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Friday, February 7, 2014

Health Care Reform Articles - February 7, 2014

Willful stupidity in the Obamacare debate

By , Published: February 5

One of the best arguments for health-insurance reform is that our traditional employer-based system often locked people into jobs they wanted to leave but couldn’t because they feared they wouldn’t be able to get affordable coverage elsewhere.
This worry was pronounced for people with preexisting conditions, but it was not limited to them. Consider families with young children in which one parent would like to get out of the formal labor market for a while to take care of the kids. In the old system, the choices of such couples were constrained if only one of the two received employer-provided family coverage.
Or ponder the fate of a 64-year-old with a condition that leaves her in great pain. She has the savings to retire but can’t exercise this option until she is eligible for Medicare. Is it a good thing to force her to stay in her job? Is it bad to open her job to someone else?
By broadening access to health insurance, the Affordable Care Act (ACA) ends the tyranny of “job lock,” which is what the much-misrepresented Congressional Budget Office (CBO) study of the law released Tuesday shows. The new law increases both personal autonomy and market rationality by ending the distortions in behavior the old arrangements were creating.
But that’s not how the study has been interpreted, particularly by enemies of the law. Typical was a tweet from the National Republican Congressional Committee, declaring that “#ObamaCare is hurting the economy, will cost 2.5 millions [sic] jobs.”
Glenn Kessler, The Post’s intrepid fact checker, replied firmly: “No, CBO did not say Obamacare will kill 2 million jobs.” What the report said, as the Wall Street Journal accurately summarized it, is that the law “will reduce the total number of hours Americans work by the equivalent of 2.3 million full-time jobs.”
Oh my God, say opponents of the ACA, here is the government encouraging sloth! That’s true only if you wish to take away the choices the law gives that 64-year-old or to those parents looking for more time to care for their children. Many on the right love family values until they are taken seriously enough to involve giving parents/workers more control over their lives.
And it’s sometimes an economic benefit when some share of the labor force reduces hours or stops working altogether. At a time of elevated unemployment, others will take their place. The CBO was careful to underscore — the CBO is always careful — that “if some people seek to work less, other applicants will be readily available to fill those positions and the overall effect on employment will be muted.”
The CBO did point to an inevitable problem in how the ACA’s subsidies for buying health insurance operate. As your income rises, your subsidy goes down and eventually disappears. This is, as the CBO notes, a kind of “tax.” The report says that if the “subsidies are phased out with rising income in order to limit their total costs, the phaseout effectively raises people’s marginal tax rates (the tax rates applying to their last dollar of income), thus discouraging work.”
But the answer to this is either to make the law’s subsidies more generous — which the ACA’s detractors would oppose because, as the CBO suggests, doing so would cost more than the current law — or to guarantee everyone health insurance, single-payer style, so there would be no “phaseout” and no “marginal tax rates.” I could go with this, but I doubt many of the ACA’s critics would.
http://www.washingtonpost.com/opinions/ej-dionne-willful-stupidity-in-the-obamacare-debate/2014/02/05/d49d1448-8e9a-11e3-b46a-5a3d0d2130da_print.html

Maine bill aims to protect doctor-patient relationships, keep insurance companies from ‘practicing medicine’

By Scott Thistle, Sun Journal
Posted Feb. 05, 2014, at 5:41 p.m.
AUGUSTA, Maine — A bill before the Legislature’s Insurance and Financial Affairs Committee is designed to protect health insurance consumers by requiring more up-front disclosure on whether a new plan will cover a patient’s current doctor and medical facilities.
Co-sponsored by state Sens. Dawn Hill, D-Cape Neddick, and Margaret Craven, D-Lewiston, the bill, LD 1629, aims to make sure consumers and health care providers understand which hospitals and doctors are included in an insurance plan and why.
The bill is in part a response to “narrow network” proposals in 2013 by MaineHealth — owner of Maine Medical Center in Portland — and Anthem Blue Cross and Blue Shield that sought to exclude doctors and other providers in the Central Maine Healthcare system, which operate in Lewiston, Rumford and Bridgton. One proposal was approved by the state, the other was denied.
At stake is how far patients would have to go to see a doctor. In many cases, some say, an insurance company’s “narrow network” would mean patients would not only have to travel farther, but also would end up changing care providers altogether.
For the most rural patients the prospects are very frightening, Rep. Paulette Beaudoin, D-Biddeford, said during a work session on the bills earlier this month.
Beaudoin, who is turning 81, said the prospect of forcing elderly patients — or even young people — who don’t have a lot of money to travel great distances to get the care they expected when they purchased a health plan is discouraging.
“I have an awful, awful, feeling about all this and it makes me a little bit sick, and the more we are going into it, the sicker I’m getting,” Beaudoin said. She said she’s happy “I won’t be around too much longer to see what’s going to happen, because it makes me feel ill for the rest of the people.”
Beaudoin said most people who have serious health problems or chronic conditions are seeking doctors and treatment close to home.
“If they are like me, you try to find doctors that are right around you so you don’t have too far to go,” she said. “And you can’t afford a taxi and you can’t afford all this. People don’t have the money and it seems like this is being lost somewhere.”
The bill also requires health insurance providers to have a fair, transparent process when determining which hospitals will be “in network” hospitals.
“This is a matter of fairness,” Hill, the bill’s sponsor, said. “Insurance companies should be upfront about which hospitals they are including in their networks and why. This is a reasonable request to ensure patients and providers are informed about decisions that have a tremendous impact on Maine people and their medical care.”
In developing health insurance plans offered in the new marketplace created by the Affordable Care Act, Anthem excluded six hospitals from its list of “in network” hospitals.
The six excluded hospitals were York Hospital in York, Parkview Adventist Medical Center in Brunswick, Mercy Hospital in Portland, Central Maine Medical Center in Lewiston, Rumford Hospital in Rumford and Bridgton Hospital in Bridgton.
The bill sets up criteria for insurers so they would have to disclose who’s in and who’s out.

Nope, not a job killer. Actually, Obamacare lowers unemployment while improving lives

By AMy Fried
While Obamacare opponents have claimed that a recent CBO report shows the law is a “job killer,” that’s a clear misrepresentation of what the study concluded.
Rather, as I explained, people would gain job flexibility and not have to work as much and as long in order to keep health care.
And, by making this choice, overall unemployment goes down
How so? As the CBO report stated, Obamacare will increase demand for goods and services, thus creating greater demand for workers.
On page 124, the report estimates that the ACA will “boost overall demand for goods and services over the next few years because the people who will benefit from the expansion of Medicaid and from access to the exchange subsidies are predominantly in lower-income households and thus are likely to spend a considerable fraction of their additional resources on goods and services.” This, the report says, “will in turn boost demand for labor over the next few years.” [source]
That Obamacare will decrease unemployment was confirmed when the CBO director, Douglas Elmendorf, visited Congress to take questions.
By the way, Elmendorf has a bachelors degree in Economics from Princeton University and a Ph.D from Harvard in Economics.
He agreed with a congressional questioner that the increase in demand for goods and services “spurs employment and would reduce unemployment over the next few years.”

Job Killer? How The Media Spin Got ObamaCare Wrong!

 Obamacare is a job killer -- that was the message across the media this week after the release of a new Congressional Budget Office report about the Affordable Care Act. But what does the CBO report really say? We speak to Pulitzer Prize-winning Los Angeles Times columnist Michael Hiltzik, who says detractors have misinterpreted a report that actually brought good news. That is not to say Obamacare does not have its drawbacks, which Hiltzik argues could be cured by a single-payer healthcare system. 


Judging Hospital Quality and Narrow Networks––Barking Up the Wrong Tree?

It isn't news for anyone to suggest the most expensive hospitals may not be worth the money. 

A recent paper published in the journal Health Affairs, "Understanding Differences Between High- and Low-Price Hospitals: Implications For Efforts To Rein In Costs" makes some excellent points regarding the pricing power of the largest hospitals and the wide variation in local prices. But then it attempts to make some comparisons between cost and quality of care concluding that "the high-priced hospitals' performance on outcome-based quality measures was mixed.".

Looking at the analysis suggesting that cost doesn't necessarily equal quality and comparing it to some real life situations I've seen leads me to believe these studies are missing something really big.

Rating the best hospitals has always been about reputation as well as quantitative measurements of things like complications and morbidity.

These quantitative measurements are valid. But they are far from the whole picture because such ratings are largely based upon short-term mortality and complication rates. For example, a hospital's rating in the popular USNews and World Report Hospital Ranking partly depends upon the mortality rate immediately after the procedure: "A hospital's success at keeping people alive was judged by comparing the number of Medicare patients with certain conditions who died within 30 days of admission in 2009, 2010, and 2011 with the number expected to die given the severity of the illness."

The Health Affairs article points out that CMS tries to go further than the largely reputation-based ratings in the USNews survey by tracking more Medicare outcomes.  The article points to the "mixed" outcome-based hospital quality measures among the hospitals with the best reputations: "They preformed worse than the low-price hospitals on measures of excess readmissions and on patient-safety indicators, including postsurgical deaths and complications."
http://healthpolicyandmarket.blogspot.com/2014/02/judging-hospital-quality-and-narrow.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

Health, Work, Lies

On Wednesday, Douglas Elmendorf, the director of the nonpartisan Congressional Budget Office, said the obvious: losing your job and choosing to work less aren’t the same thing. If you lose your job, you suffer immense personal and financial hardship. If, on the other hand, you choose to work less and spend more time with your family, “we don’t sympathize. We say congratulations.”
And now you know everything you need to know about the latest falsehood in the ever-mendacious campaign against health reform.
Let’s back up. On Tuesday, the budget office released a report on the fiscal and economic outlook that included two appendices devoted to effects of the Affordable Care Act.
The first appendix attracted almost no attention from the news media, yet it was actually a bombshell. Much public discussion of health reform is still colored by Obamacare’s terrible start, and presumes that the program remains a disaster. Some of us have pointed out that things have been going much better lately — but now it’s more or less official. The budget office predicts that first-year sign-ups in the health exchanges will fall only modestly short of expectations, and that nearly as many uninsured Americans will gain insurance as it predicted last spring.
This good news got drowned out, however, by false claims about the meaning of the second health care appendix, on labor supply.
http://www.nytimes.com/2014/02/07/opinion/krugman-health-work-lies.html?hp&rref=opinion

The health-care myths we live by

By , E-mail the writer

Swedish researchers report that antioxidants make cancers worse in mice. It’s already known that the antioxidant beta-carotene exacerbates lung cancers in humans. Not exactly what you’d expect given the extravagant — and incessant — claims you hear made about the miraculous effects of antioxidants.
In fact, they are either useless or harmful, conclude the editors of the prestigious Annals of Internal Medicine: “Beta-carotene, vitamin E and possibly high doses of vitamin A supplements are harmful.” Moreover, “other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.” So useless are the supplements, write the editors, that we should stop wasting time even studying them: “Further large prevention trials are no longer justified.”
Such revisionism is a constant in medicine. When I was a child, tonsillectomies were routine. We now know that, except for certain indications, this is grossly unnecessary surgery. Not quite as harmful as that once-venerable staple, bloodletting (which probably killed George Washington), but equally mindless.
After “first, do no harm,” medicine’s second great motto should be “above all, humility.” Even the tried-and-true may not be true. Take the average adult temperature. Everyone knows it’s 98.6 . Except that when some enterprising researchers actually did the measurements — rather than rely on the original 19th-century German study — they found that it’s actually 98.2.
But if that’s how dicey biological “facts” can be, imagine how much more problematic are the handed-down verities about the workings of our staggeringly complex health-care system. Take three recent cases:



California health exchange pulls error-ridden physician list--again

By Chad Terhune
7:24 AM PST, February 7, 2014
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Admitting it gave some consumers bad information, California's health insurance exchange pulled its physician directory for having too many errors.
Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.
The exchange yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November.
Since Obamacare policies took effect Jan. 1, many enrollees have complained that doctors won't take their insurance even though the physicians were listed as part of their network on the state website and by their health plan.
The exchange said Thursday that "while the combined provider directory was a useful service for many consumers, some enrollees located physicians thought to be in their plan, and subsequently discovered they were not."
The exchange has touted the directory as an important consumer tool because some insurers have sharply limited the number of doctors and hospitals in policies being offered under the federal healthcare law.
The state said enrollees who are unsatisfied with their provider network still have time to cancel their coverage and sign up with a different insurer before open enrollment ends March 31.
However, that may be little comfort for people who experienced computer errors and long delays to enroll the first time under the Affordable Care Act.
Customer service problems continue to plague the exchange and some insurers in light of 625,000 people enrolling through mid-January. Covered California said people waited nearly 52 minutes, on average, to speak with someone at the state's call center last week.
The exchange is in the process of hiring 350 more people to answer the phones and assist people.
Covered California said it will continue to include online links to insurers' provider directories. But the exchange directory offered the advantage of enabling people to search for doctors across health plans while shopping for coverage.
In an interview last week, officials at the California Medical Assn. said they were still finding flaws in the state's data, often because of incorrect information from insurers.
Health insurance companies, in turn, blame some doctors' offices for mistakenly turning patients away even though they are under contract for the networks.
Many insurers have adopted narrower networks to help hold down premiums on individual policies sold in and outside the exchange.
Micah Weinberg, a health-policy expert and senior advisor at the Bay Area Council in San Francisco, said these errors and the finger-pointing that has ensued could sap recent momentum on enrollment.
"One of the things that worries me a great deal about all this is that it runs the risk of setting consumers, doctors, health plans and Covered California against each other," Weinberg said.

Maine lawmakers take more time to study proposed regulation of ‘narrow band’ health insurance networks

By Scott Thistle, Sun Journal
Posted Feb. 06, 2014, at 6:14 p.m.
AUGUSTA, Maine — A legislative panel on insurance and financial services is working on how Maine might regulate “narrow band” networks offered by health insurance providers to their customers.
The Insurance and Financial Services Committee on Thursday again tabled a pair of bills that seek to improve disclosure for patients and health care providers as well as determine limits for how far a patient must travel for health care.
So far, the committee has taken a look at how other states handle the issue and what Maine’s current law allows and prohibits.
The new insurance plans, allowed under the federal Affordable Care Act, can limit where their subscribers can seek treatment and from whom.
While several lawmakers appear poised to support some kind of change to Maine law, others said the federal Affordable Care Act, which would supersede state law, remains a “moving target.”
Sen. Geoffrey Gratwick, D-Bangor, Senate chairman of the committee and a doctor, said he wanted the law to ensure that patients would get the best care available, especially for unique conditions. But he also understood that allowing patients to seek care for any condition without restraint was unreasonable.
During Thursday’s committee work session on the bills, Gratwick said patients often want to get care from whichever doctor or specialist was most recently featured in “People” magazine. But when it came to rare or difficult to treat cases, patients should be able to go to a specialist, Gratwick said.
“I think there should be a chain by which you can refer people, I want that person to be able to get the very best care they can,” Gratwick said, “But it needs to be so we are not just talking about treatment for a sore shoulder or the snuffles.”
Before the panel are bills that would require disclosure to health insurance customers before they purchase a plan that clearly shows them which providers will be in their network and which won’t.
The measure also allows health care providers, including hospitals, to find out why they were excluded from a particular health insurance provider’s network. Other lawmakers suggested an appeal of exclusion also be allowed.
Gratwick and Rep. Joyce Fitzpatrick, R-Houlton, also suggested the state find out if it can alter the way health plans are described on the federal government’s health insurance exchange.



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