Health Care Reform Articles - November 19, 2015

Bernie Sanders to Invoke F.D.R. in Speech Defining His Vision of ‘Democratic Socialism’

by Patrick HealySenator Bernie Sanders of Vermont will be channeling Franklin D. Roosevelt more than Eugene V. Debs on Thursday afternoon as he delivers the most important speech of his bid for the Democratic presidential nomination: an attempt to demystify democratic socialism, his long-held political philosophy, and tie it to his vision of America.

The unstated goal of the speech is to address Mr. Sanders’s biggest challenge: electability. While he is running strong among liberals, many other Democrats see him as an anti-establishment protest candidate from the left-wing fringe who isn’t in the party (he is one of two independents in the Senate). They fear they would be wasting their votes choosing him over Hillary Rodham Clinton in the nomination fight, even though some opinion polls show him doing just as well in the 2016 general election as Mrs. Clinton.

The rap on Mr. Sanders is that Americans, many of whom confuse socialism with the more commonly vilified communism of the former Soviet Union, would never elect a president whose ideology includes the word “socialist.”

In explaining democratic socialism, which envisions democracies with socialist economic systems, Mr. Sanders plans to position himself as the political heir to one of the Democratic Party’s great heroes, F.D.R, according to Sanders aides who provided a preview of the speech. Mr. Sanders, building on his descriptions of the Roosevelt-backed Social Security program as a “socialist” endeavor, will call for the United States to adopt the so-called second Bill of Rights that Roosevelt proposed in his 1944 State of the Union address to Congress. Roosevelt proposed guaranteeing the right to “a useful and remunerative job” for laborers, farmers and others to earn an adequate wage; housing; medical care; education; social security; and freedom from unfair competition and monopolies.

“All of these rights spell security,” Roosevelt said. “And after this war is won, we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being.” (He died the following year.)

Mr. Sanders’s speech, which will also include remarks about foreign policy and strategy against the Islamic State, is scheduled for 2 p.m. at Georgetown University in Washington. The speech can be watched here.

http://www.nytimes.com/politics/first-draft/2015/11/19/bernie-sanders-to-invoke-roosevelt-in-speech-defining-his-vision-of-democratic-socialism/?hpw&rref=politics&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Critics say high deductibles make insurance ‘unaffordable’

By Tracy Jan GLOBE STAFF  NOVEMBER 16, 2015

COLUMBUS, Ohio — When President Obama’s landmark health care law ushered in a slew of new insurance options in 2013, the Andersons could not wait to sign up.

Roger Anderson, 54, a formerly uninsured construction worker, has a bad back and a bad heart. He and his wife are still paying for his earlier heart surgery and feared another crisis could ruin them.

“This law was going to give people a chance,” said Cassaundra Anderson, 44, a freelance proof reader.

But in April, when Roger Anderson fell while hiking and hurt his shoulder, he discovered, to his dismay, that simply being insured was not enough. The Andersons’ mid-tier plan, which costs them $875 a month, requires them to meet a $7,000 deductible before insurance payments kick in.

“We can’t afford the Affordable Care Act, quite honestly,” said Cassaundra Anderson, whose family canvassed for Obama in their neighborhood, a Republican stronghold outside Cincinnati. “The intention is great, but there is so much wrong. . . . I’m mad.”

The Andersons’ experience echoes that of hundreds of thousands of newly insured Americans facing sticker shock over out-of-pocket costs. Although the law survived two Supreme Court challenges, it could still be on the line in the 2016 presidential election, posing a significant political barrier to Democrats in this critical battleground state, which includes both conservative rural sections of Appalachia and diverse cities.

The problem experienced by the Andersons is particularly acute in Ohio, which has the fourth-largest number of people enrolled in high-deductible insurance plans in the country, after Texas, Illinois, and Pennsylvania, according to America’s Health Insurance Plans, the industry’s trade association based in Washington.

Now that the law’s major provisions are in place, the outcry over cost has prompted Hillary Clinton, the Democratic front-runner, to call for changes to Obama’s signature domestic achievement.

“This will be an issue at least one more time in the 2016 election. It could absolutely still hurt Democrats,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. “Polls about the Affordable Care Act have a considerable amount of middle-income people who say either the program has done nothing for them or actually hurt them.”

Governor John Kasich, like other Republicans running for the party’s presidential nomination, blames rising insurance costs on Obama’s 2010 health reform law and has called for its repeal. Clinton defends the Affordable Care Act on the campaign trail but is pledging to lower out-of-pocket costs including deductibles and making affordable health care a “basic human right.” Senator Bernie Sanders, a self-described socialist challenging Clinton for the Democratic nomination, says Obama’s health law does not go far enough and advocates for a “Medicare-for-all” single-payer system instead.

The percentage of Ohioans who view the law unfavorably is higher than in the nation as a whole, especially among independents and Democrats, according to new data from the annual Ohio Health Issues Poll. Nearly half of Ohioans do not like the law, compared with the 42 percent national figure reported by the Kaiser Family Foundation in October.

HTTP://WWW.BOSTONGLOBE.COM/NEWS/POLITICS/2015/11/16/HIGH-DEDUCTIBLE-HEALTH-PLANS-MAKE-AFFORDABLE-CARE-ACT-UNAFFORDABLE-CRITICS-SAY/EAWZZJNRFHM6VVPDBCDZ0I/STORY.HTML?S_CAMPAIGN=EMAIL_BG_TODAYSHEADLINE&S_CAMPAIGN=

Shopping for Health Insurance Is New Seasonal Stress for Many

By ABBY GOODNOUGHNOV. 18, 2015

WASHINGTON — For 2014, the first year she got health coverage through the Affordable Care Act, Gail Galen chose a plan from a new nonprofit insurer, Oregon’s Health CO-OP. But the price jumped for 2015, so Ms. Galen switched to a policy from a different company, LifeWise Health Plan.

Now, with open enrollment for 2016 underway, she is preparing to leap to her third insurer in three years — and stocking up on whiskey, she says, only half in jest, as she braces for another round of shopping on the federal insurance marketplace.

“Every year I feel like I’m starting all over again, and I just dread it,” said Ms. Galen, 63, of Warrenton, Ore. “My stress level just shoots up.”

Over the past two years, the Affordable Care Act has created entirely new markets for health insurance, and a new way of buying it, via online exchanges that allow comparison shopping. They have brought coverage to nine million people, many of whom could not afford it or were rejected by insurers before. But these new markets have also seen sharp price swings, or changes in policies, that are driving many consumers to switch plans each year.

http://www.nytimes.com/2015/11/19/us/shopping-for-health-insurance-is-new-seasonal-stress-for-many.html?&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&hpw&rref=health

In Many Obamacare Markets, Renewal Is Not an Option

NOV. 18, 2015

By  Amanda Cox and Margot Sanger-Katz

Last year, we encouraged returning Obamacare customers to shop around for a better deal. This year, a lot of people will have no choice.

In markets throughout the country, the plan in the most popular category that was least expensive this year will not be offered next year. That means that some people who took our advice and shopped for a bargain will need to shop again, even if they’re happy with their plan.

There are 499 markets for Obamacare plans in the United States. In 89 of them, the insurance company that offered this year’s best deal in the “silver” category will not be returning for 2016. We’ve marked those areas in dark grey on our map. Most of those exits are a result of insurance co-op plans that failed. A few exits came as insurers that are still operating elsewhere decided to leave particular markets. People in these canceled plans can’t simply renew their current policy if they like it — they have to go back into the marketplace and find a new insurer.

The widespread cancellations reflect continuing shifts in the new health insurance markets, which sprang into being in 2014. Insurers are still learning what sorts of plans will be most popular and what prices will be low enough to attract customers while still covering their medical bills.

The numbers come from an analysis from the McKinsey Center for U.S. Health System Reform, which did the work of examining all the plans and matching 2015 products with 2016 offerings. McKinsey examined the larger market areas that insurance companies use to set their rates, instead of individual counties. That means that our estimate of terminated plans may be an undercount, because there are some additional counties where renewing customers will be out of luck.

Our advice from last year still applies. Even people who aren’t forced back into the marketplace could be well served by examining their options. The McKinsey analysis finds that, in many markets, people willing to switch plans could experience significant savings on their premiums. A government analysis, which looked at all the plans people currently hold, found that more than 80 percent of federal marketplace shoppers could find a better deal if they were willing to switch. And a report from the Kaiser Family Foundation published Wednesday estimated that renewers in the kind of plan we looked at would benefit from switching in 73 percent of counties.

What’s Happening to Obamacare Premiums

http://www.nytimes.com/2015/11/19/upshot/in-many-obamacare-markets-renewal-is-not-an-option.html?mabReward=CTM&action=click&pgtype=Homepage&region=CColumn&module=Recommendation&src=rechp&WT.nav=RecEngine

Health Care Law Forces Businesses to Consider Growth’s Costs

By STACY COWLEYNOV. 18, 2015

When LaRonda Hunter opened a Fantastic Sams hair salon 10 years ago in Saginaw, Tex., a suburb of Fort Worth, she envisioned it as the first of what would eventually be a small regional collection of salons. As her sales grew, so did her business, which now encompasses four locations — but her plans for a fifth salon are frozen, perhaps permanently.

Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company’s profit and the five-figure salary she pays herself from it, she said.

“The margins are not big enough within our industry to support it,” she said. “It’s not that I don’t want to — I love my employees, and I want to do everything I can for them — but the numbers just don’t work.”

The health care law’s employer mandate, a provision that business groups fought against fiercely, is intended to make affordable health insurance available to more people by requiring employers to bear some of the cost of providing it.

Without the mandate, the law’s creators feared, companies would be tempted to cancel their insurance benefits and encourage employees to move to the online marketplace exchanges created by the law, where many low- and middle-income workers qualify for government subsidies. Those who are offered insurance through their jobs are ineligible to collect subsidies if they instead choose to buy coverage through the exchanges.

The rule took effect this year for businesses with 100 or more workers, but companies with 50 to 99 employees got an extra year to comply. Those with fewer than 50 workers are exempt.

For some business owners on the edge of the cutoff, the mandate is forcing them to weigh very carefully the price of growing bigger.

“There’s kind of a deer-in-headlights moment for those who say, ‘I have this new potential client, but if I bring them on, I have to hire five additional people,’” said Philip P. Noftsinger, the payroll unit president at CBIZ, a financial services provider for businesses. “They’re really trying to assess how much the 50th employee is going to cost.”

Nearly all large companies provide health care benefits, but only 54 percent of businesses with three to 49 workers offered coverage to their workers this year, according to an analysis by the Kaiser Family Foundation. Paying even a portion of the cost can be expensive. The average annual premium for workers at small companies currently tops $6,100 for individual insurance and $16,600 for family coverage.

That premium is typically shared between the employer and employee. Businesses that fall under the health care law’s mandate are required to offer their workers “affordable” insurance, which the law defines as individual coverage that costs less than 9.5 percent of the employee’s household income. (Because employers do not know how much money their workers’ relatives make, their options for compliance include basing their calculation on only their own employees’ wages.) For a full-time, minimum-wage employee making $14,500 a year, an employer offering an average-price individual plan would have to pay around $4,700 a year.

Added to that cost are the administrative requirements. Starting this year, all companies with 50 or more full-time workers — even those not yet required to offer health benefits — must file new tax forms with the Internal Revenue Service that provide details on employee head count and any health insurance offered. Gathering the data requires meticulous record-keeping.

“These are some of the most complex informational returns we’ve ever seen,” said Roger Prince, a tax lawyer with the consulting firm Berry Dunn in Portland, Me.

Some of his clients, even small ones, have spent months reconfiguring their human resources and financial systems to track the information that the new forms demand. The health care law defines a full-time-equivalent employee as someone who works an average of 30 or more hours a week — and the hours worked by some part-time employees count toward the calculation.

For businesses that use many seasonal, variable-hour or temporary workers, like those in the hospitality industry, simply figuring out how many qualifying employees they have can be a challenge.

http://www.nytimes.com/2015/11/19/business/smallbusiness/health-care-law-forces-businesses-to-consider-growths-costs.html?action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&hpw&rref=health

Prostate cancer screening drops in US

By Lenny Bernstein WASHINGTON POST  NOVEMBER 18, 2015

The rate of prostate screenings and the incidence of prostate cancer diagnoses have both declined sharply in the years since an expert panel issued controversial recommendations that men should no longer have the simple blood test that can reveal the disease, researchers reported Tuesday.

The US Preventive Services Task Force concluded in 2012 that the prostate-specific antigen (or PSA) test causes more harm than good, saving few lives but prompting unnecessary surgery, radiation, and side-effects among men who would never die from the often slow-growing cancer. Except for those with high risk for the disease, men should avoid the blood test, the panel said.

Four years earlier, it had issued similar guidelines for men over 75. Together, the recommendations countered two decades of medical practice.

The result has been a clear decline in the number of men having the test and the discovery of cases of prostate cancer, researchers reported Tuesday in the Journal of the American Medical Association.

Otis Brawley, chief medical officer for the American Cancer Society and one of the authors of the new study, said the decline is a positive sign if it means that more doctors and patients are discussing the pros and cons of the screening and making the decision together.

‘‘It’s only a good thing if [the numbers] went down because doctors and patients consciously decided together that it shouldn’t be done,’’ Brawley said. ‘‘I think it’s terrible to tell a man he must get screened,’’ he added. ‘‘I think it’s terrible to tell a man he can’t get screened.’’

The study found that 30.8 percent of men 50 years old or older reported taking the PSA test in 2013, down from 37.8 percent in 2010 and 40.6 percent in 2008. They also found that the rate of prostate cancer diagnoses in men of that age group fell from 534.9 per 100,000 in 2005 to 416.2 in 2012. About 33,519 fewer men received a diagnosis of prostate cancer in 2012 than in 2011, they estimated.

Studies have shown that if PSA screening saves any lives at all, the number is very small, Brawley said. At the same time, surgery and radiation for the disease lead to a considerable number of side effects that affect quality of life.

http://www.bostonglobe.com/news/nation/2015/11/17/sees-sharp-decline-prostate-cancer-screenings-and-diagnoses/24hgqctVMK7gr83IFyHpEM/story.html?s_campaign=email_BG_TodaysHeadline&s_campaign=

Protect Doctor-Patient Confidentiality

NOV. 19, 2015

by Sandeep Jauhar, M.D.

WHEN should a doctor betray a patient’s confidence? This week the Supreme Court of the State of Washington heard arguments on this question in a case that has profound implications for the doctor-patient relationship.

In the case, Volk v. DeMeerleer, a psychiatrist, Howard Ashby, was sued after a patient of his, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before killing himself. (Mr. DeMeerleer also stabbed another son, who survived.) The estate of the victims, Rebecca and Phillip Schiering, took legal action, arguing that Dr. Ashby was liable because he had not warned the Schierings. A lower court ruled in Dr. Ashby’s favor on the grounds that Mr. DeMeerleer, who had occasionally voiced homicidal fantasies, had made no specific threats toward the Schierings during his treatment.

But last November an appeals court reversed that judgment, asserting that doctors could be required to warn “all foreseeable victims” of potentially dangerous patients in their care. Whether the attack on the Schierings was foreseeable, the court said, should be decided by a jury.

Though the murder of innocents is obviously a tragedy, the Washington State Supreme Court should overturn the appeals court’s decision. Not only does that judgment greatly expand the circumstances in which psychiatrists would be required to violate patients’ confidentiality; those violations in the end would also not serve the purpose for which they were intended.

Throughout history, doctor-patient confidentiality has been a cornerstone of Western medical practice. The duty to keep patients’ information private is written into the codes of ethics of medical organizations, and is even in the Hippocratic oath: “What I may see or hear in the course of treatment,” it says, “I will keep to myself.”

Patients allow physicians into their private lives on the condition that the information we learn will not be used against them. I once took care of a business executive in the emergency room who had hired call girls during a weekend drug binge. When he saw a police officer outside his room, he quietly handed me an envelope containing a large amount of white powder. I wasn’t sure what to do with it, so I discarded it. For the next several hours the patient eyed me suspiciously, probably wondering whether I had ratted him out. But it never occurred to me to do so.

http://www.nytimes.com/2015/11/19/opinion/protect-doctor-patient-confidentiality.html?hpw&rref=opinion&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Court master finds insufficient staffing, care at Maine psychiatric hospital

by Steve Mistler - PPH

AUGUSTA — The court master assigned to ensure that patients held at the state’s Riverview Psychiatric Center receive proper treatment says that inadequate staffing, training, and seclusion and restraint techniques continue to plague the 92-bed facility.

The eight-page report was submitted to the state on Oct. 26 and is now being reviewed by the Legislature’s Health and Human Services Committee. Oversight by the court master, former Maine Chief Justice Daniel Wathen, stems from a 1990 consent decree designed to ensure that people treated for mental illness receive appropriate care. Still, the latest report details overlaps in deficiencies that have prevented Riverview from regaining its federal certification, thus jeopardizing $20 million in annual funding.

The Department of Health and Human Services has fought since 2013 to regain federal certification, but has been unsuccessful.

In August DHHS Commissioner Mary Mayhew asserted that the only way to achieve certification is to build a separate facility that will hold violent patients who have been found not criminally responsible and those who are incompetent to stand trial. The separation of so-called forensic patients and civil patients, and the sharing of staff, was cited in the federal audits that led the Centers for Medicare and Medicaid services to yank Riverview’s certification.

The separation issue is not cited in the court master report, but personnel problems, including insufficient staffing levels and the use of temporary and part-time practitioners to fill vacant psychiatry positions, led the on-sight reviewer to conclude that treatment is lagging because patients cannot form trusting relationships with physicians.

The report also found that mental health workers were working long hours to compensate to help the hospital meet minimum staffing levels. Mental health workers logged over 1,083 hours overtime in August, including 312 hours of mandated overtime.

http://www.pressherald.com/2015/11/18/court-master-finds-insufficient-staffing-care-at-maine-psychiatric-hospital/