Health and Medical News and Resources

General interest items edited by Janice Flahiff

[News release] Insuring undocumented residents could help solve multiple U.S. health care challenges

From the 18 March 2015 UCLA news release

UCLA health care policy analysis finds four key problem areas for Latinos under Affordable Care Act

Latinos are the largest ethnic minority group in the United States, and it’s expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers.

Latinos’ low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA:

  • The consequences of not covering undocumented residents.
  • The growth of the Latino population in states that are not participating in the ACA’s Medicaid expansion program.
  • The heavier demand on public and private health care systems serving newly insured Latinos.
  • The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

“As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels,” Ortega said. “Resolving these four key issues would be an important first step.”

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA’s expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA’s exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

“These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time,” he said. “So it remains unclear how these clinics will continue to provide care for them.”

..

 

March 21, 2015 Posted by | health care | , , , , , | Leave a comment

[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]

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     [This is a screenshot, was unable to upload via an application similar to YouTube]

 

 

Also in the podcast, Senior Fellow David Wessel, director of the Hutchins Center on Fiscal and Monetary Policy, offers his regular “Wessel’s Economic Update.”


Show Notes:

– Improving Health While Reducing Cost Growth, What is Possible? (with Mark McClellan)
– People Who Wanted Market-Driven Health Care Now Have it in the Affordable Care Act
– 
Health360: The latest views on health policy

February 7, 2015 Posted by | Uncategorized | , , , , , | Leave a comment

[Report] A one-year assessment of the ACA | Association of Health Care Journalists

A one-year assessment of the ACA | Association of Health Care Journalists.

From the 31 October 2014 report

The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA.  It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”

Image by HealthCare.gov.

The package consists of seven sections that run the gamut, with some key numbers and charts.  Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.

Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.

Here are the seven sections covered, and the nutshell conclusion the Times provided for each.

November 4, 2014 Posted by | health care | , , | Leave a comment

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution.

From the 27 January 2014 Brookings Institute post
The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

January 30, 2014 Posted by | health care | , , , , | Leave a comment

[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.

 

November 16, 2013 Posted by | health care | , , , , | Leave a comment

[Reblog from the Brookings Institute] CHART: Winners and Losers from Obamacare

From the 1 November 2013 item at The Brookings Institution

  • Fred Dews

    Managing Editor of the Brookings Website

November 3, 2013 Posted by | health care | , , , , , | Leave a comment

Health Law Helper – Affordable Care Act Interactive Tool

Health Law Helper – Affordable Care Act Interactive Tool.

From the Consumer Reports Web site

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Related Affordable Care Act (Obamacare) Resources 

Information about the Act (Obamacare)

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)
  • Prevention and Wellness with information on how many insurers are required to cover certain preventive services at no cost to you.

October 1, 2013 Posted by | health care | , , , , | 1 Comment

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

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)

Related articles

September 21, 2013 Posted by | health care | , , , , , | 1 Comment

[Reblog] The ACA and Medicaid: Where You Live Matters

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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

September 5, 2013 Posted by | health care | , , , , | 2 Comments

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.

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,”

August 28, 2013 Posted by | health care | , , , , , , , , , | Leave a comment

[Reblog] Six Questions About Obamacare Answered

Health Insurance Forum

Health Insurance Forum (Photo credit: Aaron Landry)

From the 6 August 2013 post at Learn in Health, Living and Insurance

As a late 20-something, I could very possibly be a member of the “young invincibles,” a label used to describe people between 18 and 34 who do not have health insurance because they think they’re, well… invincible (not to mention broke).
I lucked out in that five years ago, I somehow found myself working for the largest private statewide health foundation in California, dedicated to improving the health status of underserved populations in California. The ability for communities to have solid access to health care is one of our core values. As a reflection of this value, a variety of health insurance options are provided to our employees at a very affordable rate.
As most of us know, not everyone is so lucky. 

Recently, at a party during a “what do you do” conversation, a freelance screenwriter (struggling to make ends meet) asked me what he could do to get health insurance being single, unemployed, and having a few health issues to tackle. 

He, like many of us, will be required to have health insurance pretty soon. But beyond that, we don’t know much. 

So I spent some time today leafing through healthcare.gov and other sites with any 411 to get the quick down-and-dirty of what we all need to know going into January 1, 2014, when most of us will be required to have health insurance.
1. Who needs to have health insurance?


Read the entire article here
Related Resource
Visit USA.gov’s Health Insurance page to learn about the new Health Insurance Marketplace and other types of health coverage.

Starting October 1, 2013, you can fill out an application for health insurance through the Health Insurance Marketplace. You’ll be able to compare your options side-by-side and enroll in a plan that fits your budget and meets your needs. Coverage takes effect as early as January 1, 2014. 

USA.gov’s Health Insurance page includes:

  • A brief overview on health insurance and the Affordable Care Act.
  • Key dates for enrollment and coverage through the Health Insurance Marketplace.
  • Publications to help you prepare for enrollment through the Health Insurance Marketplace.
  • Information about Medicaid, Medicare, the Children’s Health Insurance Program, and COBRA.

 

August 16, 2013 Posted by | health care | , , | 1 Comment

Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns

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 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

“…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.”

August 2, 2013 Posted by | Consumer Health, health care, Librarian Resources | , , , , , , | Leave a comment

Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns

 

I am hoping that the federal government can do a bit more to provide resources for librarians about ACA.

Back in my public library days, it wasn’t easy working with patrons when the topic was against my views!

However, I always tried to address people’s information needs without bias and as completely as possible with factual information.

“ObamaCare” questions are in the same arena.  While librarians cannot advise or fill out forms, they can at least lead folks to factual information. However, this would work best if the federal government would do everything possible to lighten the load for libraries.  This would include providing readable materials for consumers, as well as “pathways” for librarians.

Also, libraries can welcome trained volunteers and organizations to give in-depth information to folks. Many already do this around tax time with IRS trained volunteers.

Here in Toledo, folks from legal aid organizations “set up shop” in public libraries to assist folks. Representatives from the Ohio Benefit Bank do likewise. These volunteers screen people for government assistance programs as SNAP and the Medicare Savings Program.

It sure would be great if government employees and/or trained volunteers could do likewise for “ObamaCare”.  Areas could include the health exchange marketplace, Medicaid expansion, free preventative care, and more.

And with articles as this, there is a real need for information professionals, including librarians!

Ohio insurance department claims Obamacare premium rates to rise 41 percent (Cleveland Plain Dealer, August 1, 2013)

Ohio insurance regulators Thursday released rates for health insurance to be sold on the new state marketplace and said premiums for individuals will rise an average of 41 percent compared with 2013 rates.
That average brought immediate condemnation from critics of the Affordable Care Act, with U.S. House Speaker John Boehner, a southwest Ohio Republican, calling it “irrefutable evidence” that the law known as Obamacare is driving up costs and hurting the economy……..
Related articles

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. This federal initiative to get public libraries involved in assisting people to sign up goes into effect October 1.

As much as I dislike relying on news media for any valid information, a Washington Times online article “Librarian foot soldiers enlisted to help with Obamacare enrollment” published June 29 states:

CHICAGO — The nation’s librarians will be recruited to help people get signed up for insurance under President Barack Obama’s health care overhaul. Up to 17,000…

View original post 1,492 more words

August 2, 2013 Posted by | health care, Librarian Resources | , , , , , , | 1 Comment

Got 1:43 minutes to learn about health exchanges?

July 30, 2013 Posted by | health care | , , , , | 1 Comment

RAND Shrugged | The Health Care Blog

The comments section was the most interesting part of this Web page.

July 14, 2013 Posted by | Medical and Health Research News, Workplace Health | , , , , , , | Leave a comment

   

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