Thursday, July 30, 2015

Health Care Reform Articles - July 30, 2015

This week CMS established a new webpage for Section 1332 waivers of the
ACA. It includes Fact Sheets and FAQs.

Rep. Jim McDermott
Statement Introducing the State-Based Universal Health Care Act of 2015
U.S. House of Representatives
July 28, 2015

Mr. Speaker, I rise today to introduce legislation that will give states the tools they need to guarantee the health security of their citizens. The State-Based Universal Health Care Act of 2015 establishes a new procedure through which states may apply for a waiver of federal law in order to design and implement single-payer health care systems. This will allow states to achieve universal coverage and control costs by removing greed and inefficiency from the system.

One of the many achievements of the Affordable Care Act is its provisions that grant states the authority to innovate in their health care systems. Under Section 1332 of the law, a state may apply for a State Innovation Waiver that will provide it with control of federal dollars that otherwise would have been spent on premium tax credits and cost-sharing reductions for its residents. Through this waiver, a state may design a system to cover its residents, so long as benefits are at least as comprehensive and affordable as those offered by Qualified Health Plans available on the Exchanges.

However, even with this flexibility, numerous barriers limit states’ ability to design true single-payer systems. Existing waivers are narrow in scope, requiring states to seek out imperfect and convoluted solutions to circumvent federal limitations. A sweeping preemption provision in the Employee Retirement Income Security Act (ERISA) denies states authority to regulate employer-sponsored health plans. And, due to the complexities of our existing federal health programs, it is essentially impossible for a state to design a single benefit package that can be administered simply and efficiently on behalf of all of its residents.

The State-Based Universal Health Care Act removes these barriers. It builds upon the ACA’s State Innovation Waiver by offering states new tools that will allow them to truly innovate in health care. Under this legislation, a state may apply for a Universal Health Care Waiver that will grant it authority over federal health care dollars that otherwise would have been spent on the state’s residents. To the extent necessary to design a universal system, a state may waive provisions of federal law relating to the following:

* The rules governing premium tax credits and cost-sharing reductions, as provided for in existing waiver authority under Section 1332 of the ACA.

* Provisions necessary for states to pool funds that otherwise would be spent on behalf of residents enrolled in Medicare, Medicaid, CHIP, TRICARE, and the Federal Employee Health Benefits Program.

* ERISA’s preemption clause, which currently forbids states from enacting legislation relating to employee health benefit programs.

Any state seeking a Universal Health Care Waiver must design a system that covers substantially all of its residents. The benefits that each citizen receives must be at least as comprehensive and no less affordable than what would have been provided under any federal health programs for which its residents otherwise would have been eligible. Once enacted, the state plan must be publicly administered, and it may not add to the federal deficit.

The Affordable Care Act was a landmark achievement and a strong first step toward achieving health security in this country. However, we still have a tremendous amount of work left to do. The United States spends by far the most per capita on health care, yet we fail to achieve superior outcomes or even guarantee coverage as a basic human right. Insurance companies are a powerful force in our economy, enjoying billions in profits and growing power in the marketplace. Meanwhile, hospitals are consolidating at an astonishing rate, raising new questions about the quality of patient care and the future of medicine. What’s more, we have failed to make meaningful efforts to combat the skyrocketing costs of prescription drugs, threatening patient access to treatments and the financial sustainability of the entire system.

As we explore ways to build upon the successes of the ACA, it is critical that we look for creative solutions to the challenges that still exist. Granting states tools to design single-payer systems will help spur necessary innovation, achieve universal coverage, and control costs. It is time to take this next step as we continue to move forward in our historic effort to guarantee the health security of every American.

H.R.3241: State-Based Universal Health Care Act of 2015

What I Learned at the Weed Dispensary

Wednesday, July 22, 2015

Health Care Reform Articles - July 22, 2015

A Pharma Payment A Day Keeps Docs’ Finances Okay

New data on payments from drug and device companies to doctors show that many doctors received payments on 100 or more days last year. Some received payments on more days than they didn’t.
Few days went by last year when New Hampshire nephrologist Ana Stankovic didn't receive a payment from a drug company.
All told, 29 different pharmaceutical companies paid her $594,363 in 2014, mostly for promotional speaking and consulting, but also for travel expenses and meals, according to data released Tuesday detailing payments by drug and device companies to U.S. doctors and teaching hospitals. (You can search for your doctor on ProPublica's updated Dollars for Docs interactive database.)
Stankovic's earnings were certainly high, ranking her about 250th among 606,000 doctors who received payments nationwide last year. What was more remarkable, though, was that she received payments on 242 different days — nearly every workday of last year.
Reached by telephone Tuesday, Stankovic declined to comment. On her LinkedIn page, Stankovic lists herself as vice chief of staff at Parkland Medical Center HCA Inc. in Derry, New Hampshire, and as medical director of peritoneal dialysis at DaVita Inc., also in Derry.
That doctors receive big money from the pharmaceutical industry is no surprise. The new data released by the Centers for Medicare and Medicaid Services shows that such interactions are widespread, with not only doctors, but thousands of dentists, optometrists, podiatrists and chiropractors receiving at least one industry payment from August 2013 to December 2014.
What is being seen for the first time now is how ingrained pharmaceutical companies and their sales reps are in the lives of those who write prescriptions for their products. A ProPublica analysis found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014.
Take Juichih Hsu, a Maryland doctor whose specialty is family medicine. She received payments on 286 days of 365, more than anyone else. Sometimes, she received meals from several drug companies on the same day. Hsu's payments totaled $5,959 in 2014. She declined to comment when reached on Tuesday.
"There are physician practices which have very deep relationships with pharmaceutical representatives, where they are a very integral part of the practice," said Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who has written about industry relationships with doctors. "Every day it's another drug company coming in for a lunch. Sometimes it may be some drug companies are bringing breakfast and some are bringing lunch and it's just part of the culture of the practice."

Medicare to Try a Blend of Hospice Care and Treatment