Obamacare website shows improvement, new problems emerge
Posted Oct. 14, 2013, at 8:43 p.m.
The Obama administration has made headway against an online bottleneck that jammed enrollment for the president’s health care reform, but new technical problems greeted users Monday, showing how difficult it will be to get consumers registered in time for insurance coverage to start Jan. 1.
Three weeks after the launch of new health insurance plans under Obamacare, users were able to create accounts for themselves and begin the process of enrolling through the Healthcare.gov insurance marketplace, according to people aiding the sign-up effort.
But further into the process, error messages and other difficulties were apparent, leading to fresh frustrations for health insurers and nonprofit groups who want to help millions of uninsured Americans sign up for benefits as promised under President Barack Obama’s signature health care law.
“We have seen progress every day,” said Nasim Zahran of Miami’s Borinquen Medical Health Care Centers, where hundreds of people are waiting to enroll in coverage.
“Today was the first day that we got all the way to the last screen. But then an error screen popped up saying the site would be down for 72 hours,” Zahran said.
Healthcare.gov saw 14.6 million unique visits in its first 10 days, a larger-than-expected public response that raised hopes Obamacare would meet with strong enough demand in its first year.
But the site’s limited ability to enroll consumers is becoming an increasing focus of Obamacare’s Republican foes, who say the government was not ready to implement the law and should have delayed it.
Experts say the administration has until mid-November to iron out the problems or risk jeopardizing its goal of signing up 7 million people in the first year of the Obamacare marketplaces. The number includes 2.7 million healthy young adults whose participation will help offset the higher cost of insuring sicker and older beneficiaries.
Underscoring the high-stakes nature of the issue, former White House spokesman Robert Gibbs told cable-television channel MSNBC on Monday that heads should roll: “I hope they’re working day and night to get this done. And when they get it fixed, I hope they fire some people that were in charge of making sure that this thing was supposed to work.”
Republican Sen. Pat Roberts of Kansas has already called on Health and Human Services Secretary Kathleen Sebelius to resign. But analysts say that would be unlikely anytime soon. Such a high-level departure could complicate the already fragile roll-out and raise the prospect of stormy Senate confirmation proceedings for a replacement.
At town hall meetings originally intended to drive people to enroll, Blue Cross and Blue Shield of Kansas is telling consumers not to rush to purchase health coverage through Healthcare.gov, given that the enrollment period runs through March 31.
“What we are encouraging our folks in Kansas to do is give it a few weeks and let the bugs work their way out of the system,” said Mary Beth Chambers, spokeswoman for the health insurer.
http://bangordailynews.com/2013/10/14/health/obamacare-website-shows-improvement-new-problems-emerge/print/
Maine nurses say Obamacare doesn’t go far enough, argue for universal coverage
Posted Oct. 14, 2013, at 5:38 p.m.
PORTLAND, Maine — A Maine nurses group on Monday said President Barack Obama’s signature healthcare law, which is criticized by conservatives as overreaching, doesn’t go far enough toward universal health coverage.
The Maine State Nurses Association held Monday afternoon health screenings and an evening “town hall” event at the First Parish Church on Congress Street in Portland to advocate for the expansion of the federal Medicare program to cover all Americans, regardless of age.
The organization is planning to hold a second wave of screenings and another town hall event Tuesday afternoon and evening at the Bangor Public Library.
Currently, Medicare covers Americans age 65 or older, as well as some younger people with certain disabilities. Medicaid, which is a program run jointly by state and federal governments, provides health insurance coverage for qualifying low-income individuals.
But those safety nets miss thousands of Mainers who don’t qualify for government help and can’t afford health insurance, said advocates at the Monday event.
The president’s Affordable Care Act, which requires most Americans to buy health care plans in an effort to use market forces to drive down insurance prices for those least able to afford them, is a step in the right direction, but too complicated, Dr. Philip Caper said Monday.
Caper is a founding board member of the organization Maine AllCare and a Bangor Daily News columnist.
“Even under the best of circumstances, ‘Obamacare’ will leave 30 million people uninsured,” he said. “I think Obamacare is a step in the right direction … but I don’t think it does the job. The financing should be public, just as we finance our roads and our libraries and our judiciary.”
Liz Faraci, a nurse with Downeast Community Hospital in Machias, helped with the Portland screenings Monday. She said a universal, single-payer system in America would ensure that hospitals are reimbursed for all care given because all patients would be insured by the federal government.
Caper said his organization is pushing for Maine to adopt a universal health coverage plan before the federal government does. He said U.S. doctors carry four times the administrative staff as their counterparts in Canada, where the universal health coverage is offered, because of the complications of dealing with insurance companies and piecemeal government programs in place today.
“In all other wealthy countries, when people get sick, they don’t worry about how to pay for it,” he said. “Healthcare costs are the largest single cause of personal bankruptcy in our country.”
Testing the Limits of ‘Terminal’
Our new patient was 51, always a problematic age — old to some, young to others. He had turned yellow a few weeks before.
The first thing he did was go to the health food store for liver restoratives. When they did nothing, he went to his doctor’s office. The doctor wasn’t in on Thursdays, but the office nurse took one look at the intense lemon-yellow of our patient’s eyes and walked him straight to the emergency room.
There he had a busy evening, in and out of the CT scanner. The liver team stopped by. He didn’t get to his bed on our medical ward upstairsuntil dawn.
Eighteen hours before, he had been riding a crowded subway in from Brooklyn. Now, he was by far our sickest patient. A mass in his pancreas, presumably a malignant tumor, was blocking his bile ducts. His liver was failing, and it was taking the rest of him along with it.
The next step was to unblock the bile flow and biopsy the mass, but that could not be done until his kidneys were functioning, his electrolytes were balanced and his blood was induced to clot again. The liver doctors scheduled him for Monday, giving us the weekend to make all that happen.
Understandably, the patient was a little dazed when we met Friday morning, presumably from the combination of a sleepless night, bad news, and the toxins leaking from his liver. “Let’s do this Monday thing, got to know what’s going on,” he mumbled. Then he went back to sleep.
By late Friday afternoon it was clear that we were losing ground. Nothing on a general medical ward moved quickly enough to outrace the liver’s collapse. We called the intensive care unit to take him in.
Two young intensivists came up to evaluate him for transfer, both cheerful 30-somethings who looked as if they were still in grade school. It took them five minutes to go through the brief chart, a minute to chat with our groggy patient, another minute to call their supervisor, two minutes to write their note, and then they were gone.
Our patient needed “comfort care,” not intensive care, they wrote. His illness was clearly terminal. Had we notified the hospice service? Issued his “do not resuscitate” orders? Located his next of kin? We should continue our management on the ward, they concluded. They would keep an eye on him.
But they knew as well as we did that nobody with that kind of multiple organ failure makes it through a weekend on an ordinary ward. Our patient died Saturday morning after a brief, unenthusiastic flurry of resuscitative efforts, final diagnosis still unclear.
http://well.blogs.nytimes.com/2013/10/14/testing-the-limits-of-terminal/?hpw&pagewanted=print
The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic
By MAGGIE KOERTH-BAKER
Between the fall of 2011 and the spring of 2012, people across the United States suddenly found themselves unable to get their hands on A.D.H.D. medication. Low-dose generics were particularly in short supply. There were several factors contributing to the shortage, but the main cause was that supply was suddenly being outpaced by demand.
The number of diagnoses of Attention Deficit Hyperactivity Disorder has ballooned over the past few decades. Before the early 1990s, fewer than 5 percent of school-age kids were thought to have A.D.H.D. Earlier this year, data from the Centers for Disease Control and Prevention showed that 11 percent of children ages 4 to 17 had at some point received the diagnosis — and that doesn’t even include first-time diagnoses in adults. (Full disclosure: I’m one of them.)
That amounts to millions of extra people receiving regular doses of stimulant drugs to keep neurological symptoms in check. For a lot of us, the diagnosis and subsequent treatments — both behavioral and pharmaceutical — have proved helpful. But still: Where did we all come from? Were that many Americans always pathologically hyperactive and unable to focus, and only now are getting the treatment they need?
Probably not. Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.
Which is not to say that A.D.H.D. is a made-up disorder. In fact, there’s compelling evidence that it has a strong genetic basis. Scientists often study twins to examine whether certain behaviors and traits are inborn. They do this by comparing identical twins (who share almost 100 percent of the same genes) with fraternal twins (who share about half their genes). If a disorder has a genetic basis, then identical twins will be more likely to share it than fraternal twins. In 2010, researchers at Michigan State University analyzed 22 different studies of twins and found that the traits of hyperactivity and inattentiveness were highly inheritable. Numerous brain-imaging studies have also shown distinct differences between the brains of people given diagnoses of A.D.H.D. and those not — including evidence that some with A.D.H.D. may have fewer receptors in certain regions for the chemical messenger dopamine, which would impair the brain’s ability to function in top form.
None of that research yet translates into an objective diagnostic approach, however. Before I received my diagnosis, I spent multiple sessions with a psychiatrist who interviewed me and my husband, took a health history from my doctor and administered several intelligence tests. That’s not the norm, though, and not only because I was given my diagnosis as an adult. Most children are given the diagnosis on the basis of a short visit with their pediatrician. In fact, the diagnosis can be as simple as prescribing Ritalin to a child and telling the parents to see if it helps improve their school performance.
This lack of rigor leaves room for plenty of diagnoses that are based on something other than biology. Case in point: The beginning of A.D.H.D. as an “epidemic” corresponds with a couple of important policy changes that incentivized diagnosis.
Disease: The Next Big One
By DAVID QUAMMEN
BOZEMAN, Montana — Grim prognostications of pestilence are as old as the Book of Revelation, but they have not gone out of style or been rendered moot. Plague is a tribulation that science, technology and social engineering haven’t fixed. In the mid-1960s, some public health officials imagined that antibiotics and other modern therapies would enable us to “close the book” on infectious diseases and so make it possible to focus on noncommunicable afflictions, like heart attack, diabetes and stroke. But that optimism was mistaken.
By one account, published in Nature in 2008, more than 300 instances of emerging infectious diseases occurred between 1940 and 2004. These included both the first appearance of scary new viral diseases (like SARS), with the potential to cause global pandemics, and the re-emergence of older bacterial infections in new forms (like antibiotic-resistant tuberculosis and Staphylococcus aureus), which are less dramatic but also capable of causing illness and death on a large scale. The authors of that study warned that global resources to counter disease emergence were poorly allocated, with most new outbreaks occurring in tropical countries, and most scientific and surveillance efforts concentrated elsewhere.
The most gruesome emergent diseases — like those caused by Ebola virus in Africa or Nipah virus in Asia — affect relatively few. The most devastating, AIDS, is caused by a devious, patient virus that wages slow-motion war against the human body, with mortal consequences for millions. The most explosive — SARS in 2002, or some recent strains of influenza — had the potential, but for prompt action and good luck, to claim many more victims than they did.
AIDS, SARS, Ebola virus and many other new diseases have one thing in common: they are zoonotic. This means they came from nonhuman animals and made the leap to humans. The infectious agent might be a virus, or a bacterium, or another sort of parasitic microbe, or a worm; the animal in which it resides inconspicuously, before spilling over into humans, is known as its reservoir host. The reservoir host might be a bat (as with the SARS virus), or a rodent (the various hantaviruses), or a chimpanzee (H.I.V.-1). The reservoir host of Ebola virus is still unidentified — a lingering mystery — though bats again are suspected. And all of our influenzas (even the so-called swine flus) originate in wild aquatic birds.
Online firms to help enroll people in Obamacare, but not in California
Covered California, the state's health insurance exchange, is handling online enrollment on its own and, for now, it has spurned help from Silicon Valley's EHealth and other online brokers.
By Chad Terhune
5:42 PM PDT, October 14, 2013
| advertisement |
The nation's biggest online seller of health insurance has joined forces with the federal government to enroll people across the country in Obamacare, but EHealth Inc. won't be signing up any Californians.
The state's new insurance exchange, Covered California, is handling online enrollment on its own and, for now, it has spurned help from Silicon Valley's EHealth and other online brokers. In contrast, the federal exchange for 36 other states has embraced EHealth's website — EHealthInsurance.com — and other popular shopping sites to help reach millions of uninsured Americans.
This split reflects how different the rollout of the healthcare law will look among many states and the various measures officials are taking to boost enrollment.
EHealth and other Web brokers expect to begin selling policies alongside the federal exchange in coming weeks, once technical details are ironed out.
The tactic of using online brokers has drawn fire. Some consumer advocates say EHealth and other websites shouldn't be allowed to sell subsidized coverage as part of the federal healthcare law. Critics say they tend to promote policies by insurers that pay them higher commissions and don't always share pertinent information about all health plans.
"I worry that these Web-based brokers will steer consumers inappropriately," said Lynn Quincy, a senior analyst at Consumers Union, the policy arm of Consumer Reports. "It's not clear government needs them to drive up enrollment."
EHealth's chief executive, Gary Lauer, says new federal rules address those concerns by requiring online brokers to treat all insurers equally on the exchanges.
"The real objective here is to enroll as many people as possible, especially younger people," Lauer said. "I'm really puzzled why Covered California continues to resist working with us. I think they are making a big mistake."
EHealthInsurance.com, GetInsured.com and other sites rank high in online search results and attract significant Web traffic.
Their easy-to-use websites and proven technology can be a stark contrast to the numerous glitches many consumers experienced when they tried using government-run exchanges starting Oct. 1.
Covered California's website, http://www.coveredca.com, has fared better than most after some early technical problems, and it said that nearly 29,000 people applied for coverage in the first five days of enrollment.
State officials have enlisted enrollment help from community groups, hospitals, colleges and insurance agents to help reach their goal of expanding coverage to more than 2 million people by the end of next year.
http://www.latimes.com/business/la-fi-health-exchange-online-20131015,0,3626520,print.story
Our View: Maine’s long-term care financing approaching crisis
Posted:TodayUpdated: 8:12 AM
A legislative commission is posing the right questions on how to better care for the state’s elders.
If Maine has had a long-term strategy for dealing with elder care financing, it has been this: not dealing with it.
This is not sustainable. Private-pay patients cannot shoulder the entire rising cost of long-term care. Nursing homes are closing because they can’t rely on finding enough patients who can pay more than their share just to keep the lights on.
This is especially true in economically depressed rural areas, creating hardship for elders and their families when they have to go far from home to find an open bed.
And, as our boomer-heavy aging population moves from middle age to old age, these problems will get worse, not better.
http://www.pressherald.com/opinion/Our_View__Maine_s_long-term_care_financing_approaching_crisis_.html
Obamacare deductibles may cause sticker shock
Insurance companies are requiring higher out-of-pocket expenses to pay for complying with new rules
By Peter FrostChicago Tribune, Oct. 13, 2013
Adam Weldzius, a nurse practitioner, considers himself better informed than most when it comes to the inner workings of health insurance. But even he wasn't prepared for the pocketbook hit he'll face next year under President Barack Obama's health care overhaul.
If the 33-year-old single father wants the same level of coverage next year as what he has now with the same insurer and the same network of doctors and hospitals, his monthly premium of $233 will more than double. If he wants to keep his monthly payments in check, the Carpentersville resident is looking at an annual deductible for himself and his 7-year-old daughter of $12,700, a more than threefold increase from $3,500 today.
"I believe everybody should be able to have health insurance, but at the same time, I'm being penalized. And for what?" said Weldzius, who is not offered insurance through his employer. "For someone who's always had insurance, who's always taken care of myself, now I have to change my plan?"
Many Illinoisans buying health coverage on their own next year will face a similar dilemma spurred by the health care overhaul: pay higher monthly insurance premiums or run the risk of having to shell out thousands more in deductibles for health care if they get sick.
To promote the Oct. 1 debut of the exchanges, the online marketplaces where consumers can shop and buy insurance, Obama administration and Illinois officials touted the lower-than-expected monthly premiums that would make insurance more affordable for millions of Americans. But a Tribune analysis shows that 21 of the 22 lowest-priced plans offered on the Illinois health insurance exchange for Cook County have annual deductibles of more than $4,000 for an individual and $8,000 for family coverage.
Those deductibles, which represent the out-of-pocket money consumers must spend on health care before most insurance benefits kick in, are higher than what many consumers expected or may be able to stomach, benefit experts said.
By comparison, people who buy health insurance through their employer have an average individual deductible of just more than $1,100, according to the Kaiser Family Foundation.
http://www.pnhp.org/print/news/2013/october/obamacare-deductibles-may-cause-sticker-shock
Beyond the spin, some facts about the Affordable Care Act
The ACA will actually hinder efforts towards adopting a single-payer system, writes health care reform advocate.
By Margaret Flowers, M.D.Al-Jazeera, Oct. 14, 2013
On the first day that the new health insurance exchanges went into effect as part of the new health law, the Affordable Care Act (ACA), I was caught off guard by a question asked by Bruce Dixon of the Black Agenda Report. I was prepared to detail the complexities of the ACA, but Dixon’s only question was: “What would it be like if this was the first day of a single-payer health system?” Most media outlets in the US are solely focused on the ACA - either promoting it as a positive step or calling for its repeal. This limited debate misses the facts that a single payer health system, also called Medicare for all, would both resolve the fundamental failings of our current system and is the solution favored by most Americans.
What we are hearing in the US is fear-mongering from extreme right-wing groups, who have gone so far as to shut down our government in their attempt to remove funding for the health law, and deceptions from Democrats and their front groups about the virtues of the ACA. This is what happens when a basic issue such as health care is determined by politics instead of policy. In fact, the ACA was born in a right-wing think tank, the Heritage Foundation, and is only supported by “progressives” because it was passed by a Democratic president.
I suspect this manufactured confusion may sort itself out over time as more people discover that having health insurance in the US doesn’t guarantee access to necessary care. In the meantime, I will try to cut through the spin and hyperbole to explain why the ACA is not a step in the right direction and what health care would look like if we implemented a publicly-financed “Medicare for All.”
Here are the top three facts that need to be addressed:
* The rise of health care costs are slowing, but not because of the ACA.
* More people will have health insurance but that doesn’t mean they will have access to health care.
* The ACA further privatizes our health care system, which is the opposite of single payer.
White House spokesperson Jay Carney stated numerous times recently that the slowing of the rise of health care spending in the United States is a result of the Affordable Care Act. In fact, the slowing of total health care spending actually began after the economic crisis of 2008, which was prior to the ACA being signed into law in 2010. As I wrote earlier this year, the slowing of health care spending was due to self-rationing. As more of the cost of health care is shifted onto the individual, we see less utilization of health services.
For example, a recent report found that low-income workers with health plans that required high out-of-pocket payments in Massachusetts did not go to the emergency department for serious medical conditions because of the costs. They had 25 to 30 percent fewer visits, whereas high income workers with similar plans did not reduce their visits. A health survey from 2012 found significant increases in the number of people who did not get care because of the cost (80 million total), who had difficulty paying medical bills (75 million) and who went into bankruptcy as a result (4 million over 2 years).
It is not likely that the ACA will have a positive effect on health care spending, by which I mean making health care more affordable. As economist Dean Baker writes, we will continue to pay high prices for medications, medical devices and physicians. Although there are proven methods to control health care costs such as simplified administration, global budgets and negotiating bulk prices, none of them were included in the ACA. In fact, the ACA increases our already enormous administrative costs by adding new levels of administration to our health system.
http://www.pnhp.org/print/news/2013/october/beyond-the-spin-some-facts-about-the-affordable-care-act
California Working Overtime To Enroll Consumers On Marketplace -- And To Train People To Help - Kaiser Health News
SAN JOSE, Calif. -- Luisa Blue, head of the local Service Employees International Union in San Jose, has five more months to spend a million dollars. The union received a grant from Covered California, the state’s health insurance marketplace and is using some of the money to call people in their homes at night and on the weekend, as part of a massive education effort.
“Over 4,000 (people) have said tell me more about Covered California and how can I enroll to get health insurance,” Blue says of her organization’s first two weeks on the case.
But once they're primed to enroll, the hand-off to counselors who can help Californians sign up for coverage has been rocky. Many counselors are still attending training or are awaiting background checks and state-issued licenses; some just need a computer log-in.
The month of October was always supposed to be about drumming up interest, says Peter Lee, Covered California’s executive director. The state never intended, he says, to have all counselors certified this early.
“We have 20,000 county workers,” Lee says. “The vast majority have been certified and people can go into county offices. Licensed insurance agents? You know, we’ve got about 3,000 - 4,000 of 15,000 completed training. A lot of training is happening everyday and every week.”
Paper Applications?
Edward Avalos takes a certain pride in being one of the first certified enrollment specialists in the state. At Gardner Health Center in San Jose, a clinic for low-income families, the jumbo-sized calendar on Avalos’ desk is filled with appointments – he even makes house calls. He had to silence his office phone to be interviewed for just a few uninterrupted moments. Avalos has had problems signing people up online.
When that happens, Avalos pulls out a paper application.
“There was banking before computers and there was health care before computers and there will be health care after,” Avalos says.
Tracking enrollment with the fervor of a stock market watcher obscures the fact that the state is well on its way of meeting the goal of signing up 600,000 people by March, according to Gerry Kominski, director of the Center for Health Policy Research at UCLA.
“(The goal is)100,000 a month, roughly 3,300 people a day,” he notes. “In the first week, they enrolled almost 30,000 people in five days. That’s much more than 3,300 people a day. So I think even with all the glitches, they’re already off to a more than adequate start.”
Kominski says to keep its front-runner status, California needs to keep up the pace.
http://www.kaiserhealthnews.org/Stories/2013/October/11/Training-And-Outreach-In-California.aspx
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