Friday, May 31, 2013

Health Care Reform Articles - May 31, 2013

LePage loses full funding Medicaid request

The federal government will not provide 10 years of 100 percent support for a Maine Medicaid expansion, but it will still provide most of the money.

Written by Steve Mistler, State House Reporter
AUGUSTA – The federal government cannot grant Gov. Paul LePage's request for 10 years of full funding for an expansion of Medicaid in Maine, says the agency that administers the program.
The Centers for Medicare and Medicaid Services delivered the message to the LePage administration in a letter on May 24.
The decision wasn't unexpected, but it revived the heated debate among state lawmakers and Le- Page over whether Maine should extend benefits to 60,000 more low-income residents. The federal government has given several states flexibility for their participation in Medicaid expansion under the Affordable Care Act, but no state has secured a deal to fully fund expansion for a decade.
Medicaid, which operates in Maine as MaineCare, is a federal health insurance program that is jointly administered and funded with the states. Its complex eligibility and reimbursement rules enable critics and supporters alike to seize on numbers that make their case.
That's what happened at the State House on Thursday.

Feds to LePage: We can’t offer a better deal on Medicaid expansion

Posted May 30, 2013, at 9:53 a.m.
AUGUSTA, Maine — The federal government has notified the state that it cannot negotiate a better deal on Medicaid expansion under the Affordable Care Act.
Republican Gov. Paul LePage interpreted the latest news, delivered in a May 24 letter, as supporting his position that the federal government is pushing millions of dollars of cost onto Maine taxpayers and failing to give Maine the same provisions other states are receiving through the Medicaid program. Legislative Democrats and others said Thursday morning that the letter affirms the argument they’ve been making for weeks: that Maine would be financially irresponsible not to take the deal that’s already on the table.
The May 24 letter to DHHS Commissioner Mary Mayhew from Cindy Mann, director of the U.S. Centers for Medicare and Medicaid Services, came as the Legislature’s Health and Human Services Committee voted 10-4 on Thursday to send another Medicaid expansion bill to the full Legislature. That vote followed a veto by LePage last week of LD 1546, a bill that linked Medicaid expansion to repayment of the state’s remaining Medicaid debt to hospitals. The committee’s bill is a proposal to have Maine expand Medicaid eligibility separately from repaying the debt to hospitals.
Mann stated in her letter that the federal matching rate in the Affordable Care Act would pay for 100 percent of the state’s Medicaid expansion in calendar years 2014, 2015 and 2016 and decrease to 90 percent by 2020. Mann said that over the 10-year period beginning in 2014, the average matching rate for covering childless adults under the expansion equates to about 94 percent. The federal government currently pays 62.57 percent of coverage costs for about 10,500 adults without children in Maine and likely would increase that funding to 100 percent under the Medicaid expansion, according to the Centers for Medicare and Medicaid Services. Maine also would receive 100 percent funding to cover about 50,000 additional childless adults under Medicaid expansion.
“These rates are set by law, and CMS has no authority to change the matching rates by regulation or waiver,” wrote Mann. “The unprecedented matching rates for newly eligible individuals ensures that Maine can continue to cover low-income adults with significant savings over the 10-year period.”
House Speaker Mark Eves, D-North Berwick, said in a prepared statement Thursday morning that Mann’s letter “is further confirmation that Maine should take the deal.”
“We have a definitive offer,” said Eves. “There is no excuse to delay accepting these federal health care dollars to cover the cost of health care to tens of thousands of Maine people.”
LePage had a decidedly different opinion on what the letter means.

Feds bring good news to LePage, lawmakers

Posted May 30, 2013, at 6:15 p.m.
The state of Maine heard good news Thursday about details pertaining to Medicaid expansion under the federal health reform law. But no one would know it from the LePage administration’s interpretation.
The U.S. Centers for Medicare and Medicaid Services confirmed in a letter to Maine Department of Health and Human Services Commissioner Mary Mayhew that the federal government does not have authority to grant full match rate funding for parents who earn up to 138 percent of the poverty level. It will continue, as it is currently doing, to pay 62 percent of the costs of providing Medicaid to nondisabled parents if Maine participates in Medicaid expansion under the Affordable Care Act.
This is information explained within the ACA and should not be a surprise. A total of 18 states already provide Medicaid to parents earning 100 percent of the poverty line or more. They will not receive enhanced match rates under Medicaid expansion, while the remaining states will see their parent population funded at a full rate for three years when the ACA takes complete effect in 2014.
But LePage said it’s unfair for Maine not to receive more funding since it was an early expander of the program. “Once again, the federal government has failed to come through for Maine. Despite our generosity in expanding welfare over the last decade, we are being offered less than what other states are getting,” he said in a press release.
It’s unfortunate to refer to the continued federal funding level as a type of penalty because it might make people believe the state is giving up something. In reality, nothing would change from the current arrangement. The administration argues that Maine is planning to drop this population from coverage starting Jan. 1, so technically Medicaid expansion would add new parents to Medicaid who would otherwise not be eligible. But they are eligible right now, and DHHS includes transitional funding for them in LePage’s proposed 2014-15 budget.
The letter also made clear the federal government will bear the full cost of expanding Medicaid eligibility to childless adults if the LePage administration confirms certain details about services. The 100 percent funding will continue for three years and then taper down to 90 percent thereafter. Maine expected to get an enhanced rate for this population, but full funding is an excellent development.
The letter also put to rest the issue of whether the federal government would pay all the costs of Maine’s Medicaid expansion for 10 years. This was an unrealistic request by LePage that would have run counter to law. The centers confirmed, “These rates are set by law, and CMS has no authority to change the matching rates by regulation or waiver.”
Still, LePage said he was disappointed that “the feds won’t work with us to provide the additional years of funding I requested.” What is disappointing, really, is the delay this unreasonable request caused. Maine will eventually run out of time to benefit from federal funding for expansion, as the 100 percent support is tied to years 2014, 2015 and 2016. The state should be working toward expansion, not fighting against it.

Residential care for the elderly is moving into the digital age

Posted May 30, 2013, at 11:15 a.m.
HACKENSACK, N.J. — Sensors under the mattresses of elderly residents with dementia track how much they sleep at night. Others in the showers note how often they bathe, while sensors in the walls watch over their movements.
The data are sent to the nurses at the assisted living center where these residents live, a red dot appearing next to the names of residents whose normal routines have changed dramatically. This was how staff was alerted recently about a patient who is usually up and out of her apartment early, but instead had been lying in bed most of the day. It turns out she was developing pneumonia.
“We caught it early enough that we were able to treat her here instead of in the hospital,” said Indra Sooklall, director of resident care at Spring Hills Somerset, a 120-unit assisted living residence in New Jersey that installed “smart sensors” two years ago in a wing for dementia patients.
Technology is changing life inside nursing homes and other residences for seniors. The most cutting-edge among the new systems offer lofty promises of helping providers cope with the coming tsunami of aging baby boomers even as they grapple with funding cutbacks and with the increasing demand to care for sicker and older residents in less-restrictive and less-expensive settings.
Many of the recent technology upgrades inside long-term-care centers mirror the digital advances of the times, with Wii, Skype and YouTube being used to spice up therapy routines and entertainment programs. Wii games are helping get patients in rehabilitation moving again after an injury or surgery, while heath experts believe computer chess, trivia or other skill games can keep brains active and potentially ward off senility.
But the most closely watched technological revolution to hit the long-term-care industry is the growing use of motion sensors and so-called “patient-monitoring systems” to better track changes in a resident’s health and mobility.
“There are a whole host of things that are arriving on the market and being looked at as ways to improve care,” said Paul Langevin, president of the Health Care Association of New Jersey, a trade group that represents the long-term-care industry.
IT Initiatives, a Manalapan, N.J., firm that designs technology and communication systems, is finalizing contracts with seven long-term-care centers in New Jersey to install resident monitoring systems, said John Dalton, the company’s president.
One of them is at Friendship Village, a retirement community in Basking Ridge that is in the middle of a multi-year project to install technology specific to the needs of the different facilities on its campus. The nursing home and assisted living residence at Friendship Village is being outfitted with electronic-medical-records kiosks in hallways where staff will type in data about everything from blood pressure readings to when the patient was last bathed. The community’s independent living units will have telephones with LCD screens that allow residents to call for concierge-type assistance as well as high-tech personal emergency systems that send signals to the staff’s two-way-monitors.

Immigrants help Medicare stay solvent

By Noam N. Levey
Los Angeles Times, May 29, 2013
WASHINGTON — Immigrants in the United States both legally and illegally are helping sustain Medicare, contributing about $14 billion more a year to the federal health program for the elderly than they use in medical services, a new study indicates.
The surplus generated by immigrants contrasts sharply with deficits caused by native-born Americans, as medical care for elderly beneficiaries depletes Medicare’s reserves more quickly than working-age U.S. natives can refill them.
The report — published Wednesday in the journal Health Affairs as Congress debates immigration overhaul legislation — does not calculate the full impact of immigrants in the country illegally on all government healthcare programs.
But the authors estimate that these immigrants are helping to support the Medicare program because many pay taxes, while they are ineligible to receive benefits.
“Our study should raise skepticism about the widespread assumption that immigrants drain public healthcare resources,” said Dr. Leah Zallman, an internist and Harvard Medical School instructor who is lead author of the report.
Most legal immigrants, like U.S. citizens, become eligible for Medicare benefits at 65 if they have worked at least 40 quarters in this country. That means many immigrants who today sustain the program will someday draw benefits. But the authors note that, as long as immigration continues, immigrants should not be drain on the program.
“Policies that reduce immigration would almost certainly weaken Medicare’s financial health, while an increasing flow of immigrants might bolster its sustainability,” the study concludes.

Immigrants subsidize Medicare recipients, study says

By Kelly Kennedy
USA Today, May 29, 2013
WASHINGTON — Immigrants contributed about $115 billion more from their paychecks to the Medicare Trust Fund than they took out over a seven-year period in the last decade, according to researchers at Harvard Medical School.
As the Senate debates a new immigration bill and House Republicans work toward a bill that restricts access to government services for unauthorized immigrants who become legal citizens, the researchers concluded in a study released Wednesday that restricting immigration could deplete the fund.
Researchers looked at data from 2002 to 2009.
"The assumption that immigrants are just a drain has been a part of the argument that people should be denied services," said Leah Zallman, lead researcher and an instructor at Harvard Medical School. "Immigration policy has been closely linked to Medicare's finances."
Studies had shown that immigrants use less health care than U.S.-born people, including in government programs, but no one had looked at their contributions to those programs.
In 2009, the researchers found, immigrants contributed $13.9 billion more to the Medicare Trust Fund than they used, while U.S.-born people spent $31 billion more than they contributed. Immigrants, Zallman said, essentially subsidize U.S. health care.
"I was surprised by the degree of subsidy," Zallman said. "We didn't see any changes in the amount of the [immigrant] subsidy each year, but there was a decline in net contribution of U.S.-born citizens."
They found that immigrants ages 18 to 64 on average contributed only about $100 less a year than did U.S.-born people, which is contrary to conventional wisdom that immigrants don't earn enough to contribute. Both U.S.-born citizens and immigrants older than 64 contributed less than they used: $3,333 for the U.S.-born and $2,099 for immigrants.
"We should carefully examine these assumptions that have led to denial of care," Zallman said. She said the study was unable to include undocumented immigrants who paid into the system illegally through fake Social Security numbers.

Immigrants give more to Medicare than they receive, a study finds

By Sabrina Tavernise
The New York Times, May 29, 2013
Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The study, led by researchers at Harvard Medical School, measured immigrants’ contributions to the part of Medicare that pays for hospital care, a trust fund that accounts for nearly half of the federal program’s revenue. It found that immigrants generated surpluses totaling $115 billion from 2002 to 2009. In comparison, the American-born population incurred a deficit of $28 billion over the same period.
The findings shed light what demographers have long known: Immigrants are crucial in balancing the age structure of American society, providing an infusion of young, working-age adults who support the country’s aging population and help cover the costs of Medicare and Social Security. And with the largest generation in the United States, the baby boomers, now starting to retire, the financial help from immigrants has never been more needed, experts said.
Individual immigrant contributions were roughly the same as those of American citizens, the study found, but immigrants as a group received less than they paid in, largely because they were younger on average than the American-born population and fewer of them were old enough to be eligible for benefits. The median age of Hispanics, whose foreign-born contingent is by far the largest immigrant group, is 27, according to the Brookings Institution. The median age of whites in the United States is 42.
The study, which was published on the Web site of the journal Health Affairs on Wednesday, comes as Congress considers legislation that would eventually give legal status to the country’s 11 million unauthorized immigrants. The legislation has sparked a vigorous debate about whether immigrants ultimately contribute more than they receive from the federal budget. One of the sticking points has been whether immigrants should be eligible for government programs, including health benefits, before they qualify for citizenship, but while they are on the path to getting it.

Maine Democrats Draw Line Over Medicaid Expansion
05/30/2013   Reported By: A.J. Higgins

Democratic leaders in the Maine Legislature are drawing a line over Medicaid expansion, saying they will not vote on repaying money owed to Maine's hospitals until the health care issue is resolved to their satisfaction. The new position comes on the heels of the Legislature's failure to override the governor's veto of a bill linking expanded health care benefits for 70,000 Mainers with the repayment of nearly a half-billion dollars in Medicaid debt to Maine hospitals. A.J. Higgins has more.

Maine Non-Profit Gears up to Join ACA Health Insurance Market
 Reported By: Patty B. Wight

On Oct. 1, the Health Insurance Marketplace will officially open across the U.S. and in Maine. It's a component of the federal Affordable Care Act that creates an online site that allows consumers to shop and compare different insurance plans. One non-profit organization that will offer new health insurance options celebrated its grand opening today in Lewiston. Patty Wight reports.

Thursday, May 30, 2013

Health Care Reform Articles - May 30, 2013

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09

  1. Danny McCormick5
+Author Affiliations
  1. 1Leah Zallman ( is a junior scientist at the Institute for Community Health at Cambridge Health Alliance and an instructor of medicine at Harvard Medical School, in Boston, Massachusetts.
  2. 2Steffie Woolhandler is a professor of public health at the City University of New York, in New York City.
  3. 3David Himmelstein is a professor of public health at the City University of New York.
  4. 4David Bor is the Charles S. Davidson Associate Professor of Medicine at Harvard Medical School.
  5. 5Danny McCormick is an assistant professor of medicine at Harvard Medical School.
  1. *Corresponding author


Many immigrants in the United States are working-age taxpayers; few are elderly beneficiaries of Medicare. This demographic profile suggests that immigrants may be disproportionately subsidizing the Medicare Trust Fund, which supports payments to hospitals and institutions under Medicare Part A. For immigrants and others, we tabulated Trust Fund contributions and withdrawals (that is, Trust Fund expenditures on their behalf) using multiple years of data from the Current Population Survey and the Medical Expenditure Panel Survey. In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.

For Medicare, Immigrants Offer Surplus, Study Finds

Immigrants have contributed billions of dollars more to Medicare in recent years than the program has paid out on their behalf, according to a new study, a pattern that goes against the notion that immigrants are a drain on federal health care spending.
The study, led by researchers at Harvard Medical School, measured immigrants’ contributions to the part of Medicare that pays for hospital care, a trust fund that accounts for nearly half of the federal program’s revenue. It found that immigrants generated surpluses totaling $115 billion from 2002 to 2009. In comparison, the American-born population incurred a deficit of $28 billion over the same period.
The findings shed light on what demographers have long known: Immigrants are crucial in balancing the age structure of American society, providing an infusion of young, working-age adults who support the country’s aging population and help cover the costs of Medicare and Social Security. And with the largest generation in the United States, the baby boomers, now starting to retire, the financial help from immigrants has never been more needed, experts said.
Individual immigrant contributions were roughly the same as those of American citizens, the study found, but immigrants as a group received less than they paid in, largely because they were younger on average than the American-born population and fewer of them were old enough to be eligible for benefits. The median age of Hispanics, whose foreign-born contingent is by far the largest immigrant group, is 27, according to the Brookings Institution. The median age of non-Hispanic whites in the United States is 42.
The study drew on two nationally representative federal surveys, from the Census Bureau and the Department of Health and Human Services. Researchers included the contributions of legal residents who were not citizens, a group that is eligible for Medicare if certain requirements are met; unauthorized immigrants; and citizens who were born abroad.
It was not clear how much of the surplus was made up of earnings by immigrants in the country illegally, who are ineligible for most government programs.
The Census Bureau, whose data was used for the contributions portion of the study, says it attempts to count all immigrants, including those in the country illegally.
The finding “pokes a hole in the widespread assumption that immigrants drain U.S. health care spending dollars,” said Leah Zallman, an instructor of medicine at Harvard Medical School and the lead author of the study

Hospital Caring for an Heiress Pressed Her to Give Lavishly

For the last 20 years of her life, Huguette Clark, a wealthy and reclusive copper heiress, lived in a Manhattan hospital room, shades drawn, door closed. She played with dolls, watched cartoons and followed the Bush v. Gore hanging chad debacle. (She favored Gore.)
Within months of her arrival, the hospital, Beth Israel Medical Center, went after her for an all-out fund-raising campaign. They researched her family history, had officials visit her often in her room and plied her with gifts. The effort, described in court documents, quickly extended to the hospital’s chief executive and even his mother, who watched the Smurfs with Mrs. Clark and talked to her about making a will. After Mrs. Clark donated a Manet to Beth Israel, but it sold for less than expected, the chief executive wrote an e-mail joking that Mrs. Clark “didn’t take the bait and offer a half dozen more.”
That note from July 6, 2001, was among scores of hospital documents filed on Wednesday in Manhattan Surrogate’s Court as part of a battle over Mrs. Clark’s $300 million estate with her distant relatives. She died in 2011 at age 104.
The case is scheduled for trial in September, but until then, the documents provide a rare look at the inner workings of a nonprofit hospital’s fund-raising operation — one that, as the relatives see it, coerced a woman who did not need constant medical care to give it a piece of her large fortune. In one of the e-mails, which were turned over to the relatives’ lawyer under a judge’s direction, a hospital fund-raising employee wondered whether Beth Israel’s legal department would approve of Mrs. Clark’s residency there.
Admitted in 1991, Mrs. Clark ended up staying until her death, giving the hospital at least $4 million in donations, not counting millions more she paid just to live there and a $1 million bequest in her final, contested will, according to court papers.
“What this is about is not just a will contest, it’s about the accountability of professionals,” John Morken, the lawyer for the relatives, 20 grand and great-grand half-nieces and half-nephews, said.
In previous court filings, the Manhattan public administrator, who has been appointed as temporary administrator of the estate, also has criticized the hospital’s behavior — as well as that of Mrs. Clark’s accountant, lawyer, admitting doctor and a private nurse, all of whom appear in the disputed will as beneficiaries of her estate. In response to those filings, the hospital has defended its actions, saying Mrs. Clark was sharp as a whip — her dolls were “objets d’art” and a sophisticated hobby, she read the newspaper, and she gave every cent willingly.

Joblessness Shortens Lifespan of Least Educated White Women, Research Says

Researchers have known for some time that life expectancy is declining for the country’s least educated white women, but they have not been able to explain why. A new study has found that the two factors most strongly associated with higher death rates were smoking and not having a job.
 The aim of the study, which is being published Thursday in The Journal of Health and Social Behavior, was to explain the growing gap in mortality between white women without a high school diploma and those with a high school diploma or more.
 The study found that the odds of dying for the least educated women were 37 percent greater than for their more educated peers in any given year in the period of 1997 to 2001. The odds had risen to 66 percent by the period of 2002 to 2006. The authors controlled for age.
The researchers used a health survey conducted by the National Center for Health Statistics, drawing on data from about 47,000 women ages 45 to 84. The study weighed more than a dozen factors to see which were causing the divergence in mortality rates. Poverty, obesity, homeownership, marital status and alcohol consumption were among the factors investigated.
 But they mattered little. As it turned out, smoking was important, as had long been established, but researchers were surprised that joblessness had a dramatic effect, even after controlling for factors that employment would have generated, like income and health insurance.
“What is it about employment that has this huge impact on mortality, beyond the material resources it brings?” said Jennifer Karas Montez, the study’s lead author, a researcher at the Harvard Center for Population and Development Studies.
UPDATED MAY 29, 2013 5:29 PM

Is Obamacare Too Complicated to Succeed?

Posted May 29, 2013, at 5:32 p.m.
AUGUSTA, Maine — Gov. Paul LePage on Wednesday railed against an expansion of Medicaid eligibility in Maine, calling it a disturbing national trend of damaging federal mandates.
LePage also linked what he called censorship he has experienced in the past two weeks to a pattern of the same at the national level, suggesting that citizens go home and arm themselves if it continues.
“Expanding Medicaid? That’s not being run locally, that’s being run from Washington,” said LePage to reporters Wednesday at the State House, according to a report of the exchange by WCSH. “Are you that naive that you don’t realize who is pulling the strings? This is being run by our congressional delegation. … If I thought it was local, it would be no problem.”
The issue of expanding Medicaid under the federal Affordable Care Act has been simmering in state government for months. Under the law, the federal government will pay 100 percent of the cost of the Medicaid expansion, which would provide health insurance for some 70,000 Mainers, for the first three years. That funding level gradually would recede to 90 percent by 2020.
Legislative Democrats tried to force the expansion this month by linking it to a plan championed by LePage to make a final payment to Maine’s hospitals on hundreds of millions of dollars in past Medicaid debt. LePage vetoed that package last week. The veto was upheld Wednesday in the Senate, and both the governor and Democrats are preparing stand-alone bills to advance the hospital debt payment and Medicaid expansion, respectively.
“This is a national problem and it’s a direction the country is going in that we should be very concerned about,” said LePage.
LePage spokeswoman Adrienne Bennett said later Wednesday that the governor is more concerned about more than 3,000 people who are on waiting lists for social services in Maine.
“Everyone agrees that the hospital debt needs to be paid for,” said Bennett. “The governor’s issue has always been the long-term stability and affordability of a program and ensuring the most needy are covered.”
The governor also continued his criticism of Democrats for what he called “censorship” stemming from a May 19 Appropriations Committee meeting at which LePage arrived unannounced and was not allowed to speak by the committee chairwoman, Sen. Dawn Hill, D-York.
LePage’s claims of censorship continued last week when he was asked to remove a television he had placed outside his office, despite the fact Democrats invited him to take the issue to the Legislative Council, which has authority over alterations to the State House. In protest, LePage worked from the Blaine House late last week and early this week before returning to his office Wednesday.

Maine Senate upholds LePage veto of bill linking Medicaid expansion to hospital repayment

Posted May 29, 2013, at 12:44 p.m.
AUGUSTA, Maine — Democrats’ first effort to link Medicaid expansion with a plan to repay Medicaid debt to Maine hospitals died officially on Wednesday when the Senate failed to override Gov. Paul LePage’s veto of a bill that would do so.
Mirroring all previous votes on a bill that linked the two, the Senate voted 20-15 to override the veto, falling short of the two-thirds needed for an override. Democrats and independent Richard Woodbury voted for the override. All Republicans voted to sustain LePage’s veto. Only Senate Democratic Leader Seth Goodall of Richmond and Senate Republican Leader Michael Thibodeau of Winterport spoke before Wednesday’s veto vote. They reiterated past party arguments.
The provisions within LD 1546, “An Act to Strengthen Maine’s Hospitals, Increase Access to Health Care and Provide for a New Spirits Contract,” have been under debate since January but weren’t included in a single bill until earlier this month. Democrats on the Legislature’s Health and Human Services Committee attached an expansion of Medicaid under the federal Affordable Care Act to Gov. Paul LePage’s plan to repay Medicaid debt to hospitals with the proceeds of a renegotiated state liquor contract.
That angered LePage, who last week held a press conference and made a show of vetoing the bill before it had even arrived on his desk and minutes before Democrats held their own press conference on the issue. The governor said he would introduce a new bill that proposes repaying the hospitals without linking to Medicaid expansion.
As an incentive to lawmakers, LePage wrote in his veto letter to the Legislature that he has directed State Treasurer Neria Douglass to ready $105 million in voter-approved bonds to be released if lawmakers pass his hospital debt repayment plan, which is a promise the governor has voiced since January.
“The sad part of this veto is the simple fact that all of us have agreed paying our bills is the fiscally responsible thing to do,” LePage’s veto letter reads. “Additionally, the bipartisan work of the committees has recognized my original plan is the best way to do it.”
At issue is $484 million in state and federal funding that is owed to 39 Maine hospitals. Under LePage’s plan, the state’s $181 million would be covered by renegotiating a better deal for the state on the nearly 10-year-old state liquor contract and purchasing a revenue bond with the proceeds.
The arguments for and against the veto were brief Wednesday morning in the Senate and similar to the hours of testimony and legislative debate that have already centered around the question.
“Make no mistake about it. If we vote today and do not override this veto, you’re voting against paying back the hospitals,” Goodall said. “You’re voting against providing health care to 70,000 Mainers. Our resolve if we are not successful here today in overriding this veto will not be slowed down in a fashion.”
Under the federal health care reform law, the federal government covers 100 percent of costs for newly eligible Medicaid recipients for three years. That 100 percent rate gradually drops to 90 percent by 2020, when the state would make up the rest. Proponents of the expansion say it would cover almost 70,000 Mainers.
In Maine, about 50,000 adults without children would gain Medicaid coverage if the state opts to expand, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. If the state chooses not to expand, about 25,000 childless adults and parents would lose their Medicaid coverage on Jan. 1, 2014.
Maine House Rejects Bill to Ban Medicaid Coverage for Opiate Addiction Treatment
05/29/2013   Reported By: Susan Sharon
The Maine House of Representatives today voted to reject a bill that would prohibit Medicaid coverage for medications such as methadone and Suboxone, used to treat opiate addiction. With one of the highest rates in the country of people seeking treatment, Maine, opponents argued, is in no position to pull the rug out from those who want and need help. Susan Sharon has more.
Related Media
Maine House Rejects Bill to Ban Medicaid CoverageListen
The emotional, hour-long debate was kicked off by Republican Rep. Lawrence Lockman, of Amherst, who confessed to being what he called "a heretic" for not subscribing to the prevailing orthodoxy that drug addiction is a disease. Lockman is the sponsor of the bill that would terminate MaineCare coverage for methadone treatment, effective in January of 2015.

Wednesday, May 29, 2013

Health Care Reform Articles - May 29, 2013

High-End Health Plans Scale Back to Avoid ‘Cadillac Tax’

Say goodbye to that $500 deductible insurance plan and the $20 co-payment for a doctor’s office visit. They are likely to become luxuries of the past.
Get ready to enroll in a program to manage your diabetes. Or prepare for a health screening to determine your odds of developing a costly health condition.
Expect to have your blood pressure checked or a prescription filled at a clinic at your office, rather than by your private doctor.
Then blame — or credit — the so-called Cadillac tax, which penalizes companies that offer high-end health care plans to their employees.
While most of the attention on the Obama administration’s health care law has been on providing coverage to tens of millions of uninsured Americans by 2014, workers with employer-paid health insurance are also beginning to feel the effects. Companies hoping to avoid the tax are beginning to scale back the more generous health benefits they have traditionally offered and to look harder for ways to bring down the overall cost of care.
In a way, the changes are right in line with the administration’s plan: To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law’s most controversial provisions.
Bradley Herring, a health economist at Johns Hopkins Bloomberg School of Public Health, suggested the result would be more widely felt than many people realize. “The reality is it is going to hit more and more people over time, at least as currently written in law, ” he said. Mr. Herring estimated that as many as 75 percent of plans could be affected by the tax over the next decade — unless employers manage to significantly rein in their costs.
The changes can be significant for employees. The hospital where Abbey Bruce, a nursing assistant in Olympia, Wash., worked, for example, stopped offering the traditional plan that she and her husband, Casey, who has cystic fibrosis, had chosen.

As Maine hospitals grow, prices and access to medical care are put on the line

Posted May 27, 2013, at 6:04 p.m.
Dr. Michael Ciampi took over his father’s practice, located in the home on Stevens Avenue in Portland where he and his five siblings were raised, in 1999. Back then, he was one of many independent doctors in Maine.
That changed a decade ago when Ciampi moved his practice to a facility run by an offshoot of Mercy Health System of Maine, parent to Mercy Hospital. Ciampi’s father recommended the move as a way to relieve Ciampi of the burdens of running a practice, from billing paperwork to nonexistent paid time off.
At the time, moves such as Ciampi’s weren’t as common, and today, 80 percent of all primary care doctors in Maine are affiliated with hospitals or federally supported community health centers, according to the Maine Medical Association.
In some rural areas, no independent physicians remain.
Beginning in the late 1990s, health care mergers swept across Maine and the rest of the country, cementing hospitals’ market power and, many would argue, freedom to charge higher prices. In the beginning, mergers were driven by the rise of health maintenance organizations, also known as HMOs. More recently, the recession has sparked merger talks.
More than a dozen health care mergers have been proposed or completed in Maine over the last decade — a planned deal between Mercy, Ciampi’s former employer, and Eastern Maine Healthcare Systems of Brewer as the most recent.
Today, 18 of Maine’s 38 acute-care and psychiatric hospitals are members or affiliates of the state’s two largest hospital systems, EMHS and Portland’s MaineHealth.
The growing clout of hospital systems, both in Maine and nationwide, has wide-ranging implications for the cost and quality of medical treatment. Some say it has diminished insurers’ bargaining power, leading to higher prices.
Others contend that big, sophisticated systems are best positioned to halt the rise of health care costs by transforming how care is paid for and delivered.
Increasingly, decisions about the hospitals that anchor many Maine communities are made in the boardrooms of big health systems, from whether a hospital continues to deliver babies, perform certain surgeries, or in the case of Boothbay Harbor, keep its emergency room open.

South Portland doctor stops accepting insurance, posts prices online

Posted May 27, 2013, at 4:07 p.m.
SOUTH PORTLAND, Maine — Dr. Michael Ciampi took a step this spring that many of his fellow physicians would describe as radical.
The family physician stopped accepting all forms of health insurance. In early 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice’s website.
The change took effect April 1.
“It’s been almost unanimous that patients have expressed understanding at why I’m doing what I’m doing, although I’ve had many people leave the practice because they want to be covered by insurance, which is understandable,” Ciampi said.
Before the switch, Ciampi had about 2,000 patients. He lost several hundred, he said. Some patients with health coverage, faced with having to seek reimbursement themselves rather than through his office, bristled at the paperwork burden.
But the decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.
“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.”

The Republican Party’s big squeeze

Posted May 28, 2013, at 6:02 a.m.
WASHINGTON — Over the last few years, Republicans have been retreating from policy ground they once held and salting the earth after them. This has coincided with, and perhaps even been driven by, the Democratic Party pushing into policy positions they once rejected as overly conservative. The result is that the range of policies you can hold and still be a Republican is much narrower than it was in, say, 2005. That’s left a lot of once-Republican wonks without an obvious political home.
Health care is the most obvious example. The basic architecture of the Affordable Care Act is, as has been pointed out ad nauseam, a Republican idea. It was first proposed in a 1993 plan that had 20 Senate Republicans as co-sponsors. It was passed and implemented by then-Gov. Mitt Romney in Massachusetts. It was supported by Newt Gingrich. Through much of this time, Democrats viewed it with skepticism: They wanted something closer to single payer, and it seemed borderline offensive to insist that Americans buy products from for-profit insurers. But key Democrats dropped those objections in order to actually pass health reform.
Republicans could’ve pocketed the Democratic concession as a win. They could’ve celebrated the triumph of their ideas and the Democratic abandonment of single payer. They could’ve used the Affordable Care Act as a vehicle to push some of their other health policy initiatives, like medical malpractice reform, capping the employer tax exclusion and spreading health savings accounts.
Instead, they abandoned every idea even vaguely related to the Affordable Care Act. In fact, they pretty much abandoned all ideas related to universal coverage, or even big expansions of coverage. They decided some of them were downright unconstitutional. Today, House Majority Leader Eric Cantor , R-Va., can’t even get high-risk pools past his members. The health policy space on the right is radically narrower than it was a decade ago. If you’re a Republican who hasn’t been willing to change your positions on those issues, you’re a heretic today.
Health care isn’t the only example. There was a time when Republicans were leading the way on ideas to fight climate change. The first cap-and-trade bill to reduce carbon emissions was introduced into the Senate by John McCain, R-Ariz. The McCain-Palin ticket included a cap-and-trade plank. Some Republicans, like Tennessee’s Sen. Bob Corker, supported a carbon tax.
There’s no serious support in today’s Republican Party for doing anything about climate change. Even Jon Huntsman, who made headlines during the presidential election for saying he believed in global warming, didn’t want to do anything about it when he was governor of Utah. Today’s Republican Party doesn’t want a cap-and-trade plan or a carbon tax or even money for renewable-energy research. Whereas a decade ago a policy wonk who worried about the future of Earth could comfortably fit in the GOP, today anyone who wants to do anything serious about climate change has been written out of the party.

Health Care Is Spread Thin on Alaskan Frontier

BETHEL, Alaska — Americans in some rural places fret at how far away big-city medical help might be in an emergency, or at the long drives they are forced to make for prenatal care, or stitches, or chemotherapy.
Dr. Ellen Hodges only wishes it could be so easy.
She oversees health care for a population of 28,000, mostly Alaska Natives, here in the state’s far west end, spread out over an area the size of Oregon that has almost no roads. People can travel by boat or snow machine at certain times of the year, but not right now: the Kuskokwim River, which wends through Bethel to the Bering Sea, is choked with unstable melting ice in late May, magnifying the isolation that defines everything in what may be America’s emptiest corner.
“If you have a road, you’re not remote,” Dr. Hodges said.
The complex machinery of health care is being reimagined everywhere in the nation through the combined prism of new regulations and shifting economics, even here on the continent’s frosted fringe.
The grandly named Yukon-Kuskokwim Health Corporation, for example, where Dr. Hodges is chief of staff, is scrambling this spring to install a new electronic medical records system. That is a hallmark of the federal health care overhaul, compounded out here by the fact that computers run by generators in far-flung villages are subject to brownouts and fuel shortages.
Cost controls are also the way of the medical frontier no matter where you look. In other places, such constraints may be driven by insurance companies; here, by sequester-driven budget cuts to the federal Indian Health Service. The agency is the 50-bed hospital’s main support in treating the tribes and villagers who have lived for thousands of years in the boggy crescent of lowlands where the Yukon and Kuskokwim Rivers carve their paths to the sea.

My Near Miss

IT was probably our eighth or ninth admission that day, but my intern and I had given up counting. I was midway through my medical residency, already a master of efficiency. You had to be, or you’d never keep up. This one was a classic eye-roller: a nursing home patient with dementia, sent to the emergency room for an altered mental status. When you were juggling patients with acute heart failure and rampant infections, it was hard to get worked up over a demented nonagenarian who was looking a little more demented.
The trick to surviving was to shuttle patients to another area of the hospital as quickly as possible. This patient was a perfect candidate for the intermediate care unit, a holding station for patients with no active medical issues who were awaiting discharge. First we just had to rule out any treatable medical conditions — get the labs, head CT scan and chest X-ray. But the docs at the intermediate ward left at 5 p.m. and it was 4:45. I quickly scanned through the labs, called the ward’s doctor and ran through the case — demented patient, still demented, return to nursing home tomorrow.
I remember the doctor’s voice so clearly: “You’re sure the labs and everything are normal?” Yes, yes, I said, everything is fine. She hesitated, then said O.K. The intern and I high-fived each other, and bolted back to our other admissions.
The next afternoon the doctor tracked me down. Without mincing words, she told me that she’d been called overnight by the radiologist; the patient’s head CT showed anintracranial bleed. The patient was now with the neurosurgeons, getting the blood drained from inside her skull.
My body turned to stone. An intracranial bleed? You couldn’t do much worse than miss an intracranial bleed.

Obamacare is facing death by a thousand cuts

By Michael E. Capuano
OUTRIGHT REPEAL is one way to sabotage health care reform, but most opponents recognize they don’t have the votes for that, let alone enough to override a certain presidential veto. Of course, this has not prevented House Republicans from voting three dozen times to repeal health care reform. A 37th attempt took place earlier this month. All of this represents nothing more than political grandstanding. Since they haven’t been able to achieve an outright repeal, Republicans are also working to thwart implementation.
Over the last three years, the Obama administration and leaders in many states have been preparing for the full implementation of health care reform. At every step, the Republican majority in the House, their committed counterparts in the Senate, and their allies in many state houses across the country have sought to delay, obstruct, and undermine these efforts. Rather than fix the parts of the law that need to be fixed, they plot new ways to kill it by a thousand cuts.

With Money at Risk, Hospitals Push Staff to Wash Hands

At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.
This Big Brother-ish approach is one of a panoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene. With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.
Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients. So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with “red cards.” They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the “Happy Birthday” song.
All this effort is to coax workers into using more soap and water, or alcohol-based sanitizers like Purell.
“This is not a quick fix; this is a war,” said Dr. Bruce Farber, chief of infectious disease at North Shore.

Supply low, price high for popular Lyme disease antibiotic

Posted May 28, 2013, at 10:36 a.m.
LEWISTON, Maine — Maine patients, doctors and pharmacists are dealing with another drug shortage, this one an antibiotic to treat Lyme disease, the MRSA infection, pneumonia and other illnesses.
The shortage has become such a concern nationwide that U.S. Sen Susan Collins, R-Maine, and U.S. Sen. Amy Klobuchar, D-Minn., have asked the Food and Drug Administration to take action.
“According to our state epidemiologist, the number of Maine residents diagnosed with Lyme disease continues to increase each year,” Collins said in a statement released Friday. “The antibiotic Doxycycline is critically important for treating these patients, and it’s imperative that the FDA do all it can to help alleviate this shortage.”
Doxycycline is an antibiotic that can be given orally or intravenously. It is used to treat a host of conditions, including acne, rosacea, chlamydia, some types of pneumonia, the difficult-to-treat infection MRSA and Lyme disease.
The shortage began earlier this year. According to the FDA’s website, four companies deal with the drug. One says manufacturing delays have made its supply largely unavailable. Another says increased demand has limited its supply and it is providing the medication to current contracted customers only.
Officials with the Maine Center for Disease Control and Prevention has been monitoring the situation in Maine for about a month.
“We’ve had availability, but the price is going up and that’s obviously a concern, too,” state epidemiologist Stephen Sears said. “And, sooner or later, if it’s getting to be short nationally, it’s going to get short here, just as other drugs have.”
He said the department has heard Doxycycline’s price is now five to 10 times higher than it used to be, but he said that is hard to gauge because pharmacies all price differently and insurance companies pay differently.

Medicare Spending Variations Mostly Due To Health Differences, Study Concludes

MAY 28, 2013
Updated at 5:45 p.m.
The idea that uneven Medicare health care spending around the country is due to wasteful practices and overtreatment—a concept that influenced the federal health law -- takes another hit in a study published Tuesday. The paper concludes that health differences around the country explain between 75 percent and 85 percent of the cost variations. 
“People really are sicker in some parts of the country,” said Dr. Patrick Romano, one of the authors.
That’s a sour assessment for those hoping to wring large savings out of the health care system by making it more efficient. Some, such as President Barack Obama’s former budget director, Peter Orszag, assert that geographic variations in spending could mean thatnearly a third of Medicare spending may be unnecessary.
Their conclusions are based on the wide differences in spending, which in 2011 ranged from an average of $14,085 per Medicare beneficiary in Miami, to $5,563 per beneficiary in Honolulu, even after Medicare’s cost of living and other regional adjustments — but not health status — were taken into account.
The new study comes as advisors to the government consider whether regional differences are a useful tool to reduce health spending. An Institute of Medicine panel is preparing a report on whether Congress should pay less to hospitals and doctors in areas where there is heavy use of medical services, and more in regions where spending is lower. That report is due out this summer, but an interim version indicated that the panel was opposed to the idea.