Arizona Medicaid Expansion Urged By Gov. Jan Brewer, Obamacare Foe
Arizona will participate in the expansion of Medicaid, Gov. Jan Brewer said Monday in her State of the State address, making her the third Republican governor to agree to one of the key components of President Barack Obama's health care reform.
Brewer said that if she did not accept the Medicaid funds for Arizona, other states could claim those federal dollars and create jobs that otherwise would be created in Arizona. Fellow Republican governorsSusana Martinez of New Mexico and Brian Sandoval of Nevada also plan to expand Medicaid to anyone who earns up to 133 percent of the federal poverty level, which is currently $14,856 for an individual.
But 10 other Republican governors have already decided not to participate. The Supreme Court's 2012 ruling that affirmed Obama's health care law allows states to refuse to take part in the Medicaid expansion.
Although Brewer has been a consistent opponent of Obamacare, she acknowledged Monday that the law is now an unavoidable reality and that Arizona would be worse off turning down the federal dollars that will come with broadening Medicaid.
"Try as we might, the law was upheld by the United States Supreme Court," Brewer said. "The Affordable Care Act is not going anywhere, at least not for the time being."
The Arizona governor said the federal funding would help pay for some individuals already covered by the state's Medicaid program and provide some protection for the state's rural hospitals.
While Arizona is moving ahead with the expansion of Medicaid, Brewer declined to take part in another key aspect of Obamacare. In November, she notified the Obama administration that Arizona would not establish a state-run health insurance exchange. These exchanges will be the gateways for individuals and small businesses to comparison shop for health benefits and to learn whether they qualify for financial assistance or Medicaid coverage. Arizona is one of 25 states in which the federal government will have to set up the insurance exchange.
Canada keeps malpractice cost in check
By Susan Taylor Martin, Times Senior Correspondent
For neurosurgeons in Miami, the annual cost of medical malpractice insurance is astronomical — $237,000, far more than the median price of a house.
In Toronto, a neurosurgeon pays about $29,200 for coverage. It's even less in Montreal ($20,600) and Vancouver ($10,650).
The costs are strikingly different, largely because of the ways in which Canada insures doctors and protects those who are sued:
• In 1978, the Canadian Supreme Court limited damages for pain and suffering. Adjusted for inflation, the cap now is just over $300,000. The United States has no federal cap on damages, though a few states, including Florida, have imposed them.
• Instead of buying insurance from a for-profit company, as most U.S. doctors do, Canadian physicians are covered through their membership in the nonprofitCanadian Medical Protective Association.
Membership fees vary only by the type of work and region of the country. All neurosurgeons in Ontario, for example, pay the same amount regardless of how many times each may have been hit with a claim.
"We don't adjust our fees based on individual experience; it's the experience of the group,'' says Dr. John Gray, the executive director. "That's what the mutual approach is all about, and it helps keep the fees down for everyone.''
The Troubling State of Americans’ Health
To the Editor:
I applaud the excellent news article about the National Research Council/Institute of Medicine report revealing that, across most health indicators and age groups, people in the United States have shorter lives and experience more illness than people in other affluent countries (“For Americans Under 50, Stark Findings on Health,” Jan. 10).
As a member of the panel that produced the report, I hope that wide awareness of these disturbing findings will lead to reflection and public debate about what we as a nation need to do to turn this dismal situation around.
I also wish to add a point not noted in the article: that the United States’ “health disadvantage” is seen even when examining whites and high-income people alone. Minorities and the poor do have worse health and shorter lives, but our panel concluded that the problems producing the American health disadvantage affect all Americans adversely.
Mining Electronic Records for Revealing Health Data
By PETER JARET
Over the past decade, nudged by new federal regulations, hospitals and medical offices around the country have been converting scribbled doctors’ notes to electronic records. Although the chief goal has been to improve efficiency and cut costs, a disappointing report published last week by the RAND Corp. found that electronic health records actually may be raising the nation’s medical bills.
But the report neglected one powerful incentive for the switch to electronic records: the resulting databases of clinical information are gold mines for medical research. The monitoring and analysis of electronic medical records, some scientists say, have the potential to make every patient a participant in a vast, ongoing clinical trial, pinpointing treatments and side effects that would be hard to discern from anecdotal case reports or expensive clinical trials.
“Medical discoveries have always been based on hunches,” said Dr. Russ B. Altman, a physician and professor of bioengineering and genetics at Stanford. “Unfortunately, we have been missing discoveries all along because we didn’t have the ability to see if a hunch has statistical merit. This infrastructure makes it possible to follow up those hunches.”
The use of electronic records also may help scientists avoid sidestep the rising costs of medical research. “In the past, you had to set up incredibly expensive and time-consuming clinical trials to test a hypothesis,” said Nicholas Tatonetti, assistant professor of biomedical informatics at Columbia. “Now we can look at data already collected in electronic medical records and begin to tease out information.”
States Will Be Given Extra Time to Set Up Health Insurance Exchanges
By ROBERT PEAR
WASHINGTON — The White House says it will give states more time to comply with the new health care law after finding that many states lag in setting up markets where millions of Americans are expected to buy subsidized private health insurance.
Under the law, the secretary of health and human services was supposed to determine “on or before Jan. 1, 2013,” whether states were prepared to operate the online markets, known as insurance exchanges.
But the secretary, Kathleen Sebelius, working with the White House, said she would waive or extend the deadline for any states that expressed interest in creating their own exchanges or regulating insurance sold through a federal exchange.
A political benefit of this strategy is that it allows the administration to keep working with even the most recalcitrant states. Administration officials said they were trying to persuade such states to share the work of running an exchange, supervising health plans and assisting consumers.
The exchanges are a crucial element of President Obama’s health care law. Every state is supposed to have one by October, and most Americans will be required to have coverage, starting in January 2014. The federal government will run the exchange in any state that is unwilling or unable to do so. It now appears that federal officials will have the primary responsibility for running exchanges in at least half the states — far more than expected when the law was passed in 2010.
Ms. Sebelius has given “conditional approval” to 17 states that want to run their own insurance exchanges. The 17 include Utah, where officials have said they are reluctant to perform some functions of an exchange.
The Complexities of Comparing Medicare Choices
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
The roughly 50 million Americans covered by the federal Medicare program have a choice of receiving their benefits under the traditional, free-choice, fee-for-service Medicare program or from a private, managed-care Medicare Advantage plan. The private plans have a steadily increasing number of enrollees - currently 13 million, or 27 percent of beneficiaries.
A fundamental question that has engaged health-policy researchers and commentators for some time is whether coverage of Medicare's standard benefit package under Medicare Advantage plans is cheaper or more expensive than it is under traditional fee-for-service Medicare.
The answer is yes.
At the risk of going over ground already covered in Economix and in the scholarly literature on the subject, this answer may warrant some explanation.
At the risk of going over ground already covered in Economix and in the scholarly literature on the subject, this answer may warrant some explanation.
The latest round in the debate over the question was begun in August 2012 by Zirui Song, David M. Cutler and Michael E. Chernew in their paper "Potential Consequences of Reforming Medicare Into a Competitive Bidding System." In that paper, the authors explored how much more above their regular Part B premiums the elderly would have had to pay in 2009 to either a Medicare Advantage plan or to traditional Medicare if the much-debated Ryan-Wyden planfor Medicare had been in place that year.
That plan would have established a Medicare Exchange - a federal version of the insurance exchanges envisaged under the Affordable Care Act - on which Medicare beneficiaries could have chosen among private health plans that would compete with traditional Medicare on the same terms, that is, on the same competitive platform.
Medicare Spending Isn’t Out of Control
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
It's the season of holiday cocktail parties, demanding intelligent chit-chat over Chardonnay. In such data-free environments it is always safe to say, "Medicare spending is out of control!" Wise heads will nod, because it is a credo with wide currency.
After all, as I explained in my previous post, traditional Medicare, which still attracts about 75 percent of all Medicare beneficiaries, affords its enrollees free choice of providers and therapy. In the jargon of health-policy wonks, it is "unmanaged." Thus, it would not be surprising if unmanaged Medicare spending were, indeed, out of control.
But some caution is in order. A really wise guy in the crowd, one familiar with relevant data, might challenge you with: "Oh, really? In what sense is Medicare spending out of control?"
That query might have been prompted by the following data.
These data, most of which have been published by the Office of the Actuary, Centers of Medicare and Medicaid Services, of the Department of Health and Human Services (see Table 16), show that in most periods Medicare spending per Medicare beneficiary has risen more slowly than per-capita spending under private health insurance.
The exceptions are the period 1993-97, when private managed-care plans appeared to be able to hold down their outlays on health care better than did Medicare, and 2002-7, because there was a jump in spending as Medicare began, in 2006, to cover prescription drugs under the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
So anyone claiming that "Medicare spending is out of control" can fairly be asked to explain on what data that assertion is based. The responses might be interesting.
http://economix.blogs.nytimes.com/2012/12/21/medicare-spending-isnt-out-of-control/?pagewanted=print
Deal calls for merger of Mercy, hospitals
If approved, the struggling health care system based in Portland would affiliate with another one based in Brewer.
By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
Staff Writer
Six to nine months from now, Mercy Health System of Maine in Portland plans to become part of Eastern Maine Healthcare Systems in Brewer, under an affiliation agreement signed Monday.
A full merger could take more than two years and likely lead to some consolidation of Mercy's four campuses, but there's no plan to reduce the overall number of jobs in the Catholic organization, said the systems' presidents.
In the coming months, administrators from the two systems will seek approvals for the merger, including a state certificate of need, federal antitrust clearance and the Vatican's blessing.
The merger's potential impact on health care statewide remains unclear, especially in southern Maine, where Mercy competes directly with Maine Medical Center in Portland, the state's largest hospital.
EMHS signs deal with Portland’s Mercy Health
Posted Jan. 14, 2013, at 12:55 p.m.
Eastern Maine Healthcare Systems and Portland’s Mercy Health System of Maine moved one step closer to merging Monday by inking a deal more than a month after initially announcing their plans to join forces.
EMHS and Mercy signed a “definitive agreement” in which Mercy and all of its divisions, including VNA Home Health and Hospice, will be integrated into the Brewer-based EMHS, according to a news release from the organizations.
The health systems signed a non-binding letter of intent on Dec. 7, after Mercy’s planned deal with Steward Health Care System, a for-profit Massachusetts hospital chain, fell through.
The agreement, signed Monday morning, was not released. Officials from Mercy and EMHS said Monday that it was premature to discuss the deal’s terms, though the agreement eventually will become public record through the regulatory approval process. With the agreement now signed, Mercy and EMHS will seek a certificate of need from the Maine Department of Health and Human Services, federal antitrust clearance and, because Mercy is a Catholic health organization, the approval of the Vatican.
The process is expected to take six to nine months.
The agreement spells out the steps both health systems will take for Mercy to become an EMHS member. A local board will continue to provide oversight of Mercy, according to the release.
The proposed merger has sparked curiosity about why EMHS, parent organization to Bangor’s Eastern Maine Medical Center, wants to expand its reach beyond northern, central and eastern Maine. The merger would bring EMHS into the backyard of MaineHealth, parent of Maine Medical Center, Mercy’s main competitor in Portland.
EMHS wasn’t looking to plant stakes in southern Maine, but seized upon the opportunity to partner with Mercy when it arose, M. Michelle Hood, president and CEO of EMHS, said Monday.
“The more we discussed the potential of the affiliation, the clearer I think it became that this would provide us with additional ability to reshape the health care delivery system across the state,” she said in an interview.
Mercy’s strong network of primary care providers fits well into EMHS’ mission to improve the health of Maine people by offering high-quality and cost-effective health services in their communities, Hood said.
Beyond the deal with Mercy, it’s not EMHS’ intent to expand further into the Portland market, she said.
LePage to announce plan to repay $186M owed to hospitals
Posted Jan. 14, 2013, at 6:18 p.m.
AUGUSTA, Maine — Gov. Paul LePage will unveil a plan Tuesday afternoon to pay $186 million the state owes in back payments to hospitals.
The governor will release his proposal during an event at the University of New England’s dental school, which is under construction on Stevens Avenue in Portland.
Maine’s 39 hospitals are owed $484 million in total, according to a Monday release from the governor’s office. State payment of $186 million would trigger $298 million in federal matching funds, the release states.
The unpaid bills represent MaineCare payments that date as far back as 2009, two years before LePage took office.
“Maine people work hard to pay their bills, and their government must as well,” LePage said in a prepared statement announcing Tuesday’s event.
“We cannot have a prosperous economy when we owe hundreds of millions of dollars to the hospitals that care for and employ Maine people. It’s imperative that we pay these bills now.”
LePage did not address the hospital debt in the supplemental budget he proposed Friday to close a roughly $112 million shortfall for the fiscal year that ends June 30. Nor did his proposed spending plan for the biennium that begins July 1, which Finance Commissioner Sawin Millett presented Friday, include provisions to pay the hospital debt.
Dating back to his 2010 gubernatorial campaign, LePage has made repaying the debt a priority and frequent topic during public appearances. In August 2012, LePage reportedly considered calling a special session of the Legislature to deal with the hospital debt. That plan did not come to fruition.
“This is the governor’s jobs bill,” Adrienne Bennett, LePage’s press secretary, said Monday. “The governor is adamant about paying back the debt. Great-paying careers and projects at Maine hospitals have been put on hold since 2009 because the state hasn’t paid its debt.”
Bennett declined to offer details on the proposal or whether it would include any form of borrowing t
Hysterectomy rates drop as women learn their options
Posted Jan. 14, 2013, at 4:22 p.m.
SACRAMENTO, Calif. — Not until after the surgery did Sandra Nauer realize how sick she’d been.
“Oh, my gosh, I had no idea I was in such bad shape,” said Nauer, 44, who lives in Galt, Calif.
After years of excruciating back pain, fatigue and other symptoms, she had an outpatient hysterectomy on May 22 — and on June 7, she returned to work running her catering business.
“I’m a new woman,” she said. “Holy smokes, I feel like a million bucks.”
For earlier generations of women, hysterectomy was all but a rite of passage before age 50, albeit a difficult one. Even now, it remains the second-most-performed surgical procedure for American women still of reproductive age, and by age 60, one in three women has undergone the surgery, according to the Centers for Disease Control and Prevention.
Despite that, hysterectomy rates in the past three decades have dropped from almost 56 per 10,000 women to 33 per 10,000, American Congress of Obstetricians and Gynecologists statistics show, and the surgery itself has been streamlined into minimally invasive procedures that make the operation and recovery easier.
But hysterectomy remains controversial. While many medical experts see good news in pioneering advances and quick recovery times, some of them also see bad news, saying that up to two-thirds of the 600,000 hysterectomies performed each year in this country could be avoided.
“The rate has come down a little but not enough,” said Dr. William Parker, UCLA School of Medicine clinical professor and author of “A Gynecologist’s Second Opinion.”
“In the old days, hysterectomy was all we had to offer for patients. We were taught that it was the solution for almost every complaint.”
Today, alternative treatments often replace surgery, particularly for women below age 50.
“One of the problems is that the information on alternatives hasn’t seeped out as widely as it should into the medical world,” said Parker.
For younger women, 90 percent of hysterectomies deal not with reproductive cancers but rather with pelvic pain; uterine fibroids, or benign tumors; excessive bleeding; and endometriosis.
For older women, the most common underlying diagnosis is cancer.
Side effects of the surgery — which involves the removal of the ovaries in almost three-fourths of patients — can include the early onset of menopause, bladder and bowel problems and loss of sex drive.
