Monday, January 31, 2011

Health Care Reform Articles - January 31, 2011

Judge rules Obama healthcare law unconstitutional

The ruling by a federal judge in Florida goes beyond a 2010 ruling that the law's insurance mandate is unconstitutional. Two other federal courts previously ruled the law and its mandate were permissible. The stage is now set for an appeal to the U.S. Supreme Court.

By Noam N. Levey and David G. Savage, Washington Bureau
12:39 PM PST, January 31, 2011
Reporting from Washington

A federal judge in Florida dealt President Obama's healthcare overhaul another legal blow Monday, ruling that the entire law is unconstitutional because of a requirement in the legislation that Americans get health insurance starting in 2014.,0,842893,print.story

Reframing the health care debate

Published: Saturday, January 29, 2011, 2:26 PM
Guest Columnist By Guest Columnist 
By Paul Hochfeld 

Nationally, those who fear a government takeover of health care are reconsidering the recently passed reforms. In Oregon, meanwhile, Rep. Mike Dembrow, D-Portland, will be presenting a single-payer bill to to legislators in the upcoming session of the Legislature. I suggest we reframe the discussion by focusing on "value"and "risk pools." 

Here are some facts. First, on health care, Americans spend twice as much per capita as the rest of the world's developed democracies. Second, by almost any measure of population statistics, our health outcomes are poor. Third, not only does 60 percent of our total health care spending flow through the government, but all private health insurance premiums are inflated by 10 to 15 percent to cover the cost of those who can't afford insurance. Additionally, since most health care coverage is employer-based, the prices we pay for virtually all of our domestically produced goods and services are inflated by a hidden health fee, which reimburses businesses for the cost of health insurance premiums for their employees. Undeniably, we're all paying for everybody already, and we aren't getting much value for it.

January 29, 2011

Mexico’s Universal Health Care Is Work in Progress

YAUTEPEC, Mexico — When her twin girls were born seven weeks early, Azucena Mora Díaz did not have to worry about how she would pay for expensive hospital care, even though her husband has only a low-wage job as a construction worker’s assistant.
Under a government insurance plan for the poor, the girls were treated at the Women’s Hospital here and continue to receive follow-up care to monitor their development. The couple pays nothing.
“We owe everything to this,” Ms. Mora said as one of the twins, now 13 months old, squirmed in her arms, wearing a T-shirt emblazoned with a single word: “Smile.”

Jumping into the high-risk pools
By: Sarah Kliff
January 31, 2011 04:38 AM EST
Health reform’s high risk pools, so far plagued with lackluster enrollment, are showing signs that they are starting to turn around — just as House Republicans are launching an investigation into the program.
Within the past 75 days, enrollment in the federally run high risk pools has just about doubled. Approximately 10,000 Americans are currently being covered between the state and federally run insurance plans, Health and Human Services Secretary Kathleen Sebelius told reporters.

States May Face Showdown With Feds Over Cutting Medicaid Rolls

Financially strapped governors, Congress and the Obama administration could be headed for a showdown over the Medicaid health care program that covers 48 million poor, disabled and elderly people nationwide.
Arizona's governor has already asked for permission to drop people from the joint federal-state program, which states say is eating up huge portions of their budgets. But to do so, they need the green light either from Congress or the Obama administration.
If they don't get one? States warn they may need to slash payments to doctors and hospitals and make deep cuts in other programs such as education. They could even thumb their nose at the law and cut eligibility, which would force the Obama administration to decide whether to cut all federal Medicaid funding to those states.

Saturday, January 29, 2011

Health Care Reform Articles - January 30, 2011

January 28, 2011

For Governors, Medicaid Looks Ripe to Slash

Hamstrung by federal prohibitions against lowering Medicaid eligibility, governors from both parties are exercising their remaining options in proposing bone-deep cuts to the program during the fourth consecutive year of brutal economic conditions.
Because states confront budget gaps estimated at $125 billion, few essential services — schools, roads, parks — are likely to escape the ax. But the election of tough-minded governors, the evaporation of federal aid, the relentless growth of Medicaid rolls and the exhaustion of alternatives have made the program, which primarily covers low-income children and disabled adults, an outsize target.

Posted: January 29
Updated: Today at 10:19 PM

Democrats: Maine Medicaid head wrongly fired

Critics fear the MaineCare chief was replaced because he told the truth about stable spending.

AUGUSTA — Some Democrats are upset with the LePage administration's decision to fire the state's Medicaid director, saying it sends a message to other senior staffers not to distribute facts that challenge Republican ideology.

Anthony Marple, 63, who oversaw Maine's $2.6 billion-a-year Medicaid program for four years, was fired on Jan. 13, one day after he appeared before the Legislature's powerful Appropriations Committee.
A Democratic committee member, Rep. David Webster of Freeport, said Marple gave a presentation showing that the amount of money Maine has spent on Medicaid from its general fund has been stable or declined each year since 2006, even as enrollment has grown because of the recession.
Webster said the presentation may have surprised some of the committee's newly elected Republican members because it didn't line up with their campaign rhetoric.

Barack Obama Fires Up The Health Team - Kate Nocera And Jennifer Haberkorn

President Barack Obama may have said “let’s fix it and move on” in his State of the Union address, but the president is sending messages that he is ready to roll up his sleeves and keep fighting the health care battle as long as he needs to.
Obama will address the annual conference of Families USA today, and HHS Secretary Kathleen Sebelius will release a new report that shows health insurance premiums will be 14 percent to 20 percent lower in 2014 than they would have been without the law, POLITICO has learned.

Read more:

Posted on Fri, Jan. 28, 2011

GOP pushes to dismantle health law, Obama shoves back

David Lightman | McClatchy Newspapers

last updated: January 28, 2011 06:33:06 PM
WASHINGTON — The congressional battle over health care entered a new, more sharply partisan phase this week, as Republicans began building a case for dismantling the law while Democrats and President Barack Obama fought back hard.
And though Obama said Friday he'd consider a "tweak" or two, he also sent strong signals he won't accept major changes.
GOP lawmakers pressed their points at the first hearings of the new 112th Congress, and Friday, Obama answered with a rousing defense of the 10-month-old law.

Friday, January 28, 2011

Health Care Reform Articles - January 28, 2011

Although the following article does not directly relate to health care, it relates to it indirectly insofar as health care has
experienced a massive take over by corporate entities - for profit as well as non-profit - in recent years.


January 27, 2011

Obama and Corporate America

President Obama is smart to extend an olive branch to American businesses. Our economic success depends on businesses investing, growing and creating new jobs. From expanding exports to improving infrastructure, government and businesses share important goals.
From a purely pragmatic political standpoint, reaching an entente with corporate leaders will make it easer to defuse the hostility he has faced. Some of it has been purely partisan and ideological, from groups like the United States Chamber of Commerce, which deployed millions to unseat Democrats in the Congressional elections last year.

Merger Of Two Big Health Plans Could Help Control Rising Costs

WITH THE state demanding that insurers drive down health costs by negotiating better deals with hospitals, both sides are fattening up for battle. That is one reason behind the continuing expansion of the old Caritas system of Catholic hospitals and the merger that Tufts and Harvard Pilgrim health plans are mulling over. Bigger is better, both in achieving economies of scale in administration and in boosting market power.

Merger Plan To Test Tufts CEO’s Diplomatic Skills

When President Obama blasted health insurers to rally support for a health care overhaul last year, it fell to James Roosevelt Jr. to defend his industry and chide the nation’s commander in chief, in a White House room named after Roosevelt’s grandfather.
Insurers are “a positive force for both quality and [reducing] cost,’’ Roosevelt said afterward. “So to be the designated villain was an uncomfortable place to be. Now politically, I understand why that happened. But that doesn’t help your emotional reaction.’’

Obama's Healthcare Defense: Obama Offers Strong Defense Of Healthcare Law

Reporting from Washington —
Speaking to a conference of consumer advocates in Washington, 
President Obama
 on Friday delivered a spirited defense of the healthcare law he signed last year and urged supporters of the landmark legislation to continue working to implement it.
"This is making a real difference to families across this country as we speak," Obama told a gathering of Families USA, a leading national consumer group that was critical in passing the law.

3 health insurers agree to 60-day delay on rate hikes

Aetna, Anthem Blue Cross and PacifiCare agree to put off premium increases for people with individual policies while they are reviewed by the California insurance commissioner.

By Stephen Ceasar and Duke Helfand, Los Angeles Times
4:37 PM PST, January 27, 2011
Three of California's largest health insurers have agreed to delay for 60 days planned rate hikes for thousands of customers after state Insurance Commissioner Dave Jones asked for time to review the increases.

Aetna, Anthem Blue Cross and PacifiCare agreed to delay the increases for people with individual policies. Unaffected are workers insured through their employers. None of the three insurers had any immediate comment.

The announcement Thursday was in contrast to a decision Jan. 15 by Blue Shield of California to defy the commissioner and go ahead with increases that could total up to 59%.

As for Blue Shield, the San Francisco-based nonprofit, Jones said its policyholders "will not have the benefit of this additional review period to ensure compliance with the law, but I will do what is within my power to determine whether Blue Shield's proposed rates are in compliance with the law and to enforce that law."

The company is moving ahead with rate increases for the third time since October. Some of its 194,000 individual policyholders were notified recently that they would receive all three at once.,0,7648271,print.story

Why Don't Americans Live Longer?

The National Academy of Sciences has just released a fascinating report on life expectancy in rich countries around the world. The researchers who wrote the report — public-health experts, demographers, economists and others, from around the world — have tried to figure out why Americans don’t live as long as people in many other countries.

anuary 27, 2011

The Missing Ingredient in Accountable Care

This past week while spending time with nonmedical friends, I found myself referring to what health care experts have been touting as the system’s best hope for the future. My friends, eager to learn more and always game for any clarification of the health care system, leaned in to hear me expound on accountable care organizations, or A.C.O.’s.
Not just another pilot project or policy pipe dream, A.C.O.’s will be legal partnerships between clinicians andhospitals that will be part of Medicare by 2012. As a partnership, these providers will be responsible for all the health care needs of a specific population of patients who are assigned, but are not necessarily restricted, to them. Unlike fee-for-service, payers will give A.C.O.’s a lump sum to cover all care, but the A.C.O.’s will beable to keep any savings that result from more efficient and better care.

Assessing an ACO Prototype — Medicare's Physician Group Practice Demonstration

John K. Iglehart
N Engl J Med 2011; 364:198-200January 20, 2011

Wednesday, January 26, 2011

Health Care Reform Articles - January 27, 2011

OpEdNews - Article: Healthcare Reform

Michael Collins

Before it ever arrived at the president's desk for signature, the health reform act contained a fatal poison pill.
The most creative sector of the business community has a dagger at its heart in the form of the relentless, unyielding, and over burdening cost of health insurance.  The self-employed and very small businesses have seen their insurance premiums climb 20% to 75% since 2009.  To purchase an adequate family plan, a self-employed person will pays an amount 50% to 70% of the nation's median personal income, $32,000 a year, for family health plan. This includes premiums, deductibles, and out of pocket expenses.  That is twice the cost for relatively generous plans at medium to large size companies.  Very small businesses, two to twenty employees, pay about the same

Harvard Pilgrim, Tufts Say Merger Would Cut Health Costs

The leaders of Harvard Pilgrim Health Care and Tufts Health Plan said yesterday joining forces will give them the scale to expand across New England and beyond at a time when sweeping changes in the health care industry demand larger and more competitive players.

Insurers’ Merger Proposal Raises Thorny Issues

Consumers and employers, who share the cost of health insurance, were uncertain yesterday whether they would be better off if the state’s second- and third-largest insurers merge.
The bargaining clout of a larger company could help it negotiate better prices from hospitals, but one less major insurer might also mean consumers would have less choice and end up paying more, said officials of leading consumer and business groups.

Michael Hiltzik: Regulators Have Little Power To Stop Health Insurance Rate Increases

Big, powerful industries facing tougher government oversight — the health insurance industry, say — know that the legislative battle in Congress or state capitals is just the first skirmish.
The more important fight is over the regulations that implement legislative policies. That's the point where laws with teeth in them are taken to the dentist to get them pulled.

Moving Backward On Health - Bangor Daily News

1/23/11 05:56 pm  Updated: 1/23/11 05:57 pm
On the very same day, the new Republican majority in the U.S. House of Representatives voted unanimously to repeal the new health care reform law and the new Maine Republican attorney general joined other states in a lawsuit attacking the law’s constitutionality. Although the two actions have no immediate effect, they have triggered legislative and judicial struggles that will last for the next two years or more. Both were a disservice to the nation, to the economy and to the people of Maine.

Hospitals, Poor Patients Face New Costs

Payments to hospitals and other health care providers would be slashed and low-income patients served by Medicaid would have to pay higher copayments under the spending plan Governor Deval Patrick proposed yesterday for the next budget year.
But the biggest savings in the $10 billion program that serves 1.2 million residents would come from revising and rebidding Medicaid contracts to encourage health care providers to work together to drive down costs.

Officials Cite ‘Distressing’ Rise In Diabetes

WASHINGTON — The number of Americans who have type 2 diabetes has risen to nearly 26 million, federal officials announced yesterday.
In addition, about 79 million US adults have prediabetes, a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes, according to the federal Centers for Disease Control and Prevention. Prediabetes raises the risk of type 2 diabetes, heart disease, and stroke.

Detailed Human Rights Standards for Healthcare Systems

Child-only health plans endangered
By: Sarah Kliff and J. Lester Feder
January 27, 2011 01:29 PM EST
Health insurers in 34 states have stopped selling child-only insurance policies as a result of the health reform law, and the market continues to destablize.
According to a survey of state insurance departments by Republican Senate committee staff and obtained by POLITICO, states that have seen carriers exit the market include those that have been ardent supporters of the health reform law, like California and Oregon. Twenty states now have no insurers offering child-only policies.

Doctors Were Big Spenders On Health Lobbying In 2010 : Shots

The health care battles didn't end for doctors with the passage of the federal health law last year, and their lobbying shows it.

Monday, January 24, 2011

Health Care Reform Articles - January 25, 2011

Jobs, Debt And, Yes, Health Care Still, Top An American To-Do List On Eve Of Obama Speech,0,5975677.story
WASHINGTON (AP) — Health care is Shannon Taylor's "big, big hot button" and no wonder. She is a nurse in Tennessee who examines hospital bills for a health insurance company, and a mother who saw President Barack Obama's health care law come just in time for her family.
In the State of the Union speech Tuesday night, she will be looking for Obama to stand firm against Republicans who want to take the law apart. Health insurance for her daughter, who has lifetime medical problems, could hang in the balance

January 23, 2011

Verbal Sparring Over Potential Senate Vote on Health Care

WASHINGTON — Democrats and Republicans in the Senate waged a war of words on Sunday over efforts to force what would most likely be a symbolic vote on repealing the Obama administration’s health care law.
Speaking on “Fox News Sunday,” the Senate Republican leader, Mitch McConnell of Kentucky, repeated his promise to bring the repeal measure up for a vote. He first made the pledge on Wednesday after the House voted 245 to 189 to repeal the law.

January 23, 2011

Heart Doctor Group Cooperating in Federal Investigation

WASHINGTON (AP) — The leading professional group for doctors who implant defibrillators said it was cooperating in a Justice Department investigation into proper use of the devices.
The Heart Rhythm Society said in a statement on Friday that it was providing expertise to officials conducting a civil investigation into implanted defibrillators, which correct dangerous heart rhythms using electrical shocks. A spokeswoman for the group declined to give details.

January 23, 2011

Reforming the Reform

Last week, the Republican Party proved that it has the votes to repeal health care reform — but only in the House of Representatives. (Unfortunately for conservatives, the Senate and the White House also have a say in the matter.) The House vote on Wednesday may be remembered as a first step toward actual repeal, or as a futile exercise in fist-shaking. It all depends on whether Republicans can find a strategy for undoing the health care legislation that doesn’t involve an immediate frontal assault.

Can Wal-Mart Make Us Healthier? - Room For Debate

Arizona Tries New Approach To Get By Federal Medicaid Rules

Health-care law: Arizona tries new approach to get by federal Medicaid rules
By N.C. Aizenman
Washington Post Staff Writer
Sunday, January 23, 2011; 10:58 PM 
Republican efforts to repeal or limit the reach of the new health-care law took a new direction last week when Arizona lawmakers approved a novel and controversial attempt to cut Medicaid for 280,000 of the state's poor.
The bill, requested and signed by Gov. Jan Brewer (R), empowers her to make a formal request, most likely this week, for a federal waiver to avoid complying with provisions of the law that prohibit states from tightening their eligibility requirements for Medicaid.

Burlington’s PKC Is Plotting A Diagnosis Revolution | The Burlington Free Press

From its offices in Burlington’s Chace Mill building on the Winooski River, PKC Corp. is waiting for the medical profession to catch up with it.

January 24, 2011

What Comes After No?

The Republicans have vowed to “repeal and replace” President Obama’s historic health care reform law. Now that House Republicans have muscled through a symbolic repeal bill, they will have to deliver their own alternative plan. Don’t expect much.

Tufts, Harvard Pilgrim Explore Merger

The state’s second- and third-largest health plans, Harvard Pilgrim Health Care and Tufts Health Plan, are set to tell their employees today that they are exploring a merger that would reshape the region’s health insurance landscape.
Harvard Pilgrim and Tufts are close to signing a memorandum of understanding that would combine their operations in four New England states and make them a stronger competitor to the market leader, Blue Cross Blue Shield of Massachusetts, in their home state, according to several people who have been briefed on the transaction. They asked not to be identified because they were not authorized to discuss the deal.

Insurers are scouring social media for evidence of fraud

If someone receiving disability benefits for a bad back brags on Facebook or Twitter about finishing a marathon, chances are their insurance company will find out and stop the checks.

By Shan Li
6:40 AM PST, January 25, 2011
Now there's another reason to be careful about what you post on Facebook: Your insurance company may be watching.

Medicare Fraud: Tiny Pharmacy Turns Whistle-Blower

Reporting from Washington —
Last December, a specialty pharmacy in Florida enjoyed its best month ever — posting a hefty $168.7 million in revenues.
But it wasn't filling prescriptions that made Ven-A-Care of the Florida Keys Inc. such a success.
Tiny Ven-A-Care has developed a lucrative niche market: blowing the whistle on drug companies that overcharge Medicare and Medicaid — and collecting tens of millions of dollars in reward money.

January 24, 2011


Our Enthusiasm for Diagnosis
My first car was a ’65 Ford Fairlane wagon. It was a fairly simple—albeit large—vehicle. I could even do some of the work on it myself. There was a lot of room under the hood and few electronics. The only engine sensors were a temperature gauge and an oil-pressure gauge.
Things are very different with my ’99 Volvo. There’s no extra room under the hood—and there are lots of electronics. And then there are all those little warning lights sensing so many different aspects o

Health care mandates everlasting

Posted Jan. 24, 2011, at 9:50 p.m.
Having happily snoozed through constitutional law classes in college, I am now conditioned to do likewise whenever the words “Constitution” and “law” appear in the same sentence. That makes it tough for me to stay awake long enough to contemplate recent news that 25 American states are suing the federal government on the grounds that the new health care reform law is unconstitutional.

Saturday, January 22, 2011

Health Care Reform Articles - January 23, 2011

The following is an audio clip of Bill Hsiao's interview with Vermont Public Radio about his recently released proposals for overhauling Vermont's health care system.

Hsiao Calls Vermont's Health Care System "Broken"

Thursday, 01/20/11 12:08pm

Can Congress Mandate Health Insurance? : NPR

House Majority Leader Eric Cantor of Virginia discusses efforts to repeal the health care law Wednesday. The House passed a bill to repeal the law, but Senate Democrats say they will block efforts to take it up.
Behind all the rhetoric over the health care law lies a constitutional debate over authority.

Blue Cross CEO Says Providers Must Control Health Care Costs, Or Else

The chief executive of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, is calling on hospitals and doctors to step up efforts to contain health care costs, warning that those insisting on traditional fee-for-service contracts will face level or reduced payments from his company.
Andrew Dreyfus, who took the helm at Blue Cross Blue Shield in August, last week sent a letter to more than 400 leaders of hospitals and physicians practices, applying pressure on them to switch to a global payment plan. Under such a system, medical care providers are put on an annual budget and given incentives to control costs and improve care instead of being paid for individual doctors visits and procedures.

January 22, 2011

The Final Health Care Debate

G IVEN the deep divide on health care reform in the courts, the Congress and the country, the long-term viability of this historic achievement depends in part on President Obama’s ability to reduce the tension and seek common ground. In his State of the Union message, he should say something like this:

Bills would deny MaineCare to smokers, raise smoking age

Posted Jan. 21, 2011, at 12:14 p.m.
AUGUSTA, Maine — The assault on tobacco use is resuming on several fronts in the State House, including denying benefits for MaineCare recipients who smoke and restricting smoking in private clubs.
Details of those and other bills are not yet fleshed out, but sponsors say they want to reduce Maine’s smoking rate and drive down taxpayers’ costs of treating tobacco-related illnesses.
Sen. Thomas Saviello said Friday he decided to introduce a bill to keep people receiving MaineCare — the state’s Medicaid program — from receiving benefits at the suggestion of a constituent who also works in a rural health care clinic.
Saviello did not identify the woman but said she’s expected to testify in favor of his bill. He said she’s troubled when she sees MaineCare patients who have respiratory problems and smoke heavily, because taxpayers are subsidizing treatment for illnesses that could be avoided.

Tweaking Health Care - Bangor Daily News

As with any sweeping course change in public policy, improving, not repealing the landmark Patient Protection and Affordable Care Act of last year is the task for Congress. The bill, like any that regulates a large and growing sector of the economy, is likely to be riddled with provisions that create unintended consequences or with assumptions about cost reductions that do not come to fruition. A diligent Congress must listen to those affected — large and small businesses, health care providers and consumers — and take a scalpel to parts of the law, and perform transfusions on other parts.

Where Are The Jobs? Try Health Care. | The Burlington Free Press

According to the newly published “Pulse of Vermont” study by the Vermont Business Roundtable, “no single issue stood out so the state of the economy. In higher proportions than previously, Vermonters expressed a greater desire for job creation and were more persuaded than ever that economic growth contributes to an improved the quality of life.”