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Wednesday, August 6, 2014

Health Care Reform Articles - August 6, 2014

Obamacare loses some of its campaign punch for Republicans
By MICHAEL A. MEMOLI, LISA MASCARO

Six months ago, a House Republican campaign official listed the top three issues that would propel the party's candidates to victory in the midterm election: "Obamacare, Obamacare, Obamacare."
It was a strategy that worked well in 2010, when GOP electoral gains were fueled primarily by a high-profile campaign to repeal the newly passed Affordable Care Act.
But now, months removed from the political storm that resulted from the botched rollout of the law and as more Americans begin receiving healthcare under the program, many Republicans have a more nuanced view of its importance.
House Republicans are broadening their once-singular focus on the healthcare law and headed into an extended summer break without delivering on their promise to advance an alternative.
For much of the summer, in fact, the issue has receded as both a topic of daily assaults in Congress and on the campaign trail. The once-common House votes to repeal Obamacare have been replaced by a probe into improper Internal Revenue Service targeting, hearings into treatment delays for veterans and a Republican push to sue or even impeach President Obama on allegations of overstepping his constitutional bounds.
Republicans "are not finding as much traction" on Obamacare as they'd like among voters, according to Democratic strategist Stanley Greenberg. New polling from his firm found that voters in the states that will determine control of the Senate were evenly split between whether to implement and fix the health law or repeal and replace it.
Perhaps the most obvious sign of the shift has been what is seen, or not, in television advertising in key states. The percentage of broadcast television ads focused on Obamacare dipped in the spring, according to a study conducted by Kantar Media/CMAG, a nonpartisan media-tracking firm, for the Cook Political Report. The study found, however, that the percentage of Obamacare ads rose again in July.
"Back in 2010, Republicans were quite upfront about their plans to hang Obamacare around the necks of Democratic incumbents," wrote Elizabeth Wilner, a senior vice president for Kantar. "They're still running with the issue. They're just not necessarily promoting it."

Adventures in ‘Prior Authorization’

By DANIELLE OFRI
    “DEAR Doctor,” the letter from the insurance company began. “We are writing to inform you that a prior authorization is required for the medication you prescribed.”
    That’s usually where I stop reading. Thousands of these letters arrive daily in doctors’ offices across the country. They are attempts by insurance companies to prod doctors away from more expensive treatments and toward less expensive alternatives. To use the pricier option, you need to provide a compelling clinical reason.
    In theory, this is a reasonable way to control costs by making it harder to prescribe costlier medications. In practice, it is a wasteful administrative nightmare, a cavalcade of recurring paperwork, lengthy phone calls and bureaucratic battles.
    One study estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice: one hour of the doctor’s time, nearly six hours of clerical time, plus 13 hours of nurses’ time. Other studies have suggested that prior authorizations could cost individual practices tens of thousands of dollars a year.
    The letter in my hand concerned one of my patients, Mr. V., who suffers from stubborn hypertension. His chart is a veritable tome, documenting the years of effort it took to find the combination of four different blood-pressure medications that controls his hypertension without upsetting his diabetes, kidney disease and valvular heart disease or making his life miserable from side effects. We’ve been on stable ground for a few years now, a state neither of us takes for granted.
    But Mr. V. had changed insurance companies, and now one of his medications required a prior authorization. The last thing I wanted was for him to be turned away at his pharmacy and have his blood pressure spiral out of control, so I called right away to sort things out.
    Twenty minutes of phone tree later, I discovered that the problem was that I had exceeded a pill limit for one of his medications. Mr. V. needed to take 90 of those pills each month for the high dosage that his blood pressure required. I patiently explained this to the customer-care representative.
    Equally patiently, she told me that 45 pills a month was the maximum allowed for this particular medication.
    Three more phone trees and three more customer-care representatives later, my patience was flagging. Apparently a request for 90 pills was flummoxing the system. Representative No. 4 asked me to list all the blood-pressure medications that Mr. V. had been on in the past, including dates of initiation and relevant lab values, a request of epic proportions in his case.
    The representative went down her checklist. “Would taking 45 pills per month instead of 90 pills adversely affect Mr. V.’s health?” she asked.
    At first I thought she was joking. “Well,” I replied, “it would probably make his blood pressure shoot up in the second half of the month.”
    She paused, then asked her next question with the encouraging uplift of suggestion. “Has Mr. V. ever tried 45 pills per month instead of 90 pills?”
    Then I realized that she was not joking. “Are you out of your mind?” I hollered into the phone. “It’s taken years — years! — to find the right combination of meds to control his blood pressure without killing his kidneys or making him dizzy or nauseated or depressed or ruining his libido or running his potassium off the charts or breaking his bank account. Do you really think I’m going to randomly jiggle the dosages just for the hell of it?”
    “A simple yes or no will suffice, doctor.”
    Prior authorization clearly saves money for the insurance companies, at least up front. Many physicians simply give in, because the process is just too arduous.
    But prior authorization ultimately ends up costing the health care system. The time and money that medical practices devote to prior authorizations could surely be put to better use for patient care. And it’s not even clear that insurance companies save money in the long run. One study examined the records of more than 4,000 patients with Type 2 diabetes who were prescribed medications requiring prior authorizations. Those who were denied the medications had higher overall medical costs during the following year; not getting the medications probably worsened their conditions.
    I bit my tongue for the remainder of my conversation with the insurance company, holding back long enough to obtain the prior authorization that would allow Mr. V. the 90 pills he needed each month. I tried not to break the phone when I finally slammed down the receiver.
    I’m all for controlling medical costs and trying to apply rational rules to our use of expensive medications and procedures. But in the current system, everything seems to be in service of the corporate side of medicine, not the patient. The clinical rationale and the actual patient — not to mention the doctors and nurses involved in the care — are at best secondary concerns.
    In the end, we were able to keep Mr. V.’s blood pressure under control. My blood pressure, however, was a different story.



    http://www.nytimes.com/2014/08/04/opinion/adventures-in-prior-authorization.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region&_r=0

    A Doctor's Perspective On Obamacare Plans

    TOPICS: INSURANCE, MARKETPLACE, HEALTH REFORM, STATES,DELIVERY OF CARE
    By Jeffrey Cohen, WNPR
    AUG 04, 2014
    This story is part of a partnership that includes WNPR , NPR and Kaiser Health News. It can be republished for free. (details)
    On a recent afternoon at his office in Hartford, Conn., Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way.
    For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates.
    That's not something he's willing to accept. 
    "I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Gerard says. “You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on."
    Three insurers offered plans on Connecticut’s ACA marketplace in 2014,and Gerard is only accepting one. He won't say which, but he will say it pays the highest rate to doctors.
    "I don't think most physicians know what they're being reimbursed. Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to."
    Gerard's decision to reject two plans is something officials in Connecticut are concerned about. If reimbursement rates to doctors stay low in Obamacare plans, more doctors could reject those plans. And that could mean that people will get access to insurance, but they may not get access to a lot of doctors.
    That worries Kevin Counihan, who runs Connecticut's health insurance marketplace.
    "I think it could lead potentially to this kind of distinction that there are these different tiers of quality of care," Counihan says.

    The Obscure Drug With a Growing Medicare Tab

    An obscure injectable medication made from pigs’ pituitary glands has surged up the list of drugs that cost Medicare the most money, taking a growing bite out of the program’s resources.
    Medicare’s tab for the medication, H.P. Acthar Gel, jumped twentyfold from 2008 to 2012, reaching $141.5 million, according to Medicare prescribing data requested by ProPublica. The bill for 2013 is likely to be even higher, exceeding $220 million.
    Acthar’s explosive growth illustrates how Medicare’s prescription drug program — perhaps more than private health insurers and even other public health programs — is struggling to contain the taxpayer burden of expensive therapies aimed at rare conditions.
    Many outside experts say there’s insufficient evidence that the drug works better than much cheaper options for treating multiple sclerosis relapses and a rare kidney disease, conditions for which it is often prescribed. In the absence of such scientific studies, some private health insurance companies, as well as Tricare, the military’s health care program, have curtailed or eliminated spending on Acthar. Proponents of the drug say it is a worthy option for patients who have failed on other therapies.
    But Medicare has imposed no limits, leaving such decisions to the private insurers paid to administer its drug program on the government’s behalf. Medicare accounted for around a quarter of Questcor Pharmaceuticals’s sales of Acthar in 2012 — and that proportion is growing.
    Medicare cannot bar access to medications like Acthar, even in the face of rising expense and questions about efficacy, Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said in a written statement. The law mandates that Medicare’s drug program, known as Part D, cover drugs for the uses authorized by the Food and Drug Administration, he said.
    Since Acthar came on the market in 1952, the rules about F.D.A. approval have changed. At the time, drug companies simply had to demonstrate that a drug was safe, rather than that it was effective. Acthar was initially authorized as a treatment for more than 50 diseases and conditions. (The list has since been cut to 19.)
    Acthar isn’t prescribed often, just 3,387 times in Medicare in 2012. But Part D spent an average of $41,763 per prescription, making it one of the most expensive drugs around.
    The drug ranked 139th that year, in terms of total cost, out of more than 3,000 drugs prescribed in Medicare. In 2008, it ranked around 660th.
    Several of the top prescribers of Acthar have financial ties to the drug’s maker, Questcor. These doctors typically receive research grants, payments for delivering speeches on behalf of the company or compensation for serving on advisory boards.
    But some in the medical community say the program’s soaring bill for Acthar shows Medicare needs to do more to safeguard taxpayer dollars.
    http://www.nytimes.com/2014/08/05/upshot/the-obscure-drug-with-a-growing-medicare-tab.html?emc=edit_tnt_20140804&nlid=1311158&tntemail0=y&_r=0

    Freeport woman on list to get liver transplant; mom creating classic car book to pay for surgery

    By Beth Brogan, BDN Staff
    Posted Aug. 04, 2014, at 7:07 a.m.
    FREEPORT, Maine — Ten years after a doctor diagnosed her with a rare, potentially fatal liver disease that has ravaged her body and drained her bank account, Ann Day’s phone rang Thursday with the news she’s been waiting for.
    Day, 30, has been placed on the list for a liver transplant.
    “I called my mom crying,” Day said Sunday, sitting in the dappled sun outside her mother’s Freeport home.
    “And then I called people crying,” her mother, Nancie Boudreau-Smith, 53, said.
    Day, of Topsham, has autoimmune hepatitis, a rare disease in which the body’s own immune system attacks its liver.
    “My body is trying to reject itself,” she said.
    Over the last 10 years, Day estimates she’s been hospitalized on 30 different occasions — four or five in the past year alone.
    Sometimes it starts with a common cold. Other times, a bout of ascites, when fluid builds up in her belly because her liver can’t filter toxins.
    “It presses on my lungs or other organs and I can’t breathe,” she said. Recently a bout of ascites caused the lining of her stomach to perforate, resulting in an ambulance trip to Maine Medical Center after sepsis set in.
    Lifting a satchel full of the 16 prescriptions she takes each day, Day recounts the side effects of several. On prednisone, she gained 50 pounds in one month.
    “And the mood swings,” Boudreau-Smith said. “Very bad mood swings.”
    With constant medical appointments and hospitalizations, Day has had trouble holding a job, and has twice been denied Social Security disability. And even though she has medical insurance through her now-estranged husband, the out-of-pocket expenses and deductibles are adding up.
    But on Thursday, the family’s battle against her disease gained new vigor when she was placed on the transplant list.
    On Tuesday, Day will drive to the Lahey Hospital & Medical Center in Burlington, Massachussets, to learn where she falls on the waiting list.
    The urgency with which a candidate needs a liver transplant is determined on a scale of 6 to 40, according to the United Network for Organ Sharing.
    Day has been told her number is currently 17 — but it’s been as high as 27.
    Her mom, meanwhile, is attacking the illness on a different front.
    Boudreau-Smith and her boyfriend, Doug Ellis, 59, are classic car buffs. They frequently hop in his 1967 RS SS Camaro convertible and ride to “cruise-ins” — get togethers such as the one held Monday nights at the Topsham Fair Mall.
    Hoping to help her daughter defray the costs of the transplant, the lifelong medications she will need, and the months out of work, Boudreau-Smith recently began recruiting other classic car owners to submit photos of their vehicles for a “coffee table” book.

    Patients Seeking Cheaper Care Are Soliciting Bids From Doctors Online

    By Sandra G. Boodman
    Francisco Velazco couldn't wait any longer. For several years, the 35-year-old Seattle handyman had searched for an orthopedic surgeon who would reconstruct the torn ligament in his knee for a price he could afford.
    Out of work because of the pain and unable to scrape together $15,000 – the cheapest option he could find in Seattle – Velazco turned to an unconventional and controversial option: an online medical auction site called Medibid, which largely operates outside the confines of traditional health insurance. The four-year-old online service links patients seeking non-emergency care with doctors and facilities that offer it, much the way Priceline unites travelers and hotels. Vetting doctors is left to prospective patients: Medibid does not verify credentials but requires doctors to submit their medical license number for patients to check.
    Velazco paid $25 to post his request for knee surgery. A few days later, he had bids for the outpatient procedure from surgeons in New York, California and Virginia, including details about their expertise. After accepting the lowest bid -- $7,500, a fee that covered anesthesia and related costs -- he learned that his surgeon would be William T. Grant, a Charlottesville orthopedist.
    A few weeks later, after several online discussions with Grant, Velazco arrived in Charlottesville, where he had rented a $50-a-night room and would spend two weeks recuperating. On Dec. 4, 2013, he underwent knee surgery, performed in an outpatient surgery center that Grant co-owns.
    "I'm back working four days per week and climbing ladders," Velazco said recently. "I'm doing great."
    To Medibid founder Ralph Weber, a benefits consultant who said he left his native Canada for the United States in 2005 to escape "socialized health care," using the Internet to arrange non-emergency medical care is long overdue. Americans, he says, are increasingly going online to book travel and even find a mate. Medibid enables them to strip away the opacity that surrounds health-care pricing, Weber maintains, where charges vary wildly even in the same market and can be nearly impossible for consumers to obtain.

    For-Profit Home Care Agencies Cost Medicare Billions Extra, Yet Provide Worse Care: Health Affairs Study

    WASHINGTON - For-profit home health agencies are far costlier for Medicare than nonprofit agencies, according to a nationwide study published today in the August issue of the journal Health Affairs. Overall cost per patient was $1,215 higher at for-profits, with operating costs accounting for $752 of the difference and excess profits for $463. Yet the quality of care was actually worse at for-profit agencies, and more of their patients required repeat hospitalizations.
    Researchers at the City University of New York School of Public Health analyzed detailed Cost Reports filed with Medicare by 7,165 home health agencies in 2010-2011, as well as data for 22 quality measures from Medicare’s Home Health Compare database covering 9,128 agencies.

    Compared to nonprofits, operating costs at for-profit agencies were 18 percent higher, with excess administration (at $476 per patient) accounting for nearly two-thirds of the $752 difference in operating costs. For-profits also did many more speech, physical and occupational therapy visits, which are often highly profitable under the complex Medicare payment formula. In addition, profits at for-profit agencies added 15 percent on top of operating costs vs. a 6.4 percent surplus at nonprofit agencies. 

    Despite their higher costs, for-profit agencies delivered slightly lower-quality care. On average, for-profits met each quality standard only 77.2 percent of the time, vs. 78.7 percent for nonprofits. Rehospitalizations, widely viewed as an important quality measure, were more frequent among for-profit agencies’ patients: 28.4 percent vs. 26.5 percent at nonprofit agencies.

    Quality of care was worst in the South, where for-profit firms provide the overwhelming majority of care, the authors said.

    Medicare spent $18 billion on home care in 2012, the most recent year for which figures are available. Until 1980 Medicare barred for-profit agencies from its home care program, which covers homebound seniors who need skilled nursing care, or occupational, physical or speech therapy. At present, 88 percent of agencies are for-profit and they care for 81 percent of Medicare home care patients.

    “For-profit home care agencies are bleeding Medicare; they raise costs by $3.3 billion each year and lower the quality of  care for frail seniors,” said Dr. Steffie Woolhandler, professor of public health at CUNY’s Hunter College, lecturer at Harvard Medical School and senior author of the study. “Letting for-profit companies into Medicare was a huge mistake that Congress needs to correct.”
    Cabin continued: “Our findings show once again that the free-market, private-sector managed care model has failed.”

    Professor Cabin, who has decades of experience in the home care industry, undertook the research as part of his doctoral studies at the CUNY School of Public Health.


    Divide between red and blue states over healthcare deepens

    States that have aggressively put the Affordable Care Act into practice have cut the number of uninsured residents sharply -- in some cases in half or better -- while those that balked have improved little if at all, according to new data released Tuesday.
    The state-by-state numbers, from the Gallup-Healthways Well-Being Index, reinforce one of the major impacts of Obamacare so far: Political debate has widened the healthcare gap between red and blue states.
    All 10 states with the largest percentages of uninsured adults now have Republican governors and legislatures. The lowest percentages all are governed by Democrats, with the exception of Pennsylvania. 
    The 10 states with the biggest improvement in insurance coverage all took two major steps to implement the healthcare law -- they expanded Medicaid coverage, as the law allows, and they either set up their own online marketplace to let residents buy insurance or they entered into a partnership with the federal government to create one.
    By contrast, the states that still have the highest percentages of uninsured residents all declined to expand Medicaid and refused to participate in creating the online exchanges, leaving that task to Washington. Some states went further this year and actively impeded the exchanges, forbidding state employees to provide information about them, for example.
    Gallup's results have been carefully followed in the healthcare debate because they are based on a huge number of survey interviews -- 88,678 for this year's data. That allows analysis of changes at the state level as well as different demographic groups. Government figures from census surveys will not be available for many months.
    Nationwide, 18% of Americans lacked insurance last year just before the healthcare law took effect, while 13.4% were uninsured in the second quarter of this year, according to Gallup's surveys.
    Arkansas and Kentucky, both states that began with large numbers of uninsured residents, showed the biggest improvements. In Arkansas, the percentage of residents without insurance dropped from 22.5% last year -- significantly above the national average -- to 12.4% at the middle of this year. Kentucky improved from 20.4% uninsured to 11.9%.
    California had the largest drop in the sheer number of people lacking insurance; its percentage decrease ranked 8th nationally, from 21.6% last year to 16.3% at midyear.
    At the other end of the scale, Texas had the highest percentage of uninsured residents last year -- nearly 3 in 10 -- and still does. The share of uninsured Texans dropped by only 3 points, to 24% of the state's adult population.
    Last year, 14 states had one-fifth or more of the adult population lacking insurance. As of midyear, only three states remained in that group, with Georgia and Mississippi joining Texas. Florida and Louisiana were close behind.
    All five of those states are among the 21 that have ruled out expansion of Medicaid to all adults at or near the poverty level. The law allows that expansion and provides for the federal government to pick up the entire cost for the first several years and the lion's share thereafter.
    Republican governors in Utah, Indiana and Pennsylvania continue to negotiate with the federal government over expansion plans, while 26 states have expanded their programs.
    Opponents of expansion argue that Washington eventually will dump the cost on the states; some also oppose Medicaid entirely on ideological grounds.

    Obamacare causes steep drop in uninsured — in deep red states

    Arkansas and Kentucky lead all other states in the sharpest reductions in their uninsured rate among adult residents since the healthcare law’s requirement to have insurance took effect at the beginning of the year. Delaware, Washington, andColorado round out the top five. All 10 states that report the largest declines in uninsured rates expanded Medicaid and established a state-based marketplace exchange or state-federal partnership.
    In Arkansas, the rate of uninsured dropped from 22.5 percent in 2013 to 12.4 percent now — a change of over 10 percentage points.
    In Kentucky, it dropped from 20.4 percent to 11.9 percent — a change of over eight percentage points.
    In Colorado, it dropped from 17 percent to 11 percent — a change of six percentage points.
    The Kentucky example is particularly interesting. Remember, Mitch McConnell still regards the the law that created this drop in the uninsured among his own constituents as a “disaster.” Yet hundreds of thousands have signed up for coverage on the Kentucky exchange. Interestingly, as Joe Sonka has documented, the biggest drops in uninsured have occurred in eastern Kentucky — which is to say anti-Obama coal country, a.k.a., Mitch McConnell country.
    Despite all this, Alison Lundergan Grimes continues to avoid engagement on Obamacare. I get the arguments in favor of that strategy. Grimes wants to avoid getting drawn into Washington arguments that could sully what the campaign sees as her key advantage in this race: The contrast between Grimes’ newcomer status and McConnell’s decades inside the Beltway. But it really is too bad that the Affordable Care Act — or, at least the word “Obamacare,” anyway — remains so toxic on some turf that Dems can’t embrace this steep drop in uninsured, in one of the most unhealthy regions in the country, as a major policy success.
    The Arkansas example is also interesting. Arkansas moved forward with its own version of the Medicaid expansion, which presumably helped bring that rate down, and it’s noteworthy that the GOP candidate for Senate — Rep. Tom Cotton — has tended to serve up word salad when asked where he stands on it.
    Meanwhile, the Koch-founded Americans for Prosperity has spent big money on multiple ads in Arkansas featuring Obamacare “horror stories” in which the victim in each…received a cancellation letter. Yet according to Gallup, the drop in uninsured here has been steeper than in any other state — which complicates the message that the law has ended up costing more people their insurance than it has covered.

    All of these little data points help tell a larger story, which Politico told really well today: The fading of Obamacare as an issue in many states, including those with hard fought Senate races with massive expenditures such as those from the Koch group. To be sure, Dems very well could lose control of the Senate. But it is becoming increasingly accepted that even if that does happen, Obamacare might not be a major reason why — the makeup of the map and the economy could prove far more important in determining the outcome. Note this key nugget at the end of the Politico story:

    Affordable Care Act has lowered Maine’s uninsured rate, poll says

    The rate declined from 16.1 percent before Mainers could get coverage to 13.3 percent midway through this year.

    BY JOE LAWLOR STAFF WRITER

    About 35,000 more Mainers have gained coverage by signing up for health benefits through the Affordable Care Act, according to a Gallup poll released Tuesday.
    The percentage of Maine’s 1.3 million people who didn’t have health insurance dropped 2.8 percentage points, from 16.1 percent in 2013 – before people could enroll in Affordable Care Act coverage – to 13.3 percent midway through 2014, according to Gallup.
    The Gallup-Healthways Well-Being Index poll is the first state-by-state breakdown showing the impact the Affordable Care Act has had on the rate of uninsured residents.
    It found an overall drop of 4 percentage points in the rate of uninsured residents for states that expanded their Medicaid programs and built or helped manage the law’s new online insurance markets. For states that took only one of these steps or did neither, the reduction was 2.2 percentage points.
    Nationally, the uninsured rate dropped from 17.3 percent of U.S. adults in 2013 to 13.4 percent in the second quarter of 2014, the survey found.
    Maine’s percentage decline in its uninsured population ranked 22nd, tied with Montana. Arkansas and Kentucky led the nation, with drops of 10.1 percent in Arkansas and 8.5 percent in Kentucky.
    Among the 29 states that refused to expand Medicaid or operate their own health insurance marketplaces, Maine did better than the average 2.2 percent decline in the rolls of the uninsured.
    “It’s both a good and bad story here in Maine,” said Mitchell Stein, a Cumberland-based independent health policy analyst. “We did better than a lot of states that did not expand Medicaid, but easily could have had another 3 to 4 percentage point decrease if we had expanded Medicaid.”
    The Democratic-controlled Legislature approved Medicaid expansion in 2013 and 2014, but failed to override vetoes by Gov. Paul LePage, who steadfastly opposed the expansion. LePage, like many Republican governors, argued that expansion was not financially sustainable, while Democrats and some moderate Republicans said that leaving 70,000 people without coverage would hurt low-income Mainers.
    Stein estimated earlier this year that about 8,000 to 10,000 of those Mainers who would have qualified for Medicaid expansion instead purchased subsidized insurance on the marketplace.
    The federal government would have paid for 100 percent of the cost of Medicaid expansion for the first three years, and 90 percent in subsequent years.
    Still, the drop in the uninsured rate shows that Mainers desired the health care coverage, said Emily Brostek, executive director of Consumers for Affordable Health Care, a health policy think tank. Brostek said a robust grass-roots effort to sign up Mainers also made a difference.
    “There was a really big effort by so many people to make people aware that they could sign up,” Brostek said.
    Maine exceeded the U.S. Department of Health and Human Services enrollment projections by 90 percent, she said.
    LePage spokeswoman Adrienne Bennett didn’t respond to a message seeking comment Tuesday night.

    Virtual Doctor Visits Considered Major Step Forward for Maine Patients

    by Patty Wight
    Seeing the doctor is now only a few clicks away, thanks to new apps that allow you to do virtual visits on your computer, smartphone or tablet. Anthem Blue Cross and Blue Shield announced today that it's covering video visits for most of its Maine members when they use the Internet tool LiveHealth Online. Many see the development as a major step forward in convenience and access to health care.
    Patty Wight reports on virtual doctor visits.
    Say you've got a health concern such as a sore throat or a rash and you want to see a doctor. But you can't peel away from your job. Or your illness crops up in the middle of the night. Maybe the weather's too bad for driving. If it's not an emergency, a video visit is a great option, says Dr. Jeff Holmstrom, medical director at Anthem and practicing family physician.
    "They can get sound medical advice, treatment if appropriate, for routine medical conditions," he says.
    It's not a replacement for a primary care doc. It's for greater access and convenience, says Anthem spokesman Rory Sheehan. He demonstrates how to use LiveHealth Online on his smartphone.
    "So I downloaded the app," he says.
    Then he created a profile with his name, insurance and contact information. The app appears as a white square on his phone, and he taps on it.
    "So then when you get into it, you get a listing of all the providers," he says. "And it will tell you which providers are available."
    There's a picture of each doctor, all U.S.-based, along with basic information about their experience and the cost of the visit: $49. If you're covered under Anthem, a visit at LiveHealth Online will cost you a typical office co-pay: about $20. Sheehan chooses a doctor in Vermont, and as he waits for his appointment to begin, someone named "Katie" appears on his phone.
    "We're waiting here for a few minutes while your care provider opens your file and reviews the information you've shared," Katie says. "Just like in the office, they want to know a little more about you and your health care concerns before entering the room."
    About a minute later, a cheerful doctor appears by live video on Sheehan's smartphone.





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