De Blasio’s Plans to Reduce Worker Health Costs Have a Carrot and a Stick
By STEVEN GREENHOUSE and NIKITA STEWART
When Mayor Bill de Blasio announced his first labor agreements
with New York City unions this spring, he was sharply criticized for
granting long-awaited wage increases in exchange for promises of
unspecified though sizable savings on health care expenses.
Now,
some of the specifics are coming into focus: City officials and union
leaders say they hope to push municipal workers to use walk-in clinics
more and emergency rooms less, order generic drugs more often than
brand-name ones, and buy them through the mail rather than at retail
pharmacies to achieve bulk discounts.
The
city hopes the unions will agree to steer workers to use centralized,
cheaper centers for blood tests, X-rays or M.R.I.s, rather than having
those tests performed in doctors’ offices or at costly physician-owned
facilities. Patients who resist could face higher copayments, while
savings would be passed on to the city in lower premiums.
The
cost-cutting comes with high stakes: If the city and unions are unable
to save a total of $3.4 billion on health care by 2018, a mediator will
be empowered to order increases in workers’ premiums to cover the
shortfall, officials said.
As
an added inducement, if the unions help the city exceed that goal, the
first $365 million in additional savings would be distributed as
lump-sum bonuses to workers, officials said. Any savings beyond that
would be split evenly between the city and its employees.
In
interviews, Harry Nespoli, chairman of the Municipal Labor Committee,
the umbrella group of city unions, and Robert W. Linn, the city’s labor
relations commissioner, disclosed several of the cost-saving measures
being discussed as the two sides draw closer to a deal.
For
example, union officials are meeting with EmblemHealth, an insurer that
covers many municipal union members, to negotiate increased access for
employees to EmblemHealth’s more than 40 walk-in clinics across the
city.
Arrangements
like that could reduce costly emergency-room visits not only for the
city’s 350,000 workers but also for their dependents — a total of about
one million people, the officials said.
Missing
from the labor contracts with teachers and other city workers that were
announced beginning in May was any requirement for union members to
begin contributing toward their health insurance premiums. That prompted
some critics to say Mr. de Blasio was not being tough enough at the
bargaining table.
Do You Own a Gun? In Florida, Doctors Can’t Ask You That
A
few weeks ago, I had my yearly physical. As part of her history-taking,
my doctor asked if I was sexually active with my wife. Then she asked
if I was sexually active with anyone other than my wife. She does this
every year.
She’s
not asking to be intrusive. Nor is she a voyeur. She knows that having
multiple sexual partners significantly increases one’s chance of
contracting a sexually transmitted infection. Asking about that allows
her to see if I’m at risk, and then to address that risk with me.
I’m
not offended that she asks me. Asking me is part of what makes her an
excellent physician. Doctors are supposed to ask about sensitive things
in order to help keep us safe. This is especially true for
pediatricians. This kind of exchange is how we engage in prevention,
sometimes called anticipatory guidance, and study after study shows it can prevent harm.
When
pediatricians ask you about using car seats, they’re trying to prevent
injuries. When they ask you about how your baby sleeps, they’re trying
to prevent injuries. When they ask you about using bike helmets, they’re
trying to prevent injuries. And when they ask you about guns, they’re
trying to prevent injuries, too.
But not, perhaps, everywhere. In Florida, in 2011,
a law was signed that made it illegal for doctors to ask patients if
they owned a gun. If doctors violate this law, they can be disciplined,
leading to fines, citations and even a loss of their license.
A
lower court struck down the law in 2012. But last week, a panel of
judges on the United States Court of Appeals for the 11th Circuit upheld it. In their ruling, the judges declared that the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.” The clear assertion of the judges is that there is no legitimate health reason to be asking about gun ownership.
Almost 20,000 people committed suicide in the United States with firearms in 2011. More than 11,000 were killed by firearms that year, and more than 200 were killed in accidents with guns. In 2009, almost 7,400 children were hospitalized because of injuries related to guns.
Health premiums soared, Insurance Commissioner Dave Jones says
The cost of health insurance for individuals skyrocketed this year in California, with some paying almost twice what they did last year, the state's insurance commissioner said.
But Insurance Commissioner Dave Jones predicted that insurers will ease up in the coming year to prevent California voters from approving tough new rate controls on the November statewide ballot as Proposition 45.
Insurers and opponents of Proposition 45 dismissed Jones' comments as misleading and politically motivated.
At a news conference Tuesday, Jones said individuals this year paid between 22% and 88% more for individual health insurance policies than they did last year, depending on age, gender, type of policy and where they lived.
The increases did not affect poor people, whose policies are heavily subsidized, Jones said. The study results released Tuesday did not include group policies such as those offered by employers.
Jones said he authorized the study of health insurance rates after receiving numerous complaints about rising costs.
"The rate increase from 2013 to 2014, on average, was significantly higher than rate increases in the past," Jones said.
The hardest-hit were young people, he said. In one region of Los Angeles County, people age 25 paid 52% more for a silver plan than they had for a similar plan the year before, while someone age 55 paid 38% more, Jones said.
The state examined policies issued by the state's four largest health insurers: Anthem Blue Cross, Blue Shield of California, Kaiser and Health Net.
Jones took time Tuesday to lobby for Proposition 45, a statewide initiative on the November ballot that would give his office new authority to regulate proposed health insurance increases. He said California is among a minority of states that do not regulate health insurance costs.
Maine Heritage Policy Center honors DHHS Commissioner Mary Mayhew
PORTLAND, Maine — Mary Mayhew, the controversial commissioner of the Department of Health and Human Services, was honored Tuesday by the state’s pre-eminent conservative think tank, the Maine Heritage Policy Center.
Mayhew, who left a job lobbying for the Maine Hospital Association to join the LePage administration in 2011, “was critical to the conservative movement’s victories” this year, said MHPC board member Jinger Duryea, who presented Mayhew with the group’s annual Freedom and Opportunity Award.
Duryea heralded Mayhew’s “unwavering commitment to limited government, individual liberty and human dignity.”
Mayhew has emphasized streamlining and savings during her tenure at the helm of DHHS, a massive state agency with a $3.4 billion budget. She and Gov. Paul LePage, a Republican, regularly have referred to what they described as runaway spending at DHHS and said the agency should prioritize services for the disabled, children and elderly — not “able-bodied” adults living in poverty.
Dozens call on Maine to regulate chemicals found in plastic household products
By Jackie Farwell, BDN Staff
Posted July 29, 2014, at 3:08 p.m.
AUGUSTA, Maine — More than 70 people called on the LePage administration Tuesday to require disclosure of potentially dangerous chemicals commonly found in consumer products.
At a hearing before the Maine Department of Environmental Protection, parents, doctors, business owners and public health experts asked the agency to step up regulation of phthalates, a group of chemicals used to soften plastics that studies have linked to serious health problems, such as reproductive birth defects among boys and higher rates of asthma and allergies, according to the Alliance for a Clean and Healthy Maine.
The alliance, a coalition of environmental and health organizations, on May 14 delivered more than 2,000 signatures to the DEP, urging the agency to adopt a requirement that manufacturers report which products sold in the state contain phthalates.
Phthalates are found in hundreds of consumer products, including vinyl flooring, garden hoses, shower curtains, inflatable toys, adhesives, detergents and raincoats. The chemicals are also a common ingredient in fragrance used in personal care products such as soaps, shampoos, makeup and nail polishes.
Phthalates can escape from products into dust and the air, entering the body through breathing, eating and skin contact. Some studies have found phthalates can disrupt male hormones early in life, while others have tied them to slowed brain development and immune system problems.
The chemicals already are banned in toys and products marketed to children under 3.
Earlier this month, an advisory panel of the U.S. Consumer Product Safety Commission issued areport recommending that the temporary ban on five phthalates used in children’s toys be made permanent. The panel also noted that food, beverages and drugs lead to the highest exposures of some phthalates, rather than children’s toys and personal care products. Phthalates are used in food processing and packaging.
While the U.S. Centers for Disease Control and Prevention has found widespread phthalate exposure among Americans, it cautions that the health effects remain unknown. Finding detectable amounts of phthalates in the body doesn’t mean that exposure will harm a person’s health, according to the CDC.
Churning for Dollars — There Ought to Be a Law
By Donna Smith
Common Dreams, July 27, 2014
Common Dreams, July 27, 2014
Remember Liz Fowler? She was the WellPoint executive who took a brief sabbatical from her direct paychecks from the private health insurance industry to write the Affordable Care Act while working for Senator Max Baucus. Once that project was wrapped up, Liz went to work briefly for the U.S. Department of Health and Human Services as she transitioned her way back to work as a lobbyist for health industry giant Johnson & Johnson.
I met with Fowler once in Washington, D.C. I was part of a delegation of people hoping to be heard on single-payer, improved and expanded Medicare for all for life health care reform, and she had the most sincere, concern-filled gaze I had ever seen in D.C. as she did her best to show support for those who wanted something other than the profit-based, market driven reform we got. She was a marvelous actress. Once her work was done in achieving victory for the health insurance industry through the Affordable Care Act/Obamacare, Fowler set off for greener again (and received plenty of cash).
Now, in Colorado, we’re seeing Patty Fontneau, the CEO of the health insurance exchange, making her departure to return to private industry. Fontneau will take a position as president of health insurance giant CIGNA’s private exchange business. Prior to heading up the exchange, she worked for a law firm and in finance. No doubt her new role at CIGNA will provide her an income that supports the lifestyle to which she became accustomed while earning nearly $200,000 annually (plus bonuses) as the head of the Colorado exchange. It’s a safe bet she never had to apply for or worry about any tax credits or subsidies to cover her own health insurance premiums.
The only time I ever met Fontneau was after I complained to the exchange board in a public meeting about the delay in receiving a Medicaid denial so I could get on with shopping for and signing up for a policy on the exchange. Her staff and Medicaid managers wanted to make sure I knew it was my error that caused the delay. (It wasn’t.) And I never really got the gaze of concern and sincerity that Fowler had mastered at the national level.
So, what’s wrong with all this cross-pollination of private and public interests and executives in our health care industry? It is an affront to the basic common sense of most Americans and Coloradans to ask us to think that executives like Fowler and Fontneau have not been rewarded for their loyalty and success in protecting the big business interests that drive our health system. These are not people who devote themselves to public service of any kind for very long — being a public servant doesn’t generally pay enough to keep them anchored to the public good over private profits and interests.
Poor planning and oversight led to HealthCare.gov flaws, GAO finds
Federal health officials were responsible for the problem-pocked start of HealthCare.gov last year because of poor planning and lax oversight of outside contractors, according to government investigators who warned that “significant risks remain” that some Americans could again have trouble buying coverage in the federal health insurance marketplace this fall.
Such management failures are the central conclusion of the first report issued by the Government Accountability Office as part of a wide-ranging appraisal of the reasons the computer system was not ready when the marketplace opened in October.
The initial slice of the GAO’s work focuses on the main contractors the government hired to build HealthCare.gov, the Web site for the federal insurance exchange created under the Affordable Care Act. In particular, the report examines the shepherding of the contractors by the Centers for Medicare and Medicaid Services (CMS), the branch of the Department of Health and Human Services responsible for developing the marketplace.
Building “a first-of-its-kind marketplace” was certain to be a complex undertaking, the investigators conclude in the report, made public on Wednesday. But agency officials aggravated the situation by allowing too little time for the work; changing the directions it gave the main contractor, CGI Federal; and not scrutinizing the contractor’s progress, the investigators found.
The results, the GAO says, were “significant cost increases, schedule slips” and delays. Between September 2011 and February of this year, the cost for building the marketplace ballooned from $56 million to $209 million. Building HealthCare.gov, the report said, had cost $840 million as of earlier this year, the GAO found.
Consumers asked to verify income, other information — or risk losing government subsidies for health insurance
By Daniel Chang and Nick Madigan, Miami Herald
Luis Martinez of Hialeah, FL, survived two heart attacks during the more than 10 years that he went without health insurance.
So he was relieved to finally find coverage on the Affordable Care Act’s insurance exchange in March, two weeks before the enrollment deadline.
But four months after he and his wife signed up for a subsidized, bronze-level health plan with Coventry, Martinez, 51, said he feels as though he has fallen into a black hole of government bureaucracy while trying to prove his income and his wife’s citizenship in order to keep their coverage, part of a national effort to verify policyholders’ eligibility.
Martinez, who has stents implanted in his coronary arteries, said he has tried repeatedly for more than a month to comply with the government’s requests for additional documentation to resolve inconsistencies in his personal information — or risk losing his $457 monthly subsidy, and health insurance for him and his wife, Rocio Balbin, 46.
So far, officials with the U.S. Department of Health and Human Services are not satisfied with his response.
“I am against time,” said Martinez, a computer systems administrator who is studying at night to earn a bachelor’s degree in electrical engineering. “I have a dream, and I want to finish my career before I die. This is stressing me out.”
HHS officials declined to comment on Martinez’s case, but the agency is contacting hundreds of thousands of people with subsidized health plans bought under the ACA to verify their eligibility, particularly income and citizenship status, months after they first applied for and received financial aid to help them pay premiums and out-of-pocket costs for their coverage.
About eight million people signed up for a health plan through the ACA exchanges. According to the Kaiser Family Foundation, 85 percent of them were eligible for financial aid, and the government is expected to deliver about $10 billion in subsidies during the first year.
Healthcare analysts say some consumers will end up paying higher monthly premiums as a result of the verification process, while others may have to repay some or all of their subsidies if they are found to be ineligible.
But for some, like Martinez, the verification process has become a maze of red tape………….
But there is evidence that the government has been overwhelmed by the task.
In June, the HHS Office of Inspector General issued a report critical of the government’s ability to reconcile inconsistencies in the information about consumers who applied for a subsidized health plan during the first few months of the open-enrollment period. The most common inconsistencies, according to the report, involved citizenship and income information.
Inspectors also found that the federally run exchange was unable to resolve the great majority of those inconsistencies, or to even identify the number of consumers whose information did not match up with other federal records.
“The federal marketplace was unable to resolve 2.6 million of 2.9 million inconsistencies,” the report noted, “because the Centers for Medicare & Medicaid Services (CMS) eligibility system was not fully operational.”
