Saturday, June 29, 2013

Health Care Reform Articles - June 29, 2013

June 29, 2013, 8:16 a.m. EDT

Obamacare could eat up your raise

Health law prompts more companies to use salary-based premiums

Expecting to get a raise next year? It could be eaten up by your health care bill.
In an effort to meet the affordability requirement of the Affordable Care Act, which kicks in next year and requires that workers spend no more than 9.5% of their income on premiums, more employers are turning to insurance plans in which premiums vary based on a person’s salary, rather than having all workers pay a flat rate. That way, employees who make more money pay bigger premiums.
Some 12% of companies used salary-based premiums in 2012, up from 10% in 2011, according to a study by benefits consultant Mercer. The practice is especially common among large employers, with 20% of companies that have at least 5,000 employees using the strategy last year. A separate survey by the Kaiser Family Foundation found that the approach of varying premium contributions by wage level is more popular in the Northeast, where 9% of companies used the strategy, and in the Midwest, where 6% of employers did, compared with 2% of companies in the South and the West.
While the strategy, which some employers have been using for decades, is still not mainstream, more companies are adopting the system as a way to prepare for the health reform law. It makes sense for some employers to shift costs to wealthier workers, especially as health-care costs continue to grow at a faster clip than wages, says Tim Nimmer, chief actuary and chief broking officer with Aon Hewitt, a human-resources consulting firm. Companies feel more comfortable “putting that increase on their higher earners just because they can afford it,” says Nimmer. If premiums increase by $100 for a company’s chief executive it may seem “meaningless,” but “for someone making $25,000, it could be the difference between going out to eat or paying electric bills or buying gas,” he says.
The average total monthly premium for full-time employees grew to $832 this year, up nearly 14% from $731 in 2010, according to a study released by the ADP Research Institute this week. And those costs are taking up a larger percentage of income for lower-wage workers, the study found, with premiums taking up 8.4% of income for workers earning $15,000 to $20,000, up 0.9 percentage points from 2010 when premiums took up 7.5% of income. Workers earning more than $120,000, in contrast, paid 2.1% of their annual income on premiums.
Some companies will set up salary “bands” where they increase premiums in small increments of $5 or $10 based on income. Workers earning $25,000 to $50,000 may pay one rate, $50,000 to $100,00 another rate, and so on, says Nimmer. At some companies, the premium costs between lower wage workers and higher earners could vary by as much as 20%, he says.
June 26, 2013, 8:43 a.m. EDT

Young Americans may dodge health law

For 20-somethings, penalty may be preferable to buying insurance

Young Americans may have been among the biggest supporters of Obamacare, but they may also be the least likely to comply with the law.
The architects of health reform say the law will make insurance more affordable and widely available. But in 2014, benefits experts say, the cheapest option for 20-somethings will be to pay the penalty for not buying health insurance, rather than paying for any health insurance at all—that is, provided they don’t get sick.
And as more young people do the math, more seem to be deciding the Affordable Care Act isn’t such a good deal for them: Support for a national health-care plan dropped nearly 11% among American college freshmen between 2008 to 2012, with under 63% in favor of it today, down from 70%, according to UCLA’s annual student survey.
Next year, uninsured Americans must pay a penalty of $95, or 1% of their annual salary if they make more than $9,500 for the year. A person earning $50,000, for example, would pay a $500 penalty if they chose not to enroll in a health insurance plan.
But for a healthy 20-something who rarely goes to the doctor and doesn’t take prescription medications, that penalty might be far less expensive than buying a health plan through the state health exchanges, the new insurance marketplaces opening Oct. 1. Those exchanges, which will offer health coverage to people who can’t get it through their employer or by staying on their parents’ insurance, are just beginning to announce how much their plans will cost. But based on the rates released so far, the price of health insurance for a 20-something will start at about $72 a month in Washington, D.C., and $117 a month in California, for minimal coverage known as a “catastrophic plan,” available to people under 30.
That means that for someone making less than $86,400 in Washington, D.C., or less than $140,400 in California, even the cheapest health insurance would still cost more than the penalty (a 1% penalty on an $80,000 salary, for instance, would be $800, while the lowest-price insurance in Washington would cost $864 a year and in California, $1,404).
And the bare-bones plans also have high deductibles, so 20-somethings in the least expensive Washington plan would still have to pay $6,350 in medical bills before the insurance company would start to pick up the tab—a calculation that could lead more young people to see the penalty as a comparative bargain: “The concern is,How many of them will even forgo that plan and just take the penalty?” says Caroline Pearson, a vice president at Avalere Health, a health-care advisory firm.“That’s what were waiting to see.”

Contraceptives Stay Covered in Health Law

WASHINGTON — Despite strong resistance from religious organizations, the Obama administration said Friday that it was moving ahead with a rule requiring most employers to provide free insurance coverage of contraceptives for women, a decision that has touched off a legal and political battle likely to rage for another year.
The final rule, issued under the new health care law, adopts a simplified version of an approach proposed by the government in February to balance the interests of women with the concerns of the Roman Catholic Church and other employers with religious objections to providing coverage for contraceptives.
After considering more than 400,000 comments, administration officials refused to budge on the basic principle. The rule, they said, is very similar to their proposal. An exemption is included for churches. But many Catholic hospitals, schools, universities and other religious institutions will have to take steps so that coverage is available to employees and their dependents.
The issue figured prominently in last year’s elections as President Obama and other Democrats pressed their advantage with female voters. At the same time, Catholic bishops waged a national campaign arguing that the federal policy infringed on religious freedom and violated the church’s social and moral teachings on birth control and abortion.
Cardinal Timothy M. Dolan of New York, president of the United States Conference of Catholic Bishops, said the group was reviewing the final rule.
Democrats describe the mandate for coverage of birth control as one of the chief benefits of the 2010 health care law, a boon to women and their health.
“The health care law guarantees millions of women access to recommended preventive services at no cost,” said Kathleen Sebelius, the secretary of health and human services. “Today’s announcement reinforces our commitment to respect the concerns of houses of worship and other nonprofit religious organizations that object to contraceptive coverage, while helping to ensure that women get the care they need, regardless of where they work.”
Republicans say the requirement shows how intrusive and onerous the law is.

Health-Centric Homes, for a Price

Coming soon to a neighborhood near you: an empathic multimillion-dollar home that passively treats the occupant’s body like a temple. The second coming of sustainable real estate, it will fuse green technology with nourishing all-about-me amenities and direct them indoors. Homebodies, take note: the residence is designed to make the people it shelters healthier.
“The simplest way to understand what this home is capable of doing is to think of it like a 24-hour carwash that works on the human body,” said Paul D. Scialla, a co-founder and the managing partner of Delos, the Manhattan real estate firm. After conducting years’ worth of medical studies on the soundness of the science behind its product, Delos is about to make its debut in the city’s luxury marketplace with a WELL-certified condominium (the Delos name and the concept are trademarked).
The five health-centric residences are at 66 East 11th Street, an address where living well is, to recycle a throwaway line attributed to the 17th-century poet George Herbert, about to become the best revenge. Construction is under way; the first loft is scheduled to be habitable in September.
The purest air and water and the most intense soundproofing are promised: there is a buildingwide water purification system; filters will screen out air pollutants, allergens and toxins; and a circadian lighting system will stream energizing light in the morning and melatonin-enhancing light in the evening. Then there’s the posture-supportive flooring system and the WELL Shield coating, which destroys bacteria in the kitchen and bathrooms.
Mr. Scialla believes in his invention so sincerely that he retired this spring, at 39, as a Goldman Sachs partner to devote himself to Delos. The guinea pig for the project was the West 13th Street loft where he and his twin brother, Peter, live.
Renovated in 2012, the loft is stocked (subtly and in some cases invisibly) with 50 wellness amenities that deliver, he says, 23 therapies: exponentially improved air, water, light, sleep, energy and nutrition are all part of the package. The grand piano in the living room is an extra that belongs to Peter — music being the rare form of therapy, Mr. Scialla said, that Delos doesn’t cover.
The interior lighting in the West 13th Street prototype where the twins live with their golden retriever, Jake, nourishes delicate circadian rhythms with constantly changing types of illumination and blackout shading. The air is not just continually cleansed, but subtly infused by aromatherapy appropriate to the time of day — or the owner’s whims.
The rift-cut Siberian oak floors are set upon a layer of cork and rubber that reduces stress, muffles sound and nudges a body toward perfect posture. The juice bar in the kitchen enables healthy beverage selections. The blue-light panel surrounding Mr. Scialla’s bathroom mirror is a silent wake-up call even on the darkest mornings. The heated stone path to the shower provides instant foot reflexology, and inside the shower, the cascade is supplemented by a spritz of vitamin C and aloe that neutralizes chlorine and soothes the skin.
Is this a great country, or what?

Maine Medical Center will offer buyouts to about 400

Posted: June 28
Updated: Today at 12:22 AM

'Financial challenges' prompted Maine's largest hospital to look for ways to reduce its expenses.

PORTLAND — Maine Medical Center plans to offer about 400 employees voluntary early-retirement buyouts, according to a memo obtained Friday by the Portland Press Herald.
In the letter to employees, Richard Petersen, president and CEO of Maine's largest hospital, said "financial challenges" have led the hospital to look for ways to reduce "all labor and non-labor expenses" to "improve our financial stability moving forward."
"We're going to offer incentives for voluntary early retirements for about 400 people across Maine Medical Center. More information will be communicated about this program next week," Petersen wrote.
Maine Med, which announced a hiring freeze this spring, has about 6,000 employees.

Maine Medical Center to offer buyouts to 400 workers

Posted June 28, 2013, at 5:43 p.m.
PORTLAND, Maine — Financial losses have prompted Maine Medical Center to offer voluntary buyouts to about 400 employees approaching retirement.
In an internal memo to employees Friday, provided by MMC to the Bangor Daily News, President and CEO Richard Petersen said the hospital faces a $15 million gap by the end of the 2013 fiscal year, which runs from Oct. 1 to Sept. 30, in the wake of a rising number of patients who can’t pay their medical bills.
The hospital is reviewing all of its expenses and plans to introduce incentives for voluntary early retirement to employees next week, he wrote in the memo.
“We have to talk about labor — 60 percent of our expense base is in compensation and benefits — while recognizing that it rightly makes people nervous about their futures,” Petersen wrote. “Please understand that layoffs are a last resort and we’re doing all we can to minimize reductions in our workforce.”
Petersen highlighted several challenges facing hospitals nationally and in Maine, including shrinking reimbursements, “changing regulations, tighter competition and narrowing margins.”
The buyout offer follows news in early May that MMC had declared a hiring and travel freeze in an attempt to plug a $13.4 million hole in the hospital’s operating budget. MMC attributed those losses to declining patient volumes, an increase in the number of patients who need free care, declining payments from Medicare and MaineCare, and a glitch in the launch of the hospital’s electronic health records system.
In the buyout memo, Petersen also touched on $67 million in MaineCare payments owed to MMC that the state recently agreed to repay, as well as a $40 million renovation project that includes the addition of five new operating rooms.
While the hospital is “glad to be reimbursed what we’re owed for services rendered,” the MaineCare repayment “is not a windfall for Maine Medical Center,” he wrote. “The funds will be used to strengthen our financial base.”
The renovation project is needed to update aging operating rooms that leave medical teams cramped as they work on complex procedures, particularly cardiac operations, Petersen wrote.
“I believe that we will get through these challenging times together and will be a stronger organization for our efforts,” he wrote.

Anthem insurance plan with MaineHealth under review

Posted June 28, 2013, at 5:19 p.m.
GARDINER, Maine — A proposed deal between two heavy hitters in Maine’s health care market to offer insurance next year is raising concerns that patients may have to travel further for care and to find new doctors. The deal could affect tens of thousands of residents and greatly shape the rollout of President Barack Obama’s health reform law in Maine.
MaineHealth, the parent organization of Maine Medical Center in Portland, and health insurer Anthem Blue Cross and Blue Shield plan to offer a new insurance product on Maine’s health insurance exchange, an online market where consumers and small businesses can shop for coverage beginning in October 2013. The plans would take effect in January 2014. The exchanges are a key component of the reform law, which aims to widen coverage to 30 million people.
A Friday public hearing hosted by the Maine Bureau of Insurance addressed the network of hospitals and doctors that would provide care to customers who buy the Anthem-MaineHealth plans, which would be available to individuals who buy their own insurance, small businesses and the uninsured.
Workers who have health insurance through a large employer aren’t eligible to shop for plans on the exchange and wouldn’t be affected by the Anthem-MaineHealth deal.
The plans include 32 of Maine’s 38 hospitals, but exclude Central Maine Healthcare, which operates Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital, as well as Parkview Adventist Medical Center in Brunswick, York Hospital, and Portland’s Mercy Hospital.
Central Maine Healthcare officials have denounced the plan as a “backroom deal” that allows MaineHealth to undercut hospitals that compete with its health system, undermining the intent of the reform law to improve access to affordable health care. Central Maine Healthcare filed a lawsuit earlier this month to make Anthem’s application public before the insurance bureau decides whether to approve the plan. It also launched a website dedicated to defeating the deal,
Brenda Weeks, 54, of Auburn, has held an individual Anthem policy for 29 years. She’s worked hard to assemble a team of CMMC medical providers who treat her for multiple sclerosis, and now fears losing them, she said.
Weeks, who uses a wheelchair and relies on a ventilator to breathe, said she’s overwhelmed by the prospect of having to find new doctors and a different hospital, as well as a new health plan with unknown costs and coverage.
“I’ve been very loyal to them, “ she said of Anthem, which also insured Weeks through her parents when she was young. “I don’t like the idea that they are going to turn my world upside down, and that’s what will happen if I have to make these changes.”
Chuck Gill, a spokesman for Central Maine Healthcare, said Friday’s hearing has led to further confusion about which doctors are included in the network, after discrepancies in Anthem’s list were discovered.

Anthem defends network plan to state regulators
Yesterday at 11:14 PM 

Proposal that excludes some hospitals has come under fire from doctors and patients.

By Jessica Hall
Staff Writer
GARDINER — Anthem Blue Cross and Blue Shield said Friday that its proposed health insurance network with MaineHealth would provide adequate numbers of hospitals and health care providers for Mainers who seek coverage through the insurance exchange to be created by the Affordable Care Act.
In a hearing held by the state's Bureau of Insurance, Anthem said its proposed network, including 32 of Maine's 38 hospitals, would allow every subscriber to reach a primary care physician within 30 minutes and a specialist within an hour's driving time.
The company said it does not know how many Mainers would join the network.
The proposed network has come under fire, with some doctors upset that they would be excluded and some patients fearful that they would no longer be able to go to the doctors and hospitals they now use.

Maine Hospitals Excluded from Anthem Plan Cry Foul at Public Hearing
06/28/2013   Reported By: Patty B. Wight
Maine Medical Center's parent company, MaineHealth, has partnered with Anthem to offer a new online insurance product as part of the Affordable Care Act. The plan was under scrutiny at a public hearing at the Bureau of Insurance today, because it excludes six hospitals. Officials from those excluded hospitals are crying foul, saying if the proposal is approved, it will force thousands of patients to switch doctors. Patty Wight has more.
Related Media
Hospitals Excluded from Anthem Plan Cry Foul at PuListen

We need much more than Medicaid expansion

By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, June 28, 2013
It is common for people to assume that President Obama’s Affordable Care Act will lead to universal coverage; after all, that was its stated aim.
Coverage under the plan, which will not be fully implemented for seven more years, would be driven by a law making private health insurance compulsory, with an individual mandate to purchase health insurance or else pay a fine, for all but the poor, much like the reform led by Gov. Romney in Massachusetts. For the poor, the goal was to expanding Medicaid eligibility to everyone with an income below 138 percent of the federal poverty level.
But the Supreme Court, when it upheld the law as constitutional overall, also ruled that states could opt out of the Medicaid expansion.
We now know that a significant number state governments will opt out, in the end perhaps more than twenty in all. Texas, Florida, Kansas, Alabama, Louisiana, Mississippi, Georgia and Wisconsin are among the states that have decided not to expand Medicaid to all of the poor.
Some commentators and journalists have laid the blame at the feet the Supreme Court for the fact that the president’s “health care overhaul” will fall far short of universal health coverage for our nation. They cite projections that the reform was designed to enroll 16 million of today’s 50 million uninsured people in Medicaid programs. The point is that that many millions will not become eligible as long as their state governments opt out of expanding Medicaid.
But being eligible for Medicaid is different from enrolling.
In a study published this month on the Health Affairs blog, researchers Rachel Nardin, Leah Zallman and others estimated the impact of Medicaid expansion on the uninsured. They took into account the fact that people have to enroll in Medicaid by basing their estimates upon published take-up rates for public programs, prior publications, and Congressional Budget Office estimates regarding implementation of the president’s health care plan.
They found that the president’s plan, overall, “will minimally alter the demographic composition of the uninsured, regardless of whether undecided states opt-in or out. While Blacks and Hispanics will continue to be overrepresented among the uninsured, the majority will be non-Hispanic, white, low-income, working-age adults, many of them employed. The majority (around 80 percent) of the uninsured will be U.S. citizens, irrespective of states’ acceptance of Medicaid expansion. More than 4.3 million children and nearly 1.0 million veterans will remain uninsured under either scenario.”
The study also looked at the state governments presently undecided about whether to opt in or out of Medicaid expansion. The researchers found “if all currently undecided states opt-in, 29.8 million people will remain uninsured, whereas if all opt-out, the number of uninsured will total 31.0 million, 1.2 million above the opt-in scenario.”

Friday, June 28, 2013

Health Care Reform Articles - June 28, 2013

If No Medicaid Expansion, Low-Income State Residents Won't Face Mandate

A rule published Wednesday exempts low-income people from the health law's requirement to buy insurance if they live in states that decide against expanding Medicaid. News outlets also report on the latest related developments from Ohio, New Hampshire, Minnesota, Oklahoma and California.
Kaiser Health News: Capsules: No Mandate For Those Left Out Of Medicaid Expansion
Low-income Americans who live in states that have decided not to expand Medicaid eligibility will not face penalties if they fail to buy insurance next year. That's according to a final rule on exemptions to the health law's individual mandate – the law's controversial requirement that most Americans have health coverage or pay a penalty in 2014. That rule was published Wednesday (Tran, 6/27).
Reuters: Republican Battles Over Medicaid Turn To God And Mortality 

JUNE 27, 2013, 4:00 PM

A World of Rising Health Care Costs

Americans are used to hearing that health care will bust the budget. The Congressional Budget Office projected last year that Medicare, Medicaid and other government health programs would eat up 9.6 percent to 10.4 percent of the nation’s gross domestic product by 2037, crowding out many other vital programs.
But a new report from the Organization for Economic Cooperation and Development suggests that the United States is not the only country that will struggle to contain public spending on medical care. In fact, costs are likely to increase slightly less in the United States than in other industrialized countries and some big developing countries around the world.
Public spending on medical services has slowed much more sharply in other countries since the financial crisis hit government budgets around the industrial world. Government health expenditures across the O.E.C.D. grew only 0.1 percent in both 2010 and 2011, on average, after growing 4.9 percent a year between 2000 and 2009. In Greece they plummeted more than a quarter over those two years. In Britain they contracted by 2 percent. In the United States, by contrast, government health spending grew 3.3 percent in 2010 and 2.2 percent in 2011.
But health spending is expected to pick up as the economy recovers. The organization lays out two possible paths. In one, health care costs keep rising at the pace of the last decade or so – powered not only by growing incomes and the aging of the population but also by rapid medical inflation, technology advances and more intensive delivery.
Along the other, unspecified policy changes – perhaps like the Affordable Care Act — manage to slow spending to what would be justified by aging and income only.

MARCH 29, 2013, 6:00 AM

U.S. Health Care Prices Are the Elephant in the Room

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
Traditionally, the theory driving discussions on the high cost of health care in the United States has been that there is enormous waste in the system, taking the form of excess utilization of care. From that theory it follows that methods of controlling the growth of health spending should focus on ways to reduce the use of unnecessary or only marginally beneficial health care.
Largely overlooked in these discussions has been the elephant in the room: the extraordinarily high prices Americans pay for health care. However, as a group of us noted in a paper in 2004, “It’s the Prices, Stupid,” it is higher health spending coupled with lower – not higher — use of health services that adds up to much higher prices in the United States than in any other member nation of the Organization for Economic Cooperation and Development. Aside from a few high-tech services, Americans actually use less health care and rely on fewer real health-care resources than do residents of other industrialized countries.
Readers who want to get a peek at this elephant in the room should peruse the set of slides published a few days ago by the International Federation of Health Plans, a global network of private health-insurance plans with 100 members in 31 countries. The federation annually surveys prices actually paid for selected health care goods and services in the different countries.

Shown below are three slides from the set:
In most other countries, prices for health care goods and services are not negotiated between individual health insurers and individual physicians, hospitals or drug companies, as they are in the private insurance sector in United States.
Instead prices there either are set by government or negotiated between associations of insurers and providers of care, on a regional, state or national basis. The single prices for other countries shown in the chart therefore can be taken representative of prices actually paid there.
By contrast, as can be seen in the charts, in the United States there is quite a range of prices for the identical good or service.

Website sheds light on new health exchanges

Posted: June 27
Updated: Today at 1:25 AM

Individuals and small businesses in Maine can start learning about the health care process and all their options.

By JOE LAWLOR Staff Writer
While the uninsured or underinsured must wait until Oct. 1 to start purchasing health insurance on new health care exchanges, a key provision in President Obama's 2010 Affordable Care Act, they can begin learning now how the process will work.
The federal government this week rolled out a new website – – that is designed to explain the choices available to individuals and small businesses with 50 or fewer employees – those most affected by the new exchanges.
Under the hew health care law, people must have health insurance or pay a penalty – the so-called "individual mandate" provision that was the subject of much debate and a 2012 U.S. Supreme Court ruling that mostly upheld the law.
The enrollment that begins in October is for coverage that starts in January 2014.
The website introduced this week is "a place where people will be able to do apples to apples comparisons," said Ray Hurd, regional administrator of the Centers for Medicare and Medicaid Services. "People will be able to purchase health insurance at rates that are affordable to them."

Maine Legalizes Prescription Drug Imports

AUGUSTA, Maine (AP) _ Mainers will soon be able to legally buy mail-order prescription drugs from licensed out-of-country drug companies.

A new law that amended the Maine Pharmacy Act allows Mainers to save money by buying drugs through Canada's mail-order program called CanaRx and similar licensed programs in the United Kingdom, Australia and New Zealand.

The measure became law Thursday without the governor's signature. It goes into effect in 90 days.

Mainers for years participated in international mail-order pharmacy plans, but then-Attorney General William Schneider ruled in 2012 that the plans violated Maine law.

Big Changes Ahead For Those Who Buy Their Own Insurance

Gail Harriman’s health insurance costs rose four times in just over two years, from $550 a month to $1,171, an amount “more than my mortgage.” But when the self-employed San Francisco resident tried to switch insurers, she was rejected because of a minor health problem.

Harriman, 60, is among the estimated 15 million Americans who buy their own insurance and face far bigger hurdles getting and keeping it than those with job-based coverage.
“Most people who work for a company have absolutely no clue about what goes on with people who buy their own insurance,” she said. “I would never consider going without. But there have been moments when I feel it’s the bane of my existence.”
Most of the debate about how the health law will change the individual market has centered on whether consumers will experience “rate shock” from higher premiums when key changes go into effect next year. But there’s a flip side: new rules that broaden benefits, prohibit discrimination against those with health issues and cap consumers’ out-of-pocket costs, which can cut far deeper than premiums.
Currently, about one in five plans sold to consumers makes them responsible for at least half their medical costs after they’ve paid their premiums and met their deductibles, according to an analysis of government data by U.S. News & World Report and Kaiser Health News.  It could not be determined how many consumers have such plans.

Thursday, June 27, 2013

Health Care Reform Articles - June 27, 2013

Seeking a political cure for rising health costs

Expensive health insurance is a given in Switzerland, and there are concerns that the latest proposals to help rein in costs could prove to be a cure worse than the disease. Voters will have the final word on whether a single fund is preferable to the choice they have now.
Health insurance is compulsory under Swiss law, and there are currently about 60 companies providing it. In 2014 or 2015 the initiative for public health insurance will be put to a nationwide vote, which if accepted will see current providers of basic cover replaced by a single public fund.

The initiative - supported by the centre-left Social Democrats and by the Greens as well as by patient and consumer organisations – would leave only supplemental insurance in the hands of private companies.

Critics: Maine health deal hurts patients

Yesterday at 10:22 PM 

A state agency will soon decide whether letting Anthem and MaineHealth be Obamacare partners is a good idea.

By Jessica Hall
Staff Writer
Auburn resident Brenda Weeks uses a power wheelchair and has four to six doctor's appointments each month to manage her multiple sclerosis. Now a proposed health insurance deal may force the 54-year-old to switch physicians or buy a new policy.

Her doctors at Central Maine Medical Center in Lewiston would not be part of a health insurance network proposed by Anthem Blue Cross and Blue Shield, the state's largest health insurer, and MaineHealth, the state's largest network of hospitals and care providers.
A hearing will be held Friday by Maine's Bureau of Insurance on the proposed partnership between Anthem and MaineHealth. The pact includes 32 of the 38 hospitals in the state, but excludes the three hospitals owned by Central Maine HealthCare in Lewiston, along with Parkview Adventist in Brunswick, York Hospital in York and Mercy Hospital in Portland.
Some doctors are upset that they would be excluded from the plan, and some patients fear that they would no longer be able to go to the doctors and hospitals they now use. The proposal appears to run counter to President Obama's pledge that people will be able to keep their doctors and their health plans.

Dems to Kathleen Sebelius: Seniors confused on Obamacare
By: Paige Winfield Cunningham and Jennifer Haberkorn
June 27, 2013 05:13 AM EDT
Congressional Democrats told Health and Human Services Secretary Kathleen Sebelius on Wednesday that Americans are still very confused about the health care law — including older people who worry that Obamacare will change their Medicare.
Sebelius went to the Hill for another update with Democrats on Obamacare rollout. HHS this week overhauled its website, focusing more on the exchange enrollment, which starts Oct. 1.
Joining Sebelius after the meeting, House Minority Leader Nancy Pelosi praised HHS’s work so far.
“The implementation of this is fabulous,” Pelosi said. “As we observe the Fourth of July, our founders talked about the Declaration of Independence guaranteeing life, liberty and the pursuit of happiness — that is what this is all about.”
Lawmakers reported that constituents still need help understanding the changes to health care.
“There are seniors, someone mentioned, who are coming to town hall meetings and wondering what do they have to do differently,” Rep. Allyson Schwartz (D-Pa.) said after the session. “And they don’t; they are going to be fine.”

Navigators Will Play Key Role As Marketplace Launch Nears

By Frank Diamond, for the Philadelphia Inquirer
Barbara Bloomfield had it all figured out. When she retired from her job at the Pennsylvania Department of Environmental Protection, she would get into solar energy.
"But then I suddenly got arthritic knees, and I had to go for physical therapy and I thought about all the people who didn't have health care," said Bloomfield, 70, of Chestnut Hill, Pa. "So I decided to get involved in supporting the Affordable Care Act just before it came up for a vote in Congress."
She also volunteered with the Philadelphia Unemployment Project, helping those with no health coverage navigate the Byzantine world of insurance.
Navigate is the key word.
Under the act, insurance exchanges will start open enrollment on Oct. 1, essentially through websites and call centers that the uninsured and others can use to buy coverage. The actual plans will start Jan. 1. Most people will need to be insured next year or pay a penalty. Tax credits may help individuals who are up to 400 percent of the poverty line. For some, it will be the first time they have health insurance.

Test-Driving The Obamacare Software

All the outreach in the world won't count for much if the Obamacare ticket counter doesn't work.
Behind the campaign to educate the uninsured about the Affordable Care Act is the assumption that software to sell the plans will be ready and user-friendly by Oct. 1, when enrollment is supposed to start. That assumptionisn't universally shared. Some wonder if systems will be tested and finished on time. Others worry the programs will lead consumers to make dumb insurance choices.
Kaiser Health News got an early look at the exchange software that will be used in Minnesota, Maryland and the District of Columbia. A company called Connectureis developing the Web interface for consumers under 65 who don't have employer-based health coverage to shop and sign up for a plan in those states.
Connecture isn't handling the software that qualifies you to buy under the health act or verifies your eligibility for subsidies. Other companies are taking care of those. Connecture's piece is the point-of-sale program, the one that steers you through insurance choices and closes the deal.

Executive summary
Healthcare organizations, hurt by a squeeze on reimbursements and what might best be described as a recession “hangover,” have spent the past few years adapting to more modest growth rates. The industry will continue those efforts in 2014, including pushing
care to locations and personnel that cost less.
The tepid economic recovery continues to impact the health sector. The slowdown—and even decline—in personal wealth has tamped down demand for healthcare. As we reported a year ago, the sluggish recovery has created a “new normal” in healthcare spending patterns.
Individual consumers, bearing more financial responsibility for their medical bills, are questioning and sometimes delaying procedures, imaging, and elective services. New delivery models, such as accountable care organizations (ACOs) are promising, but their prospects
for significant savings remain largely unproven.
The ACA will also play a role in the slowdown in 2014, with hospitals working to hold down expensive readmissions (or face the law’s penalties) and employers being given greater power to influence employee behavior through increased or discounted premiums—up to 50% in some cases.

Wednesday, June 26, 2013

Health Care Reform Articles - June 26, 2013

US Medicaid official visits Portland for training on Obamacare insurance exchanges

Posted June 24, 2013, at 3:42 p.m.
PORTLAND, Maine — A federal health official visited Portland Monday as the Obama administration ramps up outreach efforts around Affordable Care Act provisions set to kick in later this year.
Raymond Hurd, regional administrator for the federal Centers for Medicare & Medicaid Services, led a training forum with area health care organizations at Maine Medical Center. The forum aimed to make Maine health care providers familiar with the insurance marketplaces central to the act, commonly known as Obamacare.
Hurd told the BDN Monday morning that many people are unaware that the Affordable Care Act is still on the books, after surviving Republican repeal threats and a challenge before the Supreme Court. Even fewer, he said, realize that open enrollment in the federally mandated exchange begins on Oct. 1 of this year.
At that point, Hurd said, Americans will be able to log onto and shop for federally approved health insurance plans through a single Internet portal. The website until then is setup to answer consumers’ questions about the coming changes.
The law’s so-called individual mandate requires everyone — at least those who don’t qualify for certain hardship exemptions — to get health insurance or risk being fined for noncompliance.
The law also aims to make health insurance more accessible by eliminating lifetime caps on payouts, preventing insurance firms from denying people coverage because of pre-existing conditions and limiting the criteria they can use to increase rates, Hurd said. By dramatically increasing the number of customers in the market, he said, the insurance industry’s cost burden will be spread out over a larger number of people and the prices lowered.

Republicans can help make health-insurance exchanges work

Posted June 23, 2013, at 12:13 p.m.
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures — and they should want the law’s exchanges to be successful as much as the president does.
The new state insurance exchanges are supposed to start selling health coverage Oct. 1. The idea behind these marketplaces is that allowing apple-to-apple comparisons between health plans will foster competition and lower prices. Most Republican governors and legislatures, however, have resisted running their own exchanges; 19 states have refused to play any role whatsoever.
Continued resistance could hamper an already fraught process. In a report this week, the Government Accountability Office warned that the federal government is behind schedule in building exchanges in states that have refused to do so. This makes it even more crucial that all states pitch in to help.
Why should Republican opponents of the exchanges change tack now? First, there are the crass politics: Many residents who stand to benefit are their constituents. Federal exchange subsidies are available for people earning between 138 percent and 400 percent of the poverty level, or $32,500 to $94,200 for a family of four. According to 2012 exit polls, 42 percent of people with family incomes between $30,000 and $50,000 voted for Mitt Romney; for those earning between $50,000 and $100,000, the share was 52 percent. If Republican governors think stonewalling exchanges hurts only Democrats, they’re wrong.
Then there are the economic reasons: States with weak exchanges could become less attractive to businesses. John Hickenlooper, the Democratic governor of Colorado, said this week that his state supports its insurance exchange in part to help small businesses, which want healthy and productive workers.
Finally, and most compellingly, there is the human reason — rather, 25 million human reasons. Well-run exchanges will make getting health insurance easier and more affordable. Even philosophical opponents of the Patient Protection and Affordable Care Act must cede this practical point. Obamacare also happens to be the law of the land.
Some Republican governors have already accepted a role in their exchanges. Iowa and Michigan are partnering with the federal government, while Idaho, Nevada and New Mexico agreed to build their own. It’s too late for other states to follow those courses, but there are still meaningful steps they could take.
One thing they can do is smooth the path for “navigators” — people or organizations that will help others shop for insurance on the exchanges. Florida requires navigators to register with the state, and Pennsylvania is considering a similar move. This should be fine as long as registration is quick and straightforward.

Health Exchange Outreach Targets Latinos

Andrea Velandia, 29, is just the sort of person the architects of the new health insurance marketplaces had in mind when they were thinking about future customers.
She's young, in good health, uninsured and Latino.
"We're very healthy. We don't have many issues," she says of her family. For the most part, she and her husband avoid the health system. "It's very expensive to go to the doctor to get a regular checkup," she says. "And you only have an option to go to the emergency room, which is even more expensive."
On Oct. 1, Velandia, who is from Colombia, will be able to sign up her family of four for a subsidized health insurance policy in the new Maryland Health Benefit Exchange, the state's online marketplace for insurance policies created under the Affordable Care Act.
And just as Latinos were crucial to President Obama's re-election in 2012, they are now key to the implementation of his health law.

In First, F.D.A. Rejects Tobacco Products

The Food and Drug Administration announced on Tuesday that for the first time it had begun exercising its power to regulate cigarettes and other tobacco products, an authority it was given under a 2009 law supported by President Obama.
Agency officials said they had authorized the sale of two new products — both of them Newport cigarettes made by the Lorillard Tobacco Company — and rejected four others. The law forbade them to name the rejected products, they said.
Before the law, cigarettes were manufactured without any federal regulation. Instead, states decided where and how tobacco products would be sold, but had no authority over the ingredients they contained. Now, the F.D.A. is deciding which new products can be sold. In addition to cigarettes, the agency’s authority covers loose rolling tobacco, chewing tobacco and snuff.
The agency can reject cigarettes and other tobacco products that its scientists believe pose public health risks above and beyond comparable products already on the market, a sharp departure from past practice, when tobacco companies could change existing products and introduce new ones at will.
Advocates said the F.D.A.’s use of this authority was a milestone.
“This is the first time in history that a federal agency has told tobacco companies that they could not market a new or modified cigarette because of the public health problems they pose,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group.
Dr. Margaret A. Hamburg, the F.D.A. commissioner, called the development “historic,” and said that the F.D.A. was the only agency in the world that possessed such powers. Under the law, the agency can also limit ingredients in tobacco products like nicotine. Federal officials say they are currently studying how to exercise this authority.

Our View: Maine kids' health shows value of MaineCare

Even poor children are in better health here thanks to the previous Medicaid expansion.

How we treat the most vulnerable members of our society says a lot about the kind of society we are.

Nowhere is that more true than in regard to our treatment of children. How well are they being educated? How many of them are living in poverty? Are they healthy, and are they getting the care they need to stay healthy? Are they being raised in families, neighborhoods and communities that nurture them?
Maine ranked first among the states in terms of the health of its children, according to a private charity's recent report on the status of American children, even while the number of children living in poverty grew.
This speaks volumes to the critical importance of safety-net programs in tough times and to the foresight state lawmakers showed when they expanded eligibility for health insurance under MaineCare to include more low-income children and pregnant women, in one of a series of steps starting in 1999. These decisions have been the focus of much second-guessing over the past few months.

Bill Nemitz: LePage win on Medicaid could be short-lived

Updated: 6:46 AM

Maybe it's too soon, the temperature outside pushing 90 degrees and all, to talk about January.
Yet there House Speaker Mark Eves sat in the State House this week, doing just that.
"We're just not going to stop fighting to ensure 70,000 Mainers have health care," Eves said in a telephone interview Monday. "To that end, we're going to be bringing forward emergency legislation in January to accept these federal dollars."
(We now pause for the obligatory high-fives amongGov. Paul LePage and Republican lawmakers, who last week drove the final stake into Maine's plan to accept $350 million in federal Medicaid expansion funds over the next three years -- money that will now go to other states while those 70,000 needy Mainers limp along without health coverage.)
Much has been said in recent days about how leaders of the Legislature's Democratic majority a) blew this one, b) did everything humanly possible to get their Medicaid expansion proposal passed, or c) were doomed from the get-go in their effort to hitch Maine to the federal Affordable Care Act.
Should they have tied the Medicaid expansion, quid pro quo, to LePage's top priority of paying off Maine's $184 million debt to the state's hospitals?
And once they linked Medicaid and the hospitals, should the Dems have doubled down on their promise, "No Medicaid expansion, no hospital payment?"
And what about when LePage swatted that threat away by vetoing the whole deal and corralling just enough Republican lawmakers to thwart an override? Were the Dems nuts to split the two issues and watch helplessly as the hospital payment sailed to easy passage while the Medicaid bill, torched by a second LePage veto, went down in partisan flames?

Report says poor Maine kids aren’t getting dental care, but dentists disagree

Posted June 25, 2013, at 5:13 p.m.
AUGUSTA, Maine — Maine is one of 10 states where low-income children are least likely to receive dental care, according to a national report released Tuesday that stands to reignite a months-long legislative debate that has pitted dentists against those who support allowing a new type of dental provider in the state.
The report by the Washington, D.C.-based Pew Charitable Trusts also ranks Maine second for the percentage of its dentists nearing retirement age (48.4 percent are older than 55) and in the top 12 for the share of its population living in certified dentist shortage areas (15.8 percent).
The report’s recommended solution is introducing a new type of dental provider, a dental hygiene therapist, who would perform some procedures, such as extractions and fillings, that are currently performed only by dentists.
The report comes days after the Maine Senate rejected heavily lobbied and hotly debated legislation that would have allowed dental hygiene therapists to open up shop in Maine.
The Pew Charitable Trusts was the main force behind the legislation in the Maine State House, registering 13 lobbyists who focused on the dental therapist bill, according to Maine Ethics Commission records. And Pew Charitable Trusts plans to continue pressing future Legislatures to allow dental hygiene therapists in Maine even after the Senate’s rejection of the measure last week, said Mike Saxl, managing principal for the firm Maine Street Solutions, which lobbied lawmakers on Pew’s behalf.
“There’s a huge opportunity here to have a positive impact on kids’ health,” he said. “When Maine is leading the country in the number of kids who don’t have access to care and the number of dentists reaching retirement age, it seems like a no-brainer to pursue strategies to help people get access to care.”
The Maine Dental Association, which has eight registered lobbyists, pushed hard against the dental therapist measure. Jonathan Shenkin, a pediatric dentist in Augusta and a Maine Dental Association member, called Tuesday’s report “substandard” and said it continued a campaign of misinformation Pew Charitable Trusts has used to push the dental therapist bill.
“It’s ineffective at helping policymakers navigate the complicated oral health policy arena,” Shenkin said. “If it does anything, it confuses people more about what’s best to do.”
The Pew report, citing federal government data, ranks Maine sixth in the nation for the percentage of children enrolled in Medicaid — 62.4 percent — who didn’t receive dental care in 2011.
But the Maine Dental Association points to a report from the Medicaid-CHIP State Dental Association that found Maine was one of four states that didn’t include patient visits to about 30 federally qualified dental clinics located across the state in the statistics it reported to the federal government. According to the dental association, those clinics had about 90,000 patient visits in 2011, including visits from thousands of children enrolled in Medicaid.

Vatican signs off on Mercy-EMHS merger

Posted June 25, 2013, at 10:23 a.m.
PORTLAND, Maine — Mercy Health System, which operates the city’s second-largest hospital, has taken another step toward merging with Bangor-based Eastern Maine Healthcare Systems.
The hospitals are on track to complete the deal in September, Mercy President and CEO Eileen Skinner said Monday.
Mercy received approval from the Vatican last week to transfer assets to EMHS, Skinner said. The approval was necessary because Mercy is affiliated with the Roman Catholic Church.
Mercy signed a letter of intent to negotiate its sale to EMHS on Dec. 7, 2012, after previous negotiations fell through with Steward Health Care System, a for-profit Massachusetts hospital chain.
Since then, the proposed sale has made rapid progress.
After inking a “definitive affiliation agreement” in January, Mercy and EMHS received antitrust clearance from the Federal Trade Commission in March. On May 7, the state Department of Health and Human Services held a public hearing on the two hospital networks’ application for a certificate of need to complete the merger.
” That hearing was a love fest,” Skinner said, noting that physicians, patients, and other community members spoke in favor of the merger, while no one expressed opposition.
The certificate of need application is now under review by the state. A decision is expected by September, and if the certificate is granted, it would be the last step before the transaction is completed.
Joining EMHS would represent a major change for Mercy, which was founded in 1918 as Queen’s Hospital and later changed its name after the Sisters of Mercy, a Catholic order of nuns, took over operations. Today, Mercy operates 230 hospital beds at its State Street and Fore Street campuses, as well as primary care clinics and urgent care centers.
Unlike Mercy, EMHS has no religious affiliation, although both networks are nonprofit organizations. EMHS comprises seven member hospitals in central and northern Maine, including its flagship 350-bed facility in Bangor, Eastern Maine Medical Center. The network also includes physician practices, nursing homes and home health organizations.
While the differences in geography and affiliation might make the merger seem an odd pairing, Skinner said the potential partners complement each other.
“The cultural fit is strikingly positive,” she said. “The way [EMHS] approaches goals is almost identical. Working with [EMHS] is almost like working with ourselves.”
According to Skinner, the driving force behind the merger is the federal Affordable Care Act — also known as “Obamacare” — and its creation of “accountable care organizations,” which are health-care networks that are paid on the basis of quality measurements and cost efficiency. The change is putting new economic pressures on hospitals, many of which are teaming up in response.
“This is about population health, and you have to get scale,” she said. “This is not about moving Mercy patients up to Eastern Maine Medical Center.”

Republicans should back a single-payer health care system

By Jack Bernard
The Augusta (Ga.) Chronicle, June 23, 2013
My party, the Republican Party, has staked out amazingly naïve positions on two of the key domestic issues facing us: immigration and health reform. These issues are intertwined.
Health Affairs, one of the most influential professional health care journals, has published a new Medicare study, conducted by Harvard and City University of New York researchers. It found that immigrants were responsible for 8 percent of Medicare expenditures – no surprise there.
What was astounding to me and many others was that nearly 15 percent of Medicare trust fund collections came from this same group of people. In other words, immigrants put in nearly twice the amount of money that was paid out to them.
In 2009 alone, the net gain to Medicare from immigrants was $13.8 billion, whereas native-born Americans had a deficit of $30.9 billion. Much of this difference can be accounted for because of low birth rates and the aging of our U.S.-born population, while immigrants are a much younger cohort. Further, immigrants cost Medicare less on health care because of a variety of reasons.
The bottom line: We need immigration to balance the books for Medicare, as is also true with Social Security. Without it, we will either have to cut benefits or dramatically raise taxes on a proportionally smaller and smaller work force.
So, at least for these programs, the fiscal side is clear. Immigration is a net plus.
What about the political side?
Many GOP strategists finally are seeing what I have said all along: In 2012, the party shot itself in both feet regarding immigration. Pandering in primaries may win you the nomination, but advocating for ridiculously impractical positions will not win the presidency. In any case, the deportation of 11 million people is something that will never happen, no matter who is president.
By opposing true immigration reform, including a path to citizenship, the uncompromising right wing of the GOP has accomplished two things. Both are long-term negatives for the party.
First, these “nativists” alienated legal immigrants and their families for generations to come. Hispanic voters are being driven to the Democrats, which will cause increased losses in key swing states, such as Texas and Georgia, over time.
Second, as U.S. Sen. Marco Rubio of Florida has correctly stated, by blocking congressional action the right-wingers are in effect continuing unrestrained immigration. Since there has been no national progress on immigration reform, including border security, the illegal problem just gets worse and worse.
Similarly, Republicans have staked out a losing long-term health care position: Just repeal the Affordable Care Act (Obamacare) and simply let competition reign. But voters are skeptical of the same old worn-out GOP slogans: Medicaid block grants, Medicare vouchers and weakened regulations.
None of these measures will significantly stop rapidly escalating systemic health care costs or control premiums. Most simply shift risk and/or expenses to the patient or the states – something voters do not like.