Choice of Health Plans to Vary Sharply From State to State
By REED ABELSON
When a typical 40-year-old uninsured woman in Maine goes to the new state exchange to buy health insurance this fall, she may have just two companies to choose from: the one that already sells most individual policies in the state, and a complete unknown — a nonprofit start-up.
Her counterpart in California, however, will have a much wider variety of choices: 13 insurers are likely to offer plans, including the state’s largest and best-known carriers.
With only a few months remaining before Americans will start buying coverage through the new state insurance exchanges under President Obama’s health care law, it is becoming clear that the millions of people purchasing policies in the exchanges will find that their choices vary sharply, depending on where they live.
States like California, Colorado and Maryland have attracted an array of insurers. But options for people in other states may be limited to an already dominant local Blue Cross plan and a few newcomers with little or no track record in providing individual coverage, including the two dozen new carriers across the country created under the Affordable Care Act.
Maine residents, for example, will not see an influx of new insurers. The state has an older population and strict rules that already have discouraged many insurers from selling policies, so choices will probably be limited to the state’s dominant carrier, Anthem Blue Cross, and Maine Community Health Options.
“What we’re seeing is a reflection of the market that already exists,” said Timothy S. Jost, a law professor at Washington and Lee University in Virginia who closely follows the health care law.
Obama administration officials estimate that most Americans will have a choice of at least five carriers when open enrollment begins in October. There are signs of increased competition, with new insurers and existing providers working harder to design more affordable and innovative plans. In 31 states, officials say there will be insurers that offer plans across state lines. The exchanges will be open to the millions of Americans who are uninsured or already buying individual coverage. Many will be eligible for federal subsidies.
Republicans trying to use health-care law to derail Obama’s immigration reform efforts
By David Nakamura and Sandhya Somashekhar,
After spending years unsuccessfully trying to overturn “Obamacare,” Republicans are now attempting to use President Obama’s landmark health-care law to derail his top second-term initiative — a sweeping overhaul of the nation’s immigration system.Conservatives in both chambers of Congress are insisting on measures that would expand the denial of public health benefits to the nation’s 11 million illegal immigrants beyond limits set in a comprehensive bill pending in the Senate.
In the House, Republicans are considering proposals that would deny publicly subsidized emergency care to illegal immigrants and force them to purchase private health insurance plans, without access to federal subsidies, as a requirement for earning permanent legal residency.
In the Senate, Marco Rubio (R-Fla.) has endorsed an amendment to a comprehensive immigration bill he helped negotiate that would deny health benefits to immigrants for five years after they become legal residents — two years after they would be eligible to become citizens under the legislation.
Some Republicans, eager to capitalize on public uncertainty about the complexities of the Affordable Care Act, are casting the immigration legislation as a similarly unwieldy law.
The immigration bill “reminds me of a more recent piece of legislation: Obamacare,” Sen. Mike Lee (R-Utah) said on the Senate floor last week. “It grants broad new powers to the same executive branch that today is mired in scandal for incompetence and abuse of power. Total cost estimates are in the trillions. And rather than fix our current immigration problems, the bill makes many of them worse.”
The insertion of the politics of health-care reform — one of the most polarizing issues in Washington — into the immigration debate threatens to split open the emerging bipartisan coalitions that are crucial to passing a bill.
http://www.washingtonpost.com/politics/republicans-trying-to-use-health-care-law-to-derail-obamas-immigration-reform-efforts/2013/06/16/60e21138-d442-11e2-a73e-826d299ff459_print.html
FBI: Chicago hospital kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them, reaping $160,000 from Medicare per case
Posted June 16, 2013, at 3:22 p.m.
WASHINGTON – A surgeon at Chicago’s Sacred Heart Hospital cut a hole in Earl Nattee’s throat on Jan. 3, the day before he died. It’s not clear why.
The medical file contained no explanation of the need for the procedure, called a tracheotomy, according to a state and federal inspection report that quotes Sacred Heart’s chief nursing officer as saying it happened “out of the blue.” Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can’t breathe otherwise.
Now, amid a federal investigation into allegations of unneeded tracheotomies at the hospital, Nattee’s daughter, Antoinette Hayes, wonders whether her father was a pawn in what an FBI agent called a scheme to defraud Medicare and Medicaid.
“My daddy said, ‘They’re killing me,’” Hayes recalled, in reference to the care he received at the hospital.
Based in part on surreptitious tape recordings, an FBI affidavit lays out allegations that a Sacred Heart pulmonologist kept patients too sedated to breathe on their own, then ordered unneeded tracheotomies for them — enabling the for-profit hospital to reap revenue of as much as $160,000 per case.
The Sacred Heart case is unusual because of the troubling nature of some of the allegations, said Ryan Stumphauzer, a former federal health care fraud prosecutor in Miami who reviewed the affidavit. “A typical indictment might allege phantom billing or improper coding,” he said. “This complaint alleges the hospital and doctors were performing unnecessary invasive surgery to justify false billing.”
It’s also unusual to have recordings from cooperating witnesses, he said, “but it is always very difficult to challenge a physician’s judgment.”
The government has already charged Sacred Heart owner Edward Novak, his chief financial officer and five physicians with Medicare fraud, in a criminal complaint alleging that they gave or received kickbacks in return for patient referrals.
A physician and two Sacred Heart administrators worked with federal investigators, secretly taping conversations with other hospital staff members, according to the complaint. The 90-page FBI affidavit includes a quote attributed to Novak saying tracheotomies were the hospital’s “biggest money maker.” The hospital’s pulmonologist, or respiratory specialist, is quoted as saying during an April conversation that Novak asked him “to provide two more tracheotomy cases for the hospital soon,” before inspectors — who had visited the hospital in March — returned.
Sergio Acosta, an attorney representing Novak, said his client declined to comment. Robert Clarke, attorney for Sacred Heart CFO Roy Payawal, also declined to comment.
Trans-Pacific Partnership undermines health system - Opinion - Al Jazeera English
The Trans-Pacific Partnership (TPP) is a deal that is being secretly negotiated by the White House, with the help of more than 600 corporate advisers and Pacific Rim nations, including Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore and Vietnam. While the TPP is being called a trade agreement, the US already has trade agreements covering 90 percent of the GDP of the countries involved in the talks. Instead, the TPP is a major power grab by large corporations.
The text of the TPP includes 29 chapters, only five of which are about trade. The remaining chapters are focused on changes that multinational corporations have not been able to pass in Congress such as restrictions on internet privacy, increased patent protections, greater access to litigation and further financial deregulation.
So far, all that is known about the contents of the TPP is from documents that have been leaked and reports from NGOs and industry meetings. Unlike other trade deals, the White House refuses to make the text available to the public. In fact, the negotiators refuse to publish the text until four years after it is signed into law. Why are they being so secretive? Former US Trade Representative Ron Kirk said he opposed making the text public because doing so would raise such opposition that it could make the deal impossible to sign.
From the information available, one thing is clear about the impacts of the TPP on health care: the intention of the TPP is to enhance and protect the profits of medical and pharmaceutical corporations without considering the harmful effects their policies will have on human health.
LePage vetoes bipartisan Medicaid expansion plan
Yesterday at 11:59 PMThe bill would extend health insurance to more than 60,000 low-income Mainers under the federal Affordable Care Act.
AUGUSTA — Gov. Paul LePage vetoed a Medicaid-expansion bill late Monday, taking an expected step that's sure to increase tension with Maine's legislative session due to end this week.
The veto was first announced Monday evening on Twitter by the Maine Senate Republicans, whose spokesman, Jim Cyr, provided the veto letter to the Portland Press Herald. LePage's spokeswoman, Adrienne Bennett, couldn't be reached for comment late Monday.
LePage vetoes Medicaid expansion, says ‘Maine can do better’
Posted June 17, 2013, at 9:01 p.m.
AUGUSTA, Maine — Gov. Paul LePage on Monday vetoed legislation to expand Maine’s Medicaid program, turning the focus back to majority Democrats to try and rally enough Republican votes to override it.
In his veto message, LePage wrote Maine has expanded Medicaid before — what he termed a “massive increase in welfare expansion” — and it hasn’t worked.
“Maine ran up massive debts to our hospitals as the system outgrew the taxpayers’ ability to pay,” he wrote, citing Maine’s $484 million debt to its hospitals. “At the same time, the uninsured population remained almost the same — 136,000 in 2001 to 133,000 in 2011. The only change was thousands upon thousands of Mainers leaving the commercial market for ‘free’ health care, expanding the welfare rolls from nearly 200,000 to 338,000.”
The House and Senate took final votes on the Medicaid bill, LD 1066, on Thursday. It passed in the House, 97-51, and in the Senate, 23-12. While both tallies included some Republican votes, they fell short of the two-thirds threshold needed to override LePage’s veto.
Expanding the state’s Medicaid program would provide coverage for about 50,000 adults without children who earn up to 133 percent of the federal poverty level, or $20,628 for a two-person household. The expansion would also prevent about 25,000 parents and childless adults from losing their Medicaid coverage starting Jan. 1, 2014.
In his letter, LePage warned lawmakers against accepting promises that the federal government will pay nearly all costs of expanding Medicaid over the next decade.
And he cautioned lawmakers against accepting compromise legislation that passed the House and Senate, under which Maine would withdraw from the Medicaid expansion after three years unless the Legislature decided to continue the coverage at that time.
“When we expanded in the 2000s, we were promised we could reduce eligibility if the goals were not met,” he said. “Now the federal government has tried to change the rules and lock our earlier generosity in place.”
Democratic legislative leaders reacted quickly, calling on Republicans to help them override the veto.
Maine Legislature passes partial rollback of GOP health-care law
Yesterday at 5:43 PMAUGUSTA — A pair of Democratic-backed adjustments to Republicans’ 2011 health-care reform law initially passed both houses of the Maine Legislature on Monday.
But the bills don’t have much bipartisan support. One passed with no Republican support in either the House of Representatives and the Senate. The other was backed by only five Republicans in both chambers combined.
That sets up what looks like an easy veto opportunity forGov. Paul LePage, whose administration opposes the bills. Before they get to LePage's desk, the bills face further votes in the House and Senate.
http://www.pressherald.com/politics/House-passes-partial-roll-back-of-GOP-health-care-law.html
Lewiston hospital group sues state over insurance plan
7:23 AMThe Associated Press
LEWISTON — A Maine hospital group has gone to court to get more details about a proposed new health insurance plan being put together by Anthem Blue Cross and Blue Shield and MaineHealth.
The state has said that Anthem can keep details of the plan secret as it seeks approval from the Maine Bureau of Insurance.
Lewiston-based Central Maine Healthcare filed suit in Kennebec County Superior Court last week against the superintendent of the Bureau of Insurance and the Maine Department of Professional and Financial Regulation.
The suit asks the court to open the Anthem documents made confidential by the bureau to give the public more time to comment on the proposal.
A Central Maine Healthcare spokesman tells the Sun Journal the public has a right to know.
Anthem had no comment.
Central Maine Healthcare files suit against state, says federally subsidized insurance would exclude some hospitals
Posted June 18, 2013, at 5:53 a.m.
LEWISTON, Maine — Anthem Blue Cross and Blue Shield wants to form a new insurance plan with MaineHealth. And it wants the state to keep the details of that plan secret as it seeks approval from the Maine Bureau of Insurance.
The state has said OK.
Central Maine Healthcare has said no fair.
Now it’s asking a judge to make Anthem’s application public and to give the public more time to comment on it before the bureau decides whether to approve the new insurance plan.
“We believe the public has a right to know what’s going on,” said Chuck Gill, spokesman for CMHC.
CMHC, on behalf of Central Maine Medical Center in Lewiston, area doctors and patients, filed suit in Kennebec County Superior Court late last week against Eric Cioppa, superintendent of the Bureau of Insurance, and the Maine Department of Professional and Financial Regulation. It asks the court to open the Anthem documents made confidential by the bureau, give the public more time to comment on the proposal and postpone the bureau’s June 28 hearing on the insurance plan.
Because that hearing is less than two weeks away, CMHC also asked the court to expedite its ruling. A judge is expected to consider that motion in the coming days.
Late Monday, the Bureau of Insurance said it would release some of the information CHMC is seeking: which doctors and hospitals the plan will and won’t allow patients to use. In his order to release the information, the bureau’s superintendent said, in part, the provider network list must be filed publicly with the bureau by July 1 anyway and that making the information available two weeks early is highly unlikely to allow a competitor to gain advantage.
That information is set to be released at 4 p.m. Tuesday. Anthem could ask a court to block its release. Gill said CMHC will wait to see the information before deciding whether it’s enough for the organization to drop its court action.
A representative for Anthem offered no comment on the information’s release.
Governor LePage, “Able Bodies”, Unhealthy Minds & Medicaid Expansion
Governor Lepage,
I am disturbed by your repeated references to welfare for “able bodied adults.” It needs to end. Sadly, it does not seem to occur to you that “able bodied” is an offensive term. What constitutes an “able body?” Many of my friends who’ve had amputations, partial paralysis, and an array of debilitating health conditions consider themselves “able bodied.” The use of this unfortunate phrase implies a clear standard for what an “able body” is.
We may need to disagree on many things, Governor. In my view, health care is not welfare. I concede that how one views access to health care is largely a matter of ideology. I believe that holistic health is a basic human right. I have no interest in challenging your values. I do wish for you to consider that untreated mental illness is pervasive in our state and in our country. It’s a major social problem. Being capable of work physically has nothing to do with whether or not a person lives with a mental illness.
http://recoveryrocks.bangordailynews.com/2013/06/16/addiction/governor-lepage-able-bodies-unhealthy-minds-medicaid-expansion/
The Wall Street Journal, June 16, 2013
Paying doctors for better care — not just more of it — seems like a no-brainer. Yet rigorous studies of pay-for-performance bonuses have found no health benefits and some unintended harms.
An exhaustive analysis of pay-for-performance research by the Cochrane Collaborative, an international group that reviews medical evidence, unearthed "no evidence that financial incentives can improve patient outcomes."
Consider these cases. In Britain's massive pay-for-performance program, family doctors earned almost perfect scores (and big bonuses) for hypertension treatment, but population surveys found no decrease in blood pressure or its main complication, strokes. Meanwhile, aspects of quality that didn't bring bonuses deteriorated.
The largest U.S. pay-for-performance experiment — Medicare's Premier Demonstration — also flopped. The 200 hospitals that offered bonuses scored slightly worse on patient death rates than other hospitals.
Proponents argue that programs like these were flawed in one way or another, and that the next trial — or the one after — will certainly do better. They also claim successes with other programs. But none of these claims rest on rigorous science, and all those that have subsequently been subjected to rigorous tests have failed.
http://www.pnhp.org/print/news/2013/june/should-physician-pay-be-tied-to-performance
I am disturbed by your repeated references to welfare for “able bodied adults.” It needs to end. Sadly, it does not seem to occur to you that “able bodied” is an offensive term. What constitutes an “able body?” Many of my friends who’ve had amputations, partial paralysis, and an array of debilitating health conditions consider themselves “able bodied.” The use of this unfortunate phrase implies a clear standard for what an “able body” is.
We may need to disagree on many things, Governor. In my view, health care is not welfare. I concede that how one views access to health care is largely a matter of ideology. I believe that holistic health is a basic human right. I have no interest in challenging your values. I do wish for you to consider that untreated mental illness is pervasive in our state and in our country. It’s a major social problem. Being capable of work physically has nothing to do with whether or not a person lives with a mental illness.
http://recoveryrocks.bangordailynews.com/2013/06/16/addiction/governor-lepage-able-bodies-unhealthy-minds-medicaid-expansion/
Should Physician Pay Be Tied to Performance?
No: The System Is Too Easy to Game — and Too Hard to Set Up
By Steffie Woolhandler, M.D.The Wall Street Journal, June 16, 2013
Paying doctors for better care — not just more of it — seems like a no-brainer. Yet rigorous studies of pay-for-performance bonuses have found no health benefits and some unintended harms.
An exhaustive analysis of pay-for-performance research by the Cochrane Collaborative, an international group that reviews medical evidence, unearthed "no evidence that financial incentives can improve patient outcomes."
Consider these cases. In Britain's massive pay-for-performance program, family doctors earned almost perfect scores (and big bonuses) for hypertension treatment, but population surveys found no decrease in blood pressure or its main complication, strokes. Meanwhile, aspects of quality that didn't bring bonuses deteriorated.
The largest U.S. pay-for-performance experiment — Medicare's Premier Demonstration — also flopped. The 200 hospitals that offered bonuses scored slightly worse on patient death rates than other hospitals.
Proponents argue that programs like these were flawed in one way or another, and that the next trial — or the one after — will certainly do better. They also claim successes with other programs. But none of these claims rest on rigorous science, and all those that have subsequently been subjected to rigorous tests have failed.
http://www.pnhp.org/print/news/2013/june/should-physician-pay-be-tied-to-performance
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