Pages

Sunday, November 9, 2014

Health Care Reform Articles - November 9, 2014

Justices to Hear New Challenge to Health Law

By 

WASHINGTON — The Supreme Court on Friday agreed to hear a new challenge to the Affordable Care Act, potentially imperiling President Obama’s signature legislative achievement two years after it survived a different Supreme Court challenge by a single vote.
The case concerns tax subsidies that currently help millions of people afford health insurance under the law. According to the challengers, those subsidies are being provided unlawfully in three dozen states that have decided not to run the marketplaces, known as exchanges, for insurance coverage.
If the challengers are right, people receiving subsidies in those states would become ineligible for them, destabilizing and perhaps dooming the law.
The Obama administration said it would mount a vigorous defense in the Supreme Court.
“This lawsuit reflects just another partisan attempt to undermine the Affordable Care Act and to strip millions of American families of tax credits that Congress intended for them to have,” said Josh Earnest, the White House press secretary. “We are confident that the financial help afforded millions of Americans was the intent of the law and it is working as Congress designed.”
Scott Pruitt, Oklahoma’s attorney general, said he welcomed the Supreme Court’s decision to hear the case. The administration, he said, “cannot ignore the plain language in a statute and rewrite laws with which they disagree.” He added, “This Supreme Court review will provide Oklahoma and the 35 other states that did not establish state-based exchanges with immediate and conclusive clarity as to their rights and obligations under the A.C.A. so that the states may make appropriate health care policy decisions.”



Supreme Court Takes the Obamacare Subsidy Case--Justices Will Rule Before July 1

In a wow moment, the Supreme Court announced Friday that they will take one of the four pending "Halbig" cases––specifically King v. Burwell.

The issue is over whether the new health law actually authorizes the payment of premium subsidies in the 37 states that will rely upon the federal government to run their exchange in 2015.

This effort is being made on a number of fronts but has been generally know as the "Halbig" challenge. I guess we will now call it the King challenge.

If the Supreme Court eventually affirms this challenge, anyone receiving a health insurance subsidy in the 37 states run by the feds would immediately lose it. Given that the bulk of those currently getting subsides are at the lower income range for those subsidy eligible, most would likely drop their Obamacare insurance unless they were so sick it made sense for them to beg, borrow, or steal the money they would need to continue making premium payments.

The result would be a much smaller Obamacare insurance pool disproportionately filled with sick people.

Even if a state rushed to convert its status to that of a state exchange in order for its citizens to continue to receive their insurance subsidies, the process would take at least months. In the reddest states that have been fighting Obamacare, it could take far longer. In the meantime, the entire off and on exchange individual health insurance market in these states would be dramatically destabilized.

Health Care Reform Imperiled 

By 

Will five Supreme Court justices eliminate essential health care subsidies for more than four million lower-income Americans, based on a contorted reading of four words?
It sounds inconceivable, but that would be the effect of a ruling in favor of the latest legal challenge to the Affordable Care Act. On Friday, the justices announcedthat they would hear that case, King v. Burwell, a dispute over the meaning of a single phrase — “established by the State” — in the 900-page health-care reform law.
The law, which has been under constant assault since its 2010 passage, has made health-care coverage newly available for between 8 and 11 million people this year alone.
This unprecedented achievement in social policy has improved, and surely saved, many lives. But, to the law’s implacable opponents, it represents nothing more than an oppressive big-government program that must be stomped out.
The opponents lost before the Supreme Court in 2012 in an effort to kill the law on constitutional grounds. Now they are taking aim at the tax-credit subsidies that are central to the success of health reform.
Because one subsection of the law says these subsidies are available on an exchange “established by the State,” the plaintiffs claim there can be no subsidies for anyone living in the 36 states where the federal government established a health exchange after state officials did not.
It is a superficially simple argument, which most federal judges who have considered the claim have rejected. That is because it runs counter to the explicit purpose and structure of the Affordable Care Act. As everyone involved in the law’s creation understood at the time, its success depends on making coverage both required and available to as many people as possible. As a Senate staff member told Vox.com recently, “We certainly wanted every individual in every state, regardless of their federal or state exchange status, to receive the same subsidies.”

What’s at Stake in Supreme Court’s Latest Health Care Case

Margot Sanger-Katz
Unlike the Obamacare case the Supreme Courtdecided in 2012, the one it took Friday, King v. Burwell, isn’t a threat to the entire Affordable Care Act. But it could be a threat to health insurance that the law has provided to millions of Americans in 36 states.
The law set up tax credits to help Americans afford premiums in new health insurance marketplaces. These subsidies are important to the overall structure of the law, because many middle-income Americans can’t afford to pay the full price of insurance premiums. If the Supreme Court ends up ruling for the plaintiffs, the result could be to take away those tax credits for the residents of states that did not set up their own exchanges but instead allowed the federal government to run them. Removing those tax credits would widen existing inequities in health care access between red and blue states. Millions of Americans would lose their health insurance, and markets in many states could be severely destabilized.
King v. Burwell rests on a sentence in the law that many of its authors describe as a drafting error. The law says that subsidies should go to people who bought coverage “through an Exchange established by the State,” which the law’s challengers say means that the tax credits cannot be used in the federally run marketplaces. Whatever Congress’s original intention, that’s the sort of legislative issue that Congress could fix, not a constitutional problem with the structure of the law that would mean its permanent annihilation.




Study Points to Overdiagnosis of Thyroid Cancer

By 

To the shock of many cancer experts, the most common cancer in South Korea is not lung or breast or colon or prostate. It is now thyroid cancer, whose incidence has increased fifteenfold in the past two decades. “A tsunami of thyroid cancer,” as one researcher puts it.
Similar upward trends for thyroid cancer are found in the United States and Europe, although not to the same degree. The thyroid cancer rate in the United States has more than doubled since 1994.
Cancer experts agree that the reason for the situation in South Korea and elsewhere is not a real increase in the disease. Instead, it is down to screening, which is finding tiny and harmless tumors that are better left undisturbed, but that are being treated aggressively.
South Koreans embraced screening about 15 years ago when the government started a national program for a variety of cancers — breast, cervix, colon, stomach and liver. Doctors and hospitals often included ultrasoundscans for thyroid cancer for an additional fee of $30 to $50.
In the United States and Europe, where there are no formal, widespread screening programs for thyroid cancer, scans for other conditions, like ultrasound exams of the carotid artery in the neck or CT scans of the chest, are finding tiny thyroid tumors.
Although more and more small thyroid cancers are being found, however, the death rate has remained rock steady, and low. If early detection were saving lives, death rates should have come down.
That pattern — more cancers detected and treated but no change in the death rate — tells researchers that many of the cancers they are finding and treating were not dangerous. It is a phenomenon that researchers call overdiagnosis, finding cancers that did not need treatment because they were growing very slowly or not at all. Left alone, they would probably never cause problems. Overdiagnosis is difficult to combat. Pathologists cannot tell which small tumors are dangerous, and most people hear the word “cancer” and do not want to take a chance. They want the cancer gone.
But cancer experts said the situation in South Korea should be a message to the rest of the world about the serious consequences that large-scale screening of healthy people can have.

An Epidemic of Thyroid Cancer?

by Gilbert Welch
HISTORICALLY, the science of epidemiology was directed toward identifying and controlling epidemics of infectious disease. In a study just published in the New England Journal of Medicine, my colleagues and I highlight another important job for epidemiologists: identifying and controlling epidemics of medical care.
The setting is South Korea, where, over the last two decades, the incidence of thyroid cancer has increased fifteenfold. Nowhere in the world is the rate of any cancer growing faster.
We’ve all been taught to seek biological explanations for a significant rise in disease — perhaps a new infectious agent or environmental exposure. But in South Korea, we are seeing something different: an epidemic of diagnosis.
In 1999 the government initiated a national health-screening program focused on reducing cancer and other common diseases. Although thyroid cancer screening was not included in the program, all it requires is a simple test — an ultrasound of the neck. Hospitals have ultrasound machines and so do many doctors’ offices. Both promoted thyroid cancer screening as an inexpensive add-on to the government program. It was an easy sell, particularly with the government, the medical community, the news media and cancer “survivors” praising the virtue of early cancer detection.
In doing so they inadvertently highlighted the major harm of early detection: What was a rare cancer is now the most common cancer in South Korea.
Where did all those new thyroid cancers come from? They were always there. As early as 1947 pathologists recognized that, although it was a very rare cause of death, thyroid cancer was a frequent finding during autopsies. Studies have since shown that over a third of adults have thyroid cancer. Virtually all of these cancers are small “papillary thyroid cancers,” many of which will never become evident during a person’s life.



Partners tactics have familiar ring

By 

 | GLOBE STAFF   NOVEMBER 07, 2014
Partners HealthCare, the nonprofit health system that prefers not to be known as a big business, is comparing itself to some of the biggest corporations in America to persuade a judge to allow it to acquire three community hospitals.
Partners wants Suffolk Superior Court Judge Janet L. Sanders to use antitrust cases involving Microsoft, US Airways, and Citigroup as road maps for deciding whether to approve a settlement that would allow Partners to take over South Shore Hospital in Weymouth and Hallmark Health System in Medford and Melrose. 
In those cases, Partners argued in legal filings, the courts approved the settlements not because they solved all the market problems, but because they were negotiated in good faith.
Similarly, Partners is urging Sanders to avoid trying to cure the “ills” of the state’s health care system as she considers the agreement, reached in May with Attorney General Martha Coakley, and simply make sure the settlement is rational and fair.
“It’s not going to fix everything in health care,” said Bruce D. Sokler, a lawyer for Partners. “It’s not necessarily going to satisfy everybody.” 

But opponents of the mergers argue the ills of the Massachusetts health care system, including high costs, should be front and center. Partners’ failure to cite a hospital merger to bolster its case should cast additional doubts on the merits of the settlement, they added.



Just Because a Policy Causes a Death Spiral Doesn’t Mean It’s Unsustainable



As my colleague Margot Sanger-Katz notes, a Supreme Court ruling against the Obama administration in King v. Burwell would cause significant disarray in health insurance markets, by denying subsidies to anyone buying health insurance on the individual market in states that rely on the federal health insurance exchange.
Just because some insurance markets would become a mess does not mean Republicans and Democrats would come back to the table to fix them.
Health insurance would become unaffordable for many people who do not get it through work or Medicare. Theindividual mandate wouldn’t apply to people who couldn’t afford coverage without a subsidy. And as healthy people drop out of the insurance market because of rising costs, the pool of participants could get sicker, driving premiums up further, driving even more people out of the market, and leading to what is known as a death spiral where only a handful of mostly very sick people buy insurance at a very high price.
That would be a bad outcome. But it would not necessarily be an unsustainable one. I know, because this situation was sustained in New York for over two decades before Obamacare came into being.
Two cornerstones of the Affordable Care Act are policies called community rating and guaranteed issue. Community rating means a health insurer can’t set the price of your insurance policy based on how much it’s likely to cost to cover you. Guaranteed issue means they must sell health insurance to anyone who wants it. These policies mean that healthy people will tend to pay more for insurance than they get back in claims, and sick people will tend to pay less than they get back.

The Ethics of Infection

By KATE MURPHY

“PRIMUM NON NOCERE” or “First, do no harm” is supposed to be the guiding principle of health care workers. And within civil societies, at least, not harming others is considered every person’s moral, ethical and even legal responsibility.
The heated debate over whether it’s responsible for health care workers who treated Ebola patients to go grocery shopping or bowling or get on a cruise ship before the end of the disease’s 21-day incubation period raises a larger question: What is everyone’s duty to prevent transmission of infectious diseases?
Is it ethical to go to the gym when you have a cold, visit a nail salon when you have a foot fungus or board an airplane with a stomach bug? What about the morality of sending your kids to school when they have, say, a green runny nose or were not vaccinated? Are you a bad person if you don’t get a flu shot?
When it comes to “do no harm,” the problem is defining harm and the risk of inflicting it, as well as what constitutes reasonable measures to impose on someone to minimize that risk.
“Risk is a function of two things — probability that harm will occur and severity of that harm, should it transpire,” said Lawrence O. Gostin, a professor of law at Georgetown University who specializes in public health law and human rights.
And those two factors, he said, have a rough inverse relationship. That is, the more severe the potential harm, the less probability, or risk, we are willing to assume — much less allow someone else to assume on our behalf.
http://www.nytimes.com/2014/11/09/sunday-review/the-ethics-of-infection.html?emc=edit_tnt_20141108&nlid=1311158&tntemail0=y&_r=0

Needing to Hire, Chief of V.A. Tries to Sell Doctors on Change 

By 

BURLINGTON, Vt. — The longtime corporate executive entered the college lecture hall to make a pitch the medical students had probably heard before: He was offering good starting salaries, well-financed research opportunities and rewarding work with patients in great need.
But this was not a recruiting trip for some pharmaceutical company or private hospital system. The executive, Robert A. McDonald, formerly chief executive of Procter & Gamble, runs the government’s second-largest agency, the Department of Veterans Affairs. And he has been crisscrossing the nation looking for doctors-in-training to fill staffing shortfalls that over time could jeopardize care for millions of veterans.
Three months ago, Mr. McDonald took control of a demoralized and dysfunctional 330,000-employee agency buffeted by crisis, with problems ranging from outdated software to what even the White House described as a “corrosive” and retaliatory culture.
Mr. McDonald says he was shocked by a paucity of physicians, nurses and other clinicians in some veterans’ hospitals — a shortage that the department says contributed to delays in care that led to manipulated waiting lists for appointments. Revelations about those lists ultimately cost his predecessor, Eric Shinseki, his job.

Partners pays a price after bid for South Shore Hospital

By  and 

 | GLOBE STAFF   NOVEMBER 09, 2014
Executives at other hospitals had grumbled for years about Partners HealthCare, privately calling the owner of Massachusetts General and Brigham & Women’s hospitals an “800-pound gorilla” that always seemed to get its way, often at their expense.
But it wasn’t until Partners struck a deal with Attorney General Martha Coakley in May to acquire three more hospitals that rivals finally took a public stand. Within days, leaders from four health care systems met for dinner at Tufts Medical Center, each agreeing to potentially pour hundreds of thousands of dollars into lawyers and consultants to fight the expansion.

“We must all work together in a thoughtful, deliberative and robust fashion to have our voices heard,” wrote Tufts president Michael Wagner in his invitation to the May 22 meeting, calling the Partners expansion “potentially devastating for all of us.”
The hospital uprising — which included Beth Israel Deaconess Medical Center, breaking rank with its fellow Harvard-affiliated teaching hospitals — helped transform a deal that once seemed almost a foregone conclusion into one of the most contentious and closely watched hospital expansion pushes in the country.
Suffolk Superior Court Judge Janet L. Sanders, who will hold a hearing on the proposed expansion on Monday, said she’s never seen so much opposition to a negotiated agreement.
More than 170 organizations have filed comment on the case, many critical of a deal that would cement Partners’ standing as the dominant health provider in most of Eastern Massachusetts.
“People are very careful talking about Partners,” said the Rev. Burns Stanfield, pastor of Fourth Presbyterian Church in South Boston and president of the Greater Boston Interfaith Organization, one of the first public critics of the expansion. “But once they started talking, they kept talking.”

Prop. 45's resounding defeat is a boon for health insurers

Already a financial bonanza for health insurers, Obamacare paid off for the industry again at the ballot box as Californians soundly rejected a bid to rein in health insurance rates.
Even so, the companies still face heat over their ever-increasing health insurance premiums, and pressure will build on California's Obamacare exchange to hold the line on rates.
California's biggest health plans, led by Anthem Blue Cross and Kaiser Permanente, spent millions of dollars on ads portraying Proposition 45's rate regulation as a threat to implementation of the health law. In a lopsided result, 60% of voters joined the industry in opposition.
Proposition 45 would have granted the state insurance commissioner veto power over rate increases for about 6 million Californians with individual and small-business policies. California regulators, unlike 35 other states, don't have authority to block rate hikes that are deemed excessive.
Despite the stinging loss, supporters of rate regulation vowed to keep fighting on behalf of consumers in the courts, state Legislature and possibly again at the ballot box.
In 2010, Anthem tried to raise rates by up to 39% in California. That move sparked national outrage and helped propel the Affordable Care Act into law.
"It's incredible that an industry that's so unpopular could do so well in this election," said Robert Laszewski, a healthcare consultant who has closely tracked California's implementation of the health law. "Pro-Obamacare forces and anti-regulation folks formed a 60% coalition. It was a strange set of bedfellows."
Both sides agreed the outcome could have been far different had the vote been held two years ago as intended.
The ballot measure came up short in 2012 on a state tally of petition signatures. Since then, the Covered California exchange has twice negotiated lower-than-expected rates and more than 1 million Californians signed up under the Affordable Care Act.
Nationwide, health insurers have gained millions of new customers through state exchanges and an expansion of Medicaid. Shares of health insurers have soared on Wall Street.

Anthem partners with Eastern Maine Healthcare Systems to improve care, lower costs for 40,000

By Jackie Farwell, BDN Staff
Posted Nov. 09, 2014, at 5:46 a.m.
Maine’s largest health insurer has teamed up with Eastern Maine Healthcare Systems under a new venture aimed at keeping patients healthier while reducing costs.
The deal involves Anthem Blue Cross and Blue Shield in Maine, EMHS, and an EMHS-led coalition of hospitals and physician practices across the state already working to improve the value of health care.
EMHS and its partners have agreed to avoid any cost increase for services they deliver to 40,000 Anthem policyholders. That’s no small promise in the field of American health care, where even the most ambitious reform efforts aspire to curb the escalation of costs rather than actually produce savings.
In making that pledge, EMHS has put potentially millions of dollars at stake.
“We’re committed to this, but it’s not without a lot of anxiety,” said Michelle Hood, president and CEO of EMHS. “Holding ourselves accountable to this will be a real test of our organizational willpower.”
The goal is to make patients healthier and happier by rewarding doctors and nurses for keeping them well rather than for ordering more visits and procedures. The entities have formed an “accountable care organization,” a cornerstone of the federal health reform law that many hope will rein in health care costs. Under an accountable care organization, alliances of health providers take responsibility for a specific population of patients, and they get paid based on both the cost and the quality of care they deliver.
The Anthem deal involves 15 hospitals and 405 primary care providers from 114 practices throughout Maine, which operate under the name EMHS Beacon Health.
Dan Corcoran, president of Anthem Blue Cross and Blue Shield in Maine, said the new arrangement marks a significant step forward for the insurer. The accountable care organization builds on Anthem’s existing program to improve health care and control costs, which includes about 75 percent of the primary care physicians in Maine, he said.
“This is, in my opinion, real ownership on their part to improve quality and to lower costs,” Corcoran said of EMHS.
The health providers will work with Anthem under the accountable care organization to encourage patients to get preventive care and manage chronic illnesses, which eat up three-quarters of all health care dollars and represent the leading causes of death and disability in the U.S. Critical to their success will be teams of health professionals who help patients make appointments, manage medications and follow through on doctors’ orders, such as nurse care coordinators, social workers and health coaches.
If the hospitals and doctors reduce costs while providing high-quality care, they can share in the savings. Likewise, if they fail to cut costs or miss certain quality targets, they get pinched financially.

Thank you, Kaci Hickox, for helping to stop an epidemic at its source

By Drs. Peter Millard and Bruce Brown, Special to the BDN
Posted Nov. 08, 2014, at 11:48 a.m.
Thank you to Kaci Hickox, whose bravery and selflessness in going to Sierra Leone to fight Ebola helped all of us in Maine, the U.S. and the world.
If we are going to defeat this and future epidemics, we need to stop them at their origins. If not for people like Hickox, the world would be a far more dangerous and brutal place. Hickox was willing to sacrifice her time and, possibly, her life in giving her hard-earned expertise to the people of West Africa and the rest of the world to stop Ebola at its source.
We should consider the Ebola epidemic a dry run for a devastating epidemic that is coming, sooner or later. Epidemics have always been with us. They are as inevitable as hurricanes and earthquakes. Ebola has been known for 40 years, and the public health and medical systems have substantial experience in fighting it. Ebola is one of a myriad of hemorrhagic fever viruses to which we are vulnerable — Lassa and Marburg are others. Fortunately, these viruses are transmitted only through direct contact with the blood or body fluids of a person who is sick with Ebola; they are not transmitted through the air, like the influenza virus, nor by contact with people who are incubating the illness but are not yet ill.
Two secondary cases of Ebola occurred among nurses who were caring for a dying Ebola patient in Dallas. Patients are most infectious when they are in the terminal stages and proper precautions are not followed. Patients who are ill with Ebola need to be cared for with utmost attention to personal protection.
On the other hand, there have been no secondary cases in the U.S. among people in the early stages of disease who used public transportation or other public services. Hickox is not ill, and she is not a danger to others. Should she become ill, there will be sufficient time to care for her in a proper setting. We should be ashamed that a teacher from our own state was put on leave simply because she visited Dallas. The hysteria surrounding these two cases is far more frightening to us than the epidemic itself.
In 2003, the world was struck by an outbreak of SARS, or severe acute respiratory syndrome, a virus that, like influenza, is transmitted by the respiratory route — coughing or sneezing. SARS spread rapidly to more than two dozen countries in Asia, North America, South America, Europe and Asia, causing 8,000 cases in a short time and nearly 1,000 deaths. SARS was a close call and was arrested only through a vigorous, science-based international response.
Another epidemic like SARS or influenza is likely and will only be controlled if we all work together, using proven interventions, and have people like Hickox who are willing to make sacrifices as members of the human family.
Gov. Paul LePage’s intrusion into the realm of public health, an area in which he is totally uninformed, smacks of electioneering and represents a distraction from the more urgent issues of accelerated vaccine production, health worker recruitment from North America, and hospital preparedness.
Thank you to Kaci Hickox for the reality check. By standing up for her own rights and just saying no, she said no to hysteria and yes to science and public health.anizations will track the health of the 40,000 Anthem policyholders, checking to see if, for example, diabetes patients get regular eye exams and heart attack survivors take recommended beta blockers.







Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)