Health Care Reform Articles - April 2, 2014

Maine House Gives Initial OK to Universal Health Care Study Supporters of universal health care are applauding an initial vote in the Maine House today that would authorize a study of implementing such a system in Maine. It's not the first time the issue has been studied in the state. But as Patty Wight reports, it's the first time supporters say the idea has gotten traction.

Related Media Maine House OKs Universal Health Care Study  Duration: 3:20

The question of whether Maine should attempt a universal health care system has moved like a pendulum over the past decade or so in the Legislature. In 2001, lawmakers approved a study to assess whether universal health care would work in Maine. Though the results from Mathematica Policy Research were generally favorable, the switch never happened. But supporters of the idea and the bill say things are different now. "Probably Maine is worse off today, I suspect, than it was in 2002 when the Mathematica study was done," says Joe Lendvai of MaineAllCare, a group dedicated to achieving universal health care. Lendvai says it's all the more reason to get current data. Wendy Wolf, of the Maine Health Access Foundation, says in health care-years, 2002 may as well be the Ice Age. "When you think about what has changed since that time, you look at the rampant increase in insurance premium costs, the changes in benefit structure, the aging of our population, changes in Medicaid and Medicare reimbursement." The bill approved by the Maine House is an amended version of the original that sought to implement a single-payer system in Maine. Supporters say good, hard data is needed before Maine can decide whether to move forward with universal coverage, and exactly what form it should take. Democrat Paul McGowan says this bill is an opportunity to take a big-picture look at health care. "This is not about who should pay for it, it's not about how we accomplish it, but to embrace a vision that says every resident of Maine will have access to affordable, quality health care." http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/33004/Default.aspx

Uphill all the way

As the deadline for signing up nears, Obamacare looks precarious

Mar 29th 2014 | PHILADELPHIA | From the print edition

BARACK OBAMA signed the Affordable Care Act on March 23rd, 2010. Exactly four years later J. Louis Felton, a pastor in Philadelphia, led his flock in an unusual procession: out of church and onto a sales bus owned by a local insurer. “We need to sign up,” Mr Felton says. “People in our communities have never had the opportunity to get health coverage before.” On the bus he prayed for Obamacare’s success.

It could use some help. The fight over the law makes mud-wrestling look decorous. This year Obamacare is, yet again, Republicans’ favourite weapon on the campaign trail. On March 25th it was, yet again, debated in the Supreme Court (see article). Meanwhile, Mr Obama continues to undermine his own law by delaying parts of it: this month officials said Americans could keep old plans that don’t comply with Obamacare for another two years.

America is the world’s only rich country not to have universal health care. Obamacare was meant to address that. In the past insurers charged the sick higher rates than the healthy. Since January this has been banned. To keep insurers from going bust, the law requires all Americans to have insurance or pay a fine. The premiums from cheap, healthy people are supposed to offset the costs of the sick. New online health exchanges allow people to shop for coverage. For the hard-up, Obamacare does two things. It expands Medicaid (public health care for the poor) to individuals earning up to about $16,000. And it offers subsidies to those who make more than $11,700 but less than $46,700.

In 2011 the Congressional Budget Office (CBO) projected that Obamacare would lower the number of uninsured by 21m in 2014 and 34m in 2021. Now the CBO is gloomier: it says the law will shrink the ranks of the uninsured by 13m in 2014 and 25m in 2021. More than 30m Americans will still lack coverage after Obamacare is fully implemented.

The gap that makes no sense

The law’s drafters assumed that the states would all expand Medicaid, so the subsidies only kick in above that $11,700 threshold. But after the Supreme Court said the states could refuse to expand Medicaid, half of them (mostly Republican-led) did just that. In those states, millions of people will not qualify for Medicaid but are too poor to qualify for Obamacare subsidies.

The results are perverse. In Pennsylvania, which has not expanded Medicaid, childless adults are ineligible, no matter how poor. Paul Johnson, a 51-year-old repairman, boarded that bus in Philadelphia on March 24th, hoping to find coverage. “I’ve never had a check-up,” he said. He will have to wait a bit longer. Earning less than $10,000 a year, Mr Johnson is too poor to qualify for an Obamacare subsidy. But he does not qualify for Medicaid, either. He left the bus as he had entered it, without insurance, hoping not to fall ill.

Pennsylvania and 33 other states also declined to create their own insurance exchanges. The federal government did so on their behalf, setting a new record for bureaucratic ineptitude. The launch of Healthcare.gov in October went so badly that the CBO cut its estimate for the number of enrollees this year from 7m to 6m.

http://www.economist.com/node/21599786/print

Obamacare enrollment period ends with massive surge By: Joanne Kenen and Kyle Cheney March 31, 2014 07:02 AM EDT

The first open enrollment season of Obamacare ended at midnight Monday, a day that saw millions of Americans click onto Obamacare sign-up portals, dial into call centers and stand in long lines at assistance sites nationwide. The huge surge made it increasingly likely that enrollment would hit 7 million, the finish line that seemed out of reach during much of the often rocky six-month period. Shortly after 10 p.m., the Associated Press cited two sources that said sign-ups were “on track” to hit 7 million. Administration officials wouldn’t confirm the number but said that signs were pointing in that direction. The HealthCare.Gov website took down enrollment forms just after midnight and displayed a new message that will transition people into a “special enrollment” period. “Don’t worry,” it said. “We’ll still help you get the coverage you need for this year.” (CARTOONS: Matt Wuerker on Obamacare) Federal health officials said the site would reappear in a new guise Tuesday morning with instructions for post-March 31 sign-ups. Those will be open to people who self-report that they tried to make the deadline but failed. Depending on how long special enrollment goes on, enrollment numbers could still rise significantly. The last official day of the Obamacare coverage push was hit by a double whammy of new HealthCare.gov glitches that caused confusion and delay. The federal website was down for six hours early Monday morning. Then it was up. Then it activated its “virtual waiting room.” Then it blocked newcomers from creating accounts. Then it was working again, with officials reporting more than 1.6 million visitors by 2 p.m. and more than 3 million by 8 p.m. State exchanges reported similar surges. The federal site queued visitors when traffic rose, offering them a chance to get an email notification when the site would be less congested. It held through the night, despite the crush of visitors. (WATCH: Timeline of Obamacare deadlines) State-run exchanges are also giving grace periods to people who started but didn’t finish. Some have set stricter criteria for the extensions than others. The technical problems, a flashback to HealthCare.gov’s botched launch last October, weren’t the focus the White House wanted as it tried to spur more Americans to be part of the late enrollment momentum. The intensity and tone of the White House messaging over these last days had evoked a confident turnout push on the eve of a close election. Suddenly it was about the glitchy website once again. But as the day wore on, the final surge kept growing — although it will be some time before it is known precisely how many of these people will finalize their enrollment by paying their premiums, how many were previously uninsured, and, perhaps most important, how many end up liking their new coverage well enough to help Democrats construct a counter narrative. (Also on POLITICO: The Obamacare enthusiasm gap) Numerous polls show the law remains controversial and unpopular, and the Republicans have steadily blamed the Affordable Care Act for harming the economy, raising costs, killing jobs and depriving people of access to doctors of their choice. Even some moderate Democrats, facing tough reelection fights, want to change aspects of the four-year-old law. http://dyn.politico.com/printstory.cfm?uuid=91227610-C561-4365-8C8A-50787E92864F

Was Obamacare Worth It? How Many of the Previously Uninsured Have Really Signed Up?

Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it?

Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn't get coverage.

Are enough people getting coverage who didn't have it before to justify the sacrifices the people who were already covered––in the individual, small group, and large employer market––are making or will make?

I will suggest the country will never really be able to judge how good or how bad Obamacare is until that question is answered.

Forget the Obama administration's spin over hitting 6 million. Forget all of the opposition spin over Obamacare's failings.

The country's judgment should and will come down to a simple answer to this simple question.

Of course, the more than 6 million enrollment the administration recently announced overstates Obamacare's success because this includes enrollments that were never completed since the person never paid the premium. There are lots of reasons why a consumer might not complete the enrollment. The person may have hit the enroll button a number of times and ended up paying only once. It may have been one of the infamous "834" transactions that never made sense and the consumer ended up having to enroll again later. Or, the person might have had second thoughts about the cost/benefit of Obamacare and decided not to move forward.

Then there were a measurable number of people who paid their first month's premium but never paid the second month's premium. I am told that 2% to 5% of January's enrollments never paid in February, for example.

http://healthpolicyandmarket.blogspot.com/2014/03/was-obamacare-worth-it-how-many-of.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

Health Care Signups Reach Frenzy in Final Day to Enroll

By ROBERT PEARMARCH 31, 2014

WASHINGTON — A frenzied last-minute scramble to sign up for health insurance overloaded phone lines and temporarily overwhelmed the website of the federal marketplace on Monday, as hundreds of thousands of people around the country raced to beat the deadline to obtain coverage under the Affordable Care Act.

Administration officials, stepping up the push for enrollment in the final hours, said they were confident that they would reach their original goal of having seven million people sign up for private health plans through federal and state exchanges. But the end of the open enrollment period, which began six months ago with the disastrous debut of the federal website, starts a new phase likely to be defined by the economics of health insurance as well as by politics.

Though HealthCare.gov, the federal website, performed markedly better on Monday than on the day it opened, many consumers still struggled to enroll. The site unexpectedly stopped taking applications for several hours early Monday because of a software problem discovered during scheduled maintenance overnight, said Aaron Albright, a spokesman at the Centers for Medicare and Medicaid Services, the agency running the site. For at least an hour at midday, the site again thwarted people trying to create accounts so they could buy insurance online.

“We are experiencing record volume on HealthCare.gov, with three million visits as of 8 p.m. and approximately 125,000 concurrent users at the peak” on Monday, Mr. Albright said. “As of 8 p.m., we had received one million calls to the call center.”

At the White House, officials embarked on a kind of victory lap. Jay Carney, the press secretary, said that the number of people signing up for health care would be “significantly above six million,” and he reminded journalists of the predictions of doom when HealthCare.gov crashed last fall.

Mr. Carney said he did not have “any concrete numbers” to show how many people had paid premiums, as required to activate coverage.

In a television interview with KWTV in Oklahoma, Kathleen Sebelius, the secretary of health and human services, said reports from insurers indicated that “somewhere between 80, 85, some say as high as 90 percent, have paid so far.”

http://www.nytimes.com/2014/04/01/us/health-website-failures-impede-signup-surge-as-deadline-nears.html?action=click&contentCollection=Health®ion=Footer&module=MoreInSection&pgtype=Blogs&_r=0

Mainers rush to buy insurance on final day before deadline

Health navigators report a surge of calls and appointments as individuals try to get their applications in the pipeline.

By Kevin Miller kmiller@pressherald.com
Washington Bureau Chief

Health organizations in Maine scrambled Monday to keep up with a surge of people who hoped to sign up for insurance under the Affordable Care Act before the midnight enrollment deadline.

“The phones have been ringing off the hook all day with people either finishing the process, starting the process or trying to figure out what they are eligible for,” said Emily Brostek, consumer assistance program manager for Consumers for Affordable Health Care, a nonprofit that helps Mainers navigate the process.

Americans who don’t have insurance through their employers or government programs such as Medicare and Medicaid faced the deadline to sign up for coverage or potentially pay penalties.

As expected, interest in enrollment surged in Maine and nationwide in recent weeks – so much that the federal HealthCare.govwebsite went down briefly Monday because of heavy traffic.

Maine’s enrollment had already exceeded the 23,000 people estimated by the Obama administration before sign-ups began Oct. 1. Only five states had surpassed their respective goals by wider margins, and four of them operate their own insurance marketplaces rather than relying on the federal website, as Maine does.

“We are really excited,” said Jake Grindle, a navigator for Western Maine Community Action. “Right from the start, Maine has been leading the country in terms of our enrollment rate and interest. We wish we had more people to help” process applications.

Many groups that were licensed to help Mainers sign up for coverage were not taking reservations for in-person appointments Monday, having booked all of their time slots for the day, but had staff members working the phones to answer callers’ questions.

At the Opportunity Alliance in Portland, Kate Albert estimated that it was an even split Monday between callers trying to wrap up their enrollments and late-comers beginning to explore their options.

Last week, the Obama administration announced a two-week grace period, of sorts, for people who had begun the application process by March 31 but not yet selected a plan. So Albert and other “navigators” were urging callers to at least get their names in the system on HealthCare.gov, the primary insurance-shopping portal for residents of Maine and 34 other states.

http://www.pressherald.com/news/Mainers_rush_to_buy_insurance_ahead_of_April_1_deadline_.html

Mainers rush to sign up for health insurance on ACA deadline day

By Lindsay Tice, Sun Journal,
and Jackie Farwell, BDN Staff

Posted March 31, 2014, at 5:58 p.m.

By mid-morning Monday, the state’s only health insurance co-op was getting so many calls — How do I get insurance by the deadline? Did the federal marketplace send over my sign-up information yet? How do I make a payment? — that its CEO grabbed a free desk and started answering phones.

So did its chief human resources officer. And pretty much every other employee at Maine Community Health Options in Lewiston.

The insurance company normally averages 1,000 to 1,100 calls a day. By 3 p.m. Monday, the nonprofit insurance company had received 1,611 calls — and had at least three more hours in its day to go.

“I think today it’s going to be busy all day,” said Jane Cariello, director of service operations. “We stay here until every call is answered. … We’ve offered overtime to everybody today.”

Monday marked one of the biggest deadlines for the Affordable Care Act, also known as “Obamacare.” Uninsured Americans had until midnight to begin signing up for health insurance, with the six-month open enrollment period winding to a close. Those who started the process have until mid-April to finish it.

Those who failed to start the sign-up process — or don’t complete it — must either qualify for an exemption or pay a penalty.

Individuals will not be able to buy health insurance between April 1 and Nov. 15 unless they have a qualifying life event, such as a divorce, job loss or birth of a baby.

Although Americans could buy insurance from any company or through a broker, they can only qualify for a subsidy, or discount, by buying through the marketplace.

Maine has emerged as a leader in enrollment, signing up more than 25,000 people for private health insurance through Healthcare.gov as of March 1. That beat the target set by President Barack Obama’s administration for the entire open enrollment period.

Experts expected thousands more to follow as the March 31 deadline loomed. Across Maine, health advocates were swamped with questions as residents rushed to sign up in time.

Many were stymied by technical problems with Healthcare.gov. The website, which serves as the federal government’s gateway for the marketplaces in Maine and 35 other states, stumbled twice on deadline day, pushed beyond its capacity with 1.2 million visits through noon. Many consumers couldn’t start new applications, while others were invited to leave contact information so they could be contacted when the call volumes diminished.

Maine Community Health Options is one of two Maine companies that sold plans through the marketplace, along with Anthem. MCHO wasn’t quite as busy Monday as it was leading up to Jan. 1, the last big ACA deadline, but calls were steady.

Many had just signed up and were told by the marketplace to call to make sure MCHO had their information. The problem: It can take days for that information to get forwarded to MCHO.

“People are anxious about that because they want to have coverage,” Cariello said. “We want to help them, but we can’t see them [in the computer system] yet.”

Other callers had tried to sign up through the federal marketplace online but couldn’t. A message on the site asked people to leave their email address and try back later.

Kevin Lewis, MCHO’s chief executive officer, believes the two-week grace period will help those caught in the last-minute rush.

http://bangordailynews.com/2014/03/31/health/mainers-rush-to-sign-up-for-health-insurance-on-aca-deadline-day/print/

Obama Claims Victory in Push for Insurance

By MICHAEL D. SHEAR and ROBERT PEARAPRIL 1, 2014

WASHINGTON — President Obama declared victory Tuesday in the government’s aggressive push to enroll seven million people in private health insurance plans under the Affordable Care Act, even as his senior aides braced for an escalated political battle over the law ahead of the fall’s crucial midterm elections.

The milestone may be more significant politically than for what it says about the law’s potential impact on the American health system, which remains unclear. But officials said it was unlikely to have much of an impact on public perception of the law, and the announcement did little to deflect immediate criticism from its Republican opponents.

In an afternoon Rose Garden ceremony, Mr. Obama announced that a late surge of customers to HealthCare.gov before Monday’s deadline had pushed insurance signups to 7.1 million, slightly more than the administration’s original goal. The achievement was somewhat remarkable considering the bureaucratic and technical nightmare that surrounded the website’s debut last October.

“Armageddon has not arrived,” the president said to an audience of White House staff members and supporters who greeted the announcement with an extended standing ovation. “Instead, this law is helping millions of Americans, and in the coming years it will help millions more.”

http://www.nytimes.com/2014/04/02/us/politics/obama-to-report-on-progress-of-health-care-law.html?hp&_r=1&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now&assetType=nyt_now

Continue reading the main s

Obama: The Affordable Care Act Is Working, 'Helping People... Coast To Coast'

by EYDER PERALTA

April 01, 2014 1:58 PM

President Obama emerged from the White House on Tuesday to rousing applause. He announced that 7.1 million Americans had signed up for health care through the federal exchanges set up by the Affordable Care Act.

"This law is doing what it's supposed to do," Obama said at the Rose Garden. "It's working. It's helping people from coast to coast."

Seven million was the White House's initial projection, but the rollout of the exchanges has been messy. HealthCare.gov, for example, was essentially useless for weeks after it was launched in October.

Because of that the White House brought its projection in line with the Congressional Budget Office's 6 million figure.

During his speech, Obama acknowledged that the law wasn't perfect and that the rollout wasn't perfect, but the first six months are "a step forward."

"Bottom line is this: Under this law the share of Americans with insurance is down" and the growth of the cost of health care is down, Obama said.

He went on to deliver an impassioned defense of his signature legislation, saying Obamacare has made health care in the United States better and it had affirmed the "dignity and worth" of millions of Americans.

http://www.npr.org/blogs/thetwo-way/2014/04/01/297839748/white-house-says-more-than-7-million-signed-up-for-obamacare

On ACA Deadline, King Presses for Changes to Health Care Law

03/31/2014   Reported By: Patty B. Wight

Today is the last day to sign up for insurance on the Affordable Care Act's online marketplace. Though it will take time for the full implications of the law to become clear, Maine Sen. Angus King says some changes are already in order. The independent congressman is co-sponsoring three bills to improve the federal health law for businesses and employees. As Patty Wight reports, reactions are mixed as to whether these are the right changes at the right time.

Related Media On ACA Deadline, King Presses for Changes to LawOn Originally Aired: 3/31/2014 5:30 PM  Duration: 3:35

Sen. King wants to be clear:  He supports the Affordable Care Act. But that doesn't mean it couldn't use a little tweaking. "I've never seen a piece of legislation in the history of the world that doesn't need correction over time," King says. "Probably the best example is the United States Constitution, which has been amended 27 times." King is backing three bills that he says will provide greater choice, flexibility, and affordability under the health reform law. One bill, called the Small Business Stability Act, would change the mandate that requires employers with more than 50 employees to provide health insurance, by creating a new, higher threshold of 100 or more employees.   "Which would relieve the paperwork burden on companies that are truly pretty small," King says. "And we're getting a lot of information back from companies that are in the 40 to 50 range that say, 'Look, we don't have full-time accountants. It really is getting more complicated if we have to do this.'" Supporters of the change include Maine Restaurant Association President Gregory Dugal, who says the law will help restaurant owners who felt stifled by the employee threshold. "I think that people that had multiple businesses were also trying to look at ways that they could get under that threshold. Now this gives them the ability to not even think about that, to be able to supply the jobs and to grow their business and hopefully provide even more jobs, because the expense of health insurance won't be weighing as heavily on them," Dugal says. Another bill - called the Expanded Consumer Choice Act - would add a new high-deductible "Copper" plan to the online insurance marketplace, which already offers Bronze, Silver, Gold, and Platinum plans. King says the Copper Plan would offer low premiums, and more choice for consumers. "It's a question of how much of the risk you're carrying versus the insurance company," he says. But consumer health advocates in Maine question whether the Copper plan is necessary. "In Maine, we've seen that people are really showing a high desire for more coverage - for better coverage - not less," says Emily Brostek of the Maine-based group Consumers for Affordable Health Care. Brostek says February enrollment figures show that 73 percent of Mainers who enrolled in the marketplace picked the mid-level Silver plan. Brostek says there are already existing catastrophic plans available to people who qualify for certain exemptions; the problem for consumers is how cumbersome it can be to sign up for those plans, which are only available through a paper process, not online. "So I think for people who it might be a good fit to have a higher deductbile plan, making that more of a simple process would actually serve those needs rather than creating a whole new plan, potentially." Brostek says. The third bill King is sponsoring would expand small business tax credits to more employers and for a longer period of time. http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/32985/Default.aspx

Take charge of your own healthcare

March 28, 2014Home

By Jack Forbush, DO

By now, and unless you’ve been living under a rock, you know that healthcare is in a state of flux. The Affordable Care Act has become a daily conversational piece and a topic of many heated debates. Is it the panacea for solving our healthcare crisis or simply another bureaucratic nightmare that we must learn to live with? This introductory blog posting is not intended to answer this question, but rather to initiate a conversation about how you can take charge of your own healthcare.

The Bangor Daily News is fortunate to have many well-versed individuals covering this topic, but I wanted to provide the perspective of an independent, practicing family physician whose only motivation is to empower my patients, their friends, family members and colleagues to take charge of their own healthcare.

By using the phrase “take charge of your healthcare”, what do I mean? I’m referring to every aspect of how you receive healthcare, how you collaborate with your physician, where you receive your healthcare and how to best achieve cost-effective care for you and your loved ones.

For the first part of this series, I want to take some time to talk about the increasing cost of receiving healthcare. Recent reports indicate that for those of you that have insurance coverage (either through your employer or independently purchased), your monthly premiums will double if not triple by the end of the year and the benefits you receive from your insurance carrier will continue to dwindle. Out of pocket costs for your medications, tests and office visits are projected to continue to increase. As such, you will be paying for more services out of your own wallet! You need to know what these costs will be *before* you are charged for the services!

With an increased national focus on transparency of health care costs, patients may have more opportunities to get better cost estimates of anticipated medical services. Requesting this information makes you an educated health care consumer, a “smart shopper” if you will. After all, it is your dollar that you are spending.

So what are your options?

http://thedoc.bangordailynews.com/2014/03/28/home/take-charge-of-your-own-healthcare/

Burnt Out Primary Care Docs Are Voting With Their Feet TOPICS: DELIVERY OF CARE, HEALTH COSTS, HOSPITALS, PUBLIC HEALTH, QUALITY By RONI CARYN RABIN APR 01, 2014 This KHN story was produced in collaboration with  Janis Finer, 57, a popular primary care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay. Lawrence Gassner, a Phoenix internist, was seeing four patients an hour. Then he pared back his practice to those who agreed to pay a premium for unhurried visits and round the clock access to him.  "I always felt rushed," said the 56-year-old. "I always felt I was cutting my patients off." Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62. Physician stress has always been a fact of life.  But anecdotal reports and studies suggest a significant increase in the level of discontent-especially among primary care doctors who serve at the frontlines of medicine and play a critical role in coordinating patient care. Just as millions of Americans are obtaining insurance coverage through the federal health law, doctors like Finer, Gassner and Devitt are voting with their feet. Tired of working longer and harder because of discounted insurance payments and frustrated by stagnating pay and increasing oversight, many are going to work for large groups or hospitals, curtailing their practices and in some cases, abandoning primary care or retiring early. "I was thinking of leaving medicine; I didn't think I could maintain the pace," Gassner said about why he switched to a concierge-style practice with the help of consultant MDVIP.  "I went to bed many nights lying awake, worrying that I missed something." The timing couldn't be worse. "The lack of an adequate primary care infrastructure in the U.S. is a huge obstacle to creating a high-performing health care system," said David Blumenthal, president of The Commonwealth Fund, a health care research foundation. A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those aged 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50. http://www.kaiserhealthnews.org/Stories/2014/April/01/doctor-burnout.aspx Community Health Centers May Provide Services For Those Who Remain Uninsured By Michelle Andrews APR 01, 2014 If you're uninsured, you may have run out of time. Yesterday was the formal deadline to sign up for health insurance on the marketplaces or face a penalty, unless you were already “in-line” for enrollment. Still, people who missed the cutoff or couldn’t buy insurance have options to get the health care services they need. But doing so may not be simple or assured. At the end of February, the percentage of uninsured people was 15.9 percent for the year to date, on track to decline for the third consecutive quarter, according to a Gallup survey of more than 28,000 people released last month. How low the uninsurance rate might go this year remains to be seen. Last week, the administration announced that people who hadn’t completed the enrollment process on the federally run marketplace by March 31 could get extra time to finish the process. Some states have offered similar extensions. But extensions may not matter to some people. As of mid-March, 50 percent of the uninsured said they didn’t plan to buy insurance, according to the Kaiser Family Foundation’s March tracking poll (KHN is an editorially independent program of the foundation.) The survey, conducted while open enrollment was in full swing, also found that six in 10 of the uninsured didn’t know the deadline to buy a plan was approaching. At Alexandria Neighborhood Health Services, a community health center with 11 sites in Northern Virginia, seven enrollment counselors have been working to get people signed up for coverage, with mixed results. “Some people looked at the premiums and said, ‘I can’t afford this,’” says Martha Wooten, executive director. “That’s a choice each individual has to make. The least expensive of those plans come with very high deductibles or copays.” People who did not buy a plan -- because they didn’t want it, couldn’t afford it or for other reasons -- can look to the network of 9,300 community health center sites that last year served 22 million people. The centers are slated to receive more than $9 billion in funding under the health law through 2015 to enable them to expand to meet the needs of the newly insured who may not have a regular doctor, and of medically underserved patients, including the uninsured.   http://www.kaiserhealthnews.org/Stories/2014/April/01/Community-Health-Centers-May-Provide-Services-For-Those-Who-Remain-Uninsured.aspx Newly Enrolled, but Not Counted by Insurance Exchanges By KATIE THOMASAPRIL 1, 2014 Millions of newly insured people are hiding in plain sight. They are the people who have bought new health insurance since the start of this year but have chosen for one reason or another to bypass the state and federal exchanges that opened last year under the Affordable Care Act. While the exact number is unknown, some health care experts estimate that it may be in the millions. Politicians and policy makers have focused on the number of people who signed up through the exchanges — at nearly seven million and counting a day after the March 31 deadline — but they have largely overlooked the group that did not use the exchanges, even though it could have a major impact on the program’s financial success in the years ahead. Continue reading the main story RELATED COVERAGE Obama Claims Victory in Push for InsuranceAPRIL 1, 2014 video Video: Obama on Health Care Enrollment NumbersAPRIL 1, 2014 Health Care Signups Reach Frenzy in Final Day to EnrollMARCH 31, 2014 Because insurers place customers in the same risk pool, regardless of how they enrolled, “these lives count every bit as much as the ones that came in through the exchange,” said Gary Claxton, a vice president and health care expert at the Henry J. Kaiser Family Foundation. Helen Ferguson is one of those people. Ms. Ferguson, a psychologist in Fort Worth, began her search for health insurance last fall, creating an account on the federal marketplace to shop for coverage. But when it came time to select a plan, Ms. Ferguson worried that the malfunctioning website would prevent her from signing up. So instead, she enrolled directly through Blue Cross and Blue Shield of Texas, selecting a plan that was also offered in the marketplace. “I needed the insurance so much that I just didn’t want to take a chance,” said Ms. Ferguson, 63, who had been uninsured since last May. She obtained health insurance just in time. On Jan. 3, two days after her coverage took effect, she fell and fractured her foot. “I think people forget that the law is not a website — the law is so much bigger than that,” she said. http://www.nytimes.com/2014/04/02/business/newly-insured-but-not-counted-by-the-insurance-exchanges.html?_r=3&gwh=C61A82365B1D6C127B5AF860FEBA2B93&gwt=regi Judge Won’t Block Rules on Abortion Drug in Arizona By JOHN SCHWARTZMARCH 31, 2014 A federal judge in Tucson has refused to block some of the strictest rules in the nation on the use of abortion drugs. The rules, which were approved by the Arizona Legislature in 2012 and will take effect on Tuesday, restrict the use of a medication to induce abortions during the early stages of pregnancy to the first seven weeks. The rules also restrict the use of the drug, mifepristone, to protocols approved by the Food and Drug Administration in 2000. That early approval called for the drug to be given in higher doses than is customary today, and only in doctors’ offices in the first seven weeks of pregnancy. Since those rules were first approved, doctors have found that a lower dose of the drug is effective, and that it can be safely taken outside doctors’ offices through the ninth week of pregnancy. The new restrictions, argued Planned Parenthood, one of the plaintiffs in the case, would force many women to undergo unnecessary surgical abortions, and would prevent some women from getting an abortion at all — especially in Northern Arizona, where the only abortion provider offers only the medication route. The plaintiffs sought a temporary restraining order to block the rules while a legal challenge could work its way through the courts. In denying the request on Monday, the judge, David C. Bury of United States District Court, wrote that Arizona’s rules will not unduly burden a woman’s constitutional right to an abortion, since the alternative of surgical abortions remains available. The fact that some women may have to travel hundreds of miles to clinics, twice, under the restrictions, and that the process will cost more, he wrote, “do not qualify as irreparable harm.” Judge Bury, who was appointed by President George W. Bush, wrote that it is “unlikely that plaintiffs will prevail on the merits of the constitutional claims.” In seeking an injunction, he wrote, the plaintiffs “have not established serious questions going to the merits nor that the hardship balance tips sharply towards them.” http://www.nytimes.com/2014/04/01/us/politics/judge-wont-block-rules-on-abortion-drugs.html Supreme Court to Hear Appeal of Generic Drug Case By ANDREW POLLACKMARCH 31, 2014 As the world’s largest maker of generic drugs, Teva Pharmaceutical Industries has been critical of brand-name manufacturers that try to block generic versions of their high-priced medicines. But Teva is now emulating its rivals, mounting an aggressive effort to stave off generic versions of Copaxone, its big-selling brand-name drug for multiple sclerosis, which is set to lose patent protection late in May. On Monday, Teva got help from the United States Supreme Court, which agreed to hear its appeal of a lower-court ruling that invalidated a patent that would have protected Copaxone until September 2015. Teva, based in Israel, is desperate to stave off generic competition to Copaxone, which had global sales last year of $4.3 billion; $3.2 billion of that figure came from the United States. The drug, which has been on the market for 17 years and is the best-selling treatment for M.S., accounts for about 20 percent of Teva’s revenue and about half its profit. But a generic version of Copaxone could provide needed cost relief to the health care system. The list prices of Copaxone and other older M.S. drugs have roughly quadrupled over the last decade, to about $60,000 a year. http://www.nytimes.com/2014/04/01/business/supreme-court-to-hear-appeal-of-multiple-sclerosis-drug-case.html How Exercise Can Help You Live Longer By GRETCHEN REYNOLDS  APRIL 2, 2014, 12:01 AM  Having unhealthy cholesterol numbers, elevated blood pressure or an expanding waistline substantially increases your chances of developing heart disease. But an encouraging new study finds that exercise may slash that risk, even if your other risk factors stay high. Decades ago, scientists first began linking certain health conditions with heart disease. In the famous Framingham Heart Study, for instance, researchers monitored the health and lifestyles of more than 5,200 adults living in Framingham, Mass., starting in 1948. Using the resulting data, the scientists determined that high blood pressure, cholesterol levels, obesity, age, gender and smoking each had measurable impacts on whether someone would develop cardiovascular disease. From their findings, the researchers developed the Framingham Risk Score, which calculates the likelihood of someone experiencing a heart attack within the next 10 years, based on his or her health numbers, especially blood pressure and cholesterol levels. The Framingham Risk Score calculator does not ask about physical activity. But many studies, including continuing portions of the Framingham study, have conclusively shown that people who exercise have a smaller risk of developing or dying from heart disease than sedentary people. http://well.blogs.nytimes.com/2014/04/02/how-exercise-can-help-you-live-longer/?_php=true&_type=blogs&emc=edit_tnt_20140402&nlid=1311158&tntemail0=y&_r=0 CMA to Force HCA to Sell London Hospitals By REUTERSAPRIL 2, 2014, 4:51 A.M. E.D.T. LONDON — Healthcare group HCA International must sell one or more of its hospitals in London, Britain's competition regulator said on Wednesday, after finding it had too strong a grip on the market for both self-pay and insured patients. The Competition and Markets Authority (CMA) said it was clear HCA's market power in central London allowed it to charge higher prices to insurers. The company, part of U.S.-based HCA Holdings Inc, owned more than half of the available overnight bed capacity, it said. The company said it intended to vigorously challenge the ruling in the courts. In a related move, the CMA stopped short of making rival healthcare provider BMI, Britain's largest operator, sell any of its centres, despite previously saying many private hospitals faced too little competition in local areas across Britain. The CMA had said in January that BMI, owned by South Africa's Netcare and private equity group Apax Partners, could be required to sell seven hospitals. But it had now decided it could not find clear enough evidence that a concentration of providers in areas outside central London led to higher prices for insured patients. For HCA, the CMA's decision means it would be required to sell the London Bridge and Princess Grace hospitals, or alternatively the Wellington hospital. "The sale of HCA hospitals will significantly increase competition in central London, in particular by allowing the insurers to offer corporates and individual policy holders a comprehensive alternative to HCA," said Roger Witcomb, chairman of the CMA's Private Healthcare Inquiry Group. But HCA criticised the finding. http://www.nytimes.com/reuters/2014/04/02/business/02reuters-britain-hospitals.html?hp&_r=2&& Low Vitamin D Levels Linked to Disease in Two Big Studies By ANAHAD O'CONNOR  APRIL 1, 2014, 6:38 PM People with low vitamin D levels are more likely to die from cancer and heart disease and to suffer from other illnesses, scientists reported in two large studies published on Tuesday. The new research suggests strongly that blood levels of vitamin D are a good barometer of overall health. But it does not resolve the question of whether low levels are a cause of disease or simply an indicator of behaviors that contribute to poor health, like a sedentary lifestyle, smoking and a diet heavy in processed and unhealthful foods. Nicknamed the sunshine nutrient, vitamin D is produced in the body when the skin is exposed to sunlight. It can be obtained from a small assortment of foods, including fish, eggs, fortified dairy products and organ meats, and vegetables like mushrooms and kale. And blood levels of it can be lowered by smoking, obesity and inflammation. Vitamin D helps the body absorb calcium and is an important part of the immune system. Receptors for the vitamin and related enzymes are found throughout cells and tissues of the body, suggesting it may be vital to many physiological functions, said Dr. Oscar H. Franco, a professor of preventive medicine at Erasmus Medical Center in the Netherlands and an author of one of the new studies, which appeared in the journal BMJ. http://well.blogs.nytimes.com/2014/04/01/low-vitamin-d-levels-linked-to-disease-in-two-big-studies/?hpw&rref=health