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Monday, March 31, 2014

Health Care Reform Articles - March 31, 2014

Start-Up Health Insurer Finds Foothold in New York

By 
One afternoon in late March, Kevin Nazemi stood along a wall of the small, sweltering offices of the health insurance start-up Oscar in downtown New York, trying to rally the troops.
Noting that so far more than 10,600 New Yorkers had signed up for health insurance through Oscar, Mr. Nazemi, 32, a former Microsoft marketer who was a co-founder of Oscar last year, predicted long hours as individuals raced to meet the March 31 deadline for insurance coverage this year.
As Mr. Nazemi wrapped up, the 50 or so people in the room — most of whom appeared to be wilting in the heat thanks to a malfunctioning thermostat and in dire need of a Red Bull — clapped weakly before returning to their phones or computer screens.
Nearby, another founder, Joshua Kushner, 28, the scion of a New York area real estate dynasty whose venture capital firm has placed a sizable bet on Oscar, watched silently as he pulled his bright purple hoodie up over his head.
Oscar is Silicon Alley’s challenge to the staid business of health insurance. It is trying to use its tech-world skills to provide an easier experience to consumers. Its snazzy website is extremely easy to navigate (typing in “I have a stomachache” will pull up many options of types of doctors or facilities to visit). But what sets it apart, at least for now, is telemedicine, or unlimited phone calls with physicians, and greater price transparency.
http://www.nytimes.com/2014/03/29/business/start-up-health-insurer-finds-foothold-in-new-york.html?action=click&contentCollection=Business%20Day&region=Footer&module=MoreInSection&pgtype=article

Public support for health law drops in poll

But few think federal program will be repealed

By Ricardo Alonso-Zaldivar and Dennis Junius

WASHINGTON — Despite a late surge in sign-ups, support for President Obama’s health care law is languishing at its lowest level since passage of the landmark legislation four years ago, according to a new poll.
The Associated Press-GfK survey finds that 26 percent of Americans support the Affordable Care Act. Yet even fewer — 13 percent — think it will be repealed. A narrow majority expects the law to be further implemented with minor changes, or as passed.
“To get something repealed that has been passed is pretty impossible,” said Gwen Sliger of Dallas. “At this point, I don’t see that happening.”
Sliger illustrates the prevailing national mood. Although a Democrat, she’s opposed to Obama’s signature legislation. Yet she thinks the law is here to stay.
“I like the idea that if you have a preexisting condition you can’t be turned down, but I don’t like the idea that if you don’t have health insurance you’ll be fined,” said Sliger.
That central requirement that virtually all Americans have coverage or face fines remains unpopular. Forty-one percent said it should be repealed, about double the 19 percent who said it should remain in the law as passed.
Obama, insurers, and most policy experts consider the so-called individual mandate essential to creating a big insurance pool that keeps premiums affordable.
The poll was taken before Thursday’s announcement by the White House that new health insurance markets have surpassed the goal of 6 million sign-ups, so it did not register the potential impact of that news on public opinion.
Open enrollment season began with a dysfunctional HealthCare.gov website last Oct. 1. It will end Monday at midnight, on what looks to be a more positive note.

Maine lawmakers send Medicaid expansion bill to LePage

The bill to cover more than 60,000 uninsured Mainers faces a certain veto from the governor.

By Steve Mistler smistler@pressherald.com
Staff Writer
AUGUSTA – The state Senate gave final approval Friday to a bill that would expand the state’s Medicaid health care program to more than 60,000 uninsured Mainers and establish a managed care system for the 320,000 current beneficiaries.
he proposal faces a certain veto by Gov. Paul LePage.
The Senate enacted the bill without debate or a roll call vote, sending the compromise measure co-sponsored by two moderate Republicans to the governor. The bill was designed to attract support from conservatives, but a majority of Republicans in the House and Senate backed the governor’s staunch opposition.
A veto of the bill will face override votes by the Legislature, but will likely be upheld. An override requires votes from two-thirds of the lawmakers present and voting in each chamber. The bill, while passing, failed to win two-thirds support in roll call votes in the House and Senate.
LePage and Republican legislators have said that the state’s $2.5 billion Medicaid program is already unsustainable and should not be expanded.
Democrats have countered that the federal government will fully reimburse the state for the cost of expansion through 2016 before gradually reducing the funding to 90 percent, after 2020.
They say that if Maine does not expand Medicaid, it will increase the likelihood that more than 150 low-income Mainers with chronic illnesses will die, based on statistical projections about the uninsured population.
About 36,000 people would fall into a coverage gap because their earnings are below the poverty level so they don’t qualify for subsidized insurance on the federal marketplace established by the Affordable Care Act.

Is latest MaineCare expansion proposal right answer to state’s needs?

By Ed Youngblood, Special to the BDN
Posted March 26, 2014, at 12:27 p.m.
During the time that I have been in the Maine Senate, Medicaid expansion is, by far, the most difficult issue that I have encountered.
Over the past year, I have had many meetings to listen to the concerns of my constituents.
Many of their stories were difficult to hear. No one can argue that this great country isn’t taking care of the truly needy the way it should.
Last year, I was actively involved in creating an amendment to the expansion bill that did make it better, but not good enough.
I was also involved this past year with a small group that created what is known as the Katz/Saviello amendment to Medicaid expansion, and it, too, makes it a better bill. It includes a managed care provision that calls for the state to contract with private companies to manage Medicaid recipients’ health care.
I believe that the most efficient way to control costs in the long term is to convert to this type of system. This would improve access to health care in rural areas, assist the Department of Health and Human Services to transition to a model already working for other states, and keep the program within the budgeted money as it adds participants.
But there are issues that have given me many sleepless nights:
1. We have just completed a supplemental budget to balance our 2014 budget and at least the first half-year budget for 2015. DHHS said it needed an additional $45 million to meet its projected new needs. We were able to only give the department $31 million.
2. The MaineCare program without expansion is 23 percent of the state’s total budget and growing. It will consume about 30 percent of our total budget within five years. This is unsustainable.
3. Previously, the costs involved with the expansion of MaineCare were severely underestimated. That is the cause of many of our current budget problems such as the underfunding of education, municipal revenue sharing, nursing homes and important government services such as public safety and the court system. It’s also led to increased sales taxes and other fees, more than a half-billion-dollar debt to our hospitals and longer waiting lists for people with severe handicaps. The list goes on and on.
4. The bill has a sunset after three years, which gives a future Legislature the option of rolling back the expansion. This is a lot like giving someone a nice new home but telling them not to get too attached because in three years they’re going to be kicked out.
5. DHHS projects that the three-year trial period will require it to budget about $84 million to cover costs.
6. Free insurance, “MaineCare,” is provided to 319,000 individuals. Expansion, if projections are correct, will add 70,000 people almost immediately and up to 100,000 over the next 10 years.
7. If the bill passes, it will not become law until July. It would take another year or more for the Request for Proposal process to be completed to choose three or four managed care companies to run the program. We would already be two years into the three-year sunset. With only one year under our belt, can we really evaluate the effectiveness of the expansion?
8. Will the federal government pay the promised 90 percent starting in 2020? Even if it does, Maine’s share would be $100 million to $150 million per year. Thirty-eight percent of the state budgetwould be used to fund MaineCare. Devastating.
9. Will the federal government allow us to get out of the program after three years?
http://bangordailynews.com/2014/03/26/opinion/contributors/is-latest-mainecare-expansion-proposal-right-answer-to-states-needs/print/

Repercussions and Reprieves at Health Insurance Enrollment Deadline

By 
WASHINGTON — America’s health insurance marketplace closes on Monday night, the deadline for most people to obtain coverage or face a penalty.
The confusion and uncertainty of the last six months appear likely to continue as consumers, including some who have never had insurance, begin using new policies for the first time. Here are answers to some frequently asked questions.
Q. What happens if a consumer does not sign up for insurance by the Monday deadline?
A. The consumer may be subject to financial penalties, to be paid with federal income taxes next year. However, the federal government has said it will stretch the sign-up deadline for people who started an application and could not finish it for one reason or another.
To preserve their rights, consumers can call the federal insurance marketplace (1-800-318-2596) and request a “special enrollment period.”
Officials running the federal marketplace, which serves 36 states, will provide an unspecified amount of extra time to people who are “in line as of March 31,” and some states running their own exchanges have adopted similar policies.
http://www.nytimes.com/2014/03/30/us/repercussions-and-reprieves-at-health-insurance-enrollment-deadline.html?hpw&rref=health&_r=0&assetType=nyt_now

The Health Insurance Answer That Took 3 Months

In this episode, a rare collision of the Haggler and the news. Our letter comes from a couple who have been trying for months to sign up for health insurance through Healthcare.gov, also known as the Obamacare website. And Monday, March 31, is the enrollment deadline, though the administration recently announced exemptions for people who had trouble signing up.
In other words, this column is sort of timely. The Haggler would like some credit for this. He’d also like to note that it is unlikely to ever happen again.
Q. As a regular reader of your column, I know that you have successfully slain many corporate dragons. But do you have what it takes to take on the United States government? In particular, the health care exchange set up by the Affordable Care Act?
I signed up for health insurance for my wife and myself through the online marketplace last November. But in January, my wife, Mindy, was denied a benefit from the pharmacy and was told she was not listed on the policy. This is a disaster. My wife has survived cancer, and she needs health insurance.
Numerous calls to the Health Insurance Marketplace have ensued in which it has been established that Mindy’s name was, in fact, on the application I submitted and that for some inexplicable reason her name was not communicated to our insurer, Blue Cross and Blue Shield of Florida. We have been told on successive calls that there is no logical explanation for this, and that our complaint will be “elevated” and “expedited.”
I write this in mid-March. Mindy has had no health coverage since Jan. 1.
I think it only fair to tell you that employees at my congressman’s office have had no success in trying to rectify this situation. Is the Haggler ready for a big-time challenge? I hope so.
RICHARD AGLER, TAVERNIER, FLA.
A. The Haggler does enjoy a bit of goading. So, he contacted Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, which oversees Healthcare.gov.
It would be fun to turn what follows into a lengthy tale, one in which the Haggler’s swashbuckling tactics, cunning and perseverance triumph over an intransigent bureaucracy. But the truth is duller. A day or two after an email to Mr. Albright, Mr. Agler wrote, “I think we have good news.”



In New Health Care Era, Blessings and Hurdles

By 
LOUISVILLE, Ky. — In a plain brown health clinic on a busy boulevard here, the growing pains of the Affordable Care Act are already being felt — almost too sharply for the harried staff trying to keep up with the flow of patients.
Tamekia Toure, 40, is typical of the clinic’s new patients, a single mother and recent arrival from Alabama with diabetes, high blood pressure, chronic pain and, for much of her adult life, no health insurance. For her, the new law is a godsend, providing Medicaid coverage that she would not have received before.
Then there is Donna Morse, 61, a widowed dental hygienist and yoga buff who is long overdue for a mammogram and blood work. She lost her insurance last year because it did not meet the new law’s standards. Now she has a new plan with much higher premiums, and which few doctors and hospitals will accept. So she too, warily, has landed at the clinic, one of seven here called Family Health Centers.
http://www.nytimes.com/2014/03/31/us/in-new-health-care-era-blessings-and-hurdles.html?hp&assetType=nyt_now

Obamacare has led to health coverage for millions more people

At least 9.5 million previously uninsured people have gotten health insurance since Obamacare started, surveys and reports show.

By Noam N. Levey
9:14 PM PDT, March 30, 2014
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WASHINGTON — President Obama's healthcare law, despite a rocky rollout and determined opposition from critics, already has spurred the largest expansion in health coverage in America in half a century, national surveys and enrollment data show.
As the law's initial enrollment period closes, at least 9.5 million previously uninsured people have gained coverage. Some have done so through marketplaces created by the law, some through other private insurance and others through Medicaid, which has expanded under the law in about half the states.
The tally draws from a review of state and federal enrollment reports, surveys and interviews with insurance executives and government officials nationwide.
The Affordable Care Act still faces major challenges, particularly the risk of premium hikes next year that could drive away newly insured customers. But the increased coverage so far amounts to substantial progress toward one of the law's principal goals and is the most significant expansion since the creation of Medicare and Medicaid in 1965.
The millions of newly insured also create a politically important constituency that may complicate any future Republican repeal efforts.
Precise figures on national health coverage will not be available for months. But available data indicate:
• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.
• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.
• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand's unpublished survey data, which were shared with The Times. That tracks withestimates from Avalere Health, a consulting firm that is closely following the law's implementation.
• An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents' health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.
• About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.
• Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.
Republican critics of the law have suggested that the cancellations last fall have led to a net reduction in coverage.
That is not supported by survey data or insurance companies, many of which report they have retained the vast majority of their 2013 customers by renewing old policies, which is permitted in about half the states, or by moving customers to new plans.
"We are talking about a very small fraction of the country" who lost coverage, said Katherine Carman, a Rand economist who is overseeing the survey.
Rand has been polling 3,300 Americans monthly about their insurance choices since last fall. Researchers found that the share of adults ages 18 to 64 without health insurance has declined from 20.9% last fall to 16.6% as of March 22.
The decrease parallels a similar drop recorded by Gallup, which found in its national polling that the uninsured rate among adults had declined from 18% in the final quarter of last year to 15.9% through the first two months of 2014. Gallup's overall uninsured rate is lower than Rand's because it includes seniors on Medicare.
Gallup Editor in Chief Frank Newport said that March polling, which has not been released yet, indicates the uninsured rate has declined further.
"While it is important to be cautious, the logical conclusion is that the law is having an effect," he said.
Although estimates vary, about 45 million to 48 million people are believed to have been uninsured before the marketplaces opened last year.
The survey data are bolstered by the experiences of insurance companies and state governments, which are tracking enrollment in public and private coverage.
"We are on target to exceed what was estimated," Lisa Sbrana, counsel for New York's insurance marketplace, said on a recent call organized by Families USA, a Washington-based advocacy group that supports the law. About 70% of New Yorkers signing up for coverage through the marketplace or Medicaid were previously uninsured, Sbrana said.
In Kentucky, about 75% of the state residents signing up on that state's marketplace or for Medicaid had no insurance, a state study indicates. As of Friday, more than 280,000 new people had enrolled in Medicaid in Kentucky, or nearly 91% of the residents officials estimated would become eligible for the program this year.
"We expect a huge net gain" in coverage, said Bill Nold, deputy executive of the state's marketplace
http://www.latimes.com/nation/la-na-obamacare-uninsured-national-20140331,0,1348898,print.story


Insurers already calculating 2015 premiums as Obamacare kicks in

Far more Californians than expected have bought plans through the state health insurance exchange. How sick they are will factor into next year's prices.

By Chad Terhune
5:00 AM PDT, March 30, 2014
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After months of head counts for Obamacare, it is the medical bills that will start to matter now.
Even before enrollment closes Monday, California has far exceeded its initial goals for signing up people under the Affordable Care Act. Although the sheer volume of 1.1 million policyholders is impressive for a brand new government program, the number of sicker patients is what's likely to draw the most attention.
How sick they are and the size of their medical bills will be front and center in the weeks to come as insurers begin drawing up next year's insurance rates, which will become public this summer.
The outcome — hefty rate hikes or more modest increases — in the pivotal state of California could help shape political races nationwide and the future of enrollment for President Obama's signature law.
WellPoint Inc., parent of California's leading health insurer in the exchange, Anthem Blue Cross, has already predicted "double-digit-plus" rate increases on Obamacare policies across much of the country.
Other experts discount the notion of soaring premiums because the Obama administration has programs in place to help health plans offset losses from higher-cost customers.
Meanwhile, most everyone involved is waiting to see how many additional people rush in by Monday, the last day to begin enrolling in Obamacare.
But health insurers aren't wasting any time sizing up what patients are costing them now and what that will mean for 2015 rates.
Hunkered down in conference rooms, insurance actuaries are parsing prescriptions, doctor visits and hospital stays for clues about how expensive these new patients may be. By May, insurance companies must file next year's rates with California's state-run exchange so negotiations can begin.
"If rates in California increase by 20%," said Robert Laszewski, a healthcare consultant in Virginia, "enrollment will go down and any healthy people will bail."
Those concerns are one reason the Covered California exchange, insurers and health-law supporters are trying so hard to persuade young and healthy people to enroll before Monday's deadline. The goal is to improve the chances of getting a balanced mix of policyholders and keep monthly premiums down.
No matter the final outcome, Covered California officials are confident they have done enough to avert upheaval in the market.
"I think we're in a position to be optimistic that if rates go up at all, it will be in the single digits," said Peter Lee, executive director of Covered California.
Harriet Davidson, 60, was one of the first people in line for Obamacare after being shut out of the market for years.
The self-employed consultant in Contra Costa County was rejected twice for individual health insurance because of her diabetes and a thyroid condition. The healthcare law removed that obstacle by guaranteeing access to coverage regardless of preexisting conditions.
That meant Davidson could buy a Silver plan from Blue Shield of California that costs her $92 a month — thanks to a federal subsidy.
"I probably neglected my health the last few years because of the expense," Davidson said. "Now I'm going to have every test known to man."
http://www.latimes.com/business/la-fi-obamacare-deadline-rates-20140330,0,7009095,print.story

HealthCare.gov Malfunctions on Last Enrollment Day

By DAVID S. JOACHIM

WASHINGTON — The federal website where consumers can sign up for medical coverage under President Obama’s health care law unexpectedly stopped taking applications for several hours early Monday, the last day of open enrollment, because of a software problem, the administration said.
The enrollment system on the site, HealthCare.gov, was taken offline for scheduled maintenance between 1 a.m. and 5 a.m., but then remained down for several more hours because of a software bug discovered by technology personnel during maintenance, said Aaron Albright, a spokesman for the Department of Health and Human Services.
Consumers who started an application and left their email addresses “will be invited back when the system is available,” Mr. Albright said in a written statement.
Mr. Albright added that the software problem was “not volume related.”
A surge of traffic has hit HealthCare.gov in the final days of open enrollment, the administration has said.
Last week, the administration said it would extend the deadline for people who tried to apply but were blocked by technical problems with the site. It also said that it had exceeded its revised goal of signing up six million people over the federal exchange and similar sites run by the states.

New York Curbs Medical Bills Containing Surprises

By 
Every year, thousands of New Yorkers find themselves responsible for a surprise medical bill from a doctor, like an anesthesiologist, who becomes involved in their care but, unbeknown to the patient, is not covered by their insurance.
Now a provision in the state budget agreement announced Saturday is intended to protect consumers by requiring that they be given a reasonable amount of notice when an out-of-network doctor will be treating them.
If they are stuck with a surprise bill, patients will be responsible only for whatever their co-pay would be if the doctor were in-network. The out-of-network doctor and the insurance company will have to hash out the bill using what is known as baseball arbitration, with each proposing a price and an arbitrator choosing one of them. The law will go into effect in one year.


“The heart of the bill came out of the fact that the No. 1 complaint on health insurance issues we receive year after year is people who get stuck with surprise balance bills,” Benjamin Lawsky, superintendent of the state’s Financial Services Department, which regulates insurance, said on Sunday.
Usually the doctors involved are not the primary physician whom the patient has come to know but a radiologist, pathologist or anesthesiologist involved in a procedure, like surgery or colonoscopy. Sometimes, patients make it to the operating table before they learn that the out-of-network doctor is involved in the operation.
Insurance plans typically either do not permit patients to go to doctors out of their prescribed network, or charge more when they do. Mr. Lawsky said that patients with plans restricting them to in-network doctors tend to be the patients who are most cost-conscious and can least afford surprise bills.
He said his department got several thousand complaints a year but suggested that many more people had the problem but did not complain.
“We think this is potentially a national model,” Mr. Lawsky said. “These surprise balance bills are very prevalent around the country.”

Tell Obama: ACA's a scam, we need Medicare for All

Why I am a conscientious objector to the ACA 

By Margaret Flowers, M.D.
PopularResistance.org, March 28, 2014
I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.
I am currently uninsured, so I have to make a choice. I don’t qualify for Medicaid and I’m too young for Medicare. By law, I am required to buy private insurance or pay a penalty. But I find myself in the position of not being able to do either. I can’t in good conscience give money to the health insurance industry that I am fighting to eliminate. And I can’t in good conscience pay a tax penalty that will be given to that industry. So, I am going to be a Conscientious Objector to the ACA.
I suspect that there are others who feel as I do. If you are planning to object to purchasing insurance and you support Medicare for all, you might like to join me in sending a letter to President Obama. See the petition here.
The issue is access to care, not the number who buy insurance
As the March 31 deadline to purchase health insurance or face a penalty approaches, the public debate is focused solely on enrollment numbers. Great efforts are being expended to compel people to buy insurance. The “Young Invincibles,” a term created to misrepresent uninsured young adults, are being marketed heavily. And Enroll America, a coalition of advocates and health industry executives, is working overtime to encourage volunteers to be creative in the ways they locate and convince people to purchase insurance.
The mass media and politicians are constantly talking about the health care marketplace. We are being indoctrinated with market rhetoric. Patients are called consumers and health insurance plans are called products. The problem with this is that health care doesn’t belong in the marketplace whose logic dictates that care should be denied if a profit cannot be made. Health care is a public good and something that everyone needs throughout their lifetime.
Focusing solely on the number of people who are insured is what the private health insurance industry wants the public to believe is most important. The industry spent tremendous amounts of money and time to get a law that would force people to buy insurance in order to protect and enhance their assets. They want everyone to buy their products and to make people feel reckless or irresponsible if they don’t. This is a massive campaign to distract people from asking the questions that really matter, such as whether people with insurance will be able to afford health care, whether bankruptcies from medical debt will continue and whether overall health outcomes will improve.
In the United States, having health insurance does not guarantee access to necessary health care. In fact, rather than creating health security, the ACA is degrading health care coverage in the US. It is also creating the largest transfer of public dollars to a private industry ever, as UNITE HERE reports “most of the ACA’s $965 billion in subsidies will go directly to commercial insurance companies.”
The insurance scam
biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.


Obamacare in Oregon: A failed exchange
By: Jennifer Haberkorn
March 31, 2014 05:10 AM EDT
Oregon and Washington state strongly embraced Obamacare and opened their own health insurance exchanges. The states are similar, not just geographically but politically, economically and demographically. As the first enrollment season winds down, Washington has some of the best results in the country. Next door, Oregon’s exchange website is still broken.
SALEM, Ore. — Oregon had all the right ingredients for a sparkling Obamacare success story: a Democratic doctor as governor, an eager Legislature and a history of health care innovation.
It ended up with Obamacare’s biggest technological disaster.
CoverOregon.com, the state’s equivalent of HealthCare.gov, is the only insurance exchange in the country on which people still cannot buy coverage entirely online. The flaws are so deep that Gov. John Kitzhaber concedes the state may give up on its own exchange and move to the federal HealthCare.gov next year. The challenges were so persistent that the state received federal permission to add a full month to its open enrollment season. The deadline for most of the country to become covered is 11:59 p.m. Eastern time Monday; here, enrollment will run through April.
The finger-pointing and political posturing have escalated as the exchange story has unfolded. Now, as states like Washington to the north and California to the south celebrate their progress, Oregon’s controversy is in full eruption. Kitzhaber, who is running for reelection this fall, faces mounting questions over whether he could have stopped the disaster. And the exchange board is hunting for its third leader since December.
(VIDEO: Timeline of Obamacare deadlines)
Oregon — a liberal state with an independent, hipster culture that embraces handlebar mustaches, composting and vintage shops — set sky-high expectations for what it could do with the Affordable Care Act. But Oregonians involved with the build-out interviewed here described a process that went awry early on: exchange designers who overreached, a contractor that didn’t complete the job and state officials who didn’t recognize the calamity unfolding right in front of them. That simple vision of expanding health care morphed into a byzantine mess of broken technology and political recrimination.
http://dyn.politico.com/printstory.cfm?uuid=E87EB453-DEF2-4D09-A439-738A7A0820F1

Obamacare in Washington state: 'No frills' success
By: Jennifer Haberkorn
March 31, 2014 05:10 AM EDT
Oregon and Washington state strongly embraced Obamacare and opened their own health insurance exchanges. The states are similar, not just geographically but politically, economically and demographically. As the first enrollment season winds down, Washington has some of the best results in the country. Next door, Oregon’s exchange website is still broken.
OLYMPIA, Wash. — In this far corner of the Pacific Northwest, Washington state shows what can happen when an Obamacare exchange launches — and doesn’t crash and burn.
In contrast to the other Washington’s HealthCare.gov, this Washington’s Healthplanfinder has run fairly smoothly almost from the start. While programs elsewhere sputtered and the federal portal didn’t work at all, the state signed up more than 1 in every 5 Americans who enrolled in an Affordable Care Act plan during the first month.
The 2014 enrollment season is winding down Monday with the Obama administration touting numbers above 6 million, far better than many expected. States will soon start making decisions about their exchanges for next year and thinking about how to repair deep and persistent glitches. Some are calling Washington to see how to replicate its success.
“It’s important for the whole country to have an exhibit” that others can follow with confidence, Gov. Jay Inslee said in an interview. “We know that other states have had substantially more challenges … but I think what we’ve learned is, once you get the software systems, hallelujah, it works, and we’ve been getting numbers that are sustainable in the long term.”
http://dyn.politico.com/printstory.cfm?uuid=B0FB0C81-07BF-43A5-A982-84693C8303C9

The Obamacare enthusiasm gap
By: David Nather
March 31, 2014 05:10 AM EDT
Irony alert: The Democrats’ biggest challenge this fall is to get their voters excited about a law that they asked for.
Obamacare will be a huge voting issue for Republicans — that’s already clear. They’ll turn out in droves because they hate the law. What’s less clear is how Democrats will get their supporters to the polls to say, “hey, thanks for health reform.”
And yet, the Affordable Care Act only exists because Democrats and their supporters had pushed for health reform for decades. Republicans didn’t ask for it. Independents didn’t demand it. It was liberals who wanted coverage for the uninsured, and a better system for sick people, to plug what they saw as the last remaining hole in the social safety net.
(Also on POLITICO: The Obamacare report card)
Now it’s here, and as clumsy as the rollout was, it’s the law they wanted. So the task for Democrats is to figure out how to close the enthusiasm gap — and convince their voters that Obamacare should be a voting issue for them, too.
The reality is, it’s probably going to be a negative message rather than a positive one. Most Democrats believe they can motivate voters by shifting the conversation to the GOP repeal efforts — warning voters about all the things they’d lose if the law went away.
In their view, the best campaigns will be laser-focused on how bad the old health care system was for many patients, and hammer away at Republicans as defenders of the old status quo.
“Democrats will turn out to prevent Republicans from giving insurance companies the power to raise health care costs, raising the costs of prescription drugs for seniors, and leaving kids with pre-existing conditions out in the cold,” said Democratic Congressional Campaign Committee Chairman Steve Israel. “We win by reminding voters of the catastrophic costs of repeal.”
The rapid surge of last-minute signups will help — it will make it easier for Democrats to prove there’s real interest in the law. At some point, though, they’ll have to deal with the awkward part that’s on everyone’s minds: How much do you actually talk about the botched website and the canceled policies?
(CARTOONS: Matt Wuerker on Obamacare)
Increasingly, liberal Democrats and outside groups are convinced that the formula that party strategists had recommended until now — telling candidates to stress that they’ll fix what’s wrong with the law — is not going to work. Instead, they’re saying vulnerable Democrats need to declare that millions of people have coverage now, remind everyone how bad the old system was, and accuse Republicans of wanting to return to it.
http://dyn.politico.com/printstory.cfm?uuid=0C3E2295-6EC1-4F28-9063-5A4FA5F6FDC3


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Friday, March 28, 2014

Health Care Reform Articles - March 28, 2014


Of Patients and Prices

By A.W. Gaffney, M.D.
Truthout, March 26, 2014
There are many good reasons to impatiently anticipate the end of one's medical training, which not infrequently lasts upwards of five years following medical school. But counterpoised to the oft-cited benefits -- greater autonomy, reliably increased remuneration, less reliably improved hours, and so forth -- there is also, unfortunately, an almost entirely unrecognized drawback: a largely unavoidable entanglement in the business of health care.
Now for some, such an entanglement might make the transition from training seem all the more attractive. But clearly, one need only hear about patients (or their surviving family members) being chased by collections agencies for medical bills, or about the growing problem of "medical bankruptcies" among the insured, or even about the bizarre unaffordability of asthma inhalers to see that something is seriously askew with the way the price of health care can adversely impact the circumstances of the ill. As my own clinical training now winds down, I frequently reflect on how to navigate today's highly problematic health care terrain - in which patients are increasingly exposed to the cost of care provided.
I think it's only fair to begin, however, by recognizing that unlike ethical issues revolving around artificial hearts or organ transplants, the problem of the cost of health care isn't entirely new. Hippocrates (or whoever it was that wrote the Precepts) generally saw nothing wrong in doctors looking after their pecuniary interests, though he also opined that they mustn't "extort money from those who are at death's door." The problem of US national health spending has likewise been recognized for some time: in 1971, as health care expenditures rapidly outstripped inflation, Richard Nixon proclaimed that the nation faced a "deepening crisis," which has been more or less the conventional wisdom ever since (if not without reason).
However, an awareness that something might be awry with what prices patients were being charged by hospitals, physicians, pharmaceutical companies, ambulance companies and more or less everyone in the health care industry seems to have surged into the spotlight in more recent years. The journalist Steven Brill, for instance, in an important issue-length article "Bitter Pill" in Time last year, investigated the stories of patients who received massive itemized bills for health care, which, in several instances, might very well be termed "money from those who are at death's door."
He discussed one person, for instance, who between diagnosis with metastatic lung cancer and death a mere 11 months later had accumulated some $900,000 in medical bills, debt that was then dumped onto his devastated wife. Additionally jarring, however, was Brill's exploration of the extremely high prices being charged for individual services or items to such patients (e.g. $77 for each tiny square of cotton gauze), which originated from a confidential list of hospital prices dubbed the "chargemaster."
Elizabeth Rosenthal of the New York Times has explored the issue further in an ongoing and highly revealing series. Like Brill, she finds instances of absurd prices (e.g. $3,355.96 for five stitches in the ER), though in most cases, these prices are frequently several times higher than what insurance companies - which directly negotiate reimbursements with hospitals and providers - actually pay. However, for the uninsured, the "underinsured" (i.e. those who have insurance, but with high deductibles, coinsurance or copays), those who are out-of-network, or those who have limits on coverage, the "chargemaster" is real enough. For these individuals and families, massive and arbitrary medical bills - for conditions ranging from the trivial to the deadly - can be tantamount to financial ruin.
Why is this issue coming to the spotlight now? Partially, it's a reflection of ongoing trends in the health care system that predated Obamacare but that are also not ended by it. Insured patients increasingly have more financial liability, or as the saying goes, "skin in the game," when they receive health care. High-deductible employer plans are more and more common, "four-tier" prescription drug plans are the norm, and themost commonly purchased "silver" plans on the Obamacare exchanges have an actuarial value of only 70%. All of this equates to increased "cost sharing," or out-of-pocket money paid for health care, on top of annual premiums (which are also rising). Between uninsurance and underinsurance, it's not all that surprising that unpaid medical bills apparently constitute half of accounts reported to collection agencies, compromising the credit scores and the financial opportunities of those affected. Along similar lines, 62% of US bankruptcies, according to one study, are caused by medical illnesses - even though most of these bankrupt individuals actually had health insurance at the time of their illness.
http://www.pnhp.org/print/news/2014/march/of-patients-and-prices

Most states fail on health price transparency, but not Maine

health policy, hospitals
By 
Health care prices remain hidden from patients in all but five states, preventing consumers from fully understanding their medical expenses, according to a new national report card.
Maine, however, earned a B grade. Only Massachusetts earned the same distinction, while Colorado, Vermont, and Virginia were awarded Cs. No state got an A. The rest of the country flunked.
The report was produced by the nonprofit Catalyst for Payment Reform, which works with large employers to improve transparency in health care pricing, and Health Care Incentives Improvement Institute, a Connecticut consulting nonprofit.
Last year, states fared slightly better, with 29 earning a failing grade. Maine was one of few states, among those that didn’t fail, to maintain its grade from 2013. But the grading was tougher this year. Before, states got points just for having transparency laws, but the new report judged how well those laws were actually implemented.
New Hampshire’s grade took a dive as a result. It earned an A in 2013, partly because of its law requiring prices to be publicly posted online, to an F this year, since the resulting website doesn’t work.
Maine passed a similar law, and its website is functional. Known as an “all payer claims database,” the site pools together health insurance claims to paint a picture of pricing for hospitals, doctors, and other health care providers. The database, operated by the Maine Health Data Organization, was launched in 2003, well ahead of the health pricing transparency curve.

Maine doctors, here’s what your patients think of you

health policy, Home, hospitals, public health
By 
When patients enjoy a good experience at the doctor’s office, it shows in their health, a growing body of research indicates. If you can get an appointment promptly and visit a provider who really listens and understands your medical history, you’re more likely to follow your doctor’s instructions, take change of your own health, and get a better clinical result, the thinking goes.
So how does your doctor measure up? For the first time in Maine, the public can view and compare how patients rated hundreds of medical practices across the state. Patient ratings of nearly 270 primary, pediatric, and specialty care practices are now online, based on surveys completed by roughly 40,000 adults, including parents.
The new website, mainepatientexperiencematters.org, is supported by the Maine Quality Forum, an independent state government division tasked with measuring and improving the quality of health care in Maine.
Karynlee Harrington of the Maine Quality Forum explained how the new results differ from other patient surveys.
“While many Maine practices privately survey their patients, until now there has never been a way to publicly compare patient experience ratings across practices,” she said in a press release announcing the website. “These practices showed tremendous leadership by participating in this initiative and sharing survey results with the general public.”
The voluntary survey asked randomly selected patients about aspects of their health care experience closely linked to quality, from how well doctors explained things to whether office staff was courteous and helpful. It was completed over a four-month period in late 2012/early 2013.


Survey: Mainers struggle to pay medical bills — even those with insurance

By Jackie Farwell, BDN Staff
Posted March 26, 2014, at 5:12 p.m.
Many Maine residents, even those with health insurance, struggle to afford their medical bills, a new statewide survey has found.
While the poorest Mainers reported the most difficulty affording health services, more than a quarter of residents with health coverage ran into trouble paying medical bills, according to the survey released Wednesday by the Maine Health Access Foundation.
Designed to track the impact of the Affordable Care Act in Maine, the survey polled nearly 1,000 residents in December 2013, just before new private policies purchased on Healthcare.gov took effect on Jan. 1, 2014. The research will provide a snapshot of the burden of health costs in Maine to serve as a benchmark in future years, said Dr. Wendy Wolf, president and CEO of the private nonprofit foundation.
“One of the most important questions that policymakers are going to want to know is what is happening in the wake of the Affordable Care Act with actually lowering the rate of uninsurance, and also helping people with the issue of both affordability and the types of benefits that are offered in insurance plans,” she said.
The foundation, which is leading the effort to sign Mainers up for health insurance under the ACA, partnered with market research firm GfK to conduct the survey. The poll piggybacked on a national health reform survey developed by the Urban Institute and funded by the Robert Wood Johnson Foundation and the Ford Foundation.
Bucking the national trend, Maine adults in the middle income range actually struggled more than their low-income counterparts to pay medical bills. About 35 percent of mid-range earners — with incomes between about $33,000 and $93,000 a year for a family of four — faced problems or were unable to afford their bills during the prior year, compared to 32 percent of those earning less. Many middle-income Mainers receive no government aid and don’t earn enough to buy a health policy with sufficient coverage, the survey results noted.
The Maine survey polled 992 adults between the ages of 18 and 64 across a range of incomes. Included were the uninsured; people who buy their own coverage in the individual market; those who get coverage through work; and Mainers with government-sponsored insurance, with the exception of Medicare.
The growth of bare bones, high-deductible health plans in the individual market likely contributed to many Mainers’ difficulty affording medical bills, Wolf said. Those plans will be phased out under the Affordable Care Act, except for those under age 30.
A chief goal of the law, also known as Obamacare, is to expand access to more robust and affordable health insurance, with free preventive care and a cap on out-of-pocket costs. Healthcare.gov, the federal government’s gateway for insurance marketplaces in Maine and 35 other states, targets private policies for individuals and small businesses, but also allows users to determine if they’re eligible for Medicaid.

Anti-Anxiety Drugs Tied to Higher Mortality

By NICHOLAS BAKALAR
 

A large study has linked several common anti-anxiety drugs and sleeping pills to an increased risk of death, although it’s not certain the drugs were the cause.
For more than seven years, researchers followed 34,727 people who filled prescriptions for anti-anxiety medications like Valium and Xanax, or sleep aids like Ambien, Sonata and Lunesta, comparing them with 69,418 controls who did not.
After adjusting for a wide variety of factors, the researchers found that people who took the drugs had more than double the risk of death. The study appears online in BMJ.
The researchers tried to account for the use of other prescribed drugs, age, smoking, alcohol use, socioeconomic status, and other health and behavioral characteristics. Most important, the investigators also controlled for sleep disorders, anxiety disorders and other psychiatric illnesses, all of which are risk factors for mortality.
The lead author, Dr. Scott Weich, a professor of psychiatry at the University of Warwick, said that while he and his colleagues were careful to account for as many potential risks as possible, they were not able to control for the severity of the illnesses suffered by the study participants.
Still, he said, the research “adds to an accumulating body of evidence that these drugs are dangerous.” He added: “I prescribe these drugs, and they are difficult to come off. The less time you spend on them the better.”
http://well.blogs.nytimes.com/2014/03/27/anti-anxiety-drugs-tied-to-higher-mortality/?_php=true&_type=blogs&emc=edit_tnt_20140327&nlid=1311158&tntemail0=y&_r=0

Deadline Near, Health Signups Show Disparity

By  and 
WASHINGTON — The online insurance marketplace in Oregon is such a technological mess that residents have been signing up for health coverage by hand. In Texas, political opposition to President Obama’s health law is so strong that some residents believe, erroneously, that the program is banned in their state.
But in Connecticut, a smoothly functioning website, run by competent managers, has successfully enrolled so many patients that officials are offering to sell their expertise to states like Maryland, which is struggling to sign people up for coverage.
The disparities reveal a stark truth about the Affordable Care Act: With the first open enrollment period set to end Monday, six months after its troubled online exchanges opened for business, the program widely known as Obamacare looks less like a sweeping federal overhaul than a collection of individual ventures playing out unevenly, state to state, in the laboratories of democracy.
The White House said on Thursday that more than six million people have signed up for private plans, a significant political milestone for the Obama administration. Independent analysts estimate that an additional 3.5 million Americans are newly insured under Medicaid — figures the law’s backers hail as a success.
But those numbers may not reveal much. Federal officials do not know how many of those who selected plans were previously uninsured, or how many actually paid their premiums. Independent experts warn that the intense focus on national numbers is misguided, and that it will take years to fully assess the law’s impact, much less deem it a success or a failure.
“The whole narrative about Obamacare — ‘Will they get to six million? What is the percentage of young adults going to be?’ — has almost nothing to do with whether the law is working or not, whether the premiums are affordable or not, whether people think they are getting a good deal or not,” said Drew Altman, president of the Kaiser Family Foundation, whose analysts are closely tracking the measure.
“It’s almost like trying to predict the local weather from national averages,” Mr. Altman said. “This is really now a state and local game, not a national one.”
http://www.nytimes.com/2014/03/28/us/politics/deadline-near-health-signups-show-disparity.html?_r=0



 


DOCTORS

Doctor Priorities vs. Patient Priorities

By DANIELLE OFRI, M.D.
 

Not so long ago, a middle-aged patient came to my office for a checkup. He cheerfully admitted that he hadn’t been paying attention to his diabetes for the last few years. He’d stopped taking his medicine, stopped seeing his doctors, stopped thinking about the disease altogether. When I checked his blood sugar in the office, it wasn’t just a little elevated — it was four times the normal level.
For doctors, it is always a shocker to hear a case like this. How can a patient completely ignore a disease for so long? How can a life-threatening illness just disappear from someone’s consciousness?
The patient was not in denial; he knew he had diabetes. It just wasn’t on his priority list at this point in his life. For me, it was flashing neon at the top of my list with seven exclamation points.

Don’t quit before you start

By Ellen Oxfeld
Rutland Herald, March 27, 2014
This week in a VPR interview, Senate President Pro Tem John Campbell backed away from an unwavering commitment to the historic task set out in Act 48 — creating a publicly funded guaranteed health care system for all Vermonters.
Campbell’s stated reason for this is disappointing. He demurred that he was not sure that a single-payer financing plan would be “politically viable” in the Legislature because of the “costs” of single payer.
Senator Campbell needs to reconsider. It’s true that financing a single-payer plan will cost about $2 billion; but that is actually less than we Vermonters are already paying. (In fact, in 2011, we Vermonters paid $2.5 billion in private premiums and out-of-pockets for our health care.)
It is also odd to see a Senate leader shrinking from his delegated role of doing just what he has been selected to do, lead. In the past, Senator Campbell has been a leader on many issues, such as marriage equality and in passing Act 48, the 2011 road map legislation for single-payer. Yes, successfully enacting an equitable and viable single-payer financing package will not be easy. It will take political courage.
But the facts support moving forward, not giving up before even trying. After all, in five official studies commissioned since 2001 by the state of Vermont, the conclusion has always been the same — there is no other way to guarantee health care for all Vermonters while containing costs other than a publicly financed (“single-payer”) system.
The Senate president stated that he would like an “alternate” plan in case single-payer financing does not work out. But we already have an alternate plan in place — the Affordable Care Act. And although that act has certainly helped some individuals to purchase private insurance, it still leaves in place our multi-tiered system of different private plans, with different levels of coverage and the expenses created by the complex administration of such a system.
Furthermore, a situation in which there are multiple levels of private plans can never guarantee access to health care for all. It can still leave people with inadequate financial protection, or even without health care coverage at all, in the event that they change jobs, lose jobs, or experience changes in their financial status.
Act 48 was not passed on a fanciful whim. It passed because it built upon two decades of experience and numerous studies. Alternatives to a publicly financed health care plan for all were studied and tried, but none offered the possibility of both universality and cost control. Publicly financed systems throughout the world surpass our present system by guaranteeing access to health care for all while simplifying administration and containing costs effectively.
The vision of guaranteed health care and an affordable health care system can be reached in Vermont. Vermonters will be ill served if our political leaders step away from the road map laid out in Act 48, which they voted for and passed.

Obamacare is not universal health care [Commentary]

The Affordable Care Act leaves some of our neediest citizens without insurance or a reliable source of care



By Max Romano
11:11 a.m. EDT, March 26, 2014

Mary is single, in her late 50s, widowed and earning about $2,000 a month cleaning bathrooms downtown. She's had no health insurance for the last decade, but she's received medical care when she needed it at free clinics and emergency rooms.
But now it's the era of Obamacare, and Mary hears that she has to buy health insurance. We check her options on Maryland Health Connection, the state's online health insurance exchange:
The cheapest "bronze plan" is only $2.20 per month, which will avoid a year-end fine for being uninsured, but it pays for little up until the $6,000 deductible. The "silver plans" cost $130 to $360 per month with a $900 annual deductible, but for those she'd have to choose between a health savings account, a limited HMO provider network, a 40 percent or a $40 co-pay, and many other confusing options.
None of it sounds like straightforward "affordable care" to her.
This isn't a story about error messages or frozen screens. Website crashes make news; they don't make history. This is about the real implications of Obamacare, about which ideas work in real life and which just sound good on paper.
Mary was just one of dozens of low-income Baltimoreans I met as a health insurance enrollment volunteer in a Baltimore free clinic over the past six months, but she shares the experience of thousands of Marylanders this season. Once the website glitches subsided, the reality set in that the government was telling uninsured people to spend a significant portion of their incomes on health insurance. I have seen how many low-income Marylanders will remain uninsured because of the cost and complexity of buying insurance.
If we really want universal health care, we need a public system that actually includes all people, such as extending Medicare to all Americans. Obamacare's individual mandate to buy health insurance does not reach everyone because many uninsured individuals will not "buy-in" to an expensive and overly complex insurance system.
Unlike some critics, I do not think the Affordable Care Act (a.k.a. Obamacare) got everything wrong: It has made health insurance for individuals cheaper and better. Obamacare expands Medicaid to cover more low-income people, creates tax credits to make insurance cheaper for individuals, makes it illegal for insurance companies to deny coverage based on preexisting conditions and stops insurers from rescinding coverage when beneficiaries get sick.
But while Obamacare patches some of the gaping holes in the health insurance market, it also fails to create access for many of the people who never budgeted for insurance before. The bottom line is that Obamacare will insure millions, but it will also leave tens of millions of Americans still uninsured.

http://www.baltimoresun.com/news/opinion/bs-ed-obamacare-medicare-20140326,0,5129108.story#ixzz2x5adCqZw

The Obamacare report card
By: David Nather
March 28, 2014 05:05 AM EDT
Time’s up, Obamacare. Ready for your grades?
After six months, the first enrollment season is coming to an end. So it’s time to take stock, with POLITICO’s report card that covers the highs and lows of the rollout.
If you’re a supporter of the law, you might be cringing right now — you know the areas where the grade is not going to be good. It’s pretty obvious that the Obama administration wasn’t ready for the launch, despite three and a half years to prepare. The political messaging hasn’t impressed anyone; Democrats are scampering away from what was supposed to be a legacy achievement. No one’s going to forget that notion that everyone could keep their plans.
(Also on POLITICO: Full health care policy coverage)
But the critics will have to round out their picture of the law, too. The signups have now hit 6 million — a feat that seemed impossible in the worst days of the website failures — and the administration’s outreach efforts are better than they used to be. And although there are lots of complaints about the prices, some low-income customers seem to be genuinely happy with the rates and subsidies they’re getting.
It’s also important to judge the rollout against the political headwinds the law has faced. White House officials argue that the battles against Obamacare have been stronger and longer lasting than even the fights against breakthroughs like Social Security and civil rights laws. “There’s no other law that has had to overcome all the obstacles that have been thrown at this law by its opponents,” said White House health care adviser Phil Schiliro.
But this is also a program that will affect millions of Americans, and Republicans say it’s such a bad student it should repeat a grade. “For gross incompetence, the thing should be held back a year,” said Brendan Buck, a spokesman for House Speaker John Boehner. “The law is clearly not ready for prime time — not that it ever will be — and that’s why the House has voted to delay it.”
Here’s where Obamacare was a good student and where it needs to show more effort, based on the latest research and interviews with health care experts across the board:
Enrollment
At this point, it’s all about expectations — and after months of lowering the bar, the White House has finally cleared it.
(PHOTOS: Obamacare in the Mississippi Delta)
Thanks to the fumbled launch and an unspectacular February, health care experts had been convinced that the total enrollment would be roughly five and a half million people. That turned around quickly once the enrollment websites became flooded with last-minute signups, as the White House had predicted.
And on Thursday, President Barack Obama had his best day in months when the total hit 6 million, earlier than even optimistic experts thought it would.
That’s not nothing. It’s a big recovery from October, and it’s enough to avoid a financial disaster for the insurers. It’s certainly enough to give Democrats the talking point they want against Republicans: “Do you really want to take health insurance away from millions of people?”
It’s just not the original 7 million goal, as declared by Health and Human Services Secretary Kathleen Sebelius, and Republicans won’t ever let the administration forget it. (There was even a time when CBO was predicting 8 million, right when the law passed.)
http://dyn.politico.com/printstory.cfm?uuid=461C2104-AF06-4F58-8D43-E6A86666716E
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