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Monday, December 1, 2014

Health Care Reform Articles -December 1, 2014

In First Week, More Than a Million Apply for Health Insurance on Federal Website 

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WASHINGTON — Obama administration officials said Wednesday that more than one million people had submitted applications for health insurance in the first week of this fall’s open enrollment period under the Affordable Care Act, and 45 percent of them had already selected health plans.
The applications showed that HealthCare.gov, the website for the federal insurance marketplace, was working. The federal marketplace was largely dysfunctional when it opened last fall. More than three times as many people selected health plans in one week this month as in all of October and November of last year.
“We are off to a solid start,” Sylvia Mathews Burwell, the secretary of health and human services, said in a conference call with journalists on Wednesday. “But we’ve got a lot of work to do every day between now and Feb. 15,” when the three-month enrollment period ends.
In her remarks, Ms. Burwell delivered a progress report on use of the federal website, which serves 37 states. The numbers do not include activity in the 13 states that run their own insurance exchanges.

Without health insurance, Down East women subsist on the margins

By Mary Shea, Special to the BDN
Posted Nov. 30, 2014, at 9:05 a.m.
Say you’re a woman between 50 and 64 years old needing to decide which prescription to refill. You have high blood pressure, high cholesterol and low thyroid, and you need prescription medications to help manage all three conditions. You are, however, uninsured and cannot afford all three.
Which one is the most important? For people who are uninsured, this is a common problem. Should they take their heart medication or seizure pills? They have to decide. This situation is even more severe in Washington County.
Washington County has the highest uninsured rate in the state at 17 percent. Nationwide, health insurance coverage for women has declined since 1980. During the 20th century, the health care system has largely been based on employment and marriage such that individuals with jobs or who are married to spouses with jobs have access to high-quality, affordable health insurance. Women with employer-sponsored insurance are almost twice as likely as men to be covered as dependents, making them more vulnerable to losing coverage following the death or retirement of a spouse, loss of a job or a divorce.
Washington County was one of the few counties in the northeastern U.S. where the life expectancy of women decreased between 1983 and 1999. For the first time since the 1918 Spanish influenza epidemic, Washington County women cannot expect to live as long as their mothers did.
Many women in Down East are generally employed in part-time seasonal work and are not eligible for employer-sponsored health insurance. This work consists of working in the blueberry industry, making balsam Christmas wreaths, processing crabmeat or working in a tourist industry. Others are employed year-round as personal care attendants and housecleaners. These women often have several jobs, juggling schedules to squeeze in as many hours as possible into their workweek.
The uninsured have limited access to care and are likely to delay care and seek acute care more often than those covered by health insurance. Without medical insurance, women are less likely to seek care or follow up with prescribed tests, treatments and appointments. When they do seek care, they often are more sick than insured peers of a similar age. As studies have shown, access to primary care and consistent face-to-face contact with a regular care provider are associated with better health outcomes and enhanced chronic disease management and health outcomes in general.
Incidences of chronic illness such as hypertension, diabetes and COPD increase with age and disproportionately affect the 50- to 64-year-old group. The lack of financial protection from unexpected health care expenses that increase with age can have devastating effects on health and finances.
In the past two years, the Maine Legislature voted five times to expand Medicaid. Gov. Paul LePage vetoed the expansion, and the Legislature could not override the veto.
Under the Affordable Care Act, the federal government is picking up the entire cost of new enrollees through 2016 and never less than 90 percent thereafter. Maine was the only state ­in New England and one of 23 nationally to so far decline federal money to expand Medicaid under the federal law. LePage’s decision to shrink Medicaid instead of expanding it was a radical departure from a decade-long effort to cover more people in this small rural state of farmers, lobstermen, craftsmen and other seasonal workers.
The decision not to expand MaineCare will sustain the gap in insurance coverage, and many of those who were not eligible for MaineCare prior to implementation of the Affordable Care Act are not be eligible for reduced premiums.
Among Washington County’s uninsured women, the financial priority is not health care and making sure they have their medication but paying the heat and utility bills. Ironically, as the Affordable Care Act is implemented to usher in a new era of health care, near elderly, working poor and unemployed and underemployed women may be unable to afford even the lowest premiums and will continue to subsist on the margin of health.
The next time you fill a prescription or get your routine blood tests done, think about these women who are uninsured and deciding which treatment they think is most important.
Mary Shea is an assistant professor and graduate program coordinator in the School of Nursing at the University of Maine.

Using Doctors With Troubled Pasts to Market a Painkiller

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Dr. Judson Somerville, a pain specialist in Laredo, Tex., received $67,000 in speaking fees, travel and meals in 2013 to promote a powerful and addictive painkiller called Subsys, according to a new federal database of payments that drug companies make to physicians.
But while Insys Therapeutics, the Arizona company that makes the product, was paying Dr. Somerville to promote it, he was under investigation by the Texas Medical Board. Last December, the board ordered him to stop prescribing painkillers after it found that he had authorized employees to hand out pre-signed prescriptions to patients and after it learned that three of his patients had died in 2012 of drug overdoses, most likely from drugs that he had prescribed.
Dr. Somerville, who received more money from Insys than any other doctor between August and December 2013, is just one of the company’s highly paid doctors who have recently faced legal or disciplinary trouble.
Dr. Gavin Awerbuch, a Michigan neurologist who received $56,000 from Insys, was arrested this springafter federal prosecutors said he defrauded Medicare of $7 million and improperly prescribed Subsys to patients who did not need it. Another top Insys speaker, Dr. Jerrold Rosenberg of Rhode Island, was reprimanded in September for inappropriately prescribing painkillers, including Subsys.

Suit on Health Law Puts Focus on Funding Powers 

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WASHINGTON — In mounting the latest court challenge to the Affordable Care Act, House Republicans are focusing on a little-noticed provision of the law that offers financial assistance to low- and moderate-income people.
Under this part of the law, insurance companies must reduce co-payments, deductibles and other out-of-pocket costs for some people in health plans purchased through the new public insurance exchanges. The federal government reimburses insurers for the “cost-sharing reductions.”
In their lawsuit, House Republicans say the Obama administration needed, but never received, an appropriation to make these payments to insurance companies. As a result, they contend, the spending violates the Constitution, which says, “No money shall be drawn from the Treasury, but in consequence of appropriations made by law.”
President Obama requested the money as part of the budget he sent Congress in April 2013, but Congress did not act on the request. Seeing the issue as an urgent priority, the administration began making the payments early this year, using money from a separate account established for tax refunds and tax credits.
“The cost-sharing reductions are really important and valuable,” said Judith Solomon, a vice president at the Center on Budget and Policy Priorities, a liberal-leaning research and advocacy group.

Wyoming Devises Plan to Expand Medicaid

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WASHINGTON — With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid.
The plan would provide Medicaid coverage to an additional 18,000 low-income people, according to the state’s health department. If it wins federal and state legislative approval, Wyoming will join 27 states that have expanded the program under the Affordable Care Act, including nine with Republican leadership.
As several other Republican governors have done, Mr. Mead wants to require some people who receive coverage under the expansion to pay something toward the cost. Under his plan, those earning 100 to 138 percent of the federal poverty level — for a single person, $11,670 to $16,105 a year — would have to pay monthly premiums. The premiums could range from about $20 to $50 a month, depending on household size and income, according to a summary of the plan.
The Obama administration has to sign off on the plan because it deviates from regular Medicaid expansion under the federal health care law.
People earning less than 100 percent of the poverty level would not have to pay monthly premiums. But they could owe small co-payments for certain services, as could the higher-income group. Those deemed “medically frail” would get Medicaid, which has a slightly more comprehensive benefits package, said Kim Deti, a spokeswoman for the Wyoming Department of Health.
The expansion plan would also require approval from the State Legislature, which is controlled by Republicans. If lawmakers approve the plan, it will most likely take effect in 2016. The Legislature has already rejected several bills that would have expanded traditional Medicaid. But earlier this year it authorized Mr. Mead to negotiate with the Obama administration on a modified version.

Diabetes Screening Lags in People With Hypertension

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As many as a third of adults who have high blood pressure have not been screened for diabetes, despite the fact that guidelines call for them to be checked regularly, new research suggests.
Hypertension and Type 2 diabetes frequently occur in tandem. Together they represent one of the most common chronic disease combinations and also one of the most hazardous, putting people at greater risk of having heart attacks, strokes and kidney disease. Medical groups have long known about the danger and encouraged people at risk to undergo screening.
The United States Preventive Services Task Force, for example, recommends routine blood sugar tests and other diabetes screening measures — about once every three years — for people with blood pressure readings above 135/80. The group notes that the potential benefit of screening and treating such patients for diabetes “is substantial.”
But the new research, published in the journal Preventing Chronic Disease, suggests that many people who should be screened are not. The study was carried out by scientists at the Minnesota Health Department, who looked at screening rates in Minnesota and then compared them with rates in 16 other states.
http://well.blogs.nytimes.com/2014/11/26/diabetes-screening-lags-in-people-with-hypertension/?smprod=nytcore-iphone&smid=nytcore-iphone-share

Naloxone, a Drug to Stop Heroin Deaths, Is More Costly, the Police Say

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This year, police departments across the country, including in New York City, announced plans to stock up on a medication that reverses the effects of a heroin or opioid painkiller overdose.
The move signaled a shifting approach for officers more accustomed to fighting drug abuse with arrests than with a medical antidote.
But police and public health officials from New York to San Francisco are facing sticker shock: Prices for a popular form of the medication, naloxone, are spiking, in some cases by 50 percent or more.
“It’s not an incremental increase,” said Chuck Wexler, the executive director of the Police Executive Research Forum and a proponent of putting the lifesaving drug into officers’ hands. “There’s clearly something going on.”
In Georgia, police officials have seen the price of a kit containing the drug rise to $40 from $22. Departments in New Jersey, where heroin addiction has ravaged small communities, are facing similar increases.
In New York City, a spokeswoman for the Health Department said a more than 50 percent price increase for nasal naloxone has officials “concerned” over the future of its distribution programs.



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