| Maine Health Care Advocates Press for 'Medicare for All' by Patty B. Wight |
| Before Saiyid Brent stopped in for a free basic health screening in Portland Monday night, his thoughts were on dinner - specifically, comfort food. But that changed after he was examined by a nurse. His prognosis? "Not so well!" he says, with a laugh. "My blood sugar was pretty good, but blood pressure not so great, which is a concern." Brent came in for the screening because he doesn't have health insurance. And he can't think of a good reason why he doesn't. "Um - that's a good question. Why don't I have health insurance? I'm working, why don't I have health insurance right now?" he says. "It's expensive. I mean, to get it on my own is expensive - even where I work offers it, but if I go through them, half the check's gone." Brent doesn't know whether he'll qualify for a subsidy to buy insurance under the Affordable Care Act. And for advocates behind the push for universal health care, that's not even the real issue. They say that while the Affordable Care Act brings some positive change to the U.S. health system, and will increase access and lower costs, it doesn't correct one fundamental flaw: the middle man. Or, in this case, the insurance companies. "As long as people can profit - as long as the first $5 million they make has to pay their CEO - how can that be cost-effective?" says Michelle Milton, a home care nurse.
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Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement.
Report: 5.2 Million Adults Will Fall Into ACA Coverage Gap Next Year
October 16th, 2013, 5:37 AM
About 5.2 million poor, uninsured adults will fall into the “coverage gap,” created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a study released today by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
“Millions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage,” the study concludes.
The law provides full federal funding for three years to states that expand Medicaid to cover residents under 138 percent of the poverty level (or just under $15,900 for an individual). But the Supreme Court made that requirement effectively optional for states, and most Republican led-states have opted against expanding the program.
There is no deadline by which states must opt to expand Medicaid, and a few states are still considering it.
http://capsules.kaiserhealthnews.org/index.php/2013/10/report-5-2-million-adults-will-fall-into-aca-coverage-gap-next-year/
Population Health Implications of the Affordable Care Act:
Workshop Summary (2013)
Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest proportion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health.
Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their concept of community benefit, the ACA has expanded the arena for interventions to improve health beyond the "doctor's" office. Improving the health of the population - whether in a community or in the nation as a whole - requires acting to transform the places where people live, work, study, and play. This report examines the population health-oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action.
A Push to Sell Testosterone Gels Troubles Doctors
By ELISABETH ROSENTHAL
The barrage of advertisements targets older men. “Have you noticed a recent deterioration of your ability to play sports?” “Do you have a decrease in sex drive?” “Do you have a lack of energy?”
If so, the ads warn, you should “talk to your doctor about whether you have low testosterone” — “Low T,” as they put it.
In the view of many physicians, that is in large part an invented condition. Last year, drug makers in the United States spent $3.47 billion on advertising directly to consumers, according to FiercePharma.com. And while ever-present ads like those from AbbVie Pharmaceuticals have buoyed sales of testosterone gels, that may be bad for patients as well as the United States’ $2.7 trillion annual health care bill, experts say.
Sales of prescription testosterone gels that are absorbed through the skin generated over $2 billion in American sales last year, a number that is expected to more than double by 2017. Abbott Laboratories — which owned AbbVie until Jan. 1 — spent $80 million advertising its version, AndroGel, last year.
Once a niche treatment for people suffering from hormonal deficiencies caused by medical problems like endocrine tumors or the disruptive effects of chemotherapy, the prescription gels are increasingly being sold as lifestyle products, to raise dipping levels of the male sex hormone as men age.
“The market for testosterone gels evolved because there is an appetite among men and because there is advertising,” said Dr. Joel Finkelstein, an associate professor at Harvard Medical School who is studying male hormone changes with aging. “The problem is that no one has proved that it works and we don’t know the risks.”
Dr. Eric Topol, a cardiologist and chief academic officer at Scripps Health in San Diego, is alarmed by the high percentage of patients he sees who use the roll-on prescription products, achieving testosterone levels that he described as “ridiculously high.”
The gels are of questionable medical benefit for many of the millions of men who now take them, he and other doctors say, and their side effects may well prove dangerous.
California insurance exchange reports 94,500 application starts
By Chad Terhune
5:36 PM PDT, October 15, 2013
| advertisement |
After two weeks of open enrollment, Californians have started nearly 95,000 applications for health insurance through the state's new exchange.
Covered California, the state marketplace, announced the latest figures Tuesday and it said consumer interest in the federal healthcare law remains strong.
State officials had previously reported 43,616 complete and partial applications for the first five days of enrollment through Oct. 5. These latest numbers would indicate more than 50,000 new applications through Oct. 12.
Those applications could reflect a household with more than one person. The state didn't provide further details.
Both Web traffic and call volume eased somewhat during the second week. Unique Web visits to www.coveredca.com dropped from 987,000 over the first five days to 603,000 last week. Calls slipped from 59,000 to 46,000, but the average wait time improved significantly to less than two minutes.
Covered California said it wouldn't release actual enrollment figures until next month for people choosing private insurance or getting coverage through an expansion of Medi-Cal, the state's Medicaid program.
Full coverage: Obamacare rolls out
The open enrollment period lasts until March 31, though consumers who want coverage to start Jan. 1 will have to select health plans by Dec. 15. Many experts think exchanges will face an influx of consumers just prior to the December deadline.
The state has been scrambling to train enough enrollment counselors to offer in-person assistance. Tuesday, it said 279 enrollment counselors are in place and 3,824 are awaiting certification.
Covered California has said it needs about 16,000 enrollment counselors statewide.
Officials said they have also certified 1,295 insurance agents to help with enrollment out of 17,768 agents who have applied.
Nationwide, the initial rollout of Obamacare has been marred by severe technical glitches at the federal exchange website, and to a lesser degree at the 14 states running their own online marketplaces.
Covered California has struggled to get an online search tool up and running so consumers can check what doctors and hospitals are included in specific health plans.
That feature is considered vital because many insurers in California have sharply limited the number of medical providers in their network to help hold down premiums in the exchange.
The state took the provider search tool offline Oct. 9, and an exchange spokeswoman said it's expected to return soon after improvements are made.
Starting in January, most Americans must have health insurance or pay a penalty. In 2014, the tax fine is $95 per adult or 1% of household income, whichever is greater. The fines increase in future years.
Premium subsidies are available for many lower- and middle-income people who make less than four times the federal poverty level — or about $46,000 for individuals and up to about $94,000 for a family of four.
http://www.latimes.com/business/healthcare/news/la-fi-mo-covered-california-obamacare-enrollment-20131015,0,7151652,print.story
If no debt deal reached, deep pain for Maine
Yesterday at 12:01 PM
WASHINGTON — Maine could be among the hardest-hit states in the nation if the political dysfunction in Washington leads to the double-punch scenario of a long-term government shutdown combined with a federal default, statistics show.
That could change dramatically, however, if Congress is unable to reach agreement by Thursday on increasing the country’s borrowing limit, also known as “lifting the debt ceiling.” There were signs of progress in negotiations Monday, but there also were no public breakthroughs.
Per capita, Maine has among the highest proportions of veterans, Social Security and Medicaid recipients, and residents who depend on food stamps to feed themselves or their families. The Portland area has been ranked as one of the top 25 metro regions in terms of the percentage of federal workers in the workforce.
EMMC Achieves an Important Patient Safety Milestone: Zero Preventable Medical Errors
Posted Oct. 15, 2013, at 7:26 p.m.
In 2007, EMMC and the other EMHS member hospitals made the bold commitment to completely eliminate preventable medical errors. This summer, after six years of consistent progress, EMMC took a significant leap toward achieving this vision: for the months of July and August, the medical center had zero preventable errors in the Centers for Medicare & Medicaid Services’ (CMS) core measures for heart attack, heart failure, pneumonia, and surgery.
Core measures are evidence-based standards of care that hospitals across the country are required to track and report. Examples of core measures in CMS’ four areas of focus include starting the right treatments to prevent blood clots, always giving certain medications at the right times, and providing required education to patients.
“Most of the preventable errors made in medicine are not life-threatening and do not change the course of care, but when we can completely avoid them, we help improve outcomes for our patients,” said James Raczek, MD, FAAFP, EMMC senior vice president, chief operating officer, and chief medical officer. “Starting an antibiotic just one minute past a certain window of time or keeping a urinary catheter in for an extra day constitutes an error. It’s a constant challenge to be perfect every time, but we continue to make great progress towards attaining that goal each and every month.”
EMMC performs very well compared to other hospitals. According to the most recent available data from www.whynotthebest.org, between October 2011 and September 2012, 99.31 percent of EMMC patients received all of the recommended care for heart attack, heart failure, pneumonia, and surgery. This is significantly higher than the national average of 97.85, and only 0.14 percentage points below the average of the highest performing hospitals in the nation, those in the top 10 percent.
Dr. Raczek believes that EMMC’s achievement is the result of an employee-led culture of safety that has been built at the hospital. Employees at the bedside are encouraged to identify potential safety issues and come up with solutions to prevent errors. When an error is made, it is thoroughly reviewed, and changes are implemented to prevent similar errors in the future. EMMC also leverages technology, including an electronic medical record, to reduce the likelihood of errors.
“The commitment EMMC and EMHS made to reach zero preventable errors was seen as a very progressive step forward in 2007,” added Dr. Raczek. “Even today, it’s quite a remarkable accomplishment, and we’re proud of the work our employees have done to help us become a leader in patient safety. While we’re happy to have achieved zero preventable errors for two consecutive months, we won’t rest until errors are permanently eliminated.”
LePage inadvertently proves he could be wrong about Obamacare exchange
Gov. Paul LePage last week tried to prove a political point over the partial federal government shutdown.
“With gridlock in Washington, the massive debt and the end of stimulus funds, we cannot rely on the federal government to pay for existing programs, let alone new programs,” the Republican governor said in his weekly radio address.
LePage was referring to an expansion of Medicaid under the federal Affordable Care Act that would have extended health coverage to 50,000 low-income Maine adults without children and prevented another 25,000 childless adults and parents from losing their coverage on Jan. 1.
The message from LePage was clear: Why depend on a federal government that’s proving itself undependable?
Good question — aside from the fact that the federal government has never backed off its past Medicaid funding promises, and it was well known the inflated Medicaid reimbursement rates included in the 2009 economic stimulus bill would come to an end.
As the government shutdown continued last week, millions of people across the U.S. were browsing their new options for health insurance under the federal health care reform law. And they were running into a different lack of federal dependability. While 8.6 million Americans logged on to healthcare.gov in the three days after the health law’s online marketplaces opened, according to the U.S. Department of Health and Human Services, few were able to enroll in insurance plans.
Britain’s Daily Mail newspaper reported just 51,000 people completed insurance applications through the federal website in Obamacare’s first week.
But the picture was different in the states that decided to operate their own health insurance marketplaces.
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