Florence Nightingale’s Wisdom
By VICTORIA SWEET
In medical school, as one of only 10 female students, I ignoredFlorence Nightingale assiduously. I didn’t want to play any of the roles I thought she modeled for women — obedient wife, caring sister, modest daughter.
It wasn’t until I was practicing medicine in an old-fashioned hospital in San Francisco and learned that its comfortable open wards were “Nightingale wards” that I started to take an interest. Why were they called that?
What I learned is that after theCrimean War from 1853 to 1856, in which thousands of British soldiers died from infections, Nightingale visited almost every hospital in Europe, analyzed them and then wrote up her findings in “Notes on Hospitals,” which became the guide to hospital architecture for the next century.
Its first sentences changed my idea of Florence Nightingale forever: “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle.”
As true today as it was 150 years ago — acerbic, witty and clear.
Then I got to the end of the book, where Nightingale lays out one of the first sets of hospital mortality statistics collected. Statistics had recently been applied to social phenomena by Adolphe Quetelet, and Nightingale was taken by them. “To understand God’s thought, we must study statistics,” she wrote. And to display her evidence, she came up with the polar pie chart, a visual way of understanding data we still use. It was that appendix which gave me the first inkling that this was a brilliant woman. How did I get her so wrong?
So I began to read. There are more than 300 Nightingale biographies and 16 volumes of her writings. Her life (1820-1910) spanned the 19th century, that bridge between the premodern and modern worlds, and she stood with a foot in each, with premodern feelings and modern ideas.
By VICTORIA SWEET
In medical school, as one of only 10 female students, I ignoredFlorence Nightingale assiduously. I didn’t want to play any of the roles I thought she modeled for women — obedient wife, caring sister, modest daughter.
It wasn’t until I was practicing medicine in an old-fashioned hospital in San Francisco and learned that its comfortable open wards were “Nightingale wards” that I started to take an interest. Why were they called that?
What I learned is that after theCrimean War from 1853 to 1856, in which thousands of British soldiers died from infections, Nightingale visited almost every hospital in Europe, analyzed them and then wrote up her findings in “Notes on Hospitals,” which became the guide to hospital architecture for the next century.
Its first sentences changed my idea of Florence Nightingale forever: “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle.”
As true today as it was 150 years ago — acerbic, witty and clear.
Then I got to the end of the book, where Nightingale lays out one of the first sets of hospital mortality statistics collected. Statistics had recently been applied to social phenomena by Adolphe Quetelet, and Nightingale was taken by them. “To understand God’s thought, we must study statistics,” she wrote. And to display her evidence, she came up with the polar pie chart, a visual way of understanding data we still use. It was that appendix which gave me the first inkling that this was a brilliant woman. How did I get her so wrong?
So I began to read. There are more than 300 Nightingale biographies and 16 volumes of her writings. Her life (1820-1910) spanned the 19th century, that bridge between the premodern and modern worlds, and she stood with a foot in each, with premodern feelings and modern ideas.
The Compassion Gap
SOME readers collectively hissed after I wrote a week agoabout the need for early-childhood interventions to broaden opportunity in America. I focused on a 3-year-old boy in West Virginia named Johnny Weethee whose hearing impairment had gone undetected, leading him to suffer speech and development problems that may dog him for the rest of his life.
A photo of Johnny and his mom, Truffles Weethee, accompanied the column and readers honed in on Truffles’ tattoos and weight.
“You show a photograph of a fat woman with tons of tattoos all over that she paid for,” one caller said. “And then we — boohoo — have to worry about the fact that her children aren’t cared for properly?”
On Twitter, Amy was more polite: “My heart breaks for Johnny. I have to wonder if the $$ mom spent on tattoos could have been put to better use.”
“This is typical of the left,” Pancho scolded on my Facebook page. “It’s not anyone’s fault. Responsibility is somebody else’s problem.”
To me, such outrage at a doting mom based on her appearance suggests the myopic tendency in our country to blame poverty on the poor, to confuse economic difficulties with moral failures, to muddle financial lapses with ethical ones.
There is an income gap in America, but just as important is a compassion gap. Plenty of successful people see a picture of a needy child and their first impulse is not to help but to reproach.
To break cycles of poverty, we have the tools to improve high school graduation rates, reduce teen pregnancies and increase employment. What we lack is the will to do so.
By Scott Thistle, Sun Journal
Posted March 02, 2014, at 6:03 a.m.
AUGUSTA, Maine — Early last year, the national media turned its gaze to Maine and the tawdry story of a Zumba-instructor-turned-prostitute in the affluent seacoast village of Kennebunkport.
The exploits of Alexis Wright, including the fact that she managed a client list of more than 100 people and often secretly videotaped her encounters with her customers, were making national news. So, too, was the news that Wright — who earned more than $100,000 a year in her illegal trade — was receiving welfare benefits from the state of Maine.
Wright, a single mother at the time, was later found guilty of defrauding the state to the tune of more than $40,000 in welfare benefits, a part of the case that went largely overlooked.
Wright’s crimes fetched the high-profile treatment of an international celebrity, but the amount she bilked from Maine’s welfare coffers wasn’t even close to what the state would recover from another fraud case involving Medicaid funds, which was announced 10 months later.
This time the crook wasn’t a small-town prostitute, but a multinational medical device and pharmaceutical manufacturer.
In November 2013, Johnson & Johnson agreed to pay the federal government $2.2 billion to resolve criminal and civil allegations involving the marketing of off-label, unapproved uses of three prescription drugs.
Maine, according to a report in the Washington Post, would recover $2.8 million from the case, which involved alleged kickbacks to doctors and pharmacies for promoting a trio of drugs — two anti-psychotics and one heart medication.
The settlement funds, according to the Office of the Maine Attorney General, would serve as restitution for state Medicaid funds used to pay for the unapproved medications.
And while you could hardly avoid the news about Wright, the settlement with Johnson & Johnson blipped under the radar screen of most of Maine’s media.
Comparing the two cases, and the attention — or lack of — they received helps emphasize and lend context to a letter sent last month to state legislative leaders by Maine Attorney General Janet Mills.
In her letter, Mills urged lawmakers to be fair.
“There is a great deal of talk this election year about welfare fraud,” Mills wrote. “I hope we put this issue in perspective, that we make sure we apply the rule of law fairly and uniformly, that we go after big fish as well as small, and that we not elevate one over the other.”
Over the past three years, Maine judges have ordered individuals who have defrauded benefit programs to repay $488,303. That’s an annual average of $162,767.
On the provider side, the state has seen restitution set at $18.7 million over the past four years, an annual average of $4.6 million.
Mills said Thursday that welfare-recipient fraud is dominating the political conversation, not only in Maine but across the country.
New Law’s Demands on Doctors Have Many Seeking a Network
TAYLORSVILLE, Ky. — Dr. Sven Jonsson, a primary care physician in this rural community, is seeing a steady tide of new patients under President Obama’s health care law, the Affordable Care Act. And so far, it is working out for him. His employer, a big hospital system, provides expensive equipment, takes care of bureaucratic chores and has buffered him from the turmoil of his rapidly changing business.
“This is just a much saner place for me right now,” said Dr. Jonsson, 52, who left private practice to work for the system, Baptist Health, in 2012. “I’m probably going to live another five years.”
About 25 miles away in the more affluent suburb of Crestwood, Dr. Tracy Ragland, 46, an independent primary care physician, is more anxious about the future of her small practice. The law is bringing new regulations and payment rates that she says squeeze self-employed doctors. She cherishes the autonomy of private practice and speaks darkly of the rush of independent physicians into hospital networks, which she sees as growing monopolies.
“The possibility of not being able to survive in a private practice, especially primary care, is very real,” she said.
Dr. Jonsson and Dr. Ragland represent two poles of that primary care system. Both live and work on the outskirts of Louisville, with the patience required of family practitioners who spend long days troubleshooting routine problems like back pain and acid reflux. But the similarities in their practices end there.
http://www.nytimes.com/2014/03/03/us/new-laws-demands-on-doctors-have-many-seeking-a-network.html?hp
Differences in Care at For-Profit Hospices
By PAULA SPAN
People who pay attention to hospice care, so often a godsend for the dying and their families, have noticed and wondered about two trends in recent years:
1) What began as a grass-roots movement to improve end-of-life care is becoming a business. In 1990, only 5 percent of hospices were for-profit operations; by last year, they dominated the industry, representing 63 percent of hospices.
2) We’ve also seen that hospice patients are increasingly likely to be “disenrolled” before they die. Once, this was a rare event; the greater problem was that patients waited until the eleventh hour to enroll, subjecting themselves and their families to unnecessary stress and suffering.
Now, about 20 percent of hospice patients are discharged alive, the Medicare Payment Advisory Commission has found. Some may have moved, or changed their minds about treatment, but the National Hospice and Palliative Care Organization said its surveys show that hospices, not patients, initiate a great majority of discharges.
In other words, patients are getting bounced as corporate bottom lines have come to matter more. Are these two developments connected? We’ve had our suspicions — but now we have data.
Rare Mutation Kills Off Gene Responsible for Diabetes
By GINA KOLATA
A new study based on genetic testing of 150,000 people has found a rare mutation that protects even fat people from getting Type 2 diabetes. The effect is so pronounced — the mutation reduces risk by two-thirds — that it provides a promising new target for developing a drug to mimic the mutation’s effect.
The mutation destroys a gene used by pancreas cells where insulin is made. Those with the mutation seem to make slightly more insulin and have slightly lower blood glucose levels for their entire lives.
Already Pfizer, which helped finance the study, and Amgen, which owns a company whose data played a key role in the research, are starting programs aimed at developing drugs that act like the mutation, the companies said.
But Timothy Rolph, a Pfizer vice president, cautioned it can take 10 to 20 years to get a drug to market after discovering something new about human genetics and disease.
The study, published Sunday in Nature Genetics, involved a mutation so rare that finding it was only recently possible, with vast data from large numbers of people, researchers said.
“The study is a tour de force, and the authors are the top people in the field,” said Dr. Samuel Klein, director of the center for human nutrition at Washington University School of Medicine, who was not involved in the study.
This is the first time in diabetes research that a mutation that destroys a gene has proved beneficial, noted Louis Philipson, director of the Kovler Diabetes Center at the University of Chicago. For drug development, he said, “that is very powerful.”
Fear Mongering With Medicare
Some of this could in fact happen, although the industry has cried wolf before and continues to thrive. But the key point is this: Over the past decade, enrollees in Medicare Advantage have received lots of extra benefits, thanks to unjustified federal subsidies to the insurance companies. Now they will have to do with somewhat less, unless the insurers are willing to absorb the cuts while maintaining benefits. Enrollment in these private plans, offered by companies like UnitedHealth and Humana, has more than doubled since 2006, in part because of lower premiums and extra benefits, like gym memberships, that are not included in traditional fee-for-service Medicare.
What made these perks possible was, in effect, a subsidy from taxpayers and other Medicare beneficiaries. The federal government paid the private plans, on average, 14 percent more in 2009 than it would cost to treat the same people in traditional Medicare. The insurers used this extra money to reduce enrollees’ costs and add benefits.
Berwick says he’ll make gubernatorial primary ballot
By Jim O’Sullivan
| GLOBE STAFF
MARCH 04, 2014
With all but a handful of the Democratic caucuses completed, former federal health care administrator Don Berwick claimed Monday he had secured a sufficient number of delegates to reach the gubernatorial primary ballot — a boast that other campaigns privately doubted.
Also Monday, Juliette Kayyem, a former homeland security official and Globe columnist, said she had placed second in the caucuses, another assertion that rival campaigns questioned. All five campaigns agreed that Treasurer Steven Grossman had finished the clear winner.
Attorney General Martha Coakley’s campaign, too, said she had grabbed enough delegates to qualify. Her campaign manager, Tim Foley, said in an e-mail, “We have earned more than the 15% of delegates we need to get on the ballot.”
Official counts for delegate totals do not exist, and even the various campaigns’ internal numbers are considered fluid. A plurality of delegates, strategists from different campaigns agreed, remain uncommitted.
In order to get on the primary ballot, candidates must garner 15 percent of the delegates’ votes at the state convention.
But the pool of delegates elected through party caucuses, which are nearing completion, only accounts for about two-thirds of the roughly 5,500 total delegates. It does not include “add-ons,” which, under party rules, include elected officials and representatives from interest groups and constituencies like young and disabled people.
Berwick’s campaign said its internal figures showed he had garnered the backing of “approximately 20 percent of elected delegates.”
Privately, strategists in other Democratic campaigns doubted the Berwick claim. Even if the number were accurate, it would not qualify him, on its own, for the ballot, party officials said. He would require some additional support from the add-on delegates.
But a Berwick spokesman said the campaign had locked up enough backing already.
“If the vote happened today, we would make it,” said Leigh Appleby.
In a Democratic primary field collectively racing to garner the enthusiasm of liberal party activists, Berwick has carved out a niche as a favorite among left-leaning delegates. He supports single-payer health care, in which government rather than private firms would provide health insurance, and wants the state to adopt a “fair tax approach” with a graduated income tax, and to to close tax loopholes that he said could reap “billions.”
Drug makers spending less on MD speakers
Payments decline as scrutiny from public increases
By Charles Ornstein, Eric Sagara and Ryann Grochowski Jones
Some of the nation’s largest pharmaceutical companies have slashed payments to health professionals for promotional speeches amid heightened public scrutiny of such spending, a ProPublica analysis shows.
Eli Lilly and Co.’s payments to speakers dropped by 55 percent, from $47.9 million in 2011 to $21.6 million in 2012.
Pfizer’s speaking payments fell 62 percent over the same period, from nearly $22 million to $8.3 million.
And Novartis, the largest US drug maker as measured by 2012 sales, spent 40 percent less on speakers that year than it did between October 2010 and September 2011, reducing payments from $24.8 million to $14.8 million.
The sharp declines coincide with increased attention from regulators, academic institutions, and the public to pharmaceutical company marketing practices.
A number of companies have settled federal whistleblower lawsuits in recent years that accused them of improperly marketing their drugs.
In addition, the Physician Payment Sunshine Act, part of the 2010 health care overhaul law, will soon require all pharmaceutical and medical device companies to publicly report payments to physicians. The first disclosures required under the act are expected in September and will cover the period of August to December 2013.
The Globe reported in September 2011 that payments to doctors for promoting pharmaceutical companies’ products to their colleagues appeared to be falling in Massachusetts, according to an analysis by the newspaper and ProPublica, coinciding with restrictions on the practice adopted by some of the state’s major academic medical centers.
Costly hepatitis drug Sovaldi rattles industry
By Sandhya Somashekhar, Published: March 1
When the Food and Drug Administration approved a medication called Sovaldi in December, it was hailed as a breakthrough in the fight against hepatitis C, a blood-borne disease that affects 3.2 million Americans and kills more people in the U.S. annually than AIDS.
Then California-based Gilead Sciences, the manufacturer, announced the price: $84,000 for a 12-week course, more than what many cancer treatments cost in a year.
The hefty price tag has rattled patient advocacy groups and insurance companies, who say most costly new treatments coming on the market are targeted for a smaller patient population. Putting such a premium on a drug that could help so many will be crushing, they say.
At least one prescription drug plan is encouraging doctors to delay prescribing Sovaldi for patients who can wait. One insurer has said it risks bankruptcy if it’s required to cover the drug for everyone who needs it this year. Advocates say Gilead has taken corporate greed to new levels.
The drug has also prompted a new round of hand-wringing over a larger issue: the escalating cost of specialty drugs, which are designed to treat chronic illnesses such as rheumatoid arthritis and multiple sclerosis and sometimes require special handling.
While these therapies are delivering body blows to some of the world’s most pernicious diseases, they also are testing the limits of what society is willing to pay for sought-after treatments or cures.
“The advancements that are coming in medicine are going to be stunning and amazing, both in terms of the kinds of things we can treat that we never could and what their cost is going to be,” said Matt Salo, executive director of the National Association of Medicaid Directors. “We’re going to need to think as a country about how do we value health and health care.”
In the past, treating hepatitis C was not always successful and involved lengthy treatment with injectable drugs that had significant side effects. By contrast, Sovaldi promises to cure nearly all sufferers with a once-daily pill that has far fewer side effects.
When insurers don't pay for surgery
There are many reasons insurers deny payment for medical bills, even for procedures that were approved ahead of time. Here's what can happen and what you can do about it.
By Lisa Zamosky5:00 AM PST, March 2, 2014
| advertisement |
Peter Altschuler's back surgery had been a long time coming. The 66-year-old marketing professional and actor from Santa Monica slipped a disc about 10 years ago, and he's been coping with it ever since.
A series of injections kept him pain-free for years, he said, but by 2012 they stopped doing their job. "I was in constant discomfort," he says. His doctors said it was time for surgery.
Although old enough to qualify for Medicare, Altschuler held on to an insurance policy he'd had through a professional association before turning 65.
As most health plans do, his insurer required him to obtain prior approval for his procedure. So he worked with his doctors to submit the required paperwork. It included the medical justification for his surgery, and he eventually got the green light.
But six weeks after his procedure, he got another notice, this time saying his plan wouldn't cover the cost of the surgery after all. Now, instead of a $2,500 bill, he is being charged $100,000.
There are many reasons insurers deny payment for medical bills, even for procedures that were approved ahead of time. Here is a look at what can happen and what you can do about it.
Fighting over medical necessity. Insurers' decisions about whether to pay for a procedure are based typically on whether it's considered medically necessary, says Dr. Robert A. Bitonte.
For insurers, "if the determination is that it's not medically necessary, they can decline it," he says. Bitonte is a member of the Los Angeles County Bar Assn. and past president of the Los Angeles County Medical Assn.
Insurers review cases both before and after a procedure, and they can come to a different conclusion based on what took place in the operating room.
"Medically necessary care has to be provided. The law is clear on that," Bitonte says. But how the determination of what's medically necessary is made and who has the primary right to decide — doctors or insurers — are at the heart of a heated and ongoing debate.
MaineCare expansion compromise limps to floor votes
Despite being sponsored by two Republicans, the Democrat-supported bill can only muster a 7-5 party-line vote in committee and may struggle to win a veto-proof majority.
AUGUSTA — A proposal from two Republican lawmakers to expand the state’s Medicaid program to more than 60,000 low-income residents and establish a managed care system for all 320,000 beneficiaries inched forward Monday.
Democrats on the Legislature’s Health and Human Services Committee approved L.D. 1487 in a party-line vote of 7-5. The bill, sponsored by Assistant Senate Minority Leader Roger Katz, R-Augusta, and Sen. Thomas Saviello, R-Wilton, is designed to attract Republican votes to back what has been a largely Democrat-led effort to expand the public health insurance program for the poor.
The bill’s managed care provision, which Katz said would help the state reduce costs in the $2.5 billion program, is one of several measures included to bring along enough Republican votes to circumvent an anticipated veto by Gov. Paul LePage.
Nonetheless, Republican-led resistance to the proposal remains strong. Rep. Carol McElwee, R-Caribou, a member of the health committee, supported Medicaid expansion last year, but said Monday that constituents in her district did not want expansion. She said the majority of the calls she had received urging her to support the bill were from people living in Portland.
Maine Democrats push Medicaid expansion to Senate but without key GOP vote from last year
By Mario Moretto, BDN Staff
Posted March 03, 2014, at 3:19 p.m.
AUGUSTA, Maine — A proposal by two moderate Republican senators to expand Medicaid and incorporate drastic changes in the state’s publicly funded health care program has cleared the Legislature’s Health and Human Services Committee and will now be taken up by the Senate.
The bill — crafted by Assistant Senate Minority Leader Roger Katz of Augusta and Sen. Tom Saviello of Wilton — would accept federal funding under the auspices of the Affordable Care Act to expand Medicaid, known here as MaineCare, to roughly 70,000 low-income Mainers, while also taking steps to implement managed care, a system to outsource the MaineCare program to private for- and nonprofit companies.
Katz and Saviello have put the bill forward as a compromise: Democrats get the Medicaid expansion they tried unsuccessfully to achieve last year, while Republicans get managed care and other cost-saving measures meant to control the growing price of MaineCare.
The nature of that “compromise” is up for debate between committee members: Rep. Peter Stuckey, D-Portland, said that while he opposed managed care last year, the inclusion of Medicaid expansion “provides a lot of ground for me to stand on.”
Rep. Heather Sirocki, R-Scarborough, a staunch opponent of expansion, called the pairing of managed care and Medicaid expansion “a trojan horse.”
The committee vote was expected to fall largely along partisan lines, but it came as a surprise to most that Rep. Carol McElwee, R-Caribou — one of the only House Republicans to support Medicaid expansion last year — switched her vote to oppose the measure. After McElwee’s flip, the final Health and Human Services Committee vote stood at 7-5, with each Democrat supporting the bill and each Republican opposed.
McElwee said her decision was “very difficult,” but the introduction of managed care into the mix put her into the “no” camp. She also said that while she supported MaineCare expansion last year, surveys of her constituents showed they do not.
“I have talked all weekend long to people about this, explaining my feelings, but most of the people who called me were from Portland. They weren’t from The County,” she said. “Caribou is a Republican community, and my constituents do not want MaineCare.”
McElwee’s vote could give pause to majority Democrats in the Legislature, who even with the support of two moderate Republicans still face an uphill battle to muster the Republican support necessary to override a certain veto by Republican Gov. Paul LePage. The Katz-Saviello plan was supposed to win some GOP members over, not drive them away.
Senate Majority Leader Troy Jackson, D-Allagash, represents McElwee’s district in the Maine Senate. In prepared remarks issued after the committee vote, he said thousands of Aroostook County residents stood to benefit from Medicaid expansion.
| Maine Panel Approves Medicaid Expansion Measure | |||
| 03/03/2014 03:23 PM ET | |||
The bill crafted by two Republican senators was approved by a 7-5 vote and includes implementing managed care in Maine's Medicaid program.
| |||
AUGUSTA, Maine (AP) _ A Maine legislative committee has endorsed a bill that would expand Medicaid under the federal health care law and implement other significant changes in the state's program.
The bill crafted by two Republican senators was approved by a 7-5 vote and includes implementing managed care in Maine's Medicaid program. Under managed care, the state would contract with three or four organizations that would compete for patients and set up provider networks across the state. The Republican senators hope to get enough GOP votes to override the opposition of Republican Gov. Paul LePage. But Carol McElwee, a Republican from Caribou who backed the expansion bill last year, voted against it Monday because she said she opposes managed care. LePage says expanding Medicaid under the Affordable Care Act will be too costly. |
Who gets left behind by LePage and other health expansion opponents’ “alternative”?
Opponents of Medicaid expansion in Maine keep saying there is an alternative available to the people who would be covered under an expansion.
The purported alternative is that people who would receive Medicaid under an expansion can instead buy subsidized insurance through the marketplace.
For instance, Rep. Deborah Sanderson recently said on the radio that she told pro-expansion Mainers at the statehouse they could still get coverage if there’s no expansion. And in a recent op-ed, Sanderson claimed, “Forty thousand, or over half, of the 70,000 people that would be eligible for expanded Medicaid are eligible for these plans on the exchange.”
Unmentioned is who couldn’t get any health coverage, who would be left out
If Medicaid is not expanded in Maine, the poorest people who would have been covered by Medicaid expansion would not get any help at all. They would get no subsidies to obtain insurance. None. Zippo.
Medicaid expansion opponents would leave the neediest Mainers without insurance, getting less health care.
Coverage for people earning below the poverty level was supposed to be handled by a federally funded expansion of Medicaid. But the Supreme Court ruled in June that expanding Medicaid was optional — and half the states chose not to do it, contending that the added costs would be too burdensome for taxpayers. The law didn’t anticipate the lack of Medicaid expansion, so there is a gap in coverage for those who don’t qualify for their state’s existing Medicaid plan, and who earn too little to qualify for financial help on the exchanges.
Moreover, Maine can’t cover our poorest people with Medicaid and have others eligible under expanded Medicaid just go ahead and buy subsidized insurance through the marketplace.
That’s because a state can’t cover just a portion of those who are eligible for Medicaid under the ACA.
Medicaid Expansion
A short explanation of the Affordable Care Act's Medicaid expansion is available on our ACA Basics page. This page provides more information about the Medicaid program and the ACA Medicaid expansion.
Overview
Medicaid is the nation's health insurance program for low-income individuals and families. The ACA calls for a nationwide expansion of Medicaid eligibility, set to begin in 2014. As the law was written, nearly all U.S. citizens under 65 with family incomes up to 133 percent of the federal poverty level (FPL) ($30,675 for a family of four in 2012) will qualify for Medicaid under the expansion. (About FPL; Is it 133 or 138?) This expansion will particularly benefit childless adults, who in more than 40 states cannot currently qualify for Medicaid regardless of their income level. It will also benefit low income parents, who in more than 30 states don't currently qualify even if their children do.
The Medicaid expansion was one of the major provisions at stake in the ACA cases decided by the Supreme Court in June 2012. The Supreme Court upheld the Medicaid expansion, but limited the federal government's ability to penalize states that don't comply. Therefore, where it was originally effectively mandatory for states to expand Medicaid, now it is effectively optional. While some states might not participate in the expansion given this decision, most states are predicted to eventually expand their programs. The CBO predicts that 11 million Americans will gain coverage by 2022 through this provision.
Medicaid is the nation's health insurance program for low-income individuals and families. The ACA calls for a nationwide expansion of Medicaid eligibility, set to begin in 2014. As the law was written, nearly all U.S. citizens under 65 with family incomes up to 133 percent of the federal poverty level (FPL) ($30,675 for a family of four in 2012) will qualify for Medicaid under the expansion. (About FPL; Is it 133 or 138?) This expansion will particularly benefit childless adults, who in more than 40 states cannot currently qualify for Medicaid regardless of their income level. It will also benefit low income parents, who in more than 30 states don't currently qualify even if their children do.
The Medicaid expansion was one of the major provisions at stake in the ACA cases decided by the Supreme Court in June 2012. The Supreme Court upheld the Medicaid expansion, but limited the federal government's ability to penalize states that don't comply. Therefore, where it was originally effectively mandatory for states to expand Medicaid, now it is effectively optional. While some states might not participate in the expansion given this decision, most states are predicted to eventually expand their programs. The CBO predicts that 11 million Americans will gain coverage by 2022 through this provision.
APHA and external resources are listed below.
*****
Public health professionals: Looking for resources to help you educate your community about the Marketplaces and other ACA reforms?
Consumers: Looking for information about how the ACA will affect you?
Go back to the main page of the health reform section of APHA's website for resources and links to the official websites of the ACA and the Health Insurance Marketplaces.
Study: Doctors are fueling prescription-drug addictions
A CDC report says ‘problem prescribers’ are the source for many chronic users.
By Lisa Girion
Los Angeles Times
And Scott Glover
LOS ANGELES — Doctors are fueling the epidemic of prescription drug addiction and overdose and represent the single largest supplier of these drugs to chronic abusers, according to a government study published Monday.
The finding challenges the conventional wisdom that the epidemic is caused primarily by abusers getting their drugs without prescriptions, typically from friends and family.
Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said in an interview that the study shows the need to focus more on doctors who are “problem prescribers.”
Frieden said the new study, along with the Times investigation and a second JAMA article on the widespread use of narcotic painkillers in Tennessee, all showed that physician prescribing was a key contributor to the crisis of addiction and overdose that has continued to mount since the CDC declared it an epidemic in 2011.
Prescription drugs contribute to more than 16,000 fatal overdoses annually and are the main reason drugs have surpassed traffic accidents as a cause of death in the U.S.
“At this point, virtually everyone recognizes that this is a serious problem that has been getting much worse,” Frieden said. “What we now are figuring out is what’s going to work to reverse it.”
CDC researchers analyzed data from the National Survey on Drug Use and Health, an annual snapshot of the use of illegal drugs, such as heroin and cocaine, as well as the “nonmedical use” of prescription drugs. The survey is widely used by researchers to gauge the scope and contours of the nation’s drug problem and by policymakers to determine how best to combat it.
Previous analyses of the survey had lumped all types of prescription drug misuse, from occasional to chronic, together. Those analyses identified friends and family members as the most common sources of misused prescription drugs.
The new analysis found that, while most survey respondents got prescription drugs from people they knew, chronic users got them most often, more than a quarter of the time, from a doctor.
Los Angeles Times
Did MaineCare’s crackdown on opiates fuel our state’s heroin problem?
Not long after MaineCare cracked down on the availability of narcotic prescriptions early last year, police reported a spike in heroin abuse.
Maine addiction specialists agree: They say the restrictions, while working to prevent some Mainers from getting hooked on painkillers, also squeeze the drug supply to fuel addiction elsewhere.
Enter Maine’s growing heroin problem, and the state’s ongoing distinction as one of the worst in the country for drug addiction.
State officials view the MaineCare changes as a positive step, leading to a 30 percent drop in the number of opiate prescriptions since 2011. Patients with chronic pain are benefitting from alternative approaches, such as physical and occupational therapy, and MaineCare’s also saving money, they say.
To Dr. Mark Publicker of Mercy Hospital Recovery Center in Portland, however, such prevention efforts amount are small victories in Maine’s existing drug crisis.
“At this point, focusing on prevention is like having a family sitting in their living room and teaching them fire prevention when their house is burning down,” he said. ”It really is important that the family know in the future how to prevent fires, but first they’ve got to put the fire out.”
As doctors prescribe opiates more cautiously, the street supply dwindles, driving up prices and spurring some addicts to turn to cheaper and potentially much more potent heroin, said Dr. Andrew Kolodny, a psychiatrist, public health advocate, and spokesman for the group Physicians for Responsible Opioid Prescribing.
Restricting prescription practices can help in the short term, but “the answer is to do something about the many people who are already addicted,” he said. “If you only curtail the overprescribing, without seeing that the people who are already addicted have access to treatment, then you’ll just see people turning to heroin. You have to do both.”
Not long after MaineCare cracked down on the availability of narcotic prescriptions early last year, police reported a spike in heroin abuse.
Maine addiction specialists agree: They say the restrictions, while working to prevent some Mainers from getting hooked on painkillers, also squeeze the drug supply to fuel addiction elsewhere.
Enter Maine’s growing heroin problem, and the state’s ongoing distinction as one of the worst in the country for drug addiction.
State officials view the MaineCare changes as a positive step, leading to a 30 percent drop in the number of opiate prescriptions since 2011. Patients with chronic pain are benefitting from alternative approaches, such as physical and occupational therapy, and MaineCare’s also saving money, they say.
To Dr. Mark Publicker of Mercy Hospital Recovery Center in Portland, however, such prevention efforts amount are small victories in Maine’s existing drug crisis.
“At this point, focusing on prevention is like having a family sitting in their living room and teaching them fire prevention when their house is burning down,” he said. ”It really is important that the family know in the future how to prevent fires, but first they’ve got to put the fire out.”
As doctors prescribe opiates more cautiously, the street supply dwindles, driving up prices and spurring some addicts to turn to cheaper and potentially much more potent heroin, said Dr. Andrew Kolodny, a psychiatrist, public health advocate, and spokesman for the group Physicians for Responsible Opioid Prescribing.
Restricting prescription practices can help in the short term, but “the answer is to do something about the many people who are already addicted,” he said. “If you only curtail the overprescribing, without seeing that the people who are already addicted have access to treatment, then you’ll just see people turning to heroin. You have to do both.”
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