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Thursday, May 1, 2014

Health Care Reform Articles - May 1, 2014


There’s a last chance for 70,000 to gain health coverage, and reasons against it don’t stand up

Republicans in the Maine Legislature have one last chance this year to deliver on health coverage for the state’s poorest residents.
On Thursday, when the House and Senate reconvene to take up a slew of vetoes from Gov. Paul LePage, lawmakers will have two veto letters before them nixing separate plans to expand Maine’s Medicaid program under the federal Affordable Care Act.
It’s long past time for lawmakers to take up the federal government on its offer to assume nearly all costs of expanding coverage to tens of thousands of Maine adults without children who are newly eligible for Medicaid under the federal health care law — if only Maine lawmakers agree to it.
We’re not naive enough to expect a dramatically different result on an issue that’s crossed these same legislators’ desks five times. But we’re not willing to let two more opportunities to insure 70,000 low-income Maine residents — so they can responsibly manage chronic conditions, access cost-saving treatments for addiction or visit a doctor without breaking the bank — pass by unnoticed.
One of the two pending Medicaid expansion proposals, from House Speaker Mark Eves, D-North Berwick, would use federal assistance so low-income childless adults could, starting in July 2015, purchase qualified private insurance coverage through Maine’s online health insurance exchange. (They would receive conventional Medicaid coverage until then.) The 15,000 parents who would qualify for expanded coverage would receive conventional Medicaid coverage.
The legislation is modeled after a bill passed in neighboring New Hampshire, which cleared a Republican-controlled Senate. The approach of using Medicaid expansion funds to buy private insurance was spearheaded in Arkansas under Democratic Gov. Mike Beebe and a Republican legislature.
The bill Eves has proposed isn’t perfect. Research has repeatedly found that health spending is higher overall with private insurance than with Medicaid. Other research has shown premiums and significant cost-sharing responsibilities have caused low-income enrollees to withdraw from health insurance coverage.
By relying on private insurance, Eves’ bill runs those risks. However, the bill leaves many details to be determined after it becomes law, meaning a deliberately designed, well thought-out program can mitigate those risks.
Predictably, LePage and his allies have latched onto yet another spurious argument to undermine support for yet another Medicaid expansion proposal meant to address Republican concerns about the expansion of a public health insurance program.
LePage declared in an April 17 news release that the Arkansas expansion model “is suffering enormous cost overruns into the millions of dollars,” and that state’s taxpayers will be responsible.
Indeed, Arkansas officials negotiated per-person budget caps with the federal government to secure approval for using Medicaid expansion funds to purchase private health insurance. And those costs have run ahead of projections in the first months of the program.
A paper cited by LePage, from the conservative Foundation for Government Accountability, claims spending could exceed negotiated projections by $6.6 million-$16.6 million this year if current trends persist.
But Arkansas taxpayers only are liable if Medicaid expansion’s costs exceed projections over a three-year term, giving Arkansas officials more than two-and-a-half years to rein in costs. One way they’re doing that is by restricting add-on benefits many private plans offered in the first year.
In addition, the terms of the deal Arkansas struck with the federal government grant the state flexibility to adjust those cost projections upward to more closely match actual costs.
While Medicaid expansion opponents continue to try to instill budget-busting fears in policymakers’ minds, a revised analysis from the Congressional Budget Office actually projects that, overall, states will assume a smaller share of the expansion’s costs than the office previously projected. They’ll end up spending 34 percent less between 2015 and 2024 than previously thought, according to the analysis.
As with past expansion attempts that have passed the Maine Legislature, the reasons against this expansion proposal wither away upon closer inspection. Meanwhile, the budgetary clock ticks down on a unique chance to provide life-changing health coverage to 70,000 people at minimal cost.


Maine Legislature Sustains Veto of Medicaid Expansion Bills

AUGUSTA, Maine — Maine lawmakers have failed again to override Republican Gov. Paul LePage's vetoes of bills that would expand Medicaid under the federal health care law.
The Senate voted 21-14 in favor of overturning LePage's rejection of Senate Democratic Leader Troy Jackson's Medicaid expansion bill, falling three votes short of the two-thirds majority support it needed to survive.
The House also voted 94-53 to sustain the veto of Democratic House Speaker Mark Eves' bill. It would have directed Maine to seek permission from the federal government to use the Medicaid funds to provide private health insurance on the federal exchange.
Democrats say the failure to expand will leave thousands without access to affordable coverage. But LePage and GOP lawmakers say the expansion will be too costly.


The Canadian health care system I disparaged

Single-payer regime up north represents a better way

By Wendell Potter
The Center for Public Integrity, April 28, 2014
When I returned home after a two-week speaking tour of Canada and began catching up on news about Obamacare, I was angry and upset, and not just at politicians and special interests that benefit from deception-based PR tactics. I was — and still am — mostly angry and upset with myself. And I know I always will be.
Over the course of a two-decade career as a health insurance executive, I spent hours and hours implementing my industry’s ongoing propaganda campaign to mislead people about the Canadian health care system. We spread horror stories about “rationed care” and long waiting times for medically necessary care. Our anecdotes were not at all representative of most Canadians’ experiences, but we spent millions of dollars to persuade Americans that they were.
At every stop between Halifax and Vancouver this month, I explained how the United States had achieved the dubious distinction of having both the most expensive health care system on the planet and also one of the most inequitable. While Canadian lawmakers in the 1960s were implementing a partnership between the federal and provincial governments to create the country’s publicly funded universal health insurance system — known as Medicare — our lawmakers in Washington were establishing America’s own single-payer Medicare program, but only for folks 65 and older and some younger disabled people. Congress also created the federal and state-administered Medicaid program for the nation’s poor.
Ever since, most of the rest of us have had to deal with private insurance companies and pay whatever they felt like charging us for coverage. Canadians are also paying more for coverage these days because of medical inflation and an aging population, but not nearly as much more as we in the U.S. are paying. Just about everybody in every audience I stood before gasped when I told them that health insurance premiums in the U.S. increased 131 percent between 1999 and 2009 — the main reason why 50 million of us were uninsured at the end of the last decade — and that by 2013 the average employer-based family policy cost $16,351.
At one stop in Toronto, I was asked if there was anything about the U.S. system that Canadians should consider adopting. I was stumped. I noted that while we had some of the world’s best doctors and hospitals, they were in many cases off-limits to millions of Americans, many of whom were uninsured because of preexisting conditions that made them “uninsurable” in the eyes of private insurance companies.
Later, on reflection, I realized I should have mentioned some aspects of our Medicare system and our other single-payer program — the Veterans Health Administration — both of which consistently out-perform private insurers in customer satisfaction surveys.
http://www.pnhp.org/print/news/2014/april/the-canadian-health-care-system-i-disparaged

The Problem With Free Health Care

By H. GILBERT WELCH
HANOVER, N.H. — NOW that it’s clear that Obamacare is here to stay, its supporters should focus on making the program better. Fixes are not a sign of weakness. They are a sign of responsiveness and of good management. And the Affordable Care Act does have its flaws. Here’s a big one: It favors screening over diagnosis.
While the distinction may seem arcane, it has real-world implications. Screening is what we offer to the well; it’s the effort to find abnormalities in those who do not have signs or symptoms of disease. Because screening is considered part of preventive care under the Affordable Care Act, it is provided at no charge.
Diagnosis is what we offer to those who do have signs or symptoms of disease. Because diagnosis is not preventive care, it is subject to deductibles and co-payments.
In other words: A woman over 40 can have a free screening mammogram. But if she notices a breast lump and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram. That could cost $300. So the woman at lower risk for cancer — the one with no signs or symptoms of the disease — has an incentive to be tested, while the woman at higher risk — the one with the lump — faces a disincentive.
Does that make any sense? No. But it could encourage women with breast lumps not to report their symptoms.
Just how crazy this is became apparent to me when a friend enrolled on the New Hampshire exchange. Melissa is a 50-something self-employed author. She chose to be screened for colon cancer using the test doctors are most certain lowers colon cancer mortality — annual fecal occult blood testing.
Melissa’s screening test was free under the Affordable Care Act. It was also positive — she had blood in her stool, meaning she was at higher risk to actually have colon cancer. Everyone agreed about the next step: a diagnostic colonoscopy, to figure out where the blood was coming from. That’s not free; it’s real money, thousands of dollars. But had she chosen the colonoscopy as her first screening test, it would have been free.
http://www.nytimes.com/2014/05/01/opinion/the-problem-with-free-health-care.html?emc=edit_tnt_20140430&nlid=1311158&tntemail0=y&_r=0

Envisioning the End of Employer-Provided Health Plans

The days of Americans getting health insurance through their employers may be numbered — and the change could be just as profound as the shift of employers forcing employees to manage their own retirement savings.
As the Affordable Care Act goes from thousands of pages of legalese to actual, real-life public policy, the future of employer-provided health insurance is one of the most fascinating questions. Will employers call for — and their workers accept — the practice of buying health insurance through government exchanges? How much will companies save, and will they pass those savings onto employees? Will it make workers more mobile and ready to shift jobs, or will employer-paid health insurance become a sought-after perk?
The answers go to the heart of how things work in a sector that is one-eighth of the American economy. A new report gives some hints of how large the impact might be.
By 2020, about 90 percent of American workers who now receive health insurance through their employers will be shifted to government exchanges created by the health law, according to a projection by S&P Capital IQ, a research firm serving the financial industry.
http://www.nytimes.com/2014/05/01/upshot/employer-sponsored-health-insurance-may-be-on-the-way-out.html?hp

Can You Afford Your Medicine? Doctors Don’t Ask

By ALLISON BOND
 

JAMA Forum: On Medicine and Money

BY  on 
US consumers have always had limited information about how physicians and other health care professionals practice medicine. Now, however, the April 9 release by the Centers for Medicare and Medicaid Services (CMS) of data on medical services and procedures provided to Medicare beneficiaries will help fill that gap “by offering insight into the Medicare portion of a physician’s practice,” said Health and Human Services Secretary Kathleen Sebelius in an accompanying statement. The newly released data, she added, will “afford researchers, policy makers and the public a new window into health care spending and physician practice patterns.”
All told, the newly released CMS data set provides information about more than 880 000 health care professionals who received $77 billion in Medicare payments in fiscal year 2012 for 6000 different types of services and procedures under the Medicare Part B Fee-For-Service program. Additional data releases may well follow before too long, with an eye towards enhancing transparency.
“Data transparency is a key aspect of the transformation of the health care delivery system,” said CMS Administrator Marilyn Tavenner. In addition to the new information about clinicians, CMS made hospital charge data available last May, thereby apprising consumers of the wide-ranging hospital costs for common inpatient and outpatient services.

Medicare Millionaires
As might have been anticipated, much of the media coverage of the release of the CMS data focused attention on health care professionals dubbed “Medicare millionaires” and their practice patterns. Tantalizing as such details might be, more profound issues were being sidestepped. In particular, little has been said with respect to the uncomfortable relationship between medicine and money.
This is an unfortunate state of affairs, because the ethical and moral challenges associated with the juxtaposition of medicine and money are highly deserving of our attention. A clear-eyed recognition of this age-old subject and of the all-too-common frailty of human nature were articulated as early as the 12th century by Moses Maimonides, the philosopher and physician, in the Prayer of Maimonides: “Do not allow thirst for profit, ambition for renown and admiration to interfere with my profession . . . .”
But there are no easy answers to this conundrum.

Increasing antibiotic resistance could have disastrous effects, health organization warns

By Lenny Bernstein, Washington Post
Posted May 01, 2014, at 8:06 a.m.
The planet may be headed toward a “post-antibiotic era” in which common infections once easily controlled by antimicrobial medicines are lethal, the World Health Organization reported Wednesday in its first look at antibiotic resistance that has developed in all parts of the world.
“The problem is so serious that it threatens the achievements of modern medicine,” the organization said, adding that “a very real possibility for the 21st century” is a time when standard treatments no longer work, the chances of death from infection rise and the risk of disease spreading to others will increase.
“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier and benefit from modern medicine,” Keiji Fukuda, WHO’s assistant director-general for health security, said in a news release. “Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”
Such alarm in the health-care community and elsewhere about resistance to antibiotics is not new. In September, the U.S. Centers for Disease Control and Prevention warned of “potentially catastrophic consequences” of drug-resistant microorganisms, saying they now kill an estimated 23,000 people in this country every year, and other public health groups have been clamoring about them for years.
But WHO reported that “very high rates of resistance” have been observed around the world to common bacteria that cause urinary tract, wound and bloodstream infections, as well as pneumonia. Multi-drug-resistant tuberculosis is a growing and under-reported concern, and rising resistance to anti-HIV drugs has been detected. At the same time, surveillance of the growing threat by officials worldwide is not coordinated.
In a region-by-region breakdown, WHO reported that in some settings in the Americas, up to 90 percent of Staphylococcus aureus infections are resistant to methicillin, a situation that has come to be abbreviated as MRSA. The bacteria that causes pneumonia is now less susceptible to penicillin throughout the world and exceeds 50 percent of cases in some places. In 36 countries, the last-resort treatment for gonorrhea is proving less effective.

Maine hospitals tops again in safety ranking

A national hospital safety group is asking Americans to imagine this: The populations of Miami or Atlanta are simply wiped out. That’s how many Americans die every year from preventable hospital errors – up to 440,000 patients, making such errors the third-leading cause of death in the country.
The Leapfrog Group, an employer-led hospital watchdog organization, ranks how well hospitals prevent medical errors, assigning letter grades to medical centers across the U.S. For the second year in a row, Maine leads the nation, according to the newest batch of Leapfrog’s Hospital Safety Scores.
In Maine, 74 percent of hospitals, or 14 out of 19 ranked, earned an “A” grade, making the state tops in the country. Massachusetts came in second, with 70 percent. No Maine hospital earned less than a C grade, according to the new rankings, released Wednesday.
In five states — Alaska, the District of Columbia, Idaho, Nebraska and Wyoming –no hospitals received an “A” in the updated scores.
The letter grades reflect the risk that a patient could be harmed by a preventable medical error while hospitalized. Leapfrog assigns A, B, C, D and F grades to more than 2,500 U.S. hospitals, urging patients to use the rankings to protect themselves from errors, accidents, injuries and infections.

44,000 Mainers sign up for health insurance under Affordable Care Act

By Jackie Farwell, BDN Staff
Posted May 01, 2014, at 2:22 p.m.
More than 44,000 Mainers signed up for private health insurance under the Affordable Care Act, according to federal data released Thursday that paints the most complete picture yet of Americans’ efforts to gain coverage under President Barack Obama’s health reform law.
The data reveals a long-awaited, state-by-state tally of individuals who selected private health plans through Healthcare.gov, the federal government’s gateway for insurance marketplaces in Maine and 35 other states.
From the Oct. 1, 2013, launch of Healthcare.gov through March 31 of this year, 44,258 Maine residents selected a private health plan through the site, according to the data released by the U.S. Department of Health and Human Services. That’s a swell from 25,412 Mainers at the end of February.
Maine’s tally more than doubled the early goal of 20,000 sign-ups set by grass-roots health advocates, said Wendy Wolf, president of the Maine Health Access Foundation, which organized a statewide enrollment initiative called Enroll 207.
“Maine is always a can-do state,” she said. “We do a lot with so little and this is an example of where neighbor helps neighbor to a degree that I didn’t think, frankly, we’d achieve. But we did.”
The federal report also includes some enrollment activity through April 19, such as individuals who selected plans during a special extension of the open enrollment period and those who experienced life changes that qualified them to sign up later.
Maine 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 the Obama administration for the entire open enrollment period, ahead of schedule.
In the end, though, several other states outperformed Maine by signing up higher shares of eligible residents. Vermont topped the list, enrolling 85 percent of those eligible to shop on the marketplace, followed by California, Rhode Island and Florida. Maine enrolled about 65 percent of eligible residents, the data show.
Also called “exchanges,” the marketplaces are geared toward small businesses and individuals who buy their own health insurance rather than receive coverage through work or government programs such as Medicaid and Medicare.





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