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Tuesday, July 9, 2013

Health Care Reform Articles - July 9, 2013


What Does Birth Cost? Hard to Tell

By GINA KOLATA
We’re continually told that when it comes to health care, we need to be savvy and shop around for the best prices. To that end, policy experts and politicians promote health care savings accounts, saying they make “health care consumers” (a k a patients) more conscious of prices, bringing down the cost of medical care.
Here is what happened to my daughter, Therese Allison, when she tried to be just the sort of shrewd and informed patient that politicians should love.
Therese is more than seven months pregnant and uninsured — in fact, she is uninsurable. Pregnancy is a pre-existing condition, so she can’t get health insurance at any price. And now that the birth of her baby is imminent, she wants to find out what a delivery will cost, maybe even negotiate a price for this expensive procedure.
In a way, she’s lucky. She and her husband, who are self-employed, live in New Jersey, so she qualifies under a little-known and unadvertised law that caps hospital expenses for uninsured people with incomes less than five times the poverty level.
Under the law, a hospital can charge 115 percent of what it accepts from Medicare for the same services. Although most Medicare beneficiaries are 65 or older, the federal program also includes younger people who are disabled. As a result, Medicare covers pregnancies. California, New York and, as of last year, Colorado, havesimilar laws, but none are as generous as New Jersey’s.
Her Alice in Wonderland tale began in June, when Therese’s midwife offered to call the two hospitals she uses and get their prices. Therese is planning and fervently hoping to have a normal vaginal delivery, without an epidural anesthetic, and to leave the hospital the next day.
Elmer Hospital, in Elmer, N.J, said it would charge $4,300 for a normal delivery without an epidural and with no complications. Newborn care would be $1,400 more. Kennedy University Hospital, in Washington Township, refused to say, but told the midwife that Therese could apply for Medicaid or New Jersey Family Care (she does not qualify for either) and could apply for charity care if she was turned down.
If accepted, she would have to pay only a fraction of what the hospital charged. But what would the hospital charge? The hospital was mum, saying it could not give a price because if Therese needed additional services, its quote would be wrong.
Therese called the hospitals herself. But all she heard — after calling Kennedy University Hospital three times and asking for a price — was two voice mail messages. In one, she was told to apply for New Jersey Family Care. In the other she was told to apply for Medicaid.

Sebelius Defends Law and Zeal in Push to Insure Millions

By 
WASHINGTON — Kathleen Sebelius has been facing down opponents since she was a schoolgirl campaigning for her father — a gregarious, outspoken liberal Democrat in Cincinnati, then one of the most reliably Republican big cities in the nation.
“My father was routinely called a Communist in Cincinnati,” Ms. Sebelius’s older brother, Donald D. Gilligan, said in an interview. “When he first ran for City Council, Republicans ran ads against him printed on pink paper in The Cincinnati Enquirer. Kathleen was used to being called bad names from childhood on. When your father is being called a Communist, you take a measured view of that kind of criticism.”
Now, Ms. Sebelius, 65, the secretary of health and human services, is the No. 1 public advocate for the health care law, the president’s top domestic initiative, and, just like her father, an easy target for Republicans.
Her job is to deliver health insurance to more than 25 million people, to nudge the nation toward a new era in which health care is a right, not a privilege — all this over the opposition of Republicans in Congress and in many state capitols, who are poised to pounce on any misstep.
Ms. Sebelius is on the defensive more than ever now that the White House has delayed a major provision of the law that requires larger employers to offer health insurance to full-time employees. Republicans say she has given a far too rosy picture of progress in carrying out the law. And they are demanding that she explain why people should be required to carry insurance next year if employers are not required to offer it.
In her zeal to make the health care law work, Ms. Sebelius has tested the limits of her authority. After Congress refused to provide as much as she wanted for a nationwide campaign publicizing the new insurance options, she shuffled money between government accounts and sought cash from outside groups.
Her actions have riled Republicans like Senator Lamar Alexander of Tennessee, a former governor and cabinet secretary who complained that Ms. Sebelius was circumventing Congress in possible violation of federal law.
She is defending herself and her fund-raising activities, even as she defends the law.
How many people will die because on June 19 Maine's Legislature refused to accept federal Obamacare funds to extend Medicaid health insurance to as many as 70,000 low-income working people?
Answer: Interpolating from a 2009 Harvard Medical School study that estimated 45,000 Americans died each year from inadequate health care because of their lack of insurance (among 50 million uninsured), 63 Mainers will unnecessarily die annually. The Harvard study didn't calculate the pain and suffering endured due to lack of health insurance.
The day after the legislative action, the Maine People's Alliance noted in a statement: "For one woman who came to the Legislature yesterday to fight for her health care, [the decision] means she will no longer be able to afford her epilepsy medication that costs over $20,000 a year. For one MPA member who was there for the vote last night, it means she may no longer be able to afford her mortgage."
The refusal of the Affordable Care Act funds took place when, on the final day of the legislative session, House Republicans upheld Republican Governor Paul LePage's veto of LD 1066, which would have required the state to accept the money. The feds would have paid 100 percent of the costs of the people covered for the first three years, dropping gradually to 90 percent by 2020, although the legislation only committed Maine to three years.
Taking a minute from lobbying for the override, Jim Lysen, a health-care-clinic administrator from Lewiston, told of an acquaintance faced with the choice of paying for his medications or food for his family: "He committed suicide."

Parkview aims to reduce costs by $2.5 million

Posted:Today
Updated: 1:41 AM 

The recent combining of the medical-surgical and intensive care units has cut 16 full-time positions.

By Jessica Hall jhall@pressherald.com
Staff Writer
BRUNSWICK – Parkview Adventist Medical Center has combined its intensive care unit with its medical-surgical unit and cut 16 full-time positions as part of an effort to cut $2.5 million in costs.
Fewer patients, unpaid MaineCare debt and an influx of patients who qualify for free care forced the hospital to take the cost-cutting steps, said Parkview spokeswoman Tory Ryden.
Like other hospitals in Maine, Parkview has struggled with declining numbers of patients as advancements in technology have enabled hospitals to do more outpatient procedures. Parkview had an occupancy rate of 24.6 percent in 2011.
The 16 full-time equivalent positions that were cut represented 5.4 percent of Parkview's workforce. The cuts included nursing jobs and other positions in almost every area of the hospital, Ryden said. "Every unit saw a change."

Latest handout to big insurers hurts Medicare

Instead of attacking Medicare, we should be expanding it to all

By Johnathon Ross, M.D.
The Blade (Toledo, Ohio), July 4, 2013
Medicare's costs will jump by $7.43 billion next year because of an unprecedented decision by the federal government to change payment rates for private, for-profit Medicare Advantage plans.
The government’s action will result in a huge financial windfall for big health insurers, whose Washington lobbyists pushed hard for the new rates.
Enrollment in privately run Medicare Advantage plans, which cover 13.1 million beneficiaries, was expected to dip sharply over the next few years, because of a planned reduction in government overpayments to these plans.
Studies by the Government Accountability Office and many private groups repeatedly have drawn attention to these overpayments. These studies suggest that if the 13.1 million beneficiaries were enrolled in the traditional Medicare program, their costs of care would have been 14 percent lower than the payments made to the private plans, with no loss in the quality of care.
The overpayments occur because private Medicare Advantage plans tend to enroll healthier, less-costly seniors, yet they receive a larger average payment per enrollee from the government.
The Affordable Care Act also acknowledged these overpayments. Yet the secretary of health and human services, Kathleen Sebelius, has announced that a scheduled 2.2 percent reduction in payments to the for-profit plans this year will now become a 3.3 percent increase instead.

Why physicians must reclaim their profession

By Andrew D. Coates, M.D., F.A.C.P.

The 10-minute YouTube video found after the jump shows Dr. Andrew Coates of Albany, N.Y., president of Physicians for a National Health Program, speaking at a program organized by Maryland's Healthcare is a Human Right Campaign in Columbia, Md., on June 27.

Excerpt: “We need to claim our proper place in society and part of doing that is advocating for a national health program, nothing less than something that will provide comprehensive care for absolutely everyone.”

Watch Dr. Coates on restoring integrity and justice to the medical profession by fighting for universal health care, and hear his thoughts on why doctors can no longer stand for an exclusionary and privatized system.
Why physicians must reclaim their profession By Andrew D. Coates, M.D., F.A.C.P. The 10-minute YouTube video found after the jump shows Dr. Andrew Coates of Albany, N.Y., president of Physicians for a National Health Program, speaking at a program organized by Maryland's Healthcare is a Human Right Campaign in Columbia, Md., on June 27. Excerpt: “We need to claim our proper place in society and part of doing that is advocating for a national health program, nothing less than something that will provide comprehensive care for absolutely everyone.” Watch Dr. Coates on restoring integrity and justice to the medical profession by fighting for universal health care, and hear his thoughts on why doctors can no longer stand for an exclusionary and privatized system.
http://www.pnhp.org/print/news/2013/july/why-physicians-must-reclaim-their-profession

Study: Some on Medicaid lose out under Obamacare
By: Jason Millman
July 9, 2013 05:09 AM EDT
As millions of low-income adults gain access in just a few months to Medicaid coverage under Obamacare, those already in the program could be shut out of some of the key preventive services included in the law.
And the new enrollees could have a hard time actually getting a doctor.
Those are the findings of two Health Affairs studies published Monday.
The health law requires most insurance plans to cover a set of preventive services, like cholesterol tests and mammograms, without cost-sharing. And that requirement extends to coverage for newly eligible Medicaid beneficiaries in states that choose to expand their programs, according to researchers Sara Wilensky and Elizabeth Gray of The George Washington University’s public health school.
(WATCH: TOP 5 complaints about Obamacare)
The same requirement, though, doesn’t apply to adults who already qualify for Medicaid, the researchers say. That means Medicaid enrollees living in the same state could have different experiences in the program.



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