Facing brain surgery, a health economist finds the health-care market hard to navigate
By Dahlia K. Remler,
“You should never have an HMO,” the neurosurgeon’s secretary told me on the phone, her voice filled with scorn. “You don’t have any out-of-network benefits. Dr. Bruce participates with no insurance plans. Only out-of-network benefits can be used.”I felt sick — not because of the recently discovered benign tumor in my pituitary gland or the resulting excess cortisol in my body or the delicate neurosurgery required. Rather, I felt sick with embarrassment and a sense of professional failure.
I am a health economist, a professor with a PhD from Harvard. I’m supposed to be an expert on health insurance and its complexities. How did I end up in such a bind?
I tried to recover my dignity and act like an expert: “How much does it cost if you pay out of pocket? $20,000?”
“For the surgeon. . . . But you have to pay for the hospital, too, even if the hospital is in-network. When you use an out-of-network surgeon, the whole thing counts as out-of-network,” she said.
How could I have forgotten that? I hung up with the depressing impression that having Bruce as my surgeon would cost me around $60,000 out of pocket.
http://www.washingtonpost.com/national/health-science/facing-brain-surgery-a-health-economist-finds-the-health-care-market-hard-to-navigate/2012/11/05/0a931b5c-fcf1-11e1-b153-218509a954e1_print.html
Anthem clerical error adds anxiety to woman's breast cancer fight
After Ann Walton-Teter has a double mastectomy, she learns her coverage has been canceled. Anthem Blue Cross admits mistake but timing couldn't have been worse.
David Lazarus
November 6, 2012
Ann Walton-Teter was diagnosed with breast cancer in September. About a month later, she was informed by her health insurer, Anthem Blue Cross, that her coverage had been canceled because of a missed payment.
Anthem would eventually admit that it was mistaken. But Walton-Teter, 43, had to battle the insurance giant to have her coverage restored just as she was recovering from a double mastectomy and preparing for chemotherapy.
In other words, the Santa Monica resident had to go up against a corporate bureaucracy while she was at her weakest and most vulnerable — a situation that plays out time after time nationwide as insurers challenge patients' claims or doctors' prescriptions in the midst of medical crises.
To all those who believe the U.S. healthcare system is second to none, Walton-Teter's case serves as a stark reminder that things can go horrendously wrong even if the patient does everything right.
"It's like they were bullying me to go away," Walton-Teter told me. "You buy insurance in case anything comes up. But when it does, this is how they treat you."
EMMC to build tower as part of ambitious $250M project
Posted Nov. 07, 2012, at 5:40 p.m.
BANGOR, Maine — Eastern Maine Medical Center will build a seven-story tower at its State Street campus as part of a $250 million project described as the largest ever undertaken by the hospital’s parent organization.
The board of directors for Eastern Maine Healthcare Systems, of which EMMC is a member, gave final approval to the project Tuesday, more than five years after plans were first presented.
In addition to demolishing the hospital’s Stetson building to make way for the tower, plans call for adding more than a dozen operating suites, boosting the number of private patient rooms, updating cardiac and obstetrics services, and relocating the neonatal intensive care unit.
The project is imperative for EMMC, which serves more than 40 percent of the state’s population as the only provider of many specialty medical services, including trauma and advanced critical care, in the region, said Deborah Carey Johnson, the hospital’s president and CEO.
“Without this project, specialty care in northern and eastern Maine would really be at risk,” she said.
The tower project is one of the most ambitious tackled by a Maine hospital in recent years. It’s smaller than MaineGeneral’s pursuit of a $300-plus million hospital in Augusta, but dwarfs Maine Medical Center’s plan for a $40 million expansion and update of several operating rooms. Also in Portland, Mercy Hospital has been shifting its services to a new campus on the Fore River, a multi-year project pegged at $162 million.
The most recent significant construction project at EMMC’s State Street campus was a $16 million, five-story parking garage that opened in 2009.
EMMC has focused more on outpatient services in recent years, with the construction of its health care mall on Union Street and, in 2000, of the Kagan building at its main campus, Johnson said.
“Where we’ve fallen behind a bit is on our inpatient campus,” she said.
The outpatient additions were significant, but the tower project approved this week represents a milestone for EMHS, she said.
EMHS is one of the state’s largest healthcare systems, counting not only seven hospitals among its members but also numerous home health organizations and several physician groups and nursing homes.
Obamacare gets its vindication
By Matt Miller,
George Shultz once offered advice to Cabinet secretaries seeking to make a difference, advice that applies equally well to presidents. It’s easy to be consumed by your in box in these big jobs, Shultz explained. The flow of “incoming” could keep anyone fully occupied from the moment they were sworn in to the day they left office. The key to leaving your mark is to be sure you work on priorities you select and put into other people’s in-boxes. Don’t just work off your own.
This sound counsel captures why Barack Obama’s devotion to major health reform was so important — and why the risks he took to pursue that course must make his vindication Tuesday night especially sweet.
Obama didn’t “have” to do health reform. It wasn’t in his in box. A historic economic collapse was. He could have devoted himself exclusively to economic crisis management. (Though even if he’d done that, it’s not clear the recovery would be further along. After all, the Republicans blocked the sensible infrastructure investments in his Jobs Act a year ago that would have left 1 million more Americans working today — and unemployment at 7.2 percent, not 7.9 percent).
But Obama took the longer view. He knew U.S. health care was a scandal, with outsize costs and 50 million people uninsured. Now, thanks to the president’s reelection and the certainty that the law will be phased in by 2014, everything will change.
For the first time, Americans will have guaranteed access to coverage at group rates outside the employment setting. This fact got zero discussion in the campaign, but it’s impossible to overstate its significance. We’re the only wealthy nation where such access isn’t the case today. It’s been bad for people and disastrous for entrepreneurship (because budding entrepreneurs routinely stay in jobs they dislike in order to keep health coverage if there’s illness in their family).
The status quo has been bad for business, which carries the cost of health care on its payrolls. It’s also been bad for workers, because the cash devoured by employer-paid health premiums would otherwise be available for higher wages.
Obama's win means his healthcare law will insure all Americans
By Noam N. Levey3:02 AM PST, November 8, 201
WASHINGTON — President Obama’s victory all but assures that his landmark healthcare law and its guarantee of insurance coverage for all Americans will be implemented, essentially putting an end to the Republican campaign to derail the law.
Starting in 2014, millions of Americans should be able to get health insurance for the first time. Millions more who don’t get coverage through work should be able to buy a health plan that meets new basic standards.
“It’s all over but the shouting,” said Families USA Executive Director Ron Pollack, an influential consumer advocate and leading champion of the law. “What was very questionable at the start of the year has been settled. … The Affordable Care Act will be a permanent fixture of the American healthcare system.”
California speeds revamp of health insurance market
With Obama victory, state officials move ahead with implementing healthcare changes under the Affordable Care Act and expand insurance coverage.
By Chad Terhune, Los Angeles Times
5:51 PM PST, November 7, 2012
With President Obama's reelection lifting a potential roadblock, California officials are rushing to implement the federal healthcare law and revamp the insurance market for millions of Californians starting next fall.
Republican challenger Mitt Romney had vowed to overturn the Affordable Care Act, casting uncertainty over efforts in California to use billions of federal dollars to extend coverage to many of the state's 7 million uninsured.
Wednesday, California officials disclosed plans to spend nearly $90 million next year on marketing and outreach to millions of consumers who may become eligible for premium subsidies and other assistance under the federal law starting in 2014.
Health Net posts plunge in profit, strikes deal with California
Investors cheer the deal, which ends the insurer's litigation over reimbursement, extends Medi-Cal contracts and promises extra payments if new programs lead to unexpectedly big losses.
By Chad Terhune, Los Angeles Times
November 6, 2012
Woodland Hills insurer Health Net Inc. said third-quarter net income plunged 71%, but its shares rose as the company resolved a dispute with California officials over reimbursement for government health programs.
Health Net disappointed investors in August when it slashed its full-year profit outlook and reported higher-than-expected medical costs. On Monday, Chief Executive Jay Gellert said the company was making progress on its turnaround plans. He cited a wide-ranging agreement with California healthcare officials as a major step forward.
Investors cheered the news, bidding up Health Net shares by $3.03, or 13%, to $25.71.
The deal with the California Department of Health Care Services ended company litigation over government reimbursement. As part of the agreement, Health Net said, the state will extend four existing Medi-Cal contracts by five years and provide additional payments if the company incurs larger-than-expected losses as new government programs get underway next year.
Obama's health care overhaul turns into a sprint
In the two years since passage of the Affordable Care Act, the Obama administration has been consumed with planning and playing political defense. Now it has to quickly turn to execution.
Ricardo Alonso-Zaldivar / The Associated Press
WASHINGTON — Its place assured alongside Medicare and Medicaid, President Barack Obama's health care law is now in a sprint to the finish line, with just 11 months to go before millions of uninsured people can start signing up for coverage.
Presque Isle hospital turns to agriculture to raise money, awareness of facility
Posted Nov. 06, 2012, at 12:15 p.m.
PRESQUE ISLE, Maine — Looking to celebrate its heritage and raise money for needed medical equipment, a Presque Isle hospital successfully turned to Aroostook County agriculture for help reaching its goal.
The Aroostook Medical Center this past summer launched two separate campaigns to celebrate its 100th birthday and to raise money toward the purchase of a Giraffe Warmer that will be used for premature babies at the hospital.
The vision for what now is TAMC came from Frank White, an attorney, in 1908, according to hospital officials. During that time, White had made frequent trips to outlying farms and neighboring smaller communities by horse and wagon, soliciting donations.
Through the efforts of White and other community leaders, Presque Isle General Hospital was incorporated on April 8, 1912.
In June, the hospital unveiled the TAMC Centennial Potato Plot, a two-acre section of a field on U.S. Route 1 between Presque Isle and Caribou. Cavendish Produce donated the two acres of russet potatoes that were planted. The field was envisioned as a way to celebrate the hospital’s 100th birthday and its ties to agriculture.
Hospital employees and their family members harvested the field by hand in early October.
Aroostook County candidates running for the Maine State Legislature each were presented with a commemorative five-pound bag filled with russet potatoes.
Officials with TAMC and project partners Cavendish Produce and Northeast Packaging Company also gave two commemorative bags of potatoes to U.S. Sen. Susan Collins — one for her to enjoy, the other for her to deliver to the White House. U.S. Rep. Mike Michaud also received a bag for himself and another to present to U.S. Department of Agriculture Secretary Tom Vilsack.
In late July, the hospital announced a plan to raise money for the Giraffe Warmer with some help from Houlton Farms Dairy.
Youth obesity to cost Maine $1.2 billion, UMaine study finds
Posted Nov. 05, 2012, at 3:30 p.m.
Obesity among children and teens in Maine could cost more than $1 billion over the next 20 years, according to a new University of Maine study.
Today, just under 8 percent of Maine’s children and adolescents are obese. But as those youths grow into adults, that proportion likely will rise to more than 25 percent, according to the study by Todd Gabe, an economics professor at UMaine.
Obese children are much more likely than their healthy-weight peers to grow into obese adults, the study found. The medical costs from obesity increase as people age.
“We’ve all heard about the nationwide obesity epidemic, and these figures bring the problem — especially the challenge facing our children as they become adults — closer to home,” Gabe said.
The medical costs of obesity — including inpatient and outpatient treatment and prescription drugs — for today’s school-age children in Maine will reach $1.2 billion by 2032, Gabe estimates.
That price tag reflects a snapshot of obesity among the current crop of school-age kids in Maine. It doesn’t take into account obesity among future classes of children entering their school-age years or adults.
The estimate also doesn’t include indirect costs, such as lost productivity at work when those children become adults, a factor some studies have shown to be an even bigger drag on the economy than the direct medical costs of obesity, Gabe said.
“If anything, these cost numbers are conservative,” he said.
Gabe’s study was funded in part through a partnership among the Maine Association for Health, Physical Education, Recreation and Dance; the Maine Department of Education; and UMaine’s College of Education and Human Development.
He used statistics from the U.S. Centers for Disease Control and Prevention and data including about 2,000 school-age children in Maine compiled by physical education teachers in 18 schools across the state as part of ongoing research in the UMaine College of Education and Human Development.
Physical education teachers across the state measured the fitness of students ages 10-14.
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