One step back, two steps back
July 9, 2012 at 10:13 am
Aaron CarrollSo now that the Medicaid expansion is optional, some states are trying to see if they can make other parts of Medicaid optional, too:
Within hours of the Supreme Court’s ruling on June 28, lawyers in the Maine attorney general’s office began preparing a legal argument to allow health officials to strike more than 20,000 Medicaid recipients from the state’s rolls—including 19- and 20-year-olds—beginning in October to save $10 million by next July.“We think we’re on solid legal ground,” Attorney General William Schneider said in an interview. “We’re going to reduce eligibility back to the base levels in a couple of areas,” he said. Maine, like some other states eyeing cuts, earlier expanded its Medicaid program beyond national requirements.Other states, including Wisconsin and Alabama, are expected to follow Maine’s lead, though there is disagreement over whether the high court gave the states such leeway. That could lead to battles between states and the federal government that could drag the health law back to the courts. New Jersey and Indiana also said they were evaluating the decision and did not rule out challenging the requirements.
Good News for Mental Illness in Health Law
By RICHARD A. FRIEDMAN, M.D.
Americans with mental illness had good reason to celebrate when the Supreme Court upheld President Obama’s Affordable Care Act. The law promises to give them something they have never had before: near-universal health insurance, not just for their medical problems but for psychiatric disorders as well.
Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all.
This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases.
Now comes the Affordable Care Act combining parity with the individual mandate for health insurance. As Dr. Dilip V. Jeste, president of the American Psychiatric Association, told me, “This law has the potential to change the course of life for psychiatric patients for the better, and in that sense it is both humane and right.”
To get a sense of the magnitude of the potential benefit, consider that about half of Americans will experience a major psychiatric or substance disorder at some point, according to an authoritative 2005 survey. Yet because of the stigma surrounding mental illness, poor access to care and inadequate insurance coverage, only a fraction of those with mental illness receive treatment.
Drug-coated stents are overused, study finds
Cardiologists are routinely overusing drug-coated stents to prop open blocked arteries in the heart rather than using bare-metal stents for patients at low-risk of another blockage, according to a study conducted by researchers at Massachusetts General Hospital and other institutions.
While drug-coated stents release medication to help prevent the artery from closing again — which would necessitate insertion of a second stent — they cost about $1,000 to $2,000 more than the bare-metal ones. Also, they require patients to take anticlotting drugs for at least a year, increasing the risk of internal bleeding and burdening patients with out-of-pocket costs.
LePage: 'Gestapo' clouded message
The governor's statement stops short of a public apology.
AUGUSTA - Gov. Paul LePage used his own editorial judgment when he described the IRS as the "new Gestapo" in his radio address last Saturday.But the governor acknowledged Monday that his reference to the Nazi secret police "clouded" his message about the federal health care law.
LePage's written statement stopped short of a public apology, which had been demanded by national and local Jewish groups. However, Emily Chaleff, director of the Jewish Community Alliance of Southern Maine, said LePage called her to personally apologize for his remarks.
NOTABLE QUOTES FROM GOV. PAUL LEPAGE
“As your governor, you’re going to be seeing a lot of me on the front page saying, ‘Governor LePage tells Obama to go to hell.’ ”
Statement at lobstermen’s forum in Brooksville, Sept. 26, 2010
“Tell them they can kiss my butt.”
Statement to a reporter, in response to a question about his refusal to meet with the NAACP, Jan. 14, 2011
“The only thing that I’ve heard is if you take a plastic bottle and put it in the microwave and you heat it up, it gives off a chemical similar to estrogen. So the worst case is some women may have little beards ... and we don’t want that.”
Statement on a TV news show about Bisphenol-A, a chemical banned by the Maine Department of Environmental Protection, February 2011
“The problem is the middle management of the state is about as corrupt as you can be. Believe me, we’re trying every day to get them to go to work, but it’s hard.”
Statement at a town hall meeting in Newport, April 27, 2012
“We the people have been told there is no choice. You must buy health insurance or pay the new Gestapo – the IRS.”
Statement during radio address, July 7, 2012
Posted July 09, 2012, at 8:51 p.m.
Three Maine health care organizations will participate in a new model designed to improve the health and lower the costs of Medicare patients, the U.S. Department of Health and Human Services announced Monday.
The three health systems have been approved as “accountable care organizations,” or groups of providers tasked with better coordinating each patient’s care. Seniors on Medicare will receive letters notifying them if their doctor is participating in one of the accountable care organizations.
The three health organizations in Maine are:
• MaineHealth Accountable Care Organization in Portland, with 1,595 physicians.
• Central Maine ACO in Lewiston, which includes 566 physicians.
• Maine Community Accountable Care Organization LLC in Augusta, a federally qualified health center with 125 physicians.
The Department of Health and Human Services, the agency that oversees Medicare, the federal health insurance program for senior citizens, will track how well the accountable care organizations lower costs and improve care. Those that do both successfully will get a cut of the savings in the form of bonus payments, with the rest going to the federal government. Those that don’t, depending on their arrangement, will forgo the extra money or pay a penalty.
MaineHealth, parent to Maine Medical Center in Portland, opted for the less risky arrangement, according to Andrea Dodge Patstone, vice president of strategic initiatives. MaineHealth can earn back up to half of any savings it realizes, which is a lower percentage than the system could have netted, but also carries no risk of a financial penalty, she said.
“There’s no financial gain to be had unless you’re delivering on these quality measures that are so important to patient care,” she said.
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