Report claims state health insurance reform not working
Posted Sept. 22, 2012, at 12:40 p.m.
AUGUSTA, Maine — A Republican-backed state law aimed at lowering health insurance premiums in Maine is being panned in a new report by affordable health care advocates.
But supporters of the law, especially those who wrote and co-sponsored it in the Maine Legislature, say the law is working but needs to be fully implemented before anyone draws conclusions about its effectiveness.
Supporters say key provisions of the law, including one that allows people to buy health insurance across state lines, have not yet gone into effect.
In its report issued earlier this month, Consumers for Affordable Health Care examined health insurance rate renewal information at the Bureau of Insurance. The report focused on renewal rates for insurance customers in the individual and small-group markets.
What they found did not bode well for the new law’s effectiveness, said Joe Ditre, executive director of the consumer group.
Key findings showed 54 percent of individual policyholders in Maine saw premium increases, while 90 percent of small business policyholders saw rates go up. Small-group plans cover up to 50 employees.
The report also draws attention to a new $4 assessment tacked on to all health insurance policies in Maine as a result of the law.
That assessment is used to build an annual fund of nearly $21 million that a new nonprofit organization , the Maine Guaranteed Access Reinsurance Association, also created by the law, uses to reinsure the most costly or high-risk clients on the books of Maine insurance companies.
“No one knows they are paying this tax,” Ditre said. “They are being taxed, and this is all under the radar.”
Liking It or Not, States Prepare for Health Law
By ABBY GOODNOUGH
PHOENIX — Like many Republican governors, Jan Brewer of Arizona is a stinging critic of President Obama’s health care law. When the Supreme Court upheld it in June, she called the ruling “an overreaching and unaffordable assault on states’ rights and individual liberty.”
Yet the Brewer administration is quietly designing an insurance exchange — one of the most essential and controversial requirements of the law. Officials in a handful of other Republican-led states say they are also working to have a framework ready by Nov. 16, the deadline for states to commit to running an exchange or leave it to the federal government to run it for them. That is just 10 days after Election Day, which is likely to decide the future of the law.
Given that the health care overhaul remains a lightning rod — just last week, Oklahoma revised a lawsuit against it — even the most tentative discussions about carrying it out in Republican states tend to take place behind closed doors or “underground,” as the leader of a health care advocacy group in the South put it.
In Mississippi, Mike Chaney, the insurance commissioner, who is laying the groundwork for a state-based exchange there, recently learned the difficulties of moving forward in anything but the utmost secrecy. At a luncheon this summer he found himself facing down an opponent of the law in a confrontation that is now circulating on YouTube.
“I was invited to the picnic, and I was the main course,” said Mr. Chaney, a Republican and an elected official.
Medicare Bills Rise as Records Turn Electronic
By REED ABELSON, JULIE CRESWELL and GRIFFIN J. PALMER
When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs.
But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care.
Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a New York Times analysis of Medicare data from the American Hospital Directory. Regulators say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars as well.
The most aggressive billing — by just 1,700 of the more than 440,000 doctors in the country — cost Medicare as much as $100 million in 2010 alone, federal regulators said in a recent report, noting that the largest share of those doctors specialized in family practice, internal medicine and emergency care.
For instance, the portion of patients that the emergency department at Faxton St. Luke’s Healthcare in Utica, N.Y., claimed required the highest levels of treatment — and thus higher reimbursements — rose 43 percent in 2009. That was the same year the hospital began using electronic health records.
The share of highest-paying claims at Baptist Hospital in Nashville climbed 82 percent in 2010, the year after it began using a software system for its emergency room records.
In e-mailed statements, representatives for both hospitals said the increases reflected more accurate billing for services. Faxton also said its patients required more care than in past years.
Romney's Medicaid Remarks On '60 Minutes' Raise Eyebrows
Mitt Romney talks with 60 Minutes correspondent Scott Pelley.
It's not so much what Mitt Romney said about whether the government should guarantee people health care in his interview on CBS's 60 Minutes Sunday that has health care policy types buzzing. It's how that compares to what he has said before.
Panel Reminds Doctors to Screen for Alcohol Misuse
By SABRINA TAVERNISE
Primary care doctors and nurses should screen their adult patients to determine whether they are misusing alcohol, and provide counseling when risky behavior is detected, a panel of medical experts reaffirmed on Monday.
About a third of Americans misuse alcohol, though far fewer are addicted, according to the panel, the United States Preventive Services Task Force. The misuse results in an estimated 85,000 deaths a year, making illness related to alcohol abuse the third-leading cause of preventable death in the United States, after smoking and obesity.
After reviewing recent research, the panel concluded that primary care doctors and nurses could help patients cut down on drinking by offering a brief counseling session or a series of sessions. Doctors would determine whether counseling was needed by asking a simple set of questions about alcohol use during the patient’s primary care visit.
The National Institute on Alcohol Abuse and Alcoholism considers more than 14 drinks a week excessive for men and more than seven drinks a week excessive for women. It says daily consumption should not be more than four drinks for men and three for women.
The questions that doctors should ask, the task force said, include, “How often do you have a drink containing alcohol?” and “How often do you have five or more drinks on one occasion?”
The task force did not recommend the same screening and counseling for adolescents because, it said, it was less clear whether the benefits would outweigh the potential harm, like anxiety or the stigma of being singled out.
The Conservative Mind
By DAVID BROOKS
When I joined the staff of National Review as a lowly associate in 1984, the magazine, and the conservative movement itself, was a fusion of two different mentalities.
On the one side, there were the economic conservatives. These were people that anybody following contemporary Republican politics would be familiar with. They spent a lot of time worrying about the way government intrudes upon economic liberty. They upheld freedom as their highest political value. They admired risk-takers. They worried that excessive government would create a sclerotic nation with a dependent populace.
But there was another sort of conservative, who would be less familiar now. This was the traditional conservative, intellectual heir to Edmund Burke, Russell Kirk, Clinton Rossiter and Catholic social teaching. This sort of conservative didn’t see society as a battleground between government and the private sector. Instead, the traditionalist wanted to preserve a society that functioned as a harmonious ecosystem, in which the different layers were nestled upon each other: individual, family, company, neighborhood, religion, city government and national government.
Because they were conservative, they tended to believe that power should be devolved down to the lower levels of this chain. They believed that people should lead disciplined, orderly lives, but doubted that individuals have the ability to do this alone, unaided by social custom and by God. So they were intensely interested in creating the sort of social, economic and political order that would encourage people to work hard, finish school and postpone childbearing until marriage.
A Call for Caution on Antipsychotic Drugs
By RICHARD A. FRIEDMAN, M.D.
You will never guess what the fifth and sixth best-selling prescription drugs are in the United States, so I’ll just tell you: Abilify and Seroquel, two powerful antipsychotics. In 2011 alone, they and other antipsychotic drugs were prescribed to 3.1 million Americans at a cost of $18.2 billion, a 13 percent increase over the previous year, according to the market research firm IMS Health.
Those drugs are used to treat such serious psychiatric disorders as schizophrenia, bipolar disorder and severe major depression. But the rates of these disorders have been stable in the adult population for years. So how did these and other antipsychotics get to be so popular?
Report: Premium hikes for top Medicare drug plans
By RICARDO ALONSO-ZALDIVAR/Associated Press
WASHINGTON — Seniors enrolled in seven of the 10 most popular Medicare prescription drug plans will be hit with double-digit premium hikes next year if they don't shop for a better deal, says a private firm that analyzes the highly competitive market.
FILE - In this Feb. 20, 2008, file photo, a shopper walks toward the pharmacy at a Little Rock, Ark., Wal-Mart store. A study says seniors in seven of the 10 most popular Medicare prescription drug plans will be hit with double-digit premium hikes next year if they don�t shop for a better deal. The report by Avalere Health is a reality check against the Obama�s administration�s upbeat pronouncements. Back in August 2012, officials had announced that the average premium for basic prescription drug coverage would stay the same in 2013, at $30 a month.
Why care under the Affordable Care Act will be unaffordable
Posted Sept. 25, 2012, at 1:56 p.m.
Several recent articles should dispel any remaining notion that care provided under the so-called Affordable Care Act will in fact be affordable.
Just the opposite is true.
Just the opposite is true.
The Wall Street Journal reported that when physicians sell their practice to hospitals and become hospital employees, services they provide to patients become significantly more expensive. The reason for this, simply put, is that overhead is much higher, and third parties reimburse at a higher rate for exactly the same service.
Another way to say this is that hospitals are less efficient than a private office. And, as I have pointed out, physicians are considerably less productive when working for a salary, as opposed to fee-for-service. This was an entirely predictable outcome.
Yet, health planners behind the Affordable Care Act pinned their hopes for cost containment on exactly this consolidation occurring. The act promotes Accountable Care Organizations; groups of “providers” and administrators who will assume financial risk for caring for patients assigned to them, by accepting a lump-sum payment to cover all their medical needs.
Accountable Care Organizations are the latest version of managed care, and will have similar problems. They will have a strong financial incentive to cherry pick healthy patients; those with serious problems will end up in emergency rooms and hospitals, where care is much more costly.
This brings us to the most recent article from the New York Times, which shows that when hospital emergency rooms and physician practices adopt electronic health records, reimbursements for physician services go way up.
Wait a second. Isn’t the EHR the magic wand that is somehow going to result in huge efficiencies and cost savings? Well, not exactly. It seems doctors and hospitals are able to use the EHR to “enhance” documentation of patient encounters and services provided, which entitles them to “up-code” and receive higher reimbursement from third party payers.
Feds: Health reform law helps Mainers save $13 million
Posted Sept. 24, 2012, at 1:33 p.m.
Federal officials say Maine seniors and people with disabilities have saved $13.1 million on prescription drugs since President Obama’s health reform law was enacted in 2010.
The health care law has allowed Mainers in the Medicare prescription drug coverage gap known as the “doughnut hole” to save an average of $522 during the first eight months of this year, according to the U.S. Department of Health and Human Services.
The health reform law, fiercely opposed by Republicans, calls for the doughnut hole to be closed by 2020. The law began phasing out the coverage gap in 2010, giving Medicare beneficiaries who hit the doughnut hole a $250 rebate. Last year, beneficiaries received discounts on generic drugs and some brand name medications.
The Affordable Care Act improves Medicare coverage for prescription drugs and provides seniors with preventive care at no cost. U.S. HHS touted a new report this week that found the law will save the average person with traditional Medicare coverage $5,000 from 2010 to 2022. People on Medicare who have high prescription medication costs will save more, around $18,000, over that period.
“I am pleased that the health care law is helping so many seniors save money on their prescription drug costs,” U.S. HHS Secretary Kathleen Sebelius stated in a recent press release. “A $5,000 savings will go a long way for many beneficiaries on fixed incomes and tight budgets.”
Nationally, more than 5.5 million people have saved nearly $4.5 billion on prescription drugs since the law was enacted, according to U.S. HHS.
The reform law also made a number of preventive health services, such as yearly wellness checks and colorectal cancer screenings, free to seniors without co-pays or deductibles. U.S. HHS said in February that the law provided more than 400,000 Maine residents with preventive care last year.
The Affordable Care Act has been vehemently opposed by Republicans, becoming a centerpiece issue in this year’s presidential campaign. Republican presidential nominee Mitt Romney has vowed to repeal the law while keeping of its more popular provisions, saying the law harms businesses and represents a government takeover of health care.
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