5 Challenges Facing Medicaid At 50 [Reblog]

From the 27 July 2015 Kaiser Health News blog item

A “sleeper” provision when Congress created Medicare in 1965 to cover health care for seniors, Medicaid now provides coverage to nearly 1 in 4 Americans, at an annual cost of more than $500 billion. Today, it is the workhorse of the U.S. health system, covering nearly half of all births, one-third of children and two-thirds of people in nursing homes.

Enrollment has soared to more than 70 million people since 2014 when the Affordable Care Act began providing billions to states that chose to expand eligibility to low-income adults under age 65. Previously, the program mainly covered children, pregnant women and the disabled.

Unlike Medicare, which is mostly funded by the federal government (with beneficiaries paying some costs), Medicaid is a state-federal hybrid. States share in the cost, and within broad federal parameters, have flexibility to set benefits and eligibility rules.

Though it provides a vital safety net, Medicaid faces five big challenges to providing good care and control costs into the future:
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Study: 23 pct of US adults with health coverage underinsured

Study: 23 pct of US adults with health coverage underinsured.
From the May 2015 Commonwealth Fund study

Abstract

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.

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BACKGROUND

The Affordable Care Act has transformed the health insurance options available to Americans who lack health benefits through a job. Numerous surveys have indicated that the law’s coverage expansions and protections have reduced the number of uninsured adults by as many as 17 million people.¹

But Congress intended the Affordable Care Act to do more than expand access to insurance; it intended for the new coverage to allow people to get needed health care at an affordable cost. Accordingly, for marketplace plans, the law includes requirements like an essential health benefit package, cost-sharing subsidies for lower-income families, and out-of-pocket cost limits.² For people covered by Medicaid, there is little or no cost-sharing in most states.

But most Americans—more than 150 million people—get their health insurance through employers.³ Prior to the Affordable Care Act, employer coverage was generally far more comprehensive than individual market coverage.⁴ However, premium cost pressures over the past decade have led companies to share increasing amounts of their health costs with workers, particularly in the form of higher deductibles.⁵

In this issue brief, we use a measure of “underinsurance” from the Commonwealth Fund’s Biennial Health Insurance Survey to examine trends from 2003 to 2014, focusing on how well health insurance protects people from medical costs. Adults in the survey are defined as underinsured if they had health insurance continuously for the proceeding 12 months but still had out-of-pocket costs or deductibles that were high relative to their incomes (see Box #1). The survey was fielded between July and December 2014. This means that we could not separately assess the effects of the Affordable Care Act on underinsurance because people who were insured all year in the survey had insurance that began before the law’s major coverage expansions and reforms went into effect. People who had new marketplace or Medicaid coverage under the Affordable Care Act would not have had that coverage for a full 12 months, as it would have begun in January 2014 at the earliest. Similarly, people with individual market coverage who were insured all year would have spent all or part of the period in plans that did not yet reflect the consumer protections in the law.⁶

…

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• Commonwealth Fund: “Underinsurance” Unchanged under Obamacare
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[News release] Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions

From the 22 May 2015 HealthCare Blog post

By ROSS KOPPEL and STEVEN SOUMERAI

A few days ago, we wrote an editorial for US News and World Reports on the scant or dubious evidence used to support some healthcare policies (the editorial is reproduced in full below).  In that case, we focused on studies and CMS statements about a select group of Accountable Care Organizations and their cost savings. Our larger point however is about the need to reconsider the evidence we use for all healthcare-related decisions and policies. We argue that an understanding of research design and the realities of measurement in complex settings should make us both skeptical and humbled.  Let’s focus on two consistent distortions.

Evidence-based Medicine (EBM).  Few are opposed to evidence-based medicine.  What’s the alternative? Ignorance-based medicine? Hunches?  However, the real world applicability of evidence-based medicine (EBM) is frequently overstated. Our ideal research model is the randomized controlled trial, where studies are conducted with carefully selected samples of patients to observe the effects of the medicine or treatment without additional interference from other conditions. Unfortunately, this model differs from actual medical practice because hospitals and doctors’ waiting rooms are full of elderly patients suffering from several co-morbidities and taking about  12 to 14 medications, (some unknown to us). It is often a great leap to apply findings from a study under “ideal conditions” to the fragile patient. So wise physicians balance the “scientific findings” with the several vulnerabilities and other factors of real patients.  Clinicians are obliged to constantly deal with these messy tradeoffs, and the utility of evidence-based findings is mitigated by the complex challenges of the sick patients, multiple medications taken, and massive unknowns. This mix of research with the messy reality of medical and hospital practice means that evidence, even if available, is often not fully applicable. 

Relative vs. Absolute Drug Efficacy:

Let’s talk a tiny bit about arithmetic. Say we have a medication (called X) that works satisfactorily for 16 out of a hundred cases, i.e., 16% of the time.  Not great, but not atypical of many medications.  Say then that another drug company has another medication (called “Newbe”) that works satisfactorily 19% of the time. Not a dramatic improvement, but a tad more helpful (ignoring how well it works, how much it costs, and if there are worse side effects).  But what does the advertisement for drug “Newbe” say?   That “Newbe” is almost 20% better than drug “X.” Honest. And it’s not a total lie.  Three percent (the difference between 16% and 19%) is 18.75%, close enough to 20% to make the claim legit. Now, if “Newbe” were advertised as 3% better (but a lot more expensive) sales would probably not skyrocket. But at close to 20% better, who could resist?   

Policy:  So what does this have to do with healthcare policy?  We also want evidence of efficacy with healthcare policies but it turns out that evaluation of these interventions and policies is often harder to do well than are studies of drugs. Interventions and policies are introduced into messy pluralistic systems, with imprecise measures of quality and costs, with sick and not-so-sick patients, with differing resources and populations, with a range of payment systems, and so on and so on. Sometimes, randomized controlled trials are impossible.  But sometimes they are possible but difficult to effect. Nevertheless, we argue they are usually worth the effort. Considering the billions or trillions of dollars involved in some policies (e.g., Medicare changes, insurance rules) the cost is comparatively trivial.

But there’s another question: What if a decent research design is used to measure the effects of a large policy in a select population but all you get is a tiny “effect?”  What do we know? What should policymakers do? Here’s what we wrote in our recent editorial in the US News and World Report….

 

[Reblog] A 5-star rating system for nursing homes and the unintended consequences on health care disparities

From the 8 May 2015 post at Science Health

Information about the quality and performance of health care facilities can be confusing to consumers. Dozens of government organizations, trade groups and websites rate doctors, hospitals and long-term care facilities on all kinds of scales, from patient satisfaction to medical outcomes.

In 2008, the Centers for Medicare and Medicaid Services (CMS) attempted to simplify some of this data by creating a five-star rating system for nursing homes. The idea was that public reporting would drive improvement in care, helping nursing home residents and their families choose higher quality facilities, in turn encouraging nursing homes to improve quality to retain residents.

This data can be of limited use, however, for people whose decisions are constrained by insurance networks, cost and geography. People who are enrolled in both Medicare and Medicaid, often called “dual eligibles,” are particularly limited in their choices for long-term care. They are much more likely to have lower incomes, disabilities or cognitive impairment, and to receive low-quality health care in poor neighborhoods than other Medicare beneficiaries.

A new study in the May issue of Health Affairs by public health researchers from the University of Chicago, Harvard, and Penn confirms that despite best intentions, the new rating system exacerbated health disparities between this dual eligible group and non-dual eligible nursing home residents, i.e. those with better financial support. By 2010, two years after the system began, both groups lived in higher quality nursing homes overall, but non-dual eligible residents were more likely to actively choose a higher-rated nursing home. The gap between the two groups also increased: dual eligibles were still more likely to live in a one-star home, and less likely than non-dual eligibles to live in a top-rated home.

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[News release] Medicaid Is a Very Good Investment Even If It Does Not Lower Cholesterol, Blood Pressure, or Blood Sugar

Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

From the 25 March 2015 Columbia University news release

Quality-Life Year Gains Average $62,000

March 26, 2015 — Researchers atColumbia University’s Mailman School of Public Health analyzed the results of the Oregon Health Experiment, where eligible uninsured individuals were randomly assigned Medicaid or to stay with their current care. Considered controversial because the experiment found no measurable gains for physical health it did reveal benefits for mental health, financial wellbeing, and preventive screening. In terms of quality-adjusted life years, the researchers showed that Medicaid is an excellent value—a $62,000 gain in quality-adjusted life years. Study findings are online in the American Journal of Public Health. 
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From the 2 March 2015 Guttmacher Institute press release

Increasing Publicly Funded Family Planning Services Could Substantially Reduce These Costs

U.S. government expenditures on births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21 billion in 2010, according to “Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010,” by Adam Sonfield and Kathryn Kost. In 19 states, public expenditures related to unintended pregnancies exceeded $400 million in 2010. Texas spent the most ($2.9 billion), followed by California ($1.8 billion), New York ($1.5 billion) and Florida ($1.3 billion); those four states are also the nation’s most populous.

Previous research has demonstrated that investing in publicly funded family planning services enables women to avoid unwanted pregnancies and space wanted ones, which is good not only for women and families, but also for society as a whole. In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 would have been 75% higher.

Sonfield and Kost report that the total gross savings from averting all unintended pregnancies in 2010 would have been $15.5 billion. This is less than the total public cost of all unintended pregnancies, because even if all women had been able to time their pregnancies as they wanted, some still would have had planned births that were publicly funded. These potential savings do not account for the cost of providing family planning services and other interventions that might be required to prevent the unintended pregnancies.

“Reducing public expenditures related to unintended pregnancies requires substantial new public investments in family planning services,” says Sonfield. “That would mean strengthening existing programs, such as the Title X family planning program, as well as working to ensure that the Affordable Care Act achieves its full potential to bolster Medicaid and other safety-net programs. We know we can prevent unintended pregnancies and the related costs. There are public programs in place that do it already, but as these data show, there is significantly more progress to be made.”

The new research also highlights the central role played by Medicaid and other public insurance programs in providing critical pregnancy-related care—including prenatal care, labor and delivery, postpartum care and infant care—that help keep women and babies healthy. Fifty-one percent of the four million births in the United States in 2010 were publicly funded, including 68% of unplanned births and 38% of planned births.

“These findings demonstrate the continuing importance of Medicaid and other public health insurance programs in preserving maternal and child health, and in supporting pregnancy-related care,” says Adam Sonfield, coauthor of the new report.

For more information:

Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since 2002

Fact Sheet: Unintended Pregnancy in the United States (national)

State Facts on Unintended Pregnancy

Fact Sheet: Publicly Funded Family Planning Services in the United States (national)

State Facts on Publicly Funded Family Planning Services

State Data Center

How can I order Evidence Reports/Technology Assessments (ERTAs) or Comparative Effectiveness Reviews?

 

What are Evidence Based Reports?

EPC Evidence-Based Reports (home page and links to reports)

The Agency for Healthcare Research and Quality (AHRQ), through its EPCs, sponsors the development of various reports to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reports provide comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs review all relevant scientific literature on a wide spectrum of clinical and health services topics. EPCs also produce technical reports on methodological topics and other types of evidence synthesis-related reports.

Where do Technology Assessments come from?

The Technology Assessment (TA) Program at the Agency for Healthcare Research and Quality (AHRQ) provides technology assessments for the Centers for Medicare & Medicaid Services (CMS). These technology assessments are used by CMS to inform its national coverage decisions for the Medicare program as well as provide information to Medicare carriers.
Fact sheets and reports can be found through The Technology Assessment (TA) Program

 

 

How can I order Evidence Reports/Technology Assessments (ERTAs) or Comparative Effectiveness Reviews? [From http://www.ncbi.nlm.nih.gov/books/NBK45610/ (accessed 3 March 2015)]

The Evidence Reports/Technology Assessments (ERTAs) and Comparative Effectiveness Reviews (CERs) are provided to Bookshelf by the Agency for Healthcare Research and Quality (AHRQ). AHRQ has a publications clearinghouse, which can be accessed through this link: http://ahrqpubs.ahrq.gov/OA_HTML/ibeCZzpHome.jsp

 

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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.”

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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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Explore how changing nursing home culture affects care

From the 28 January 2014 article at Covering Health

 

Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.

English: Nursing Home in Goldthorn Hill. This area of Wolverhampton has a cluster of nursing homes. (Photo credit: Wikipedia)

For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes.  Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.

Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Are there nursing homes in your community that are doing things differently? Have any instituted policies or processes that show improvements in care coordination, outcomes, quality, or other key measures? Are there homes that are resisting change? Why? Which one(s) best exemplify person-centered care? How do these changes affect the workforce?

Nursing Home Compare from CMS provides the data behind complaints, violations, quality, and cost, among other metrics. This article in The Philadelphia Inquirer is a great example of interweaving research with personal narrative. Another approach might be to look at trends in the city, state, or region. How are nursing homes marketing themselves to consumers? To referral sources? Have their business models changed?

Experts on all sides have been talking about culture change for more than a decade. And in 2008, a Commonwealth Fund report explored culture change in nursing homes. Has the time finally come, for real?

 

Read the entire article here

 

Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.

 

Articles referred to above

 

• Transforming Nursing Home Culture: Evidence for Practice and Policy

   

• What Does the Evidence Really Say About Culture Change in Nursing Homes?
• A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters
• High-Performance Workplace Practices in Nursing Homes: An Economic Perspective
• Medicaid Capital Reimbursement Policy and Environmental Artifacts of Nursing Home Culture Change
• Building a State Coalition for Nursing Home Excellence

• Implications for Policy: The Nursing Home as Least Restrictive Setting

   

 

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[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

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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.

,,,,

 

Read the entire article here

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[Reblog] How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks | Full Text Reports…

How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks | Full Text Reports….

 

From the 10 January 2014 Full Text Report

 

January 10, 2014

How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks
Source: New England Journal of Medicine (via MIT)

Enrollment in Medicaid helps lower-income Americans overcome depression, get proper treatment for diabetes, and avoid catastrophic medical bills, but does not appear to reduce the prevalence of diabetes, high blood pressure and high cholesterol, according to a new study with a unique approach to analyzing one of America’s major health-insurance programs.

The study, a randomized evaluation comparing health outcomes among more than 12,000 people in Oregon, employs the same research approach as a clinical trial, but applies it in a way that provides a window into the health outcomes of poor Americans who have been given the opportunity to get health insurance.

“What we found was that Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication,” says Amy Finkelstein, the Ford Professor of Economics at MIT and, along with Katherine Baicker of Harvard University’s School of Public Health, the principal investigator for the study. “We find decreases in rates of depression, and we continue to find reduced financial hardship. However, we were unable to detect a decline in the incidence of diabetes, high blood pressure, or high cholesterol.”

 

 

 

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[Infographic] The Top Five Most Expensive Conditions Treated in US Hospitals, 2011

From the Agency for Healthcare Research and Quality

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[JAMA Perspective] Dead Man Walking

Whether one is for or against all or parts of Obamacare, surely, we as a country can do better in providing needed health care to the poor, especially the poorest of the poor.

Excerpts from the November 2013  JAMA article by Michael Stillman, M.D., and Monalisa Tailor, M.D.

…For many of our patients, poverty alone limits access to care. We recently saw a man with AIDS and a full-body rash who couldn’t afford bus fare to a dermatology appointment. We sometimes pay for our patients’ medications because they are unable to cover even a $4 copayment. But a fair number of our patients — the medical “have-nots” — are denied basic services simply because they lack insurance, and our country’s response to this problem has, at times, seemed toothless.

In our clinic, uninsured patients frequently find necessary care unobtainable. An obese 60-year-old woman with symptoms and signs of congestive heart failure was recently evaluated in the clinic. She couldn’t afford the echocardiogram and evaluation for ischemic heart disease that most internists would have ordered, so furosemide treatment was initiated and adjusted to relieve her symptoms. This past spring, our colleagues saw a woman with a newly discovered lung nodule that was highly suspicious for cancer. She was referred to a thoracic surgeon, but he insisted that she first have a PET scan — a test for which she couldn’t possibly pay.

However unconscionable we may find the story of Mr. Davis, a U.S. citizen who will die because he was uninsured, the literature suggests that it’s a common tale. A 2009 study revealed a direct correlation between lack of insurance and increased mortality and suggested that nearly 45,000 American adults die each year because they have no medical coverage.1 And although we can’t confidently argue that Mr. Davis would have survived had he been insured, research suggests that possibility; formerly uninsured adults given access to Oregon Medicaid were more likely than those who remained uninsured to have a usual place of care and a personal physician, to attend outpatient medical visits, and to receive recommended preventive care.2 Had Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer, and his abdominal pain and obstipation would surely have been urgently evaluated.

…

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Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014

English: Created by vectorizing Image:Medicare and Medicaid GDP Chart.png with Inkscape (Photo credit: Wikipedia)

 

From the 4 October 2013 Kaiser report

 

Oct 07, 2013 | Vernon K Smith, Ph. D., Kathleen Gifford, and Eileen Ellis of Health Management Associates,Robin Rudowitz and Laura Snyder

The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state.  At this time, the intensity of fiscal pressures and the focus on cost Medicaid containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program. The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states:  Arizona, Florida, Kentucky and Washington. Key findings from the survey include the following:

• Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013.  In FY 2014, national enrollment and spending growth are expected to rise.  States moving forward with the Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds.
• The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states whether they are implementing the ACA Medicaid expansion or not.
• Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs and better balance the delivery of long-term services and supports across institutional and community-based settings.
• Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity.
• Looking ahead, FY 2014 will be a transformative year for Medicaid.

 

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Incentivizing Healthy Behaviors in Low-Income Patient Populations

Incentivizing Healthy Behaviors in Low-Income Patient Populations.

From the 24 October 2013 blog item at Leavitt Partners

What works and 8 lessons other health care organizations learn

Data suggests costs can be better contained if all people are practicing healthy life behaviors.[i] State and Federal leaders, charged with holding down costs without sacrificing access to or quality of care, agree with this principal—and as a health insurance payer with one of the longest histories of serving low-income individuals, state Medicaid programs have explored many approaches to incentivizing positive health-related behaviors in its patient populations.

On January 1 2014, about half of the states will expand their Medicaid programs to newly eligible individuals with income below 133% FPL. Insurance subsidies will also be provided to individuals with income between 100% and 400% FPL, increasing access to commercial insurance to those with low- to moderate-incomes. As health care organizations begin managing the health and wellbeing of these newly insured groups, many will be looking for ways to control long-term costs by incentivizing healthy changes in behaviors.

In order to better understand which approaches are the most effective, Leavitt Partners analyzed case studies and program outcomes to answer the following questions:

What are the most effective approaches to motivate low-income adults to make positive changes in their behavior (for themselves and children)?

What are the most effective approaches to motivate low-i

– See more at: http://leavittpartners.com/2013/10/incentivizing-healthy-behaviors-low-income-patient-populations/#sthash.DyBTYRJG.dpuf

 

Related articles

• Refusal to Expand Medicaid May Leave Millions Uninsured (hispanicbusiness.com)
• Koch Brothers Spending Millions to Deny Health Coverage to Low-Income Americans (readersupportednews.org)
• CBS News: Explosion in Medicaid Enrollments May ‘Threaten Entire Structure’ of Obamacare (mediaite.com)
• Obamacare Allowed Oregon to Cut Its Uninsured Population By 10 Percent Already (illuminatebytanya.wordpress.com)
• Gov. McCrory says North Carolina may be forced to expand Medicaid (charlotteobserver.com)
• States’ Refusal To Expand Medicaid May Leave Millions Uninsured (drhiphop85.com)
• “Incentivizing Harmful Behavior”: Sabotaging Obamacare Is A Lucrative Endeavor For Many Republicans (mykeystrokes.com)
• The ACA’s Million Dollar Question: Will Enough People Sign Up? | Via Meadia (cg68doc.newsvine.com)

 

Over One Million Community Health Center Patients in 25 States Will Remain Uninsured and Left Out of Health Reform, New Report Says

From the 16 October 2013 summary at Full Text Reports

Source: George Washington University School of Public Health

A new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University School of Public Health and Health Services (SPHHS) examines the impact of health reform on community health centers (CHCs) and their patients. “Assessing the Potential Impact of the Affordable Care Act on Uninsured Community Health Center Patients: A Nationwide and State-by-State Analysis,” estimates that more than 5 million health center patients would have gained coverage had all states participated in a sweeping Medicaid expansion. However, nearly half of all CHCs are located in states that have opted out of the expansion. As a result, more than a million uninsured CHC patients who would have been covered under a nationwide Medicaid expansion will be left without the protection of health insurance, the report says.

Additional quotes from the report (George Washington University School of Public Health press release)

Shin and his colleagues analyzed data from both the 2009 Health Center User Survey and the 2011 Uniform Data System to gauge the impact of the ACA on health center patients nationally and in all 50 states and the District of Columbia.  Based on conservative assumptions, the analysis showed that over one million health center patients in the opt-out states who would have gained Medicaid coverage under an expansion will likely remain without insurance. These patients are very poor but do not qualify for the traditional Medicaid program and often cannot pay for health care – even at reduced fees, the study concludes. Ironically, these patients are also too poor to qualify for subsidies that would allow them to purchase health insurance at reduced rates on the new Health Insurance Exchanges.

The bottom line for the 518 health centers located in the opt-out states: the report says they’ll forgo approximately $555 million they would have received had their states expanded Medicaid, yet by law, they will still be treating all community residents, including those who lack health insurance or the means to pay for care.

“Health centers in the opt-out states will face an ongoing struggle to meet the need for care in medically underserved communities as a result of the potential loss of hundreds of millions of dollars in revenues in 2014 alone,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at SPHHS and a co-author of the report.

The report paints a very different picture for the 582 health centers in states that participate in the Medicaid expansion. Approximately 2.8 million patients at these health centers will gain coverage as a result of that decision. This added coverage will translate into a potential revenue increase of over $2 billion, which will support expanded staff and services.

States that have rejected the Medicaid expansion might reconsider and decide to expand coverage. Ohio’s just-announced Medicaid expansion is estimated to translate to over 63,000 residents gaining coverage and an additional $29 million in revenue gains in 2014 across 33 health centers. But in the near term, the report warns that many poor people living in the 25 opt-out states will continue to lack coverage and might find long wait times at clinics, long distances to find care, and other barriers that could translate to delays in treatment or no care at all. CHCs in those states will be unable to add much-needed services such as mental health or dental care, or to expand into remote or other seriously underserved areas—places where people have to travel for hours just to find a doctor.

“Community health centers represent the backbone of the nation’s safety net, providing high quality care to more than 20 million Americans who live in underserved neighborhoods,” says Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. “Without the Medicaid expansion, CHCs in opt-out states will fall behind and will have trouble providing the kind of care that keeps people and communities healthy.”

– See more at: https://sphhs.gwu.edu/content/over-one-million-community-health-center-patients-25-states-will-remain-uninsured-and-left#sthash.lgwN3pNL.dpuf

Related articles

• Over 1 million community health center patients will remain uninsured and left out of health reform (eurekalert.org)
• Report: Neediest health centers to get least ACA funding (sacbee.com)
• States Resisting Obamacare Will Forgo $500 Million In Federal Funding, Leaving 1 Million Americans Uninsured (medicaldaily.com)
• Health insurance exchange enrollment in Georgia still unknown (chronicle.augusta.com)
• After saying no to feds on Medicaid expansion, Florida may ask for more money (miamiherald.com)
• New federal money earmarked for local community health centers (stltoday.com)
• Siouxland providers prepare for patient surge from health law (siouxcityjournal.com)
• Health centers enroll Floridians in Obamacare as application problems persist (watchdog.org)
• State set for health sign-up (jsonline.com)
• Health reform: Local hospitals prep for new ACA mandates (mtstandard.com)

 

Expect Snags in Affordable Care Act Rollout (With Links to Additional Information)

Earlier this week I attended a workshop for Ohio Benefit Bank volunteers.  All sessions I attended addressed different aspects of the Health Insurance Exchange.  The take home message was that while there are challenges, there is hope that overall ObamaCare will do more good than bad.

It is very important to go to reliable resources for unbiased and timely information about ObamaCare
I strongly recommend the resources** listed below

 

Some excerpts from the 19th September 2013 Stateline report Expect Snags in Affordable Care Act Rollout

There will be glitches when the major provisions of the Affordable Care Act are implemented starting Oct. 1. Huge glitches. Many glitches. Bet on it.

That is a prediction not only from those resolutely opposed to the ACA. Even those quite excited about President Barack Obama’s federal health law have the same expectation: The rollout of the biggest new social program in nearly 50 years is not going to be pretty.

“When you’re dealing with tens of millions of new clients, mistakes are inevitable,” said Henry Aaron, a health economist at the Brookings Institution. “You’re going to have thousands of mistakes.”

…

“People can make comparisons to Medicare Part D and to Medicare itself, but nothing this big has ever been tried.”

In the simplest terms, the task at hand is to enroll 16 million currently uninsured Americans into health insurance plans or an expanded Medicaid. That process begins Oct. 1 with coverage starting Jan. 1.

…

Although Americans have until the end of March to sign up for health insurance, a crush of demand at the very start could overwhelm exchange call-in centers, websites and personnel. No one will say this out loud, but administrators are hoping for a steady trickle rather than a flood, at least in the early going.

All of the eligibility determinations and subsidy calculations will require a seamless transfer of information. The exchanges will have to interact with the U.S. Treasury for income information. They will have to communicate with the Department of Homeland Security to verify citizenship. And all this information must be handled without violating the privacy of consumers.

“CMS (the Centers for Medicare and Medicaid Services) has designed and tested a system that they think is going to work, and they know where the risks and vulnerabilities are,” said Charlene Frizzera, president of her consulting firm, CF Health Advisors, and a former acting administrator of CMS. “The question is, how will they deal with those vulnerabilities they anticipated and those they haven’t anticipated?

….

Dennis G. Smith, also a former head of what is now CMS, believes one weak point will be in the calculation of Medicaid eligibility. He believes it is likely that the exchanges and state Medicaid offices will use different formulas or time frames for determining eligibility, leading to frustration and confusion for many consumers.

“Exchanges will send a whole bunch of people to Medicaid and Medicaid will say ‘Nope, they don’t qualify,’ and send them back to the exchanges,…

…

states with federal exchanges are doing no outreach at all, which raises the possibility that residents of those states will remain uninformed and do nothing.

….

Even people who get the message may arrive at the exchanges having never before purchased health insurance and unfamiliar with the way premiums, co-pays and deductibles work. Others may lack documentation proving citizenship, residency and income.

…

Perhaps the question that causes the most trepidation in the Obama administration is whether healthy young people will sign up for health insurance as the ACA requires. Because young people tend to be healthy and file relatively few insurance claims, their premiums are supposed to help pay for claims of older, sicker people. If the only people buying insurance are old and the sick, insurance premiums will be prohibitively expensive…

Read the entire press release here

***Related Resources

• Health Reform: Seven Things You Need to Know (Consumer Reports) [2012]- 15 pages with topics as newly enacted protections and benefits,what to expect in 2014, essential benefits defined, and how it will affect you

• About the Law (HHS.gov/healthcare) has information on coverage, costs, and care.

Other pages at HHS.gov/healthcare (US Dept of Health and Human Services)Live Chat courtesy of  the US Department of Health and Human Services (HHS)

• Link to Live Chat in lower right corner of all pages of mostHealthcare.gov, linked pages at including this one)

• Insurance Marketplace with links on information and how to enroll

• Facts and Features including a timeline
  • Other related timelines here and here

• FAQ pages  (Learn – All Topics ) from Healthcare.gov (U.S. Department of Health and Human Services) include
  • Health Insurance Marketplace – a great FAQ page with links to state information. Also answers to some specific questions as dental coverage, how to estimate costs, how to protect from fraud, and unemployed options
  • Getting Lower Costs on Coverage 
  • Health Insurance Basics
  • State by State Information

• Health Reform  (Kaiser Family Foundation)
  • For Consumers: Understanding Health Reform
  • How to Get Coverage in 2014
  • Frequently Asked Questions about Health Reform

• Health Reform-Beyond the Basics (A Project of the Center on Budget and Policy Initiatives)

Related articles

• Online health insurance exchange gearing up quietly in Mo. and Illinois (stltoday.com)
• Lookout for scams related to the Affordable Care Act (quinnscommentary.com)
• What to expect as Affordable Care Act comes into effect (wwltv.com)
• Affordable Care Act enrollment begins Oct. 1 (kgw.com)
• Obamacare to help, but not poorest in states that rejected Medicaid expansion: Tennessee, Georgia (timesfreepress.com)
• Obamacare Hasn’t Drastically Decreased Uninsured Rate (nation.time.com)
• For millions, insurance will cost less than $100/month (usatoday.com)

[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 Prescription Drug Cost Assistance Programs

Recently I updated my Health Resources for All Web site.

If anyone has any suggestions (including additions), please let me know in the comments section or email me at jmflahiff at yahoo dot com.

 

Here’s the list from Prescription Drug Cost Assistance

[Sorry, it did not copy/paste very well!!]

General Guides

BenefitsCheckUp, a service of the National Council on Aging, can help you find public and private programs that may be able to help pay for your prescription drugs.

Government Programs

Extra Help (sometimes called the Low-Income Subsidy, LIS)

• Medicare Part D assistance through the US Social Security Administration
• Current income and resource limits may be found here
• Automatic enrollment for for those on full Medicaid and SSI
  • Others enroll at http://www.social security.gov, or 1-800-772-1213
  • Or contact your State Health Insurance Counseling and Assistance Program (SHIP)
    • Select SHIP from the pull down menu on the left
• Temporary Part D drug coverage information here

Find a Medicare Prescription Drug Plan (Center for Medicare & Medicaid Services)
Helps find prescription drug coverage regardless of income, health status, or how you pay for prescription drugs today.Click here for when you may enroll.  Additional information on Part D prescription drug plans here.

Nonprofits and Commercial Programs

NeedyMeds

• Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care. Includes coverage gap programs.

(More at their About page, Printable brochure here)

             Contact them through their Web site or by telephone (800-503-6897)

• Patient Assistance Programs page includes links to specific programs with application forms.
  • Patient Assistance Program Eligibility Criteria and Medicare Part D
• Other links include
  • Diagnosis-Based Assistance
  • NeedyMeds Drug Discount Card
  • Disease Resource Pages
  • State-Sponsored Programs
  • State Health Insurance Assistance Program Sites
  • Additional links to coupons, rebates, and more

 

Free Rx Plus

• A way to receive discounts on prescription drugs at participting pharmacies. 
• Printable coupon at Web site
• Contact by email or phone (1-888-412-0869). FAQ page here.
• How it Works
  1. Use FreeRxPlus® Bin and Group numbers for FREE access to savings on prescriptions, lab tests, and imaging services.
  2. For access to Lab Test savings: Locate a lab or order your test call toll-free 1-888-412-0869
  3. For access to Imaging Savings: Locate an imaging center or order your service call toll-free 1-888-412-0869
  4. For access to Prescription Savings: Click HERE and locate a participating pharmacy or search for medication pricing. Then simply present your FreeRxPlus® card to the pharmacist for immediate saving

Partnership for Prescription Assistance 

 A collaboration of pharmaceutical companies, health care providers and advocacy organizations. 

Use their services online or contact them at 1-888-477-2669Prescription Assistance Page includes

• Programs searchable by drug, company or program. Results nationally and by state.
• Savings cards (printable) for participating pharmacies
• Diabetic programs and supplies

 PatientAssistance.com, Inc

PatientAssistance.com is a free resource designed to help connect patients who can’t afford their prescription medications with patient assistance programs. Generally for the uninsured and underinsured.

 Patient Advocate Foundation (PAF)

1-800-532-5274

The PAF helps to solve health insurance and access problems. The website has information on resources, programs, and provides personal help. PAF offers assistance to patients with specific issues they are facing with their insurer, employer and/or creditor regarding insurance, job retention and/or debt crisis matters relative to their diagnosis of life threatening or debilitating diseases.

Services provided by PAF include:

• CINV CareLine

  CINV (chemotherapy-induced nausea and vomiting) CareLine is a patient hotline designed to provide case management assistance to patients diagnosed with cancer and experiencing chemotherapy-induced nausea and vomiting who are seeking education and access to care.

• Co-Pay Relief Program

  The Co-Pay Relief Program currently provides direct financial support to insured patients, including Medicare Part D beneficiaries, who must financially and medically qualify to access pharmaceutical co-payment assistance. The program offers personal service to all patients through the use of call counselors; personally guiding patients through the enrollment process

RxAssist

RxAssist is a website with information, news, and a database that are all designed to help you find out about ways to get affordable, or free, medications. The database includes information on the pharmaceutical companies’ patient assistance programs, or programs that provide free medication to low-income patients. RxAssist was created by Volunteers in Health Care, a national, nonprofit resource center for health care programs working with the uninsured.

National Organization for Rare Disorders (NORD) Patient Assistance Program may be able to help you find free or reduced-fee prescription drugs for your condition.

Prescription Drug Assistance Programs(American Cancer Society)

RxHope: Patient Assistance Information(Pharmaceutical Research and Manufacturers of America)

 

Related articles

• Medicare Part D Prescription Drug Coverage Review; Medicare and Medicaid Policy News and changes 2013 and 2014 : Learning and Finance (pattidudek.typepad.com)
• NCPDP Releases Medicare Part D Prescription Drug Coordination of Benefits (COB) Process White Paper (biomedreports.com)
• Save on drug costs (medicare4us.wordpress.com)
• UPDATE: Medicare Annual Open Enrollment Changes Are Expected, Allsup Explains (biomedreports.com)
• UPDATE: Medicare Annual Open Enrollment Changes Are Expected, Allsup Explains (sys-con.com)
• Medicare Part D Continues To Improve Access To Drugs (forbes.com)
• Medicare Part D: Don’t Mess with Success (azhealthconnections.com)
• Medicare Annual Open Enrollment Changes Are Expected, Allsup Explains (biomedreports.com)
• The cost of prescription drugs in the United States are the highest in the world (rxexports.wordpress.com)

 

Useful Video For Understanding 2014 Health Care Changes and “Obama Care”

Great 7 minute overview, published by KaiserHealthCare. Really liked how the graphics (including Playschool like cartoon figures) outlined the major points without making me feel like a dummy!

From the 26 August 2013 post at Sara Zia Ebrahimi

Do you have a good sense of what the new health care options are starting 2014? The HR folks at work just shared this cute 7minute video that does a good job of clarifying what the options are and the advantages and disadvantages of each. I found it really useful and thought I’d pass it along.

Related articles

• Five Myths About Obamacare You Shouldn’t Believe (Think Progress)

• How Much Health Care Reform Will We See By 2014?(redwoodfn)

• Straight No Chaser: Top Seven Facts You Should Know About the Affordable Care Act (Obamacare)
• The Math of State Medicaid Expansion (jflahiff.wordpress.com)
• Republicans Back Major Obamacare Benefit For Poor (huffingtonpost.com)

Excerpts

  ” Individual exchanges in 34 states will be created via the federal government – but on July 5, it quietly granted another concession. The Department of Health and Human Services relaxed a requirement for the 16 other states and the District of Columbia to verify the income and health coverage status of applicants to those individual exchanges. These 17 exchanges will only check the income eligibility of applicants at random next year, and they will wait until 2015 to check if applicants are getting employer-sponsored health benefits.^5″

“Where do things stand state-by-state with the Medicaid expansion? Just 23 states and the District of Columbia have signed up for it. (You’ll recall that the Supreme Court allowed states to opt out of it when it ruled that the ACA was constitutional in 2012.) In these states and in Washington D.C., those with earnings of up to 138% of the federal poverty level may qualify for Medicaid (that works out to earnings of $15,856 for an individual and $32,499 for a family of four). The expansion of Medicaid in these states doesn’t require the federal government to recreate the wheel, but delays could happen in other ways. In Michigan, for example, state legislators have passed their own version of a Medicaid expansion requiring a 90-day federal review process, which will put Michigan weeks behind in enrolling participants in expanded Medicaid coverage.^6,”

• If you qualify for Medicare, new insurance marketplaces aren’t for you While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, Kaiser Health News repor (soraglobal.me)
• UPS to drop 15,000 spouses from insurance… (bizjournals.com)
• Viewpoints: Health care companies need to focus on driving down costs (sacbee.com)
• Has Anyone Asked the Patient? (americanthinker.com)
• Health costs are growing really slowly. Americans haven’t noticed. (washingtonpost.com)
• Michigan Senate Approves Medicaid Expansion To Low-Income Adults, But How Soon Is The Question? (detroit.cbslocal.com)
• The Math of State Medicaid Expansion (jflahiff.wordpress.com)
• Republicans Back Major Obamacare Benefit For Poor (huffingtonpost.com)

North Carolina Just Made It A Lot Easier To Figure Out If Your Hospital Is Ripping You Off

From the 23 August 2013 Think Progress article

North Carolina Gov. Pat McCrory (R) has signed abill that will require the state’s hospitals and ambulatory surgical centers to publicly disclose how much they charge — and how much insurers pay them — for 140 common medical procedures. The information will be posted to the Tar Heel State’s Department of Health and Human Services website and provide consumers a way of knowing which hospitals are giving them the most bang for their buck.

….

The federal government took a small step towards addressing this lack of transparency by releasing charge records for the most common inpatient procedures at more than 3,300 hospitals across 306 locales in May. The numbers confirmed health care experts’ suspicions: the cost of U.S. medical care is essentially arbitrary, with even hospitals in the same county charging anywhere from $7,000 to $99,700 for the same procedure. And the hospitals charging the most money don’t even offer much better services. Reform advocates say these staggering fluctuations are a direct result of price opacity.

But North Carolina’s law actually goes further than the federal government did by giving consumers even more relevant information. The top-line charge data released by the government isn’t actually what insurers and patients pay hospitals. The actual payments are negotiated between the hospitals, insurers, and uninsured Americans. To address that, the North Carolina will require hospitals to disclose the actual prices paid by Medicare, Medicaid, and Americans without any health coverage for the procedures in question, as well as the average and range of prices paid by the top five insurers in the state.

…

Read the entire article here

Related articles

• With Gov. Pat McCrory in the audience, Colin Powell blasts North Carolina’s racist voter law (dailykos.com)
• McCrory signs ‘hospital transparency’ bill into law (charlotte.news14.com)

 

Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns

 Reblogged from 21st Century Library Blog:

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.

Read more… 1,597 more words

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)

• US consumers don’t understand health insurance, Carnegie Mellon research shows (Medical News Today, 2 August 2013)

“…only 11 percent of respondents presented with a traditional insurance plan incorporating all four of these elements were able to compute the cost of a four-day hospital stay when given the information that should have enabled them to do so…

“”The ACA deals with the problem of consumer misunderstanding by requiring insurance companies to publish standardized and simplified information about insurance plans, including what consumers would pay for four basic services,” noted lead author Loewenstein. “However, presenting simplified information about something that is inherently complex introduces a risk of ‘smoothing over’ real complexities. A better approach, in my view, would be to require insurance companies to offer truly simplified insurance products that consumers are capable of understanding.”

• What Makes a Good Librarian? (mediabistro.com)
• Perception of the New Librarian (waycrosslibrarian.wordpress.com)
• [Repost] The ACA Countdown (jflahiff.wordpress.com)
• Got 1:43 minutes to learn about health exchanges? (jflahiff.wordpress.com)
• Obama Will Use Librarians To Push Obama-Care (sweetness-light.com)
• Shopping for Health Insurance? Visit Your Local Library For Help With The Exchanges (medicaldaily.com)
• Librarians to Help With Health Insurance Law (infodocket.com)
• WH won’t release video of Obama thanking librarians for pushing Obamacare (bizpacreview.com)
• White House recruits librarians to promote ObamaCare (foxnews.com)
• Louisiana Library workers told they will help ObamaCare Applicants (forum.prisonplanet.com)

Related articles

• Louisiana Library workers told they will help ObamaCare Applicants (forum.prisonplanet.com)

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)

 

Excerpts from the Rand Report

 

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)

 

State Medicaid Coverage Limited in Treating Painkiller Addiction — Stateline

Source: A Public Health Approach to Drug Control in Canada, Health Officers Council of British Columbia, 2005 (Photo credit: Wikipedia)

 

State Medicaid Coverage Limited in Treating Painkiller Addiction — Stateline.

 

Excerpts from the 17 July 2013 article at Stateline Daily

 

To Mark Publicker, a doctor in Portland, Maine, who practices addiction medicine, it’s a clear case of discrimination. You wouldn’t deprive a diabetic of insulin. You wouldn’t stop giving hypertension drugs to a patient with high blood pressure after successful treatment. You wouldn’t hold back a statin from a patient with high cholesterol…

..

Many private insurance companies and state Medicaid agencies across the country impose sharp limitations on access to medications used in the treatment of the addiction to prescription painkillers known as opioids.

A report commissioned by the American Society of Addiction Medicine found that Medicaid agencies in just 28 states cover all three of medications that the Food and Drug Administration has approved for opioid addiction treatment: methadone, buprenorphine and naltrexone. The study also found that most state Medicaid agencies, even those that cover all three medications, place restrictions on getting them by requiring prior authorization and re-authorization, imposing lifetime limitations and tapering dosage strengths. The study was done by the substance abuse research firm Avisa Group.

“Now that we finally have medications that are shown to be effective and cost-effective it is shameful to throw up roadblocks to their use,” said Mady Chalk, director of the Center for Policy Research and Analysis at the Treatment Research Institute, which researches all aspects of substance abuse.

By any measure, there is an epidemic in the misuse of prescription drugs, most of it involving abuse of opioid painkillers such as OxyContin or Percocet. The Centers for Disease Control and Prevention reported that 12 million Americans acknowledged using prescription painkillers for nonmedical reasons in 2010.

…

 

 

 

Related articles

• Painkiller addicts hit Medicaid limits (usatoday.com)
• Prescription drug overdose deaths skyrocket among women (bangordailynews.com)
• Sharp Rise in Women’s Deaths from Overdose of Painkillers (articles.mercola.com)
• Doctors prescribe narcotics too often for pain, CDC chief says – Los Angeles Times (latimes.com)
• Newly born and withdrawing from drugs: As number of Maine babies exposed to opiates rises, experts explore new options (bangordailynews.com)
• How Long-Term Use of Painkillers Affects the Brain (painkillersaddiction.wordpress.com)
• CDC Chief: Doctors Prescribe Pain Killers Too Often (counselheal.com)
• Many Preventive Services Not Available To Medicaid Beneficiaries (medicalnewstoday.com)
• Accepting or Rejecting the Medicaid expansion provision contained in the ACA will be determined by outcome of the Virginia Governor’s race this November. (coherentramblingsforcoherentminds.wordpress.com)

 

Feds release nursing home inspections, free of censor’s marks

Public Health--Research & Library News

From ProPublica:

In response to a Freedom of Information Act request by ProPublica, the government has released unredacted write-ups of problems found during nursing home inspections around the country. We’re making them available today for anyone who wants to download the complete versions.

For several months now, ProPublica has made redacted versions of this same information available in an easily searchable format in our Nursing Home Inspect [1]tool. These versions, which reside on the U.S. Centers for Medicare and Medicaid Services website, Nursing Home Compare [2], sometimes blank out patients’ ages, medical conditions, dates and prescribed medications.

The agency has said the redactions are intended to balance patient privacy concerns with the need to inform consumers about the quality of care. ProPublica requested the unredacted reports because they are public records and because the added information can make them more useful.

In response to a Freedom of Information Act request…

View original post 168 more words

Oklahoma Looks for Ways to Keep Mentally Ill Ex-offenders Out of Prison

English: Oklahoma State Penitentiary (Photo credit: Wikipedia)

 

From the 23 October 2012 article at Stateline Daily

 

…

Central to that program is ensuring that participants leave custody already signed up for Social Security Disability and Medicaid, which immediately provides them with some income and health care and – crucial for them – psychiatric medication and counseling.

By comparison, unless they are disabled in some way, typical inmates leaving prison in Oklahoma do not qualify for either Social Security or Medicaid benefits. Usually, they are given a lift to the bus station, a ticket to anywhere they want to go in the state, $50, and sometimes a handshake.

Lowering Recidivism

If the measure of success is keeping mentally ill ex-offenders out of prison, the Oklahoma Collaborative Mental Health Re-Entry Program has been a success. The recidivism rate over a three-year span for those participating in the program is 25.2 percent, compared to the 42.3 percent rate for a comparable prison population before the program started in 2007. On the basis of those results, the program earned an innovation award this year from the Council of State Governments.

Law enforcement is positive about the program as well. “Anything that keeps them on their medication and in treatment is a positive step,” says Phil Cotten, acting director of the Oklahoma Association of Chiefs of Police.

Not the least of those extolling the program are its beneficiaries, some of whom have no doubt about the boomerang route their post-prison life would have followed without the re-entry experiment…

..

Criminalizing Mental Illness

Like every other state, Oklahoma has seen a correlation between the emptying of its psychiatric hospitals in the sixties and seventies and its ever-increasing prison population. According to Oklahoma’s Department of Corrections, half of its prisoners have a history of or currently exhibit some form of mental illness (resulting in a threefold increase in the number of prisoners receiving psychotropic drugs between 1998 and 2006). Some call it the criminalization of mental illness. In a different time, many of the symptomatic mentally ill ended up in psychiatric wards; today they go to prison, a situation that Robert Powitsky, the chief mental officer of the Oklahoma Department of Corrections, calls a “travesty.”

“The new front-line mental health workers are law enforcement officers and the new psychiatric hospitals are the prisons and the jails,” says Powitzky, who has spent most of his four-decade long career as a psychologist in prison systems. “It’s wrong, it’s just plain wrong.”…

 

[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)

 

States Crack Down on Mental Health Prescriptions

 

From the 14 August 2012 edition of Stateline

n the past two years, Illinois has done just about everything it could to reduce the amount it spends on prescription drugs for mental health. It has placed restrictions on the availability of 17 medications used to treat depression, psychosis and attention-deficit disorder. Doctors now have to explain to Medicaid why the drugs are necessary before a patient can get access to them. Then in July, as part of an effort to cut overall Medicaid spending by $1.6 billion, the state capped the number of prescriptions for Medicaid recipients to four a month, even if they previously were taking a broader cocktail of behavioral medications.

In financial terms, there is no question that it has worked. Last year, the state’s Medicaid mental health drug spending budget was reduced by $112 million. The new cap on prescription drugs is expected to save another $180 million.

Up until 2011, behavioral health drug spending made up about a quarter of Illinois’ Medicaid prescription drug costs. The state spent about $392 million that year on drugs for treating mental health patients. In fiscal 2012, the state spent $280 million on mental health drugs.

But what are the implications for quality of care? Some physicians argue that they are disastrous. “It’s a mess,” says Dr. Daniel Yohanna, a psychiatrist at the University of Chicago Medical Center.  “People who were stable on some drugs have been unable to get them. It has created a significant problem.”

Michael Claffey, of the Illinois Department of Healthcare and Family Services, says the state is aware of the complaints from the mental health community, but adds, “we don’t have unlimited funds. We need doctors to work with us…If a patient needs a drug, they will get approval.”..

..

About half of Medicaid mental health patients had difficulty accessing at least one medication, and about a quarter of them then stopped taking their medications, according to a Psychiatric Services report in 2009 on physicians’ experiences in 10 state Medicaid programs. Physicians reported that many patients experienced an adverse event, such as hospitalization, homelessness or even suicide because they couldn’t get their drugs.  Another study, reported in the May 2008 issue of Health Affairs, showed that between 2003 and 2004, Maine’s prior authorization program for atypical antipsychotics (drugs that treat serious psychoses) resulted in a 29 percent greater risk that patients suffering from schizophrenia would fail to follow their treatment protocol.

Competing studies, on the other hand, suggest that mental health drugs aren’t being properly prescribed, particularly to those under 18, and that imposing restrictions can improve quality of care by requiring physicians to reconsider why they are writing a prescription. I..

…

In Illinois, Yohanna says he has seen examples of inappropriate prescribing of psychotropic drugs and agrees that “prior approval can help with that.” But he thinks that requiring all doctors to get approval for drugs “is just throwing a blanket on things without really dealing with the worst offenders.” He says a policy like Washington State’s second opinion program would be a good idea, as well as setting up a system where there are fewer restrictions on doctors who had responsible prescribing patterns. Currently Yohanna says, it can take two to three days to get a drug approved.

Related articles

• 16 states begin rationing Medicaid prescription drugs (fellowshipofminds.wordpress.com)
• Obamacare Bares its Teeth as States Begin Rationing Drug Prescriptions for Medicaid Patients (pumabydesign001.com)
• Report: Too Little Mental Health Care For Boomers (huffingtonpost.com)
• Govt to provide free mental health drugs (thehimalayantimes.com)
• Mental Health Care Disparities Persist For Black Children (blackdoctor.org)
• Psychotherapy Is Effective but Underutilized, Review Shows (jflahiff.wordpress.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)

 

Medicaid Expansion Could Cut Death Rate

ADAPT Medicaid Rally (Photo credit: SEIU International)

From the 25 July 2012 article at MedPage Today

Expanding Medicaid programs might actually reduce mortality in low-income adults, a three-state study found, calling into question states opting out of the Affordable Care Act’s (ACA) Medicaid expansion in light of last month’s landmark Supreme Court ruling.

All-cause mortality in New York, Maine, and Arizona dropped by 19.6 deaths per 100,000 adults — a 6.1% decrease (P=0.001) — over a 10-year period when Medicaid coverage was expanded, a study published online in theNew England Journal of Medicine found…

…

The ACA required states to expand Medicaid to cover all non-elderly, low-income persons with incomes below 138% of the federal poverty level starting in 2014. States who chose not to expand their Medicaid programs were penalized financially under the law.

However, the Supreme Court deemed that expansion requirement unconstitutional, meaning that states could now choose to opt out without a penalty. Since then, Republican governors in Texas, South Carolina, Florida, Louisiana and elsewhere have vowed to refuse the Medicaid funding.

To see if expanding Medicaid coverage resulted in improved health status, Sommers and colleagues examined data from large health surveys for adults ages 20 to 64 who were observed 5 years before and after Medicaid programs were expanded in New York, Maine, and Arizona. Those states expanded to cover childless adults between 2000 and 2005. Neighboring states without major Medicaid expansion — New Hampshire, Pennsylvania, Nevada, and New Mexico — were used as controls.

The study found new enrollees were older, disproportionately minorities, and twice as likely to be in poor health as the general population, all suggesting higher mortality.

Results also were adjusted to account for economic measures that could have caused states to expand Medicaid when economies where thriving which could cause a spurious correlation between health and expansion.

Tim Sweeney, health policy director for the nonprofit think tank Georgia Budget and Policy Institute, told MedPage Today in an interview that the Sommers study confirms that access to health insurance makes people healthier. “It can’t do anything but help in the perspective of helping states move forward in their decision making,” Sweeney said.

The ACA includes coverage of 100% of the cost of expanded coverage for the first 3 years, dropping down to 90% by 2020. That federal backing allows participating states to cover thousands of low-income residents with little investment, and hospitals and doctors could see a drop in uncompensated care they provide.

“Resisting states effectively intensify the huge uncompensated care burden faced by their hospitals, deprive other healthcare industry players of important revenues, and keep their medically underserved communities from receiving an enormous economic infusion,” the perspective stated….

,,,There are several limitations to the study, Sommers admitted. Mortality data couldn’t be controlled for characteristics other than race, sex, or age. Also, the data were largely driven by New York, so results may not be generalizable to other states. Lastly, the nonrandomized design cannot control causality.Even for think tanks like Sweeney’s, it’s hard to tell how many new patients doctors could treat because many already access care now without Medicaid, Sweeney said.

Sommers reported he had no conflicts of interest. One of his co-authors reported relationships with Eli Lilly, the Medicare Payment Advisory Commission (MedPAC), Strategy 1, Campbell Alliance, TIAA-CREF, and Geraon Lehman.

The editorialists reported they had no conflicts of interest.

Related articles

• To Gauge ObamaCare Impact, Ignore CBO and Focus on AQC (The Health Care Blog)
  “The big health care story in Washington, D.C this week comes down to three letters: CBO. The Congressional Budget Office released its latest projections about the Affordable Care Act’s cost and coverage, concluding that the Supreme Court’s changes to the ACA will lead to some states to opt out of its Medicaid reform. As a result, the ACA’s cost would fall by $84 billion over 11 years but lead to about three million fewer people receiving health insurance……”

  Deaths Fell in States That Expanded Medicaid, Harvard Study Says (bloomberg.com)

• Expanding Medicaid to Low-Income Adults Leads to Improved Health, Fewer Deaths (pattidudek.typepad.com)
• Expanding Medicaid cuts death rates, study finds (msnbc.msn.com)
• Study: New Medicaid expansion could be a lifesaver (bangordailynews.com)
• Study: New Medicaid expansion could be a lifesaver (miamiherald.com)
• Study: Expanded Medicaid saves lives (upi.com)
• Study: Medicaid Expansion Leads To Improved Health, Fewer Deaths (boston.cbslocal.com)
• Expansion of Medicaid Cuts Death Rate (medicationhealthnews.wordpress.com)
• Medicaid expansion in U.S. states cut death rates, Harvard study shows (newsday.com)
• Expanding Medicaid to low-income adults leads to improved health, fewer deaths (eurekalert.org)

Life After the American Community Survey?

I am very concerned how federal funding for socioeconomic programs is going to be distributed equitably without relevant, current,  and reliables statistical information….

From the 22 May 2012 article at Stateline Daily

The U.S. Senate is expected to vote next month on an appropriations bill that could end the U.S. Census Bureau’s survey of state and local population, income, health and other data. Known as the American Community Survey, the federally funded program continuously samples about 3.5 million households each year to produce crucial data used to divvy some $400 billion in government money to states and localities, according to the Census Bureau.

…

Medicaid is the biggest federal program that relies on American Community Survey data to shift funding when states’ average incomes rise or fall. At about $270 billion in federal funding and nearly a quarter of state budgets, the federal-state health insurance program for low-income people uses the survey’s income data to determine federal allocations that can have huge impacts on state budgets.

Allocation of education grants, highway money and other social services funding also rely on the data.  States also use the information to allocate state money to county and local governments. So far, it is unclear what data the federal government would use to allocate billions in grant money, if the survey is discontinued…

Related articles

• What Killing the American Community Survey Would Actually Mean (theatlanticcities.com)
• Killing the American Community Survey Blinds Business (businessweek.com)
• The idiotic war on the American Community Survey (modeledbehavior.com)
• The GOP’s anti-research agenda (maddowblog.msnbc.msn.com)
• What Happens When Congressmen Don’t Understand Statistics (alan.com)
• Why the American Community Survey is worth keeping (flowingdata.com)
• A Future Without Key Social and Economic Statistics for the Country (flowingdata.com)

What’s Wrong With a Welfare Nation?

Posted on January 31, 2012 by mikethemadbiologist

At The Atlantic, a post by Alex Tabarrok, “The Innovation Nation vs. the Warfare-Welfare State“, has been making its way around the bloggysphere, in part due to the big shout out to science, as embodied by this figure:

Tabarrok:

We like to think of ourselves as an innovation nation, but our government is a warfare/welfare state. To build an economy for the 21st century we need to increase the rate of innovation and to do that we need to put innovation at the center of our national vision.

Innovation, however, is not a priority of our massive federal government. Nearly two-thirds of the U.S. federal budget, $2.2 trillion annually, is spent on the four biggest warfare and welfare programs, Medicaid, Medicare, Defense and Social Security. In contrast, the National Institutes of Health, which funds medical research, spends $31 billion annually, and the National Science Foundation spends just $7 billion.

I’m all for cutting back on the warfare state–that senitment is as old as the biblical prophets. And spending more money on non-military research is a good thing (and while we’re on the subject, go sign this petition). Regular readers will know I agree with that. But I’m not sure what’s wrong with the so-called welfare programs.

I’m all for controlling healthcare costs and figuring out ways of delivering care more effectively (who could possibly be against these things?).

Medicaid anti-smoking program saved big money, study says

 

Image via Wikipedia Date 14 June 2010Source Fast Facts: Smoking Cessation, by Robert West and Saul Shiffman, p. 59

Medicaid anti-smoking program saved big money, study says

Excerpt from the 13 January Stateline Daily article

Numerous studies have shown that investments in programs aimed at helping people quit smoking reap significant long-term reductions in health care costs. Even so, fiscal stress has caused states to dramatically reduce spending on anything that does not yield immediate returns.

 
Now new data suggests that states may not have to wait so long for the returns. According to astudy conducted by George Washington University, a Massachusetts Medicaid program saved $3 in Medicaid hospitalization expenses for every dollar it invested in a comprehensive smoking cessation counseling and treatment program — and the savings accrued in the first 16 months of the program.

While not all Medicaid patients who underwent the treatment were able to quit smoking permanently, the group as a whole had far fewer hospital admissions for cardiovascular problems than it did before entering the program. According to the report, the annual medical savings attributable to even a brief reduction in smoking was $571 per participant, far outweighing the $183-per-person cost of the program.

“The good news from a state budget perspective is that even if people stop smoking temporarily, there can be immediate savings,” says Leighton Ku, one of the study’s authors. “From a public health perspective we’d like to help people stop smoking for good,” Ku says. “But the study showed a rapid reduction in the number of people having heart attacks and other cardiovascular problems, and that led to immediate savings.”

Related articles

• Nicotine patches and gum don’t work long-term for smokers, Harvard study finds (boston.com)
• Study: Smoking Cessation Programs Produce $3 In Savings For Every $1 Spent (thinkprogress.org)
• Alberta working on youth anti-smoking policy (cbc.ca)
• Parents Show Modest Gains After Smoking Programs (nlm.nih.gov)
• Quitting smoking cold turkey just as effective as using the patch (dvice.com)
• Nicotine patches, gum don’t prevent relapse, study finds – Los Angeles Times (latimes.com)
• Pay people to stop smoking? (cnn.com)
• The Process of Vaping (eciganywhere.wordpress.com)
• Dutch government backtracks on anti-smoking (sfgate.com)

States could see substantial savings with tobacco control programs

States could see substantial savings with tobacco control programs

From the Eureka News Alert, Mon Nov 28, 2011 00:00

(San Francisco State University) States that have shifted funds away from tobacco control programs may be missing out on millions of dollars of savings in the form of medical costs, Medicaid payments and lost productivity by workers. Results of a cost-benefit analysis, published in the journal Contemporary Economic Policy, show that if tobacco control programs are funded at the levels recommended by the CDC, states could save 14-20 times more than the cost of implementing the programs.

Related articles

• Call to enforce tobacco control ord (nation.com.pk)
• case study: tobacco control in South Africa (gph2110.wordpress.com)
• Tobacco Control In South Africa (gph2110.wordpress.com)
• Taxes and Tobacco Control in South Africa (gph2110.wordpress.com)
• Tobacco Use Prevention and Global Health Effectiveness (gph2110.wordpress.com)
• CDC: States with Strong Tobacco Control Programs More Likely to Reduce Smoking Rate (ibtimes.com)
• Smoking Down Over Five-Year Period (prweb.com)
• The economic benefits of tobacco control rapidly outweigh tobacco tax revenues (gizmag.com)

How Human Services Programs and Their Clients Can Benefit from National Health Reform Legislation

From the Report Summary (Urban Institute)

Human services programs-the Supplemental Nutrition Assistance Program, Temporary Assistance to Needy Families, subsidized child care, etc.-and their clients can benefit from national health reform. Millions of low-income health coverage applicants can be connected with human services programs, as the latter programs: (a) help health programs efficiently reach eligible consumers; (b) access unprecedented, time-limited federal funding for modernizing eligibility computer systems while limiting risks to current funding; (c) keep social services offices available as an avenue for seeking health coverage; and (d) use a forthcoming Medicaid expansion to accomplish core human services goals related to employment and child development.

 

 

Related articles

• Health Reform and the Supreme Court (nytimes.com)
• Health Care Is Inexorably Changing, Despite Legal Uncertainty – NYTimes.com (policyabcs.wordpress.com)
• Supercommittee laying off health law (politico.com)
• Health Reform Costs, Benefits Explained in NCPA Consumer’s Guide (prweb.com)

HHS issues new strategic framework on multiple chronic conditions

From the December 14 2010 US Health and Human Services news release

The U.S. Department of Health and Human Services today issued its new Strategic Framework on Multiple Chronic Conditions― an innovative private-public sector collaboration to coordinate responses to a growing challenge.

More than a quarter of all Americans ― and two out of three older Americans ― have multiple chronic conditions, and treatment for these individuals accounts for 66 percent of the country’s health care budget. These numbers are expected to rise as the number of older Americans increases.

The health care system is largely designed to treat one disease or condition at a time, but many Americans have more than one ― and often several ― chronic conditions. For example, just 9.3 percent of adults with diabetes have only diabetes, according to the Medical Expenditure Panel Survey from the Agency for Healthcare Research and Quality (AHRQ). And as the number of chronic conditions one has increases, so, too, do the risks of complications, including adverse drug events, unnecessary hospitalizations and confusion caused by conflicting medical advice.

The new strategic framework ― coordinated by HHS and involving input from agencies within the department and multiple private sector stakeholders ― expects to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions by  fostering change within the system; providing more information and better tools to help health professionals  ― as well as patients ― learn how to better coordinate and manage care; and by facilitating research to improve oversight and care.

“Individuals with multiple chronic conditions deserve a system that works for them,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “This new framework provides an important roadmap to help us improve the health status of every American with chronic health conditions.”

The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program. And individuals with multiple chronic conditions also face increased out-of-pocket costs for their care, including higher costs for prescriptions and support services.

“Given the number of Medicare and Medicaid beneficiaries with multiple chronic conditions, focusing on the integration and coordination of care for this population is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD.

The Affordable Care Act, with its emphasis on prevention, provides HHS with exciting new opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them.

“We need to learn rapidly how to provide high quality, safe care to individuals with multiple chronic conditions.  AHRQ’s investments assess alternative strategies for prevention and management of chronic illness, including behavioral conditions, in persons with varying combinations of chronic illnesses,” said AHRQ Director Carolyn M. Clancy, MD.

HHS has taken action in recent months to improve the health of individuals with multiple chronic conditions. Some examples include:

• Administration on Aging (AoA)/ Centers for Medicare and Medicaid Services Administrator (CMS)

AoA and CMS jointly announced $67 million in grants to support outreach activities that encourage prevention and wellness, options counseling and assistance programs, and care transition programs to improve health outcomes in older Americans.

• Agency for Healthcare Research and Quality (AHRQ)

AHRQ awarded more than $18 million dollars (American Recovery and Reinvestment Act) in two categories of grant awards to understand how to optimize care of patients with multiple chronic conditions.

• Assistant Secretary for Planning and Evaluation (ASPE)

As part of an existing $40 million ASPE contract, the National Quality Forum is undertaking a project to develop and endorse a performance measurement framework for patients with multiple chronic conditions.

• Centers for Disease Control and Prevention (CDC)

CDC is supporting a new project ― Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life ― in which the Institute of Medicine will convene a committee of independent experts to examine the burden of multiple chronic conditions and the implications for population-based public health action.

• Centers for Medicare and Medicaid Services (CMS)

CMS has provided recent guidance to State Medicaid directors on a new optional benefit available Jan. 1, 2011, through the Affordable Care Act, to provide health homes for enrollees with at least two chronic conditions, or for those with one chronic condition who are at risk for another.

• Food and Drug Administration/ Assistant Secretary for Planning and Evaluation (FDA/ASPE)

FDA and ASPE launched a study to examine the extent to which individuals with multiple chronic conditions are being included or excluded from clinical trials for new therapeutic products.

• Indian Health Service (IHS)

IHS has expanded its Improving Patient Care Program to nearly 100 sites across the tribal and urban Indian health system to assist in improving the quality of health care for patients with MCC.

• National Institutes of Health (NIH)

NIH has committed $42.8 million for a study to determine whether efforts to attain a lower blood pressure range in an older adult population will reduce other chronic conditions.

• Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA awarded $34 million in new funding to support the Primary and Behavioral Health Care Integration Program, which seeks to promote the integration of care with people with co-occurring conditions.

For more information about the new HHS Strategy on Multiple Chronic Conditions, go to:http://www.hhs.gov/ash/initiatives/mcc/

 

 

HHS Offers New Tool for Medical School Students to Learn, Detect Medicare Fraud

From a November 8, 2010 US Health and Humans Services (HHS) news release

The Department of Health & Human Service’s Office of Inspector General has released a new tool geared toward educating medical school students on Medicare and Medicaid fraud and abuse laws, according to a news report byThe Hill.

The tool is a booklet, titled “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse,” that will be delivered to medical schools across the country. The booklet covers education on specific fraud and abuse laws and physician relationships with payors, other providers and vendors.

The booklet’s release follows an OIG report that suggested medical school students aren’t adequately trained on healthcare fraud law.

Read The Hill‘s news report about the OIG’s “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse.”

Read other coverage about healthcare fraud reports:

– WSJ: AMA Keeping Data on Physicians and Individual Healthcare Providers Confidential

– Report: Number of Suspected New York Medicaid Fraud Cases Doubled Since Last Year