Johnson & Johnson to pay $8.3m in artificial hip case
By Barry Meier
NEW YORK —
Arkansas plan shows that health care law’s Medicaid expansion leaves flexibility for states
By Sandhya Somashekhar, Published: March 9
The Obama administration has taken a hard line with governors about an option to expand Medicaid under the new health law, telling them to take it or leave it — but leave it and lose access to millions of federal dollars.
It turns out there is some wiggle room after all.
In an unexpected move, Health and Human Services Secretary Kathleen Sebelius recently agreed to a proposal by Arkansas Gov. Mike Beebe (D) to reject the Medicaid expansion and instead use federal money to buy private health insurance for the 200,000 people who would have been covered under the expansion.
That kind of arrangement could be appealing for other states in which expanding Medicaid, the health program for the poor and disabled, has been politically unpopular.
HHS officials have indicated other states might be permitted to use a similar strategy.
“We’re exploring avenues in which that might be able to happen,” said Gary Cohen, director of HHS’s Center for Consumer Information and Insurance Oversight, in a conference call with reporters Thursday.
Details of the Arkansas plan have yet to be finalized or agreed to by the state legislature. Still, the possibility that states can go a third route, rather than accepting or rejecting the Medicaid expansion outright, has thrown an element of uncertainty into the politically charged atmosphere surrounding the 2010 health-care law, which will extend health coverage to millions of uninsured Americans next year.
But it has also perplexed some experts who say the Arkansas move, if adopted by other states, could be vastly more expensive for the government.
According to Congressional Budget Office estimates, it will cost about $9,000 to buy a person private insurance on the health insurance exchanges created by the law, compared with about $6,000 to add the person to Medicaid.
“This is the feds committing themselves to paying much more, which doesn’t make a whole lot of sense,” said Leonardo D. Cuello, director of health reform for the nonprofit National Health Law Program.
Brown may forge alliance with GOP governors on health plan
The governor and Republican leaders see the Affordable Care Act as a solution to healthcare systems overtaxed by large numbers of uninsured.
By Anthony York, Los Angeles Times
7:54 PM PST, February 21, 2013
Among the governors now moving nearly as aggressively as Brown to implement the federal healthcare law are conservatives who have long fought to unravel it. They are finding that they cannot afford to pass up Obama's offer of billions of dollars in federal aid to cover expansion of their Medicaid programs for the poor.
Arizona's Jan Brewer, New Mexico's Susana Martinez and Nevada's Brian Sandoval — all Republicans — have bucked the GOP trend on the Obama law by opting to accept the new federal money. In Florida, where 20% of residents do not have health insurance, Gov. Rick Scott announced Wednesday that he is joining the renegade group.
They, like Brown, are struggling with healthcare systems overtaxed by large numbers of uninsured residents. At the annual Washington conference, the governors will have an opportunity to strategize on how to hold the Obama administration to its promise to pay for the initial Medicaid expansion.
Though not on the formal conference agenda, aides say the subject is likely to come up at a meeting the governors have scheduled with the president Monday and in private meetings between governors and senior administration officials.
With Congress and the White House in the midst of a fresh fiscal showdown, governors are concerned about whether Obama can keep his commitment. Western states in particular, with their high rates of uninsured residents, fear that they could be left with a crushing bill to pay.
Ironically, although many Republicans have worked to undermine Obama's policy, states with GOP governors could see the largest influx of federal dollars as a result of it. Of the 11 states with the highest percentage of uninsured residents in the country, 10 are led by a Republican executive. The exception in the group is California.
"California is perhaps the bluest state in the nation," said Anthony Wright, executive director of Health Access, a consumer advocacy organization. "But when it comes to healthcare, its issues are like those of a red state."
Like California, the Southwestern states have growing Latino populations that stand to gain from the new healthcare law more than other groups. Currently, 27% of all Latinos in the United States are covered by Medicaid, compared with 11% of the general population, according to the Kaiser Family Foundation. Turning away public dollars that could help those residents could be politically risky for Republicans who have struggled to earn Latino support.
While some Republican leaders have been behaving more like Democrats, Brown has been echoing Republican skepticism about Washington's financial commitment to helping states implement the new law.
http://www.latimes.com/health/la-me-brown-healthcare-20130222,0,5170633,print.story
Experts point out health care options for Mainers
Maine residents should not panic, they say, because there will be help getting health insurance.
By GLENN ADAMS The Associated Press
AUGUSTA - About 127,000 uninsured Mainers will be required to get health insurance or face penalties starting next year under the federal health care overhaul. But experts say they shouldn't panic because there will be options for coverage, and help getting it.
The requirement, known as the individual mandate, has been one of the most hotly debated pieces of the federal health care overhaul and was at the center of last year's Supreme Court decision upholding the law.
About half of Mainers are covered by employer-provided health insurance, and about 42 percent have individual health insurance policies or are covered by public programs including Medicare and Medicaid, according to the Commonwealth Fund. Ten percent of Maine's population is uninsured and will fall into the individual mandate category, the private health care research nonprofit Kaiser Family Foundation estimates.
One uninsured Mainer who's hoping the new law will make coverage possible is Melisa Belanger, who lives in the rural town of Burnham and, like her husband, works two jobs. The only policy available to her through her employer costs $800 a month and has a $10,000 deductible, Belanger said.
"I'm really hoping something can be done for people that are stuck in the middle without any help," Belanger said.
The federal law provides for two ways of covering people who fall under the requirement set by the individual mandate: through expanded Medicaid coverage or subsidies for private insurance.
Expanding Medicaid coverage is an open question in Maine as the Legislature sorts out its spending priorities for the next two years. Republican Gov. Paul LePage remains opposed to the idea, while Democratic leaders say expansion is a priority.
If Medicaid isn't expanded, people who earn up to 133 percent of the federal poverty level but don't get insurance won't be penalized by the government. But many of them wouldn't be eligible for subsidies either and would likely go without health insurance, said Mitchell Stein of Consumers for Affordable Health Care, an Augusta-based group that advocates for quality insurance for everybody.
The federal law also says those whose incomes are 100 to 400 percent of the federal poverty level can qualify for subsidies, which will be based on incomes. People will be required to spend 2 to 9½ percent of their incomes for health coverage, Stein said.
Those consumers will be able to go to an online marketplace, known as an exchange, and shop for insurance.
For those who simply don't comply with the individual mandate, the government will deduct the penalty from their tax returns or, if there is no refund, send them a bill. But Stein doesn't think that will be the case with many.
AUBURN — Gov. Paul LePage said Friday that he will be happy to issue voter-approved bonds totaling $105 million, but only if lawmakers first pass his plan to repay $184 million in debt to Maine's hospitals by borrowing against future liquor sales revenue.
"The pen's right here," LePage said at Roopers Beverage in Auburn, where bottles of liquor lined the shelves behind him as he spoke to the press. "In fact, if I could trust them, I'd do it on a promise."
The comments marked the latest back-and-forth between LePage and Democratic lawmakers, who have not embraced his plan and earlier this week accused the governor of holding bonds hostage until he gets his way.
LePage wants the state to take back control of liquor sales when the current wholesale contract expires next year. He has proposed hiring a contractor to monitor inventory, manage accounts and advertising, and coordinate with suppliers. He says that would give the state a bigger share of liquor proceeds.
The state would borrow money to repay the hospitals, paying off the debt over time with liquor revenue.
The governor has threatened to veto every bill that comes to him until his bill passes. He didn't back off Friday.
http://www.pressherald.com/politics/LePage-Will-issue-bonds-after-hospital-payback-plan-gets-OK.html
Maine’s debt to hospitals: 30-year roots, decade-old political saga
By Matthew Stone, BDN Staff
Posted March 08, 2013, at 4:37 p.m.
AUGUSTA, Maine — When supporters and opponents of Gov. Paul LePage’s plan to pay off Maine’s $484 million hospital debt square off at a State House hearing Monday, they’ll be discussing a liability with roots that stretch back three decades.
Maine has accrued debts to hospitals for services they provide to patients covered under the state’s Medicaid program since the early 1980s. That’s when the state started using a system to pay its hospital Medicaid bills that made debt part of the process.
The liability didn’t start to pile up in a big way until about a decade ago, however. Since then, it’s become the basis for frequent political fights among Republicans and Democrats in Augusta.
Prospective payments
The prospective interim payments, or PIPs, which Maine’s Medicaid program started to use in the early 1980s to pay hospitals for the services they provided to Medicaid patients, assured a steady revenue stream for health care providers, said Jeff Austin, vice president of government relations and communications at the Maine Hospital Association.
Regardless of patient volume, providers could expect the same payout each week. “It’s a good system, particularly for small providers,” Austin said.
State officials calculated that weekly payment for hospitals based on annual cost reports the hospitals submitted to the state. If the weekly payouts — the prospective interim payments — fell short of a hospital’s actual costs by the end of the year, the state would owe the hospital. If the state’s payments exceeded a hospital’s costs, that hospital would owe the state.
Debt didn’t accrue in a significant way during the first two decades of the PIP, said Herb Downs, director of the audit division at the Maine Department of Health and Human Services. At the end of fiscal year 2000, the state had $10.4 million in Medicaid debt on the books, according to the Office of the State Controller.
The state could more or less estimate hospitals’ costs and accurately judge the weekly payouts, he said. And when the state owed hospitals, it could generally settle up on schedule — meaning about 18 months to two years after the service was provided — without letting the debt build up.
“You had them go both ways,” with the state owing hospitals at times and the hospitals owing the state at other times, Downs said. “There’s always a settlement amount for sure, but it’s not big numbers. The big numbers don’t come until probably 2005, 2006, 2007.”
By the end of fiscal year 2005 — a fiscal year runs July 1 through June 30 — the debt had grown to $254.7 million. The debt level peaked in 2008, when it reached $546.4 million.
Teachers, colleges getting early lesson in Obamacare
By Eric Zorn
Chicago Tribune, March 5, 2013
They jokingly refer to themselves as "road scholars," the part-time, often itinerate employees who teach the majority of the classroom hours at community colleges.
Without their willingness to work for modest pay, tuition at these colleges would be out of reach for many of those looking to put a foot on the first rung of secondary education.
And now some of these instructors are finding themselves among the first to be ensnared by a requirement of Obamacare — the Affordable Care Act — as their employers are planning to cut their teaching hours to make sure they don't qualify for health care benefits under the new law.
Friday morning, adjunct professors and their supporters are planning a protest rally during an Illinois Council of Community College Presidents meeting in Lombard to urge leaders of the state's community colleges to "Keep the 'care' in the Affordable Care Act," as their promotional flier puts it.
Here's the problem: Starting next year, Obamacare will require companies that employ more than 50 full-time workers to provide health insurance to employees who work 30 or more hours a week, or else pay a fine.
But what's an "hour" for a college teacher? Depending on the subject matter, level of interaction with students and other factors, one hour in the classroom can require two, three or more hours of preparation, grading, conferences and so on.
"How do we account for all that time? How do we measure it?" asks David Baime, senior vice president for governmental relations for the American Association of Community Colleges, which represents 1,167 institutions nationwide. "With almost 70 percent of our (classroom) credits now taught by adjuncts, the colleges are extremely concerned about how the law will be interpreted and the extra costs they might get hit with."
http://www.pnhp.org/print/news/2013/march/teachers-colleges-getting-early-lesson-in-obamacare
Chicago Tribune, March 5, 2013
They jokingly refer to themselves as "road scholars," the part-time, often itinerate employees who teach the majority of the classroom hours at community colleges.
Without their willingness to work for modest pay, tuition at these colleges would be out of reach for many of those looking to put a foot on the first rung of secondary education.
And now some of these instructors are finding themselves among the first to be ensnared by a requirement of Obamacare — the Affordable Care Act — as their employers are planning to cut their teaching hours to make sure they don't qualify for health care benefits under the new law.
Friday morning, adjunct professors and their supporters are planning a protest rally during an Illinois Council of Community College Presidents meeting in Lombard to urge leaders of the state's community colleges to "Keep the 'care' in the Affordable Care Act," as their promotional flier puts it.
Here's the problem: Starting next year, Obamacare will require companies that employ more than 50 full-time workers to provide health insurance to employees who work 30 or more hours a week, or else pay a fine.
But what's an "hour" for a college teacher? Depending on the subject matter, level of interaction with students and other factors, one hour in the classroom can require two, three or more hours of preparation, grading, conferences and so on.
"How do we account for all that time? How do we measure it?" asks David Baime, senior vice president for governmental relations for the American Association of Community Colleges, which represents 1,167 institutions nationwide. "With almost 70 percent of our (classroom) credits now taught by adjuncts, the colleges are extremely concerned about how the law will be interpreted and the extra costs they might get hit with."
http://www.pnhp.org/print/news/2013/march/teachers-colleges-getting-early-lesson-in-obamacare
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