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Thursday, June 4, 2015

Health Care Reform Articles - June 4, 2015


In Vermont, Frustrations Mount Over Affordable Care Act

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BURLINGTON, Vt. — Just a few years ago, lawmakers in this left-leaning state viewed President Obama’s Affordable Care Act as little more than a pit stop on the road to a far more ambitious goal: single-payer, universal health care for all residents.
Then things unraveled. The online insurance marketplace that Vermont built to enroll people in private coverage under the law had extensive technical failures. The problems soured public and legislative enthusiasm for sweeping health care changes just as Gov. Peter Shumlin needed to build support for his complex single-payer plan. Finally, Mr. Shumlin, a Democrat, shelved the plan in December, citing the high cost to taxpayers. He called the decision “the greatest disappointment of my political life.”
As the United States Supreme Court prepares to rule in a case that could gut a major element of the Affordable Care Act — federal subsidies for low- and middle-income people — Vermont should have little to worry about. Only states that use the federally run insurance marketplace stand to lose subsidies if the court rules against the Obama administration, and Vermont is among the 14 states that fully run their own.
But even though its residents’ subsidies appear safe for now, Vermont stands as a cautionary tale. Despite an eventual cost of up to $200 million in federal funds, its online marketplace, or exchange, is still not fully functional, while disgust with the system is running deep among residents and lawmakers alike.
Meanwhile, the hopes for a single-payer system, once tantalizingly close, may be lost for years. Under such a system, the government operates one health insuranceplan for all residents, covering their medical costs instead of having private insurers do it.
“It’s just been a spectacular crash, really,” said State Representative Chris Pearson, a member of Vermont’s Progressive Party. “We’ve gone from this vision of being the first state to achieve universal health care, to limping along and struggling to comply with the Affordable Care Act.”

State Obamacare Exchanges Experience Growing Pains

The states that set up their own insurance marketplaces have nothing to lose in King v. Burwell, the big Supreme Court case that will be decided by the end of June. But that doesn't mean those states are breathing easy. 
With varying degrees of difficulty, all of the state-based exchanges are struggling to figure out how to become financially self-sufficient as the spigot of federal start-up money shuts off. 
Here are dispatches from Minnesota, Colorado and Connecticut on this tricky transition. 
Minnesota – Tough Politics
Even though Minnesota's exchange, MNsure, ran much more smoothly in its second year than its disastrous first, some Republicans opposed to Obamacare from the beginning hoped to do away with it this legislative session. 
"This has been an abject failure from day one to present. If you're denying that, your head is in the sand," says state Rep. Nick Zerwas. 
His colleague, Rep. Nancy Franson, agrees: "We should have never gotten into the exchange. We should just move straight to the federal exchange and bypass the state of Minnesota." 
Even the Democratic architect of the law that created MNsure wanted to dissolve its board and make MNsure a state agency. 
In the end, lawmakers ended their session leaving MNsure intact. But they voted to ask the feds to allow Minnesotans to get tax subsidies for health insurance regardless of whether they shop on the open market or through MNsure. 
The legislature also created a bipartisan task force to consider MNsure's future. Republican Rep. Matt Dean says those relatively small measures make a big point. 
"The final agreement I think that we have going to the governor right now acknowledges that there's major trouble with MNsure, that the current situation is not sustainable," Dean said. 
Democratic Sen. Tony Lourey helped create MNsure. He likes the idea of letting Minnesotans shop outside of MNsure and still get subsidies, but, he says, "I'm not particularly optimistic that it would be approved by federal officials. If it were approved, I think we would have to talk about then how do we structure the financing of the exchange." 
He says it would be even more difficult to fund the exchange with far fewer customers unless they could bring in new money. 
One option is to add a tax to all health plans sold, not just those sold on MNsure. 
Meanwhile, with fewer people signing up for plans through MNsure than anticipated, revenue is way down. That coupled with federal money drying up by year's end has MNsure moving to cut $2.5 million from its budget over the next three years. 
--Mark Zdechlik
Colorado – Glitches And Expenses
Colorado's exchange has cleared its political hurdles for the most part, but technical glitches and financial challenges remain. 
Marc Drillings knows this all too well. He wanted to buy insurance on the Connect for Health, Colorado's exchange.
................This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.

13% Left Health Care Rolls, U.S. Finds

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WASHINGTON — About 13 percent of people who signed up for health insurance coverage in 2015 under the Affordable Care Act have fallen off the rolls, many because they failed to pay their share of premiums, the Obama administration said Tuesday.
The administration announced in March that 11.7 million people had signed up for coverage through federal and state marketplaces. On Tuesday, federal officials disclosed that enrollment stood at 10.2 million as of March 31.
Sylvia Mathews Burwell, the secretary of health and human services, issued the new enrollment report and highlighted data indicating that 6.4 million people were receiving federal subsidies to buy insurance in states where the marketplace, or exchange, was run by the federal government.
Those federal subsidies could be halted if the Supreme Court rules in favor of critics of the Affordable Care Act, who contend that the law authorized subsidies only in states that established their own exchanges. A ruling is expected in the next four weeks.
Nationwide, the administration said, the federal government is paying insurance subsidies in the form of tax credits to 8.7 million people, including 2.3 million in states that run their own exchanges. The average tax credit for those who qualified for financial assistance was $272 a month, the administration said.
The insurance marketplaces got off to a rocky start in October 2013, and President Obama paid a hefty political price as millions of consumers were frustrated trying to buy insurance. But the administration recovered, after making urgent repairs to HealthCare.gov, and by May 2014 the White House was celebrating the fact that eight million people had signed up for insurance in the first open enrollment period.
Federal officials on Tuesday disclosed that enrollment was substantially lower at the end of the year. About 6.3 million consumers were enrolled in health coverage through the marketplaces and had paid their premiums as of Dec. 31, 2014, they said.
But Ms. Burwell said there had been growth in enrollment since then. “The health insurance marketplaces are working,” she said Tuesday. “We’ve seen a historic reduction in the uninsured, and consumers are finding the coverage they need at a price they can afford.”

Understanding the Rate Increases for Health Care Plans


Insurance companies have begun announcing rate increases for the health care plans they will sell next year on the Obamacare marketplaces, and a handy new website from the federal government makes searching for rate change requests easier than ever.
Some of the rate increases are substantial. But for several reasons, simply looking at the current numbers can be misleading.
And when my colleague Reed Abelson wrote about requests that are coming in, she also noted that some rates are coming down.
Here are other things you should keep in mind.

These are just requests.

Many state insurance regulators choose to approve insurance rates before they are final. And the federal government, as part of Obamacare, set up a system in which it would scrutinize any rate increase of more than 10 percent. That means that the rate proposals under review right now are just that: proposals. Last year, many big rate requests were later amended under pressure from regulators. Some of the increases that look hefty now may turn out to be more modest.

This Cancer Doctor Is Leading the Attack on Astronomical Drug Prices

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As the one-year cost of cancer drugs edges up to $200,000 per patient, a top doctor from Memorial Sloan Kettering Cancer Center used his speech before a massive gathering of colleagues to call for limits on the cost of cancer therapies. “These drugs cost too much,” Dr. Leonard Saltz, a gastrointestinal oncologist, said in an unusual speech at the American Society of Clinical Oncology meeting on Sunday.
“We need to first accept that there has to be some upper limit as to what we as a society are going to be willing to spend on a patient, and we have to be willing to engage in that discussion,” Saltz told Bloomberg in an interview from the meeting in Chicago. “It’s a very uncomfortable discussion. We should be willing to have it. Because we’re not having the conversation, only the people selling the drugs are weighing in on what they should cost.”
Saltz has been among an outspoken group of physicians at Memorial Sloan Kettering that has railed against high-priced cancer drugs. He co-wrote a 2012 op-ed in theNew York Times defending the decision to stop prescribing a “phenomenally expensive” new drug. In his latest broadside he lit into the cost of a melanoma drug combination from Bristol-Myers Squibb, just hours after another physician from his hospital presented data showing the combination could delay the progression of advanced melanoma by months.
The cocktail combining two existing Bristol-Myers Squibb drugs, Opdivo and Yervoy, would cost the average patient $295,000 for a little less than a year of therapy, Saltz calculated. If all advanced cancer patients in the U.S. received drugs at that price, he projected, the total cost would reach $174 billion per year. An experimental high-dose regimen of another new drug highlighted in Saltz’s speech could cost patients as much as $1 million a year.



Saltz based his cost estimates on existing prices for individual drugs sold separately. Bristol-Myers declined to say whether it would offer discounts for the combination when it is approved. “It’s premature to speculate on what the pricing strategy will be,” says Michael Giordano, head of oncology development at Bristol-Myers Squibb. He says the company offers one of the “most robust patient assistance programs” to make sure underinsured cancer patients get access to its drugs.
The cost debate is intensifying as drug companies such as AstraZeneca, Roche, Bristol-Myers Squibb, and Merck race to develop medications that harness the body’s own immune system to fight various forms of cancer. Two of the first drugs on the market, Opdivo and Merck’s Keytruda, cost about $150,000 per year. Drugmakers are starting to combine the immune-therapy drugs for greater effectiveness, raising the potential prices even more.


Price of a common surgery varies from $39,000 to $237,000 in L.A.
By  AND 
A short drive in the Los Angeles area can yield big differences in price for knee or hip replacement surgery.
New Medicare data show that Inglewood's Centinela Hospital Medical Center billed the federal program $237,063, on average, for joint replacement surgery in 2013.
That was the highest charge nationwide. And it's six times what Kaiser Permanente billed Medicare eight miles away at its West L.A. hospital. Kaiser billed $39,059, on average, and Medicare paid $12,457.
The federal program also paid a fraction of Centinela's bill -- an average of $17,609 for these procedures.
The average charge nationwide for a major joint replacement operation was $54,239, according to federal figures.
Joint replacement surgeries are Medicare's most common inpatient procedure, costing the federal government more than $6.6 billion in 2013.

State Senate OKs health coverage for many immigrants here illegally
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The state Senate on Tuesday approved a hotly debated measure that would allow many immigrants in the state illegally to sign up for special healthcare programs that would offer the same benefits as Medi-Cal.
The action comes just days after lawmakers significantly scaled back the plan, which originally would have offered state-subsidized Medi-Cal to people in the country without authorization.
State Sen. Ricardo Lara (D-Bell Gardens) said his proposal provides “what we can realistically achieve now” for the estimated 2 million people in the state illegally.
“We are talking about our friends. We are talking about our neighbors and our families who are denied basic healthcare in the richest state of this union,” Lara told his colleagues.
The bill would allow up to 240,000 minors to sign up for Medi-Cal and allow some low-income adults to sign up for a separate program that provides the same services. Higher-income people would be able to buy non-subsidized coverage through Covered California if the federal government provides permission for them to do so.
As the son of parents who were immigrants formerly in the country illegally, Lara said many people spend long hours in emergency rooms waiting for treatment.
“Many often forgo medical care because of the fear of medical debt,” Lara said in support of SB 4.
The vote was 28-11, with most but not all Republicans opposed to the legislation, which next goes to the Assembly for consideration.

To Be Sued Less, Doctors Should Consider Talking to Patients More


by Aaron Carroll
Doctors call it defensive medicine. They order extra tests, perform extra procedures or push for more office visits because they think that without them, they’re at greater risk of being sued.
But studies don’t support the notion that this extra precaution reduces their risk.
What might help physicians avoid being sued is getting along better with their patients. Or at least, they could become better communicators.
Sometimes, when confronted with such assertions, doctors lash out. It’s the system’s fault. It’s the lawyers. It’s greedy patients. But these declarations ignore one important fact: Lawsuits aren’t random. Some doctors are sued far more than others.
As far back as 1989, a study of obstetricians in Floridafound that about 6 percent of obstetricians accounted for more than 70 percent of all malpractice-related expensesover a five-year period. These physicians did not just have a short run of bad luck. A follow-up study found that one of the most significant predictors of being sued was being sued in the past. Doctors who are sued are different in some way from those who aren’t.
Now it’s possible that these physicians were bad doctors, and that they deserved this. If that’s the case, then this is the malpractice system operating efficiently, and no one would have any reason to complain. But this relationship held true for both paid and unpaid claims. Some doctors were more likely to be sued, regardless of whether the cases against them were eventually found to have merit.
To understand why patients file claims, we have to talk to them. Many researchers have. A study in 1992 found that about a quarter of mothers who had sued physicians because of deaths or permanent injuries in their newborn infants “needed money.” But there were answers given more frequently that had nothing to do with remuneration. A third of respondents said that their doctor would not talk openly to them, half said their doctor had tried to mislead them, and 70 percent said that they were not warned about long-term neurodevelopmental problems in their children.
Another study, published two years later, looked at the relationship between physicians’ history of malpractice suits and their patients’ satisfaction. Patients seeing doctors who were sued in the past were significantly more likely to report that their doctor rushed them, did not explain reasons for tests or ignored them. Doctors sued most often were complained about by patients twice as much as those who were not, and poor communication was the most common complaint.

Maine data show dangerous rates of unvaccinated students; See data by school

An analysis of school-by-school opt-out rates finds regional pockets of resistance, subverting 'herd immunity' and increasing the threat of an infectious outbreak.
by Joe Lawlor
Dangerously high numbers of unvaccinated children attend classes at dozens of elementary schools across Maine, with immunization opt-out rates reaching levels where an outbreak of infectious diseases could sicken many children, according to public health experts who reviewed statewide data obtained by the Maine Sunday Telegram.
In the schools most at risk, children who haven’t been immunized account for more than 10 percent of the kindergarten or first-grade students, threatening the “herd immunity” that prevents diseases like measles, mumps, polio and pertussis from spreading. In some schools, more than 20 percent are unvaccinated, according to data compiled for the Telegram by the Maine Center for Disease Control and Prevention.
The reason: Parents refusing vaccines for their children, mostly opting out of required immunizations on philosophical grounds.
State lawmakers are considering bills that would make it more difficult for parents to forgo vaccines for schoolchildren. The bills – including one that would require a consultation and signature by a medical professional before being permitted to opt out on philosophical grounds – are being hotly contested by pro- and anti-vaccination advocates.


Maine Schools Report Record-Breaking Number of Chicken Pox Cases 

By  • JUN 2, 2015
AUGUSTA, Maine - The Maine Center for Disease Control and prevention says the state has nearly double the number of chicken pox cases this school year compared with last.
Dr. Christopher Pezzullo, chief health officer for the state, says, since September, there have been 85 cases. In the same timeframe last year, there were 44.
"What I'm going to attribute both the numbers to is the fact that our immunization rates are slightly lower than the national average for chicken pox," Pezzullo says.
Pezzullo says Maine has a 90 percent immunization rate for chicken pox. He says the goal is to boost that rate to 95 percent to help ensure herd immunity - that is, when a certain percentage of the population is immunized to protect those who can't get the vaccine.


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