Friday, January 31, 2014

Health Care Reform Articles - January 31, 2014

Doctors cut from Medicare Advantage networks struggle with what to tell patients

By Published: January 25

Thousands of primary-care doctors and specialists across the country have been terminated from privately run Medicare Advantage plans, sparking a battle between doctors who say patient care is being threatened and insurers that insist they have to reduce costs and streamline their operations.
Medical associations, which describe the dismissals as the largest in the program’s history, say the cuts are forcing some patients to leave their doctors in mid-treatment and creating gaps in the types of medical specialists covered in some areas. They’re taking their protests to court, and having some success.
In December, a federal judge in Connecticut issued an injunction that temporarily prohibits an insurer from dismissing doctors in Fairfield and Hartford counties. Another lawsuit is pending in New York, and doctors groups in several other states are threatening legal action.
The American Medical Association, the nation’s premier doctors organization — along with 39 state affiliates and 42 patient and medical specialty groups — has called on the Obama administration to intervene and put pressure on insurers to reverse the terminations.
Insurers say they must shrink their physician networks because they face billions of dollars in government-payment cuts over the next decade — reductions that are being used partly to fund insurance coverage for millions of people under the federal Affordable Care Act. They also say the smaller networks will allow them to curb premium increases and to remain nimble as they prepare for an influx of patients under the law.
Medicare Advantage, an alternative to traditional Medicare, covers 13 million beneficiaries, or 27 percent of the people in the federal health-care program for the elderly. Besides providing the standard benefits, the thousands of Medicare Advantage plans often offer extra perks such as free eyeglasses and adhesive bandages. They can do that because, for years, the government has paid the plans more, per patient, than it spends on regular Medicare.
That has been a sore point for Democrats, who used the health-care law to cut payments to Medicare Advantage by $156 billion over the next decade.

Notification complaints
The doctor terminations, most of which took effect Jan. 1, are striking a nerve partly because of the way insurers have notified some physicians.

The Washington Post, Wonkblog, Jan. 24, 2014

Moody’s just downgraded the health insurance industry. Obamacare was part of the reason.

By Sarah Kliff 

Stephen Zaharuk is a Moody's senior vice president who covers the health insurance industry. That makes him the guy who authored the report downgrading the credit outlook for health insurance companies from "stable" to "negative" on Thursday. We spoke Thursday afternoon about his outlook for the health-care industry, the big unknowns looming in 2014, and why the downgrade happened now. Some of his quotes made it into this story in Friday's paper and what follows is a transcript of our discussion, lightly edited for clarity.

Sarah Kliff: In your report on health insurers, you list a lot of different factors that contributed to the downgrade. Can you give any sense of how important each one was? Was it the rocky rollout of the health-care law driving this? Or something else?

Stephen Zaharuk: Each one has an effect. We started with the Affordable Care Act, which obviously has the most interest as the newest piece. Basically we're seeing the rollout, which wasn't as sufficient as it should have been, and we're not seeing the enrollment numbers that were expected, based on the insurers' pricing assumptions. We're also hearing about back-end issues, which haven’t been in the forefront of  the news. The more concerning thing is, are they going to get paid the premiums that they need in the exchanges?

Also concerning is the fact that, because of this rollout, there are changes made to regulations. We changed the enrollment dates and extended enrollment for a period of weeks, and kept policies that aren't compliant with the Affordable Care Act for another year. All these things, they are probably not, by themselves, a big worry. But together they add more risk. There's a concern there could be more of these to come. Once you have the precedent of changing a regulation with an announcement like that, that makes the financial landscape uncertain.

That's all to do with the Affordable Care Act. We also have Medicare Advantage which is a big program for insurance companies. About 28 to 27 percent of seniors are signed up for that. In 2014, there was a lowering of the amount they get to provide that care, and they're scheduled to get another reduction. We’re concerned about how far these cuts will go, and how long this will be a viable product. You might see a lowering of benefits, or some might exit the marketplace.

And then there’s just the normal pressures we are seeing because of the economy. Employment is not not as robust as we'd hoped, so commercial membership is pretty stagnant.

Key Senate Republicans Offer Their Plan To Replace Obamacare

Republicans have offered a wide array of proposals to "repeal and replace" the Affordable Care Act since it became law in 2010. But few have come with the pedigree of the plan just unveiled by a trio of senior Senate Republicans.
The Patient Choice, Affordability, Responsibility and Empowerment Act, or CARE for short, is a proposalbeing floated by Sens. Richard Burr, R-N.C., Orrin Hatch, R-Utah, and Tom Coburn, R-Okla.
Hatch is the senior Republican on the Senate Finance Committee; Burr is on the health subcommittee of theHealth, Education, Labor and Pensions Committee; Coburn is a physician. All three have spent much or all of their legislative careers working on health policy.
"Obamacare just isn't working," Hatch said on the Senate floor Monday afternoon. "Try as he might during tomorrow night's State of the Union address, President Obama will not be able to convince the American people that his health care law is anything other than an unmitigated disaster."
At a briefing for health reporters, aides to the senators said the goal of their proposal is to focus on bringing down costs. Hence the plan would repeal the ACA's requirements that most people have insurance, as well as requirements that insurers offer minimum benefits and employers offer insurance or face potential fines.
The Republican proposal also would eliminate most of the taxes and fees that the law imposes to pay for the generous tax credits offered to help people pay for the required insurance.
And the plan would repeal the requirement that insurers cover people with pre-existing health conditions, although people who remain "continuously covered" for at least 18 months could not be denied or charged more. And while the plan would keep the ACA's ban on insurers' imposing a lifetime limit on insurance benefits, annual limits could return.
The GOP plan offers its own set of tax credits to help those with lower incomes afford coverage, and like those in the ACA, they would be adjusted for age but not for geography. That means the tax credit would be the same across the nation, even though insurance costs differ widely in different parts of the country.

Antibiotics in Animals Tied to Risk of Human Infection

Sunday, January 26, 2014

Health Care Reform Articles - January 26, 2014

PA Man Confronts Governor For Refusing To Expand Medicaid: ‘How Many People Have To Die?’

This week, Pennsylvania Gov. Tom Corbett (R) had a run-in with one of his constituents [3] as he was leaving a fundraising event. Scot Rosenzweig — who identified himself as a fellow Republican — showed Corbett a large photograph of his fiancee, Dina Nelson, who died at the age of 41 because she was uninsured and couldn’t afford a liver transplant. “I think maybe we should consider accepting the Medicaid expansion,” Rosenzweig told his governor, explaining that people like Nelson need access to lifesaving health treatment.
“I can’t do that,” Corbett responded.
Corbett is one of 25 governors who have declined to accept [4] Obamacare’s optional Medicaid expansion, a move that is preventing an estimated 700,000 [5] low-income Pennsylvanians from accessing public health insurance. Rather than accepting the federal funds designated for expanding his state’s Medicaid pool, Corbett is trying to win federal approval for analternate plan [6], called “Healthy Pennsylvania,” that would give low-income people subsidies to buy private coverage. But Corbett’s plan has beensharply criticized [7] by anti-poverty advocates, who say it could actually reduce benefits for the state’s neediest constituents.
In his exchange with Rosenzweig, Corbett reiterated his desire to implement “Healthy Pennsylvania,” which he hopes to put in place by 2015. He said he can’t both accept Obamacare’s Medicaid expansion and fix the existing problems he sees with the Medicaid program. But that didn’t satisfy Rosenzweig.
“How many people have to die while we work on the problems?” he asked Corbett

High deductibles perpetuate system’s issues

By Jonathan D. Walker, M.D.
The Journal Gazette (Fort Wayne, Ind.), Jan. 14, 2014
“Doc, I need to get this done before my new deductible kicks in.” Physicians hear this a lot; it reflects the increasing use of so-called consumer-directed health plans, where people are responsible for the first several thousand dollars of care before their insurance company has to pay. If you don’t already have one, you probably will soon.
And, believe it or not, this trend has nothing to do with Obamacare. The adoption of high-deductible plans is a symptom of a deeper problem: the fact that everything costs way more in America than anywhere else. For decades, there has been so much money sloshing around the system that there has been an “arms race” over who can charge the most. And for-profit insurance companies have never had the leverage to actually bring those prices down – the system is too fragmented.
There are some good things that come from those prices; part of that money goes to developing new treatments and technology. But a lot of that money ends up being wasted. For instance, a huge amount is thrown away on needless bureaucracy. A 2003 paper in the New England Journal of Medicine estimated that up to 30 percent of our health care costs come from administrative waste.
And it gets even worse. Researchers have shown that some of the care provided may not be as necessary or effective as doctors think. For instance, there is a whole website created by the American Board of Internal Medicine to help doctors and patients decide which tests and treatments actually are useful (
So we have a system that is insanely expensive, that wastes money on needless paperwork and may not always provide the right type of care. But no one can fix it because it is too disjointed and unwieldy. So what do you do if you are a for-profit insurance company? You figure out a way to make someone else pay’s-issues

Obamacare coverage hits 3 million mark
By: Jason Millman
January 24, 2014 01:57 PM EST
The Obama administration announced Friday that 3 million people have signed up for health insurance through Obamacare exchanges since Oct. 1 — still behind the pace the administration hoped to set for the law’s first enrollment period but steady enough to encourage officials.
Signups in private plans through state and federal exchanges grew by about 800,000 since the end of December, when there was a late surge to sign up for coverage that started Jan. 1. Before the health care law’s deeply flawed rollout, the administration hoped to have 3.3 million in exchanges by the end of December and 7 million by the time the 2014 enrollment season closes March 31.
Officials are counting on another significant surge by the end of March.
PHOTOS: 12 Democrats criticizing the Obamacare rollout)
“As our outreach efforts kick into even higher gear, we anticipate these numbers will continue to grow, particularly as we reach even more uninsured young adults, so that they know that new options and new ways to help eligible individuals pay for their premium are now available,” Marilyn Tavenner, the Centers for Medicare & Medicaid Services administrator, wrote in a blog post Friday.
Tavenner’s post didn’t provide any age breakdown or further details on the new enrollment figures, including how many people had officially completed enrollment by paying their first month’s premium. CMS also hasn’t said how many of those enrolling through exchanges previously lacked insurance.
White House Press Secretary Jay Carney said Friday that the latest exchange enrollment data represent a “dramatic improvement” from where exchange signups were last October. They show that the problems with were the major obstacle in getting people signed up — not Americans’ lack of interest in obtaining coverage, he stressed.
“How are we doing? I think that we’re making significant progress,” Carney said. “But you won’t hear anyone in this building … say that we’re done with this effort.

In Target’s wake, businesses plot Obamacare paths
By: David Nather and Paige Winfield Cunningham
January 24, 2014 05:54 PM EST
Target became the latest big company to follow the old drill: drop health coverage for some workers, blame Obamacare and watch Republicans pounce.
Home Depot and Trader Joe’s made similar changes to their health plans last year, and UPS limited coverage for spouses. Each time, it drew ugly headlines for the health care law.
While each situation was a little different, the initial conclusion that Obamacare was leaving consumers worse off starts to gets squishy when the details are unpacked. But an impression was created.
(Also on POLITICO: Obamacare coverage hits 3M mark)
And since many employers are still figuring out how to respond to the new law, it’s worth discerning lessons from Target’s announcement this week that it would stop offering coverage to part-time workers, give them $500, and advise them on signing up for health coverage on the new Obamacare exchanges.
Here are the Target takeaways:
More shoes are going to drop
Some business groups say they wouldn’t be surprised if more companies shift their part-time workers to Obamacare, if they ever offered them health coverage in the first place.
That’s because employers are still making decisions about how they’ll react to the health care law. The employer mandate, which will require all businesses with the equivalent of 50 or more more full-time workers to provide health coverage or pay fines, was delayed until 2015. Many businesses are still figuring out what they’ll do.
(Also on POLITICO: Ryan: Debt talks may target ACA)
And they’re still learning whether the Obamacare health exchanges are actually a viable alternative. The federal enrollment website,, is working better for the 36 states it serves, and states like California and Kentucky are having big successes with their own exchanges. But in several states, like Maryland and Oregon, the state-run websites are even worse than the federal one was and it’s not easy to enroll.
Some employers — including Starbucks — say they’ll keep covering part-time workers just as they have for two decades.
But some employers are sure to shift their part-time workers to the exchanges — especially in the retail and restaurant industries, which rely heavily on part-time workers. Every time that happens, especially with a well-known company like Target or Trader Joe’s, there will be another damaging headline that includes “Obamacare” and “dropped health coverage.”

Doctors Abusing Medicare Face Fines and Expulsion