." Reuters (5/31, Morgan) also covers the story.
Lawrence: Medicare "Fixable" Through Healthcare Reform.
In the Washington Post (5/31), Bryan R. Lawrence, founder of New York-based investment partnership Oakcliff Capital, writes that "Medicare may be the most sacred government program in the United States," and "given its central role in our fiscal challenges, it makes sense to examine why this program is so popular." He cites "two key factors," that "retired Americans receive high-quality care but have virtually no idea what their Medicare benefits cost," and "every working American has Medicare taxes deducted from each paycheck and has been told that the money is paid into a trust fund for his or her future benefits." Lawrence argues that "Medicare is a transfer of wealth from younger to older Americans," which is a problem "fixable" through healthcare reform.
Number Of People Covered By HSA Plans Rises By 18 Percent.
CQ (5/31, Norman, Subscription Publication) reports, "The number of consumers signed up for high-deductible health plans rose by 18 percent in 2011, the health insurance industry's trade group reported Wednesday." As CQ notes, "America's Health Insurance Plans' annual census of health savings account (HSA) insurance plans found that 13.5 million people are covered by them as of January 2012, up from 11.4 million the previous January and 6.1 million in 2008."
Modern Healthcare (5/31, Subscription Publication) notes that "the savings account-type high-deductible plans have grown steadily since they were first offered in 2004."
The NPR (5/31, Hancock) "Shots" blog describes how "17 percent of US workers with employer-based insurance were enrolled in an HSA or an HRA, according to the Kaiser Family Foundation." Also, "states with the highest portion of HSA enrollees were Vermont, at 20 percent; Minnesota, with 14 percent; and Montana and Utah, both with 12 percent." The Kaiser Health News (5/31, Hancock) "Capsules" blog also covers this story.
Analysis: Health Insurance Tax Credit For Small Businesses A "Disappointment."
The AP (5/31, Alonso-Zaldivar) reports, "Many small businesses struggle to afford health insurance for their workers, but a new tax credit meant to help them seems to be turning into a disappointment," and this has "put the Obama administration in the awkward position of asking Congress to help fix the problems by allowing more businesses to qualify and making it simpler to apply. But Republicans who run the House say they want to repeal what they deride as 'Obamacare,' not fix its flaws." Furthermore, "It doesn't help the administration's plea that the biggest small-business lobbying group," the National Federation of Independent Business, "is a lead plaintiff asking the Supreme Court to overturn the Affordable Care Act
Aetna Chief Executive Says Supreme Court Will Keep Part Of Affordable Care Act.
Bloomberg News (5/31, Nussbaum) reports that Aetna Inc. Chief Executive Mark Bertolini believes that the US Supreme Court most likely will not overturn the entire Affordable Care Act, suggesting that "even if Republicans control Congress and win the White House in November, many of the law's regulations will survive in some form." Bertolini adds that while there may be a movement in Congress to repeal the legislation, there will soon be efforts to replace it with something else because no lawmaker wants to deprive families of some of the more popular provisions, such as "allowing parents to keep children on their health plan until age 26 as well as a ban on benefit limits."
Bipartisan Plan Proposes Premium Support To Address Medicare Funding Shortfall.
FOX News (5/30, Angle) says on its website, "When it comes to the debate over Medicare's future, lawmakers appear all too willing to ignore a disturbing fact -- every household in America would have to pay $230,000 more in taxes to cover the unfunded promises made under the health care entitlement." To address the anticipated shortfall, Sen. Ron Wyden (D-OR) and Rep. Paul Ryan (R-WI) are "proposing something called premium support, which would allow health care insurers to compete for the business of seniors." Obama has said of the idea, "While we do need to reduce health care costs, I'm not going to allow that to be an excuse for turning Medicare into a voucher program that leaves seniors at the mercy of the insurance industry." Meanwhile, House Democratic Leader Nancy Pelosi has criticized supporters of the plan, asserting that "they want to end the Medicare guarantee. They want seniors to pay more, as the Medicare guarantee is terminated."
Japsen: Affordable Care Act May Be Helping To Improve Customer Service From Insurers.
In a column published in Forbes (5/30), Bruce Japsen writes, "Though the health care overhaul faces an uncertain fate next month before the US Supreme Court, preparations for the massive rollout of its medical care coverage might already be leaving a legacy of improved customer service. The health insurance industry, often at or near the bottom of a consumer's customer service experience when compared to other industries, is paying more attention and spending more money on improving how health plans interface with patients on the other end of the telephone, a web site or, lately, through an app. ... Insurance companies are taking steps to build their relationship with customers as health plans prepare to compete between each other on exchanges where benefit packages will be offered."
Federal Budget Proposal Would Impact Medicaid, CHIP.
The AP (5/30) reports, "Republican US Senate candidate Kurt Bills said Tuesday that he would support eliminating four federal Cabinet departments, instituting a 17-percent flat tax for individuals and corporations, increasing the retirement age and limiting Social Security payments for higher-income people." Bills "said he backs a recent federal budget proposal from US Sen. Rand Paul of Kentucky," which "proposes balancing the US budget within five years and reducing the national debt by $2 trillion in the next decade through deep cuts to federal spending and entitlements." In addition, "the plan proposes shifting Medicaid, the State Children's Health Insurance Program, food stamps and child nutrition programs to a block-grant method of delivery."
Hospital-At-Home Concept Getting More Attention.
USA Today /Kaiser Health News (5/30, Graham) reports that the hospital-at-home "concept is getting more attention with increased pressure from the national health overhaul to improve the quality of medical care and lower costs." In the majority of hospital-at-home "programs, doctors examine the patient daily, and nurses and aides visit up to three times a day, often for extended periods. Patients are admitted for three to five days after being seen in the emergency room, referred by a physician or discharged early from a hospital."
SCOTUS Ruling Would Impact State-Based Insurance Marketplaces.
The Washington Post (5/27, Aizenman) reported on varying outcomes for states if the Supreme Court overturns some or all of the 2010 healthcare law. Some two dozen states are "stalled" in setting up insurance marketplaces, while a dozen or more "have moved swiftly" on their plans. The Post examined readiness in Maryland, California, and Rhode Island, interviewing state health officials about what they have done and how a Supreme Court decision would affect them. Maryland's health chief Joshua Sharfstein said states could find their plans in jeopardy with the most minimal change -- eliminating the individual mandate. The "nuclear option," in contrast, would be if the court overturns the whole law and "federal funds...disappear." Some states are looking at what changes they could make themselves in the absence of federal law.
Analysis: Safety-Net Programs, Except Medicaid, Serving Fewer People.
USA Today (5/29, Wolf) reports on an analysis of government data, which showed that "three years after the recession officially ended, most of the nation's safety-net programs finally are serving fewer people. ... Only Medicaid, the federal-state health care program for the poor, remains at its peak, due to the slow recovery, the erosion of employer-sponsored insurance and federal rules that prohibit states from slashing eligibility. Still, even Medicaid has started to level off in some states."
Kaiser Permanente, Unions Try Novel Approach To Rein In Rising Health Costs.
In an editorial, the Los Angeles Times (5/29) writes that the "giant healthcare provider Kaiser Permanente and a coalition of unions led by the United Healthcare Workers [UHW]" have "recently signed a contract that creates a novel incentive for [healthcare] workers to get in better shape, testing the notion that peer pressure may be a more effective way to promote healthy lifestyles than individual rewards or penalties." After pointing out that "the incentive is unusual because it's based on the group's progress, not each employee's," the Times concludes, "But as UHW-West President Dave Regan recently told The Times, the current fitness of healthcare workers makes them a poor advertisement for the benefits of a healthy lifestyle. The union's contract with Kaiser shows that it's ready to start rectifying that."
Illinois Lawmakers Approve Medicaid Budget Cuts.
The Chicago Tribune (5/25, Long) reports on $1.6 billion in budget cuts approved by Illinois lawmakers on Thursday, noting that "hundreds of thousands of poor Illinoisans would lose health coverage, prescription drug discounts for seniors would be dropped and dental care for adults would be greatly curtailed." While some lawmakers were angry over the "major Medicaid reductions," which they said "will jeopardize the lives of the state's most vulnerable residents," supporters insisted that "failure to approve the bill could lead to cuts throughout state government and result in collapse of the entire Medicaid system."
The Peoria (IL) Journal Star (5/25, Finke) reports, "Representatives voted 94-22 to adopt the cuts, which range from outright elimination of some programs – like Illinois Cares Rx, a prescription drug assistance program for seniors – to taking extra steps to ensure that those receiving aid are entitled to it. ... Several minority lawmakers said the cuts will hurt Illinois' neediest people. They said the state instead should eliminate business tax breaks or expand the state sales tax to come up with additional money for Medicaid."
The Chicago Sun-Times (5/25, McKinney) quotes Julie Hamos, director of the state Healthcare and Family Services department, who said, "We believe this will save the Medicaid program." The piece notes that Hamos' agency "would be authorized to hire a firm to determine that everyone on Medicaid's rolls is eligible by weeding out those with out-of-state addresses, those making too much to qualify for Medicaid or who are deceased and anyone over...age 19 in the All Kids program." Also reporting this story are the St. Louis Post-Dispatch (5/25, McDermott) and the Belleville (IL) News-Democrat (5/25).
This Fall, Many Americans To Get Easy-To-Understand Health Plan Benefit Summaries.
CQ (5/25, Reichard, Subscription Publication) reports that beginning this September, "173 million Americans will get an easy-to-understand summary of the benefits and out-of-pocket costs of their health plans, says a report Families USA released Thursday." CQ writes, "Mandated under a summary of benefits requirement in the healthcare law (PL 111-148, PL 111-152), the summaries may give the controversial law a bit of a boost in the eyes of a skeptical public." What's more, "the summary requirement is likely to survive if the Supreme Court ruling on the constitutionality of the 2010 law stops short of fully striking it down."
Law Professor Says Healthcare Drafters, Defenders Ignored The Constitution.
Michael W. McConnell, a professor of law and director of the Constitutional Law Center at Stanford Law School, writes in an opinion piece for the Wall Street Journal (5/25, Subscription Publication) that the Supreme Court of The United States' role in deciding the legality of the Affordable Care Act is a tough one, and that should the law be overturned, the interpretation of the Constitution by conservative justices should not be construed as judicial activism by liberals. Furthermore, McConnell says the government failed to state a principle grounded in Constitutional text under which the law is legal; and blames Democrats in Congress for ignoring the Constitution when the law was being drafted.
Study: Almost 1.3 Million Veterans Lack Health Insurance.
The National Journal (5/25, Fox, Subscription Publication) reports, "About 10 percent of US veterans under the age of 65 lack health insurance and are not being cared for by the Department of Veterans Affairs, either, according to study published on Thursday" by the Urban Institute. The "study estimated that 1.3 million veterans and nearly 950,000 members of their families lack health insurance." The National Journal adds, "But the 2010 health reform law might help nearly half of these veterans get health care through expansions of Medicaid, because they make so little money...wrote" the researchers, "who used Census data on 129,000 veterans for their study."
CQ (5/25, Norman, Subscription Publication), which publishes a similar story, notes, "Some of the states that have made the least progress setting up health insurance exchanges also are home to many uninsured military veterans, according" to Thursday's study, "which was funded by the Robert Wood Johnson Foundation." CQ points out the Affordable Care Act-authorized exchanges "will go into effect in 2014." The Urban Institute's study was "completed using 2010 census data from the American Community Survey," CQ adds.
Half Of All Individual Medical Insurance Policies Would Not Meet ACA Minimums.
The New York Times (5/24, B3, Abelson, Subscription Publication) reports that a study published Wednesday in the academic journal Health Affairs concludes that "half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court." Should the Supreme Court uphold the Affordable Healthcare Act, "employer-provided insurance plans are likely to continue to be more generous, but the law would significantly improve the quality of coverage for individuals in several ways." A significant amount of improvement in individual coverage plans will come from "eliminating the ability of insurers to refuse to offer coverage to people who have pre-existing conditions."
The Washington Post (5/24, Kliff) "Wonkblog" reports, "Health insurance plans will have to beef up on benefits if they want to stay in business under Obamacare." According to the blog post, "the health overhaul law mandates a wave of new requirements all intended to make health insurance more robust. It requires health plans to cover a set of 'essential health benefits,' a comprehensive package of benefits outlined in the law."
The Hill (5/24, Baker) "Healthwatch" blog notes that under the new standards of the Affordable Care Act, "many consumers will get more benefits and will likely face lower out-of-pocket costs - but premiums could rise as a result." The Health Affairs study reports that "even the most basic plan under the ACA's new standards would be significantly more generous than what most people get today on the individual market."
National Journal (5/24, Sanger-Katz, Subscription Publication) reports, "In order to meet the actuarial value targets for 'bronze plans,' the lowest category, current plans would have to pay for more care. That likely means they would be more expensive to consumers."
Politico (5/24, Cheney) notes that "as more tax dollars go toward subsidizing low- and middle-income Americans so they can get health coverage, advocates for immigrants say it may be increasingly difficult to care for the undocumented, who are excluded from the law's coverage expansion and the new insurance exchanges." Bloomberg News (5/24, Wayne) and Modern Healthcare (5/24, Zigmond, Subscription Publication) offer similar coverage.
Health Sector Making Effort To Reduce Cost Of Care.
In a front-page story, the New York Times (5/24, A1, Abelson, Subscription Publication) reports that "after years of self-acknowledged profligacy, hospitals, doctors and health insurers say there is a strong effort under way to bring medical costs under control. Their goal is to slash the rate of growth in the nation's $2.7 trillion healthcare bill by roughly half to keep it more in line with overall inflation." The Affordable Care Act "helped accelerate" these efforts, and "even if the Supreme Court decides next month to declare the entire law unconstitutional, many experts in the field say the momentum is likely to continue."
Experts Say Patients Still Lack Tools To Make High-Deductible Plans Pay Off.
The Tennessean (5/24, Wilemon) reports that while high-deductible health plans "are intended to lower overall health spending by making consumers more cost-conscious...experts say hospitals and physician practices have been slow to embrace the changes to make this paradigm work." According to Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, "The vision was we were going to expose patients to greater financial responsibilities for the cost of their care, and we were going to give them the tools to help make them make better informed decisions, and there was going to be transparency on cost and quality." Cassil added, "There has been pretty rapid movement of high-deductible plans, but the tools to help consumers navigate the health system have not kept pace."
Health Insurance Cutbacks Impose Costs On Insured Americans.
NPR (5/23, Stein) "Shots" blog reports, "More than 1 in 5 Americans had a problem getting insurance to pay for a hospital, doctor or other health care in the past year, according to a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health." The blog post discusses the difficulties many Americans face in getting access to care when companies cut back on health insurance options, and the post quotes Drew Altman, president and CEO of the Kaiser Family Foundation, as saying, "Beneath the surface what health insurance is in the country has been changing really dramatically. And just in plain language it's becoming skimpier and skimpier and less and less comprehensive."
Experts Say Healthcare Transformation To Continue Regardless Of Supreme Court Ruling.
The New York Times (5/23, A12, Pear, Subscription Publication) reports on comments by Sen. Sheldon Whitehouse (D-RI) and Dr. Richard J. Gilfillan, director of the federal Center for Medicare and Medicaid Innovation, who said that "the new health care law is already transforming the way care is delivered, and the changes will continue regardless of how the Supreme Court rules on the mandate for most Americans to carry health insurance." Speaking at a forum held by the Center for American Progress, Whitehouse remarked, "The delivery system reforms will survive, and we should not be stalling and dawdling because we are anxious about what the court will do." Gilfillan added, "We are confident that the law will be upheld," but either way, he said, "the marketplace is boiling with new ideas, new opportunities."
The National Journal (5/23, Clark, Subscription Publication) quotes Gilfillan, who said, "There's a spirit out there in the country, and it starts with the great people who work hard every day to deliver health system reform, not in Washington. The Affordable Care Act put the seeds out and they're blossoming."
Congressional Republicans Undecided On Next Move In Healthcare Debate. The Wall Street Journal (5/23, Radnofsky, Bendavid, Murray, Subscription Publication) reports that Congressional Republicans have mixed opinions on what should be done if the healthcare reform law is struck down by the Supreme Court next month. While some, like Rep. Joe Heck (R-NV) want to debate legislation "as soon as possible," others, like Rep. Jim Jordan (R-OH) caution against moving too fast. The Journal notes that a lot rides on what Mitt Romney proposes.
New PSA Recommendations May Not Affect Medicare Coverage.
CQ (5/23, Norman, Subscription Publication) reports, "The US Preventive Services Task Force may have issued a controversial final recommendation against routine prostate cancer screening for men, but the move appears unlikely to affect Medicare coverage -- at least in the short term." CQ adds, "In letters to members of Congress in February, Health and Human Services Secretary Kathleen Sebelius said that 'while the department has discretion to modify or eliminate coverage for the PSA test based on the Task Force's recommendation, I do not intend to eliminate coverage of this screening test under Medicare at this time.'" Yesterday, "a Centers for Medicare and Medicaid Services spokeswoman said Tuesday that the secretary's statement stands."
Employment-Based Health Coverage Declining Due To High Costs.
The Wall Street Journal (5/23, Greene) reports that employer-based health coverage is declining after having experienced a brief uptick immediately after the recession. According to the Journal, the percentage of workers with health coverage in their own name fell from 60.4% to 56% between December 2007 and June 2009. After rising by about one percentage point at the end of 2009, health coverage among workers fell to 55.8% by April 2011. The blog post notes that the report found that the biggest reason workers were uninsured was the cost of coverage. Modern Healthcare (5/23, Evans, Subscription Publication) also covers this story.
IRS Anticipates More Small Businesses To Take Advantage Of Healthcare Tax Credit.
The Hill (5/23, Baker) reports in its "Healthwatch" blog, "The IRS expects more small businesses to begin taking advantage of a new healthcare tax credit that has been criticized as too small to make a difference." According to a Treasury Department spokeswoman, "the IRS is working with the companies that make tax software to build in new alerts for businesses that might be eligible," as well as "reaching out to tax preparers and insurance agents. And it's planning more Web presentations for small-business owners, following up on a webinar that brought in roughly 7,500 viewers."
Catholic Groups File Suits Over Birth Control Mandate.
In a front-page story, the Wall Street Journal (5/22, A1, Radnofsky, Subscription Publication) reports that on Monday, 43 Roman Catholic institutions, including the University of Notre Dame and the Catholic University of America, filed lawsuits against the Obama administration over its contraception mandate. Cardinal Timothy Dolan of New York, president of the US Conference of Catholic Bishops, remarked, "We have tried negotiation with the administration and legislation with the Congress-and we'll keep at it-but there's still no fix. Time is running out, and our valuable ministries and fundamental rights hang in the balance, so we have to resort to the courts now." The Journal notes that there was no public response from the Obama administration.
The Washington Post (5/20, A6, Boorstein) reports that "Catholic bishops were already leading the fight against the mandate," and "other conservative religious organizations had filed lawsuits this year. But Monday's 12 lawsuits on behalf of 43 separate institutions involved only Catholics and for the first time included 13 dioceses - the seats of the bishops themselves." In a statement from the Archdiocese of Washington, the HHS department is accused "of violating the First Amendment and federal law by requiring Catholic organizations to 'sacrifice their beliefs in order to be able to continue their mission of serving all people in need.'"
The New York Times (5/22, A17, Goodstein, Subscription Publication) reports, "Among those filing suit are the Archdioceses of New York, Washington and St. Louis; the Dioceses of Dallas, Fort Worth, Pittsburgh, Rockville Centre on Long Island and Springfield, Ill.; the University of Notre Dame and the Catholic University of America; and Our Sunday Visitor, a Catholic publication. ... The defendants are the Treasury, Labor and Health and Human Services Departments." The Times notes that "the White House declined to comment on Monday, instead providing Mr. Obama's comments when he announced his attempt at the compromise in February: 'These employers will not have to pay for, or provide, contraceptive services. But women who work at these institutions will have access to free contraceptive services, just like other women.'"
The Los Angeles Times (5/22, Duncan) notes that "the suits are the latest in a series of fights on the issue. Recently, Georgetown University took sharp criticism for inviting HHS Secretary Kathleen Sebelius to speak at this year's graduation." The Washington Times (5/22, Cunningham) adds that "the lawsuits come a week after the US Conference of Catholic Bishops rejected the administration's revised final version of the mandate, saying that the administration's various exceptions for religious groups didn't go nearly far enough to protect religious freedom."
The Hill (5/22, Viebeck) reports in its "Healthwatch" blog that "Notre Dame's participation is notable because Obama gave a controversial commencement speech at the school in 2009. Anti-abortion-rights groups criticized the school for inviting Obama because of his position on abortion. ... White House spokesman Jay Carney said in February that Obama takes objectors' concerns 'very seriously' and is 'very aware of and engaged in this issue.'" Carney added, "We're not trying to win an argument here. ... We're trying to implement a policy that will affect millions of women."
The AP (5/22, Zoll) reports, "Erin Shields, a spokeswoman for the Health and Human Services Department, said Monday the agency does not comment on pending litigation. The liberal advocacy group Catholics United accused the bishops of serving a 'right-wing political agenda.'"
Experts Predict Most States Will Employ Health Insurance "Partnerships."
Politico (5/22, Feder, Millman) reports that when health insurance exchanges open in 2014, "many insurance experts and health policy consultants predict only a dozen or so states will be ready to run exchanges on their own - and a few say that projection may be too sunny." The piece notes that "for most states, the likely scenario is 'partnerships,'" which "is intended to be a transitional step for states that can't meet the deadline to open their doors in 2014. But now it's likely to be the default, not the fallback." Amanda Cowley, HHS' acting director of state health exchanges, said at a meeting of California's exchange board last week, "We'll do everything we can to make it work. But it won't be as good as a state-based exchange."
Illinois Moves Closer To Drastic Medicaid Cuts.
The AP (5/22, Johnson) reports that yesterday, "Illinois moved closer to drastic Medicaid cuts Monday with proposed legislation that could excise nearly $1.4 billion from the state's program by shrinking benefits, such as regular adult dental care, and cutting payments to most hospitals and nursing homes." The bill, "backed by Gov. Pat Quinn, falls short of the $2.7 billion in cuts that Quinn originally said would be needed to prevent the health care program for the poor and disabled from collapsing." The piece adds, "Medicaid payments to many hospitals would be cut by 3.5 percent, but the bill exempts rural community hospitals and safety-net hospitals from the cuts."
The Belleville (IL) News-Democrat (5/21) quoted Association of Safety-Net Hospitals spokeswoman Julie Sznewajs, who said that "Latino and black caucus members are 'standing strong for their communities' by supporting the exception for 'safety-net' hospitals." The particular "rural hospitals that would benefit are ones designated as 'critical care' hospitals -- small ones that have fewer than 25 beds." As of yesterday "afternoon, however, it was unclear which of the urban hospitals will qualify as safety-net hospitals. The determination is based on a complicated formula that takes into account the number of Medicaid patients at a hospital as well as the amount of charity work it provides, said Danny Chun, spokesman for the Illinois Hospital Association."
GAO: Healthcare Law Tax Credits Not High Enough For Small Businesses.
The Hill (5/22, Baker) reports in its "Healthwatch" blog that according to the Government Accountability Office, "tax credits in President Obama's healthcare law aren't big enough to prompt small businesses to start offering healthcare benefits." While initial Congressional Budget Office estimates predicted "that the credits would total $2 billion in 2010...businesses only claimed $468 million, according to the GAO." GAO said, "While some small employers could be eligible for the credit if they began to offer health insurance, small business group representatives and discussion group participants told us that the credit may not offset costs enough to justify a new outlay for health insurance premiums." Modern Healthcare (5/22, Subscription Publication) also reports this story
HHS Hires PR Firm To Promote Healthcare Reform Law.
The Hill (5/22, Baker) reports in its "Healthwatch" blog that "the Health and Human Services Department has signed a $20 million contract with" public-relations firm Porter Novelli "to highlight part of the Affordable Care Act." According to an HHS official, "the new, multimedia ad campaign is designed to educate the public about how to stay healthy and prevent illnesses."
The Washington Times (5/22, Cunningham) reports in its "Inside Politics" blog, "A Department of Health and Human Services spokesperson said the goal is to make sure Americans understand how the law will benefit them." The spokesperson remarked, "The campaign will inform the American people about the many preventative benefits now available to those with Medicare, Medicaid and private health insurance as a result of the Affordable Care Act."
Health Insurance Claims Database To Help Investigate Cost Of Healthcare.
The Washington Post (5/22, Kliff) reports in its "Wonkblog" that the nonprofit Health Care Cost Institute has launched "a database of 5 billion health insurance claims (all stripped of the individual health plan's identity, to address privacy concerns)," and "researchers will be able to access that data, largely using it to" answer "what makes health care so expensive." The Post notes that the "database is massive," as data was "voluntarily supplied by Aetna, Humana, UnitedHealth and Kaiser Permanente," and "covers 33 million Americans with employer-sponsored health insurance." Meanwhile, HCCI used the database to compile its own report , concluding "that higher prices charged by hospitals and other prices have driven health care cost growth during the recession, rather than Americans using more medicine."
Hospice Marketers Seeking To Exploit ACA Provision.
USA Today (5/22, Kennedy) reports, "Hospice marketers, exploring possibilities for new revenue to help continue the industry's remarkable growth, are looking to exploit a provision in the 2010 health care law by persuading hospitals to send Medicare patients into end-of-life hospice care instead of readmitting them to the hospital. Such a move, the hospice marketers say, will enable hospitals to avoid paying the Medicare penalties required by the new law when hospitals discharge patients and then have to readmit them within 30 days: Instead of readmitting the patients, hospitals should send them to hospice care, which also is covered by Medicare."
Think Tank Adds To Criticism Of Medicare Quality Ratings For Private Plans.
The Washington Post /Kaiser Health News (5/20, Serafini) reported that the American Action Forum issued a report last week that joined the GAO and the Medicare Payment Advisory Commission in criticizing the government's star rating system for private Medicare plans that aims to improve the quality of patient care with bonus incentives. The conservative think tank argued that some government standards "are difficult to measure and that it's hard to score well when plans don't always know the criteria in advance." Medicare Advantage plans this year will see their payments cut by$6 billion under the healthcare law, so they find the bonus money particularly attractive, as it can offset about half of the reduction. For his part, Douglas Holtz-Eakin of the American Action Forum claims that the larger bonuses "were a political calculation by the Obama administration to head off an exodus of health plans -- and a backlash from angry senior citizens -- before the November election."
Professor Advocates Graduated Eligibility.
In the New York Times (5/21) "Opinionator," Ezekiel J. Emanuel, an oncologist and former White House adviser, and a vice provost and professor at the University of Pennsylvania, suggests a "better" bipartisan Social Security and Medicare reform: Graduated eligibility. He says, "Instead of having a fixed age at which people can get Social Security and Medicare, we should link the age of eligibility to lifetime wealth. The richer you are, the older you would have to be to be eligible for Social Security and Medicare." According to Emanuel, graduated eligibility "would not completely close the shortfall of the trust funds, but it would put Social Security and Medicare on a stronger financial footing, while reaffirming their universal nature and reflecting the fortunate fact that Americans are living longer."
Rise In Healthcare Costs Attributed To Higher Prices.
Politico (5/21, Feder) reports on a study by the Health Care Cost Institute that "could pose a challenge to the basic premise of President Barack Obama's approach to controlling health costs - that spending will come down if doctors don't give patients as much unnecessary medical care." Instead the study "found that costs rose 3.3 percent in 2010 even though people actually used fewer services ... because the services themselves got more expensive." The study is based on data from "the nation's largest insurers - Aetna, Humana, Kaiser Permanente and UnitedHealthcare."
CQ (5/21, Bristol) explains the study found that, "increases in per capita health spending for privately insured Americans from 2009 to 2010 were driven primarily by hospitals and other medical facilities raising their prices, not by people getting more and costlier services." And "the authors of the report said they were most surprised by the results that showed health expenditures increasing fastest for those 18 and younger, with an estimated annual expenditure growth of 4.5 percent" compared to 3.1 percent for those 55 to 64 and 2.2 percent for those 45-54. In addition, "the biggest increases in facility prices were in mental health and substance abuse inpatient admissions, at 8.6 percent; outpatient surgery, 8.9 percent; and outpatient emergency room visits, 11 percent."
Kaiser Health News (5/21, Appleby) adds, "The study's findings raise questions that go to the heart of the nation's $2.6 trillion annual bill for health care: Why are prices for medical services rising far faster than inflation?"
Modern Healthcare (5/21, Evans) reports, "Prices climbed for nearly all of 30 categories of healthcare in the report."
Bloomberg News (5/21, Nussbaum) reports, "Today's report found the growth in spending for employer- backed plans slowed in 2010 for the third year in a row. Even so, the average price of prescription drugs rose 3 percent, inpatient admissions cost 5.1 percent more and the price of outpatient visits increased 10 percent."
Fate Of PCIP Patients In Limbo Should ACA Be Struck Down.
The AP (5/18, Alonso-Zaldivar) reports that "nearly 62,000...'uninsurable' patients are getting coverage through a little-known program for people who have been turned away by insurance companies because of pre-existing medical conditions." The program is called the Pre-Existing Condition Insurance Plan (PCIP), and according to a government report, plan participants "tended to be middle-aged patients with no access to employer coverage and with medical conditions that require continuous care. The top five diagnoses: cancer, heart disease, degenerative bone diseases, organ failure requiring a transplant and hemophilia." Should the Supreme Court strike down the Affordable Care Act (ACA), officials in some states are now considering including PCIP patients in their own state-run, high-risk health insurance pools. So far, Federal government officials have not said what will happen to patients in PCIP should the ACA be found unconstitutional.
Healthcare Sparks Divisions Among Republicans In Washington.
Politico (5/18, Sherman) says it took conservatives only thirty minutes to express criticism of House Speaker John Boehner and his leadership team for a new strategy leaked to the media: "Republicans would try to replicate popular parts of Obama's health care law if the Supreme Court overturns the law this summer. Rather than sending out news releases or rushing to cable TV for a rant, conservatives blasted House Republican leadership on a private Google email group called The Repeal Coalition," which featured comments showing that healthcare reform remains a hot topic. The "behind-the-scenes fight among Republicans richly illustrates why House GOP leadership is so cautious, sensitive and calculating when it comes to dealing with the conservative right."
The Washington Post (5/18, Kliff) reports in its "Wonkblog" that "Republicans are, in a way, caught between a rock and a hard place: They want to keep the popular parts of the law, but not the unpopular part - the individual mandate - that makes those well-liked provisions work. Without it, Avik Roy" points out in a Forbes article , "the requirement for insurers to cover everyone falls apart."
Boehner Affirms Repeal Commitment. The Hill (5/18, Baker) "Healthwatch" blog says Speaker Boehner on Thursday sought to allay concerns that Republicans would leave intact the more popular parts of healthcare reform if the US Supreme Court overturns the law. He said, "We voted to fully repeal the president's healthcare law as one of our first acts as a new House majority, and our plan remains to repeal the law in its entirety. Anything short of that is unacceptable." Meanwhile, on Thursday morning, US Rep. Peter King joined the conservative lobbying effort aimed at urging the GOP to abandon even the more popular parts of the healthcare reform law. He said of the healthcare reform law, "I want all of it pulled out by the roots."
State Republicans Take Different Paths On ACA. The Washington Times (5/18, Cunningham) says the US Supreme Court's pending decision on ACA has "left some Republican-controlled states plowing ahead to set up state-run health insurance 'exchanges,' while others have balked at doing anything that would seem to embrace the law, though that risks the chance of the federal government coming in and taking over." The Obama Administration has mobilized to help states with the transition by releasing guidelines in March and awarding funds to states that get the exchanges started. The Times adds, "But most Republican statehouses haven't been willing to set up exchanges quite yet. Except for Colorado, where Republicans rule the House, all 12 state legislatures to pass exchange bills are led by Democrats."
HHS Releases Blueprint For Establishing Health Insurance Exchanges.
The Wall Street Journal (5/17, Radnofsky, Subscription Publication) reports on new guidance by the Obama administration regarding state health insurance exchanges. CMS's Steve Larsen remarked, "We strongly encourage states to engage us in a partnership model if they are not ready to proceed with a full state-based exchange."
Kaiser Health News (5/17, Appleby) reports, "States must provide details to the federal government by Nov. 16 – just 10 days after the presidential election – on how they will run online insurance marketplaces," and "those that don't meet the deadline – or that can't operate their own marketplaces, called exchanges – will have it done for them by the federal government, starting in January 2014." Larsen "said the initial approach would be an open marketplace, but he told reporters that in future years other options may be explored." He "reiterated the government's stance that the court will uphold the law and that the president will be re-elected, and he said 'states should turn their attention to moving forward.'"
CQ (5/17, Subscription Publication) reports that in a news release, HHS said, "This guidance describes how HHS will consult with a variety of stakeholders to implement an FFE, where necessary, how states can partner with HHS to implement selected functions in an FFE, and key policies organized by exchange function."
Reuters (5/17, Morgan) reports that according to HHS Secretary Kathleen Sebelius, 34 states and the District of Columbia have received federal grant money to aid in the establishment of exchanges. She remarked, "What this shows is that states are making real progress in delivering quality, affordable health coverage to their residents and they want to be up and running by January 2014."
The Washington Post (5/17) reports in its "Wonkblog" that "there is certainly a big difference between committing to the task of setting up exchanges - and actually following through. Health policy analysts have questioned whether the feds have sufficient resources for the task in front of them." The Cato Institute's Michael Cannon remarked, "A lot of states will be in a holding pattern until the election. The question is, can HHS get states up and running in a year? I don't see how they can do it."
Six States Awarded Grants For Healthcare Exchanges. The Oregonian (5/17, Rojas-Burke) reports that HHS Secretary Kathleen Sebelius announced yesterday that six states have been awarded "tens of millions of dollars in federal grants this year to help them launch health insurance exchanges." Among them, Oregon "landed $6.68 million, on top of a previously awarded $58 million," and Washington "landed $128 million, bringing its total to $152 million." The Oregonian adds, "While some states fight the federal health reform law or await acting until the Supreme Court rules on a constitutional challenge, Oregon, Washington and about 30 others have committed to getting state-run exchanges ready to start enrollment next year."
The AP (5/17) reports, "Tennessee is one of six states that will share in more than $181 million in federal health care grants. The U.S. Department of Health and Human Services announced the grants Wednesday, saying Tennessee will receive $4.3 million to use in establishing Affordable Health Care Insurance Exchanges." The Tennessean (5/17, Ward) also reports on Tennessee's grant.
The St. Louis Business Journal (5/17, Weiderman, Subscription Publication) reports, "Health and Human Services (HHS) Secretary Kathleen Sebelius said today that Illinois received a $32.8 million grant to help establish an Affordable Insurance Exchange."
The Puget Sound Business Journal (5/17, Bauman, Subscription Publication) reports, "Washington state received approval for $128 million in federal funding for the next phase of implementing the federal Affordable Care Act, Gov. Chris Gregoire announced Wednesday."
The Telegraph (IL) (5/17, Brino) reports, "The U.S. Department of Health and Human Services gave Illinois $32.7 million to set up a health insurance exchange - even as legislative efforts to do so were abandoned amid uncertainty about the national health care law's future." Government Health IT (5/17, Mosquera) also reports on the grants.
House Republicans Prepare Post-Supreme Court Healthcare Plans.
As House Republicans await a Supreme Court ruling on President Obama's healthcare law, Politico (5/17, Sherman, Haberkorn) reports that party leaders "are quietly hatching a plan of attack." If the law is upheld, House Republicans will "take to the floor to tear out its most controversial pieces, such as the individual mandate and requirements that employers provide insurance or face fines." If the law is overturned in whole or in part, they will offer bills "to keep the popular, consumer-friendly portions in place - like allowing adult children to remain on parents' health care plans until age 26, and forcing insurance companies to provide coverage for people with pre-existing conditions." Politico notes that the post-ruling plan is an indication that Republicans "are aggressively preparing for a big-time health care debate in the heat of an election-year summer."
Federal Researcher: Individual Health Policies May Save Money For Many.
Modern Healthcare (5/17, Daly, Subscription Publication) reports, "People who purchase health insurance policies on the individual market may save an average of $280 annually under the healthcare overhaul's coming insurance exchanges, according to projections by a federal researcher." The article notes, "Steven Hill, a senior economist in the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, analyzed costs for the 11 million beneficiaries in the individual insurance market in recent years and projected their future costs under the Patient Protection and Affordable Care Act."
CDC Report Addresses Several Components Of American Health.
The Time (5/17, Sifferlin) "Healthland" blog reports on "Health, United States, 2011," which is "the government's 35th annual comprehensive health report from the CDC's National Center for Health Statistics (NCHS)."
The Huffington Post (5/17, Chan) reports, "In terms of medical testing, the researchers found that the rate of mammograms among women ages 40 and older has remained about the same (between 67 percent and 70 percent) between 2000 and 2010." Additionally, "the data showed that more people are getting colorectal tests, with the percentage of 50- to 75-year-olds getting the test rising from 34 percent in 2000 to 59 percent in 2010."
Bloomberg BusinessWeek (5/17, Lopatto) reports, "Obesity, which leads to chronic ailments, such as diabetes and heart disease, was twice as high among boys and three times as high for girls in families whose head of household lacked a degree compared with more educated households."
The report also found, according to Modern Healthcare (5/17, McKinney, Subscription Publication), that "children living below the poverty line watched more television, were less likely to have visited a dentist during the past year and were more likely to receive a diagnosis of attention-deficit/hyperactivity disorder."
According to the Minneapolis Star Tribune (5/17, Stoxen) "Health Check" blog, "The report found that more-educated people with higher incomes suffer from fewer chronic diseases and live longer than the less educated poor." According to report co-author Amy Bernstein, a project director in the division of analysis and epidemiology at the Centers for Disease Control and Prevention's National Center for Health Statistics, "Not having education and being poor is detrimental to your health," in part "because people with fewer advantages often have health habits that include worse diet, less exercise and smoking, she explained. In addition, they are likely to be uninsured or have limited access to health care -- disparities that haven't changed much in the decade covered by the report, Bernstein said."
Milliman Medical Index: Family Healthcare Costs To Exceed $20,000 Annually.
The Milwaukee Journal Sentinel (5/16, Boulton) reports on data from the annual Milliman Medical Index that expects healthcare costs for a family of four to reach $20,728 this year, with employers picking up $12,144 and employees paying the remaining $8,584. The cost "works out to about $1,727 a month," more than the average monthly mortgage payment of $1,670. The index expects health care costs to rise 6.9% this year. "That is the lowest increase in the 10 years of this study. Yet it is more than triple the current rate of inflation."
The Los Angeles Times (5/16, Terhune) "Money & Co." blog reports, "Miami was the most expensive of the 14 cities surveyed, at $24,965, Milliman found, and Phoenix was the cheapest, at $18,365."
The Huffington Post (5/16, Young) reports, "Spending on physician services will reach $6,647 and spending on hospital stays will rise to $6,531, making them the two biggest components of a typical family's annual health care expenses, the report says." The federal health law "'has had only a limited effect' on health care costs, the report" says. Forbes (5/16, Nance-Nash) also covers the story.
Legal Immigrants To Have New Healthcare Coverage Options Under ACA.
Politico (5/16, Cheney) reports, "Come 2014, when core provisions of the Affordable Care Act kick in, millions of legal immigrants will have new options for gaining health coverage. And like US citizens, most will be subject to the individual mandate, under which they will be required to get coverage to avoid a penalty." The piece notes that "advocates say states have good reasons to reach out and get uninsured legal residents covered - especially as the federal government picks up most of the tab."
Insurance Companies To Lose One Trillion In Revenue If ACA Found Unconstitutional.
The Washington Post (5/16, Kliff) reports in its "Wonkblog" that Bloomberg Government "number crunchers have taken a look at what happens if the Supreme Court strikes down the Affordable Care Act and its expected expansion of health care coverage to 32 million Americans. They find that, should the Affordable Care Act be found unconstitutional, insurance companies will lose $1 trillion in revenue between 2013 and 2020." Bloomberg Government health care analyst Matt Barry remarked, "It's the sheer size of the number that was startling. I don't know if people fully appreciate the stakes involved here. It's not just politics - there's a lot of money, and a lot to lose."
The Hill (5/16, Viebeck), in its "Healthwatch" blog, quotes Barry, who said, "It's a confirmation of, one, how much money we're spending as a nation on healthcare, and two, how much is riding on this court case and the Supreme Court's decision. You're talking [about] an amount of money here that can affect the economy, not just an industry."
Several Health Insurers Providing Specific Cost Estimates For Physician Visits.
American Medical News (5/16, Berry) reports, "Health insurers have replaced online tools that showed only rough guesses as to how much a doctor's visit will cost with new ones that estimate specific dollar amounts for both overall and patient out-of-pocket costs." Over "the past year, several health plans have released new versions or made significant updates to their cost estimation tools." These "newer tools show not just a negotiated price but also the anticipated cost to a patient based on his or her benefit plan, as well as how much of the deductible is met."
Groups Concerned By Rules Governing State Health Benefits Exchanges.
CQ (5/15, Norman, Subscription Publication) reports that a "coalition of children's health advocates" including the American Academy of Pediatrics, the Children's Defense Fund, Children's Hospital Association and March of Dimes expressed concern that "low-income families might slip through the cracks in the new state health benefits exchange system" in a letter responding to regulations proposed by the Department of Health and Human Services under the Affordable Care Act. They argue that "states will be given too much time to ponder their final say-sos on whether people are eligible for insurance coverage," and "they were 'very troubled' by a decision to allow the state exchanges to decide if they want to give up responsibility for making eligibility decisions on Medicaid." The groups argue that split responsibility for making determinations slows down responses and makes applications for aid more complicated.
HHS Seeks Comment On Nationwide Health Information Network.
CQ (5/15, Reichard, Subscription Publication) reports, "Health and Human Services officials are asking for public comment on how to run a nationwide health information network that would allow medical data to be shared quickly online as a way to lessen duplicative testing, reduce medical errors and generally promote teamwork in the delivery of health care." In a Federal Register notice, the department said, "This is an opportune time to solicit input on how the governance mechanism for the nationwide health information network should be shaped." In addition, it is "a good time to see 'how we could effectively use our statutory authority to complement existing federal regulations.'"
More Businesses Offering Health Benefits To Same-Sex Couples.
Kaiser Health News (5/15) reports, "President Obama's pronouncement last week in favor of same-sex marriage has no legal effect on employers' decisions on whether to offer benefits to workers' domestic partners, but some advocates believe it could reinforce a decade-long trend toward coverage." As the article notes, "Last year, 52 percent of all employers offered domestic partner health benefits, with the percentage varying widely by region and industry, according to a nationally representative sample of about 3,000 employers surveyed by benefit consultant Mercer. That's up from 31 percent in 2010."
Health Insurers Slow To Adjust To Chemotherapy Shift.
The Washington Post /Kaiser Health News (5/15, Andrews) reports that while "increasingly, pills are the drug of choice rather than intravenous chemotherapy that drips into a patient's vein," health insurers "have been slow to adjust to the change." However, "since 2007, 19 states and the District have passed laws requiring insurers to provide coverage for oral cancer drugs that is equivalent to infusion drugs, according to the National Patient Advocate Foundation."
States Waiting To Set Up Health Insurance Marketplaces.
The Washington Post (5/13, Aizenman) reports that insurance marketplaces are "in limbo" in some two dozen states where Republican officials are "refusing to act until the Supreme Court decides its constitutionality." The Post says "the battles primarily break along partisan lines," although there are some exceptions. Some Democrat legislators "have proved unwilling to push for an exchange," while "technical details" are holding up other states. If they are bogged down, states could have "little time to adapt" and prove they've made progress by Jan. 1, 2013, when they would "face a federal takeover."
Congress To Obtain Insurance Coverage Through Exchanges If Healthcare Law Upheld.
The Philadelphia Inquirer (5/14, Mondics) reports, "No matter how the case turns out, one group of Americans is assured of getting quality health insurance when the Supreme Court rules on President Obama's Affordable Care Act in June: members of the court itself," because they get their "health insurance through the same plan available to members of Congress and other federal employees - and though benefits have been trimmed in recent years, it remains among the best." But, if the law is upheld, "members of Congress would have to leave the generous federal plan and obtain their coverage through online insurance exchanges, or markets." Mark Pauly, professor of health care management at Wharton, remarked, "It is more of a gesture to show that members of Congress are willing to experience what ordinary Americans are willing to accept."
Hospitals Paying More Attention To Safety Protocols Since CMS Adopted "No-Pay" Rule.
American Medical News (5/14, O'Reilly) reports, "The 2008 'no-pay' rule adopted by the Centers for Medicare & Medicaid Services to encourage hospitals to stop medical complications has led to consistently funded infection control departments, more collaboration with physicians and other front-line staff, and higher compliance with evidence-based guidelines," according to a study published in the May issue of the American Journal of Infection Control. "More than 80% of infection-control professionals believe the CMS policy has led to greater focus on the health care-associated infections targeted under the rule," the survey of "317 infection preventionists at a nationally and industrially representative sample of hospitals" found.
New Rules Seek To Ease Regulatory Burden On Hospitals, Healthcare Providers.
USA Today (5/11) reports, "The Obama administration announced...it has changed or eliminated five regulations, saving the economy an estimated $6 billion." The President "also signed a new executive order 'making it a continuing obligation of our government to scrutinize rules on the books to see if they really make sense,' said a White House statement." The "changed regulations affect street signs, railroads, hospital paperwork and gas stations."
The Hill (5/11, Viebeck) "Healthwatch" blog reports that the "first rule issued Thursday will make small revisions to the Medicare Conditions of Participation in order to give hospitals more flexibility in their operations." A "second rule would eliminate overlapping or outdated rules that govern healthcare providers."
Bloomberg BusinessWeek (5/11, Zajac) reports, "Hospitals will be allowed to replace some staff physicians with nurse-practitioners and physician assistants, saving the industry an estimated $330 million a year, the government said." Hospitals "will also be able to reorganize supervision of their outpatient departments, saving an estimated $305 million a year." Meanwhile, "dialysis clinics, which treat people suffering kidney failure, won't be required to build fire-protection structures that are necessary in hospitals, where patients are unconscious or immobilized."
CQ (5/11, Norman, Subscription Publication), in an article titled "HHS Issues New Regulatory Relief Rules, But Not Without Push-Back," reports, "More than 1,100...letters objecting to a provision in the hospital rule were the result of a writing campaign by anesthesiologists" who "objected to a provision that they said would go too far in expanding the types of medical professionals -- namely nurse practitioners -- able to administer drugs and biologics, including powerful painkillers vulnerable to abuse. CMS kept that proposal in the final rule."
Some Republicans Argue Against Comprehensive Healthcare Proposal.
The Hill (5/11, Baker) reports in its 'Healthwatch' blog that some Republican members of the Congress are now arguing against proposing their own alternative to the Affordable Care Act. Instead they are arguing that "voters will recoil from another sweeping revamp of the healthcare system." Instead they favor "an incremental approach that keeps the focus on individual policies." Yet others are arguing that the party needs to have some fairly clear set of policies to propose as a replacement for the ACA.
Lazarus: Patients Deserve Itemized Invoices.
In his column in the Los Angeles Times (5/11), David Lazarus observes, "It's tough enough to be without health insurance. But do healthcare providers have to make it even worse by treating you like a moron?" Whereas some insurance companies require detailed bills with charges fully broken down from clinicians, Lazarus questions why uninsured patients in Los Angeles County are not provided with itemized statements after visiting county-run clinics. Lazarus concludes that "patients deserve a full accounting of what treatment was provided and at what price" and maintains that itemized invoices should be "standard for everyone."
Report: More Than 70 Percent Small Businesses Eligible For Healthcare Tax Credit.
CQ (5/10, Bristol, Subscription Publication) reports that according to a Families USA and Small Business Majority study , "seventy percent of small businesses with fewer than 25 employees are eligible for tax credits to help them provide insurance for their workers. ... The report estimates that the credit would affect 19.3 million Americans employed by small companies and that the total value of the tax credits in 2011 is more than $15.4 billion."
The Hartford Courant (5/10, Sturdevant) "Insurance Capital" blog reports, "If all the small businesses in Connecticut took advantage of the tax credit, the savings would be $166 million, or an average of $864 for each of the 192,400 affected workers, according to the nonprofits' research." However, "the report does not say what percentage of Connecticut small business are already taking advantage of the tax credit."
The South Florida Business Journal (5/10, Subscription Publication) reports, "More than 70 percent of the small businesses in Florida are eligible for a health care tax credit included in the Affordable Care Act." The report adds that "the total tax credit that could be received by every eligible business in Florida is $1.1 billion, or $765 per worker." The Hill (5/10, Baker) "Healthwatch" blog also reports this story.
Health Insurers Stick To Rate Increases Despite HHS Scrutiny.
Politico (5/9, Millman) reports that health insurance companies cited by the US Department of Health and Human Services (HHS) "for 'unreasonable' premium hikes are refusing to back down in the first year of HHS's new rate review authority." While "the health reform law gave HHS the power to scrutinize 'unreasonable' rate hikes in states that didn't have robust review programs," such "'scrutiny' doesn't give the department power to actually block the rates from going into effect." In four cases, HHS has used "its bully pulpit to publicly shame insurers whose rates don't pass its sniff test," but when "faced with the choice of dealing with some negative press on the national stage or upending their business plan, the four insurers that have been dinged by HHS have all chosen to stick with the business plan."
Romney, GOP Embrace Major Changes To Medicare, Social Security.
McClatchy (5/9, Lightman) reports that Mitt Romney and congressional Republicans "are taking a bold political gamble" by embracing changes to Medicare and Social Security that, "among other things, would alter dramatically how seniors get health coverage a decade from now." McClatchy notes that Democrats "think the GOP has given them a gift," but "it's not clear who's got the political advantage, if any. The major GOP Medicare plans wouldn't affect anyone now 55 and over, and those under that age may care more about arresting the ballooning federal debt – and Medicare's impact on it – than the health of the program decades from now."
Analysis: Insurance Exchanges Should Be Used By States To Narrow Plan Choices.
The Hill (5/9, Baker) reports in its "Healthwatch" blog on an analysis published in Health Affairs, which said that "states should use their new insurance exchanges to narrow down the number of plans consumers can choose from," and urges states to "follow Massachusetts's example as they create their exchanges." Lead author Rosemarie Day, a former deputy director of Massachusetts's exchange, "said consumers in Massachusetts preferred choosing from a handful of carefully vetted, clearly described healthcare plans," and added that "there is less evidence for the model used in Utah, where any plan that meets certain minimum standards can participate in the exchange."
AARP: Congress Should Not Extend Social Security Payroll Tax Holiday.
The National Journal (5/9, Subscription Publication) reports, "Congress may have just renewed the payroll-tax holiday in February, but the AARP is already trying to ensure it doesn't happen again." The organization "sent a press release on Monday sure to act as a GOP dog whistle, rekindling previous tensions over how reductions to the payroll tax would affect the Social Security Trust Fund." The Journal says "the early warning from AARP is a clear hint that not everyone in Washington believes lawmakers' claims that the payroll tax holiday was always meant to be temporary." Another National Journal (5/9, Subscription Publication) news roundup includes the same story.
American Cancer Society Helps Cancer Patients With Medicare/Medicaid Paperwork.
The Huffington Post (5/9, Reynolds) reports, "When someone is diagnosed with cancer, they are so deluged with information about their health and how to treat the disease so that managing their Medicare or Medicaid coverage gets overlooked." The American Cancer Society offers volunteers to help patients deal with the paperwork. Patients diagnosed with cancer are urged to "connect with their hospital's social worker for help in navigating their Medicare and Medicaid coverage."
Healthcare Access Found To "Worsen Dramatically" Over Past Decade.
McClatchy (5/8, Galewitz) reports on a study by Urban Institute researchers, published in the journal Health Affairs, which found that "tens of millions of adults under age 65 – both those with insurance and those without – saw their access to health care worsen dramatically over the past decade," which is interpreted to mean that "more privately insured Americans are delaying treatment because of rising out-of-pocket costs, while safety-net programs for the poor and uninsured are failing to keep up with demand for care." The study noted that while the healthcare reform law "won't necessarily solve all those access problems," it "does offer several new strategies, such as new payment methods to control rising costs, which could help improve access, but there's no guarantee they will work."
Reuters (5/8, Morgan) quotes the researchers, "If the key coverage provisions in the (law) are ruled unconstitutional or repealed, projections indicate that the numbers of uninsured people will grow. Given what we have observed over the past decade, we would be likely to see further deterioration in access to care for all adults -- insured and uninsured alike."
The Huffington Post (5/8, Young) reports, "Between 2000 and 2010, more working-age adults reported they had no regular source of medical care, hadn't seen a doctor or a dentist within a year, had unmet medical and dental needs and went without health care because of cost."
The Milwaukee Journal Sentinel (5/8) reports, "An estimated 13% of the adults under 65 in Wisconsin reported not seeking health care because of the cost in 2010, according to the study."
The Washington Post (5/8, Kliff) "Wonkblog" reports, "A forthcoming paper in the Journal of Health Economics...finds that high rates of uninsurance mean worse outcomes even for those with coverage." In the paper "health-care economist N. Meltem Daysal compared outcomes for insured heart attack patients in California over a six-year period, 1999 to 2006, when the state saw a 19 percent reduction in mortality rates for such cases" and found there was much variation in how health outcomes were improving.
Texas Medicaid Spending Outpacing Tax Revenues To Pay For Services.
The AP (5/8, Tomlinson) reports, "Texas' share for providing health care to poor children, the impoverished elderly and the disabled is growing faster than tax revenues to pay for services, creating another state budget challenge next year, top agency officials told lawmakers Monday." The state's "Medicaid director, Billy Millwee, told lawmakers that his program will likely achieve only 88 percent of the cost savings forecast in the current budget" According to the AP, "experts had warned lawmakers last year that they were underfunding the Medicaid program by $4.8 billion, an amount lawmakers will have to make up when they meet again next year."
Consumer-Directed Health Plans May Restrain Costs, But May Reduce Care.
The AP (5/8, Alonso-Zaldivar) reports in a story appearing on at least 230 news sites, "It's the hottest trend in job-based health insurance: plans that give you a personal savings account for medical bills but also require you to pay a hefty share of costs before coverage kicks in." As the AP notes, "such 'consumer-directed' plans could save billions for employers, providing relief from high health care costs," a study published in the journal Health Affairs concludes. The story adds, however, that "there's a warning flag, a risk that workers will forgo needed care, even preventive services covered at no extra cost to them." The story is also covered by Reuters (5/8, Subscription Publication) and the National Journal (5/8, Fox, Subscription Publication).
Insurers Take Different Approaches To Cost Of Specialty Medications.
The Washington Post (5/8, Andrews) reports on the insurance classification of specialty medications and the effect different classifications have on patients. One person is described as having gone from a plan that covered an MS medication in full to one that charged her $800 every four weeks, to another that fully covered the cost of the medication. "In coming years, experts say, more people will have to navigate the confusing and expensive terrain of such 'specialty' medications." One reason is the absence of generic competition among biologics. To respond to the cost of specialty medications, insurers are trying different strategies. Some charge "a percentage of the medications' cost" with some capping the total out-of-pocket cost to the insured, while others "seek to reduce costs through intensive case management," and others make use of "value-based insurance design," under which "treatments that are deemed to provide important clinical benefits cost employees less than ones that are less effective."
Neese: Self-Employed In Need Of Lower Healthcare Coverage Costs.
In The Hill (5/8) "Congress" blog, Terry Neese, CEO and Founder, Institute For Economic Empowerment Of Women, writes that "for the moms out there who also happen to be small business owners, they have one major Mother's Day wish that they are sending out to our nation's leaders: resolve the healthcare crisis and give us some definitive answers on what will happen when it comes to health insurance costs." She argues that "they are anxiously waiting for the Supreme Court to make its final decision on the fate of President Obama's landmark healthcare reform," and "whether in favor or against, Democrat or Republican, one fact is certain for all those who are self-employed: something needs to be done to lower skyrocketing health care coverage costs."
Federal Court: Texas Cannot Bar Planned Parenthood From Medicaid During Suit.
The Los Angeles Times (5/7, Hennessy-Fiske) reports that on Friday, a three-judge panel of the 5th Circuit Court of Appeals ruled "that Texas cannot ban Planned Parenthood from receiving state funds while a federal lawsuit over funding is pending." The court ruled that "there's evidence the new law preventing Planned Parenthood and other abortion providers from participating in a Medicaid and state-funded health program is unconstitutional."
The AP (5/7) reports, "The court said Texas Attorney General Greg Abbott hadn't shown that Texas would be irreparably harmed by holding off on enforcing the new law until a trial can be held in Austin." Similar coverage is offered by Bloomberg News (5/7, Rovella) and Reuters (5/7, MacLaggan).
Kaiser Finds Improvements In Medicaid Costs Control.
The Washington Post (5/7, Kliff) reports in its "Wonkblog" that "the Kaiser Family Foundation put out new data Friday that Medicaid's per-person costs grew 2.5 percent between 2007 and 2010, significantly slower than the rate of growth in private insurance and a full point lower than overall medical trend." The report noted, "The comparison of Medicaid to other health spending indicators suggests that while Medicaid acute care spending may be growing faster than growth in the economy, Medicaid has done considerably better in controlling per capita costs than has private coverage."
Reuters (5/7) quotes the study, which said, "During periods of economic downturn, people lose employment and income and are more likely to qualify for Medicaid; thus, program enrollment increases more rapidly as economic conditions worsen."
North Texans Currently Pay More For Health Insurance Than National Average.
The Dallas Business Journal (5/4, Hethcock, Subscription Publication) "DBJ Confidential" blog reported, "Dallas-area residents pay more for health insurance than the national average, according to a study of rates by GoHealthInsurance." The Business Journal notes, "The cost of living in an area impacts the cost of health insurance, said Mark Colwell, consumer marketing manager at GoHealthInsurance...Doctors and hospitals in cities with more expensive real estate or higher daily operational expenses typically pass those costs along to the consumer."
Judge: Texas Must Stop Requiring Parent To Accompany Child To Medicaid Appointments.
The Austin (TX) American-Statesman (5/4, Lindell) reports, "State health officials must stop, at least temporarily, requiring that a parent or guardian accompany children on Medicaid appointments, a Travis County judge ruled Thursday." However, "health officials responded that the order could endanger children and hamper fraud-prevention efforts." The judge "issued the restraining order on behalf of three unnamed child patients who sued, arguing that the restriction has impaired their health by forcing them to miss doctor-ordered therapy."
US Spending On Healthcare Blamed On Higher Prices.
Politico (5/3, Smith) reports, "The United States spends more on health care than 12 other industrialized countries, a new Commonwealth Fund study finds – but that doesn't mean this country's care is any better." At a per capita cost of "nearly $8,000" the report found that "health care spending in the US dwarfs," the others' spending with "Norway and Switzerland...a distant second and third...at a little more than $5,000." Meanwhile the US "ranked at the bottom for the number of doctor consultations ... had shorter hospital stays," and "a smaller number of hospital beds." The report attributes spending to "high prices for medication and medical services, as well as a good deal of use of expensive technology," and a high rate of obesity. It also found that "quality in the US health care system is variable and not notably superior," to compared countries which are "Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom."
National Journal (5/3, Sanger-katz, Subscription Publication) reports, "The staggering $8,000 per person that the United States spends on health care can't be explained by our aging population, our overuse of doctors and hospitals, our wealth, or our rates of smoking." Instead, "the Commonwealth Fund concludes that high health care prices are the major culprit. US patients pay more to doctors, drug companies, and hospitals than patients in other countries. Other possible factors are our high rates of obesity and a possible tendency to overuse a few particularly expensive procedures."
Healthcare IT News (5/3, Monegain) reports, "Higher prices and greater use of technology appear to be the main factors driving the high rates of US spending on healthcare, rather than greater use of physician and hospital services." The US also has "among the highest rates of potentially preventable deaths from asthma and amputations due to diabetes, and rates that are no better than average for in-hospital deaths from heart attack and stroke."
WPost Looks At How Insurance Might Change Under Healthcare Overhaul.
The Washington Post (5/3, Kliff) reports in its "Wonkblog" that "in the health reform debate, there's a lot of crystal-ball gazing about what employers will do when, in 2014, tens of millions of Americans become eligible for publicly-subsidized health insurance. ... A new report, out Tuesday from Republicans on the House Ways and Means Committee, estimates that America's 100 largest companies could save a collective $422 billion over a decade." The piece notes that it is "worth understanding why employers offer insurance now, and how that might change under the Affordable Care Act."
Holder, Sebelius Announce Charges In Massive Medicare Crackdown.
The announcement by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius that federal prosecutors have charged 107 doctors and others in a massive Medicare fraud crackdown generated heavy media coverage last night and this morning, including coverage on two network newscasts.
ABC World News (5/2, story 6, 0:40, Sawyer) reported on "the largest nationwide bust in Medicare history. Seven cities, from Chicago to Miami, Houston to Baton Rouge showing us how gigantic this problem is, 107 doctors, nurses and social workers were charged and the FBI said they had scrammed taxpayers out of nearly half a billion dollars."
The CBS Evening News (5/2, story 8, 0:30, Pelley) reported, "Federal agents have executed a massive roundup of suspects for Medicare fraud, breathtaking in its scope. There were raids yesterday in seven cities. One hundred and seven people are accused tonight in scams to steal $452 million from the program. They include doctors, nurses, and owners of mental health centers who allegedly billed taxpayers for treatments that patients never received."
The AP (5/3) calls it "the latest in a string of major arrests in the past two years as authorities have targeted fraud that's believed to cost the government between $60 billion and $90 billion each year. On Wednesday, hundreds of federal agents fanned out around the country, raiding businesses, seizing documents and charging 107 suspects in Miami, Los Angeles, Houston, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La. The government suspended payment to 52 providers as part of the investigations."