Pages

Tuesday, June 2, 2015

Health Care Reform Articles - June 2, 2015

Seeking Rate Increases, Insurers Use Guesswork

By   

 


In a sign of the tumult in the health insurance industry under the Affordable Care Act, companies are seeking wildly differing rate increases in premiums for 2016, with some as high as 85 percent, according to information released on Monday by the federal government for the 37 states using HealthCare.gov as their exchange.
The data from the Centers for Medicare and MedicaidServices included only proposed rate increases of 10 percent or more, and federal officials emphasized that it would be months before final rates were set. Regulators in some states have the authority to overrule rate increases they deem to be too high.
Experts cautioned against relying too heavily on the data as a predictor of prices for next year.
“Trying to gauge the average premium hike from just the biggest increases is like measuring the average height of the public by looking at N.B.A. players,” said Larry Levitt, an executive with the Kaiser Family Foundation.
But many insurers, including those seeking relatively hefty increases below 10 percent, say they are asking for higher premiums because they remain unsure about the future and what their medical costs will be.

“The insurers are in the business of taking risk, but the one thing they hate is uncertainty,” Mr. Levitt said.
Many unknowns remain. Among them are the questions of how many more people will sign up for coverage and what the state of their health will be. Healthier customers can generally lower costs for the overall group. Other uncertainties include the effect of the law’s protections against large losses for insurers, and a Supreme Court decision that will determine whether subsidies will be available in the states participating in the federal exchange.



Data Shows Large Rise in List Prices at Hospitals

 
By  and 
The prices that hospitals ask customers to pay for a series of common procedures have increased by more than 10 percent between 2011 and 2013 — more than double the rate of inflation.
But the amounts paid by Medicare, the government health care program for seniors and the disabled, has stayed flat, according to data released Monday by the federal government. The hospitals’ rising list prices mainly affect the uninsured and people who use hospitals outside their insurance network.
The information about charges and payments was part of a large release of data, representing about $62 billion in Medicare payments and more than seven million hospital discharges. The data release also included information about roughly 950,000 doctors and health care practitioners who received $90 billion in Medicare payments. Cancer and eye doctors again topped the list of high earners.
The list of doctors receiving the highest reimbursements in 2013 included two familiar names from a year earlier, both of whom are facing legal action for their billing practices.
The second-highest earner in 2013 was Dr. Asad Qamar, a Florida cardiologist who received $16 million in 2013, according to an analysis by The New York Times. In January The Times reported that he is being suedby the federal government as part of two whistle-blower lawsuits that claim he performed unnecessary surgeries.
Greg Kehoe, a lawyer for Dr. Qamar, said that his client had a large medical practice with other doctors and that he provided excellent care.
The third-highest biller was Dr. Salomon Melgen, a Florida ophthalmologist who has been indicted on Medicare fraud charges and on claims that he traded gifts and trips for political favors from Senator Robert Menendez, a New Jersey Democrat who was himself indicted on corruption charges this year. Dr. Melgen received $14.4 million from Medicare in 2013.


The Columbia Journalism Review: "Why We Need Stronger Coverage of Covered California"

The California Press Gets a Critique It Has Long Deserved 


Covered California, the Obamacare state-run health insurance exchange has long been the subject of occasional posts on this blog––none of them flattering.

The constant spin in the face of facts that comes out of Covered California and the way the press, particularly in California, has often just reprinted that spin hasn't been appreciated here.

I am happy to report––and admittedly relieved––that it isn't just me that thinks the reporting has been less than objective.

But would you believe that conclusion would have come from the esteemed Columbia Journalism Review (CJR) in a story titled, "Why We Need Stronger Coverage of Covered California"? The journal is part of the Columbia Graduate School of Journalism.

In the past months I have pointed out that:
And then there was former CBS News Emmy winning investigative journalist, Sharyl Attkisson, with her two part expose, "Incompetence, Mismanagement Plague California's Obamacare Insurance Exchange" and "Insider's Detail Culture of Secrecy at California's Obamacare Exchange" on The Daily Signal, that filled in the details behind all of the high expense, poor consumer service, and now dismal enrollment results for the more than $1 billion taxpayers spent in California on that Obamacare exchange.

All of this time hardly a critical peep came from the California press and it sure looked to me like they were all happier just to reprint Covered California's upbeat press releases.

In her Friday story, the Columbia Journalism Review's Trudy Lieberman said the following:
In recent months, Covered California has cited each of these measures ["good" enrollment news] to tout its success. And though outside analysts have raised some notes of caution, press coverage has largely followed the lead set by the exchange. The result is coverage that has too often been reactive, short on enterprise, and with missed opportunities to ask some necessary questions. Covered California may ultimately have a success story to tell––but it will need to face some sharper skepticism before we can be sure.
And also from the CJR story:
It can be exhausting to sort out all of the different metrics, and the state's healthcare reporters have had plenty of other stories. But going forward, the exchange warrants closer scrutiny than, for the most part, it got this year. And while reporters should definitely be attentive to outside evaluations both critical and positive...there is a role for journalists to play, too, in getting out there and talking to people...

ObamaCare’s Problems Continue to Fester: Cost, Complexity, Quality, Coverage, Corruption in Covered Calfornia.

By Lambert Strether of Corrente.
California is a bellwether state for the such success as ObamaCare[1] has had, as well as for its failures. From the Kaiser Foundation’s recent report (“Coverage Expansions and the Remaining Uninsured: A Look at California During Year One of ACA Implementation”):
California is a bellwether state for understanding the impact of the ACA. The state’s sheer size and its high rate of uninsured prior to ACA implementation means that its experience in implementing the ACA has implications for national coverage goals. In addition, California was an early and enthusiastic adopter of the ACA; the state implemented an early Medicaid expansion through its Low-Income Health Program (LIHP) and was the first to create a state-based Marketplace.
Long-time health care reporter Trudy Lieberman argues for a focus on California from her outpost at the Columbia Journalism Review:
Why we need stronger coverage of Covered California
It’s not easy to figure out how to monitor the progress of Covered California, the country’s largest state-run health insurance exchange.
Lieberman then goes on to look at coverage of enrollment figures, and the tendency of our famously free press to write the easy benchmark story and print Covered California’s rosy press releases, instead of going out and doing actual reporting; we’ll get the numbers below. Lieberman concludes:
[G]oing forward, the exchange warrants closer scrutiny than, for the most part, it got this year. And while reporters should definitely be attentive to outside evaluations both critical and positive—like a recentHealth Affairs study that found exchange plans were of comparable or even better quality than plans bought on the private market—there is a role for journalists to play, too, in getting out there and talking to people about their insurance arrangements. 
Amen. And I hope readers who have Covered California policies, or Medical, will chime in with their experiences, good and bad.
Absent in-depth reporting of people’s real experiences with Covered California, I’ll aggregate the press coverage I can find — there has been an uptick, lately — under the headings of Cost, Complexity, Quality, Coverage, and — saving the juiciest for last — Corruption. Of course, problems in all these areas are functions of ObamaCare’s overweening complexity, which is a result of the broken system architecture required by official Washington’s determination to preserve the private health insurance because markets, instead of adopting the simple, rugged, and proven single payer approach (see here at “largest controlled experiment in the history of the world”).

Houlton woman’s life forever changed by infection after surgery

By Jen Lynds and Jackie Farwell, Special to the BDN
Posted June 01, 2015, at 3:22 p.m.
HOULTON, Maine — When Jerolyn Ireland suffered a seizure one evening in 2012 and was rushed to the hospital only to find out she had a brain tumor, she thought it was the worst experience she’d ever go through.
She was wrong.
The 73-year-old Houlton woman learned that the tumor was noncancerous, but her struggle with a form of staph called Methicillin-resistant Staphylococcus aureus, or MRSA, was just beginning. 
MRSA is among the most worrisome infections that hospitals and other health care facilities face, fueled by overuse of antibiotics in the U.S. and worldwide. 
Bacteria linger on surfaces, such as surgical instruments, bed linens and door handles, or spread from room to room by unwashed hands and the coughs and sneezes of sick patients.
On any given day, one in every 25 U.S. patients contracts an infection during a hospital stay, according to a March 2014 study in the New England Journal of Medicine. Of those infected, 75,000 died in 2011, the U.S. Centers for Disease Control and Prevention estimates.
More recently, an outbreak of a so-called “superbug” at UCLA’s Ronald Reagan Medical Center exposed the dangers of unsanitary medical equipment, as reported in February by the Los Angeles times. The outbreak, linked to a common but faulty medical scope, led to the deaths of two patients, infected at least five others and may have exposed nearly 180 more.
In Maine, hospitals are increasingly preventing more infections and more closely following safety protocols, according to a new state report. Maine ranks first in the country for hospital safety overall, as measured by the watchdog organization The Leapfrog Group.
But state health officials warn that a dangerous form of strep infection is on the rise, leading to five deaths this year. Called invasive group A streptococcal disease, the infection can be contracted almost anywhere, but often turns up in hospitals and other health care facilities. 
Some patient advocates want Maine to do more to prevent and publicize hospital infections. The state reports only some types of infections and releases no data on how many patients are disabled or killed by them, they say.

The costs of infection

For Ireland, the brain tumor was the beginning of a long road of illness.
“When you hear brain tumor, of course you think the worst,” said Ireland, who spent more than 40 years as a nurse and had planned to keep working until at least age 75. “But when they told me it was benign, I felt a bit better, I thought I would just have the surgeries and be done with it.”
When Ireland suffered the seizure, she fell out of bed and a heavy bureau fell on top of her, breaking both her shoulders. She needed surgery to repair the injuries and was soon immobilized with both arms in casts.
After the surgery at Eastern Maine Medical Center in Bangor and a stay in a rehabilitation facility, she returned to work. 
“I really thought that was the end of it, it was over,” she said. “But then one day I just woke up and noticed that there was a lot of drainage from my surgical site.”
The surgical site had become infected with what would eventually be diagnosed as MRSA.
MRSA has grown resistant to the antibiotics commonly used to treat ordinary staph infections. Many MRSA infections occur in people who have been in hospitals or other health care settings, such as nursing homes and dialysis centers. 
Maine’s overall rate of MRSA infections in health care facilities was 28 percent lower than a national baseline in 2014, according to the state report. But Maine changed how it collects MRSA data last year — now reporting cases confirmed by lab tests rather than diagnosed and documented by doctors — making comparisons to prior years difficult. The rates also reflect the presence of MRSA on a patient’s body but may or may not indicate active infections, as in prior years.
Ireland said that at first, her doctor could not see her right away. Then, the infection progressed.
Her son Mark Boutlier, a paramedic, drove her to Bangor to get the surgical site checked out. He left his mother resting in the car while he waited at the pharmacy, only to find out that the doctor had prescribed an antibiotic that cost $1,800.
“We were just floored,” he said. “I could not afford that and neither could my mother. It was just outrageous.”
Ireland eventually underwent five surgeries on her skull and spent three months in Houlton Regional Hospital to completely treat the MRSA. She still suffers from memory loss, seizures and can no longer work. 
She lost her home, a lakeside property with a pontoon boat, and now resides in a senior housing complex.
Ireland estimates she owes approximately $200,000 in medical bills. While she had insurance coverage, the remaining medical bills devastated her finances, she said, and affected her son and daughter in-law, Krista.

The dangerous ‘red-state model’

By Katrina vanden Heuvel  June 2 at 8:35 AM
“My focus is to create a red-state model that allows the Republican ticket to say, ‘See, we’ve got a different way, and it works,’ ” Kansas Gov. Sam Brownback said in 2013. 
Brownback was talking about the massive supply-side tax cuts at the center of his policy agenda, which he had promised would provide “a shot of adrenaline into the heart of the Kansas economy.” Instead, it led to a deep hole in the state budget, a downgrade in the state’s credit rating and weak economic growth compared with neighboring states. As top income earners and business owners pocketed their tax cuts, Kansas’s poverty rate went up.
The failure of Brownback’s plan has made headlines not only because of its consequences in Kansas but also because of its potential impact on national politics. Brownback explicitly intended his plan to inform the policy debate in 2016 and beyond, but his gambit didn’t work as planned. As The Post’s editorial board wrote last year, “Mr. Brownback’s Kansas trial is rapidly becoming a cautionary tale for conservative governors elsewhere who have blithely peddled the theology of tax cuts as a painless panacea for sluggish growth.”
However, Kansas’s budget woes have overshadowed another important element of Brownback’s red-state experiment: his refusal to expand Medicaid under the Affordable Care Act. In the latest issue of The Nation, features editor Kai Wright reports on the devastating consequences of that decision.
As Wright explains, Kansas has some of the most restrictive Medicaid eligibility requirements in the country. The program is available only to non-disabled adults earning less than 32 percent of the federal poverty level, and most childless adults don’t qualify, regardless of income. The Affordable Care Act was supposed to raise that threshold to 138 percent, but Brownback declined to implement the Medicaid expansion. As a result, thousands of poor Kansans who would qualify for Medicaid in other states remain uninsured.
Brownback has often characterized his opposition to expanding Medicaid and other poverty programs, in Wright’s words, as a “moral rejection of dependency.” Last June, for example, Brownback told the Heritage Foundation’s Daily Signal Web site that Kansas had not expanded Medicaid because “We’re trying to push people that are able-bodied right now to get a job.” Similarly, Brownback pledged in his State of the State address this year to continue “helping people move from dependence on the government to independence.”


Obamacare beats GOP’s nothing, expanding Medicare would be even better

By Tom Gates, M.D.
Lancaster (Pa.) Online, June 1, 2015
I was astonished to read U.S. Rep. Joe Pitts’ criticism that Obamacare does not do enough to cover the uninsured, leaving 30 million without coverage, and that it “achieves too little at too high a cost.” Astonished, because for the last five years Pitts and his congressional colleagues have to all appearances been concerned not with covering the uninsured, but rolling back the modest progress we have made.
Since I graduated from medical school 35 years ago, the number of uninsured in this country has risen inexorably year after year, more than doubling over the course of my career. The number of uninsured peaked at around 50 million in 2010, with a modest decrease of about 2 million from 2011 to 2013 as the initial provisions of the Affordable Care Act took effect.
Then in 2014, when Medicaid expansion and the new insurance exchanges kicked in, the number of uninsured fell by 15 million — far and away the biggest decrease in uninsured since Medicare was passed. The ACA has performed better than predicted, at a lower cost than projected, and, contrary to congressional critics like Pitts that it would be a “job killer,” its full implementation in 2014 coincided with the biggest net gain in employment in 15 years.
Pitts says that “Republicans in Congress have many ideas that are more practical than the ACA,” but doesn’t divulge to us, his constituents, what those ideas might be. So here is a suggestion for Pitts and his colleagues: If you are really concerned about the 30 million Americans who remain without health insurance, and you don’t like the ACA because it “achieves too little at too high a cost,” then support the proposal of Rep. John Conyers, D-Mich., HR 676, the Expanded and Improved Medicare for All Act.
Medicare is arguably the most valuable and popular government program of the last half-century. Together with Social Security, it has lifted tens of millions of older Americans out of poverty. It has consistently out-performed the private sector, with lower inflation and much lower administrative costs than private health insurance.
Conyers’ proposal would build on Medicare’s success, extending it to cover not just the elderly and disabled, but all Americans. Like traditional Medicare, this “single payer” system would allow patients complete freedom to choose their preferred physicians and hospitals (no more “out-of-network” denials). Providers would remain private entities competing for our business, but would be paid out of a government fund rather than the myriad of competing and profit-driven insurance companies. By eliminating $400 billion a year in private insurers’ administrative costs, there would be enough savings to cover those 30 million uninsured, plus eliminate all deductibles and co-pays.
How is this possible? According to the Institute of Medicine, as much as 30 percent of our current health care expenditure is pure waste, amounting to some $700 billion per year. Much of this waste comes from the high cost of administering our needlessly complex system. Insurance companies, ultimately beholden to their stockholders, make money by providing insurance to the healthy while finding ways to avoid covering the sick. Private, for-profit insurance companies have overhead and administrative costs of 12 percent to 20 percent, compared to 1.6 percent for Medicare (according to the 2013 Medicare trustees report).
If expanded and improved Medicare for all, with no deductibles and co-pays, sounds too good to be true, remember that every other advanced country in the world has been able to provide universal coverage at a much lower per-capita cost than the U.S., with health outcomes often better than our own. Why do we settle for less?
As we approach the 50th anniversary of the passage of Medicare in July 1965, let us urge Pitts and his colleagues not to cut or further privatize Medicare, but protect it, improve it, and most importantly, expand it to cover everyone. Urge Congress to pass HR 676. That would be real health care reform.
Dr. Tom Gates is a family physician who lives in Manheim Township and has practiced in downtown Lancaster for 20 years.


Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)