The following article is another great example of the "free market" at work in health care.
- SPC
Patients’ Costs Skyrocket; Specialists’ Incomes Soar
CONWAY, Ark. — Kim Little had not thought much about the tiny white spot on the side of her cheek until a physician’s assistant at her dermatologist’s office warned that it might be cancerous. He took a biopsy, returning 15 minutes later to confirm the diagnosis and schedule her for an outpatient procedure at the Arkansas Skin Cancer Center in Little Rock, 30 miles away.
That was the prelude to a daylong medical odyssey several weeks later, through different private offices on the manicured campus at the Baptist Health Medical Center that involved a dermatologist, an anesthesiologist and an ophthalmologist who practices plastic surgery. It generated bills of more than $25,000.
“I felt like I was a hostage,” said Ms. Little, a professor of history at the University of Central Arkansas, who had been told beforehand that she would need just a couple of stitches. “I didn’t have any clue how much they were going to bill. I had no idea it would be so much.”
Ms. Little’s seemingly minor medical problem — she had the least dangerous form of skin cancer — racked up big bills because it involved three doctors from specialties that are among the highest compensated in medicine, and it was done on the grounds of a hospital. Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones.
With health law, less-easy access in N.H.
Lone insurer in plan reduces roster of hospitals to keep premiums low
WASHINGTON — When Nancy Petro needs routine tests to make sure her thyroid cancer and high blood pressure have not returned, the retired gas station attendant and general store clerk must now drive an hour over mountainous roads to seek care, even though there is a hospital just minutes from her home in rural northern New Hampshire.
Petro, 62, had been uninsured until January, when she obtained coverage through President Obama’s groundbreaking health law. The benefit, just $26 a month, came with a downside, however.
To keep premiums affordable, Anthem Blue Cross and Blue Shield of New Hampshire, the only insurer in the state offering coverage in the new insurance marketplace, radically reduced the hospitals in its network. Petro’s local provider did not make the cut.
Petro’s case reflects how Obama’s health law has upset the previous balance in the insurance landscape. As new coverage begins this month, most policies sold through the insurance marketplaces offer some type of restricted hospital network in exchange for lower premiums.
List of Smoking-Related Illnesses Grows Significantly in U.S. Report
WASHINGTON — In a broad review of scientific literature, the nation’s top doctor has concluded that cigarette smoking — long known to cause lung cancer and heart disease — also causes diabetes, colorectal and liver cancers, erectile dysfunction andectopic pregnancy.
In a report to the nation to be released on Friday, the acting surgeon general, Dr. Boris D. Lushniak, significantly expanded the list of illnesses that cigarette smoking has been scientifically proved to cause.
The other health problems the report names are vision loss, tuberculosis,rheumatoid arthritis, impaired immune function and cleft palates in children of women who smoke.
Smoking has been known to be associated with these illnesses, but the report was the first time the federal government concluded that smoking causes them.
The finding does not mean that smoking causes all cases of the health problems and diseases listed in the report, but that some of the cases would not have happened without smoking. The surgeon general has added to the list of smoking-related diseases before. Bladder cancer was added in 1990 and cervical cancer in 2004.
Navigating a New Health Plan, After the Surge
By ANN CARRNS
YOU’VE no doubt heard about problems some people are encountering when they try to use the health insurance they’ve bought through the federal and state exchanges. A backlog of applications, the result of a surge in enrollments at year’s end for coverage starting this month, has resulted in many people experiencing delays in getting insurance cards, policy numbers or authorization for treatment.
Keith Lichtman, an interior designer in Manhattan, knows the problems only too well. He had to pay out of pocket for treatment for strep throat because his doctor’s office could not verify his coverage under a plan he enrolled in through New York’s state-operated marketplace, NY State of Health. He hopes to be reimbursed, but he said a series of missteps since he enrolled has left him frustrated. “There was a real lack of organization in the New York health exchange,” he said, adding that he also got confusing information from his new health insurer.
Mr. Lichtman had an individual health plan that, like millions of others, was canceled because it did not meet requirements under the Affordable Care Act. After a few false starts in November — he said he encountered shutdowns at the New York website, and long waits getting questions answered on the phone — he was able to enroll in a new plan through UnitedHealthcare. He paid his first month’s premium through UnitedHealthcare’s website on Dec. 20, and arranged to have his monthly premium automatically deducted from his bank account.
When he called to check on his coverage, he was first told that the plan had no record of his first month’s premium, so he paid it again — only to have the first payment show up, resulting in an overpayment. (He requested a credit and has received it, he said.)
Immigrants without legal status remain mostly in healthcare limbo
As the Affordable Care Act generally expands coverage, those in the country illegally are largely at the mercy of their counties.
By Soumya Karlamangla
5:09 PM PST, January 19, 2014
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When Alva Alvarez gets sick, she buys over-the-counter medicine from the grocery and takes as much as she can until she feels better. The mother of five resorts to this because she can't afford a visit to the doctor to figure out what's ailing her.
Although scenarios like this are supposed to disappear as millions of Americans become newly insured under the national healthcare law, Alvarez's situation isn't likely to improve and could get worse. The San Bernardino resident represents the biggest — and mostly invisible — group of people left out of the Affordable Care Act: immigrants in the country illegally.
Concerned by this, state Sen. Ricardo Lara (D-Bell Gardens) proposed Jan. 10 that such immigrants be allowed to get health insurance through a program such as Medi-Cal.
The new healthcare law increases the number of people who can join Medi-Cal, the state's low-income health plan, and requires nearly everyone else to buy insurance. But those in the country illegally aren't eligible for either, which leaves Lara and other advocates worried about the success of universal healthcare if that group's options for coverage decrease as legal residents' options increase.
"It's a lot harder to steer a boat if there are people hanging off the sides," said Anthony Wright, executive director of advocacy group Health Access California.
Typically, people without health insurance have relied on a mix of publicly supported community and free clinics, emergency rooms and county health systems. But as more and more people become insured under the new law, the vastly different ways that California counties have served patients without legal immigration status is prompting concern that large numbers of residents will fall through the cracks.
In San Bernardino County, where Alvarez lives, the government doesn't offer regular health services to immigrants here illegally. If she were to move 12 miles south to Riverside County or half an hour's drive west to Los Angeles County, she would qualify for free county-provided medical care.
That already uneven patchwork could intensify as clinics, hospitals and counties see huge changes in demand and funding because of the Affordable Care Act. Citing financial constraints because of the healthcare overhaul, Fresno County has been trying to stop providing for immigrants without legal status since late last year. And as the effects of the new law continue to play out across the state, it's unclear if any pieces of the healthcare safety net will exist for those immigrants.
The California and Welfare Institutions Code requires that counties be providers of last resort, that they "relieve and support all incompetent, poor, indigent persons, and those incapacitated by age, disease, or accident, lawfully resident therein."
To fulfill this obligation, counties typically pay for basic health services, such as a yearly checkup or emergency room costs, for their poorest residents. However, the vagueness of that mandate — paid for with a combination of state and county money — has caused leaders of the state's 58 counties to disagree over whom they must cover and to what degree.
Some counties offer free or low-cost healthcare to all patients with incomes up to three times the poverty level. Others provide care only for those at or below the poverty level, currently set at an annual income of $15,500 for a two-person household. Some counties require that patients have a medical emergency before they can get care. Some provide for immigrants without documentation, others — such as San Bernardino, San Diego and Orange — don't.
The law doesn't explicitly require counties to include the state's 2.8 million immigrants who lack legal status.
http://www.latimes.com/local/la-me-immigrant-healthcare-20140120,0,5353414,print.story
Study finds Mainers say no to lighting up in cars, homes in wake of statewide smoke-free law
By Jackie Farwell, BDN Staff
Posted Jan. 20, 2014, at 1:30 p.m.
When Bangor became one of the first cities in the country to ban smoking in cars carrying children, supporters touted the benefits to public health, while opponents argued the ordinance “moralized” against smokers.
The 2007 ordinance set the stage for a statewide smoke-free vehicle law, which new research indicates then paved the way for more Mainers to voluntarily ban smoking in their cars and homes.
Before the statewide law passed in 2008, just shy of 75 percent of Maine adults reported instituting a smoke-free car rule, according to the new study by University of New England researcher Rebecca Murphy-Hoefer. After the law, that number increased to 78.8 percent. Those few percentage points translate to more than 33,000 Mainers.
Since more people could be expected to ban smoking in their cars in the wake of the law, Murphy-Hoefer also examined smoking bans in Mainers’ homes, which are “completely unregulated,” she said. “It’s an excellent indicator of social norms.”
About 80 percent of Maine adults banned smoking in their homes before the law, compared to 83.1 percent after, a rise of about 25,000 Mainers, according to the study published in the health journal “Preventing Chronic Disease.”
The study is the first in the country to examine the prevalence of smoke-free vehicle and home rules both before and after the passage of statewide law, Murphy-Hoefer said. But other research has shown a relationship between smoke-free policies and changing attitudes toward the acceptability of tobacco use and exposure to secondhand smoke, she said.
“It’s not a surprise, that’s what we hoped, but it looks as though the people of Maine have really embraced this law and have learned from the education that surrounded the law,” said Murphy-Hoefer, an evaluator for the Partnership for a Tobacco-Free Maine.
The statewide law is just one factor contributing to shifting attitudes around tobacco in Maine, she said. Maine’s also a leader in implementing clean indoor air laws and policies, she noted, citing the work of the Breathe Easy Coalition, which promotes voluntary smoke-free laws in multi-unit housing facilities.
The rise in smoke-free car and home rules indicates Mainers are taking steps to protect not only children but also nonsmokers from the harmful effects of tobacco, Murphy-Hoefer said.
“When you see these changing social norms, you see better public health, and that’s what we’re seeing in Maine,” she said.
Alexander Group’s report is a failure. DHHS should demand better
What is 130 pages long, costs Maine taxpayers $108,000, offers them a plethora of policy judgments they didn’t need or ask for, is woefully incomplete and will prove of no help at all in settling an important state policy debate?
That would be the Medicaid expansion feasibility study assembled by Gary Alexander and his firm, the Alexander Group, at the request of Gov. Paul LePage’s administration and delivered last week to the Maine Legislature.
As we’ve stated already, the Alexander Group delivered to LePage a political document disguised as impartial analysis created at taxpayers’ expense.
What’s even more disappointing is that Maine could really benefit from an impartial and complete analysis of Medicaid expansion that addresses not only the policy’s costs but also the benefits.
Alexander and his team fell well short of delivering this needed service. The team calculated only the cost of expansion — in a methodologically suspect way that inflated the final number — without considering any effects, either direct or indirect, that offset the cost.
The Maine Department of Health and Human Services should inform its contractor that he and his team delivered an incomplete product and instruct him to finish the job.
In examining the costs and benefits of Medicaid expansion in Maine, the Alexander Group had examples to follow from numerous states that either performed or commissioned comprehensive assessments of the impact of extending coverage to more low-income adults.
In Ohio — where Republican Gov. John Kasich ultimately expanded Medicaid — such an analysis sought to answer questions about new costs, potential expansion-related state budget savings, expansion’s effect on state revenues, the net state budget effect, economic and health effects on Ohio residents, and Affordable Care Act-related effects Ohio would face even if it didn’t expand coverage.
Alexander’s report neglected to even address half of those questions for Maine.
The cost of the foundation-funded Ohio report was $113,500, according to the Health Policy Institute of Ohio, which led the initiative. And the analysis involved experts from multiple organizations — including Ohio State University, the Urban Institute and Regional Economic Models Inc. — because no single organization had the expertise to properly answer all questions. The Alexander Group, if it didn’t have the appropriate expertise, could have commissioned qualified firms to assess effects on the economy, health, state revenue and more.
The $113,500 cost of the Ohio analysis is a comparable cost to that of the Alexander report, but Maine got nothing resembling a comparable result.
Even on the side of the issue the Alexander Group did examine, the analysts drew conclusions grounded in ideology rather than analysis.
MaineCare: As expansion debate rages, already ‘eligible’ remain in limbo
Much of the focus on the new Affordable Care Act enrollment numbers released Monday has centered around private insurance. In Maine, that’s the 13,704 residents who have chosen a health plan through either Anthem or nonprofit insurer Maine Community Health Options.
But another 3,236 Mainers who signed onto Healthcare.gov since October have learned they’re possibly eligible for Medicaid, known as MaineCare here. Maine’s not expanding the health insurance program for the poor under the ACA, so these are residents who theoretically qualify for the program now, but for whatever reason haven’t already signed up. Healthcare.gov has categorized them as eligible for either Medicaid or CHIP, the Medicaid program for children.
But another 3,236 Mainers who signed onto Healthcare.gov since October have learned they’re possibly eligible for Medicaid, known as MaineCare here. Maine’s not expanding the health insurance program for the poor under the ACA, so these are residents who theoretically qualify for the program now, but for whatever reason haven’t already signed up. Healthcare.gov has categorized them as eligible for either Medicaid or CHIP, the Medicaid program for children.
In fact, many of those more than 3,000 Mainers likely are children, judging from a new analysis by the Kaiser Family Foundation. The report found that in states like Maine not expanding Medicaid, children account for the majority of uninsured people who are eligible for the program. Of the 11,000 uninsured Mainers who could sign up for MaineCare, 7,000, or nearly 63 percent, are children, the analysis found.
These aren’t children who would qualify if Maine were to expand Medicaid, they’re kids who lack health insurance and already qualify for MaineCare but aren’t enrolled. Why is another question. Perhaps their parents aren’t aware that their kids are eligible, or they have other reasons for not enrolling them.
Survey Data and Market Reports Say the Uninsured Are Not Signing Up for Obamacare
In my last post, I asked, "But what if most of the uninsured literally don't buy Obamacare?"
"Only 11% of consumers who bought new coverage under the law were previously uninsured," according to a survey of 4,563 consumers eligible for the health insurance exchanges done by McKinsey & Company and reported in Saturday's Wall Street Journal.
The Journal reports that "insurers, brokers, and consultants estimate at least two-thirds" of the 2.2 million people who have so far signed up in the new exchanges are coming from those who already had coverage.
This is consistent with anecdotal reports from insurers I have talked to that are seeing very little net growth in their overall individual and small group markets as of January 1.
That's even worse than I thought it would be even considering the January 1 individual policy cancellations and small group renewals that are driving employers to reconsider offering coverage––and that is saying something. The vast majority of the individual cancellations, particularly because of the early renewal and extension programs, are yet to come. The same can be said for the small group renewals.
This also tells us why the first three months of the Obamacare enrollment had a relatively high average age––they came from the same market that tended to skew older that the health plans already covered.
When McKinsey asked why subsidy eligible people weren't buying, 52% cited affordability as the reason. Readers of this blog will know that I'm not shocked to hear that given what I have been writing about the high after-tax premiums, net of the subsidies, people are finding, as well as the high deductibles and narrow provider networks the subsidized Silver and lowest cost Bronze exchange plans are offering people.
"Only 11% of consumers who bought new coverage under the law were previously uninsured," according to a survey of 4,563 consumers eligible for the health insurance exchanges done by McKinsey & Company and reported in Saturday's Wall Street Journal.
The Journal reports that "insurers, brokers, and consultants estimate at least two-thirds" of the 2.2 million people who have so far signed up in the new exchanges are coming from those who already had coverage.
This is consistent with anecdotal reports from insurers I have talked to that are seeing very little net growth in their overall individual and small group markets as of January 1.
That's even worse than I thought it would be even considering the January 1 individual policy cancellations and small group renewals that are driving employers to reconsider offering coverage––and that is saying something. The vast majority of the individual cancellations, particularly because of the early renewal and extension programs, are yet to come. The same can be said for the small group renewals.
This also tells us why the first three months of the Obamacare enrollment had a relatively high average age––they came from the same market that tended to skew older that the health plans already covered.
When McKinsey asked why subsidy eligible people weren't buying, 52% cited affordability as the reason. Readers of this blog will know that I'm not shocked to hear that given what I have been writing about the high after-tax premiums, net of the subsidies, people are finding, as well as the high deductibles and narrow provider networks the subsidized Silver and lowest cost Bronze exchange plans are offering people.
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