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Sunday, November 2, 2014

Health Care Reform Articles - November 2, 2014

Bill Nemitz: Suit up, Maine, in case governor’s ignorance of contagion is contagious

Here’s a counterintuitive solution to Maine’s not-really-Ebola crisis:
Take Gov. Paul LePage, Health and Human Services Commissioner Mary Mayhew and Maine Center for Disease Control and Prevention Director Sheila Pinette and lock them in a remote cabin somewhere in Aroostook County.
It’s the best way to prevent their ignorance from infecting the entire state of Maine.
You’d think that with less than a week before voters go to the polls to decide whether to re-elect him, LePage would first and foremost be avoiding anything that even remotely resembles political quicksand.
Yet there the Big Guy stood on Thursday, neck deep in a controversy of his own making, as nurse Kaci Hickox got on her bicycle in Fort Kent and reminded us all what the right to life, liberty and the pursuit of happiness looks like.
And right alongside LePage stood Mayhew and Pinette, Maine’s answer to Dumb and Dumber.
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Infinitely more galling is their insistence that Nurse Hickox, fresh back from saving lives in West Africa, is a threat to public safety when, in fact, she isn’t. Not to mention their pathetic attempts to keep her confined to her home in Fort Kent when they have no such legal authority whatsoever.
http://www.pressherald.com/2014/11/02/bill-nemitz-suit-up-maine-in-case-governors-ignorance-of-contagion-is-contagious/

To the Editor:
The Ebola crisis could be a test case for health care management on a national scale. It may provide an extraordinary opportunity to improve the adequacy of our national health care.
The Centers for Disease Control and Prevention, after its initial failure, swiftly mobilized to meet a public health emergency threat. It coordinated communication to all health care facilities, standardized education for health care personnel and created protocols for improved quality of care in emergency situations.
It has demonstrated that scientifically informed rather than politically tinged state efforts are effective. Just as with national defense, only a coordinated, unified response by the federal government is capable of meeting such an emergency.
Fortunately such a model is translatable not just for medical emergency situations, but to all levels of medical care. The Affordable Care Act remarkably has had the foresight to focus on prevention and public health as well as individual treatment.
Ebola has focused our government’s role in the delivery of health care. We can implement universal single-payer health care insurance that incorporates the A.C.A.’s principles of preventive medicine and public health by expanding Medicare, a proven high-quality, reliable insurance delivery system.
Not only would this improve the nation’s health care, but through its effectiveness and savings, it could also be a stimulus for improving the health of the economy.
CAROL C. NADELSON
HOWARD CORWIN
Brookline, Mass., Oct. 28, 2014
Dr. Nadelson is a professor of psychiatry at Harvard Medical School and past president of the American Psychiatric Association. Dr. Corwin is a retired clinical professor at Tufts University School of Medicine.
http://www.nytimes.com/2014/11/01/opinion/using-ebola-care-as-a-national-health-model.html?emc=edit_tnt_20141031&nlid=1311158&tntemail0=y&_r=0

Repeal of Health Law, Once Central to G.O.P., Is Side Issue in Campaigns

By 

WASHINGTON — In early October, with his poll numbers stubbornly lagging his Democratic opponent’s, Ed Gillespie did something almost no other Republican candidate has done this campaign season. Mr. Gillespie — a lobbyist, former chairman of the Republican National Committee and now Senate candidate in Virginia — unveiled a plan to replace the Affordable Care Act.
The proposal, which would use tax credits and a federally funded “high risk pool” to cover the uninsured, opened him to criticism. It most likely would cover fewer people than President Obama’s health care law, while having fewer statutory protections and still requiring billions from the federal government.
Almost no one questioned its seriousness, but almost no one took up the cause.
“The A.C.A. is bad policy, but it was passed because of legitimate concerns about the affordability and accessibility of health care coverage,” Mr. Gillespie said in an interview. “And we need to show we share those concerns.”
In a campaign season that was supposed to be dominated by attacks on the health care law, few Republicans actually made the law’s repeal a centerpiece — and fewer still offered an alternative. Besides Mr. Gillespie, Mike McFadden, the Republican challenger to Senator Al Franken in Minnesota, also gave it a shot. Like Mr. Gillespie in his race against Senator Mark Warner, Mr. McFadden holds little chance of defeating the incumbent he is running against next Tuesday.



California spends $13.4 million to fix Obamacare service woes
By CHAD TERHUNE
lifornia's health insurance exchange hired two outside firms for $13.4 million to address long wait times for consumers calling about their Obamacare coverage.
Covered California said it will pay $9.8 million to Faneuil Inc. and $3.6 million to Maximus Inc. to add more call-center capacity during the next open enrollment season starting Nov. 15.
"We had call response times that were far too long," said Peter Lee, the exchange's executive director. "We were swamped."
Many consumers and insurance agents have complained about the exchange's shoddy customer service and long hold times. In August, the exchange answered 1% of calls within 30 seconds, far short of its 80% goal.
The average wait time was under five minutes Thursday, according to the exchange.
Lee said the exchange is nearly doubling its service-center staff to 1,300 to help more than 1 million Californians renew their health-law policies by Jan. 1. The first batch of renewal notices for 2015 went out this week.
The state said it has spent $22.6 million on improving the speed and reliability of its website and online enrollment.
Covered California said more than 200,000 people have signed up for Obamacare coverage since regular enrollment ended in April under the Affordable Care Act.
But in a sign of the churn in the individual insurance market, an additional 150,000 people dropped out of the exchange after getting health benefits at work or failing to pay their premium.
People who move, lose their employer coverage or have some other qualifying event in their life can enroll outside the normal sign-up period.
Overall, Covered California said it has 1.1 million people enrolled now, down from its previous tally of 1.2 million.
Part of that was because the exchange said 81% of enrollees paid their initial premium compared with its earlier estimate of 85%.
Opponents of the health law have criticized the federal and state exchanges for not disclosing detailed enrollment figures in a timely manner.
The exchange wants to close open enrollment in mid-February with 1.7 million people enrolled.

Healthcare overhaul ramps up business at WellPoint

By Associated Press
WellPoint Inc. raised its 2014 earnings forecast again and trumped third-quarter expectations as the overhaul of the healthcare system adds millions of people to the nation's health insurance rolls, and at a lower cost than was expected at the nation's second-largest health insurer.
The Blue Cross-Blue Shield insurer expects earnings growth in 2015 as well, and CEO Joseph Swedish said the company is weighing larger dividends.

WellPoint now expects 2014 adjusted earnings to range between $8.75 and $8.85 per share. That's up from a forecast it made in July for earnings of more than $8.60 per share.
The new forecast marks the third time this year that WellPoint has raised its outlook.
Analysts had been looking for annual per-share earnings of $8.74 per share, according to FactSet.
WellPoint also posted adjusted earnings of $2.36 a share in the third quarter, which was much better than the $2.28 that analysts had projected, according to a poll by Zacks Investment Research.
The Indianapolis insurer's big quarter comes after competitors Aetna Inc. and UnitedHealth Group Inc. also topped quarterly expectations and raised their annual forecasts.
http://www.latimes.com/business/la-fi-wellpoint-earns-20141030-story.html


Looking a Dangerous Disease in the Mouth


By 
 
What’s the most common chronic childhood disease in the United States? It’s worth remembering on Halloween that the answer is tooth decay, which is five times more common than asthma and 20 times more common than diabetes.
Tooth decay affects children from all backgrounds, but it’s concentrated among low-income and rural populations, who have the most difficulty accessing and affording dental care. Most dentists in private practice don’t accept Medicaid or public insurance, and tens of million of Americans live in areas with dentist shortages. In 2008, only about a third of children on Medicaid received dental care under the program (PDF). (The elderly and people with disabilities are also badly underserved.) In 2009, untreated, preventable dental problems led to 830,000 emergency room visits.
The United States health care system has many absurdities, but one of the craziest is that it treats the mouth as if it were disconnected from the rest of the body. It’s easier, and more affordable, to get treated for an infection in, say, the toe.
From a health perspective, this makes no sense. “Your mouth is an essential human organ system,” said Leon A. Assael, dean of the School of Dentistry at the University of Minnesota. “And tooth decay will destroy it through an infectious process that [if untreated] will go deep into the bone of your jaw and spread into your blood stream with potentially negative systemic consequence.” Dental disease is connected to many health problems and is particularly worrisome for pregnant women and diabetics.
One approach gaining momentum in the United States to extend access to underserved groups is based on an idea that was pioneered in New Zealand 93 years ago, and has been adopted in more than 50 countries. The idea is to train “dental therapists,” who, like dental hygienists, work under the supervision of dentists, but who can also drill teeth and perform non-complex extractions.
So far, in the United States, dental therapists provide care in three states. In Alaska, they work in 80 villages, serving about 40,000 Alaska Natives on tribal lands. “Most of them didn’t have a dental provider working or living in their communities previously,” said Mary Williard, a dentist who heads the Dental Health Aide Training Program for the Alaska Native Tribal Health Consortium. In 2009, Minnesota authorized the training of dental therapists to serve predominately low-income patients. Maine recently followed suit.

Health insurance ends for FairPoint union members on strike as tensions rise

By Darren Fishell, BDN Staff
PORTLAND, Maine — About 800 Maine-based union members on strike at FairPoint Communications will lose their health insurance coverage at midnight Friday, a move that increases financial pressure on them but that union leaders said they had long expected.
The policies ending Friday covered 100 percent of premiums for about 2,000 employees in Maine, New Hampshire and Vermont. Conflict over terms of the company’s health insurance plan was part of the bargaining process that left both sides dissatisfied and ended Aug. 28, when the company declared an impasse.
The cancellation of health care policies is the first major financial hit since the strike started two weeks ago, but union leaders said the company is facing financial pressure, too, as it rolls out its contingency plan to manage customer calls and service needs during the strike.
Jenn Nappi, assistant business manager for the International Brotherhood of Electrical Workers Local 2327, said union members prepared for the loss of health insurance and other challenges that would come from a strike by saving and, in some cases, taking other part-time jobs starting in the spring.
“If [FairPoint] thinks slapping their employees in the face by canceling their health benefits is going to break them, they are sadly mistaken,” Nappi said. “It was disappointing because they didn’t need to do it.”
Days before the strike, the company froze employee pensions. Both measures are part of the terms the company imposed on workers in declaring the contract impasse.

Defects Found Before Debut of Health Insurance Site for Small Businesses
By 

WASHINGTON — The Obama administration has discovered a number of defects in the online marketplace that will offer health insurance to millions of small-business employees, but federal officials said the problems could probably be fixed before the website goes live on Nov. 15.
The website, for businesses with 50 or fewer employees, was created by the Affordable Care Act and was supposed to open Oct. 1, 2013, but officials could not meet that deadline. Since then, they have been trying to build the site.
Testing began last week in Delaware, Illinois, Missouri, New Jersey and Ohio, just days after federal officials gave experts in the industry a preview at a White House meeting.
Small-business owners, employees, insurers and insurance agents welcomed the website for the Small Business Health Options Program, known as the SHOP exchange, but said they had found defects that needed to be corrected.
For example, they said, some health insurance plans approved for sale on the exchange did not show up on the website. The site worked well with some web browsers, like Chrome, but not with others, like Internet Explorer and Firefox. Premiums and other charges for some plans were erroneously displayed as percentages rather than dollar amounts — 350 percent rather than $350, for example. For some households, the principal subscriber was listed as a dependent, or vice versa.

In LePage’s Maine, health coverage looks more like the South than New England

Maine Politics
By 
The year’s governor’s race will clearly and indisputably affect how many Mainers will have health coverage and thus how many will suffer and die prematurely.
A map, based on data from Civis Analytics and Enroll America, shows health insurance coverage by county.
While every state but New England has counties mostly in the 0-10% with a few in the 10-12% range, nearly all of Maine is over 12%, with some areas in the 14-16% range.
Screen shot 2014-10-30 at 1.46.48 PM
As a news report on this data notes, state policies and governors really matter:
That state boundaries are so prominent in the map attests to the power of state policy in shaping health insurance conditions. The most important factor in predicting whether an American who had no insurance in 2013 signed up this year was whether the state that person lives in expanded its Medicaid program in 2014. 
Maine looks more like the South than New England.


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