Leader of Connecticut’s Health Marketplace Is
Named to Run Federal Program
By ABBY GOODNOUGH AUG. 26, 2014
WASHINGTON — The Obama administration on Tuesday named Kevin J. Counihan, who ran Connecticut’s successful health insurance marketplace, as the chief executive of the federal marketplace serving consumers in 36 states.
Mr. Counihan will start on Sept. 8, a little more than two months before the next sign-up period for health insurance begins on Nov. 15. Sylvia Mathews Burwell, the secretary of Health and Human Services, hired Mr. Counihan for the new position of chief executive as part of an effort to improve management of the federal marketplace and to avoid the technological failures that paralyzed its website, HealthCare.gov, last fall.
Ms. Burwell said Mr. Counihan would be “a clear, single point of contact for streamlined decision-making.”
Although he comes to the federal marketplace with a record of success — enrollment in health plans exceeded expectations in Connecticut under his watch, and the state’s online marketplace ran relatively smoothly — Mr. Counihan now faces a far bigger challenge. He will be under pressure to get millions more Americans signed up for insurance during the three-month enrollment period, even as millions who already bought plans through the online marketplaces will need to renew them or switch to new coverage.
http://www.nytimes.com/2014/08/27/us/politics/Kevin-J-Counihan-chief-executive-health-marketplace.html?hpw&rref=health&action=click&pgtype=Homepage&version=HpHedThumbWell&module=well-region®ion=bottom-well&WT.nav=bottom-well
Vancouver Sun, Aug. 25, 2014
The middle-aged woman came to my family medicine practice for a routine visit to check her high blood pressure. It was the highest I’ve ever seen in the office: 280/180. I told her to go to the emergency department for probable admission to the hospital.
Her eyes crinkled, and tears fell silently. I thought she was crying because I had frightened her about the urgency of her condition. I was wrong.
“I can’t go to the hospital,” she said, “I can’t afford it.”
I have practised for more than 30 years in a health centre that cares for low-income patients in Charlotte, N.C. As is typical in the United States, our patients rely on a hodgepodge of funding sources. Almost all patients face some financial barriers to care.
A few have private insurance (increasingly with high co-pays and deductibles), many have Medicare (for the elderly) or Medicaid (for some of the poorest of the poor), and many are uninsured. Of the uninsured, some are “self-pay” and some qualify for sliding-scale charges pegged to their income.
While my patient with extreme hypertension is deeply etched into my mind, I could tell you many similar stories.
The typical new patients in my practice have not had health care for months or years. In many cases, they once had employer-based insurance and access to private doctors, then lost their job and thus their coverage and their physicians. Some cry when they talk about the interruption of these long-term relationships with their doctors.
One such patient had been hospitalized with severe congestive heart failure and had lost his full-time job because of his illness. Although he continued to work part-time, he was uninsured and could no longer see his usual doctor.
It took months for him to see me. When he did, I promptly sent him to a cardiologist who prescribed open-heart surgery. He received it, but he could have died waiting for care, as thousands of Americans do every year.
The constant churning of patients in and out of coverage, or in and out of private insurance plans (each with a restrictive network of providers), is cumbersome and costly. Such transitions require patients to seek out new doctors who request and scrutinize old records and sometimes order tests, not realizing they have already been done.
The U.S. system creates other challenges to providing good care. Some patients miss appointments simply because they don’t have enough money for their insurance co-pays.
I approach each patient with an algorithm. This patient has Blue Cross/Blue Shield and has these options, this one has Medicare and another set of options for referrals and medications, this patient is on sliding scale and another set: oops, no options here for certain services. It is even more complicated, because the options change.
Unlike many other places in the U.S., we are fortunate at my health centre to have many services for the uninsured, but there are still many gaps. Elective orthopedic surgery, for example, is not even an option.
I have a patient with a painful hand condition and several patients who need knee or hip replacements. Many of them would be able to work if they could afford the recommended surgery, but instead they live in pain and poverty.
I know some people in Canada decry excessive waiting times for elective procedures. The waiting times for patients on the U.S. side are sometimes infinite or until they reach the age of 65 (decades away for some), when they finally receive our Medicare.
Medical care in the United States costs twice as much per capita as in Canada, yet we have tens of millions who are uninsured, two million people a year who are victims of medical bankruptcy, and some of the worst health statistics in the developed world.
http://www.pnhp.org/print/news/2014/august/beware-siren-song-of-private-payer-care
By ABBY GOODNOUGH AUG. 26, 2014
WASHINGTON — The Obama administration on Tuesday named Kevin J. Counihan, who ran Connecticut’s successful health insurance marketplace, as the chief executive of the federal marketplace serving consumers in 36 states.
Mr. Counihan will start on Sept. 8, a little more than two months before the next sign-up period for health insurance begins on Nov. 15. Sylvia Mathews Burwell, the secretary of Health and Human Services, hired Mr. Counihan for the new position of chief executive as part of an effort to improve management of the federal marketplace and to avoid the technological failures that paralyzed its website, HealthCare.gov, last fall.
Ms. Burwell said Mr. Counihan would be “a clear, single point of contact for streamlined decision-making.”
Although he comes to the federal marketplace with a record of success — enrollment in health plans exceeded expectations in Connecticut under his watch, and the state’s online marketplace ran relatively smoothly — Mr. Counihan now faces a far bigger challenge. He will be under pressure to get millions more Americans signed up for insurance during the three-month enrollment period, even as millions who already bought plans through the online marketplaces will need to renew them or switch to new coverage.
http://www.nytimes.com/2014/08/27/us/politics/Kevin-J-Counihan-chief-executive-health-marketplace.html?hpw&rref=health&action=click&pgtype=Homepage&version=HpHedThumbWell&module=well-region®ion=bottom-well&WT.nav=bottom-well
Covered California officials, insurance chief clash over Prop. 45
by Chad Ternune
California's Obamacare exchange and the state insurance commissioner are on a collision course over Proposition 45, a popular ballot measure aimed at reining in health insurance rates.
Covered California officials lashed out at the statewide ballot initiative this week and warned that it could be disastrous to the state's implementation of the federal healthcare law.
In November, voters will decide whether to give Insurance Commissioner Dave Jones veto power over rate increases for about 6 million Californians who have individual and small-business policies. Without this authority, Jones says, consumers will keep being subjected to excessive rate hikes and Obamacare won't be affordable.
Until now, the state-run exchange had largely avoided a public clash over Proposition 45 with Jones, a Democrat who supports the health law. That restraint disappeared at an exchange board meeting Thursday, and officials there will take up a vote next month to formally oppose it.
These moves thrust Covered California into the middle of what's expected to be a highly contentious and costly campaign.
Anthem Blue Cross, Kaiser Permanente and other companies have already contributed more than $37 million to defeat the measure. Insurers argue that the initiative is unnecessary because the Affordable Care Act already imposes new rules to protect consumers.
The ballot fight starts with broad support for Proposition 45. A Field Poll released this week found 69% of California voters favored the proposition. That support may wane once ads attacking the measure ramp up.
Obamacare chief in California gets $53,000 bonus
By Chad Terhune
California's health insurance exchange awarded its executive director a one-time bonus of $53,000 after the state enrolled 1.2 million people in Obamacare coverage.
Covered California's board chairwoman, Diana Dooley, said Peter Lee had not received a raise in three years, so the exchange granted the executive director a 20% incentive award based on his annual salary of $262,644.
Lee, a former healthcare official in the Obama administration, was instrumental in building California's state-run marketplace.
Consumer advocates credited him with securing lower-than-expected rates from health insurers in his first two years on the job, and with surpassing the state's enrollment goals.
California accounted for about 15% of the overall U.S. enrollment of 8 million people in individual policies under the Affordable Care Act.
The state also avoided many of the online glitches that plagued the federal exchange at Healthcare.gov and other state sites.
Several state exchange directors didn't survive the rollout of Obamacare this year. Officials in Oregon, Minnesota and Maryland all resigned as troubles mounted.
Lee hasn't been immune to criticism. On Thursday, after his bonus was announced at a meeting of the exchange's board, two state lawmakers faulted him for low enrollment among African Americans.
Beware siren song of private-payer care
In the U.S., the doctor is in, but maybe financially unavailable
By Jessica Schorr Saxe, M.D.Vancouver Sun, Aug. 25, 2014
The middle-aged woman came to my family medicine practice for a routine visit to check her high blood pressure. It was the highest I’ve ever seen in the office: 280/180. I told her to go to the emergency department for probable admission to the hospital.
Her eyes crinkled, and tears fell silently. I thought she was crying because I had frightened her about the urgency of her condition. I was wrong.
“I can’t go to the hospital,” she said, “I can’t afford it.”
I have practised for more than 30 years in a health centre that cares for low-income patients in Charlotte, N.C. As is typical in the United States, our patients rely on a hodgepodge of funding sources. Almost all patients face some financial barriers to care.
A few have private insurance (increasingly with high co-pays and deductibles), many have Medicare (for the elderly) or Medicaid (for some of the poorest of the poor), and many are uninsured. Of the uninsured, some are “self-pay” and some qualify for sliding-scale charges pegged to their income.
While my patient with extreme hypertension is deeply etched into my mind, I could tell you many similar stories.
The typical new patients in my practice have not had health care for months or years. In many cases, they once had employer-based insurance and access to private doctors, then lost their job and thus their coverage and their physicians. Some cry when they talk about the interruption of these long-term relationships with their doctors.
One such patient had been hospitalized with severe congestive heart failure and had lost his full-time job because of his illness. Although he continued to work part-time, he was uninsured and could no longer see his usual doctor.
It took months for him to see me. When he did, I promptly sent him to a cardiologist who prescribed open-heart surgery. He received it, but he could have died waiting for care, as thousands of Americans do every year.
The constant churning of patients in and out of coverage, or in and out of private insurance plans (each with a restrictive network of providers), is cumbersome and costly. Such transitions require patients to seek out new doctors who request and scrutinize old records and sometimes order tests, not realizing they have already been done.
The U.S. system creates other challenges to providing good care. Some patients miss appointments simply because they don’t have enough money for their insurance co-pays.
I approach each patient with an algorithm. This patient has Blue Cross/Blue Shield and has these options, this one has Medicare and another set of options for referrals and medications, this patient is on sliding scale and another set: oops, no options here for certain services. It is even more complicated, because the options change.
Unlike many other places in the U.S., we are fortunate at my health centre to have many services for the uninsured, but there are still many gaps. Elective orthopedic surgery, for example, is not even an option.
I have a patient with a painful hand condition and several patients who need knee or hip replacements. Many of them would be able to work if they could afford the recommended surgery, but instead they live in pain and poverty.
I know some people in Canada decry excessive waiting times for elective procedures. The waiting times for patients on the U.S. side are sometimes infinite or until they reach the age of 65 (decades away for some), when they finally receive our Medicare.
Medical care in the United States costs twice as much per capita as in Canada, yet we have tens of millions who are uninsured, two million people a year who are victims of medical bankruptcy, and some of the worst health statistics in the developed world.
http://www.pnhp.org/print/news/2014/august/beware-siren-song-of-private-payer-care
Oregon: State Sues Over Health Website
by Reuters
The state sued Oracle America Inc. and six of its top executives on Friday, accusing the software giant of fraud for failing to deliver a working website for the Affordable Care Act program. The lawsuit, filed in Marion County Circuit Court, claims that fraud, lying and “a pattern of racketeering” by Oracle cost the state and its Cover Oregon program hundreds of millions of dollars. Oregon paid Oracle about $240.3 million for a system that never worked, the suit said. Oracle issued a statement saying that the suit “is a desperate attempt to deflect blame from Cover Oregon and the governor for their failures to manage a complex I.T. project.” It added, “The complaint is a fictional account of the Oregon health care project.” The company said it expected to prevail in both the state court lawsuit and in a breach of contract suit it filed against Cover Oregon two weeks ago in federal court.
Part D Gains May Be Eroding
by Paula Span
In 2003, when President George W. Bush signed the major Medicare expansion that would establish prescription drug coverage, he called it “a promise, a solemn promise, to America’s seniors.”
Medicare Part D, which took effect in 2006, initially made plenty of people angry. Some Congressional Democrats had argued that it would “privatize Medicare” by relying on insurance companies, while a number of Republicans insisted that the nation couldn’t afford the new program. Ordinary older adults learned to fear falling into the infamous “doughnut hole” coverage gap.
But in its first few years, national data shows, Part D did help elderly Medicare beneficiaries make modest progress. Out-of-pocket costs decreased. Better able to afford their medications, seniors were less likely to stop taking them for financial reasons. And they were less likely to do without other basic needs — like food and heat — in order to pay for drugs.
“I expected that to keep going,” said Jeanne Madden, a health policy analyst at Harvard Medical School. Instead, as she and a team researchers from Harvard and the University of Massachusetts report in the most recent issue of Health Affairs, those downward trends took a U-turn in 2009. “Things improved after Part D, continued to improve for a few years, and then reversed,” she said in an interview.
Obamacare has growing support, even if its name does not
by E.J. Dionne, Jr.
The Affordable Care Act was supposed to be a slam-dunk issue for Republicans in this fall’s elections. Karl Rove told us so in April, writing that “Obamacare is and will remain a political problem for Democrats.”
So how’s that Obamacare thing working out for the GOP?
The most significant bit of election news last week was the decision of Sen. Mark Pryor, the embattled Arkansas Democrat, to run an ad touting his vote for the health care law as a positive for the people of his increasingly Republican state.
Pryor’s ad is so soft and personal that it’s almost apolitical. After his dad, the popular former senator David Pryor, tells of his son’s bout with cancer, he notes that “Mark’s insurance company didn’t want to pay for the treatment that ultimately saved his life.” The picture has widened to show Mark Pryor sitting next to his father. “No one should be fighting an insurance company while you’re fighting for your life,” he says. “That’s why I helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for preexisting conditions.”
Who knew a law that critics claim is so dreadful could provide such powerful reassurance to Americans who are ill?
Democrats have never fully recovered from the Obama administration’s lousy sales job for (and botched rollout of) what is, legitimately, its proudest domestic achievement. That’s one reason Pryor doesn’t use the word “Obamacare” in describing what he voted for. Another is that, in many of the states with contested Senate races this year, most definitely including Arkansas, President Obama himself is so unpopular that if you attached his name to Social Security, one of the most popular programs in American history would probably drop 20 points in the polls.
No Link Found for Deaths and Veterans’ Care Delays
by Richard A. Oppel, Jr.
An investigation by the watchdog office for the Department of Veterans Affairs has been unable to substantiate allegations that 40 veterans may have died because of delays in care at the veterans medical center in Phoenix, according to a letter from the new secretary of Veterans Affairs.
The allegations of deaths created a national scandal that eventually led to the ouster of the previous secretary of Veterans Affairs, Eric Shinseki.
Outrage over the manipulation of waiting list data in Phoenix and other veterans medical centers also led to passage by Congress of a $15 billion plan to improve access to medical providers. The director of the Phoenix hospital, Sharon Helman, has been placed on leave and the department has begun the process of firing her.
A report by the department’s office of inspector general is expected to be released this week that will describe findings from its investigation into Phoenix. Officials from the inspector general’s office have declined to comment on what the report will say.
However, a letter sent from the new Veterans Affairs secretary, Robert A. McDonald, to the inspector general responding to the report’s findings states that the investigation was unable to prove a link between the deaths of 40 veterans and delays in care.
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