Health Care Reform Articles - January 25, 2019

U.S. healthcare stocks seen maintaining momentum after strong 2018

by Lewis Krauskopf - Reuters - January 14, 2019

NEW YORK (Reuters) - One of the rare market bright spots last year, the U.S. healthcare sector remains a Wall Street darling despite a slow start to 2019. 

As 2019 begins, healthcare .SPXHC is the most favored of the 11 main S&P 500 sectors, according to a Reuters review of ratings from 13 large Wall Street research firms, which recommend how to weigh those groups in investment portfolios.
Healthcare shares overall rose 4.7 percent last year, one of only two S&P 500 sectors, along with utilities, to post positive returns in 2018 as the benchmark index fell 6.2 percent.
Proponents cite the healthcare sector’s reasonable valuations, strong balance sheets and dividend payments among many companies, as well as the group’s upbeat outlook for earnings, which are less susceptible to economic cycles than other businesses.
If economic growth is slowing, some investors are wary of being too invested in cyclical sectors that thrive during an upswing, but do not want to be too defensive either.
“We are trying to find things that skirt both of those two categorizations, and healthcare is a really nice diversified earnings stream,” said Noah Weisberger, managing director for U.S. portfolio strategy at Bernstein.
Such diversity stems from the variety of companies comprising the sector: manufacturers of prescription medicines, makers of medical devices, such as heart valves and knee replacements, health insurers, hospitals and providers of tools for scientific research.
From a stock perspective, that means the sector includes potential fast-growing stocks, such as biotechs that can carry more risk and more reward, or large pharmaceutical companies and others that offer steadier, slower growth.
Investment advisory firm Alan B. Lancz & Associates sold some pharmaceutical holdings late last year that had posted big gains, such as Merck & Co (MRK.N), to move into biotech stocks it believed were undervalued, said Alan Lancz, the firm’s president.
“We have maintained our overweighting, which is unusual for us with a sector that has outperformed so dramatically,” Lancz said. “But mainly there are segments within the sector that still offer opportunity.”
(GRAPHIC: Healthcare is most favored sector on Wall Street - tmsnrt.rs/2HaLYKT)
For 2019, healthcare companies in the S&P 500 are expected to increase earnings by 7.5 percent, ahead of the 6.3 percent growth estimated for S&P 500 companies overall, according to IBES data from Refinitiv.
Health insurer UnitedHealth Group Inc (UNH.N), the sector’s third-largest company by market value, kicks off fourth-quarter earnings season for healthcare on Tuesday.
“Healthcare is one of the few sectors with high quality, above-market growth and it’s relatively immune to the array of macro headwinds that we see out there,” said Martin Jarzebowski, sector head of healthcare for Federated Investors.
Healthcare shares could also benefit from anticipation of increased dealmaking activity after two large acquisitions of biotechs were already announced this year.
Despite healthcare’s outperformance last year, the sector is trading at the same valuation as the S&P 500 - 14.5 times earnings estimates for the next 12 months - whereas healthcare on average has held a premium over the market for the past 20 years, according to Refinitiv data.
The sector also is valued at a discount, by such price-to-earnings measures, to defensive sectors, including consumer staples .SPLRCS, which trades at 16.6 times forward earnings, and utilities .SPLRCU, which trades at 15.8 times.
(GRAPHIC: Healthcare stocks, by the numbers - tmsnrt.rs/2H7Mnxw)
According to the Reuters review of sector weightings, healthcare is followed by financials .SPSY, then technology .SPLRCT. Real estate .SPLRCR ranks as the most negatively rated group.
The healthcare sector has lagged in the early days of 2019, rising less than 1 percent against a 3 percent rise for the S&P 500.
Some investors doubt healthcare will maintain its outperformance. JP Morgan strategists downgraded the sector to “underweight” last month, pointing in part to political rhetoric possibly turning “more negative on healthcare leading up to the 2020 presidential elections.”
The healthcare sector struggled ahead of the 2016 election, with the high U.S. cost of prescription medicines a prominent issue during the presidential campaign. With renewed scrutiny on drug pricing, such concerns linger.

UBS, global growth worries send European shares into the red

The sector could suffer if investors become more optimistic about economic growth and flee defensive stocks, while the popularity of healthcare as an investment could work against it if the trade becomes overly crowded.
“There is risk there,” said Walter Todd, chief investment officer at Greenwood Capital in South Carolina. But given issues affecting other sectors, he said, “when you look around the market...you arrive by default at healthcare, and so I think that’s why a lot of people are interested in the sector.”
https://www.reuters.com/article/us-usa-stocks-healthcare-idUSKCN1P82A6

After Falling Under Obama, America’s Uninsured Rate Looks to Be Rising

by Margot Sanger-Katz - NYT - January 23, 2019

The number of Americans without health insurance plunged after Obamacare started. Now, early evidence suggests, it’s beginning to climb again.
New polling from Gallup shows that the percentage of uninsured Americans inched up throughout last year. That trend matches other data suggesting that health coverage has been eroding under the policies of the Trump administration.
Gallup estimated that the uninsured rate for adults increased by 1.3 percentage points. That would mean an increase of more than three million people without insurance between the first quarter of 2018 and the end of the year. Gallup said this was a four-year high, although a major methodology change a year ago may make such longer-term comparisons less precise.
“There’s no question that some of the reductions in the uninsured rate that we have measured over the course of Obamacare has now been given back,” said Dan Witters, the research director for the survey.

That may not be a surprise given the White House’s approach to health policy. It has consistently criticized the Affordable Care Act. And it has sought to weaken it legally, pulling back on funding to publicize coverage opportunities, and approving policies that make it harder for eligible people to enroll and stay enrolled in state Medicaid programs.
The administration has signaled that the use of certain public health insurance programs, like Medicaid, might count against immigrants applying for green cards. Other, more complex policy changes increased the cost of individual health insurance last year, although prices were on track to fall slightly, on average, this year.
Still, the increase in uninsured Americans could be a new pattern, even for the Trump administration. Although earlier surveys from Gallup and the Commonwealth Fund, a health research group, measured a rising uninsured rate, big government surveys from the census and the Centers for Disease Control and Prevention found coverage rates that were holding steady.
The employment picture has continued to improve during the Trump presidency, and more Americans have found full-time jobs. That trend is usually associated with improvements, not declines, in health coverage.
Data about initial sign-ups for last year’s Obamacare marketplace plans showed a decline of about 1.2 million people. There is less information about the number of Americans who buy their insurance directly from health insurers. But a report from the Department of Health and Human Services suggested that about one million fewer people bought coverage in 2017 than 2016, largely because of price, and declines may have continued last year.

The federal government has allowed states to impose new barriers to Medicaid, and enrollment declines appear to be occurring there, too. States have asked people to provide more documentation to enroll, or to verify their eligibility more often, policies that have been shown to depress enrollment.
Two states have imposed work requirements for some users of their programs, with five more about to start. Overall numbers from federal reports on Medicaid enrollment show 1.5 million fewer people insured through the program from December 2017 to October 2018, the most recent month with available data. The biggest declines came in Tennessee and Texas, which have begun to reconsider eligibility more often. In both states, Medicaid numbers fell by 11 percent.
Eliot Fishman, the policy director at the consumer health advocacy group Families USA and a former Medicaid official, has been tracking the Medicaid numbers. He said the big drops in several states were largely the result of state policy changes that might have attracted more federal pushback under the Obama administration.
“There’s a number of states where you’re looking at a high proportion of Medicaid enrollment and a high proportion of the state’s population losing health insurance flying under the radar,” he said. “That has public health effects.”
Several states will expand their Medicaid programs this year, after voters approved ballot initiatives, so further declines from work requirements and other policies in some states may be balanced out by gains in coverage elsewhere.
Measuring the precise shape of any coverage declines may take some time. It will be several months before results from the federal surveys on 2018 are final. Benjamin Sommers, an associate professor at the Harvard School of Public Health, who has worked extensively with Gallup data, said he was waiting for more research before drawing firm conclusions about how many Americans had lost coverage, given the recent changes in the Gallup survey. (After years of conducting its surveys by telephone, Gallup in 2018 changed to mail and internet responses.)
“It’s suggestive, and definitely merits us digging deeper into this,” he said.
https://www.nytimes.com/2019/01/23/upshot/rate-of-americans-without-health-insurance-rising.html

 Health-care industry preps offense against Medicare-for-All 
by Paige Winfield Cunningham - The Washington Post - January 22, 2019

With support growing for universal health coverage, just what does "single-payer" mean? Here's the breakdown. (Jenny Starrs, Danielle Kunitz/The Washington Post)

Democrats newly in control of the House are sending quivers of fear throughout the U.S. health-care industry as they begin advancing Medicare-for-All measures that could result in a big financial blow to private health insurers, hospitals and doctors.
Industry leaders — who have united to fight what they view as a threat to the country’s existing patchwork system of public and private payers — told me they're planning to ramp up advertising and lobbying efforts this year to argue against such a dramatic overhaul of the health insurance system, saying education is all that’s needed to turn more Americans against the idea.
“I get the sense that progressives have gotten a total free pass. There is no pushback against those calling for Medicare-for-All,” said David Merritt, executive vice president for public affairs at America’s Health Insurance Plans.
“The people who are going to be impacted, like patients, like doctors who treat patients, like insurance plans that cover patients — no one has started to say in an organized and sustained way, ‘Here are the consequences if we do go down that path,' ” Merritt said.
Last summer, AHIP joined with the Federation of American Hospitals, the American Medical Association, the Pharmaceutical Research and Manufacturers of America, and 14 other groups in what they’ve named the Partnership for America’s Health Care Future.
Their mission: to convince Americans that a single-payer system would deeply hurt their access to vital health-care services. Their aim is to dissuade Democrars from fully embracing Medicare-for-All -- once a progressive hobby horse that has moved mainstream as House Democrats announced they'll hold hearings on such proposals this year.
Their argument goes like this: If the government is the sole payer, it could deny coverage for certain services and demand lower rates from providers, potentially forcing them out of business altogether. A single-payer option, especially one as dramatic as the Medicare-for-All plan offered by Sen. Bernie Sanders (I-Vt.), would also cost the government considerably more money, probably requiring tax hikes.
“It became quite clear [Medicare-for-All] was something a small but increasing number of policymakers were pushing for,” said Jeff Cohen, executive vice president for public affairs at the Federation of American Hospitals. “And so we all looked at each other and said, ‘We might have a problem on our hands if we’re not doing the education and awareness campaign we need to be doing.' ”
As the Intercept detailed in November, a leaked planning document from the group says its campaign is intended to “change the conversation around Medicare for All” and “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”
The U.S. Chamber of Commerce has also vowed to use its deep lobbying pocket to fight single-payer proposals. Government-run health care “just doesn’t work,” Chamber CEO Thomas Donohue said in his annual “State of American Business” address this month. “We’ll use all our resources to make sure that we’re careful there.”

It’s certainly true there’s an unprecedented level of enthusiasm among Democrats for making publicly backed health insurance more widely available. About half of all Democrats in contested House races backed a Medicare-for-All approach, according to a count by National Nurses United.
Fifteen Senate Democrats and 124 House Democrats have signed onto Medicare-for-All bills. Included among them are all four members of Congress who have so far announced presidential bids: Sens. Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Kamala Harris of California and Rep. Tulsi Gabbard of Hawaii. Aides to Harris, who was the first senator to sign onto Sanders's bill, said Medicare-for-All will be included in her campaign platform, per my colleague Jeff Stein.
And polls have found a majority of voters favor the idea of Medicare-for-All — although support fades somewhat when respondents hear arguments that it could give the government too much control over health-care or require more taxes.
But industry leaders contend that Medicare for All didn’t sell nearly as well on the campaign trail as some have imagined.
They point to the most competitive House districts, where the winning Democrats largely didn’t run on — or even support — the idea. Of the the 35 Democrats who seized Republican-held seats, 23 didn’t support Medicare-for-All, and seven more who did support it nonetheless didn’t run on it, according to an analysis by Forbes Tate Partners, a public affairs and lobbying firm founded by former Democratic administration officials that is managing part of the coalition.
Highly publicized candidates such as freshmen Reps. Alexandria Ocasio-Cortez of New York and Rashida Tlaib of Michigan embraced Medicare for All. But in moderate districts and swing states, Democrats such as Reps. Lauren Underwood of Illinois and Donna Shalala of Florida kept the idea of a single-payer system an arm's length away.
Republicans helped contribute to the narrative that Democrats are overwhelmingly in favor of Medicare-for-All, running ads on the issue against even candidates that hadn’t endorsed it, as my colleague Dave Weigel reported in the fall.

Some backstory here: At the start of the cycle, many Rs thought that D voters would back only the most left-wing candidates in primaries. In nearly every swing race, they didn't. Solution: Pretend they did!

— Dave Weigel (@daveweigel) September 26, 2018

There are a variety of Medicare-for-All ideas being floated by lawmakers, ranging from a dramatic shift to a single-payer system to merely lowering the age for Medicare eligibility. The partnership is opposed to virtually any idea that would result in fewer people getting private coverage — for the obvious reasons that the government would then pay providers and insurers a lot less money.
But they also make this point: Why upend a system in which 92 percent of Americans already have health coverage to expand it to the 8 percent who don’t? Merritt and Cohen said they’re pushing Congress to focus on expanding coverage to the remaining uninsured while advancing measures to improve care and cut costs for everyone else.
“It’s not sexy, it doesn’t fit on a bumper sticker, and perhaps it’s hard to rally around,” Cohen said. “But there are things Congress can do that will begin to chip away at the anxieties people currently have regarding their health care. There are things people will see materially, sitting at home at the kitchen table, I think we shouldn’t discount.”
  https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/01/22/the-health-202-health-care-industry-preps-offense-against-medicare-for-all/5c44c7701b326b29c3778c54/?utm_term=.0429ecbdb83f

Meeting Individual Social Needs Falls Short Of Addressing Social Determinants Of Health

Brian Castrucci and John Auerbach - Health Affairs - January 16, 2019

Until recently, efforts to improve the health of Americans have focused on expanding access to quality medical care. Yet there is a growing recognition that medical care alone cannot address what actually makes us sick. Increasing health care costs and worsening life expectancy are the results of a frayed social safety net, economic and housing instability, racism and other forms of discrimination, educational disparities, inadequate nutrition, and risks within the physical environment. These factors affect our health long before the health care system ever gets involved.
Hospitals and health care systems have started to address these social determinants of health through initiatives that buy food, offer temporary housing, or cover transportation costs for high-risk patients. The prevalence and initial success of these efforts are clear in headlines such as: "What Montefiore’s 300% ROI from Social Determinants Investments Means for the Future of Other Hospitals," "Social Determinants of Health Gain Traction as UnitedHealthcare and Intermountain Build New Programs," and "How Addressing Social Determinants of Health Cuts Healthcare Costs." But when you take a closer look, these articles aren’t about improving the underlying social and economic conditions in communities to foster improved health for all – they’re about mediating patients’ individual social needs. If this is what addressing the social determinants of health has come to mean, not only has the definition changed, but it has changed in ways that may impede efforts to address those conditions that impact the overall health of our country.
In 2008, the World Health Organization’s Commission on the Social Determinants of Health defined those determinants  as the “conditions in which people are born, grow, live, work, and age” and “the fundamental drivers of these conditions.” This term prioritizes a broad, community-wide focus on the underlying social and economic conditions in which people live, rather than the immediate needs of any one individual. While health care leaders have realized that programs to buy food, offer temporary housing, or cover ridesharing programs are less expensive than providing repeat health care services for their highest cost patients, such patient-centered assistance does not improve the underlying social and economic factors that affect the health of everyone in a community.  While targeted, small-scale social interventions provide invaluable assistance for individual patients, we must also remain focused on the social determinants that perpetuate poor health at the community level.
A recent speech by Health and Human Services (HHS) Secretary Alex Azar highlighted the dichotomy between individual-level “social needs” and community-level “social determinants.” Secretary Azar emphasized that factors like housing and transportation have an important effect on Americans’ health. He asked rhetorically, "How can someone manage diabetes if they are constantly worrying about how they’re going to afford their meals each week? How can a mother with an asthmatic son really improve his health if it’s their living environment that’s driving his condition?” And he appropriately noted that we “can’t simply write a prescription for healthy meals, a new home, or clean air.”
In his discussion of how to address health-related community conditions, Secretary Azar, like a growing number in health care, focused on the social needs of individual patients. In his speech, he recounted the success of the Accountable Health Communities model, noting that “participating providers screen high utilizers of healthcare services for food insecurity, domestic violence risk, and transportation, housing, and utility needs. If needed, patients are set up with navigators, who can help determine what resources are available in the community to meet the patient’s needs.” He even went so far as to suggest that Medicaid may allow hospitals to pay for housing, healthy food, and other services. But in order to improve our nation’s health, we must look beyond “superutilizers,” Medicaid recipients, and those who are already sick. Secretary Azar appropriately noted that health care navigators “can help determine what resources are available in [a] community.”  However, while growing in popularity, health care navigators and similar enhancements to health care can’t actually change the availability of resources in the community. They can’t raise the minimum wage, increase the availability of paid sick leave, or improve the quality of our educational system. These are the systemic changes that are necessary to truly address the root causes of poor health.
 Even if they don’t address broader social conditions within patients’ communities, health providers’ efforts to meet individuals’ non-medical needs are praiseworthy and potentially life-saving. In Chicago, Advocate Health Care saved nearly $5 million by screening for malnutrition risk factors and establishing an enhanced nutrition care program.  In Boston, a six-months-or-longer, home-delivered meals benefit for dual Medicare-Medicaid eligible patients was associated with significant reductions in emergency room visits and overall health care cost savings. An initiative to link WellCare Medicaid and Medicare Advantage plan members to social service organizations resulted in an annual savings of $2,400 per person. In Hennepin County, Minnesota, millions of dollars were saved by offering unconventional services to patients with complex health, housing, and social service needs. The University of Illinois at Chicago reduced costs by 18 percent by identifying homeless patients who could benefit from housing support. These are just a few of the studies and reports documenting the health care system’s efforts to go beyond its own walls to improve health outcomes, decrease consumption of medical services, and reduce costs.
While individual-level interventions are beneficial, characterizing them as efforts to address social determinants of health conveys a false sense of progress. These strategies mitigate the acute social and economic challenges of individual patients, but they do so without implementing long-term fixes.  They are often limited to a small segment of the population – those who are in the worst health and have the greatest health care costs. Meanwhile, those patients who do not rank among the “sickest and most expensive” are ignored.
Policy makers have the power to address the social and economic conditions that affect community health. For example, in Kansas City, Missouri, voters recently approved a ballot initiative empowering health inspectors to respond to tenant complaints about a broad range of housing conditions, funded by an annual fee of $20 per unit for landlords. Earlier this year, the City Council of Alexandria, Virginia voted to raise the city’s meal tax to fund affordable housing. These communities and others like them have embraced the need for policy intervention to improve the social determinants of health for their citizens.
National initiatives offer states and local communities a roadmap for identifying and implementing gold-standard strategies to improve public health. In an initiative known as Health Impact in 5 Years (or HI-5), the Centers for Disease Control and Prevention (CDC) developed a list of 14 evidence-based policies to improve population health. CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, provides city leaders with a package of nine policy solutions that can help millions of people live longer and better lives.
Hospitals and health systems may be stepping up by referring a patient with mold in his or her apartment to a tenant’s right advocate, feeding a patient who needs food, or providing an on-site exercise program. But these interventions do not address the mold in that patient’s next-door neighbor’s apartment, community access to healthy food, or the availability of low-cost exercise options.  These community-level changes can only be made through policy action. While they work to address their patients’ immediate needs, hospitals and health systems would do well to recognize and support community-level policy actions.
This isn’t about picking one approach over another – we need social and economic interventions at both the community and individual levels. We often discuss health using the metaphor of a stream, with upstream factors bringing downstream effects. Social needs interventions create a middle stream (Exhibit 1). They are further upstream than medical interventions, but not yet far enough. Social needs are the downstream manifestations of the impact of the social determinants of health on the community.  Improvements in our nation’s health can be achieved only when we have the commitment to move even further upstream to change the community conditions that make people sick. The demand for social needs interventions won’t stop until the true root causes are addressed. This should ring especially true as the movement to Accountable Health Communities and value-based care gains momentum. Any success these new payment structures enjoy will be short-lived if the underlying social conditions in the communities where they work remain unchanged. While the allure of short-term economic gains from mediating patients’ social needs nearly ensures media and stakeholder attention, the incentives to advance policy, legislation, and regulation to improve health more broadly are often less clear. Redefining the meaning of “social determinants” to be mostly or only about the immediate social needs of expensive patients makes it harder to focus on the systemic changes necessary to address root causes of poor health. 

In 2003, David Kindig and Greg Stoddart offered a comprehensive definition of population health. Twelve years later, Kindig expressed concern that the use of the term had grown too broad, writing that it’s “growing use, most notable in the Triple Aim and in clinical settings, has resulted in a conflicting understanding of the term today.” Is the term “social determinants” heading for a similar fate? If we, even inadvertently, imply that the social determinants of health can be solved by offering Uber rides to individual patients or by deploying community health navigators, it will be challenging, if not impossible, for public health advocates to make the case for proven policies like alcohol sales control, complete streets, and healthy food procurement.
Words matter.  Common definitions ensure that we understand each other. When health care leaders and public health officials use “social determinants of health” to mean different things, it becomes more difficult for us to engage meaningfully with community partners, who will struggle to differentiate between these complementary but different approaches. This may seem like semantics, but when we use this term too broadly, we risk losing the specificity needed when calling on partners to make far-reaching social change, and we weaken our ability to implement the community-level efforts necessary to improve community health. And, ultimately, that doesn’t help any of us get healthier.
https://www.healthaffairs.org/do/10.1377/hblog20190115.234942/full/?

Donald Trump Did Something Right

His administration has ordered hospitals to reveal their prices. If patients and politicians pay attention, this could be a big deal.

By Elisabeth Rosenthal - NYT - January 21, 2019

As Donald Trump was fighting with Congress over the shutdown and funding for a border wall, his administration implemented a new rule that could be a game-changer for health care.
Starting this month, hospitals must publicly reveal the contents of their master price lists — called “chargemasters” — online. These are the prices that most patients never notice because their insurers negotiate them down or they appear buried as line items on hospital bills. What has long been shrouded in darkness is now being thrown into the light.
For the moment, these lists won’t seem very useful to the average patient — and they have been criticized for that reason. They are often hundreds of pages long, filled with medical codes and abbreviations. Each document is an overwhelming compendium listing a rack rate for every little item a hospital dispenses and every service it performs: A blood test for anemia. The price of lying in the operating suite and recovery room (billed in 15-minute intervals). The scalpel. The drill bit. The bag of IV salt water. The Tylenol pill. No item is too small to be bar coded and charged.
But don’t dismiss the lists as useless. Think of them as raw material to be mined for billing transparency and patient rights. For years, these prices have been a tightly guarded industrial secret. When advocates have tried to wrest them free, hospitals have argued that they are proprietary information. And, hospitals claim, these rates are irrelevant, since — after insurers whittle them down — no one actually pays them.

Of course, the argument is false, and our wallets know it.
First of all, hospitals routinely go after patients without insurance or whose insurer is not in their network. When Wanda Wickizer had a brain hemorrhage in 2013, a Virginia hospital billed her $286,000 after a 20 percent “uninsured” discount on a hospital bill of $357,000 — the list price, according to chargemaster charges. Medicare would have paid less than $100,000 for her treatment.
Second, those list prices form the starting point for negotiations, allowing hospitals and insurers to take credit for beneficence, when there is none.
I recently received an insurance statement for blood tests that were priced at $788.04; my insurer negotiated a “discount” of $725.35, for an agreed-upon price of $62.69 “to help save you money.” My insurer’s price was around 8 percent of the charge. Since my 10 percent co-payment amounted to $6.27, my insurer happily informed me, “you saved 99 percent.”
Not!
If a supposedly $1,000 TV is “on sale” for $80, it’s not really a discount. It’s an absurd list price.
Just as airlines have been shown to exaggerate flight times so they can boast about on-time arrivals, hospitals set prices crazy high so they can tout their generous discounts (while insurers tout their negotiating prowess).

Another rationale for those prices is just plain greed. Dr. Warren Browner, the chief executive of California Pacific Medicine, describes this as the “Saudi Sheikh problem”: “You don’t really want to change your charges if you have a Saudi sheikh come in with a suitcase full of cash who’s going to pay full charges,” he said.
But in an era when American patients are expected to be good consumers and are paying more of their bills in the form of co-pays and deductibles, they have a right to the information on list prices. They have a right to make sure they are reasonable.
Although making chargemaster pricing public will not, by itself, reform our high-priced medical system, it is an important first step. Maybe, just maybe, a hospital will think twice before charging a $6,000 “operating room fee” for a routine colonoscopy if its competitor down the street is listing its price at $1,000. Making this information public should bring list prices more in line with what is actually paid by an insurer, a far better measure of value.
And while the lists are far from user-friendly, researchers and entrepreneurs can now create apps to make it easier for patients to match procedures to their codes and crunch the numbers. With access to list prices on your phone, you could reject the $300 sling in the emergency room and instead order one for one-tenth of the price on Amazon. You could see in advance the $399 rate your hospital charges for each allergen it applies in a skin test and avoid the $48,000 allergy test — with an $8,000 deductible.
As a next step, regulators should insist that these prices be easily accessible on hospitals’ home pages — perhaps in the place of “PAY YOUR BILL NOW” — and translated into plain English. Seema Verma, the head of the Centers for Medicare and Medicaid Services, has suggested that she may well do so.
Patients can help, too: Check out your hospital’s price list. If it’s not detailed or complete enough, demand more. For discrete items, like an M.R.I. of the brain or a vitamin D blood test, take the trouble to scan the chargemaster for the item. Reject an overpriced procedure (even if your insurer is paying the bulk of the bill) and take your business elsewhere.
Justice Louis Brandeis famously said, “Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.” But, in this case, the reform will work only if people take the trouble to look — and to act — now that the lights are turned on.
https://www.nytimes.com/2019/01/21/opinion/trump-hospital-prices.html

Trump Proposals Could Increase Health Costs for Consumers

by Robert Pear - NYT - January 21, 2019

WASHINGTON — Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.
The proposal, to be published this week in the Federal Register, would apply to health insurance plans sold under the Affordable Care Act.
Health plans have annual limits on consumers’ out-of-pocket costs. Under the proposal, insurers would not have to count the full amount of a consumer’s co-payment for a brand-name drug toward the annual limit on cost-sharing. Insurers would have to count only the smaller amount that would be charged for a generic version of the drug.
For example, if a consumer filled a doctor’s prescription for a brand-name drug with a $25 co-payment, rather than using a generic medicine with a $5 co-payment, the consumer might get credit for only $5 in out-of-pocket spending. Consumers would have to spend more of their own money before reaching the annual limit on out-of-pocket costs.

In addition, insurers would not have to count the value of coupons and other financial assistance provided to consumers by drug manufacturers if generic alternatives were available. This change could significantly increase consumers’ out-of-pocket costs for some of the more expensive prescription drugs and has prompted protests from groups representing patients.
President Trump has repeatedly vowed to reduce drug prices and to lower out-of-pocket drug costs. But for some consumers, the latest proposal could have the opposite effect.
The proposal highlights a potential conflict between patients with a particular disease, who may benefit from the use of coupons, and other consumers more generally. Economists say that coupons can raise health care costs by encouraging people to use more expensive drugs.
“The availability of a coupon may cause physicians and beneficiaries to choose an expensive brand-name drug when a less expensive and equally effective generic or other alternative is available,” the Trump administration said in explaining its proposal. “When consumers are relieved of co-payment obligations, manufacturers are relieved of a market constraint on drug prices.”
Moreover, it said, “coupons can add significant long-term costs to the health care system that may outweigh the short-term benefits.”

But Bari Talente, an executive vice president of the National Multiple Sclerosis Society, said, “Many people with M.S. rely on co-pay assistance, even for generic medications.”
In the last few years, she said, generic versions of the drug Copaxone have become available, but even they have high prices. One of the generic medicines costs $60,000 to $65,000 a year, she said.
Carl E. Schmid II, the deputy executive director of the AIDS Institute, a public policy and advocacy organization, said the administration’s proposal could sharply increase out-of-pocket costs, so that a consumer who now pays virtually nothing might have to pay $3,500 a year or more for a drug to treat H.I.V.
“That increases the likelihood that people won’t pick up their drugs, won’t take their drugs,” Mr. Schmid said.
Leyla Mansour-Cole, the policy director of the Diabetes Patient Advocacy Coalition, a nonprofit group, said the Trump administration proposal “caused trepidation” for some patients.
“In theory, co-pay coupons could encourage people to take higher-priced drugs,” Ms. Mansour-Cole said. “In reality, people use them to get the medicines that their doctors prescribe, despite astronomically high deductibles.”
The administration is proposing several other changes that could increase costs for consumers.
Under the proposal, fewer people would qualify for federal subsidies, and those who qualify could be required to spend a larger share of their income on insurance premiums.

In addition, the proposal could lead to a small increase in out-of-pocket costs, which include co-payments and deductibles for doctors’ services and hospital care.
The changes would result from a new method of calculating inflation in health insurance prices — a factor used in computing the amount of premium subsidies and the annual limit on consumers’ out-of-pocket costs.
The Trump administration estimated that the changes would save the government $900 million annually in subsidies in 2020 and 2021 and $1 billion a year in 2022 and 2023. In addition, it predicted that 100,000 fewer people would have coverage through the insurance exchanges created under the Affordable Care Act.
The administration said that some of the 100,000 people might buy short-term insurance policies, which do not have to cover pre-existing conditions or provide all the benefits required by the health law. But, it said, most are “likely to become uninsured.”
Either way, the administration said, “these individuals will be bearing a larger share of the costs of their own health care consumption.”
The proposed rule may reduce federal spending and the need to collect taxes in the future, the administration said. “However,” it added, “the increased number of uninsured may increase federal and state uncompensated care costs.”
The administration estimated that premiums — after subsidies, in the form of tax credits — would be 1 percent higher as a result of its proposal.

The limit on out-of-pocket costs is already high; a consumer can be required to spend as much as $7,900 a year. Under the formula now in use, the limit would rise to $8,000 next year. Under the Trump administration proposal, it would increase to $8,200.
Administration officials said their proposal would more accurately measure insurance price inflation. But Democrats refused to accept that explanation, noting that Mr. Trump had tried to repeal the Affordable Care Act during his entire first year in office.
Senator Ron Wyden of Oregon, the senior Democrat on the Finance Committee, described the new proposed rule as “Trump’s latest attempt to sabotage health care.”
The Trump administration is also proposing a new requirement to increase the number of health insurance plans that omit coverage of abortion services.
Under the proposal, insurers that provide coverage of abortions would also have to offer at least one plan providing the same benefits but excluding coverage of abortions.
The administration said it was concerned that some people who wanted to buy insurance under the Affordable Care act refrained from doing so because they had religious or moral objections to abortion coverage. The administration acknowledged that some states like California, New York and Oregon generally required insurers to offer abortion coverage on the exchange, and it appears that the proposed federal requirement would not override such state laws.
https://www.nytimes.com/2019/01/21/us/politics/trump-obamacare-drug-costs.html

Can a Nice Doctor Make Treatments More Effective?

By Lauren Howe and Kari Liebowitz - NYT - January 22, 2019

 

In the age of the internet, it’s easier than ever to pull together lots of information to find the best doctor. And if you’re like most patients, the metric you probably rely on most is the doctor’s credentials. Where did she go to school? How many patients has he treated with this condition?
You might also read some Yelp reviews about how nice this doctor is; how friendly and how caring. But all that probably seems secondary to the doctor’s skills; sure, it would be great to have a doctor whom you actually like, but that’s not going to influence your health the way the doctor’s competence will.
But our research in the psychology department at Stanford University suggests that this view is mistaken. We found that having a doctor who is warm and reassuring actually improves your health.
The simple things a doctor says and does to connect with patients can make a difference for health outcomes.

Even a brief reassurance to a patient from a doctor might relieve the patient’s symptoms faster. In a recent study that one of us conducted, our research group recruited 76 participants to receive a skin prick test, a common procedure used in assessing allergies. The provider in this study pricked participants’ forearms with histamine, which makes skin itchy and red.
Then, the doctor examined the allergic reactions. For some patients, the doctor examined them without saying much. But for other patients, the doctor had some words of encouragement. He told them: “From this point forward, your allergic reaction will start to diminish, and your rash and irritation will go away.” It turns out that this one sentence of assurance from a provider led patients to report that their reactions were less itchy — even though the doctor didn’t give any medication or treatment along with his words. Words alone from the provider relieved patients’ symptoms.
This tells us that a physician’s words might be more powerful than we normally realize. And research shows that it is not only when patients are taking placebos that demeanor matters. In fact, provider words influence the efficacy of even our most powerful drugs and treatments.
But as anyone who has been on the receiving end of a terse “You’re fine” knows, it’s not just what you say, it’s how you say it.
In another study one of us worked on, we assessed whether the same words from a doctor influence patients differently depending on how warm or competent the doctor seemed. Again, patients received a histamine skin prick. Depending on what experimental group they were assigned to, patients met a provider trained to act in one of two very different ways. One group met the provider many of us dream of: she acted both warm and competent, calling patients by name, smiling, chatting and making eye contact. Her office was spotless, she spoke clearly and confidently, and she pulled off the medical procedures without a hitch.

The other group, however, met the kind of doctor all too many of us have encountered: glued to the computer screen throughout the exam, the provider didn’t bother introducing herself and asked questions only to gather practical information. She also stumbled through some of the procedures in the messy exam room and sounded rather unsure of herself.
In both groups, the provider gave patients a cream that she said was an antihistamine to reduce the allergic reaction and decrease itching. The cream was merely unscented hand lotion: a placebo. (A benefit of doing this research in the lab is that for the purposes of the study, we can temporarily lead patients to believe something that is untrue, something doctors could never do in a real clinic visit.)
Decades of robust literature on placebo effects demonstrate that, even without any active ingredients, this cream should reduce the allergic reaction. But no one had examined how the doctor’s demeanor might influence the effects of a placebo treatment.
Our study revealed that the placebo cream reduced participants’ allergic reactions only when the provider projected warmth and competence. When the provider acted colder and less competent, the placebo cream had no effect. It seems that it’s not just what the doctor says about a treatment that matters. It matters how the doctor who says it engages with patients. Doctors who are warmer and more competent are able to set more powerful expectations about medical treatments. Those positive expectations, in turn, have a measurable impact on health.
So, we saw that when the provider projected both desirable qualities of warmth and competence, her words had an effect. When she projected neither, they did not.
What about a provider who seems competent, but not warm? One other group of patients met a provider who seemed highly competent but remained businesslike and distant throughout the interaction, and they did not respond to the placebo cream as much as when the provider acted warm and competent.
Patients of even the most accomplished and skillful doctors may benefit more when that doctor also connects with them.

All of this research suggests that doctors who don’t connect with their patients may risk undermining a treatment’s success. Doctor-patient rapport is not just a fluffy, feel-good bonus that boosts Yelp reviews, but a component of medical care that has important effects on a patient’s physical health. Particularly as artificial intelligence promises a world where we don’t need to go to the doctor for minor questions, we should not overlook the value of interacting with a human doctor and hearing words of encouragement.
And while physicians may worry that building rapport with patients requires too much time in a health care setting with visits that are already too short, there are simple ways to build warmth and competence — such as smiling, looking patients in the eye and asking their names — that don’t tax doctors beyond their limits.
We often think the only parts of medical care that really matter are the “active” ingredients of medicine: the diagnosis, prognosis and treatment. But focusing only on these ingredients leaves important components of care underappreciated and underutilized. To really help people flourish, health care works better when it includes caring.
https://www.nytimes.com/2019/01/22/well/live/can-a-nice-doctor-make-treatments-more-effective.html

 Removing investor-owned hospitals is not a bail out-- it’s the right thing to do.
by Kay Tillow - Daily Kos - January 25, 2019
Rep. Pramila Jayapal has been re-writing HR 676, the model improved Medicare for all legislation that has united and advanced a growing single payer movement since it was introduced into Congress in 2003.  HR 676 is evidence-based and written to enact the Physicians Proposal for a National Health Program.
Unless the movement acts quickly to assure HR 676’s ban on for-profit institutions is maintained, Jayapal’s new bill will remove this vital section of HR 676.
It’s a compromise that there is no need to make.  We are getting hearings in this Congress.  Why should we take the impact of the for-profits out of the discussion before the debate starts?  We gain nothing.  The ban on for-profits has been in HR 676 since the beginning.  It did not stop 124 congresspersons from signing on to it.  It did not stop unions, organizations, cities, counties, and many others from endorsing it.  It was one of the popular provisions that all of those who have dealt with these for-profit hustlers welcomed.
HR 676 included in Section 103 the following:
“No institution may be a participating provider unless it is a public or not-for-profit institution.  Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.”
And
“For-profit providers of care opting to participate shall be required to convert to not-for-profit status.”¹
That was placed in HR 676 for good reason.  Physicians for a National Health Program states in their proposal that “…because investor ownership of health care providers is known to compromise quality and divert funds from clinical care to overhead and profits the NHP (National Health Program) would not include such providers.”²
The consequences of for-profit institutions in health care are stark—even deadly.  In a review by researchers involving 15 observational studies of 26,000 hospitals and 38 million patients by Devereaux et al, the writers stated:  “Our pooled analysis of the adult population studies demonstrated that private for-profit hospitals were associated with a statistically significant increase in the risk of death.”³
In the United States, said co-author Dr. Holger Schönemann, assistant professor at the University of Buffalo, a 2% increased risk means that 14,000 people die each year at for-profit hospitals who would have lived if treated at non-profit hospitals.⁴
Preventing the deaths of 14,000 people a year is a pretty good reason to take a stand on this rather than write it off as a minor detail.
“According to CMS, for-profit nursing homes are cited for quality deficiencies 28 percent more often than non-profits, and for deficiencies that place residents in immediate jeopardy 53 percent more frequently,”⁵ say health policy experts Drs. Steffie Woolhandler and David Himmelstein.
“For-profit hospitals spend less on nurses and other clinical aspects of care, but more on administration and financial management; for-profit chains have often been cited for questionable business practices and have been repeatedly implicated in large scale fraud,”⁶ assert Woolhandler and Himmelstein.
The evidence is overwhelming.  So why would the ban on for-profit institutions in HR 676 be removed in the rewriting?
Some mistakenly say they don’t want to remove the for-profits because they don’t want to “bail out” those giant corporations.  But this is not a bail out.  A bail out is a situation in which the government uses public money to save a corporation or industry from failing.⁷
Hospital Corporation of America (HCA) and Tenet are far from failing.  In the first quarter of 2018 HCA saw their profits double to $1.1 billion.⁸
In the same quarter, Tenet reported a surprise $99 million profit after expanding a cost-cutting plan.⁹
Florida’s new Senator Rick Scott walked away (scot free) from the charges that his Columbia/HCA hospital corporation defrauded Medicare by paying only $1.7 billion dollars in fines and using the rest of the ill-gotten gains to promote his successful political career.¹⁰ 
These giants don’t want to be bought out.  They want to stay in the system for the massive profits they make.  It is not a bail out when HR 676 converts them to non-profit so that their facilities can be used for the benefit of patients.¹¹
Some assert that paying compensation for the hospitals will cost too much.  It will save lives and even money in the long run and is totally affordable by the use of 15 year bonds as set forth in HR 676.¹²
Taking out the ban on for-profit hospitals will not make our single payer legislation any easier to pass, yet it removes from the discussion the extremely important issue of what profits do to a health care system, to patients, to the costs.  Taking the discussion of profits in health care off the table will deprive the nation of the ability to debate the issue in the upcoming fight.
Some assert that Rep. Jayapal is going to leave the for-profits in the system but somehow regulate them.  Our system would then be burdened by the massive administrative task of trying to rein in the giants.  And it won’t work.  Single payer is supposed to simplify administration so that we can use those wasted funds for expansion of care.
If the for-profits are in, they will make profits and they will harm patients, and they will cost all of us.
Don’t weaken the bill before we get started.  Call Rep. Jayapal and ask her to put patients before profits and keep the ban on for-profit institutions in her Medicare for All bill.
Her number is Phone: 202-225-3106.
https://www.dailykos.com/stories/2019/1/20/1828017/-Removing-investor-owned-hospitals-is-not-a-bail-out-it-s-the-right-thing-to-do?_=2019-01-20T17:38:49.574-08:00

Progressives Warn Against Democrats Pushing 'Diluted' Half-Measures as Alternative to Medicare for All

by Jake Johnson - Common Dreams - January 22, 2019

With Medicare for All polling at an unprecedented 70 percent support among the American public and headed toward its first-ever congressional hearing, Politico on Tuesday reported that there is a growing effort among congressional Democrats—including some 2020 presidential hopefuls—to "water down" the grassroots push for a transformative single-payer program by offering up more incremental approaches to solving America's for-profit healthcare crisis.
"Only improved Medicare for All, aka single-payer, could accomplish those goals, reining in costs while achieving first-dollar universal coverage for everyone in the nation."
—Dr. Adam Gaffney, Physicians for a National Health Program
The proposals listed above, which Politico encapsulated with the term "Medicare for More," are just a handful of ideas Democratic lawmakers have put forth as ostensibly more "pragmatic" paths to achieving a humane healthcare system.
But grassroots Medicare for All advocates and campaigners—whose voices were absent from Politico's report—strongly objected to any plan that leaves intact central elements of a status quo that has produced enormous profits for the insurance and pharmaceutical industries, while leaving millions of Americans with soaring costs or entirely uninsured.
"Improved Medicare for All has support from an overwhelming majority of Democratic voters, so why the sudden proliferation of public option proposals? We should be very skeptical of these sorts of bills," Dr. Adam Gaffney, president of Physicians for a National Health Program (PNHP), told Common Dreams.
"They would not solve the fundamental problems of the American healthcare system, such as uninsurance, underinsurance, enormous administrative waste, or sky-high drug prices," Gaffney added. "Only improved Medicare for All, aka single-payer, could accomplish those goals, reining in costs while achieving first-dollar universal coverage for everyone in the nation. This should be the moment that lawmakers coalesce behind the single-payer bills in the House and the Senate."
According to Politico, Democratic leaders as well as rank-and-file lawmakers like Sens. Sherrod Brown, Tim Kaine, and others are refusing to throw their support behind Medicare for All, instead backing plans that "range from modest Medicare reforms to more ambitious restructurings that would extend government-run care to millions of new patients—an array of options that fall short of campaign trail promises for full Medicare for All."
Michael Lighty, a founding fellow of the Sanders Institute, told Common Dreams that such incremental approaches completely fail to address the fundamental crises at the heart of the U.S. healthcare system, which is the most inefficient and ineffective in the industrialized world.
"The dilution of improved Medicare for All remains the greatest threat to guaranteeing healthcare for all," Lighty said. "Without eliminating all barriers to care—starting with the huge out-of-pocket costs workers must pay—we cannot create a just healthcare system. We cannot reduce the huge administrative costs if we continue a fragmented system dominated by commercial insurance companies. This diluted approach would institutionalize big profits, high executive salaries, and political clout for the healthcare industry."
Lighty concluded that Democrats should stop pushing half-measures and work to "improve Medicare for everybody."
In addition to efforts by some Democrats to undercut Medicare for All with non-universal plans that critics say would fail to deliver badly needed results, the insurance industry and major business lobbying groups like the Chamber of Commerce are ramping up their own campaigns to crush single-payer before it gets off the ground.
"What will the Democratic Party (in the aggregate) do in response? Will it support the health and welfare of the American people, or continue the abuse of the American people by supporting those who extract wealth from suffering?"
—Thomas Neuburger
Thomas Donohue, the president and CEO of the Chamber of Commerce, vowed earlier this month to use all of the resources at his disposal to "combat" Medicare for All.
As part of the effort to overcome this deep-pocketed opposition, National Nurses United (NNU) is holding nationwide Medicare for All "barnstorms" next month to help "build the mass collective action we know we'll need to win."
In a Tuesday op-ed on Common Dreams, essayist Thomas Neuburger wrote that Democrats will soon be forced to pick a side in the immensely consequential fight over the future of the American healthcare system.
"When Medicare for All becomes a bill, the fight will be a cage match with the bright lights on," Neuburger noted. "What will the Democratic Party (in the aggregate) do in response? Will it support, whole-heartedly and by its actions, the health and welfare of the American people, or continue the abuse of the American people by supporting those who extract wealth from suffering?"
https://www.commondreams.org/news/2019/01/22/progressives-warn-against-democrats-pushing-diluted-half-measures-alternative

Mass. General Hospital plans large addition

Priyanka Dayal McCluskey - Boston Globe - January 22, 2019

Massachusetts General Hospital, the busiest medical center in the state, plans to spend more than $1 billion to build a large addition to its crowded campus to keep up with the demand for high-end medical care and compete for patients from around the globe.
The project is likely the largest ever proposed by a hospital in the state, and promises to reshape a busy stretch of downtown Boston between Government Center and the Longfellow Bridge.
It would include two connected 12-story towers on Cambridge Street, with hundreds of private patient rooms, a heart center, a cancer center, operating rooms, and other clinical areas. Mass. General expects to be able to treat at least 100 to 200 additional patients when the building — spanning 1 million square feet — is complete in about seven years.

The project comes as other hospitals in the city are expanding as well. It is expected to be bigger than the more than $1 billion expansion now underway at Boston Children’s Hospital. Beth Israel Deaconess Medical Center is also planning a smaller 10-story tower in the Longwood Medical Area.

Mass. General’s addition, with a completion date of 2026, would be built on property the hospital already owns. Hospital officials would demolish the existing Parkman Street parking garage and construct underground parking below the new building. They expect the project will involve 4,500 construction jobs and allow them to hire new hospital employees.
Mass. General will file its preliminary plans with the city Wednesday. The project requires city and state approvals and is likely to face scrutiny because of its significant cost — and the worry that the costs could trickle down to local patients and consumers. Mass. General, owned by Partners HealthCare, is widely renowned and among the state’s most expensive hospitals.
In interviews, hospital officials described the expansion plan as critical to supporting the growing numbers of patients who need cancer treatment, cardiac care, transplant surgeries, and other services.
The hospital’s facilities are largely outdated, they said. Most Mass. General patients have to share rooms. Only 38 percent of rooms are private, among the lowest percentages in the city, said Dr. Peter Slavin, president of Mass. General.
“If this region wants a world-class academic medical center like MGH, we have to renew our campus and keep it modern and terrific for our patients and competitive not only with local competition but the national competition as well,” Slavin said.
Mass. General currently has more than 1,000 beds and is usually filled almost to capacity, officials said. On any given day, dozens of beds may have to go unused because of infection control and other reasons.
During a tour one recent afternoon, the emergency department was full, as patients spilled into the hallways. More than 30 were waiting to be admitted, but no beds were immediately available.
“We always have patients down here waiting to be admitted,” said Dr. David Brown, chief of emergency medicine. “More beds will help to relieve that pressure.”
While most of Mass. General’s patients are from Massachusetts or New England, the hospital also competes for patients with complex medical needs from all over the world. About 3 percent of its patients are from states outside the region, and 1 percent are from other countries, hospital officials told the Globe.
Patient numbers have been growing, as have profits: Mass. General earned $252.4 million in income from operations last fiscal year, on revenue of almost $4.1 billion.
Founded more than two centuries ago, Mass. General’s campus is a mix of old and new. Some patient floors still in use today were constructed around the time of World War II. Patients in those areas are paired up, separated by just a curtain.
By comparison, the hospital’s last big addition, the Lunder building, has spacious single rooms, giving patients and families more privacy, and a quieter place to recover.
The proposed new building, which has yet to be named, would be twice as large as Lunder, which opened in 2011. It would include 450 single patient rooms, but hospital officials also plan to close and repurpose older patient areas, so they ultimately expect to gain about 100 to 200 new patient beds, they said.
Mass. General, which is structured as a nonprofit, recently began a campaign to raise $3 billion from private donors for the hospital’s programs over seven years. Hospital officials expect that about 20 percent to 30 percent of the cost of the new building would be paid for by donations.
The project still needs approval from several agencies including the Boston Planning & Development Agency and the state Department of Public Health. It also could be reviewed by the Health Policy Commission, which studies issues that affect the cost of health care.
In 2016, the commission warned that Boston Children’s Hospital’s expansion was likely to raise medical costs by drawing patients from other lower-priced hospitals. The Department of Public Health later approved that project with conditions. Mass. General’s project could face similar scrutiny.
Mayor Martin J. Walsh, in a statement Tuesday, voiced initial support for Mass. General’s plans.
“It’s important that our hospitals are making the improvements needed to keep Boston at the global forefront of health care,” Walsh said. “We look forward to closely reviewing Mass. General Hospital’s proposal once it is filed and beginning the comprehensive public process with input from the community.”
City Councilor Josh Zakim, whose district includes Mass. General, noted the hospital is not trying to acquire new land but is staying within its existing footprint.
“It’s certainly a significant project, but it’s not encroaching on the neighborhood,” Zakim said. “We do need to make sure we have modern facilities, enough beds for people from around the world to get treatment here.”
Zakim added that he’d like to see the hospital contribute to traffic improvements on Cambridge Street, which is often congested.
“They’ve generally been a good neighbor,” he said. “I’m looking forward to seeing where this goes.”
https://www.bostonglobe.com/business/2019/01/22/mass-general-hospital-plans-large-addition/bGugz9Fr5E7HoZ88IHFTdM/story.html?camp=breakingnews:newsletter

Mills right to reject failed GOP policy on health care

by David Farmer - Bangor Daily News - January 23, 2019

In a major victory for sound public policy over naked politics, Gov. Janet Mills continued her efforts to expand access to health care to Maine people.
This time, she bucked the Trump administration and former Gov. Paul LePage by rejecting a change to the state’s Medicaid program, which would have erected unnecessary barriers to health insurance for low-income families.
The policy changes, which LePage sought and the Trump administration granted, are often referred to as “work requirements,” meaning that a person receiving health care through Medicaid has to work or volunteer to get coverage.
In reality, the focus-group tested, polling-approved moves are all about denying health care to people. The idea is driven by the misguided idea that people who are poor are lazy and don’t want to work.
In truth, there are real barriers to work for many of the people for whom the requirements would have applied, including a lack of training or education, lack of transportation or the need to care for a sick or disabled child or relative.
Last summer, the Kaiser Family Foundation examined four states that had implemented waivers similar to the one sought by LePage and rejected by Mills. It’s not a pretty picture.
The research found that most people who receive Medicaid and can work, already are, but the jobs they have don’t pay enough to lift them out of poverty. There’s no incentive to find work – because most folks are already punching the clock.
Instead, the requirements set up a difficult-to-navigate bureaucracy that makes it hard for some with steady, long-term employment to comply, putting their health care at risk.
Simple fact: Sick people – and those without access to health care tend to be sicker – have a hard time holding down a job.
Arkansas is one of the first states in the country to put in place these new restrictions, and the results have been terrible. Nearly 17,000 people lost access to health care.
The Indianapolis Star took a look at the horrible consequences in Arkansas and asked if Indiana might suffer the same fate: “If the experience of Arkansas is any guide, Indiana’s plan to require people on Medicaid to work could wind up creating more problems than it solves.”
The Des Moines Register also weighed in on Iowa’s exploration of so-called work requirements: “The GOP idea to add a work requirement to Medicaid is a lame justification for pursuing bad policy. It would erect a barrier for Iowans seeking health insurance, not solve the state’s labor shortage.”
And the left-leaning Center on Budget and Policy Priorities put it this way: “Medicaid work requirements can’t be fixed. Unintended consequences are inevitable result.”
Most of those losing coverage, the center found, are people who are already working or should be exempt but lose coverage because of increased red tape, bureaucracy and paperwork.
Work requirements might sound good, especially to some of the state’s more conservative voters, but Mills made the right decision to put sound policy ahead of sloganeering.
In fact, she’s taking a proactive approach to helping knock down the barriers that prevent some people on Medicaid from working. She’s directed the Maine departments of Labor and Health and Human Services to help Maine people develop the skills they need and help them to find a job.
“Ensuring that Maine people have access to health care and are healthy is the first step to getting them back into the workforce,” acting DHHS Commissioner Jeanne Lambrew said.
As can be expected, LePage – tanned, rested, ready and always eager for the microphone – weighed in on Twitter. Needless to say, he’s not a fan of Mills and her commitment to expanding access to health care.
Beyond that, it was just more blah, blah, blah from a former governor desperate to stay in the spotlight.
Once again, Mills – an accomplished political brawler in her own right – is showing that she won’t let GOP talking points or the ghost of a governor past haunt her into doing the wrong thing.
Just three weeks in, Mills is setting a high bar and showing that she heard voters when they said they wanted more health care, not less. And on that, she’s delivering.
http://davidfarmer.bangordailynews.com/2019/01/23/republicans/mills-right-to-reject-failed-gop-policy-on-health-care/