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Wednesday, February 29, 2012

Health Care Reform Articles - March 1, 2012








Single-Payer Health Care Is Coming To America-Are We Ready?

Speaking at a recent conference, Mark Bertolini, CEO and Chairman ofAetna Insurance, announced that the end is near for profit driven health insurance companies. “The system doesn’t work, it’s broke today. The end of insurance companies, the way we’ve run the business in the past, is here.”


Patients going to Maine ERs with toothaches, other dental problems

By Jackie Farwell, BDN Staff
Posted Feb. 29, 2012, at 4:26 p.m.
Two patients recently visited Dr. Wendy Alpaugh’s dental practice in Stonington after complaining to their doctors of painful facial swelling. Two expensive CAT scans later, both wound up in the dentist’s chair for a root canal.
“If they had realized how much less it would have cost them if they’d maintained the preventive care,” Alpaugh said, trailing off.
Toothaches and other avoidable dental problems were the primary culprit behind more than 830,000 emergency room visits nationwide in 2009, a 16 percent jump from 2006, according to a reportreleased this week by the Pew Center on the States.
In Maine, dental disease was the top reason Medicaid recipients and uninsured people ages 15-24 visited ERs in 2006, Pew reported, citing a study by the Muskie School of Public Service at the University of Southern Maine. That year, tooth decay, abscesses and other dental problems were responsible for 3,400 emergency visits by Medicaid patients. The study highlighted poor access to preventive and acute dental care as major drivers.



Blue Shield seeks $10.5 million in damages from O.C. doctor group

Blue Shield of California alleges that an Irvine physician group, now owned by UnitedHealth Group, refused to treat some of its members and tried to switch them from Blue Shield coverage.

By Chad Terhune, Los Angeles Times
March 1, 2012
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Blue Shield of California has demanded $10.5 million in damages from a large Orange County physician group that was recently acquired by rival insurer UnitedHealth Group Inc., a sign of rising tension as insurers and hospitals snap up more medical providers in advance of federal reform.

The nonprofit insurer said Wednesday that it had filed a demand for binding arbitration with Monarch HealthCare of Irvine, the largest physician group in Orange County, which contracts with 2,300 independent doctors and serves 176,000 patients. Optum, a unit of Minneapolis-based UnitedHealth, acquired Monarch in November.

Blue Shield alleges that Monarch, under its new ownership, refused to treat some of its members and tried to switch them from Blue Shield coverage — in violation of its contract. "There is an active recruitment of our members to UnitedHealth," said Juan Davila, the San Francisco insurer's senior vice president for network management.
http://www.latimes.com/business/la-fi-mo-blue-shield-dispute-20120301,0,2422719,print.story



Brown gets no promise of federal help for Medi-Cal

Governor says Sebelius hints that there may be other ways for the state to save money on health insurance for the poor.

By Anthony York, Los Angeles Times
10:00 PM PST, February 26, 2012
Reporting from Washington


Health and Human Services Secretary Kathleen Sebelius on Sunday threw cold water on Gov. Jerry Brown's plan to ask California's poor to contribute to their federally subsidized healthcare — payments the governor has proposed to save the state more than $500 million a year.

Brown met with Sebelius for 45 minutes in Washington, where he renewed his pitch for more flexibility in how the state handles Medi-Cal, its health-insurance program for the poor. The governor wants co-pays from recipients for emergency-room visits as well as routine trips to the doctor and dentist, beginning in October.

"Everybody has to have some skin in the game," Brown said of his co-pay plan. "For some people, they're so destitute that's impossible. OK, I understand that. But … I think there's a wiser path than the one we're on."

The Obama administration turned down a similar request earlier this month. On Sunday, Brown said, Sebelius told him that there were legal obstacles to his proposal but hinted that there were other ways the state may be able to save money in its Medi-Cal program, which helps more than 7 million Californians. Brown said the secretary did not specify what those ways might be.

Sebelius' office did not respond to requests for comment.



New York protest tries to kick off revival of Occupy movement

Wed, Feb 29 2012
By Gianna Palmer
NEW YORK (Reuters) - A few dozen Occupy Wall Street protestors marched on the world headquarters of pharmaceutical giant Pfizer Inc. on Wednesday, a lukewarm kick off to a nationwide day of revival for the movement loosely organized around denouncing economic inequality.
Police on motorcycles escorted the peaceful but loud group of about 50 protestors marching from the park outside the New York Public Library to nearby Pfizer, close to Grand Central Terminal.
"Shame on Pfizer! You're a bunch of liars!" chanted the protestors as they milled around barricades in front of Pfizer, the world's largest drug maker, and were watched by about 50 police officers.


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Sunday, February 26, 2012

Health Care Reform Articles - February 29, 2012

Five myths about Medicare

By John Rother, Published: February 24

1. Medicare is inefficient and fails to control costs.
The trustees of Medicare last year projected that the program’s share of gross domestic product would increase from the current 3.7 percent to about 5 percent in 2030 and nearly 6 percent by 2050. But since Medicare’s inception in 1965, its spending growth, on a per-person basis, has stayed consistent with or lower than the increase in private health insurance premiums.
The Congressional Budget Office recently predicted that per capita Medicare spending will grow 1 percent faster than the rate of inflation over the next decade. The CBO attributes the slower projected trend in Medicare spending to the enactment of President Obama’s health-care overhaul, which reduced high payments to Medicare HMOs, and to the anticipated influx of younger, healthier baby boomers, which will lower the average cost per beneficiary. Medicare enrollment is projected to accelerate over the next 25 years, from 47.5 million today to 80 million in 2030.
http://www.washingtonpost.com/opinions/five-myths-about-medicare/2012/02/02/gIQAnXxtXR_print.html


MaineCare: There’s plenty of outrage to go around

Published on Sunday, Feb 26, 2012 at 12:12 am | Last updated on Monday, Feb 27, 2012 at 11:11 am 53 Comments
When Gov. Paul LePage first proposed cutting $221 million from the state’s Medicaid rolls, he said we had been generous to a fault. We had, over the years, added benefits that we could no longer afford.
As the legislative debate heated up, along with the governor’s temper, the chief executive took a different tack.
“Maine Medicaid programs have grown at an unsustainable rate,” he said, “and spending is out of control. I ask you, where is the outrage?”
http://www.sunjournal.com/news/our-view/2012/02/26/mainecare-there-s-plenty-outrage-go-around/1158785


If You Feel O.K., Maybe You Are O.K.


By H. GILBERT WELCH


Hanover, N.H.
EARLY diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one) heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening.
It is a precept that resonates with the intuition of the general public: obviously it’s better to catch and deal with problems as soon as possible. A study published with much fanfare in The New England Journal of Medicine last week contained what researchers called the best evidence yet that colonoscopies reduce deaths from colon cancer.
Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children.


No Extra Benefits Are Seen in Stents for Coronary Artery Disease


By NICHOLAS BAKALAR


The common practice of inserting a stent to repair a narrowed artery has no benefit over standard medical care in treating stable coronary artery disease, according to a new review of randomized controlled trials published on Monday.
Stable coronary artery disease is the type of heart ailment that causes angina, or chest pain, after physical exercise or emotional stress but generally not at other times. The review did not include studies of the emergency use of stents for heart attacks.


New Maryland Economic Impact Study by Gerald Friedman, Ph.D.

February 22, 2012
The following is the executive summary of the economic impact study of the Maryland Health Security Act. You can download the full study here.
Maryland is on an unsustainable economic path; health care costs are absorbing a growing share of personal income. Between 1991 and 2011, health care spending in Maryland increased by $35 billion, nearly 10-times the rate of population growth and almost twice the rate of growth in per-capita income. Should health care spending continue to increase at this rate, spending will pass $100 billion in a little over a decade. Little of this increased spending can be attributed to improvements in health care; instead, the fastest growth has been in administration and billing operations while many remain without adequate health insurance or access to needed care.

FEBRUARY 27, 2012, 5:49 PM

Knee Replacement May Be a Lifesaver for Some

By TARA PARKER-POPE
Stuart Bradford
By the time 64-year-old Laura Milson decided to undergo total knee replacement after 12 years of suffering from arthritis, even a short walk to the office printer was a struggle.
After her surgery last August at the Rothman Institute at Thomas Jefferson University in Philadelphia, Ms. Milson spent a week in rehabilitation and says she hasn’t stopped walking since. “My son says to me, ‘You have to slow down,’ and I say, ‘No, I have to catch up!,’ ” she said. “It’s a whole different life.”
For Ms. Milson, who lives in Shrewsbury, Pa., replacing the joint in her right knee came with a surprising bonus: a 20-pound weight loss in two months. “I joked with my doctor, ‘I think you put a diet chip in my knee,’ ” she said. “The weight just sort of came off.”
Now she has joined Weight Watchers to drop a few extra pounds and is training for a three-day breast cancer walk in October.
For years surgeons have boasted of the pain relief and improved quality of life that often follow knee replacement. But now new research suggests that for some patients, knee replacement surgery can actually save their lives.

latimes.com/news/nation/nationnow/la-na-nn-medicare-fraud-20120228,0,6359381.story
Federal law enforcement officials announced what they called the largest healthcare fraud case in the nation’s history, indicting a Dallas area physician for allegedly bilking Medicare for nearly $375 million in billings for nonexistent home healthcare services.

Top Justice Department officials, working for several years to stem a rampant rise in healthcare fraud around the country, also revealed Tuesday that 78 home health agencies that were working with the physician, Dr. Jacques Roy, will be suspended from the Medicare program for up to 18 months.


Health Care Myths and Realties

by WENDELL POTTER on FEBRUARY 27TH, 2012
Seeking the truth about high-deductible plans.
Recent news releases from two very different organizations paint entirely separate pictures of what can happen to people once they sign up for a high-deductible health plan.
One release from Cigna, the giant for-profit insurance firm I used to work for, would lead us to believe that human resource managers who haven’t moved all of their company’s employees into a high-deductible plan should be canned for fiscal ineptness.
The other, from GiveForward, a Web site where people can create personal fundraising pages, tells of the real-world consequences when people in high-deductible plans become seriously ill or get hurt.

Safety Alerts Cite Cholesterol Drugs’ Side Effects


By 


Federal health officials on Tuesday added new safety alerts to the prescribing information for statins, the cholesterol-reducing medications that are among the most widely prescribed drugs in the world, citing rare risks of memory loss, diabetes and muscle pain.
It is the first time that the Food and Drug Administration has officially linked statin use with cognitive problems like forgetfulness and confusion, although some patients have reported such problems for years. Among the drugs affected are huge sellers like Lipitor, Zocor, Crestor and Vytorin.
But federal officials and some medical experts said the new alerts should not scare people away from statins. “The value of statins in preventing heart disease has been clearly established,” said Dr. Amy G. Egan, deputy director for safety in the F.D.A.’s division of metabolism and endocrinology products. “Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects.”

State supreme court rejects Anthem appeal of rate increase

By Jackie Farwell, BDN Staff
Posted Feb. 28, 2012, at 2:04 p.m.
PORTLAND, Maine — State regulators were justified last May in denying a planned rate hike by Anthem Health Plans of Maine, the state’s highest court ruled Tuesday.
The Maine Supreme Judicial Court sided unanimously with former Bureau of Insurance Superintendent Mila Kofman’s decision to slash by nearly half a rate increase affecting about 11,000 Mainers covered by Anthem’s individual health insurance policies. The rates took effect July 1, 2011, and run through June 30.
Anthem’s appeal marked the third time in three years that the firm, the only insurance company offering individual policies in the state, has appealed Kofman’s rate decisions. Justices have ruled in her and the state’s favor each time.
On Tuesday, the court ruled Kofman reasonably determined that Anthem’s proposed rate increase of 9.2 percent was “excessive.” Kofman set the average increase at 5.2 percent and limited the firm to a 1 percent profit margin.
Anthem originally sought a 9.7 percent increase before amending its request down.


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Saturday, February 25, 2012

Health Care Reform Articles - February 25, 2012

A Test in Time



Researchers had previously shown that colonoscopies, which look for and remove tumors and suspicious precancerous lumps in the intestines, could reduce the incidence of colorectal cancer. But they didn’t know for certain that the procedure would save lives. Now they have evidence that it does. A study published in the latest issue of The New England Journal of Medicine that tracked 2,600 patients for as long as two decades found that the test cut the death rate in half, a very substantial reduction.
That should reassure millions of Americans who have undergone colonoscopies that the test was worth the unpleasant preparations. And it ought to goad millions who are still ducking the tests to get over their squeamishness.

Reporting from Washington -- Gov. Jerry Brown delivered a message to the Obama administration this week in Washington: Back off.

The governor wants the federal government to let him make more cuts in the Medi-Cal program that serves low-income Californians and to exempt state schools from new sanctions that could cost hundreds of millions of dollars.

Brown said he raised the issues in a White House meeting with President Obama and 11 other Democratic governors Friday morning and in a private meeting with Education Secretary Arne Duncan on Thursday.

Lawmakers probe Prime Healthcare Services' billing practices

A hearing is called to investigate allegations of excess charges and boosting revenue by refusing to transfer out-of-network patients.

By Chad Terhune, Los Angeles Times
February 25, 2012


Controversial medical and billing practices by hospital chain Prime Healthcare Services came under scrutiny at a hearing before California lawmakers one day after the company's chief executive abruptly resigned.


Center for Economic and Policy Research
February 2012
Health-insurance Coverage for Low-wage Workers, 1979-2010 and Beyond
By John Schmitt

In 2010, over 38 percent of low-wage workers lacked health insurance from
any source, up from 16 percent in 1979.

Coverage problems are particularly severe for Latino workers. Almost 40
percent of all Latino workers (not just low-wage workers) have no health
insurance of any form. African American (about 22 percent) and Asian (about
17 percent) workers are also much less likely to have coverage than white
workers (about 12 percent).
http://www.cepr.net/documents/publications/health-low-wage-2012-02.pdf
Implementing Health Reform: Essential Health Benefits And Medical Loss Ratios
by Timothy Jost
On December 16, 2011, the Department of Health and Human Services issued a bulletin describing the approach that it intended to take to defining the essential health benefits (EHB) that individual (nongroup) and small group plans must cover under the Affordable Care Act.  In that bulletin, HHS indicated that each state will select a benchmark plan from a menu of alternatives.  Services covered by that benchmark plan will set the minimum EHB that all small group and nongroup plans in the state must cover.  Plans must cover, however, all ten categories of essential health benefits listed in the ACA.http://healthaffairs.org/blog/2012/02/18/implementing-health-reform-essential-health-benefits-and-medical-loss-ratios/

Medicare And Commercial Health Insurance: The Fundamental Difference


by Diane ArcherandTheodore Marmor
As the debate over Medicare continues in connection to America’s fiscal problems, it is critical to understand how Medicare differs from commercial health insurance for working people.  There is a fundamental difference between these two types of health insurance plans, one social and one commercial.




Vt. would allow 'bronze plan' to encourage health

(AP)  MONTPELIER, Vt. — Vermont Gov. Peter Shumlin and legislative leaders said Monday they wanted to make it possible for more of the state's small businesses to offer lower premium health insurance plans sometimes known as "bronze plans" until the state can implement its single payer health care system.

Speaking Monday in Montpelier, Shumlin and leaders from the House and Senate, all Democrats, said they would also allow businesses with more than 50 employees to remain outside the federally-mandated health care exchange until 2016.

"We feel strongly that the exchange is not the answer to all Vermont's health care problems," Shumlin said at a news conference in the Montpelier Statehouse. "We feel that as we design an exchange it should have maximum flexibility and allow shoppers to make choices for insurance until we implement our plan in Vermont."





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