Affordable Care for those still uninsured
|Nurse practitioners are providing badly needed health care to the uninsured working poor in Appalachia -- medical mercy for those left out of Obamacare and ineligible for Medicaid. Scott Pelley reports.
http://www.cbsnews.com/videos/affordable-care-for-those-still-uninsured/
This is a must-see! What are we thinking?
The Mentally Ill, Behind Bars
Mayor Bill de Blasio and his new correction commissioner, Joseph Ponte, have inherited a city jail system in which nearly 40 percent of the 12,000 inmates have mental illnesses — up from about a quarter just seven years ago. Yet despite the stark shift, the system has not been redesigned to serve the complex needs of inmates with mental illnesses.
To remedy this shameful problem, the mayor and the commissioner need to focus on three areas: improving mental health care behind bars; ensuring that all mentally ill inmates are enrolled in Medicaid before they are released, so they have access to care and medication; and encouraging the growth of an important new program that steers mentally ill people who present no danger to the public into mental health programs instead of jail.
The full scope of this problem was outlined two years ago in a study of the city jails by the Council of State Governments Justice Center, a research and policy group. The study found that inmates with mental disabilities cost three times as much as other inmates, and that their numbers were growing, even as the city jail population as a whole was declining.
The study also found that mentally ill inmates stay in jail nearly twice as long — an average of 112 days compared with 61 days — partly because the mentally ill have less money to put toward bail and fewer connections to family or friends willing to get them out.
The perils these people face behind bars are underscored by two recent cases involving mentally ill people who died while detained on Rikers Island, one of the largest jails in the country. A corrections officer wascharged in March by federal prosecutors with violating the civil rights of a 25-year-old prisoner, Jason Echevarria, for refusing to help when Mr. Echevarria pleaded for medical care after swallowing the toxic contents of a soap packet in his cell.
| Maine House Overturns Gov Veto and Sustains Two Others | |||
| 04/04/2014 12:35 PM ET | |||
Maine's House of Representatives has voted to overturn Republican Gov. Paul LePage's veto of a bill that makes changes to the law requiring health care providers to make available a price list of common procedures.
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AUGUSTA, Maine (AP) _ The House voted 138-4 on Friday in favor of overriding the bill that requires providers to tell patients that cost estimates are available through the Maine Health Data Organization.
LePage said that providing a price for services could be misleading because it may exclude other costs, like the room charge. He said patients should be given a complete estimate of health care charges. The House sustained two other vetoes, including a measure that would have directed the state to analyze the rates for providers of preschool services for children with developmental disabilities. |
State Officials Cite Technology Problems on Health Insurance Sites
By ROBERT PEAR
WASHINGTON — Officials from five states, on the defensive at a congressional hearing, said Thursday that their health insurance exchanges had been hobbled by technology problems like those that bedeviled the federal marketplace. But they said their states were recovering.
The states — Hawaii, Maryland, Massachusetts, Minnesota and Oregon — all have Democratic governors who support the Affordable Care Act. They built their own exchanges with millions of dollars of federal money, but many residents in all five states were frustrated as they tried to enroll online last fall.
“Our rollout was rocky,” said Scott Leitz, the interim chief executive of the Minnesota exchange. “Our launch was plagued by software errors and technical glitches.”
Greg Van Pelt, an adviser to Gov. John Kitzhaber of Oregon, said the website there was “only partially functioning.”
Tom Matsuda, the interim executive director of the Hawaii exchange, said that it had received $205 million in federal grants and enrolled only 7,600 people. That works out to an average of $27,000 for each person enrolled, Republicans said at the hearing, which was held by two panels of the House Committee on Oversight and Government Reform.
Representative James Lankford, Republican of Oklahoma, asked how the five states, after receiving a billion dollars in federal grants, could have such difficulty.
“And how many more taxpayers’ dollars will be required to bail out state exchanges?” he asked.
Democrats at the hearing were still jubilant over the White House announcement that more than seven million people had signed up for private insurance through federal and state exchanges in the six-month open enrollment period that ended on Monday. Obama administration officials said they did not know how many of the new policyholders were previously uninsured.
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Look for Cancer, and Find It
By DENISE GRADY
Mammography has become a fighting word in recent years, with some researchers questioning its value and others staunchly defending it.
One especially disturbing criticism is that screening mammography may lead to “overtreatment,” in which some women go through grueling therapies — surgery, radiation,chemotherapy — that they do not need. Indeed, some studies estimate that 19 percent or more of women whose breast cancers are found by mammography wind up being overtreated.
This problem occurs, researchers say, because mammography can “overdiagnose” breast cancer, meaning that some of the tiny cancers it finds would probably never progress or threaten the patient’s life. But they are treated anyway.
So where are these overtreated women? Nobody knows.
They are out there somewhere, studies suggest. But the figures on overtreatment are based on theory and calculations, not on counting the heads of actual patients known to have experienced it. No one can point to a particular woman and say, “Here’s a patient who went through the wringer for nothing.”
Overdiagnosis is not the same as a false positive result, in which a test like a mammogram initially suggests a problem but is proved wrong. False positives are frightening and expensive, but overtreatment is the potential harm of mammography that worries doctors most, according to an article published last week in The Journal of the American Medical Association.
But the authors also say that estimates of how often overdiagnosis and overtreatment occur are among the least reliable and most controversial of all the data on mammography.
In the past, overdiagnosis was thought to apply mainly to ductal carcinoma in situ, or D.C.I.S., a breast growth that may or may not turn cancerous. Now, researchers think that invasive cancers are also being overdiagnosed and overtreated by mammography.
The concept of overtreatment is based on the belief that not all breast cancers are deadly. Some never progress, researchers suspect, and some progress so slowly that the patient will probably die of something else, particularly if she is older or has other health problems.
But mammography can find all of these tumors, even those too small to feel. And doctors and patients rarely watch and wait — once a tumor is found, it is treated, because nobody knows how to tell the dangerous ones from those that could be safely left alone.
“Everyone has an anecdote of a small spot on mammography year after year that was finally biopsied and turned out to be positive — invasive, low grade,” said Dr. Constance Lehman, a radiologist at the Fred Hutchinson Cancer Center and the director of breast imaging at the University of Washington in Seattle.
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Obamacare has spawned a misguided debate
By Michael Gerson, Published: April 7
Supporters of Obamacare are celebrating that the law is not an unmitigated disaster, just a mitigated one.
As enrollment closed (for most) on March 31, the system passed 7 million exchange sign-ups. What some are taking as a triumph of governmental competence was actually an emergency rescue by private-sector volunteers after a laughable failure of government to construct and run its own system. This has hardly been a confidence-builder when it comes to public faith in bureaucracy. But never mind.
And never mind that the actual goal was not 7 million exchange sign-ups; it was health insurance enrollments, which are likely to be significantly fewer. And never mind that the number of the previously uninsured seems a remarkably small portion of these sign-ups — well under half. (Health wonk Bob Laszewski estimates that only about 27 percent of Americans eligible for Obamacare subsidies have enrolled in the system.) And never mind that, even including the Medicaid expansion, the most optimistic estimates of reductions in the number of the uninsured are much less than what the Congressional Budget Office projected before the rollout began. And never mind that all these decreases in the uninsured seem small in comparison to the amount of money spent, displacement caused and political capital expended.
And never mind that the proportion of younger and healthier enrollees to those with preexisting conditions is still being determined and that many analysts expect double-digit insurance premium increases in many state exchanges (particularly those with limited insurance competition). And never mind that health-care cost inflation has suddenly spiked to a 10-year high.
The Obama administration is pausing to bow at mile two of a marathon. And supporters, naturally, are grateful for some reason, any reason, to cheer. But the whole story of Obamacare has been a cycle of overpromising and disappointment. And advocates seem determined to continue it.
Still, some conservative critics of Obamacare — those advocating repeal and, well, nothing — are inhabiting their own ideological daydream. President Obama did not invent a right to health care, just a right to a highly regulated form of health insurance. Americans had jury-rigged a system long before. Under a federal law from the 1980s, hospitals taking Medicare can’t deny emergency treatment to people based on their ability to pay for it. Medicare and Medicaid provide insurance to the elderly and poor. This combination of emergency-room care and health entitlements amounts to a guarantee of a certain kind of health care — often provided late in disease progression, after a long wait in line, by harried, overwhelmed doctors trying to navigate in (or game) a system of wage and price controls.
Conservatives need this to sink in: America already has a right to a certain minimum of health treatment, which is not going away. It is an expression of compassion and decency. But it is not well-designed or efficient. And it leaves millions of people with an inferior quality of care.
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Complaint challenges legality of Canadian company’s medication sales to Mainers
In a case affecting those in need of cheaper drugs, the head of a state pharmacy group alleges the Canadian firm’s sales are illegal.
The president of the Maine Pharmacy Association has filed a complaint with state regulators alleging that a Canadian company broke state law by selling him generic drugs from prescriptions that were filled in India, Turkey and Mauritius.
In a complaint to the Board of Pharmacy, Kenneth “Mac” McCall, who is also an associate professor at the University of New England School of Pharmacy, says that Maine law requires the company, Canada Drug Center, to sell Maine consumers only drugs that are made or processed in Canada.
Although McCall said he filed his complaint independently, it follows a federal lawsuit filed last fall by several interest groups that want to overturn Maine’s new law – including the Maine Pharmacy Association.
“For me, I think it’s important that Mainers know what they are getting,” McCall said in an interview. “It’s a matter of safety.”
It’s not clear yet how the Board of Pharmacy will respond to McCall’s complaint, but the outcome will interest thousands of Mainers who turn to Canadian sources for more affordable prescription medications, despite warnings from the Food and Drug Administration and consumer groups about the risks of online drug purchases.
The exact number of Mainers who are buying drugs from outside the U.S. is not known.
A lawyer for Canada Drug Center, which has filed a formal response with the Board of Pharmacy, questioned McCall’s motives in an interview.
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In LePage’s Maine, little trust in state government
Columns, Maine Politicseconomy, LePage, Maine, Maine Center for Economic Policy, Maine Heritage Policy Center, Medicaid
By Amy Fried
Somewhere out there are 30 Mainers who told someone from the Gallup poll that they trust Maine state government “a great deal.” That works out to about 5 percent of the 601 people the organization polled.
You have to wonder what those very trusting 30 people would say to the rest of us. Admittedly, though, the number starts to look better when combined with those who trust state government “a fair amount.” These two categories together add up to 40 percent.
But 40 percent is not very good when you consider that Maine sits in the bottom three of states for trust in state government. And it looks even worse when you realize that the other two of the bottom three states, Illinois and Rhode Island, are states with significant histories of corruption that has led to politicians going to jail.
So what’s going on in Maine? Why is there so little trust in state government? It’s really odd when you consider that Maine has such a strong pattern of strong civic participation. Usually when many people are involved consistently, they have good feelings about the political system and their ability to make a difference.
Perhaps the mystery can be illuminated when we look at the polling question. When Gallup called, the pollsters asked, “How much trust and confidence do you have in the government of the state where you live when it comes to handling state problems — a great deal, a fair amount, not very much or none at all?”
Mainers — 60 percent of them — are not confident about how state government is handling state problems.
And who can blame them?
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Obama Administration Retreats On Private Medicare Rate Cuts
By JAY HANCOCK
KHN Staff Writer
APR 08, 2014
Under intense, bipartisan political pressure, the Obama administration backed down for the second year in a row on proposed payment cuts for insurance companies that offer private plans to Medicare members.
After estimating in February that the cuts required by the Affordable Care Act as well as other adjustments would reduce would reduce what it pays insurers next year by 1.9 percent per beneficiary, the Department of Health and Human Services said Monday it would instead give Medicare Advantage plans a raise of 0.4 percent.
America's Health Insurance Plans, the main industry lobby, said it was still studying the announcement. While it acknowledged that Monday's action leaves payments higher than what HHS had originally proposed, it disputed the agency's statement that 2015 rates would rise. AHIP had calculated the originally proposed cuts to be nearly 6 percent, not 1.9 percent.
Adjustments to the February proposals "will help mitigate the impact on seniors," AHIP CEO Karen Ignagni said in a statement. "But the Medicare Advantage program is still facing a reduction in payment rates next year…"
Ana Gupte, an industry analyst for Leerink Partners, agreed, saying the rates disclosed Monday will cut Medicare Advantage payments by about 3 percent. Still, that's a smaller reduction than what she calculated to be 5.5 percent in HHS's first proposal, she said in a note to clients.
The administration, for its part, portrayed the rates disclosed Monday as even better than the flat, year-to-year change that insurance companies sought.
"The industry asked us to use whatever means we could to keep the rates close to parity, to where they are today," Jonathan Blum, principal deputy administrator at the Centers for Medicare & Medicaid Services, told reporters. The rates set Monday are "a little higher than what the industry had recommended," Blum said.
Among other alterations, HHS dropped a plan to abandon the use of home-visit diagnoses for assigning member risk scores that affect payments. That proposal alone would have shaved 2 percentage points off what Medicare Advantage plans get from the government, according to a study commissioned by AHIP.
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