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Tuesday, June 11, 2013

Health Care Reform Articles - June 11, 2013


Obama cites California to tout his healthcare law

President Obama pointed to California's progress in implementing the Affordable Care Act as he tries to get Americans on board with the healthcare law.

By Noam N. Levey and Christi Parsons
This post has been updated, as indicated below.
3:00 AM PDT, June 7, 2013

[Updated, 10:56 a.m. June 7: SAN JOSE – President Obama on Friday morning held up California as an example of how his healthcare law will help consumers, citing the state’s progress getting health insurers to offer better plans at affordable prices.
“A lot of opponents of the Affordable Care Act … had all kinds of sky-is-falling, doom-and-gloom predictions that not only would the law fail, but what we would also see is costs would skyrocket,” the president told reporters at a stop in Silicon Valley. “It turns out that what we are seeing in the states that have committed themselves to implementing this law correctly, we’re seeing some good news.”
Obama also urged Californians and other Americans who don’t have health coverage to sign up this fall.
And he highlighted a multimillion-dollar partnership between the nonprofit California Endowment and major Spanish-language media outlets aimed at getting Latinos to enroll in health insurance next year. The Obama administration and other supporters of the law believe Latinos are crucial to the law’s success.]
The endowment, which has allocated $225 million to help implement the Affordable Care Act, plans to spend about $70 million for advertising, much of it in Spanish-language media, including Univision, Telemundo, La Opinion and Radio Bilingue.
The president's remarks come two weeks after state leaders announced lower-than-expected premiums that millions of Californians will face when a new state insurance marketplace opens this fall for those who don't get health benefits through their employer.
http://www.latimes.com/news/nationworld/nation/la-na-obama-healthcare-20130607,0,2751455,print.story


State may fill gap in federal health care coverage

WASHINGTON — A congressional mistake that could cause nearly 4 million people to be ineligible for federal subsidies in President Obama’s health care law has prompted Massachusetts officials to launch a new effort to try to close the gap.
Under what has become known as a “glitch” in Obama’s health plan, eligibility for insurance subsidies will be based on how much it costs workers who buy an individual plan, not the far more expensive family plan. The glitch would affect uninsured spouses and an estimated 460,000 children of workers who cannot afford the family coverage offered through employers.
Although that was not what lawmakers say they intended, partisan congressional gridlock has closed off efforts to fix the glitch before the ambitious overhaul aimed at universal coverage kicks in fully next year.
So officials in Massachusetts, where the framework for the national law was first enacted, are stepping in, saying they want to fix the glitch to help those affected in the Bay State. Advocates say they hope Massachusetts’ efforts will focus new national attention on the problem.


Hundreds in government had advance word of Medicare action at heart of trading-spike probe

By  and Published: June 9

Hundreds of federal employees were given advance word of a Medicare decision worth billions of dollars to private insurers in the weeks before the official announcement, a period when trading in the shares of those firms spiked.
The surge of trading in Humana’s and other private health insurers’ stock before the April 1 announcement already has prompted the Justice Department and the Securities and Exchange Commission to investigate whether Wall Street investors had advance access to inside information about the then-confidential Medicare funding plan.
Sen. Charles E. Grassley (R-Iowa) told The Washington Post late last week that his office reviewed the e-mail records of employees at the Department of Health and Human Services and found that 436 of them had early access to the Medicare decision as much as two weeks before it was made public.
The number of federal employees with advance knowledge is surely higher; the figures Grassley’s staff compiled did not include people at the White House’s Office of Management and Budget who also saw the information. The e-mail records of those employees have not been made available to Grassley.
The discovery that sensitive information was so widely disseminated could complicate the forensic task for investigators trying to determine who may have leaked confidential information, and it brings further attention to the government’s handling of policy details valued by Wall Street traders.
“This should sound an alarm,” Grassley said. “It should result in better controls to avoid unfair access to information that the average investor could never tap.”
Tracing leaks of confidential financial information can be especially challenging in official Washington, where Congress and the executive branch — along with the reporters and lobbyists who track them — are accustomed to a relatively unfettered exchange of information, compared with the more regulated environment on Wall Street.
The potential sensitivity of such exchanges was brought home for Grassley last month, when the Justice Department hand-delivered to his office a letter asking for details about a staff member’s communications with a former staffer. That former Grassley staffer was a lobbyist who occasionally worked in the burgeoning field of “political intelligence,” which specializes in providing government information to investors for a fee.
Grassley has led calls in the Senate for more scrutiny of that field, and he has said he plans to introduce legislation that would require political-intelligence consultants to disclose their activities, as lobbyists are required to do.
http://www.washingtonpost.com/politics/hundreds-in-government-had-advance-word-of-medicare-action-at-heart-of-trading-spike-probe/2013/06/09/044944d0-cec7-11e2-8845-d970ccb04497_print.html


Rethinking the Twice-Yearly Dentist Visit

For decades, dentists have urged all adults to schedule preventive visits every six months. But a new study finds that annual cleanings may be adequate for adults without certain risk factors for periodontal disease while people with a high risk may need to go more often.
Almost half of adults age 30 and older, about 65 million, have a form of chronic inflammatory gum disease that can ultimately lead to tooth loss. The new study, published Monday in The Journal of Dental Research, suggests that the frequency of dental visits for cleanings and other preventive services should be tailored to each person’s risk factors for periodontal disease.“The findings suggest that for low-risk patients, a yearly prophylactic visit does prevent tooth loss over a protracted period of 16 years, and there’s no significant difference in an added visit,” said Dr. Robert J. Genco, a periodontist and SUNY distinguished professor of oral biology at the University at Buffalo, who was not involved in the study. “They found if you had more than one risk factor, that maybe two visits isn’t optimal.”
Prevention reduces tooth loss, but there has been little evidence to support a twice-yearly visit to the dentist for everyone. The new study looked at insurance claims data for 5,117 adults, primarily in Michigan, to determine whether tooth extraction was linked to a previous history of one or two dental visits a year in patients with varying risks for periodontal disease. The subjects were classified as high risk if they smoked or had diabetes or certain variations in the interleukin-1 gene, which some studies have suggested may be linked to periodontal disease in white people. Subjects were deemed low risk if they had none of these risks.
Researchers found no statistical difference in tooth loss among low-risk patients whether they went for a checkup once or twice a year. But in the high-risk camp, roughly 17 percent of patients who had had biannual visits had a tooth extracted, compared with roughly 22 percent of those who had had just one visit a year.
The researchers said that even two visits a year might not suffice to reduce tooth loss in patients with multiple risk factors.

MONDAY, JUNE 10, 2013

Will the Affordable Care Act's Health Insurance Exchanges Be Ready On Time? The Obama Administration's Top Secret Enterprise

Last week, I received my weekly email update from the Maryland health insurance exchange:
Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based exchanges. Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier. This major information technology milestone received high marks by federal partners. We will continue with development of Maryland Health Connection over the next several weeks and begin user acceptance testing in July.
This report tells us a few things.
http://healthpolicyandmarket.blogspot.com/2013/06/will-affordable-care-acts-health.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

Doctors brace for pain as 10% cut to Medi-Cal rates looms

The cuts, affecting physicians, dentists and pharmacists, were enacted in 2011 to counter a budget deficit. But with the state on surer footing, medical providers want to restore funds for poor Californians.

By Anna Gorman and Anthony York, Los Angeles Times
8:42 PM PDT, June 10, 2013
In a office decorated with Chinese art and diagrams of body parts, Dr. George Ma cares for more than 4,000 patients.
Nearly three-quarters are covered by Medi-Cal, the state's public insurance program for low-income Californians, and Ma said he receives $10 a month to treat most of them.
This summer, when California makes a controversial 10% cut to Medi-Cal rates, he could get paid less. Ma said he didn't go into safety net medicine for the money, but he worries that the reductions will make it even harder for his patients to get medication, medical equipment and appointments with specialists.
The reductions to providers like Ma will also create a massive glitch in the implementation of national healthcare reform — the cuts to Medi-Cal rates are to occur just as more people prepare to join the program under the Affordable Care Act. Currently 8.3 million poor Californians are covered by Medi-Cal, and more than 1 million new enrollees are expected beginning next year.
State officials argue the 10% decrease is necessary to keep healthcare spending under control, but medical providers fear it will devastate an already shrinking workforce and jeopardize patient care.
The reductions target physicians, dentists, clinics, pharmacists and hospital-based nursing facilities. The cuts, which are retroactive to 2011, are necessary to bring the state's books into balance, according to Gov. Jerry's Brown's administration. They are projected to save the state $459 million in the fiscal year that starts July 1.
"There were a lot of very difficult decisions that were made to restore the fiscal solvency of the state," said Diana Dooley, secretary of the state Health and Human Services Agency.
The governor proposed the reduced payments, and lawmakers approved them in 2011 as part of a larger effort to close a multibillion-dollar state deficit. But with the books now balanced and the state in better fiscal shape, many lawmakers want to restore that money for those who care for the poorest Californians.
http://www.latimes.com/news/local/la-me-health-cuts-20130611,0,4853261,print.story


Why one person urges Maine lawmakers to expand Medicaid

Posted June 10, 2013, at 12:44 p.m.
There has been a lot of talk from people in the State House about the costs and benefits of accepting federal funds to provide health insurance for up to 70,000 Mainers. They’ve talked about the merits of the deal, the money Maine will save, the jobs that will be created and the importance of providing health care to nearly 70,000 people.
We haven’t heard as much from any of those 70,000 people who would benefit from health care expansion.
I am one of them, and I want to tell you my story.
I was very sick when I was young, and I spent a lot of time at a hospital in Boston as doctors tried to figure out what was making me so sick. When I was 4, I was diagnosed with Cystic Fibrosis, a chronic disease that causes my body to produce excess mucus, which clogs my lungs and makes it hard for me to breathe.
Because my parents had health insurance, they were able to get me the treatment and medicine I needed, and I was able to go home.
That’s also when I started playing hockey.
At first, my doctors didn’t want me to play. But my dad thought it would be good for me, and he stood up for me. He was right. Hockey allowed me to be a normal kid away from the hospital and the doctor’s visit. On the ice, I am just Sean Bourgeois, not Sean Bourgeois with Cystic Fibrosis.
It turns out, I was a pretty good hockey player. When I graduated from Winslow High School, I went into Junior A hockey, which was the quickest way for me to accomplish my dream of playing professional hockey.
I had some great experiences playing. For more than a year, I played for the Maine Moose here in Augusta, and I got to play a game with the Boston Bruins. It was an incredible experience to share the ice with some of my idols, like Ray Bourque and Cam Neely.
I couldn’t always play, so when I did, I made the most of it. In 2009, I played for the New Jersey Kings. A full Junior A hockey season is more than 60 games, but because I would get sick, I played only 14 games that year. In those 14 games, I scored 46 goals and performed a hat trick (three goals) in 36 seconds.
Junior A hockey doesn’t pay the bills, so while I was playing, I was also working full-time, and eventually it was too much. It took a toll on my health, and my illness made it harder for me. I came home and was hospitalized. I realized that I couldn’t afford to work full-time and play hockey. It was too much for my body.
Right now, I am hospitalized for about two weeks every two to three months to have my lungs cleared. I can’t work full time and keep the health insurance I receive through my disability insurance.







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