Care about Obamacare? Then you should really care about Arkansas.
By Sarah Kliff,
Three weeks ago, when Arkansas governor Mike Beebe was in Washington for the National Governors Association meeting, he made a trip to Health and Human Services.
Beebe had an unusual Obamacare proposal. The Arkansas legislature did not want to expand Medicaid for those under 133 percent of the federal poverty line, an option under the Affordable Care Act. Instead, it wanted to use billions in Medicaid funding to buy private insurance for that same population.
To the surprise of many (including Beebe), the Obama administration approved, in concept, the idea.
That was just three weeks ago. Now, by my count, there are four other states considering the Arkansas approach: Florida, Ohio, Louisiana and Maine. They’re the states below in yellow, alongside states with governors who have already committed to the Medicaid expansion, in pink.
This includes two governed by stalwart Obamacare opponents. Maine Gov. Paul LePage notably said, a few months ago, that he was “not lifting a finger” to implement the law in his state.
Louisiana Gov. Bobby Jindal, meanwhile, told Greta Van Susteren in July that expanding Medicaid “is a huge mistake for the country, certainly for the state of Louisiana.”
There’s even some chatter about pursuing such an option in Texas.
It’s hard to underscore how much Arkansas’s simple suggestion — that it be able to use Medicaid dollars to buy private insurance for the expansion population — has the potential to change the face of the Affordable Care Act. If these four states signed onto the Medicaid expansion through the Arkansas option, the Urban Institute estimates that 2.4 million people would gain health insurance coverage.
That works out to about 15 percent of the overall Medicaid expansion population that Urban expects to gain coverage under this part of the health care law.
We still don’t know the final details of the Arkansas agreement — or whether there is a final agreement. There are questions about whether this option will be more expensive than a traditional Medicaid expansion (the public program tends to cost a few thousand dollars less per enrollee).
What we do know, though, is that there are some very strong opponents of the Obamacare law — ones that have pledged never to expand Medicaid — who suddenly find this option palatable. It has the potential to grow the Medicaid expansion by millions of Americans, edging closer to the pre-Supreme Court version of the health-law’s coverage expansion.
GOP: We’ve been lying all along
Boehner's admission that we don't really have a debt crisis reveals his party's ulterior, program-cutting motives
BY DAVID SIROTA
I never thought I’d write these words, but here goes: Thank you, John Boehner. Thank you, Mr. Speaker, for finally admitting on national television that all the fiscal cliffs, sequestrations and budget battles you’ve created are, indeed, artificially fabricated by ideologues and self-interested politicians and not the result of some imminent crisis that’s out of our control.
America owes this debt of gratitude to Boehner after he finally came clean on yesterday’s edition of ABC’s “This Week” and admitted that “we do not have an immediate debt crisis.” (His admission was followed up by Budget Committee Chairman Paul Ryan, who quickly echoed much the same sentiment on CBS’ “Face the Nation”).
In offering up such a stunningly honest admission, the GOP leader has put himself on record as agreeing with President Obama, who has previously acknowledged that demonstrable reality. But the big news here isn’t just about the politics of a Republican House speaker tacitly admitting they agree with a Democratic president. It is also about a bigger admission revealing the fact that the GOP’s fiscal alarmism is not merely some natural reaction to reality, but a calculated means to other ideological ends.
U.S. Drug Costs Dropped in 2012, but Rises Loom
By KATIE THOMAS
Spending on prescription drugs nationwide has been slowing for years because of the increasingly widespread use of low-cost generics. But in 2012, something unheard-of happened: money spent on prescription drugs actually dropped.
The dip was small — 1 percent, to $325.7 billion — but it was the first time the research firm IMS Health had recorded a decrease in United States drug sales since the company began tracking such numbers in 1957. And this month, the pharmacy benefit manager Express Scripts reported that spending on commonly used pills — like those that treat high blood pressure and cholesterol — dropped by 1.5 percent, the first time that had happened since Express Scripts began following drug trends 20 years ago.
But even as the United States is in the midst of what has been called a “golden” period in spending on drugs, some are warning that the ever-expanding use of generics has masked a growing problem for the government, insurers and others who pay the bill for prescription drugs: the rising cost of complex specialty medicines that treat cancer,rheumatoid arthritis and other diseases.
“This is a charmed era that won’t last forever,” said Paul B. Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan research group that studies health care trends. “When you talk to benefits managers at large employers or insurers, the trend of specialty pharma is very, very prominent. You might even say they regard it as their biggest problem.”
The potential for higher spending on drugs comes as the nation is struggling over how to contain the cost of health care, which many experts agree is a major threat to the country’s fiscal condition.
Despite a recent slowdown in the growth of spending on overall health care, Republicans and Democrats alike have warned that rising health costs will eventually overwhelm the federal budget and make basic health care unaffordable for many Americans. Drugs, while not the major cause of rising costs, nonetheless account for about 15 percent of the nation’s health care expenditures.
How Creative Is Your Doctor?
By DANIELLE OFRI, M.D.
What are you doing creatively these days?
It’s not a question you hear commonly, and certainly not in a medical journal. But that was the title of a commentary in a recent issue of Academic Medicine. It caught my eye, because medicine is a field with a strong history of creativity, but its daily practice feels less and less so. Health care is being pushed steadily toward standardization, insisting on an algorithmic approach to diagnosis and treatment. Some ramifications of this trend have been beneficial, but many of these algorithms have been mechanized to the point where there is little need for human beings and their intricately personal neural networks.
Part of this stems from the way in which we are taught to think about clinical medicine. Medical school can seem like an ongoing exercise of committing lists to memory, the only creativity being the mnemonics for memorizing branches of the facial nerve or diseases with anion-gap metabolic acidosis. When students present cases, there is a sense of roteness. A patient with chest pain, for example, becomes, “Rule-out M.I. (myocardial infarction). Get an EKG, serial troponin levels, stress test, cardiology consult….”
Some of this roteness, of course, is thoroughness. You need to cover all your bases to ensure you are not missing anything serious. But rote recitation inhibits the ability to think beyond diagnostic straightjackets.
In one of my recent clinic sessions, I saw four patients with diabetes over the course of a morning. One was a young man whose glucose, weight and early-onset heart disease resist control, despite jogging 10 miles a day and eating like a rabbit. Another was an elderly woman with fragile bones, congestive heart failure and a medication list longer than my arm. A third was a middle-aged man unable to compromise a single French fry in his diet. And the fourth was a middle-aged woman whose depression snowplows all of her other salutary efforts.
Other than insulin dysregulation, these patients have nothing in common. Yet our medical approach is expected to be “standardized.”
Call for screening of healthcare enrollers meets resistance
California needs 20,000 workers to sign people up in the new health insurance exchange. In the process, they would have access to sensitive consumer data.
Chad Terhune, Los Angeles Times
5:51 PM PDT, March 15, 2013
At issue is the level of screening these "assisters" should receive before they handle confidential information about the people they are enrolling this year in the state's new health insurance exchange, called Covered California.
These enrollers, who will earn $58 from the state for every application completed, would have access to highly sensitive consumer information such as Social Security numbers, dates of birth, income data and tax returns.
Covered California, the state agency implementing the federal healthcare law, says these enrollment advisors must be thoroughly screened to deter fraud and protect consumers. But critics say the state's proposal is overly intrusive and will prevent too many minorities from helping at a time when enormous manpower and quick action are required.
"I understand some form of background check is likely, but I have fears about adding bureaucratic mountains that slow us down," said Robert Ross, a Covered California board member and chief executive of California Endowment, a healthcare foundation. "There are people who have turned their lives around and who are trusted by the most difficult-to-reach populations. Not having their talent and expertise could be a problem."
These 20,000 assisters across California would not be government employees. Nonprofit and other community groups that are working with the state on outreach and enrollment will be responsible for recruiting and hiring many of them.
The federal law calls for these assisters to play a crucial role in explaining an array of new insurance options as well as complex terms such as deductibles and cost sharing to a range of Californians, many of whom don't speak English or have easy access to the Internet.
The state's goal is to enroll 1.4 million Californians next year and eventually reach more than 5 million residents who are uninsured or may qualify for federal premium subsidies. By January, most Americans must buy health insurance or pay a penalty under the federal Affordable Care Act.
Carla Saporta, health policy director at the Greenlining Institute, a nonprofit group that advocates for racial and economic justice, has urged the state insurance exchange to proceed carefully.
"Background checks would create barriers for a lot of communities of color and disproportionately exclude African American and Latino men from participating," she said. "We need a massive amount of people to help with outreach."
Next week, the exchange board is expected to discuss this issue and establish its rules for background checks. Other states are wrestling with similar issues as they scramble to implement the federal healthcare law in time for enrollment to begin in October.
California insurance officials, insurance agents and other patient advocates say they are surprised by the level of resistance to rigorous screening.
"I was just shocked that groups that represent the consumer interest summarily dismiss what I think is a very real probability of immense consumer fraud," said California Insurance Commissioner Dave Jones. "I'm very concerned we will have a host of problems without a system of background checks, fingerprinting and monitoring, which weeds out criminals."
Health insurance agents in the state undergo fingerprinting and background checks every two years. Since January 2011, state officials have revoked licenses of 514 agents or brokers on all forms of insurance. Some of the most common complaints include misrepresentation, fraud and improper handling of premiums.
"Regrettably, we see far too many cases of identity theft, embezzlement and outright fraud," Jones said.
http://www.latimes.com/business/la-fi-insure-criminal-checks-20130315,0,3851882,print.story
Hospital report cards, designed to enlighten, often confuse
Posted March 18, 2013, at 9:33 a.m.
How good a hospital is St. Mary Mercy Livonia Hospital? Depends on whom you ask.
The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an “A” to this Michigan hospital. The company Healthgrades named it one of America’s best 50 hospitals.
But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary’s payments by a fraction this year.
Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as ”Best Hospitals Honor Roll,” ” America’s Best Hospitals” and ” 100 Top Hospitals.” Illinois, Florida and other states have created their own report cards. In some places, such as California, there are more than a dozen organizations offering assessments on hospital quality.
But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers. Some hospitals rated as outstanding by one group are ignored or panned by another. Ratings results from an individual group can change significantly from year to year.
“We’ve alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,” said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.
And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as California public health officials have fined it $425,000 repeatedly for endangering patients.
As ratings multiply, more and more hospitals have something they can boast about. A third of U.S. hospitals—more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.
“I worry a lot about these ratings,” said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. “They’re all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.”
No comments:
Post a Comment