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Sunday, September 1, 2013

Health Care Reform Articles - September 1, 2013


Public Angrily Weighs in on Anthem Insurance Proposal

But there's a catch the new plans would exclude providers at six Maine hospitals, and that means subscribers would have to find new doctors. Critics say that Anthem is teaming up with MaineHealth to create a monopoly at the expense of patients.

Opponents of the plan made their feelings known, emphasizing their disapproval with applause for those who spoke against it. Many wore lime green t-shirts that said "Please keep care local." Craig Smith is a primary care physician in Bridgton who says he will not be included in Anthem's new provider network.

"You are essentially cutting out an enormous number of hospitals, an enormous number of providers and patients, and treating our patients like sheep who are just being loaded on trucks and driven across the state to see somebody else. It's disgusting," Smith said.


On Obamacare, a chance for Congress to do something useful

The Affordable Care Act faces a monumental public relations challenge as some of its major provisions start to take effect in the coming months.
First, there’s the popularity challenge.
In mid-June, 43 percent of Americans had an unfavorable view of the health care reform bill signed into law in 2010, according to the Kaiser Family Foundation’s health tracking poll. Thirty-five percent of Americans held a favorable view.
Among likely voters, Rasmussen Reports last week found the split was 41 percent favorable, 54 percent unfavorable.
Some 33 percent of respondents told Kaiser’s pollsters the law would make them worse off, compared with 19 percent who thought they would be better off because of the law and 40 percent who thought it would make no difference.
But regardless of what people think of the Affordable Care Act, there’s nearly universal agreement that health insurance is basically a necessity. Eighty-seven percent of respondents agreed that having health insurance was “very important” to them.
Then — and perhaps more importantly — there’s the awareness challenge.
In April, Kaiser’s tracking poll found 42 percent of Americans thought the Affordable Care Act was no longer the law.
Indeed, House Republicans have voted 40 times to repeal the law they hate with all their might — but for which they have no alternative. Their repeal votes won’t go anywhere in a Democratic Senate and while Barack Obama is president, but their repeated attempts to overturn the law could be having a public relations effect. Twelve percent of Americans in April thought Congress had overturned Obamacare.
In that context, try conveying to the public what a complicated law actually does, and you have a major public relations puzzle on your hands.
Enter members of Congress.
In 2014, 7 million Americans are expected to enroll in individual health insurance plans through online insurance marketplaces. Enrollment in those marketplaces opens Oct. 1. A majority of those 7 million Americans — the Kaiser Family Foundation estimates 65 percent — haven’t previously had health insurance coverage.
It’s also safe to say a significant portion of those 7 million aren’t yet aware of the coverage options that will be available to them and how they can enroll.
How can members of Congress help when so many of them have sought only to destroy the Affordable Care Act?
Senators, representatives and their staffers will be among those 7 million Americans expected to enroll in health insurance exchanges during the exchanges’ first year (enrollment is expected to reach 24 million by 2017). Under a provision in the law that was originally an attempt to sink it altogether, members of Congress and their staffs will drop the coverage they receive through the Federal Employees Health Benefits program on Jan. 1. In its place, they’ll choose from the plans offered in their states through health insurance exchanges.
Since our elected officials will be navigating health insurance exchanges just as millions of other Americans are, members of Congress can serve as examples to their uninsured constituents.
Senators should speak openly about how they’ll decide which coverage option is best for them and how they’ll learn about the available options. Representatives should show their constituents how they plan to sign up for coverage. (In Maine, residents will access the state’s health insurance exchange through www.healthcare.gov.)
People who need insurance will pick up bits and pieces of information through the public awareness campaign the White House is making a top priority this year. But they’ll probably learn best through example. And members of Congress are examples with big mouthpieces.
Of course, we’d expect the members of Congress who support the Affordable Care Act would be more eager than their colleagues on the other side of the aisle to take on this role. We can already hear the partisan accusations from Obamacare critics aimed at members of Congress who try to show their constituents how they can obtain health insurance.
But is it really advancing a purely political cause to help constituents obtain health insurance coverage — something that 88 percent of them say they need?
We look at it as an opportunity for a Congress that hasn’t been able to accomplish much to, at last, do something useful.

Doctors Badmouthing Other Doctors

By PAULINE W. CHEN, M.D.
A physician friend known for her conscientious work recently disclosed that a year ago she was named in a malpractice lawsuit. The revelation rattled me not only because there were no discernible errors in the care she provided, but also because I couldn’t believe who had provoked the patient to hire a lawyer.
It was another doctor.
“I’m shocked that nothing was done sooner,” the other doctor had said when the patient went for a second opinion. “You could have died.”
The patient later decided to sue.
Like many who heard the story, I was quick to criticize the other physician. Throughout training and regularly at work, we are reminded of the importance of professionalism and respect. Shifting blame, doctors are taught, demoralizes other clinicians, undermines patient trust and compromises patient outcomes.
Surely, I thought, the doctor who had trashed our colleague was out of line, his comments aberrant. But it didn’t take long for me to recall instances when friends and I had been equally critical about other doctors’ work. And while I wanted to remember those indiscretions as private, limited to a few colleagues at most, I wasn’t entirely sure.
I had to wonder: are we all capable of talking like that in front of patients?
The answer, according to a recent study in The Journal of General Internal Medicine, is an unqualified and disturbing, “Yes.”
Over the last decade, few issues have garnered as much interest among health care experts as disrespectful behavior among doctors. While sociologists have devoted careers to researching the topic, it wasn’t until the 1990s that the medical profession itself began to take serious note.
Spurred on by the increasing complexity of medicine, concerns about safety and patient satisfaction and an ever-growing urgency to contain costs, the Institute of Medicine convened a national panel of health care experts to discuss “the chasm” between what could be and what was actually being done for patients. In 2002, they published anambitious report that called for a “sweeping redesign of the entire health system.” Realizing that vision, said the panel, would require, among other changes, better collaboration and cooperation among physicians and the creation of a “culture of respect.”

MaineCare underfunding hurts facilities

Posted:Today
Updated: 9:33 AM 

The crisis at nursing homes and assisted-living centers is getting some lawmakers' attention.

By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
Maine's long-term care system is in trouble and state lawmakers are starting to notice.
St. Joseph's Rehabilitation & Residence in Portland is discharging 34 residents to make way for a major renovation intended to attract more private-pay residents and help offset the underfunded cost of MaineCare recipients.
Houlton Regional Hospital will close its nursing home wing later this month, eliminating 28 long-term care beds and putting additional strain on a 90 percent occupancy rate among Maine's nursing homes.
The Penobscot Nursing Home and Northern Bay Residential Care in the Hancock County town of Penobscot are financially solvent again after being placed in receivership in 2008. However, they still face the challenges of underfunded MaineCare reimbursements and a rapidly growing senior population that has more acute physical and mental health needs.
"We're paying our bills," said Irving Faunce, the administrator who was appointed to steer the Penobscot facilities out of the red.
"But Maine- Care reimbursements haven't increased for several years, which means it's very difficult to generate a positive bottom line," Faunce said.
Meanwhile, the spectrum of geriatric health issues that assisted-living facilities and nursing homes are dealing with is larger than ever, Faunce said. Many long-term care residents have several illnesses, such as heart disease, kidney failure, diabetes and dementia, while the number of seniors with mental illness is growing, too.

Washington Notebook: Clinic head says 'doughnut hole' may last under Obamacare

Posted:Today
Updated: 12:59 AM

A sizable population will be left without health insurance, Caroline Teschke of the Portland Community Free Clinic says.

By Kevin Miller kmiller@mainetoday.com
Washington Bureau Chief
The Portland Community Free Clinic caters to Mainers caught in the dreaded "doughnut hole" -- earning too much to qualify for MaineCare but too little to buy health insurance.


The Affordable Care Act -- also known as Obamacare -- was intended to reduce the ranks of the uninsured. But the law may not necessarily close the "doughnut hole," according to Teschke. The administration of Gov. Paul LePage resisted efforts to expand MaineCare, the state's Medicaid program, under the law. And a sizable population will remain who won't be able to afford subsidized insurance on the new health care exchanges that start on Oct. 1, Teschke predicted.
During a tour of the facility last week, U.S. Rep. Chellie Pingree told clinic workers and volunteers that she's "thrilled" the clinic fills a needed gap in services, but that she wishes universal health insurance would make free clinics unnecessary. Pingree is married to S. Donald Sussman, majority owner of MaineToday Media, publisher of the Portland Press Herald/Maine Sunday Telegram, Kennebec Journal and Morning Sentinel.
Meanwhile, the political battles over Obamacare will continue this month in Washington as some Republicans attempt to defund the controversial law even while Congress attempts to work out a larger budget deal to avoid a government shutdown.

Young adults may be less resistant to join Obamacare

By arah Kliff, The Washington Post
Posted Sept. 01, 2013, at 6:31 a.m.
WASHINGTON — The conventional wisdom is that young adults, the so-called young invincibles, will prove the hardest demographic to sign up for coverage under President Barack Obama’s health-care law.
But one market research firm recently completed a survey of more than 3,500 uninsured Americans that shows young adults might actually be the easiest recruits.
“I think the fear that the risk pool is going to be very sick people is unwarranted,” said Richard Hamer, managing principal at Minneapolis-based Deft Research. “I think a lot of studies show that the main obstacle is affordability, and that just won’t be as much of an issue with younger people.”
The Obama administration has made no secret of whom it wants to sign up: the young and healthy. These are the people who tend to have the lowest health-care costs — and they are why the White House is taking meetings with people from Web sites such as Funny or Die, encouraging them to promote the law.
The concern for months has been that young people won’t sign up for health insurance. The reason the White House needs them — their low health-care costs — is the same one that could make them the least likely demographic to purchase health care.
Deft Research, in conjunction with the consumer information site HealthPocket, surveyed 3,584 uninsured people in an effort to determine whether that was true.
“Our objective was to figure out who is most likely to buy,” Hamer said. “The first year’s tax penalty isn’t that high so there’s not much of a penalty. So we asked a series of questions about attitudes toward health insurance.”
Among the questions they asked the research participants: “If you were considering health insurance for next year, and these two options were your only choices, which would you be most likely to choose?”
Choice A was a health plan that came with an average premium of $320. For those who earned less than 400 percent of the poverty line and would qualify for financial assistance, they were given the subsidized price.
Choice B was not buying health coverage and paying the $95 tax penalty.
They found that young adults with lower incomes were the most likely to say they would go with Choice A.

GOP Lawmakers Demand Information From Groups Getting Navigator Grants

TOPICS: HEALTH REFORM, POLITICS, INSURANCE
By MARY AGNES CAREY
KHN Staff Writer
AUG 30, 2013
In a move that the administration described as a "blatant and shameful attempt to intimidate," 15 Republican members of the House Energy and Commerce Committee are asking recipients of the $67 million in health law navigator grants to brief the panel on how they intend to spend the money. 
The Aug. 29 letter directs the grantees to schedule a meeting no later than Sept. 13 and to provide additional documentation, including a written description of the work they intend to do, the number of employees and volunteers, their duties and how much they’ll be paid.
The committee members are also requesting information about how the navigators will be trained and monitored. "All documentation and communication" related to the grant, including application materials, are requested, including any communication between their organization and federal agencies involved in the health law, such as the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, according to the letter.
In addition, the letter asks for documentation of any contact with Enroll America, a group with close ties to the Obama administration. The organization is trying to educate consumers about new insurance options and drive enrollment in the new marketplaces opening this fall for coverage that takes effect in January.
Navigators will provide assistance on the phone and in person to individuals signing up for coverage in the health law’s insurance marketplaces, as well as for public programs including Medicaid and the Children's Health Insurance Program. They will receive 20 hours of online training and have to pass a test before they can start working. Their efforts could include help in evaluating health plans for sale on the marketplaces, also known as exchanges. They are not, however, allowed to expressly tell people which policy to choose.
Timothy Jost, a professor at Washington and Lee University School of Law, called the letter "an obvious attempt at intimidation of navigator programs, most of which are nonprofits that don’t have the resources to hire lawyers to fight this, nor the time to respond at this very busy time. ... This attempt to bully these programs is shameful." 
Erin Shields Britt, a spokeswoman for the Department of Health and Human Services, said, "This is a blatant and shameful attempt to intimidate groups who will be working to inform Americans about their new health insurance options and help them enroll in coverage, just like Medicare counselors have been doing for years."



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