Health Care Reform Articles - October 12, 2014

The Insiders: It is a myth that Obamacare is “working”

by Ed Rodgers

As Election Day approaches, President Obama and his allies have been repeating a common refrain on the campaign trail and in the mainstream media that the Affordable Care Act is “working.” In his speech at Northwestern University last week, President Obama said that, “while good, affordable health care might seem like a fanged threat to the freedom of the American people on Fox News, it turns out it’s working pretty well in the real world.” Vox’s Ezra Klein similarly accused Republicans of trying to paint Obamacare in a bad light in his piece entitled “In conservative media, Obamacare is a disaster.  In the real world, it’s working.” And in an embarrassingly fawning piece in Rolling Stone magazine, New York Times op-ed columnist Paul Krugman had nothing but praise for the president – and Obamacare in particular – saying, “here we are, most of the way through the first full year of reform’s implementation, and it’s working better than even the optimists expected.”

Well, that all depends on what they mean by “working.” Enough of the happy talk.

There is a big difference between “working” and “having some effect.” Of course Obamacare is having some effect – how could it not?  Millions have lost the insurance plan they had and liked, millions have lost access to the doctor they had and liked, millions aren’t covered at their most convenient hospital, and millions have had to scramble to recover from the damage done by Obamacare. The law is having an effect, but in the real world, the effect is not positive.

In a recent Gallup poll, 27 percent of Americans say that Obamacare has hurt them, and only 16 percent say Obamacare has helped them and their families. And 46 percent overall believe “the law will make the U.S. health care system worse in the long run.”

http://www.washingtonpost.com/blogs/post-partisan/wp/2014/10/09/the-insiders-it-is-a-myth-that-obamacare-is-working/

Bellows calls for universal health care, releases ad featuring Stephen King

By Seth Koenig, BDN Staff

Posted Oct. 09, 2014, at 4:13 p.m.

PORTLAND, Maine — Democratic U.S. Senate candidate Shenna Bellows touted her support for a universal health care program and decried incumbent Republican Sen. Susan Collins’ votes to repeal the Affordable Care Act during a Thursday morning news conference in Portland.

The event took place the same day the Bellows campaign took to the airwaves to play up one of its star supporters, native Mainer and bestselling author Stephen King. In the latest campaign television advertisement, King, a longtime donor to liberal candidates and causes, calls Bellows a “breath of fresh air” and said he has “never worked so hard or hoped so strongly for a change in leadership.”

During Thursday’s news conference, Bellows sought to differentiate herself from Collins on the topic of health care, saying Maine’s senior senator — who has a wide lead in fundraising and polling — fell in line with her party in votes to repeal President Barack Obama’s signature Affordable Care Act.

Bellows also criticized Collins for endorsing Republican Gov. Paul LePage, who five times has vetoed efforts by Democratic lawmakers in Maine to expand federal Medicaid coverage in the state as allowed under Obamacare.

For her part, Bellows said she believes the Affordable Care Act is a “good first step” but said Congress should take steps toward the type of universal, government-run health care program used in Canada and many other developed nations.

“Partisan politics have stopped too many Mainers from getting the health care they need,” said Bellows, the former head of the American Civil Liberties Union of Maine. “No matter which way the political wind blows, I will stand up for universal health care for all.”

Lance Dutson, spokesman for Collins’ campaign, cited Canadians traveling to Maine for medical treatments as an indication of flaws in the universal health care model.

“A Canadian-style government-run system leads to excessive delays in care, prevents people from seeing the health care providers of their choice and stifles innovation,” he said. “We have seen in Maine the number of Canadians who come to Fort Kent and Bangor for treatments because they cannot get the care they need in a timely manner.”

Supporters of the expansion of Medicaid, which is distributed in the state under the MaineCare program, say doing so would take advantage of federal dollars to provide coverage to 70,000 Mainers who can’t afford it and don’t qualify for aid.

http://bangordailynews.com/2014/10/09/politics/elections/bellows-calls-for-universal-health-care-releases-ad-featuring-stephen-king/print/

Medicaid, Often Criticized, Is Quite Popular With Its Customers

OCT. 9, 2014

Low-income people in three Southern states were recently asked whether they preferred Medicaid or private insurance. Guess which one they picked?

A study published in the journal Health Affairs found that poor residents of Arkansas, Kentucky and Texas, when asked to compare Medicaid with private coverage, said that Medicaid offered better “quality of health care” and made them better able to “afford the health care” they needed.

Medicaid, the federal-state program for poor and disabled Americans, is a frequent political target, often described as substandard because of its restricted list of doctors and the red tape — sometimes even worsethan no insurance at all.

But repeated surveys show that the program is quite popular among the people who use it. A 2011 survey from the Kaiser Family Foundationfound that 86 percent of people who had received Medicaid benefits described the experience as somewhat or very positive. A slightly more recent Kaiser survey showed that 69 percent of Americans earning less than $40,000 a year rated the program important to them or their families.

http://www.nytimes.com/2014/10/10/upshot/medicaid-often-criticized-is-quite-popular-with-its-customers.html?mabReward=RI%3A7&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine&abt=0002&abg=0

‘We are not afraid of competing against mail-order pharmacies’: Portland firm thrives in specialty medication market

By Darren Fishell, BDN Staff

Posted Oct. 10, 2014, at 7:47 a.m.

PORTLAND, Maine — It’s rare to hear a business praise its state’s regulations, but a Portland pharmacy is relying in part on Maine law to gain a stronger foothold in the growing market for specialty medication.

By volume, the market is dominated by major national mail-order pharmacies, but the founders at Apothecary By Design see things shifting in their direction, making Maine one battleground between regional and national pharmacies selling specialty pharmaceuticals.

“The model of what is the right way to manage specialty pharmacy… that’s a story that’s not played itself out yet,” said Mark McAuliffe, one of the pharmacy’s five founders. “We would argue that it’s critical to have a regional presence.”

Specialty pharmacy is to retail pharmacy as the surgeon is to primary care. It’s the fastest-growing segment of the pharmaceutical industry, driven by new treatments for conditions like Hepatitis C, cancer and multiple sclerosis.

That’s part of what’s driven Apothecary to grow more than threefold, to 64 employees, and increased revenue more than 21-fold since opening in 2008, the year it began with a focus on filling retail prescriptions in Portland’s East Bayside neighborhood.

“We want to own specialty pharmacy in Maine,” said Catherine Cloudman, another of the pharmacy’s founders.

The company sees itself as part of a shift away from large mail-order pharmacies, whose promise of savings are a matter of ongoing public health policy debate at the national level.

The debate deals with the largely behind-the-scenes decision-makers who determine which patients on which health plans can qualify for coverage for which drugs. The discussion involves issues of health care cost, quality of care and choice for patients and doctors.

For patients, what’s at stake is the range of choices a doctor has for treatments. That is, which drugs a given insurance plan will cover. But another aspect of choice comes in which pharmacies can provide drugs for a certain insurance plan.

Maine law requires that any certified pharmacy willing to meet an insurer’s terms can fill a prescription.

“That’s not true in a lot of other states,” McAuliffe said. “We’re not afraid of competing against mail-order pharmacies, we are afraid of not being allowed to compete.”

But hurdles for getting into that market for specialty pharmacy are a little higher.

http://bangordailynews.com/2014/10/10/business/we-are-not-afraid-of-competing-against-mail-order-pharmacies-portland-firm-thrives-in-specialty-medication-market/print/

The single-payer model: a foundation for professionalism

By Randall White, M.D.
Canadian Healthcare Network (Toronto), Oct. 8, 2014
Obtaining orthopedic services in British Columbia is harder than it needs to be. People sometimes wait for months, but successful programs to expedite access exist, such as the Osteoarthritis Service Integration System, operated by Vancouver Coastal Health. Although the government should create more such programs, such efforts are diverted in the defence of our single-payer, not-for-profit universal healthcare system from a group that hopes to break the “government monopoly” on healthcare funding in Canada.
Dr. Brian Day, founder of Vancouver’s Cambie Surgery Centre, and other commercial specialty clinics are suing B.C. to allow private funding of medical care. This would facilitate expansion of private diagnostic and surgical procedures and undermine the single-payer model. The integrity of Canada’s entire health system could be at risk.
Advocates for commercialized healthcare funding, now prohibited by the Canada Health Act, often promote a “hybrid model.” In 2012, Dr. Day wrote in a newspaper column that European countries successfully combine universal care with a public-private system, but he failed to address the different contexts of North America and Europe.
European insurance and healthcare sectors are highly regulated. For instance, in France, even supplemental health-insurance funds are not-for-profit, unlike in Canada, where supplemental insurance, now limited to pharmacueticals, dental, vision and complementary care, is offered by for-profit corporations.
Canada has extensive commercial ties to the United States, not to Europe, and were the “hybrid” advocates to prevail, U.S. insurers could invoke NAFTA to gain access to an expanding Canadian health-insurance market.
U.S. insurance companies are unlikely to submit to a European-style model in Canada, where regulation in most sectors is already more American than European because of harmonization under NAFTA.
Furthermore, these insurance companies have the resources to get what they want. In 2013 the leading U.S. health insurers reported $12.7 billion in profit on $313.7 billion in revenue (U.S. dollars). According to OpenSecrets.org, that same year health insurers spent $154 million on lobbying U.S. lawmakers.
Using their financial clout, they could quickly change the landscape in Canadian healthcare funding for not only procedural medicine but primary care, mental-health care and other specialties.
Private-insurance-inspired managed care, capitation, pre-authorizations, routine refusals of reimbursement, restrictions on hospital admissions, onerous and costly paperwork, and loss of autonomy, which plague U.S. physicians (I know because I practised there) could follow.
Investor-owned healthcare delivery goes hand-in-hand with commercial insurance, which is why private-clinic owners are so eager to eliminate the single-payer model. They can benefit handsomely from purchase by larger entities.
For instance, in 2012, the Canadian corporation Centric Health bought Vancouver’s False Creek Healthcare Centre, founded by Dr. Mark Godley, for $24 million. Of course, this is small potatoes for U.S. hospital chains, which might invoke NAFTA to gain access to private Canadian clinics and hospitals were they to grow in size and value.
The potential for fraud also looms, as witnessed In the United States. In 2007, the company PacifiCare overbilled Medicare, the U.S. healthcare program for seniors, for an estimated $423 million. B.C.’s healthcare budget, $16 billion and growing, could become a big target for corporate scammers.
As a psychiatrist, I was especially offended by the scandal in U.S. for-profit psychiatric hospitals that investigative reporter Joe Sharkey detailed in his 1994 book "Bedlam: Greed, Profiteering, and Fraud in a Mental Health System Gone Crazy." Psychiatrists and administrators colluded to hospitalize well-insured adults and children, some of whom had minor disorders, against their will. If we veer away from our single-payer model, are we in jeopardy of creating a similar culture here?
The question for Canadian physicians is whether the guiding principle for organizing healthcare should be the public interest or the generation of profits. For me the choice is clear.
http://www.pnhp.org/print/news/2014/october/the-single-payer-model-a-foundation-for-professionalism

Why Americans Are Drowning in Medical Debt

Healthcare is the number-one cause of personal bankruptcy and is responsible for more collections than credit cards.

By Olga Khazan
The Atlantic, October 8, 2014
After his recent herniated-disk surgery, Peter Drier was ready for the $56,000 hospital charge, the $4,300 anesthesiologist bill, and the $133,000 fee for orthopedist. All were either in-network under his insurance or had been previously negotiated. But as Elisabeth Rosenthal recently explained in her greatNew York Times piece, he wasn't quite prepared for a $117,000 bill from an “assistant surgeon"—an out-of-network doctor that the hospital tacked on at the last minute.
It's practices like these that contribute to Americans' widespread medical-debt woes. Roughly 40 percent of Americans owe collectors money for times they were sick. U.S. adults are likelier than those in other developed countries to struggle to pay their medical bills or to forgo care because of cost.
Earlier this year, the financial-advice company NerdWallet found that medical bankruptcy is the number-one cause of personal bankruptcy in the U.S. With a new report out today, the company dug into how, exactly, medical treatment leaves so many Americans broke.
Americans pay three times more for medical debt than they do for bank and credit-card debt combined, the report found. Nearly a fifth of us will hear from medical-debt collectors this year, and they'll gather $21 billion from us, collectively.

The company also found that 63 percent of Americans have received a medical bill that was more than they expected to pay. Some of that is a result of hospital errors: Nearly half of the Medicare insurance claims NerdWallet examined contained billing mistakes.
Another contributing factor is that hospitals charge wildly different amounts for the same procedures. In the most extreme example NerdWallet analyzed, the highest charge for an inpatient stay for severe intestinal bleeding was 54 times higher than the lowest charge. At most, California patients paid more than $291,000 for the procedure, while those in Arkansas paid just $5,400.
It's worth noting that the Affordable Care Act's individual mandate and Medicaid expansion might alleviate some of this debt strain over the coming years. But otherwise, patients have few options beyond attempting to research hospital charges ahead of time—which is probably the furthest thing from a person's mind when they are most in need of a hospital.
http://www.theatlantic.com/health/archive/2014/10/why-americans-are-drowning-in-medical-debt/381163/

Hidden Costs For 'Fully Covered' Care Can Slam Patients' Wallets

By Ann Doss Helms, Charlotte Observer

OCT 09, 2014

Jennifer Moxley of Charlotte had her children early, so when she had problems with her birth control method she decided to get a tubal ligation.

Under the Affordable Care Act, that sterilization surgery is one of the preventive services that’s supposed to be fully covered by insurance. But when her gynecologist checked with her insurance company, Moxley was told she’d end up paying $9,000 for anesthesia, medication and the hospital room.

“It’s a ridiculous loophole,” Moxley said.

In North Carolina and across the country, hidden costs have popped up on “fully covered” services ranging from contraception to cancer screening to annual checkups.

The goal of mandating coverage is to make sure people don’t skip relatively simple tests, inoculations and procedures that can head off health crises and big medical bills. But the line between covered prevention and costly diagnosis can easily be crossed. Meanwhile, insurers, providers, advocates and officials are still wrangling over the rules, at a time when a growing number of people must cover thousands of dollars out of pocket.

“I don’t understand why it is falling to consumers to do the enforcement and oversight,” said Jeffrey Levi of the Trust for America’s Health, a Washington based nonprofit that focuses on preventive health. “The fact that you have to ask and study regulations is creating just the sort of barrier this benefit is designed to eliminate.”

Levi says he believes those barriers are falling, but the complexity of the system makes it slow.

Dr. Rig Patel, president of the N.C. Society of Gastroenterology, agrees. Colonoscopies, done to screen for colorectal cancer in people over 50, have proven one of the most problematic procedures for creating surprise costs to patients.

Patel, who practices in Raleigh, said his staff has seen a significant increase in full payments over the last few months. But he said some policies still bill patients and create frustration for the medical staff. “It is crazy how confusing it is,” Patel said.

Bottom line: Patients need to do their research. In some cases they can avoid the out-of-pocket costs. In others, they just need to be prepared to pay.

http://www.kaiserhealthnews.org/Stories/2014/October/09/Charlotte-Observer-hidden-costs-for-fully-insured-patients.aspx

A maze to opt out of Obamacare individual mandate

By RACHAEL BADE 

There are dozens of ways to escape Obamacare’s individual mandate tax — but good luck figuring that out come tax season.

Tens of millions of Americans can avoid the fee if they qualify for exemptions like hardship or living in poverty, but the convoluted process has some experts worried individuals will be tripped up by lost paperwork, the need to verify information with multiple sources and long delays that extend beyond tax season.

“It’s not going to be pretty,” said George Brandes, vice president of health care programs at Jackson Hewitt, a tax prep firm. “Just because you theoretically qualify for hardship, or another exemption, doesn’t mean you’re going to get it.”

The worries may foreshadow a messy tax season next year as the one in 10 Americans who remain uninsured calculate their tax bill for the first time under Obamacare’s individual mandate.

Those without health insurance will have to cough up $95 per person or 1 percent of their income, whichever is greater. That penalty eventually jumps to $695 or 2.5 percent.

The White House expanded the list of exemptions allowing the uninsured to bypass the penalty for legitimate reasons, including religious restrictions, falling on rocky times or a death in the family. Another big out created after the controversy over canceled health plans was the so-called affordability exemption that allows people to opt out if premiums are still not affordable.

he Congressional Budget Office expects 23 million of the 30 million Americans who remain uninsured in 2016 to qualify for exemptions. It’s part of the reason the CBO in June downgraded from 6 million to 4 million the number of people it estimates will pay the penalty.

The uninsured have two ways to opt out: The easiest way is fill out a new tax form for those exemptions that don’t require Obamacare marketplace approval. Some will be simple, including the exemption for being uninsured for under three months or those living below a certain income — about $10,150 for singles and $20,300 for married couples.

But many must be approved by the marketplace, including for people citing religious beliefs, like being Amish, or those who qualify for the dozen or so “hardships,” such as being evicted, experiencing domestic violence or having a health plan canceled because it doesn’t meet the law’s requirements.

http://www.politico.com/story/2014/10/obamacare-opting-out-111730.html#ixzz3Fk4

Bangor nursing home faces sanctions after maggots found in resident’s bandaged wound

By Nok-Noi Ricker, BDN Staff

Posted Oct. 09, 2014, at 6:41 p.m.

BANGOR, Maine — A local nursing home and rehabilitation center is facing federal sanctions after maggots were discovered in a resident’s bandaged wound, according to the Maine Department of Health and Human Services.

The state’s Division of Licensing and Regulatory Services inspected the Eastside Center for Health and Rehabilitation on Mt. Hope Avenue after receiving an anonymous complaint about an incident in September.

The inspection found the facility had allowed flies into the building because it “failed to ensure the environment was free from hazards associated with windows with broken and missing screens,” according to the DHHS statement of deficiencies obtained by the Bangor Daily News through a Freedom of Access request.

A resident at the 69-bed facility had complained to a nurse on Sept. 7 about a burning and itching sensation in his or her chest area.

“When the bandage was removed, the staff observed that the resident had maggot larvae coming out of the resident’s chest open area,” according to the DHHS documents. The resident had a chest tumor. The statement did not indicate if the wound was surgical or a result of the tumor itself.

Nurses cleaned the wound and added a new dressing, according to the statement, and a doctor ordered Permethrin Cream, a medication typically used to treat scabies and head lice. The DHHS statement also indicates that this was the only patient at the facility that was affected.

The DHHS statement says the state conducted a two-day on-site investigation after the anonymous complaint and found the facility failed to “ensure windows were maintained in a functional, safe and sanitary manner.”

Pest control company invoices also indicate that the facility was sprayed for infestation on Aug. 1 and again on Sept. 9, two days after the maggot report, according to the statement of deficiencies.

Staff were advised not to open windows without screens, and the administrator asked that all the windows be replaced, according to the correction plan filed by Eastside. It states the facility would replace 45 windows, including all resident rooms and non-opening windows, by Oct. 1.

The facility filed a corrective plan of action with the state on Oct. 1, according to the DHHS documents. It stated a contractor was called Sept. 10 to fix the window screens, and that it would replace the 45 windows, including those in all resident rooms.

National HealthCare Associates, which purchased the Bangor nursing home and six other Maine-based facilities within the last year, said in an email Thursday that all of the problems identified have been resolved.

“We are pleased to report that the findings by the state were not related to the direct provision of care to our residents,” Timothy Brown, National HealthCare spokesman, said in the email. “Rather, the report noted concerns related to the center’s window maintenance. We take these inspection concerns very seriously and are pleased to report that we have already rectified all of the findings raised.”

“Eastside Center cares deeply about our patients and will work tirelessly to maintain our high levels of care and are pleased to report that we are in full compliance with our plan of correction,” Brown said.

http://bangordailynews.com/2014/10/09/health/sanctions-weighed-against-bangor-nursing-home-after-maggot-larvae-found-in-a-residents-bandaged-wound/print/