Friday, March 29, 2013

Health Care Reform Articles - March 29, 2013

Does Medicaid expansion really penalize Maine taxpayers?

Posted March 28, 2013, at 1:51 p.m.
The LePage administration’s letter to the federal government seeking ways to bring new Medicaid funding to Maine is encouraging. It has stimulated new discussions about the Affordable Care Act, the role Medicaid plays in Maine and how federal funds support the program.
In the current debate, we hear that Maine has seen a reduction in federal reimbursement. Medicaid, called MaineCare here, is a shared responsibility. Today the federal government provides about $62 for every $38 the state spends on Medicaid services. Each year a formula, based on per capita income, is calculated to determine how much federal money a state will receive.
Maine is treated just like all the other states and, like about half of them, has seen its federal funding decrease. Conversely, some years our federal rate increases. The formula is cyclical, reflecting income changes in the states. The funding formula should be updated, but only Congress can do that.
Congress enacted a one-time, temporary Medicaid increase to help states through the recession. Maine and all states benefited from that temporary payment bump that began October 2008, knowing it expired in June 2011.
The Affordable Care Act now provides states with 100 percent federal funding for three years and 90 percent thereafter if they cover low-income adults who were previously ineligible for Medicaid. Some argue that the act penalizes states such as Maine: Because adults were already covered here, Maine cannot qualify for this new federal funding.
But in 2009, during the Affordable Care Act debate, states that were “early expanders” of Medicaid raised similar concerns. Working together, and with congressional and White House staff, we secured a special provision in the law. Maine will receive more federal funding (81 percent versus the current 62 percent) to cover childless adults in 2014. That amount increases each year until it reaches 90 percent, just like other states receive in 2020 and beyond.
The federal government will pay fully for those on the waiting list for services. There is another pathway in the law that may even qualify us to receive full funding for adults already on the program.
As early expanders, we knew we’d see savings through the Affordable Care Act. Some of those now served by Medicaid could instead became eligible for private insurance premium tax credits offered through the new insurance exchanges and paid for by the federal government, not the state. The savings to states such as Maine have been cited by liberal and conservative sources alike.
In some states, parents will also be funded at 100 percent for three years when the Affordable Care Act is fully in place in 2014. But all states already covered some parents (the median is 66 percent of the federal poverty level), and 18 states, including Maine, had already covered parents above 100 percent of the poverty level. By law, no state will receive higher funding for those already covered. Much of that expansion in Maine, however, was paid by the initiative Dirigo Health, not state general funds.

We are being damned: Americans losing faith in failed health care system

Posted March 28, 2013, at 3:55 p.m.
We who lead in the American health care system — primarily physicians and hospitals — are slowly having our credibility with the public eroded. The main reason for this is our collective failure to credibly lead this country in its journey to a health care system that safely and affordably cares for all Americans.
The latest such blow to our credibility is “Bitter Pill: Why Medical Bills Are Killing Us,” published four weeks ago as the cover story in Time magazine In a 26,000-word article, Steven Brill challenges the idea that hospitals have any justification for their high prices, and details a litany of hospital pricing markups of routine medical supplies such as alcohol wipes by more than a hundredfold. He tells story after story of patients charged extraordinary prices for care they could not do without by hospitals with strong profit margins and CEOs making multimillion-dollar salaries.
The Time article was just the latest of at least four articles or reports in the past 15 years that have shaken the faith many Americans have had in the people and places that take care of them. The first of these was “Crossing the Quality Chasm” ( ), the Institute of Medicine’s 2001 report on the quality and safety of patient care in American hospitals. It exposed the frequency and pervasiveness of errors in medical care, the likelihood such errors and inadequacies were causing thousands of deaths each year, and laid the responsibility for fixing our deeply flawed safety systems squarely at the feet of its caregivers. In doing so, the report said the high prices we pay for our care do not systematically buy us greater safety.
The second of these was a 2006 report from the Commonwealth Foundation comparing the outcomes and quality of care provided by the world’s most expensive health system (ours) with the care provided in 60 other countries. It shredded the idea that we had the best health care system in the world; in fact, we ranked 35th, and had not improved much when the analysis was done again in 2008 (—Results-from-the-National-Scorecard-on-U-S—Health-System-Performance—2008.aspx). So the idea we were getting better care than other countries paying a lot less per person for health care has been laid to rest.
The third of these articles was Atul Gawande’s “The Cost Conundrum: What a Texas Town Can Teach Us About Health Care.” ( In it, he tells the story of two Texas cities that are worlds apart in how patients are cared for, so far apart that Medicare patients in one city cost taxpayers almost twice as much to care for as Medicare patients in the other city, without demonstrably better health as a result. It laid bare the lack of a credible reason for physicians to care for patients so differently.
None of these seminal articles is without flaws, and none tells a complete story. Brill’s article in Time magazine, for example, fails to explain that the bizarre way we price care in hospitals is a direct result of the bizarre way hospitals are paid for that care. It portrays all hospitals as self-serving, failing to describe those hospitals and health systems trying desperately to do right by patients in a payment system that often punishes them for doing that, and working hard to rapidly change their part of this chaotic mess.

Empathy gap in medical students

Stress can harden students’ attitudes toward patients, but schools are trying to change that

Sunday, March 24, 2013

Health Care Reform Articles - March 24, 2013

Note: I'm on a road trip for the next couple of weeks, so these blogs will be updated a little less frequently and a little more sporadically.  Enjoy anyway!


LePage wants more funding, flexibility before expanding Medicaid

Posted March 20, 2013, at 1:32 p.m.
AUGUSTA, Maine — Gov. Paul LePage’s administration is seeking additional federal funds and Medicaid flexibility as a condition for Maine to participate in an expansion of the state’s Medicaid program under the federal Affordable Care Act.
In a letter sent Monday to U.S. Health and Human Services Secretary Kathleen Sebelius, Maine Health and Human Services Commissioner Mary Mayhew asked the federal government to cover 100 percent of expansion costs for a decade and requested additional flexibility in the way Maine operates its Medicaid program.
Meanwhile, a Democratic representative from Gorham on Wednesday introduced legislation that would sign Maine up to accept the federal Medicaid expansion funds. Rep. Linda Sanborn, who was joined at a news conference by other Democratic legislators and doctors from the Maine Medical Association and the Maine Osteopathic Association, said the move would save Maine money in the long run while providing more residents with health insurance.
Mayhew’s letter came a week after the LePage administration and federal officials began talks about a potential expansion of Maine’s Medicaid program. LePage, a staunch opponent of the Affordable Care Act, had remained opposed to the expansion but began conversations with officials at the U.S. Department of Health and Human Services after eight other Republican governors endorsed Medicaid expansions in their states despite their opposition to the federal health care law.
Under the health care law, the federal government covers 100 percent of Medicaid expansion costs for newly eligible residents for three years. After that, the federal share gradually drops to 90 percent in 2020 and the states pick up the remaining share. Maine is asking the federal government to cover 100 percent of costs for 10, rather than three, years.
Maine is one of a handful of states that the federal government considers an “expansion state” because it broadened its Medicaid program more than a decade ago to cover many of the residents — including parents and adults without children — who would be newly eligible for Medicaid in most states under the health care law.
Mayhew told Sebelius this situation puts Maine at a disadvantage compared to other states.

Is medical device tax next piece of Obamacare to be scrapped?

The Senate voted 79-20 Thursday evening to repeal a 2.3 percent excise tax on medical devices, dealing a blow to one of the new taxes imposed to pay for health care reform.
The vote isn't binding -- it came on an amendment to the Senate's budget resolution, which is only a framework for future policy. But it showed there's bipartisan support for ditching this tax. Democrats in states with strong medical device industries, such as Minnesota, joined Republicans in voting to repeal it. The tax went into effect in January and already has cost companies $388 million, according to the Medical Device Manufacturers Association.
The tax is "a drain on innovation, on job creation and on our ability to provide groundbreaking medical innovations to patients," said Sen. Orrin Hatch of Utah, who is the ranking Republican on the Senate Finance Committee, which has jurisdiction over tax legislation.
That committee's chairman, Sen. Max Baucus, D-Mont., voted against the amendment, as did Senate Majority LeaderHarry Reid, D-Nev.
That means getting a binding vote to repeal the tax remains an uphill battle. Democratic leaders are hesitant to admit that any part of health care reform was a bad idea.

Report Card on Health Care Reform

Republican leaders in Congress regularly denounce the 2010 Affordable Care Act and vow to block money to carry it out or even to repeal it. Those political attacks ignore the considerable benefits delivered to millions of people since the law’s enactment three years ago Saturday. The main elements of the law do not kick in until Jan. 1, 2014, when many millions of uninsured people will gain coverage. Yet it has already thrown a lifeline to people at high risk of losing insurance or being uninsured, including young adults and people with chronic health problems, and it has made a start toward reforming the costly, dysfunctional American health care system.
EXPANDING COVERAGE Starting in 2010, all insurers and employers that offer dependent coverage were required to offer coverage to dependent children up to age 26. An estimated 6.6 million people ages 19 through 25 have been able to stay on or join their parents’ plans as result, with more than 3 million previously uninsured young adults getting health insurance. The law requires private health insurers to provide free preventive care, without co-pays or deductibles. Some 71 million Americans have received at least one free preventive service, like a mammogram or a flu shot, and an additional 34 million older Americans got free preventive services in 2012 under Medicare.
Private insurers are now required to cover children with pre-existing conditions, which means that an estimated 17 million such children have been protected against being uninsured.
And more than 107,000 adults have enrolled in a federally run insurance plan for people with pre-existing conditions. The law also bars insurers from canceling policies on sick people; previously, 10,000 people a year had their policies rescinded.
The law appropriated $11 billion over five years to build and operate community health centers, a major factor in increasing the annual number of patients served to 21 million, a rise of 3 million from previous levels. Some $5 billion has been put into a reinsurance program that has encouraged employers to retain coverage for retirees and their families; 19 million people benefited with reduced premiums or cost-sharing.

Drugmakers cut marketing payments to Maine doctors

Pharmaceutical firms reduce fees to physicians for speaking engagements amid wider disclosure, but increase money paid for research.

By Eric Russell
Staff Writer
Drug companies have long enlisted doctors to serve as de facto spokespeople for specific products, and have paid them handsomely to do so.
However, an increase in disclosures by some drug companies in recent years of the amount they pay doctors – disclosures that will be mandatory by next year – appears to be reducing the amount of money those companies are giving doctors in Maine.
From 2010 to 2012, the amount of money paid by drug companies to Maine doctors for speaking engagements dropped by 60 percent, according to data compiled by ProPublica, an investigative journalism website. Money paid to doctors in Maine for research, usually clinical drug trials, increased by 40 percent from 2011 to 2012.
ProPublica launched its Dollars for Docs initiative in 2010 to track the money drug companies spent to test and market their products. The database was recently updated to include disclosures for 2012, including hundreds from Maine.
The list is not comprehensive because not all drug companies are required to disclose the information yet, but it does offer a glimpse into the financial relationships and incentives between pharmaceutical companies and doctors.