A Medical Credit Card Has Surprising Costs
By ANN CARRNS
It might sound like a good idea at the time: You’re at the dentist’s office, and the receptionist offers you a way to stretch payments for an expensive procedure over many months, apparently with no interest.
But often such payment plans can have surprising costs for patients and can end up putting them in debt, said the Consumer Financial Protection Bureau. On Tuesday, the agency announced that it was ordering GE Capital Retail Bank and its CareCredit medical credit card unit to refund up to $34.1 million to pay customers who it said were victims of deceptive credit-card enrollment tactics over the last several years. More than one million patients who may have wrongly accrued charges on their card could be eligible for reimbursement.
Richard Cordray, the bureau’s director, said the agency had received hundreds of complaints about the card and found that many patients who were offered it thought they were signing up for an interest-free payment plan. But, in fact, they were applying for a deferred-interest credit card that had a no-interest promotional period of up to two years. Interest accrued during the promotion at an annual rate of 26.99 percent – much higher than a typical bank credit card, he said. If the balance wasn’t paid by the end of the promotional period, the patient became liable for the interest, resulting in “a very expensive loan,” he said.
Other similar credit cards are available, but CareCredit is one of the largest in the industry, the bureau said. It is offered by about 175,000 doctors, dentists, vision care and veterinary offices across the country. There are about four million active CareCredit cardholders.
Providers like the cards because they get paid up front, but the cards can get unwitting patients into debt at a time when they may not be fully focused on financial details. “They’re not on guard financially,” he said. “Their focus is on getting better.”
Many patients did not receive copies of the credit agreement, he said, but relied on oral explanations from office staff members who often received little training.
Mr. Cordray said the bureau’s order found that CareCredit had engaged in “harmful consumer practices” since January 2009. Under the order, GE Capital Retail bank will provide clear disclosures about CareCredit so customers fully understand the product, and bank representatives will contact most patients within 72 hours to explain the product over the phone. For some transactions over $1,000, patients must enroll directly through a CareCredit representative rather than through a staff member of the doctor or dentist’s office. The company must also notify customers when the promotional period is ending.
Colin Powell pitches single-payer health care in U.S.
By Alex Lazar
ABC News, Dec. 9, 2013
ABC News, Dec. 9, 2013
Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea.
“I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life,” Powell said, according to the Puget Sound Business Journal, last week at an annual “survivors celebration breakfast” in Seattle for those who, like Powell, have battled prostate cancer. “And I don’t see why we can’t do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing.”
Europe, Canada and Korea all have a “single-payer” system, in which the government pays for the costs of health care.
Some Democrats who strongly advocated for, and failed to get, a single-payer system in the 2010 Affordable Care Act, still believe the current law doesn’t go far enough to reform the US health system.
A retired four-star general and former chairman of the Joint Chiefs of Staff, Powell told the audience about a woman named Anne, who as his firewood supplier, faced a healthcare scare of her own. Anne asked Powell to help pay for her healthcare bills, as her insurance didn’t cover an MRI she needed as a prerequisite to being treated for a growth in her brain. In addition, Powell’s wife Alma recently suffered from three aneurysms and an artery blockage. ”After these two events, of Alma and Anne, I’ve been thinking, why is it like this?” said Powell.
“We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care,” Powell. “(Let’s show) the rest of the world what our democratic system is all about and how we take care of all of our citizens.”
Powell, who has taken heat from Republicans for twice endorsing President Obama’s election and reelection bids, said he hopes universal healthcare can one day become a reality in the U.S. ”I think universal health care is one of the things we should really be focused on, and I hope that will happen,” said Powell. ”Whether it’s Obamacare, or son of Obamacare, I don’t care. As long as we get it done.”
Helping Brazil’s Poor Heal at Home
By DAVID BORNSTEIN
We often hear about the harmful effects of poverty on health, particularly the health of children. But we hear less about the decisive role health plays in triggering, or exacerbating, poverty.
When a member of a struggling family falls ill, it means a loss of income, potentially major costs, and much stress and fear. That’s more than a family living on the margins can withstand — even if they are lucky enough to have insurance. These so-called “health shocks” happen everywhere, but they are particularly devastating for people in the developing world, especially those who inhabit overcrowded slums – the mega-shantytowns with poor sanitation, untreated water, damp, smoky houses, and few public services that are home to a third of the world’s city dwellers.
That’s why it’s worth paying attention to the work of an organization called the Associação Saúde Criança (ASC), based in Rio de Janeiro, which helps poor, urban families with seriously ill children. A recent study conducted by three researchers from Georgetown University found that the organization produced surprisingly strong results — including an 85 percent decrease in hospitalizations and a 92 percent increase in household income — results sustained years after the program stopped working with the families (pdf).
“These are already very poor families and we would expect these health shocks to send them down to a place where the family just can’t recover,” explained Jennifer Tobin, assistant professor at Georgetown, who co-authored the study, with James Habyarimana and Daniel Ortega Nieto. “Not only are these families doing better when they leave Saúde Criança than before the child’s illness, but 3 to 5 years later they’re doing even better.”
The Associação Saúde Criança (or children’s health association) was founded in 1991 by Vera Cordeiro, a physician working out of Hospital da Lagoa, a large public hospital in Rio de Janeiro. Cordeiro had grown weary of seeing children caught in a cycle of “hospitalization, re-hospitalization, and death.” Lagoa served families from the poorest areas in and around the city, including Rio’s North Zone, the Baixada Fluminense, and Rocinha, one of the largest slums in Latin America.
Children would arrive in the pediatric unit with respiratory diseases, parasites, blood diseases, serious congenital illnesses, cancer, sickle cell anemia — and, after receiving treatment, they would be discharged back into the same dismal conditions that triggered or worsened the illnesses. Predictably, the kids would return, each time sicker.
Treating the Cause, Not the Illness
By DAVID BORNSTEIN
In 1965, in an impoverished rural county in the Mississippi Delta, the pioneering physician Jack Geiger helped found one of the nation’s first community health centers. Many of the children Geiger treated were seriously malnourished, so he began writing “prescriptions” for food — stipulating quantities of milk, vegetables, meat, and fruit that could be “filled” at grocery stores, which were instructed to send the bills to the health center, where they were paid out of the pharmacy budget. When word of this reached the Office of Economic Opportunity in Washington, which financed the center, an official was dispatched to Mississippi to reprimand Geiger and make sure he understood that the center’s money could be used only for medical purposes. Geiger replied: “The last time I looked in my textbooks, the specific therapy for malnutrition was food.” The official had nothing to say and returned to Washington.
In some ways, the United States has come a long way since Lyndon Johnson declared the “war on poverty.” But in others, we’re still at square one. We now have a variety of federally-supported nutrition programs, but the health care system remains senselessly disconnected from the “social determinants of health.” In this regard, the United States has fallen behind the rest of the world. If a politician in India announced a public health plan that neglected malnutrition, he would be ridiculed. Here, leaders make this kind of omission all the time. Almost all of the debate about the 2010 Affordable Care Act was consumed with questions about health care access and quality. But if we really want to improve the health of millions of people, we have to address the conditions that make them sick.
In some ways, the United States has come a long way since Lyndon Johnson declared the “war on poverty.” But in others, we’re still at square one. We now have a variety of federally-supported nutrition programs, but the health care system remains senselessly disconnected from the “social determinants of health.” In this regard, the United States has fallen behind the rest of the world. If a politician in India announced a public health plan that neglected malnutrition, he would be ridiculed. Here, leaders make this kind of omission all the time. Almost all of the debate about the 2010 Affordable Care Act was consumed with questions about health care access and quality. But if we really want to improve the health of millions of people, we have to address the conditions that make them sick.
One of the most impressive organizations in the country that is developing an approach to do this is Health Leads, which mobilizes and trains about 1000 volunteers each year who staff resource desks located in the waiting rooms of 23 hospital clinics or health centers in Baltimore, Boston, Chicago, New York, Providence, R.I., and Washington. At these sites, doctors now regularly “prescribe” a wide range of basic resources — like food assistance, housing improvements, or heating fuel subsidies — which Health Leads’ volunteers “fill” — applying their problem solving skills (and tenacity) to identify resources anywhere they may be available.
Health Leads was co-founded by Rebecca Onie in 1996, while she was an undergraduate student at Harvard University. Onie had first witnessed the intimate relationship between poverty and health while volunteering at Greater Boston Legal Services, where she assisted low-income clients who had housing problems. Many lived in dilapidated apartments with leaky pipes, broken windows, rooms full of mold, and walls infested with cockroaches and rats. Often families couldn’t afford to pay for heat. Towards the end of the month, some ran out of food. Onie found herself interviewing mothers whose children came to the office wheezing and coughing from asthma and lung infections — health problems caused or triggered by bad housing. Often, the children had been in and out of hospitals for years; many had fallen far behind in school.
Exercise as Potent Medicine
By GRETCHEN REYNOLDS
Exercise can be as effective as many frequently prescribed drugs in treating some of the leading causes of death, according to a new report. The study raises important questions about whether our health care system focuses too much on medications and too little on activity to combat physical ailments.
For the study, which was published in October in BMJ, researchers compared how well various drugs and exercise succeed in reducing deaths among people who have been diagnosed with several common and serious conditions, including heart disease and diabetes.
Comparative effectiveness studies are a staple of science, of course, especially in pharmaceutical research. Scientists often track how well one drug treats a condition compared with the outcome if they use a different drug. But few studies have directly compared drugs with exercise, and even fewer have compared outcomes in terms of mortality or whether the intervention significantly lessens the chance that someone with a disease will die from it, despite treatment.
So Huseyin Naci, a graduate student at the London School of Economics and Political Science, and Dr. John Ioannidis, the director of the Stanford Prevention Research Center at the Stanford University School of Medicine, decided to create a comprehensive comparison of the effectiveness of drugs and exercise in lessening mortality among people who had been diagnosed with one of four diseases: heart disease, chronic heart failure, stroke or diabetes. They chose these particular conditions because those were the only ones for which they could find studies that had examined whether exercise lessened the risk of death among patients with that disease, Mr. Naci said.
He and Dr. Ioannidis then gathered all of the recent randomized controlled trials, as well as previous reviews and meta-analyses of older experiments relating to mortality among patients with those diseases, whether they had been treated with drugs or exercise.
They ended up with data covering 305 past experiments that, collectively, involved almost 340,000 participants, which is an impressive total. But most of the volunteers had received drugs. Only 57 of the experiments, involving 14,716 volunteers, had examined the impact of exercise as a treatment.
Still, the numbers were large enough that Mr. Naci and Dr. Ioannidis could create an elaborate network of cross-references, comparing the outcomes when people received certain drugs, followed exercise regimens or, occasionally, both. The exercise routines, typically part of rehabilitation programs, usually involved walking or other aerobic routines but sometimes consisted of weight training or other exercises.
The researchers compared mortality risks for people following any of the treatment options.
The results consistently showed that drugs and exercise produced almost exactly the same results. People with heart disease, for instance, who exercised but did not use commonly prescribed medications, including statins, angiotensin-converting-enzyme inhibitors or antiplatelet drugs, had the same risk of dying from — or surviving — heart disease as patients taking those drugs. Similarly, people with diabetes who exercised had the same relative risk of dying from the condition as those taking the most commonly prescribed drugs. Or as the researchers wrote in statistics-speak, “When compared head to head in network meta-analyses, all interventions were not different beyond chance.”
Troubled MaineCare rides broker may want more funds
A document signaling that a request is in the works angers legislators already out of patience over the contractor’s service problems.
AUGUSTA — Lawmakers were outraged Tuesday that a contractor under fire for providing substandard service for MaineCare’s non-emergency transportation system may be seeking more funding, even while being blamed for thousands of patients missing rides to medical appointments.
Connecticut-based Coordinated Transportation Solutions may be asking the state for more money to supplement its $28.3 million, one-year contract, Rep. Drew Gattine, D-Westbrook, said during a meeting of the Legislature’s Health and Human Services Committee.
Gattine read from documents, filed in October and released by the state Department of Health and Human Services last week, that indicated CTS was having financial issues. There was no mention of how much more funding the company may be requesting or how much was needed.
“An amendment to our contract to address the financial implications of increased volume and demand is in process,” says the Corrective Action Plan that CTS filed at the state’s request.
DHHS released the plan after the Portland Press Herald requested it. Gattine and other legislators had asked for the plan previously but their requests were ignored, said Gattine and others.
Gattine, an attorney, said he believes the sentence in the action plan is a strong indicator that the contractor believes it needs more money, and that it is negotiating with the state regarding funding.
Sen. Colleen Lachowicz, D-Waterville, said she’s “shocked” that the company would ask for more money. “They haven’t done anything to earn the money they’ve already made,” she said.
http://www.pressherald.com/news/Troubled_MaineCare_provider_asking_for_more_money_.html?pagenum=full
The Single-Payer Alternative
By NANCY FOLBRE
Nancy Folbre is professor emerita of economics at the University of Massachusetts, Amherst.
Rush Limbaugh’s take on the disastrous rollout of the Affordable Care Act could, ironically, warm the hearts of those at the other end of the political spectrum. He contends that President Obama knew all along that the Affordable Care Act would crash and burn, but pushed it through so that the conflagration would clear the way for single-payer health insurance.
The conspiracy charge sounds deranged, but problems with the new health insurance system may indeed revitalize demands for more substantive reforms, which many policy makers and voters set aside in the putative interests of political pragmatism. Whatever the advantages of a single-payer system such as that currently administered by Medicare, one view held, American voters were unlikely to get behind it.
Yet one of the greatest advantages of a single-payer system — its relatively low administrative costs — has been thrown into sharp relief by problems registering with the new health exchanges. Andwhile Republicans despise the Affordable Care Act despite its conformity with many of their earlier proposals, their proposed changes(other than simple rollback) look complicated, kludgy and costly to administer.
The malfunctioning website has magnified problems inherent in coordinating enrollment across many different companies in many different exchanges in cooperation with many different government agencies. The harmonization challenges are orders of magnitude greater than those faced by a single company or a single state, making streamlining difficult. Improved software can do only so much.
In theory, competition and choice should increase efficiency. In practice, health insurance companies are able to take advantage of the complexity and uncertainty surrounding health care choices to make comparison shopping very difficult.
Lack of clear information about the prices of medical procedures, combined with a proliferation of insurance options whose potential benefits will be strongly affected by unpredictable events (such as being involved in an automobile accident or developing cancer), put consumers in a weak position.
Montefiore Faces Neighborhood Opposition to Medical Complex in Bronx
By WINNIE HU
A new medical center in the Bronx might seem like a welcome addition to a borough of 1.4 million residents facing a growing health crisis from obesity, diabetes, asthma and chronic diseases.
But an outcry has erupted over Montefiore Medical Center’s plan for an 11-story ambulatory care center in Riverdale that would treat as many as 1,000 people a day. Montefiore officials say the center would provide one-stop medical services in a community with a need for them.
But dozens of Riverdale residents have banded together to fight a “Montefiore monstrosity,” as they call it, that would create traffic and parking nightmares on their narrow streets and destroy the charm of their community. This week, the local community board passed a resolution opposing the center.
“This is an intrusion,” said Steven Benardo, 65, a retired school superintendent for Bronx special education services who lives a half-block from the planned center. “This is a medical mall dropped in the middle of a residential community.”
The center would be part of Montefiore, a health care system of six hospitals and 150 clinics that stretches across the Bronx and into lower Westchester County. It would be in a 93,000-square-foot building to be constructed by a local developer, Simone Metro Properties, and include doctors’ offices, an urgent care clinic, a laboratory, an area for X-ray services, a small cafe in the lobby and a multilevel parking garage. The day-to-day operations would be overseen by Westmed Practice Partners, a health care management services company.
Dr. Steven M. Safyer, the president and chief executive of Montefiore, described the center as a “medical village” that could bring together Montefiore staff and affiliated doctors who are now spread out over two dozen sites in Riverdale, and host rotating specialists from Montefiore’s campus in nearby Norwood.
“We are listening to the voices of the community, including those of our patients and their families who have consistently asked Montefiore to have a less fragmented, more holistic presence in Riverdale,” Dr. Safyer said.
U.S. Cites Rise in Health Plan Signups as Sebelius Testifies
By ROBERT PEAR
WASHINGTON — The number of people selecting health insurance plans in the federal and state marketplaces increased last month at a brisk pace, bringing the overall figure to nearly 365,000, the Obama administration said on Wednesday. The November number was more than double the one for October, but still well below the administration’s goal.
The new enrollment data became available as Kathleen Sebelius, the secretary of health and human services, clashed again with Republicans at a hearing of the House Energy and Commerce Committee.
Ms. Sebelius acknowledged that flaws in the federal website had “dampened enthusiasm” for the health care law and had deterred many people from enrolling. But she said that “evidence of the technical improvements to HealthCare.gov can be seen in the enrollment numbers,” which she described as “very positive.”
More than a quarter-million people picked health plans last month, and more than half of them were in state-run exchanges, the administration said in a report issued Wednesday. In the federal exchange, 110,400 people chose health plans last month, four times as many as in October, when many consumers were unable to see details of health plans because of problems with the federal website.
Ms. Sebelius also announced that she had ordered an internal investigation of the botched rollout of the site.
“I have asked our inspector general, Dan Levinson, to review the development of HealthCare.gov,” Ms. Sebelius said. “We need a thorough review of the contractor performance and program management structure that resulted in the flawed launch of the website.”
It is unclear whether the inspector general will investigate the role of Ms. Sebelius or White House officials who supervised the development of the website over the last two years.
F.D.A. Restricts Antibiotics Use for Livestock
By SABRINA TAVERNISE
WASHINGTON — The Food and Drug Administration on Wednesday put in place a major new policy to phase out the indiscriminate use of antibiotics in cows, pigs and chickens raised for meat, a practice that experts say has endangered human health by fueling the growing epidemic of antibiotic resistance.
This is the agency’s first serious attempt in decades to curb what experts have long regarded as the systematic overuse of antibiotics in healthy farm animals, with the drugs typically added directly into their feed and water. The waning effectiveness of antibiotics — wonder drugs of the 20th century — has become a looming threat to public health. At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections.
“This is the first significant step in dealing with this important public health concern in 20 years,” said David Kessler, a former F.D.A. commissioner who has been critical of the agency’s track record on antibiotics. “No one should underestimate how big a lift this has been in changing widespread and long entrenched industry practices.”
The change, which is to take effect over the next three years, will effectively make it illegal for farmers and ranchers to use antibiotics to make animals grow bigger. The producers had found that feeding low doses of antibiotics to animals throughout their lives led them to grow plumper and larger. Scientists still debate why. Food producers will also have to get a prescription from a veterinarian to use the drugs to prevent disease in their animals.
Federal officials said the new policy would improve health in the United States by tightening the use of classes of antibiotics that save human lives, including penicillin, azithromycin and tetracycline. Food producers said they would abide by the new rules, but some public health advocates voiced concerns that loopholes could render the new policy toothless.
Health officials have warned since the 1970s that overuse of antibiotics in animals was leading to the development of infections resistant to treatment in humans. For years, modest efforts by federal officials to reduce the use of antibiotics in animals were thwarted by the powerful food industry and its substantial lobbying power in Congress. Pressure for federal action has mounted as the effectiveness of drugs important for human health has declined, and deaths from bugs resistant to antibiotics have soared.
Wisconsin: Medicaid Delay Bill Advances
By THE ASSOCIATED PRESS
The State Assembly passed a bill on Wednesday that would give those losing their Medicaid coverage three more months to sign up for private plans through the new federal online marketplace. Assembly Republicans said that the Obama administration’s health care failures forced them to take quick action on a bill that Gov. Scott Walker proposed and called the Legislature into special session for this month. It would delay for three months removing an estimated 72,000 people above the poverty level from the state’s BadgerCare Plus Medicaid program. But to pay for the extension, 83,000 childless adults below the poverty level will not get Medicaid until April. Democrats objected strongly to that part of the proposal. Representative Cory Mason said the Republican plan “pits the poorest against those who are less poor.” The Senate is scheduled to take it up next week.
Broader Approach Urged to Reduce Gun Violence
By BENEDICT CAREY
The most effective way to reduce gun violence without significantly curtailing Second Amendment rights is to treat the problem as a public health issue, like smoking or drunken driving, rather trying to profile potential shooters, according to a report released Thursday by a panel of experts who were commissioned by the American Psychological Association to study the issue in the wake of the Newtown, Conn., massacre.
The panel reviewed evidence on a wide variety of interventions intended to reduce violence, including suicides and homicides, in schools and in the workplace. It concluded that trying to predict who will act out by profiling was unreliable, and that more systemic preventive policies were far more effective.
The report offers a list of such policies, including legal changes like tighter background checks on gun sales, and programs in schools to teach nonviolent conflict resolution. The report also sharply criticized the lack of government money to study firearm violence.
“There’s been so much focus on crisis response, on getting to the scene on time and fortifying our schools, and that’s not going to take care of the problem,” said Dewey G. Cornell, a clinical psychologist and professor of education at the University of Virginia, who led the panel. “We need to focus on prevention more broadly, before the violence, to have a real impact.”
Experts who were not involved in compiling the report generally agreed with its conclusions, while acknowledging that some of the recommendations were politically challenging.
“It’s the most comprehensive and balanced analysis I’ve seen on gun violence in America, and it shows just how hard this problem is and how difficult it will be to solve,” said J. Reid Meloy, a forensic psychologist at the University of California, San Diego, and editor of the International Handbook of Threat Assessment.
Obamacare signups accelerate in Maine, but short of projections
Posted Dec. 11, 2013, at 10:51 a.m.
The number of Mainers signing up for health insurance under the Affordable Care Act has jumped nearly sixfold, though nationally enrollments through the balky healthcare.gov remain far short of White House projections, according to new federal data released Wednesday.
In the two months after the site’s Oct. 1 launch, about 1,750 Maine residents chose a health plan through the federal government’s gateway for the marketplaces in Maine and 35 other states, according to a report from the U.S. Department of Health and Human Services. That’s a surge from just 271 Mainers in October.
Many more people finished their applications but hadn’t yet chosen a health plan. In Maine, 16,325 individuals completed applications through the site or the mail and learned whether they were eligible for a marketplace plan or Medicaid, and whether they qualified for federal financial help to afford coverage, according to the department’s data.
Nearly 6,000 Mainers qualified for financial assistance, while 1,079 adults or their children were deemed eligible for Medicaid, or MaineCare.
The state, however, which runs MaineCare jointly with the federal government, hasn’t received complete information about potential enrollees, according to John Martins, a spokesman for the Maine Department of Health and Human Services. Without it, DHHS can’t determine whether Mainers funneled through healthcare.gov actually are eligible for MaineCare, he said.
Study: States rejecting Medicaid expansion costing taxpayers billions
December 5, 2013
States choosing not to expand Medicaid eligibility under the Patient Protection and Affordable Care Act will forgo billions of dollars in federal funds while their residents contribute to the cost of the expansion in other states, according to a studyreleased today by the Commonwealth Fund. The study estimates the net loss to a state if it does not participate in the expansion in 2022. For 20 states opting not to expand eligibility as of November, those losses range from $166 million in Wyoming to $9.2 billion in Texas. The ACA expanded Medicaid eligibility to Americans earning up to 138% of the federal poverty level ($32,499 for a family of four), a provision that became voluntary for states under a 2012 Supreme Court decision. Because federal funds for state Medicaid programs come from general revenues, taxpayers in states not participating in the expansion will share in the overall cost without benefitting from the expanded health coverage, the report notes.
Medicaid, insurance fixes may be big trouble later
An Obamacare fix quietly announced on Black Friday could put states at risk for higher Medicaid costs and even fraud.
Although Medicaid sign-ups through HealthCare.gov have been considered a rare bright spot in the flawed Obamacare rollout, the federal portal has been unable to send those Medicaid applications to the states for final processing. If states can’t receive and complete their work on Medicaid applications by the end of the year, people could go without Medicaid coverage in early 2014 despite having an eligibility determination.
To circumvent the broken transfer process, the Obama administration agreed Friday to let states use an incomplete set of data — known as a “flat file” — to enroll people in Medicaid, even though those files lack critical information that states normally use to verify eligibility.
“We anticipate that the strategy … will enable states to ensure that eligible individuals have timely access to Medicaid and [Children’s Health Insurance Program] coverage in a simple and streamlined manner,” administration Medicaid chief Cindy Mann wrote in a letter to state Medicaid directors.
But the expedited enrollment process comes with big risks for states, and it’s up to them to decide whether they’re willing to risk the integrity of their Medicaid programs to sign up people faster.
“We are supposed to, as states, do our due diligence in signing up only people who are eligible,” Kathleen Nolan, state policy director for the National Association of Medicaid Directors, said Monday. “The letter is silent on what’s going to happen when it comes time to evaluate program integrity issues.”
States are concerned that many of the flat files they’ve received from HealthCare.gov don’t indicate whether applicants have also attempted to enroll in Medicaid directly through a local agency, leaving states vulnerable to duplicate sign-ups. And there’s been no end-to-end testing to gauge potential issues with the information states get. Complicating the issue further is the work many states are doing to rebuild their own Medicaid eligibility systems to align with new Obamacare requirements.
In PracticeTracking the Affordable Care Act
-
WASHINGTON — The Obama administration said Tuesday that 1.46 million people had applied and been found eligible for Medicaid or the Children’s Health Insurance Program in October, far more than had selected a private health plan in the new insurance marketplaces.Of those found eligible for the Medicaid or CHIP, slightly more than half were in states that have decided to expand Medicaid, as permitted under the Affordable Care Act.But 48 percent of the people found eligible for the programs — 697,000 people — were in states that have not expanded Medicaid.The new health care law has produced many changes in the way states assess eligibility for Medicaid, and it provided money to states to upgrade antiquated computer systems. These changes, combined with publicity around the rollout of the federal law this fall, apparently contributed to increases in the number of applications for Medicaid and in the number approved.“In October, in states that are fully participating in the expansion of Medicaid coverage made possible by the law, we’ve seen a more than 15 percent jump in applications compared with the average monthly enrollment in July through September,’’ the Department of Health and Human Services said. “This shows a real need and desire for coverage for low-income Americans.’’
HealthCare.gov’s Mysterious New Number: ‘834’
Now that the front-end of HealthCare.gov appears to be working properly, the media’s focus is quickly shifting to the back-end systems that are supposed to provide insurance companies with accurate information about consumers enrolling in their plans.The issue is an important one because if insurance companies get incorrect data, their future customers may not be enrolled properly and that could lead to headaches — or worse — come January when patients show up at doctors’ offices or hospitals thinking they are insured but really aren’t.Sarah Kliff at The Washington Post has been flagging this issue for some time, writing in October how the “834” transactions that the government sends insurers each night could make or break the law.http://www.propublica.org/article/healthcare.govs-mysterious-new-number-834?utm_source=H2RMinutes+HIX+Dec.+12%2C+2013&utm_campaign=HIX+Minutes+12%2F12%2F13&utm_medium=email
No comments:
Post a Comment