Health Care Law Is ‘Working Fine,’ Obama Says in Addressing Criticism
By ROBERT PEAR
WASHINGTON — President Obama said Tuesday that his health care law was “working fine,” and he played down concerns that the law could disrupt coverage or lead to higher premiums for people who already had health insurance.
At the same time, federal officials released simplified application forms to be used by people seeking health insurance, tax credits and other government subsidies under the law, which Mr. Obama signed three years ago.
The new application forms — one for individuals is three pages long, and another for families is seven pages — are significantly shorter than a 21-page draft that the administration circulated earlier this year.
Major provisions of the law take effect next Jan. 1, when most Americans will be required to have health insurance.
The law represents one of the biggest changes in domestic policy in decades, as significant in some ways as the creation of Social Security or Medicare. But at a news conference on Tuesday, Mr. Obama suggested that most Americans would not be affected by changes taking effect next year. And some of his comments may lower public expectations.
Americans who already have insurance do not have to worry about “implementation issues,” Mr. Obama said. These matters, he said, will affect a “small group of people, 10 to 15 percent of Americans — now, it’s still 30 million Americans, but a relatively narrow group — who don’t have health insurance right now, or are on the individual market and are paying exorbitant amounts for coverage that isn’t that great.”
“What we’re doing,” Mr. Obama said, “is we’re setting up a pool so that they can all pool together and get a better deal from insurance companies. And those who can’t afford it, we’re going to provide them with some subsidies.”
He added: “That’s it. I mean, that’s what’s left to implement, because the other stuff’s been implemented, and it’s working fine.”
Consumer advocates, employers and insurers have been saying for months that the Obama administration needed to step up planning for the new health insurance options. Consumers can sign up in October for coverage that starts in January. Some employers, especially those with many part-time, temporary and seasonal employees, say they expect to have difficulty carrying out new requirements for employer-sponsored coverage.
Questioning the Pelvic Exam
By JANE E. BRODY
In America, when a woman goes to her gynecologist, she is typically given a pelvic exam whether or not she has symptoms or concerns that might warrant one. That’s one reason an estimated 63.4 million pelvic exams are performed annually in this country.
Now a growing number of experts are asking whether it’s necessary to do so many.
“This is not the case in other countries that get better results without doing routine pelvic exams,” Dr. Carolyn L. Westhoff, a gynecologist at Columbia University Medical Center, said in an interview.
“I’m an American gynecologist, and that’s how we were trained. It took many years for me to ask, ‘Why are we doing this?’ ”
For most women, Pap smears are now recommended just once every three to five years — and for some, not at all. No doubt many women would be delighted to skip the routine pelvic exam, too, which many find uncomfortable and embarrassing.
A woman undergoing the exam is bare below the waist. She lies on the examining table on her back with her knees bent and legs spread apart, her feet in stirrups and her buttocks near the end of the table. The doctor inserts a lubricated, gloved finger into her vagina and, with the other hand, presses down on her abdomen to check the shape and size of her uterus and ovaries.
It’s called a bimanual exam. Dr. Westhoff is among an increasing number of experts now challenging the value of this time-honored practice, which is done as a matter of course when women come in for routine gynecological checkups or Pap smears.
These experts say that for women who are well, a routine bimanual exam is not supported by medical evidence, increases the costs of medical care and discourages some women, especially adolescents, from seeking needed care.
Moreover, the exam sometimes reveals benign conditions that lead to follow-up procedures, including surgery, that do not improve a woman’s health but instead cause anxiety, lost time from work, potential complications and unnecessary costs.
“The number of women who follow this unfortunate path each year is unknown but is likely sizable given the sheer number of pelvic examinations performed each year in the United States,” Dr. George F. Sawaya wrote in the Archives of Internal Medicine in December 2011.
Advocates Say Managed-Care Plans Shun the Most Disabled Medicaid Users
By NINA BERNSTEIN
Managed-care companies in New York have come under fire for signing up vigorous older adults referred to them by social day care centers, customers whose health needs are relatively small.
But on Tuesday, legal advocates for the disabled told the state’s Medicaid director that the most seriously impaired people were getting the opposite treatment.
Among the examples reported to the director, Jason A. Helgerson, in a meeting were cases in which the advocates said representatives of the managed-care plans deterred people who were bedbound or affected by dementia from enrolling in a plan, often by refusing to do an assessment at all, or by falsely saying that the plan’s budget or policies did not allow as much care as the person needed.
The meeting was closed to the news media, but Mr. Helgerson vowed to hold plans accountable, participants said, and some said they were encouraged that he worked with them to come up with a list of quick fixes, including a dedicated complaint line.
But the issues raised at the meeting illustrated again the difficulties as Gov. Andrew M. Cuomo, through the state Department of Health, moves tens of thousands of Medicaid recipients who need long-term care, like personal aides or nursing homes, into managed-care plans.
Medicaid pays the privately run managed-care plans roughly $3,800 a month for each person they enroll in New York City, regardless of how many services they need. The idea, borrowing from the use of health maintenance organizations to deliver health insurance, is to save money and harness competition among private plans to provide better, more efficient community care than under costly and fraud-ridden fee-for-service models.
But representatives from a dozen advocacy organizations for disabled people warned Mr. Helgerson that they were seeing a systemic problem: some of the neediest people were not being allowed to enroll, or were being denied the hours of service they need without a meaningful chance to appeal.
“The plan’s incentive to enroll low-need people creates a conflict of interest and opens to Medicaid fraud — see adult day care,” advocates wrote in an 18-page document for the meeting.
U.S. pledge on Medicaid sparks clash in Maine
Democrats say the clarification on federal funding paves the way for expansion in Maine, but LePage officials say it falls short.
WASHINGTON — Maine Democrats clashed with the LePage administration overMedicaid on Tuesday after federal officials signaled that Washington would likely pay all initial costs to cover an additional 10,500 low-income Mainers.
Democrats saw the letters from U.S. health and human services officials as another reason why Maine should go along with the Medicaid expansion in the federal Affordable Care Act.
The question of who would pay "was really the question that people were waiting to hear the answer to," said House Speaker Mark Eves, D-North Berwick. "Now that we have that answer, we can move forward with confidence knowing what the costs would be to the state."
But LePage administration officials said Washington has yet to respond to Maine's request for a special deal that would have the federal government cover all of Maine's expansion costs for an additional seven years.
"There are too many unanswered questions," said Adrienne Bennett, spokeswoman for Republican Gov. Paul LePage. "Expansion is going to cost the state as much as $100 million in a few years."
SEC subpoenas firm, individuals in a case of leaked information
By Tom Hamburger and Dina ElBoghdady,
The Securities and Exchange Commission has issued subpoenas to a firm and individuals in connection with the leak last month of a federal funding decision that appeared to cause a surge in stock trading of several major health companies.
The move deepens the government’s scrutiny of the growing “political intelligence” industry, which has been thriving on delivering valuable information from Washington to investors. This relatively new breed of companies capitalizes on the fact that decisions made in Washington — whether a regulator blocking a big merger or a lawmaker tweaking legislation — can create opportunities for stock traders to make money.
The latest case emerged April 1 when Height Securities, a Washington-based stock brokerage firm, alerted its clients that the government would soon make a decision favoring private health insurers who participate in a Medicare program.
The alert went out 18 minutes before the end of the trading day, sparking a surge in trading in the shares of several major health-care firms, including Humana and Aetna. The official government announcement was made after trading closed for the day.
On Wednesday, several people familiar with the probe confirmed that the SEC has subpoenaed a Height Securities analyst and Mark Hayes, a health-care lobbyist who advised the firm on legislative issues. Hayes’s law firm, Greenberg Traurig, was also subpoenaed by the SEC, according to the sources, who spoke on the condition of anonymity because the matter was under federal investigation.
The SEC has conducted an interview with Hayes, who voluntarily submitted to four hours of questioning, these people said. The FBI was present at the meeting, suggesting that the Justice Department has taken a deep interest in the matter, one of the people said. A Justice Department spokesman declined to comment on an ongoing investigation.
The SEC also declined to comment, but people familiar with the investigation said the agency began issuing subpoenas in mid-April seeking e-mails and other internal documents after a report on the matter in the Wall Street Journal.
All the parties involved deny any wrongdoing, their attorneys and company officials said.
Republicans to sick people: Tough luck
By Matt Miller,
There was a striking Republican stumble on health care the other day that deserves to be parsed because it reveals so much about the party’s current dilemma. I’m talking about the tea party revolt that embarrassed House Majority Leader Eric Cantor (R-Va.) and forced him to withdraw a modest bill to bolster the high-risk insurance pool meant to help sick Americans until Obamacare’s insurance exchanges are up and running next year.
A word of warning, however: what follows contains political attitudes so petty and out of touch they may disturb younger readers.
Cantor, you’ll recall, has been trying to get his party to embrace some ideas that would show Republicans are not just austerity monomaniacs blind to middle class anxieties. In a speech on “Making Life Work” not long ago, Cantor laid out a handful of initiatives in this vein, like boosting flex time and retraining. One idea was to strengthen the high-risk pool that covers Americans with pre-existing conditions. Obamacare established this program as an interim patch for vulnerable Americans until the law’s community rating kicks in, at which point everyone can buy coverage regardless of health status. But this national high-risk pool is so poorly funded (as has been the case with similar state pools for years) that only a few of the country’s uninsurables have availed themselves of the protection.
Now, to put what happened next in context, you need to understand that Republicans who resist universal coverage but who resent being labeled “heartless” have always been quick to say that they’re as concerned as the next guy about people with predictably high health expenses. The answer, they say, rather than some broad “socialist” risk pooling, is to set up publicly subsidized high risk insurance programs. That way these unlucky souls get help while leaving private health plans to cover the rest of us in ways that don’t force higher premiums on everyone.
Note that in either scenario our sense of decency requires the cost of predictably high health expenses to be spread beyond the individual — either through slightly higher premiums for everyone in a pooled system, or via public subsidies to the relative handful of sicker Americans in the high risk pool. (Every large company that offers health benefits, by the way, has taken the “socialist” path — an irony no one ever mentions.)
In theory, then, the high-risk pool approach can work — though in practice, since sick Americans lack political clout, these pools tend to be treated like stepchildren in the budget process.
Hence Cantor’s “Help Sick Americans Now Act.” Let Republicans back an approach they’ve philosophically endorsed before, Cantor thought, and by funding it a bit more generously than Obama has, show that the GOP can solve a problem that haunts (and often bankrupts) luckless families.
Part-timers to lose pay amid health act's new math
Some workers are having their hours cut so employers won't have to cover them under Obamacare. But many will benefit from the healthcare law's premium subsidies and Medicaid expansion.
Los Angeles Times
5:00 AM PDT, May 2, 2013
The law requires large employers offering health insurance to include part-time employees working 30 hours a week or more. But rather than provide healthcare to more workers, a growing number of employers are cutting back employee hours instead.
The result: Not only will these workers earn less money, but they'll also miss out on health insurance at work.
Consider the city of Long Beach. It is limiting most of its 1,600 part-time employees to fewer than 27 hours a week, on average. City officials say that without cutting payroll hours, new health benefits would cost up to $2 million more next year, and that extra expense would trigger layoffs and cutbacks in city services.
Quiz: Test your healthcare knowledge
Part-timer Tara Sievers, 43, understands why, but she still thinks it's wrong.
"I understand there are costs to healthcare reform, but it is surely not the intent of the law for employees to lose hours," said the outreach coordinator at the El Dorado Nature Center in Long Beach. "It's ridiculous the city is skirting the law."
Across the nation, hundreds of thousands of other hourly workers may also see smaller paychecks in the coming year because of this response to the federal healthcare law. The law exempts businesses with fewer than 50 full-time workers from this requirement to provide benefits.
But big restaurant chains, retailers and movie theaters are starting to trim employee hours. Even colleges are reducing courses for part-time professors to keep their hours down and avoid paying for their health premiums.
Overall, an estimated 2.3 million workers nationwide, including 240,000 in California, are at risk of losing hours as employers adjust to the new math of workplace benefits, according to research by UC Berkeley. All this comes at a time when part-timers are being hired in greater numbers as U.S. employers look to keep payrolls lean.
One consolation for part-timers is that many of them stand to benefit the most from the healthcare law's federal premium subsidies or an expansion of Medicaid, both starting in January.
The law will require most Americans to buy health insurance or pay a penalty. Yet many lower-income people will qualify for government insurance or be eligible for discounted premiums on private policies.
"For people losing a few hours each week, that's lost income and it has a real impact," said Ken Jacobs, chairman of the UC Berkeley Center for Labor Research and Education. "But many low-wage, part-time workers will also have some affordable options under the federal law."
http://www.latimes.com/business/la-fi-part-time-healthcare-20130502,0,3005638,print.story
No comments:
Post a Comment