Ask Well: Long-Term Risk of Antidepressants
By RICHARD A. FRIEDMAN, M.D.
QAre there any substantial studies that focus on the side effects of long-term (10-plus years) use of S.S.R.I.’s?
WASHINGTON — President Obama sought to tamp down fears Tuesday that his landmark healthcare law would raise insurance costs and cause other disruptions, saying most Americans were already benefiting from it and others soon would.
"Any time you're implementing something big, there's going to be people who are nervous," the president said at a news conference at which he delivered a new pitch for the 2010 legislation. "For the average American out there, for the 85 and 90% of Americans who already have health insurance, this thing's already happened."
Key parts of the law have been implemented, including a provision allowing people in their early 20s to remain on their parents' health plans and requirements that insurers offer preventive benefits such as physical exams and cancer screenings without co-payments.
Referring to Americans enrolled in plans, Obama said, "Their insurance is more secure."
But the law's signature benefit — a guarantee that all Americans can get insurance, even if they are ill — doesn't take effect until next year. Building a system to deliver on that promise has been the law's most complex and costly challenge.
The Obama administration is now scrambling, as are some states, to set up state-based insurance marketplaces so that, beginning in October, Americans who do not get health benefits through work will be able to select a plan for coverage in 2014.
Administration officials are also working to persuade states to expand their Medicaid programs next year to cover low-income Americans on the government health insurance plan. The law's supporters hope these coverage expansions will extend health insurance to as many as 30 million people over the next decade.
But Republican opposition to the law, delays in issuing key regulations and persistent public confusion have fueled growing nervousness among some supporters, including Democrats on Capitol Hill.
Last month, Senate Finance Committee Chairman Max Baucus (D-Mont.), a leading architect of the law, told Health and Human Services Secretary Kathleen Sebelius that he feared a "train wreck" when online exchanges open this fall to sell health insurance to consumers.
Adding to the anxiety are warnings from insurers that requirements in the law will force them to dramatically increase premiums for consumers who buy insurance on their own or get it through a small business. Millions of consumers are expected to qualify for federal subsidies.
Although most 2014 rates have not been issued yet, CareFirst BlueCross BlueShield shocked many observers recently by proposing to raise premiums for individuals who buy insurance on their own in Maryland by an average of 25%. The proposed rate hike is now under review by state regulators.
http://www.latimes.com/health/la-na-ob
ama-healthcare-20130501,0,821087,print.story
Reader Question • 2255 votes
A
The short answer is no. But your question gets to the heart of an important problem that we have in this country: that all medications are approved by the Food and Drug Administration on the basis of relatively short-term studies, even though many are used long-term for medical and psychiatric disorders that are chronic, if not lifelong.
The F.D.A. approves antidepressants like selective serotonin re-uptake inhibitors, or S.S.R.I.’s, if the drug beats a placebo in two randomized clinical trials that typically last 4 to 12 weeks and involve a few hundred patients. Longer-term maintenance studies, usually lasting one to two years, indicate that S.S.R.I.’s do not cause any serious harm, though they have plenty of side effects, like weight gain and sexual dysfunction.
Once a drug hits the market, we have only a voluntary system of reporting adverse effects in the United States; there are no systematic long-term studies of any drug lasting 10 or more years. Still, S.S.R.I.’s have been used since the late 1980s and given to more than 40 million Americans, so it’s reasonable to say that if these drugs caused any significant toxic effects, we would have seen many such reports.
latimes.com
Obama seeks to allay healthcare law concerns
The president is trying to calm anxieties about insurance rate hikes, in part by publicizing the law's benefits and showcasing efforts to sign up the uninsured.
By Noam N. Levey, Washington Bureau
7:31 PM PDT, April 30, 2013
"Any time you're implementing something big, there's going to be people who are nervous," the president said at a news conference at which he delivered a new pitch for the 2010 legislation. "For the average American out there, for the 85 and 90% of Americans who already have health insurance, this thing's already happened."
Key parts of the law have been implemented, including a provision allowing people in their early 20s to remain on their parents' health plans and requirements that insurers offer preventive benefits such as physical exams and cancer screenings without co-payments.
Referring to Americans enrolled in plans, Obama said, "Their insurance is more secure."
But the law's signature benefit — a guarantee that all Americans can get insurance, even if they are ill — doesn't take effect until next year. Building a system to deliver on that promise has been the law's most complex and costly challenge.
The Obama administration is now scrambling, as are some states, to set up state-based insurance marketplaces so that, beginning in October, Americans who do not get health benefits through work will be able to select a plan for coverage in 2014.
Administration officials are also working to persuade states to expand their Medicaid programs next year to cover low-income Americans on the government health insurance plan. The law's supporters hope these coverage expansions will extend health insurance to as many as 30 million people over the next decade.
But Republican opposition to the law, delays in issuing key regulations and persistent public confusion have fueled growing nervousness among some supporters, including Democrats on Capitol Hill.
Last month, Senate Finance Committee Chairman Max Baucus (D-Mont.), a leading architect of the law, told Health and Human Services Secretary Kathleen Sebelius that he feared a "train wreck" when online exchanges open this fall to sell health insurance to consumers.
Adding to the anxiety are warnings from insurers that requirements in the law will force them to dramatically increase premiums for consumers who buy insurance on their own or get it through a small business. Millions of consumers are expected to qualify for federal subsidies.
Although most 2014 rates have not been issued yet, CareFirst BlueCross BlueShield shocked many observers recently by proposing to raise premiums for individuals who buy insurance on their own in Maryland by an average of 25%. The proposed rate hike is now under review by state regulators.
http://www.latimes.com/health/la-na-ob
ama-healthcare-20130501,0,821087,print.story
MaineHealth partners with Anthem on health care cost-cutting model
Posted May 03, 2013, at 5:33 p.m.
PORTLAND, Maine — One of Maine’s largest hospital systems has teamed up with the state’s biggest private health insurer in an effort to improve patients’ health while lowering costs.
MaineHealth, parent organization of Portland’s Maine Medical Center, has partnered with Anthem Blue Cross and Blue Shield in Maine to launch an “accountable care organization,” a new model designed to move away from the existing health care system that pays providers based on the number of patients they see and the amount of services and procedures they order. The hope is that tying health care payments to how well doctors, nurses and other providers work together to improve patients’ health will help patients and rein in expenses.
“We really think this is a step in the right direction in terms of moving from paying for volume to paying for value,” said Colin McHugh, regional vice president of provider engagement and contracting for Anthem. “This really will be felt by individuals and employer groups.”
Maine already has a few other accountable care organizations — two health groups announced plans for such organizations in 2012 and Brewer-based Eastern Maine Healthcare Systems became one of the first health networks in the country to pursue the model in 2011. MaineHealth also operates another model that serves patients covered by Medicare, but its deal with Anthem marks the first commercial accountable care organization in Maine.
The Anthem accountable care organization would mirror MaineHealth’s Medicare model, folding in Anthem customers and the same group of more than 1,000 physicians, largely primary care doctors, said Andrea Patstone, vice president of strategic initiatives for MaineHealth.
Health systems across the country are experimenting with the model, which was formalized under the recent federal health reform law. Unlike the managed care model of the 1990s, accountable care organizations do not restrict which doctors or hospitals a patient may visit. Individuals also may opt out of sharing their health information with an accountable care organization.
The model ties insurance reimbursements to how well health providers keep patients healthy while stemming costs. Under the MaineHealth-Anthem partnership, MaineHealth would get a cut of any savings it realizes, provided the system meets health care quality benchmarks. Those benchmarks typically include measures such as patient satisfaction and preventive health screenings.
Anthem customers would benefit from any savings in the form of lower premiums, McHugh said.
If MaineHealth fails to meet savings and quality goals, it would owe some money back, Patstone said.
Study: Except for less depression, Oregon Medicaid expansion led to no major health gains
Posted May 02, 2013, at 11:44 a.m.
As fights over the health-care law’s expansion of Medicaid engulf state legislatures, a sweeping new study indicates that the program is unlikely to quickly improve enrollees’ physical health.
The research, published Wednesday in the New England Journal of Medicine, found that low-income people who recently gained Medicaid coverage in Oregon used more health-care services and had less trouble paying their bills. They also saw significant improvements in mental health outcomes, with rates of depression falling by 30 percent.
But on a simple set of health measures, including cholesterol and blood pressure levels, the new Medicaid enrollees looked no different than a separate group, who applied for the benefit but were not selected in a lottery.
“It’s disappointing,” said Zeke Emanuel, a former Obama health policy adviser. “This says there are benefits to providing Medicaid but that we also need to fix the system.”
The new data could come to bear in states’ decisions on whether to expand Medicaid to cover millions of low-income Americans in 2014, as the Affordable Care Act allows. Many states with large uninsured populations, most notably Florida and Ohio, have yet to decide whether to move forward.
The research uses data from Oregon, where the state held a lottery among low-income adults in 2008 for a limited Medicaid expansion. Of the 90,000 people who applied, 10,000 ultimately gained coverage.
The lottery gave researchers a unique opportunity to conduct the first randomized experiment on Medicaid coverage, by studying those who gained insurance through the lottery and comparing them against a similar group of adults who did not.
“It’s probably one of the most important long-term studies on the effects of health insurance coverage,” said Sara Collins, vice president at the CommonWealth Fund. “People are following it very closely.”
The first study of the Oregon lottery population, published in 2011, found that new Medicaid enrollees tended to self-report better health after gaining coverage. Catastrophic out-of-pocket spending was “virtually eliminated,” indicating that the public program provided helpful assistance in paying medical bills. said Amy Finkelstein, a study co-author and professor at the Massachusetts Institute of Technology.
The paper published Wednesday delved into greater detail on how patients used the health-care system and whether their health improved as a result. It found that those who gained coverage tended to make more trips to the doctor and receive a higher number of prescriptions. Their annual medical spending was $1,172 higher than those who did not gain coverage in the lottery.
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