Large urban hospitals disadvantaged by medicare/medicaid patient satisfaction rating system [News release]
Large urban hospitals disadvantaged by medicare/medicaid patient satisfaction rating system.
From the 25 May 2015 Mt. Sinai news release
The largest urban health systems do worse on government patient satisfaction scores than smaller, non-urban hospitals according to a new study by Mount Sinai researchers published this month in the Journal of Hospital Medicine.
NEW YORK– May 19, 2015 /Press Release/ ––
The largest urban health systems, which serve as safety nets for large patient populations with lower socioeconomic status and greater likelihood to speak English as a second language, do worse on government patient satisfaction scores than smaller, non-urban hospitals likely to serve white customers with higher education levels, according to a new study by Mount Sinai researchers published this month in the Journal of Hospital Medicine.
Patient satisfaction scores, in part due to the Affordable Care Act of 2010, are a key part of the formula that determines reimbursements levels to hospitals by the Centers for Medicare and Medicaid Services (CMS). The ACA has encouraged hospitals to evolve from a fee-for-service model to one based on measures of value, including patient satisfaction. Hospitals are rewarded or penalized based on metrics that assess quality and efficiency of care in part culled from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.
The study authors suggest that the current formulas need adjustment to be fair to large, urban hospitals, and offer a formula to achieve this equity.
“Our analysis found that the lowest satisfaction scores were obtained from population-dense regions of Washington, DC; New York State, California, Maryland and New Jersey, and the best scores were from Louisiana, South Dakota, Iowa, Maine and Vermont,” said senior author Randall Holcombe, MD, Professor, Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, and Chief Medical Officer for Cancer for The Mount Sinai Health System.
“Across the country, large hospital size and non-English as a primary language predicted poor patient satisfaction scores while white race and higher education level predicted better scores,” said co-author Daniel McFarland, DO, Clinical Fellow, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai. “Other demographic factors were also important but these four were the most significant.”
“This study points out that the interpretation of patient satisfaction scores can be very complex,” said Sandra Myerson, MBA, MS, BNS, RN, Senior Vice President and Chief Patient Experience Officer of the Mount Sinai Health System. “It is important to understand these trends in order to provide the highest quality of patient experience.”
[News release] Insuring undocumented residents could help solve multiple U.S. health care challenges
From the 18 March 2015 UCLA news release
UCLA health care policy analysis finds four key problem areas for Latinos under Affordable Care Act
Latinos are the largest ethnic minority group in the United States, and it’s expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers.
Latinos’ low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.
Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA:
- The consequences of not covering undocumented residents.
- The growth of the Latino population in states that are not participating in the ACA’s Medicaid expansion program.
- The heavier demand on public and private health care systems serving newly insured Latinos.
- The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.
“As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels,” Ortega said. “Resolving these four key issues would be an important first step.”
Insurance for the undocumented
Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.
For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA’s expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.
For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA’s exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.
In addition, previous research has shown that undocumented people often delay seeking care for medical problems.
…
As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.
“These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time,” he said. “So it remains unclear how these clinics will continue to provide care for them.”
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[Podcast] Alice Rivlin discusses the Affordable Care Act, America’s health, and leading the CBO
From the 6 February post at Brookings
“I think the Affordable Care Act is actually doing quite well,” says Senior Fellow Alice Rivlin in this podcast. Rivlin, the Leonard D. Schaeffer Chair in Health Policy Studies and director of the Engelberg Center for Health Care Reform at Brookings, cited the expansion of medical insurance coverage, declining cost growth, and other positive factors for the ACA. She also reflects on continued political opposition to the law, the impending King v. Burwell Supreme Court case, and what it was like to stand up a new federal agency, the Congressional Budget Office, in 1975.
[This is a screenshot, was unable to upload via an application similar to YouTube]
[This is a screenshot, was unable to upload via an application similar to YouTube]
Also in the podcast, Senior Fellow David Wessel, director of the Hutchins Center on Fiscal and Monetary Policy, offers his regular “Wessel’s Economic Update.”
Show Notes:
– Improving Health While Reducing Cost Growth, What is Possible? (with Mark McClellan)
– People Who Wanted Market-Driven Health Care Now Have it in the Affordable Care Act
– Health360: The latest views on health policy
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[Issue Brief] The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect – The Commonwealth Fund
From the January 2015 Issue Brief
Overview
New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act’s subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014. Read the brief.
Publication Date:
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[Brookings Report] Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals | Full Text Reports…
Pharma Pays $825 Million to Doctors and Hospitals, ACA’s Sunshine Act Reveals
From the report
Disclosure of the financial relationships between the medical industry and health care providers is a very important step toward transparency. Patients heavily rely on the recommendations of their doctors to make any kind of decision regarding their health and thus should have full awareness of payments between their doctors and the medical industry. Patients have a right to be informed about possible conflicts of interests.
A not so well-known provision of the Affordable Care Act is the Sunshine Act. The purpose of this act is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. Mandated by the Sunshine Act, on September 30th, Centers for Medicare and Medicaid Services (CMS) publicly released the first set of data, under the Open Payments title. This data includes $3.5 billion paid to over half a million doctors and teaching hospitals in the last five months of 2013.
A subset of Open Payments data that is individually identifiable includes two categories of payments. The first category are the payments that are made for other reasons such as travel reimbursement, royalties, speaking and consulting fees and the second are payments which are made as research grants. These datasets together include more than 2.3 million financial transactions which amount to a total of more than $825 million.
Total Payments by Manufacturers of Drugs, Medical Devices, and Biologicals
General Payments
Teaching hospitals and physicians together received $669,561,563 in general payments from 949 different medical manufacturers. Interestingly, close to 70 percent ($460,369,403) of this amount was paid to individual physicians and the rest was paid to teaching hospitals. More than half of the total general payments were made by only 20 companies led by Genentech, which paid $130,065,012 in general grants to various hospitals and doctors and in particular, City of Hope National Medical Center.
Research Payments
Two hundred and ninety-four manufacturers awarded 23,225 research grants to teaching hospitals and physicians. The total value of these grants was $155,815,828. About 70 percent ($107,969,961) of these grants were awarded to teaching hospitals and the rest were awarded to physicians. The top 20 manufacturers contributed more than 75 percent of the total value of these grants. By awarding $17,973,563 in research grants Bristol-Myers Squibb, leads the pack.
The following chart breaks down the payments of the top 20 most generous manufacturers of drugs, medical devices and biologicals to teaching hospitals and individual physicians.
Not surprisingly, the release of the payments data was not immune from criticism. The harshest ones were from the American Medical Association (AMA). In particular, the AMA cited “inadequate opportunity for physician review” and “inaccuracy of the data” as the main problems with the release of open payments data. Moreover, AMA was so concerned about the “misinterpretation” of the data that it released an official “Guide for Media Reporting” in which it “strongly encourage[s] members of the media to… help the public understand the important role that appropriate relationships between physicians and industry has in advancing the practice of medicine.”
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[Report] A one-year assessment of the ACA | Association of Health Care Journalists
A one-year assessment of the ACA | Association of Health Care Journalists.
From the 31 October 2014 report
The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA. It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”
The package consists of seven sections that run the gamut, with some key numbers and charts. Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.
Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.
Here are the seven sections covered, and the nutshell conclusion the Times provided for each.
- Has the percentage of uninsured people been reduced? Yes, the number of uninsured has fallen significantly.
- Has insurance under the law been affordable? For many, yes, but not for all.
- Did the Affordable Care Act improve health outcomes? Data remains sparse except for one group, the young.
- Will the online exchanges work better this year than last? Most experts expect they will, but they will be tested by new challenges.
- Has the health care industry been helped or hurt by the law? The law mostly helped, by providing new paying patients and insurance customers.
- How has the expansion of Medicaid fared? Twenty-three states have opposed expansion, though several of them are reconsidering.
- Has the law contributed to a slowdown in health care spending? Perhaps, but mainly around the edges.
[Reblog]Technology and the doctor-patient relationship
Technology and the doctor-patient relationship.
From the 1 July 2014 KevinMD article
I often hear people talking about their doctors. I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors. I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient relationship has degraded in our culture.
In large part, I believe this is due to technology.
The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit. Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.
So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient? In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.
Here’s the problem, though. Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.
These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.
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[News article] Health Insurance, Death Rates and the Affordable Care Act
Health Insurance, Death Rates and the Affordable Care Act.
From the 12 May 2014 article at Pew State and Consumer Initiatives
The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act.
In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that “health reform in Massachusetts was associated with a significant decrease in all-cause mortality.”
A portion of the chart
The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person’s life expectancy.…..
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[Reblog] Engage with McGovern Lecturer Prior to MLA 14
From the Krafty Librarian blog (May 2014)
Engage with McGovern Lecturer Prior to MLA 14
It is crunch time and I know everybody going to MLA 14 in Chicago is scrambling to tie up lose ends at work or for Chicago. But as you go over your schedule for MLA you might want to check out the McGovern Lecturer, Dr. Aaron Carroll’s blog or his Facebook page. Dr. Carroll has invited MLA members and attendees to begin a conversation with him in advance of the annual meeting on topics of interest by posting on his blog, friending him on Facebook, following him on Twitter, or emailing him.
For his lecture, Dr Carrol will be addressing issues on the Affordable Care Act and health care policy. His blog, “The Incidental Economist: Contemplating health care with a focus on research, an eye on reform,” is “mostly about the U.S. health care system and its organization, how it works, how it fails us, and what to do about it.” Dr Carroll is one of the Editors in Chief of the blog which also has several contributors who have “professional expertise in an area relevant to the health care system” as researchers and professors in health economics, law and other health service areas.
The Affordable Care Act and its impact on libraries and how librarians can help hospitals deal with certain aspects of it is a bit of a interest for me. I have taught several classes to library groups in the past year about librarians can better align their goals to that of the hospital. Since many hospitals goals are now focused around parts of the Affordable Care Act it makes sense that medical libraries develop strategies to support their institution’s Affordable Care Act goals.
For example…How can the medical library help the hospital
- Prevent readmissions
- Increase focus on preventive care
- Improve patient satisfaction
- Deal with Meaningful Use (not exactly ACA but very entwined)
Depending on the focus of the library or librarian, we might be able to help more than we or our administration realize. Here is what some libraries are doing already…
- Partnering with IT or CIO to provide evidence based medicine resources within the EMR
- Partnering with IT or CIO to make sure that order sets are based on best available evidence
- Embedded librarians rounding with patient care teams to help provide necessary information for patient care
- Help provide patient education documents and information and make them accessbile to patients through the patient portal
- Work with doctors to provide a prescription for health information to the patient through the EMR
Not only is it important the librarians do these things to help their institutions (BTW no one librarian can do it all but they should be doing something) achieve their goals, but it is equally important that we need to be MEASURING our impact. If we don’t measure it, it didn’t happen. Measuring can be tricky but it is necessary, especially if you want to keep your library and your job. Gone are the days where you can say I did 103 MEDLINE searches for doctors and that helped them treat patients. Really? How do you know those MEDLINE searches helped them? Did you ask what became of the search? Did you track how your information was being used? All you know is that you did 103 searches. You don’t know whether that was a benefit to the institution or not. We assume it was, but administration doesn’t assume anything.
I am looking forward to hearing Dr. Carroll speak. But before I see him at MLA, I am going to try and start to engage with him to find out what we librarians can do to help our institutions deal with the ACA and make our ourselves more valuable to the institution. I encourage everyone else to do the same with their own thoughts and questions prior to MLA.
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[Reblog] Journalist explains what to expect from new mental health parity rules
From the 27 January 2014 post at Covering Health – Monitoring the pulse of health care journalism
by Joseph Burns | January 27, 2014
About Joseph Burns
Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.
Michelle Andrews
Later this year, health plans will be under new mental health parity rules affecting how insurers should cover patients with mental health and substance abuse disorders.
Michelle Andrews, a health policy reporter and columnist for Kaiser Health News, explains the issue in a new tip sheet, “Mental health parity rule clarifies standards for treatment limits, coverage of intermediate care.”
These rules, governing the limits that health insurers can place on coverage for patients needing mental health and substance abuse care, will be important to consumers for several reasons. One reason involves what services health plans must provide when covering mental health benefits –keep in mind that health plans do not need to offer mental health care. But if they do, they need to cover inpatient and outpatient services, emergency room care and prescription drugs, Andrews reports. Also, the rules prohibit health insurers from setting limits on treatment that are more restrictive than the limits set on a plan’s medical-surgical coverage, she adds.
In addition, intermediate-level mental health services, such as residential treatment and intensive outpatient services for patients needing substance abuse treatment or mental health care, should be covered at the same level as the insurer covers residential and intensive outpatient services for medical-surgical patients, Andrews adds. Often patients needing mental health and substance abuse care require residential or intensive outpatient treatment.
The new parity rules also do not allow health insurers to charge higher co-payments, deductibles, or out-of-pocket maximums for mental health and substance abuse treatment without setting similar co-payment, deductibles, and out-of-pocket limits for medical-surgical coverage.
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[News article] Little-known aspect of Medicaid now causing people to avoid coverage
From the 23 January 2014 Washington Post article
Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house.
The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-
income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets.…
after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.
“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.
Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.
It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.
“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”
Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.
..
after the Affordable Care Act made it mandatory for most people to carry health insurance, Oregon’s Medicaid office decided to change its approach because people scared about asset recovery were not signing up for coverage. New rules that took effect last year state that asset recovery now applies only to long-term care.
“We needed to take another look at heath insurance coverage from the point of view of it not being a public benefit that’s voluntary,” Mohr Peterson said.
Other states have taken a much more lax approach to asset recovery in the past, hesitant to target poor people whose only valuable asset might be the farm that has been in their family for generations. Experts say there are no good, recent national data on how asset recovery is applied, with states differing drastically and working on a case-by-case basis.
It wouldn’t make sense for a state to pursue a claim on the property of a new Medicaid recipient under the health-care law, said Matt Salo, executive director of the National Association of Medicaid Directors.
“There’s no way any state is going to see it as cost-effective or politically sensible to do that,” he said. “It’s a scare tactic.”
Still, when it comes to something as central to middle-class identity as a home and what people can pass on to their heirs, it is perhaps not surprising that some people are not taking any chances.
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Dental Care Coverage and Use: Modeling Limitations and Opportunities | Full Text Reports…
Dental Care Coverage and Use: Modeling Limitations and Opportunities | Full Text Reports….
January 17, 2014Source: American Journal of Public Health
Objectives.
We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.Methods.
We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.Results.
Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.Conclusions.
Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.
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[Reblog from the Brookings Institute] CHART: Winners and Losers from Obamacare
From the 1 November 2013 item at The Brookings Institution
From Senior Fellow Justin Wolfers, co-editor of the Brookings Papers on Economic Policy:
See commentary on this chart by Dave Weigel on Slate.com.
Get more Brookings expert analysis and commentary on the Affordable Care Act.
Fred Dews
Managing Editor of the Brookings Website
Population Health Implications of the Affordable Care Act: Workshop Summary (2013)
From the 16 October 2013 summary at Full Text Reports
Source: Institute of Medicine
Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement.
Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest proportion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health.
Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their concept of community benefit, the ACA has expanded the arena for interventions to improve health beyond the “doctor’s” office. Improving the health of the population – whether in a community or in the nation as a whole – requires acting to transform the places where people live, work, study, and play. This report examines the population health-oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action.
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[Reblog] The ACA and Medicaid: Where You Live Matters
From the 4 September 2013 post at HealthCetera – CHMP’s Blog
What a difference a state makes. Ask my friend, a laborer whom I’ll call John.
Some months ago, John realized that a cyst-like lump on his trunk was growing and becoming bothersome. He has no health insurance so he paid out-of-pocket for a physician to examine it. Tests were negative and he was told it was “probably nothing.” The lump continued to grow and became uncomfortable, but John couldn’t afford to have it removed. When he shared this information with me, I told him that he probably qualified for Medicaid in New York State. He looked into it and discovered that he did. He signed up for it and went to a surgeon to remove the lump, now the size of a baseball and causing him increasing discomfort. After the test results came back, the surgeon told John that it was a malignant tumor. Fortunately, there is no evidence of metastasis, and John can proceed with the necessary treatments under Medicaid.
This story would likely have a very different outcome if John lived in Florida, Maine, Idaho, Kentucky or another of the 26 states that have not signed up to expand their Medicaid programs, as called for under the Affordable Care Act (ACA). As of September 2013, only 24 states plus the District of Columbia have committed to expanding their Medicaid programs.
How can this be? The 2012 Supreme Court’s review of the constitutionality of the ACA supported the federal government’s right to require that individuals purchase health insurance (the “individual mandate”), but it struck down a requirement that states expand their Medicaid programs to all adults under the age of 65 years who earn 138% or less of the federal poverty level (FPL) (in 2013, the poverty level is $15,626 for an individual and $32,499 for a family of four). States that failed to do so were to have forfeited their existing Medicaid programs that covered mostly women and children under the FPL. (Children ages 6 to 18 who fall at or under the FPL were covered by the existing Medicaid program; under the ACA, they are now covered up to 138% of the FPL under a separate section of the law that is untouched by the Supreme Court ruling.)
After the Supreme Court ruling, expansion of Medicaid became an option for states rather than a requirement. Why would states not want to do this? One reason is that it would cost the states some additional monies, though not very much. From 2014 to 2016, the federal government would pay 100% of the cost of the expansion. After 2016, it would pay 90% of the costs and the states would pay 10%. Seems like a deal for the states, but politics enters into the equation. The majority of the states opting out of the expansion are “red” states where the governor and/or legislature oppose “Obamacare”. Many of these states are at the bottom of the rankings of key health indicators.
I thought John would have qualified for the new state health insurance exchange that New York is implementing. The exchange will subsidize the cost of insurance for people in all states from 133% of the FPL (139% for people living in states that have adopted the Medicaid expansion) to 400% FPL. But John’s income is under the 139% in New York State, so he qualified for Medicaid.
John may be living a much longer life because New York opted to expand its Medicaid program. What about the unfortunate folks who live in states that didn’t opt in?
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing
Related articles
- IV Costs are High for No Explainable Reason
- Health Insurance “Coverage Gap” Coming to a Red State Near You (crooksandliars.com)
- The Math of State Medicaid Expansion (jflahiff.wordpress.com)
- Who Are The Uninsured In America? (sanfrancisco.cbslocal.com)
- Your Affordable Care Act Questions, Answered (aauw.org)
- Study: Nearly half of U.S. births covered by Medicaid (stltoday.com)
- Three reasons why Missouri should expand Medicaid (stltoday.com)
Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns
I am hoping that the federal government can do a bit more to provide resources for librarians about ACA.
Back in my public library days, it wasn’t easy working with patrons when the topic was against my views!
However, I always tried to address people’s information needs without bias and as completely as possible with factual information.
“ObamaCare” questions are in the same arena. While librarians cannot advise or fill out forms, they can at least lead folks to factual information. However, this would work best if the federal government would do everything possible to lighten the load for libraries. This would include providing readable materials for consumers, as well as “pathways” for librarians.
Also, libraries can welcome trained volunteers and organizations to give in-depth information to folks. Many already do this around tax time with IRS trained volunteers.
Here in Toledo, folks from legal aid organizations “set up shop” in public libraries to assist folks. Representatives from the Ohio Benefit Bank do likewise. These volunteers screen people for government assistance programs as SNAP and the Medicare Savings Program.
It sure would be great if government employees and/or trained volunteers could do likewise for “ObamaCare”. Areas could include the health exchange marketplace, Medicaid expansion, free preventative care, and more.
And with articles as this, there is a real need for information professionals, including librarians!
Ohio insurance department claims Obamacare premium rates to rise 41 percent (Cleveland Plain Dealer, August 1, 2013)
Ohio insurance regulators Thursday released rates for health insurance to be sold on the new state marketplace and said premiums for individuals will rise an average of 41 percent compared with 2013 rates.That average brought immediate condemnation from critics of the Affordable Care Act, with U.S. House Speaker John Boehner, a southwest Ohio Republican, calling it “irrefutable evidence” that the law known as Obamacare is driving up costs and hurting the economy……..Related articles
- [Repost] The ACA Countdown (jflahiff.wordpress.com)
- Got 1:43 minutes to learn about health exchanges? (jflahiff.wordpress.com)
While I’ve been busy with other things, I let this issue raised at ALA slip past unnoticed. Issues in library world don’t go unnoticed for very long, especially when they deal with government intrusion. Apparently, during ALA 2013 Conference a video was played in which there was a White House appeal to public librarians to help Americans understand the new Affordable Healthcare Act insurance system that goes into effect whenever – maybe. This federal initiative to get public libraries involved in assisting people to sign up goes into effect October 1.
As much as I dislike relying on news media for any valid information, a Washington Times online article “Librarian foot soldiers enlisted to help with Obamacare enrollment” published June 29 states:
CHICAGO — The nation’s librarians will be recruited to help people get signed up for insurance under President Barack Obama’s health care overhaul. Up to 17,000…
View original post 1,492 more words
[Reblog]Reform creates new incentives in health care
An aside…
Twice a week I volunteer at a soup kitchen/clothing distribution center. And three times a week I make phone calls screening folks for the Social Security Extra Help program which helps very low income people with their prescription drug costs.
English: U.S. Health Insurance Status (Under 65) (Photo credit: Wikipedia)
Many folks are hard pressed to come up with $4.00 copays.
Reblog From the 24 July 2013 article at Kevin MD
KOHAR JONES, MD | POLICY | JULY 24, 2013
I advocated for the Affordable Care Act, and celebrated when it was passed.
It’s good to have everyone covered, I thought.
Insurance for everyone is the first step to health care for all.
Alas, access to health insurance isn’t the same as access to health care.
First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for the general health needs of a community. The poorest neighborhoods with the worse reimbursements already have a severe shortage of providers. More people with health care coverage, means more people will be seeking routine care, and we don’t have more providers ready to see them all.
For patients, this will mean longer waits to see a provider. Or for providers, it will mean longer hours at work to see more patients.
Second, the ability to buy subsidized health insurance doesn’t automatically mean the ability to pay for health care.
I just learned that patients who are unable to pay their co-pays within 90 days may then need to face the entire medical bill on their own. How bad can a co-pay be, you may ask?
“When I say I have zero income, that means I have no money. None,” said one of my patients from the community health center where I work as a family physician on the South Side of Chicago, when I was encouraging him to buy generic medications at Walmart or Target. “$4 is too much for me,” he said. “I’d need to steal to buy it. “
Zero income means an enormous challenge to pay anything, borrowing from a network of friends and relatives and searching out social programs for medical assistance. In some states, Medicaid will be expanded to cover everyone who is near the federal poverty line. Other states are choosing not to expand coverage to young men. Private insurance plans may effectively leave them unable to afford health care, even if they are able to afford subsidized health insurance on the state exchanges.
When patients who live on the financial edge, who currently don’t have health insurance miss their co-payments, they will become liable to pay the entire cost of the doctor’s visit. After 90 days with no co-pay, then insurance companies would owe nothing. The people who are poorest , who have the toughest time scraping together the money to cover their co-pays, may ultimately be responsible for paying not only their co-pay, but the entire medical bill, while also paying insurance premiums.
This would be unfortunate.
I wish we could turn back the clock and create a simpler system where everyone had access to care without needing to worry about who pays what. Instead we have recreated pricing mechanisms that in effect result in tiered payments where the poorest patients continue to pay the most.
People are poised to buy into a broken system at the stroke of midnight announcing January 1, 2014.
The health insurance exchanges are coming—faciliating the buying and selling of imperfect products that promise access they can’t fully deliver, while potentially leaving vulnerable patients without full access to health care.
And still this is better than the alternative, where patients had no coverage at all, and the system wasn’t incentivized to find ways to become more efficient and more effective.
There will be new incentives in healthcare. We’ll see what happens. The American healthcare system will need to continue to adjust to the needs of patients, to be responsive to the most vulnerable, in order to ensure a healthier America.
Kohar Jones is a family physician who blogs at Progress Notes.
Related articles (all sides!)
- The Math of State Medicaid Expansion (jflahiff.wordpress.com)
- When considering health care costs, US physicians prioritize patients’ best interests (Medical News Today)
- Viewpoints: Finding the benefits in reforming health care (sacbee.com)
- Physician Skepticism About the Basic Doctrines of Health Care Reform: We’re In This Together and, by the way, More Believe In Care Management Than the EHR (diseasemanagementcareblog.blogspot.com)
- Oregon medical community gears up for expansion (kansascity.com)
- Cash-only doctors abandon the insurance system (money.cnn.com)
- Railroading the health care law (kansascity.com)
- My Family’s Obamacare (zocalopublicsquare.org)
- Highmark forms alliance in bid to cut health costs (triblive.com)
- Major Health Insurer Pulls Out of South Carolina, Two Other States, Because of ObamaCare (pjmedia.com)
- Poll: only 11 percent of doctors think the ObamaCare exchanges will be ready (humanevents.com)
-
Views of US Physicians About Controlling Health Care Costs (Full Text Reports)
July 24, 2013Views of US Physicians About Controlling Health Care Costs
Source: Journal of the American Medical AssociationImportance
Physicians’ views about health care costs are germane to pending policy reforms.Objective
To assess physicians’ attitudes toward and perceived role in addressing health care costs.Design, Setting, and Participants
A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.Main Outcomes and Measures
Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.Results
A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for “eliminating fee for service” (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the “uncertainty involved in patient care disconcerting” was negatively associated with cost-consciousness (β = −1.95; 95% CI, −2.71 to −1.18; P < .001).Conclusion and Relevance
In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.The increasing cost of US health care strains the economy. Because physicians’ decisions play a key role in overall health care spending and quality, several recent initiatives have called on physicians to reduce waste and exercise wise stewardship of resources.1- 4 Given their roles, physicians’ perspectives on policies and strategies related to cost containment and their perceived responsibilities as stewards of health care resources in general are increasingly germane to recent pending and proposed policy reforms.5 We surveyed US physicians about their views on several potential proposed policies and strategies to contain health care spending, assessed physicians’ perceived roles and responsibilities in addressing health care costs, and ascertained physician characteristics associated with those views.
The Math of State Medicaid Expansion
English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)
In June 2012, the Supreme Court ruled on the constitutionality of key components of the Affordable Care Act; and foremost among these were the individual mandate and Medicaid expansion. The Court judged the former to be constitutional but allowed states to “opt out” of the Medicaid expansion and some states have indicated that they will exercise this option. How might state choices affect health care coverage and costs?
The Patient Protection and Affordable Care Act (ACA) provides for three basic ways to increase health insurance coverage: the expansion of Medicaid to cover the poorest population; the provision of subsidies for those with low or medium incomes to purchase coverage on the new health insurance exchanges; and the institution of an individual mandate requiring everyone to have insurance. Taken as a whole, the ACA is highly controversial. However, Medicaid expansion and the individual mandate are particularly contentious issues, and the constitutionality of both was challenged, ultimately landing on the docket of the Supreme Court.
In June 2012, the Court ruled that the individual mandate was constitutional but gave states the option of not participating in the Medicaid expansion slated to begin in 2014. As of the spring of 2013, governors from 14 states had indicated publicly that they will choose to opt out.
The state-by-state breakdown as of spring, 2013. States where governors have stated they will not expand Medicaid are indicated in white, states that are leaning toward opting out or seeking alternative options are indicated in gray, and the remainder are red.
Source: The Advisory Board Company
What does Medicaid expansion offer states?
- More federal Medicaid funds: Under the ACA, the federal government will pay 100 percent of the coverage costs for those newly insured under Medicaid expansion. After 2016, the federal share gradually shrinks to 90 percent, substantially more than the 57 percent they currently pay on average.
- Greater access to care for the poor: Medicaid expansion makes health care more accessible to the poorest segment of the population — those earning less than 138 percent of the federal poverty level (this amounts to an income of about $16,000 for a single person or $32,000 for a family of four in 2013).
- Reduced outlays for uncompensated care: Providing insurance to the very poor reduces uncompensated costs of treatment for this group — an estimated $80 billion in 2016. Currently, about one-third of these expenditures come from state coffers.
- Reduces financial risk for the lowest-income Americans: Analysis of Oregon’s Medicaid experiment found that the financial hardship associated with medical coverage was dramatically reduced.
The report goes on to explain
- Without Medicaid expansion, the poorest population could fall through a coverage gap.
- What could be done about the coverage gap for low-income populations?
- The bottom line.
Related articles
- The math of Medicaid expansion in North Carolina (samefacts.com)
- The Cost of Not Expanding Medicaid | The Henry J. Kaiser Family Foundation (policyabcs.wordpress.com)
- Medicaid Expansion (mackinac.org)
- At southwest Missouri Medicaid panel, public voices against expansion silent (politicmo.com)
- Study: Obamacare could cause 1 million low-income Americans to move from work to welfare (aei-ideas.org)
- Senate Immigration Bill Contains $20 Billion Medicaid Mandate (breitbart.com)
- Medicaid expansion will cost Pennsylvania (triblive.com)
- Could the Obamacare Dream Turn Into a Nightmare for This Industry? (fool.com)
- AFP makes misleading attacks on “private option” for Medicaid expansion (arktimes.com)
- Editorial: Desperately flailing at Obamacare as it saves lives and money (stltoday.com)
RAND Shrugged | The Health Care Blog
The comments section was the most interesting part of this Web page.
Public health extremism (Obama Care, Health Law, and Bioethics)
Johns Hopkins University Press Blog
Guest post by Maxwell J. Mehlman
In a November article for the New England Journal of Medicine, Harvard law professors Michelle Mello and Glenn Cohen argue that in upholding the Affordable Care Act’s individual insurance mandate as a tax the Supreme Court “has highlighted an opportunity for passing creative new public health laws.” As a bioethicist who writes extensively on the question of coercive public health this troubled me on several fronts. In this case, Mello and Cohen give an example of the laws that they have in mind: higher taxes on people whose body-mass index falls outside of the normal range, who do not produce an annual health improvement plan with their physician, who do not purchase gym memberships, who are diabetic but fail to control their glycated hemoglobin levels, and who do not declare that they were tobacco-free during the past year.
Some of these suggestions seem ineffectual…
View original post 411 more words
Why Health Care is a Civil Right
Health care systems (Photo credit: Wikipedia)
I rarely overtly “get political” at my blog.
However, this seems to go beyond politics to what living in a functional democracy or republic is all about.
From the 31 October 2012 article at Medical News Today
I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.
Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we don’t have a right to vote for any natural reason; we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right.
Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled — i.e. ‘patients’ — in society. I’m a patient, and I can tell you: lack of health care makes it impossible for me to participate freely and fully in society. Among the reasons …
- I can’t choose my work. Because health care is tied to employment, and not all jobs have benefits, I can’t do things that might be socially useful or personally satisfying but lack benefits. I can never start a business, for example, because I wouldn’t have health insurance.
- I can’t buy the things I need. Patients are denied the free purchase of goods and services by restrictions on the healthcare market: FDA regulations, prescription requirements, doctor licensing, insurance rules. These restrictions help make health care safer and more effective, but they also sharply curb supply of medical goods and increase their price, which is paid disproportionately by patients.
- I can’t participate fully in the political process. I rarely volunteer in my community — dealing with my healthcare takes up most of my free time. I can’t give money to causes or candidates I support, because I don’t have any to spare. Moreover, a sick person is less likely to risk losing employer-provided insurance by organizing a union, whistle-blowing against fraud, or reporting discrimination in the workplace.
None of these exclusions is intrinsic to illness, but due instead to the structure of our society. And each reason is more compelling to the extent illness and injury are produced by pollution, toxic products, and other societal causes. A patient’s basic right to justice requires us to respond to the likelihood that we — as a society — had something to do with their illness.
One of the counter-claims made against this line of reasoning is that nobody is entitled to claim a health provider’s labor as a right. But there are many other professions which are subject to civil rights claims: teachers, firefighters, lawyers, to name a few. Moreover, physicians and other providers are able to do their job effectively in large part due to public investment in research and technology.
Unfortunately, the Affordable Care Act did not go far enough to guarantee patients right to health care. Access to insurance is not the same as access to care, as any patient will tell you. The ACA was a small step in the right direction, but we still need legislation recognizing patients’ right to health care. Whatever the outcome of the election, health care must be acknowledged as a civil right.
Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.
Related articles
- Health Care in European Countries (travelwyse.wordpress.com)
Rational Rationing vs. Irrational Rationing
English: This image depicts the total health care services expenditure per capita, in U.S. dollars PPP-adjusted, for the nations of Australia, Canada, France, Germany, Japan, Switzerland, the United Kingdom, and the United States with the years 1995, 2000, 2005, and 2007 compared. An ‘OECD Health Data 2010’ report is used for the information, which is available here. Note that there is additional information in this list. (Photo credit: Wikipedia)
Rational Rationing vs. Irrational Rationing By DAVID KATZ, MD in the 13 September 2012 article at The Health Care Blog
Excerpts
n a system of universal, or nearly universal health insurance such as in Massachusetts, decisions about what benefits to include for whom are decisions about the equitable distribution of a limited resource. If that is rationing, then we need to overcome our fear of the word so we can do it rationally. By design or happenstance, every limited resource is rationed. Design is better.
In the U.S. health care system, some can afford to get any procedure at any hospital, others need to take what they can get. Some doctors provide concierge service, and charge a premium for it. Any “you can have it if you can afford it” system imposes rationing, with socioeconomic status the filter. It is the inevitable, default filter in a capitalist society where you tend to get what you pay for.
That works pretty well for most commodities, but not so well for health care. As noted, failure to spend money you don’t have on early and preventive care may mean later expenditures that are both much larger, and no longer optional — and someone else winds up paying. If you can’t afford a car, you don’t get one; if you can’t afford care for a bullet wound — if you can’t afford CPR — you get it anyway, and worries about who pays the bill come later.
But those costs, and worries, do come later — and somewhere in the system, we pay for them.
By favoring acute care — which can’t be denied — our current system of rationing dries up the resources that might otherwise be used for both clinical preventive services and true health promotion. Fully 80 percent of all chronic disease could be eliminated if our society really rallied around effective strategies for tobacco avoidance, healthful eating, and routine physical activity for all. But when health care spending on the diseases that have already happened is running up the national debt, where are those investments to come from? The answer is, they tend not to come at all. And that’s rationing: not spending on one thing, because you have spent on another.
Nor is this limited to health care. The higher the national expenditure on health-related costs, the fewer dollars there are for other priorities, from defense, to education, to the maintenance of infrastructure. If cutting back on defense calls the patriotism of Congress into question, then classrooms get crowded and kids are left to crumble. Apparently, it is no threat to patriotism to threaten the educational status of America’s future. …
Related articles
- How Would You Like Your Rationing – Rational, or Irrational? (thehealthcareblog.com)
- U.S. health care system wastes $750B a year (cbc.ca)
- Waste and Promise Seen in U.S. Health Care System (nytimes.com)
Door to Door in the Heartland, Preaching Healthy Living
From the 10 September 2012 article at the New York Times
By SABRINA TAVERNISE
Published: September 10, 2012OKLAHOMA CITY — Like a missionary, Michael Bailey, a county health worker, spends his days driving his beat-up Nissan around this city’s poorest neighborhood, spreading the word in barber shops and convenience stores about the benefits of healthy diet and exercise. “Look at the kids,” he said. “Overweight, huffing andwheezing. Their lives will be miserable if this doesn’t change.”
Mike Bailey visited James Harris at his barbershop in Oklahoma City. Mr. Bailey has persuaded residents to enroll in a heart disease prevention program.Mr. Bailey believes that food is slowly killing his community here, and signing people up for a program to prevent heart disease is his way of saving souls.Local governments across the country are creating dozens of such experiments with money from the Obama administration’s Affordable Care Act. It is part of a broad national effort set in motion by the law to nudge a health care system geared toward responding to illness to one that tries to stop people from getting sick in the first place. To that end, the law created the $10 billion Prevention and Public Health Fund, the largest-ever federal investment in community prevention.Supporters say the effort is long overdue in an age where preventable disease is the single largest cause of death. Indeed, unhealthy behaviors, like smoking and poor diet, account for 40 percent of premature deaths in the United States, while poor health care and limited access to the health care system accounted for a tenth of such deaths, according to an analysis of federal data and mortality studies by J. Michael McGinnis, a senior scholar at theInstitute of MedicineBut critics say efforts to influence behavior will have only a modest effect without policy measures like taxes on soda and restrictions on marketing to children to change the food environment.
Oklahoma City, run by a Republican mayor, Mick Cornett, has with little notice won federal prevention money through the new law, a surprising source of financing in this deeply conservative Republican state. The governor, Mary Fallin, turned away $54 million in federal money to help prepare for the new law last year.
Republicans in Congress derided the prevention program as “a slush fund to build sidewalks, jungle gyms and swing sets,” but Mr. Cornett has embraced its approach, turning this city — labeled one of the fattest in America in 2007 by Men’s Fitness magazine — into a laboratory for healthy living. In recent years, he has transformed it with bike lanes, walking paths and an Olympic rowing complex. He started a drive called “This City Is Going on a Diet.” He even accepted an invitation from Michelle Obama, who has made childhood obesity her signature cause, to attend the 2010 State of the Union address.
“We don’t believe in individual freedom to the extent of letting people make poor health decisions and just wither away without help,” Mr. Cornett said in an interview.
Many scientists doubt such programs actually work. Only a handful of the dozens of published studies on obesity interventions have produced results, and only when participants were intensively engaged, said Tom Baranowski, a professor of pediatrics at Baylor College of Medicine. “Sending newsletters and calling is not enough,” he said.
But some public health experts say that the kinds of things being tried under the law could help bring a cultural shift. The single biggest behavioral success of the last century — the dramatic reduction in the share of Americans who smoke — took 50 years of education, regulation and medical intervention. Likewise, only a mixture of approaches has a chance of eventually reducing rates of obesity, these experts say.
“Over time all of this effort builds up so people come to think about the problem and their own behavior in a different way,” said Bruce Link, a professor of epidemiology and sociology at the Mailman School of Public Health at Columbia University.
In Oklahoma City, county officials have focused on the least healthy ZIP code — 73111 — a sun-seared stretch of one-story bungalows, fast food restaurants and minimarts. Heart disease mortality rates are 10 times as high as in the healthiest neighborhood, which is next to one of the biggest medical complexes in the state, including a teaching hospital with a large share of charity care.
In addition to the heart program, which offers free medicine and checkups in exchange for taking a health class, the area is getting a new health complex with sports fields and walking trails, and a physical education coordinator for city schools. Public messages against sugary drinks are plastered on buses and benches. Health workers will identify the area’s highest-risk patients, connect them with doctors, and follow up with them after checkups, a measure Gary Cox, director of the county health department, said was designed to reduce emergency room visits.
Thousands of fliers for the heart program were mailed out last year, but there were few takers until Mr. Bailey, the health department worker, began persuading people to sign up in the spring….
Related articles
- Door to Door in Oklahoma City, Preaching Healthy Living (nytimes.com)
- Health in a Hair Salon: Outreach Project Rooted in Beauty Shop(jflahiff.wordpress.com)
- Barbers: Cut, Shave, Lower Your Blood Pressure (Jflahiff.wordpress.com)
[on the Affordable Care Act] HealthNewsReviews.org Guest post: Bewitched, bothered and bewildered
Reblog from 7 August 2012 article at HealthNewsReview.org
The following is a guest post submitted by Harold DeMonaco, MS, one of our expert story reviewers for HealthNewsReview.org. The opinions stated are his.
——————————————————————————————
I, like many, read the internet version of my local newspaper. And in doing so, I am provided with an opportunity to view the comments of my fellow residents on topics of importance. My local newspaper is a bit right leaning and as a result, the vox populi is as well.
Many of those who post thoughts on current events do so with great fervor and some with great frequency. The tone and tenor of the “discussions” can vary but were at their most vitriolic when writers could use pseudonyms. Many of the most vocal appear to have departed when a requirement was made to self identify posts to the site. Several continue to provide the rest of us with the fruits of their years and breadth of experience as well as their keen intellect.
Given the right leanings of the newspaper and the most vocal of the vox populi, it is not surprising that the Affordable Care Act (presumably a four letter word for many) is viewed in a somewhat negative fashion. This is somewhat surprising since presumably the writers are either the beneficiaries of then Governor Romney’s surprising insight into healthcare or to the workings of President Johnson’s Great Society and Medicare. Massachusetts has managed to insure just about every citizen in the state and has now enacted legislation to better control health care costs. While there is work to be done to develop an ideal healthcare delivery system in Massachusetts and control costs, near universal access has been accomplished.
Why then do people object so strenuously to Obamacare? Is it their fear of government control? If so, the objectors should rightfully refuse Medicare, a pay as you go, government run insurance program managed by the Centers for Medicare and Medicaid. I suspect that the underlying reason is really rooted in economics. In essence, it is a zero sum game. If you win something, I must lose something.
The Blue Cross Foundation of Massachusetts periodically publishes updates on the Massachusetts experiment. Here are the latest findings:
- 439,000 more Massachusetts residents have health insurance coverage than did before reform.
- Massachusetts has the highest rate of insurance in the country with 98.1 percent of residents insured.
- There has been no evidence of subsidized coverage “crowding out” employer-sponsored insurance, and employer offer rates have grown from 70 percent to 77 percent since implementation of reform.
- Public support for Massachusetts health reform has remained strong with two out of three adults supporting reform.
- Most employers believe health reform has been good for Massachusetts and 88 percent of Massachusetts physicians believe reform improved, or did not affect, care or quality of care.
- The cost of health care and the annual rate of increase in health care spending remains a challenge. With no intervention, per capita health care spending in Massachusetts is projected to nearly double by 2020.
Given the intensity of the debate around Obamacare, I would have assumed that more news stories would provide readers with more information about the Massachusetts experience. More often than not however, readers are provided with partisan arguments for and against the Affordable Care Act. While there is a good deal of noise, there often is little in the way of real information.
The following is a guest post submitted by Harold DeMonaco, MS, one of our expert story reviewers for HealthNewsReview.org. The opinions stated are his.
——————————————————————————————
I, like many, read the internet version of my local newspaper. And in doing so, I am provided with an opportunity to view the comments of my fellow residents on topics of importance. My local newspaper is a bit right leaning and as a result, the vox populi is as well.
Many of those who post thoughts on current events do so with great fervor and some with great frequency. The tone and tenor of the “discussions” can vary but were at their most vitriolic when writers could use pseudonyms. Many of the most vocal appear to have departed when a requirement was made to self identify posts to the site. Several continue to provide the rest of us with the fruits of their years and breadth of experience as well as their keen intellect.
Given the right leanings of the newspaper and the most vocal of the vox populi, it is not surprising that the Affordable Care Act (presumably a four letter word for many) is viewed in a somewhat negative fashion. This is somewhat surprising since presumably the writers are either the beneficiaries of then Governor Romney’s surprising insight into healthcare or to the workings of President Johnson’s Great Society and Medicare. Massachusetts has managed to insure just about every citizen in the state and has now enacted legislation to better control health care costs. While there is work to be done to develop an ideal healthcare delivery system in Massachusetts and control costs, near universal access has been accomplished.
Why then do people object so strenuously to Obamacare? Is it their fear of government control? If so, the objectors should rightfully refuse Medicare, a pay as you go, government run insurance program managed by the Centers for Medicare and Medicaid. I suspect that the underlying reason is really rooted in economics. In essence, it is a zero sum game. If you win something, I must lose something.
The Blue Cross Foundation of Massachusetts periodically publishes updates on the Massachusetts experiment. Here are the latest findings:
- 439,000 more Massachusetts residents have health insurance coverage than did before reform.
- Massachusetts has the highest rate of insurance in the country with 98.1 percent of residents insured.
- There has been no evidence of subsidized coverage “crowding out” employer-sponsored insurance, and employer offer rates have grown from 70 percent to 77 percent since implementation of reform.
- Public support for Massachusetts health reform has remained strong with two out of three adults supporting reform.
- Most employers believe health reform has been good for Massachusetts and 88 percent of Massachusetts physicians believe reform improved, or did not affect, care or quality of care.
- The cost of health care and the annual rate of increase in health care spending remains a challenge. With no intervention, per capita health care spending in Massachusetts is projected to nearly double by 2020.
Given the intensity of the debate around Obamacare, I would have assumed that more news stories would provide readers with more information about the Massachusetts experience. More often than not however, readers are provided with partisan arguments for and against the Affordable Care Act. While there is a good deal of noise, there often is little in the way of real information.
Related articles
- The 716 Billion Dollar Lie (boomantribune.com)
- GOP budget plan’s real target: Medicare (salon.com)
- Robert Reich: Whose Plan Destroys Medicare — Obama’s or Romney-Ryan’s? (huffingtonpost.com)
- Romney struggles to get square with Ryan’s Medicare plan (firstread.nbcnews.com)
- Medicare reform: Obama vs. Ryan vs. Romney (totalbuzz.ocregister.com)
- Romney struggles to square with Ryan’s Medicare plan (firstread.nbcnews.com)
- Schreibman and Gibson fence over Medicare (timesunion.com)
- Obama’s Medicare Reforms Expanded Benefits For Seniors (tpmdc.talkingpointsmemo.com)
- The Difference Between Obama And Ryan’s Medicare Cuts (tpmdc.talkingpointsmemo.com)
- Federal Court Dismisses Challenge to Affordable Care Act’s Contraception Requirement (pattidudek.typepad.com)
Two postings about proposed state Medicaid expansion (The Health Care Blog)
Yes, this is a controversial topic, but thought I’d include these items, the comments for both blogs are interesting.
My thoughts? Health insurance coverage does need revising..because caring for our nation’s health is a shared responsibility…
Why Should You Care Whether or Not Your State Decides to Expand Medicaid Coverage?
By expanding Medicaid, the state-federal partnership that offers health insurance to low-income Americans, the Affordable Care Act set out to cover some 17 million uninsured – or roughly half of the 34 million who are expected to gain coverage under reform. But when the Supreme Court ruled on the Affordable Care Act in June, it struck down a key provision which threatened that if a state refused to co-operate in extending Medicaid to more of its citizens, it could lose the federal funding it now receives for its current Medicaid enrollees…
..
Health care costs, premiums would rise
What these governors ignore is the impact that the loss of those Medicaid dollars will have on insurance rates in their states, says Joe Paduda, editor of Managed Care Matters. Hospitals have been counting on the influx of new Medicaid dollars to reduce the cost of uncompensated care. Today, hospitals spend billions delivering care to patients who are both uninsured and very poor. If more patients have Medicaid, the pile of unpaid bills will shrink.
Assuming that Medicaid will expand, the Affordable Care Act has already trimmed subsidies to hospitals that care for a disproportionate share of impoverished patients. But now, if states turn down the Medicaid funding, the hospitals in these states “are going to have to make up the revenue loss from somewhere,” says Paduda, “and that ‘somewhere’ is going to be from privately-insured patients. That will lead to health insurance costs increasing much faster in ‘non-expansion’ states than in the rest of the country.”
We have been told that in some red states conservatives “hate poor people.” But my guess is that they’ll hate higher premiums more. If premiums go up, governors who turned down federal Medicaid dollars will have to answer to voters…
…
Now that some states are balking, the Congressional Budget Office estimates that 6 million of the 17 million who were supposed to be covered by the Medicare expansion will be left out of the program. Fortunately, 3 million of those 6 million will be eligible for sliding-scale subsidies that the ACA provides to help low-income and middle-income Americans purchase private insurance – if they earn between 100 percent and 400 percent of the federal poverty level. ($11,170 to $43,320 for an individual).
What is less fortunate is that the CBO estimates that those subsidies will cost Washington $3,000 more per person than if the same people were covered by Medicaid: private health insurance plans have higher administrative costs than Medicaid and also tend to pay providers more.
3 million left out in the cold
The other 3 million will be left out in the cold. The subsidies, which come in the form of tax credits, are earmarked for those who earn between 100 percent and 400 percent of the federal poverty line. Ironically, if a person earns “too little” (less than 100 percent of the FPL), they are not eligible for the subsidy. (The ACA assumed that they would be covered by the new Medicaid.)
At the same time, if they earn “too much” to qualify for Medicaid in a state that limits eligibility to 50 percent of the FPL, they will be shut out of that program as well – leaving them in a no-man’s land where they have no sure access to medical care.
In those cases where they do receive the care they need, the rest of us will wind up covering their unpaid bills as we watch our insurance premiums climb.
The Supreme Court May Have Saved Lives … by Keeping People Off Medicaid
magine that you are the head of a family of three, struggling to get by on an income, say, of $25,000 a year. You’ve signed up for your employer’s health plan because you want your family to get good health care when they need it. But that takes a big bite out of your paycheck — $250 a month.
When you first heard about the president’s health plan, you heard him say that if you like the plan you’re in you can keep it. That was good news. You also believed the whole point of the reform was to help families like yours get health insurance if for some reason you had to seek insurance on your own.
Now get ready for some surprises. The first will be an announcement that in another year or so your employer’s health plan will no longer be available to you. The reason: plain economics. People at your income level will qualify for as good or better health insurance in a new health insurance exchange. And almost all the premium will be paid for by the federal government. Most people like you would rather have higher wages than a health plan that duplicates what you can get almost for free, your employer will reason. So in order to compete for labor, your company will have to give prospective employees the compensation package they most want. And your employer will be right.
Then there will be a second surprise. Under the new rules, if you are eligible for Medicaid, you can’t get private insurance in the exchange. Further the health reform law is designed to force the states to raise the income level for Medicaid. If your state complies, someone with your income will be eligible for Medicaid and you won’t be allowed in the exchange!
Now if you were a resident alien, the rules are different. Since they don’t generally qualify for Medicaid, immigrant families at your income level can get subsidized private insurance in the exchange. But alas, you’re a citizen. So this option isn’t open to you.
Now let’s say you are under the impression that Medicaid is second rate insurance and you remember that your employer promised to pay more in wages once your health benefit is gone. What about using the higher wages from your employer to buy private insurance outside the exchange?
Now get ready for the third surprise. There isn’t going to be any market for private insurance outside the exchange — at least not for you. The insurance companies are going away. The brokers are going away. The market is going away.
Now for the final surprise. The only option open to you under the Affordable Care Act is Medicaid! Why should you care? Because your initial impression is correct. Medicaid is second rate insurance.
In most places Medicaid patients have a terrible time finding doctors who will see them and facilities that will admit them. That’s why so many of them turn to community health centers and the emergency rooms of safety net hospitals for basic medical care. Medicaid enrollees turn to emergency rooms for their care twice as often as the privately insured and even the uninsured. In fact, if you’re trying to get a primary care appointment, it appears your chances are better if you say you are uninsured…
..
Here is where is gets little bit tricky, owing to the bizarre structure of ObamaCare. The new health law is trying to get the states to expand Medicaid eligibility to 138% of the federal poverty level ($15,415 for an individual or $26,344 for a family of three). But let’s suppose that, thanks to the Supreme Court, a state doesn’t do anything. It turns out that only people who are between 100% and 138% of poverty can then go into the exchange and get private insurance.
So if your employer does raise your pay and pushes you over that threshold, you qualify. However, while your salary is still only $25,000 you may not be eligible for Medicaid. Here’s the double whammy: You will not be allowed into the exchange either. You will be in a sort of “no-man’s-land” donut hole. And the only way out will be for you to somehow earn more income. Or, lie about it. This may be one of the very few instances where people will find it their self-interest to tell the IRS their income is higher than it really is!
According to the CBO about two-thirds of the states will not expand eligibility above 100% of the federal poverty level. That’s why 3 million citizens will be liberated and will get private insurance instead. Moreover, the subsidies in the exchange are incredibly generous. The most the family has to pay is 2% of their income.
Further, the private plans in the exchange will pay providers about 50% higher fees that the rock bottom payments they would have gotten from Medicaid. This will be a huge relief for safety net facilities that are scraping by on inadequate resources as it is. And it’s a reason why the CBO may have underestimated how many states will find this option very attractive.
ObamaCare is still a Rube Goldberg contraption that desperately needs repealing and replacing. But in the interim, the Supreme Court has done a lot of families a big favor.
Related articles
- Falling through cracks if states don’t expand Medicaid (vitals.nbcnews.com)
- State’s poorest could be left without health insurance if Medicaid expansion is rejected (dispatch.com)
- Concern For The Poorest Americans If States Opt Out Of Medicaid Expansion (medicalnewstoday.com)
- Should Colorado opt out of the Medicaid expansion as outlined in the Affordable Health Care Act? No (denverpost.com)
- Medicaid gap could widen (toledoblade.com)
- Affordable Care Act Cheaper, Will Cover Less Lives Depending on States’ Actions (hmprg.typepad.com)
- Medicaid. Again. (washingtonmonthly.com)
- Drive to expand Medicaid is stalled (kansascity.com)
- Rationing Begins: States Limiting Drug Prescriptions for Medicaid Patients (righttruth.typepad.com)
- Medicaid and the November Elections (pubcit.typepad.com)
- Medicaid Expansion Could Cut Death Rate (jflahiff.wordpress.com)
- Medicaid expansion refusal hurts hospitals (sfgate.com)
- Poorest Americans at risk if states opt out of Medicaid expansion (medicalxpress.com)
- Study: Many Doctors Not Accepting Medicaid Patients (thinkprogress.org)
- Perry caught in Medicaid contradiction (thehill.com)
- Poorest Americans at risk if states opt out of Medicaid expansion (eurekalert.org)
- Texas Gov. Perry Uses Medicaid Expansion in Budget Assumption (news.firedoglake.com)
- Rick Perry Factors Into State Budget Obamacare Funds He Had Pledged To Reject (thinkprogress.org)
- Rick Perry budgets with Medicaid money he said he’d reject (dailykos.com)
More than 16 million people with Medicare get free preventive services in 2012 Affordable Care Act made many preventive services no cost to beneficiaries (with link to a planning guide)
Affordable Care Act made many preventive services no cost to beneficiaries
From the 20 July 2012 article at the US Dept of Health and Human Services
The Affordable Care Act – the new health care law – helped over 16 million people with original Medicare get at least one preventive service at no cost to them during the first six months of 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today. This includes 1.35 million who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act. In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.
“Millions of Americans are getting cancer screenings, mammograms and other preventive services for free thanks to the health care law,” said Secretary Sebelius. “These new benefits, made possible through the health care law, are helping people stay healthy by giving them the tools they need to prevent health problems before they happen.”
Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings. Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.
The law also added an important new service for people with Medicare — an Annual Wellness Visit with the doctor of their choice— at no cost to beneficiaries.
For more information on Medicare-covered preventive services, please visit: http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html
To learn what screenings, vaccinations and other preventive services doctors recommend for you and those you care about, please visit the myhealthfinder tool at www.healthfinder.gov.
Related articles
- Half on Medicare in AZ use free preventive care (Rim Country Gazette)
- Pennsylvania seniors with Medicare receive free screenings (Times-Tribune)
- Michigan seniors strive to stay healthy (TheDailyReporter)
-
Ask Medicare Helps Caregivers Plan for the Future (Center for Medicare and Medicaid Services)
Baltimore, MD, June 28, 2012 /PRNewswire/ — Now is an ideal time for caregivers to get organized, manage personal finances and plan for the future. Effective long-term planning can help bring peace of mind and is particularly important for the nation’s growing number of caregivers who must manage their own affairs while attending to the health and well-being of another. Nearly 66 million U.S. residents¹ provide care for a chronically ill, disabled or aging family member or friend. This can involve:
- Setting up doctor appointments for the many free, preventive services available to Medicare beneficiaries,
- Reviewing drug plan coverage,
- Planning for changes in in-home care needs, or
- Preparing for a transition from the home to an assisted living or nursing home facility.
The Centers for Medicare and Medicaid Services initiative, Ask Medicare, can help caregivers plan by offering a wealth of consumer-focused information, including personal stories from other caregivers on overcoming common challenges, a free e-newsletter, and decision-making tools addressing a range of health care issues. The “How Can you Plan for the Future?” checklist provides planning ideas.
Community health centers compare well with private practices, Stanford researcher finds
Community Health Center of Burlington (Photo credit: origamidon)
From the 10 July 2012 article at EurekAlert
STANFORD, Calif. — Government-funded community health centers, which serve low-income and uninsured patients, provide better care than do private practices, a researcher at the Stanford University School of Medicine has found.
Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California, San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.
Their study is to be published online July 10 in the American Journal of Preventive Medicine. Stafford is the senior author.
The results of the study are particularly encouraging given that the Affordable Care Act, which the U.S. Supreme Court upheld June 28, depends on community health centers to provide services to previously uninsured patients.
“If community health centers are going to be taking up some of the new demand, we can be confident that they’re giving relatively good care,” Stafford said.
…
Related articles
- What is it like for a nurse in a Community Health Center? (giveacareindy.org)
- Florida health centers receive ‘Obamacare’ funding (tampabay.com)
- Mass. community health centers awarded $600K (bostonherald.com)
- West Hawaii Community Health Center Kealakekua Expands Care to Serve All Ages (damontucker.com)
- Stanford researchers move fetal genome testing ahead (sfgate.com)
- Affordable Care Act Helps Improve Access to High Quality, Coordinated Care (whitehouse.gov)
- Three community clinics receive $2.2 million in federal grants (jsonline.com)
- Health care dilemma (photos.mercurynews.com)
The Health Care Law and You (USA.gov Update) & A Commentary
Read this section to learn more about your rights and protections, insurance choices, and insurance costs. Get information on important benefits and programs available to seniors and small businesses.
- Timeline: What’s Changing and When
The health care law puts in place reforms that will roll out through 2014 and beyond. Use the timeline or a printable list of key features in chronological order to learn what’s changing and when.
- Implementation Resources
Find out how the health care law is being carried out across the country. Find links to regulations, authorities, grants, letters, reports, and other information related to the Affordable Care Act.
- The Supreme Court on health reform: Everybody wins! (KevinMD.com)
- The Supreme Court Ruling on the Affordable Care Act—A Bullet Dodged (with a video) (Brookings Institute)
“…The outcome can be stated simply. People must pay a tax if they fail to carry approved health insurance. States may extend Medicaid coverage as specified in the Affordable Care Act, but if they don’t, none of the funds for previously eligible Medicaid enrollees will be in jeopardy. All other provisions of the Affordable Care Act stand….
…
Behind this seemingly simple outcome stand sharp disagreements over constitutional interpretation.
For starters, by a vote of 5 to 4, the Court rejected the federal government’s argument that it can use its power to regulate interstate commerce to require people to carry insurance. Congress can impose a tax on those who don’t carry such insurance, but the concept of ‘mandate’ really doesn’t arise. …
- U.S. Supreme Court and the Federal Health Law (National Conference on State Legislatures)
“The U.S. Supreme Court handed down its decision today in U.S. Department of Health and Human Services (HHS) v. Florida. There were four issues before the Court regarding the Patient Protection and Affordable Care Act (PPACA): the applicability of the Anti-Injunction Act; the constitutionality of the individual mandate; the severability of the individual mandate provisions from other provisions of PPACA; and the constitutionality of the Medicaid expansion.”
(Includes a chart explaining the legal arguments for and against each of these issues along with the Court’s ruling)
- Obamacare Seems To Be Reducing Federal Govt Health Costs(MedicalNewsToday, 29 June 2012)
It appears that federal costs for reimbursing private health insurers are beginning to drop, after Patient Protection and Affordable Care Act (ACA), also known as Obamacare, has begun to come into effect.
The Medicare Rights Center released a report today that provides an analysis of Medicare benefits through the Medicare Advantage (MA) program in New York. Before the ACA went into place, its detractors said that insurers would exit the market and prices would rise for everyone. This doesn’t appear to be the case. …. - The Health Care Bloghas several related posts including
- SCOTUS Surprise by Robert Reich (28 June 2012)
“The big surprise, for many, was the vote by the Chief Justice of the Court, John Roberts, to join with the Court’s four liberals…Roberts nonetheless upheld the law because, he reasoned, the penalty to be collected by the government for non-compliance with the law is the equivalent of a tax – and the federal government has the power to tax. By this bizarre logic, the federal government can pass all sorts of unconstitutional laws – requiring people to sell themselves into slavery, for example – as long as the penalty for failing to do so is considered to be a tax.Regardless of the fragility of Roberts’ logic, the Court’s majority has given a huge victory to the Obama administration and, arguably, the American people. The Affordable Care Act is still flawed – it doesn’t do nearly enough to control increases in healthcare costs that already constitute 18 percent of America’s Gross Domestic Product, and will soar even further as the baby boomers age – but it is a milestone. And like many other pieces of important legislation before it – Social Security, Medicare, Civil Rights and Voting Rights – it will be improved upon. Every Democratic president since Franklin D. Roosevelt has sought universal health care, to no avail.
- What the SCOTUS ruling means for HealthCare by By DOUGLAS HOLTZ-EAKIN (JUne 28, 2012)
“…The ACA remains a damaging, anti-growth vehicle for taxation. The so-called Medicare surtax increases marginal tax rates on the return to saving, investment, and innovation. The medical device tax will hurt innovation and cost jobs. A bill to repeal it is gathering dust in the Senate. Also, the insurers fee – the “premium tax” – will roil insurance markets, disrupt patient-provider relationships, and the vast majority of the burden will fall on the middle class.The ACA remains an unwise expansion of entitlement programs at a dangerous fiscal moment in U.S. history. The U.S. has suffered a downgrade, has a debt-to-GDP ratio over 100 percent – a level historically associated with 1 percentage point slower growth and a heightened probability of financial crisis – and faces a spending-driven explosion of debt over the next decade. Also, the ACA does not reform Medicare, which has a cash-flow deficit of nearly $300 billion annually and is responsible for one-fourth of all federal debt since 2001.Finally, the ACA is a vast regulatory expansion. …”
Short Animated Video on Current Health Care System Changes – Kaiser Health Reform
Health Reform Hits Main Street – Kaiser Health Reform
From the Kaiser Health Reform Source Web page
Confused about how the new health reform law really works? This short, animated movie — featuring the “YouToons” — explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Learn more about how the health reform law will affect the health insurance coverage options for individuals, families and businesses with the interactive feature “Illustrating Health Reform: How Health Insurance Coverage Will Work.”
Related articles
- Kaiser Foundation – Illustrating Health Reform: How Health Insurance Coverage Will Work (bespacific.com)
- Health Reform Hits Main Street – Video (aa47.wordpress.com)
- Health Care Reform explained in three minutes (brickcity.wordpress.com)
- Wham! Bang! Pow! Health reform? (wrnihealthcareblog.wordpress.com)
When a colonoscopy (or other insurance approved screening ) might not be free
As we enter 2012, many patients will be changing to new insurance plans.
And for a few, deductibles will be rising.
One thing that’s emphasized in the Affordable Care Act, however, is that preventive services would remain “free.”
However, consider this story of a man, who thought he wouldn’t have to pay for his screening colonoscopy, instead was charged over $1,000 for the procedure.
From USA Today,
Bill Dunphy thought his colonoscopy would be free.
His insurance company told him it would be covered 100 percent, with no copayment from him and no charge against his deductible. The nation’s 1-year-old health law requires most insurance plans to cover all costs for preventive care including colon cancer screening. So Dunphy had the procedure in April.
Then the bill arrived: $1,100.
The reason? During the procedure, polyps were found and rightfully removed. But in doing so, it changed the colonoscopy from a screening procedure to a diagnostic procedure, thus making it applicable to the patient’s deductible.
Such semantics are important, as insurance companies will seize them at every opportunity to pass on costs to both patients and hospitals….
Read the entire article by Kevin Pho
Related articles
- Preventive care: It’s free, except when it’s not (goerie.com)
- Preventive care: It’s free, except when it’s not (usatoday.com)
- Loophole in U.S. law means not all preventive care free (ctv.ca)
- Preventive care: It’s free, except when it’s not (sfgate.com)
- Preventive care: It’s free, except when it’s not (seattlepi.com)
- Preventive Care Is Free — Except For When It’s Not (huffingtonpost.com)
- Preventive Care: It’s Free, Except When It’s Not (maboulette.wordpress.com)
- Preventive care: It’s free, except when it’s not (mysanantonio.com)
- Preventive care: It’s free, except when it’s not (seattletimes.nwsource.com)
- Know What to Expect From Colonoscopy Prep (everydayhealth.com)
Health Insurance Info will be more easily understood next year – Cracking the health insurance code
From the Moberly Monitor (13 December 2011)
Understanding health insurance and your options will get easier, thanks to a little known measure of the Affordable Care Act (ACA). Starting in 2012, health insurance companies and employers must provide information in a way that is clear and easy to understand.
“This may seem like a small thing,” says Dr. Karen Edison, director of the Center for Health Policy at the University of Missouri. “But being able to read an insurance form and know what’s actually covered is critical to making good health care decisions for you and your family. Until now, much of the information that has been provided has been very hard to understand.”
Clear summaries of coverage for treating cancer or managing diabetes and other health conditions will help you better understand what your health care plan actually covers, as well as make apples-to-apples comparisons among several plans. Being able to compare plans will help you and your employer find the best plan for your health needs and budget.”….
Related articles
- 2.5 Million Young Adults Gain Health Insurance Due to the Affordable Care Act (bespacific.com)
- The Recession and Health Insurance (medicalinsuranceinfo.typepad.com)
- What You Don’t Know About Health Insurance May Cost You (dailyfinance.com)
- Letter: Universal Health Mandate (nytimes.com)
- New Data: Thanks to Health Reform, 2.5 Million More Young Adults Have Health Insurance (whitehouse.gov)
An annual checkup on the Affordable Care Act
An annual checkup on the Affordable Care Act
An excerpt from the article by by DAVID NASH, MD, MBA at the December 2011 issue of KevinMD.com
As we approach the end of what has been another roller-coaster year for our country, it seems an appropriate time for an “annual checkup” on healthcare reform in the U.S.
Like many of my colleagues, I have followed the implementation of the monumental Patient Protection and Affordable Care Act (ACA) with great interest, mild trepidation, and a small measure of optimism.
It’s hard to believe that almost two years have flown by since the passage of this historic, game-changing legislation that will influence how healthcare is delivered and reimbursed in the U.S. for decades to come.
Although debates will continue to rage about the law and its sweeping array of mandates, the ACA and the overwhelming majority of its provisions are likely here to stay.
The popular media tends to focus on the “chief complaints” — a few hot-button issues such as “death panels” and the significant number of state-sponsored challenges to the legality and “constitutionality” of some of the law’s provisions.
However, in the course of a comprehensive “annual physical” exam, it is clear that a surprisingly large number of the law’s provisions have already gone into effect — smoothly and as planned across the entire industry.
Here are just a few …..
Related articles
- Affordable Care Act Videos Educate Consumers (thielst.typepad.com)
- Morning CheckUp: December 6, 2011 (thinkprogress.org)
- Important to Implement Affordable Care Act (burkeassociatesmyblog.wordpress.com)
The State of Quality Improvement Science in Health
The State of Quality Improvement Science in Health
What Do We Know About How to Provide Better Care?
By: Devers KJ
Published: November 2011
“The well-documented problem of quality, the Affordable Care Act’s numerous quality provisions, and economic realities for public and private payers have increased pressure on providers to improve health care quality. This paper reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care.
The paper makes recommendations for enhancing QI efforts in health care, including providing stronger incentives for health care providers and organizations to prioritize quality; improving education, training, and technical assistance for providers; leveraging electronic health records or other health information technology that can support QI efforts; and increasing collaboration between federal agencies, foundations, private purchasers, professional associations, and industry groups.”
Department of Health and Human Services Updates HealthCare.gov Insurance Finder
Take health care into your own hands
HealthCare.gov Insurance Finder Gets Better for Consumers
On Monday, November 15, 2010, the Department of Health and Human Services updated the HealthCare.gov Insurance Finder with more information on private insurance plans.
Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information about private and public health coverage options into one place to make it easy for consumers to learn about and compare their insurance choices.
HealthCare.gov and its Insurance Finder are critical new tools for consumers, making the health insurance market more transparent than it has ever been.
On October 1, the Insurance Finder added price estimates for private insurance policies for individuals and families, allowing consumers to easily compare health insurance plans – putting consumers, not their insurance companies, in charge and taking much of the guesswork and confusion out of buying insurance.
Insurance companies are also required to include two notable metrics never before made public:
- The percentage of people who applied for insurance and were denied coverage.
- The percentage of applicants who were charged higher premiums because of their health status.
Significant Increase in Options for Consumers to Compare & in Number of Health Insurance Companies in Finder
Today’s update represents a significant increase in the number of private insurance plans and the number of issuers represented:
- On October 1, there were 4,400 plans for individuals and families listed in the Finder, and today’s update brings that number to over 8,500.
- On October 1, there were 230 health insurance companies the individual and family market represented in the HealthCare.gov Insurance Finder, and today’s update brings the number of health insurance companies in the Finder to 299.
This update to HealthCare.gov further enhances the ability of Americans to find health care coverage that meets their needs and get the best value for their money. And it represents a significant expansion in the transparency that HealthCare.gov is bringing to the insurance marketplace – transparency that leads to more competition between insurers and better value for consumers.
Posted: November 15, 2010
Related articles
- HealthCare.gov Insurance Finder Gets Better for Consumers (bespacific.com)
- To Advance Consumer Understanding of Insurance, U.S. Department of Health & Human Services Releases Data Files Containing Current Inventory of Private Insurance Plans Listed in HealthCare.gov (browardhomehealthcareagency.com)
- A New Tool for Comparing Health Care plans (inc.com)
- Feds Use Internet To Improve Customer Service (informationweek.com)
About
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.com
I will reply within 48 hours.
This blog is a companion site to my Health and Medical News and Resources Web site with…
- Great places to start (locating health information)
- Links to help from others (as health care providers and support groups)
- Interactive tools (as health calculators and apps)
- Select related news sites and blogs
My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.
- Science Daily – Your source for the latest research news
- MedlinePlus email updates from the US National Institutes of Health
- Partners in Information Access for the Public Health Workforce – a collaboration of U.S. government agencies, public health organizations and health sciences libraries
- US Agency for Healthcare Research and Quality (AHRQ) news now with updates on the agency’s efforts to “improve the quality, safety, efficiency, and effectiveness of health care for all Americans”
- Research Buzz, “news about search engines, digital archives, online museums, databases, and other Internet information collections since 1998”
- Scout Report, a “weekly publication offering a selection of new and newly discovered Internet resources of interest to researchers and educators”
- KevinMD.com -“Social Media’s leading physician voice”
- EurekAlert-Medicine and Health
Health and Medical News and Resources 