Doctors cut from Medicare Advantage networks struggle with what to tell patients
By Ariana Eunjung Cha,
Thousands of primary-care doctors and specialists across the country have been terminated from privately run Medicare Advantage plans, sparking a battle between doctors who say patient care is being threatened and insurers that insist they have to reduce costs and streamline their operations.Medical associations, which describe the dismissals as the largest in the program’s history, say the cuts are forcing some patients to leave their doctors in mid-treatment and creating gaps in the types of medical specialists covered in some areas. They’re taking their protests to court, and having some success.
In December, a federal judge in Connecticut issued an injunction that temporarily prohibits an insurer from dismissing doctors in Fairfield and Hartford counties. Another lawsuit is pending in New York, and doctors groups in several other states are threatening legal action.
The American Medical Association, the nation’s premier doctors organization — along with 39 state affiliates and 42 patient and medical specialty groups — has called on the Obama administration to intervene and put pressure on insurers to reverse the terminations.
Insurers say they must shrink their physician networks because they face billions of dollars in government-payment cuts over the next decade — reductions that are being used partly to fund insurance coverage for millions of people under the federal Affordable Care Act. They also say the smaller networks will allow them to curb premium increases and to remain nimble as they prepare for an influx of patients under the law.
Medicare Advantage, an alternative to traditional Medicare, covers 13 million beneficiaries, or 27 percent of the people in the federal health-care program for the elderly. Besides providing the standard benefits, the thousands of Medicare Advantage plans often offer extra perks such as free eyeglasses and adhesive bandages. They can do that because, for years, the government has paid the plans more, per patient, than it spends on regular Medicare.
That has been a sore point for Democrats, who used the health-care law to cut payments to Medicare Advantage by $156 billion over the next decade.
Notification complaints
The doctor terminations, most of which took effect Jan. 1, are striking a nerve partly because of the way insurers have notified some physicians.
http://www.washingtonpost.com/national/health-science/doctors-cut-from-medicare-advantage-networks-struggle-with-what-to-tell-patients/2014/01/25/541bfbd8-77b4-11e3-af7f-13bf0e9965f6_story.html
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/24/moodys-just-downgraded-the-health-insurance-industry-obamacare-was-part-of-the-reason/The Washington Post, Wonkblog, Jan. 24, 2014
Moody’s just downgraded the health insurance industry. Obamacare was part of the reason.
By Sarah Kliff
Stephen Zaharuk is a Moody's senior vice president who covers the health insurance industry. That makes him the guy who authored the report downgrading the credit outlook for health insurance companies from "stable" to "negative" on Thursday. We spoke Thursday afternoon about his outlook for the health-care industry, the big unknowns looming in 2014, and why the downgrade happened now. Some of his quotes made it into this story in Friday's paper and what follows is a transcript of our discussion, lightly edited for clarity.
Sarah Kliff: In your report on health insurers, you list a lot of different factors that contributed to the downgrade. Can you give any sense of how important each one was? Was it the rocky rollout of the health-care law driving this? Or something else?
Stephen Zaharuk: Each one has an effect. We started with the Affordable Care Act, which obviously has the most interest as the newest piece. Basically we're seeing the rollout, which wasn't as sufficient as it should have been, and we're not seeing the enrollment numbers that were expected, based on the insurers' pricing assumptions. We're also hearing about back-end issues, which haven’t been in the forefront of the news. The more concerning thing is, are they going to get paid the premiums that they need in the exchanges?
Also concerning is the fact that, because of this rollout, there are changes made to regulations. We changed the enrollment dates and extended enrollment for a period of weeks, and kept policies that aren't compliant with the Affordable Care Act for another year. All these things, they are probably not, by themselves, a big worry. But together they add more risk. There's a concern there could be more of these to come. Once you have the precedent of changing a regulation with an announcement like that, that makes the financial landscape uncertain.
That's all to do with the Affordable Care Act. We also have Medicare Advantage which is a big program for insurance companies. About 28 to 27 percent of seniors are signed up for that. In 2014, there was a lowering of the amount they get to provide that care, and they're scheduled to get another reduction. We’re concerned about how far these cuts will go, and how long this will be a viable product. You might see a lowering of benefits, or some might exit the marketplace.
And then there’s just the normal pressures we are seeing because of the economy. Employment is not not as robust as we'd hoped, so commercial membership is pretty stagnant.
Key Senate Republicans Offer Their Plan To Replace Obamacare
Republicans have offered a wide array of proposals to "repeal and replace" the Affordable Care Act since it became law in 2010. But few have come with the pedigree of the plan just unveiled by a trio of senior Senate Republicans.
The Patient Choice, Affordability, Responsibility and Empowerment Act, or CARE for short, is a proposalbeing floated by Sens. Richard Burr, R-N.C., Orrin Hatch, R-Utah, and Tom Coburn, R-Okla.
Hatch is the senior Republican on the Senate Finance Committee; Burr is on the health subcommittee of theHealth, Education, Labor and Pensions Committee; Coburn is a physician. All three have spent much or all of their legislative careers working on health policy.
"Obamacare just isn't working," Hatch said on the Senate floor Monday afternoon. "Try as he might during tomorrow night's State of the Union address, President Obama will not be able to convince the American people that his health care law is anything other than an unmitigated disaster."
At a briefing for health reporters, aides to the senators said the goal of their proposal is to focus on bringing down costs. Hence the plan would repeal the ACA's requirements that most people have insurance, as well as requirements that insurers offer minimum benefits and employers offer insurance or face potential fines.
The Republican proposal also would eliminate most of the taxes and fees that the law imposes to pay for the generous tax credits offered to help people pay for the required insurance.
And the plan would repeal the requirement that insurers cover people with pre-existing health conditions, although people who remain "continuously covered" for at least 18 months could not be denied or charged more. And while the plan would keep the ACA's ban on insurers' imposing a lifetime limit on insurance benefits, annual limits could return.
The GOP plan offers its own set of tax credits to help those with lower incomes afford coverage, and like those in the ACA, they would be adjusted for age but not for geography. That means the tax credit would be the same across the nation, even though insurance costs differ widely in different parts of the country.
Antibiotics in Animals Tied to Risk of Human Infection
A federal analysis of 30 antibiotics used in animal feed found that the majority of them were likely to be contributing to the growing problem of bacterial infections that are resistant to treatment in people, according to documents released Monday by a health advocacy group.
The analysis, conducted by the Food and Drug Administration and covering the years 2001 to 2010, was detailed in internal records that the nonprofit group, the Natural Resources Defense Council, obtained through a Freedom of Information Act request and subsequent litigation.
In the documents, some of which were reviewed by The New York Times, scientists from the F.D.A. studied 30 penicillin and tetracycline additives in animal feed. They found that 18 of them posed a high risk of exposing humans to antibiotic-resistant bacteria through food.
Resistant bacteria make it difficult and sometimes impossible to treat infections with ordinary antibiotics. The scientists did not have enough data to judge the other 12 drugs.
At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections, the Centers for Disease Control and Prevention estimates. Representatives of the food industry largely blame hospitals and treatments given to people for the rise of deadly superbugs. But many scientists believe that indiscriminate use of antibiotics in animal feed is a major contributor.
Farmers and ranchers feed small amounts of the drugs to animals over their lifetimes to keep them healthy in crowded conditions, causing bacteria to develop a resistance passed on to people through the environment and eating meat from the animals.
Florida's Decision Hurts County With Highest Uninsured Rate
CLEWISTON, Fla. – – In the city that calls itself “America's Sweetest Town,” the smell of burning sugar cane pierces the 80 degree January air.
Steam billows from the 12-story U.S. Sugar Corp. factory that dominates the landscape and the economy in this region, halfway between the Gulf of Mexico and the Atlantic Ocean. Some describe the aroma as sweet, others as sour -- a metaphor of sorts for the Affordable Care Act and its impact on this South Florida county that has the state’s highest uninsured rate.
Thirty-five percent of Hendry County’s 33,000 residents under age 65 lack health insurance, according to the latest census figures, much higher than Florida’s 25 percent average, which is the nation’s second highest state rate.
If any place in America needs help getting residents insurance coverage and a leg up on improving their health, this is it.
But nearly a month after the health law’s expansion of coverage began, local health officials say little has changed for most uninsured residents.
“I kept hearing about Obamacare and how no American would go uninsured, but then I was let down,” says Kelly Cody, 48, a diabetic with an inoperable brain tumor who has gone without health insurance for nine years.
Cody, along with many of Hendry’s uninsured, is ineligible for Medicaid, which in Florida is limited to pregnant women and children, the disabled, some elderly and very poor parents.
The Healthy, Not The Young, May Determine Health Law's Fate
Now that the problems with the balky HealthCare.govwebsite are largely fixed, the Obama administration is finally feeling comfortable enough to launch some of the outreach it planned for last fall.
Its top target: young adults, specifically those between 18 and 35.
Actress and comedian Aisha Tyler and former Los Angeles Laker Magic Johnson are among the celebrity spokesmen. Both have released videos (one funnier thanthe other). The administration plans to air ads during the upcoming Winter Olympics and March Madness college basketball tournament.
The theory has been that without young and healthy people in the insurance pools, premiums will spiral upward in future years. But people have started to wonder just how critical those young people really are to making the health exchanges operate smoothly.
"There's been this incredible focus on reaching young invincibles and getting them to sign up for insurance," says Larry Levitt, senior vice president of the Kaiser Family Foundation. "But it turns out the invincible part is actually much more important than the young part."
Opting Out Of Medicaid Expansion: The Health And Financial Impacts
January 30th, 2014
The Affordable Care Act (ACA) was designed to increase access to health insurance by: 1) requiring states to expand Medicaid eligibility to people with incomes less than 138 percent of the Federal Poverty Level (FPL) ($19,530 for a family of three in 2013), with the cost of expanded eligibility mostly paid by the federal government; 2) establishing online insurance “exchanges” with regulated benefit structures where people can comparison shop for insurance plans; and 3) requiring most uninsured people with incomes above 138 percent FPL to purchase insurance or face financial penalties, while providing premium subsidies for those up to 400 percent of FPL.
Recent studies suggest that Medicaid expansion will result in health and financial gains. Older studies also found salutary health effects of expanded or improved insurance coverage, particularly for lower income adults. These studies also document an increase in utilization of most health care services. Most recently, the Oregon Health Insurance Experiment (OHIE) found a striking increase in emergency department use as well as other outpatient care.
The Supreme Court ruled in June 2012 that states may opt out of Medicaid expansion, and as of November 2013, 25 states have done so. These opt-out decisions will leave millions uninsured who would have otherwise been covered by Medicaid, but the health and financial impacts have not been quantified.
In this post, we estimate the number and demographic characteristics of people likely to remain uninsured as a result of states’ opting out of Medicaid expansion. Applying these figures to estimates of the effects of insurance expansion from prior studies, we calculate the likely health and financial impacts of states’ opt-out decisions.
The Consequences of Opting Out
We Are Giving Ourselves Cancer
DESPITE great strides in prevention and treatment, cancer rates remain stubbornly high and may soon surpass heart disease as the leading cause of death in the United States. Increasingly, we and many other experts believe that an important culprit may be our own medical practices: We are silently irradiating ourselves to death.
The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. Our resulting exposure to medical radiation has increased more than sixfold between the 1980s and 2006, according to the National Council on Radiation Protection & Measurements. The radiation doses of CT scans (a series of X-ray images from multiple angles) are 100 to 1,000 times higher than conventional X-rays.
Of course, early diagnosis thanks to medical imaging can be lifesaving. But there is distressingly little evidence of better health outcomes associated with the current high rate of scans. There is, however, evidence of its harms.
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