Health Care Reform Articles-JULY 24, 2012

Reconsidering the PSA test

Men weigh pros and cons of prostate cancer screenings in light of new testing guidelines

By Deborah Kotz

 |  GLOBE STAFF

  JULY 23, 2012

It’s been two months since a government task force recommended against doctors routinely ordering prostate cancer screening tests. But many physicians disagree with the new guidelines, leaving men in a quandary: Should they continue to be screened with a prostate-specific antigen (PSA) blood test and digital rectal exam beginning at age 50, or should they skip the screening altogether? Some doctors still order a PSA without asking their patients, others have in-depth discussions to reach a shared decision, and still others decline to offer it at all.
http://www.bostonglobe.com/lifestyle/health-wellness/2012/07/22/men-weigh-pros-and-cons-prostate-cancer-screenings-light-new-testing-guidelines/E7WI5i4hgzlNuyro297fhO/story.html

The Medicaid albatross

By Robert J. Samuelson, Published: July 22

It’s no secret that the states are in as much budget trouble as the federal government. Doubters should read a new report from a group headed by former Federal Reserve chairman Paul Volcker and former New York Lt. Gov. Richard Ravitch. By this account, states face four insistent forces: pension underfunding of at least $1 trillion; rapidly rising Medicaid spending; possible cuts in federal aid that provides $1 in $3 of state spending; and weak growth of tax revenue that, in 2011, remained 7 percent below its pre-recession peak.
What looms are higher state taxes and reduced services, affecting schools, police, parks, prisons, public universities, roads and social services. Up to a point, cuts may not do much damage; every government has waste. But we are rapidly passing this point.
Can we do anything? Well, yes. We could nationalize Medicaid — the federal-state health insurance program for the poor. We could transfer all its costs to the federal government; in exchange, the federal government would end state aid for K-12 education and transportation. Though initially a dollar-for-dollar swap, the change would give states more control over their budgets.
Created by Congress in 1965, Medicaid is hijacking state politics. Although the federal government covers a majority of costs (typically, 57 percent), the rapid rise in the states’ share compels cuts in other programs or steeper taxes. In the past decade, Medicaid spending has increased at nearly twice the rate of states’ tax revenue, notes the Volcker-Ravitch report.
The pressures will only intensify as America ages. Although Medicaid serves primarily a younger population (half are children), two-thirds of its costs stem from the 25 percent of much sicker beneficiaries who areelderly and disabled, reports the Kaiser Family Foundation. An older America will raise these costs and squeeze states’ other services.

http://www.washingtonpost.com/opinions/robert-samuelson-the-medicaid-albatross/2012/07/22/gJQAAgp42W_print.html

CBO: Court ruling cuts cost of health-care law, but leaves 3 million more uninsured

By Lori Montgomery, Updated: Tuesday, July 24, 2:57 PM

President Obama’s signature health-care initiative will cost a bit less than expected thanks to last month’s Supreme Court ruling, but the court’s decision is also likely to leave millions of poor people without access to health insurance, congressional budget analysts said Tuesday.
In its June 28 ruling, the court upheld the bulk of the Affordable Care Act, but struck down its plan to require states to expand their Medicaid programs to cover poor people who earn as much as 138 percent of the federal poverty level.
As a result of the court’s decision, the nonpartisan Congressional Budget Office now expects that some states will refuse to fully expand their Medicaid programs or will not do so immediately when most provisions of the law take effect in 2014.
In those states, people who earn 100 percent to 138 percent of the federal poverty level will be eligible to receive government subsidies to obtain private insurance on newly created insurance exchanges. But people who earn less than the full poverty level could be left in the cold, the CBO said.
By 2022, the CBO forecasts that the court ruling will cut state Medicaid and child health rolls by about 6 million people, while increasing enrollment in the insurance exchanges by about 3 million people. The number of people without any form of health insurance, meanwhile, would rise by about 3 million people, the CBO said.
The upshot for the federal budget would be positive, the CBO said. While spending on subsidies for people in the exchanges would increase by about $210 billion over the next decade, spending on Medicaid and children’s health would decline by $289 billion.
Factoring in other changes, the total cost of the coverage expansion would be $1.168 trillion, the CBO said, compared with an original estimate of $1.252 trillion — a net reduction of $84 billion.
http://www.washingtonpost.com/business/economy/cbo-court-ruling-cuts-cost-of-health-care-law-but-leaves-3-million-more-uninsured/2012/07/24/gJQAoak56W_print.html

New law could shift employee health benefits to private market

The Affordable Care Act could entice companies to give employees a fixed amount to buy their own insurance.

http://www.latimes.com/business/la-fi-employers-opt-out-20120630,0,4778467.story

Congressional Research Service says states can’t shrink Medicaid as LePage administration plans

http://bangordailynews.com/2012/07/23/politics/congressional-research-service-says-states-cant-shrink-medicaid-as-lepage-administration-plans/