The Online Resource for Massachusetts Poverty Law Advocates

Feed aggregator

As Mass. Lawmakers Take Up Addiction Bill, What’s Most Effective Treatment?

CommonHealth (WBUR) - 3 hours 52 min ago

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

As Massachusetts lawmakers work on differences in the $20 million bill designed to address the state’s opioid crisis, questions remain about which treatments are best.

Several business and insurance leaders have written to Gov. Deval Patrick saying that some parts of the bill may not encourage the most effective addiction treatment. Essentially, they say, more beds may not be the answer, but more medication and longer outpatient care might be better.

The House bill requires insurers to pay for at least 10 inpatient days of addiction treatment if that’s determined to be medically necessary; the Senate bill requires up to 21 days of inpatient coverage.

But the American Society of Addiction Medicine estimates that 95 percent of opioid-dependent patients do not need inpatient care, and might be better off with medication maintenance and several months of outpatient therapy. Lawmakers maintain that they do not want to mandate any form of treatment.

“If we have this epidemic that continues to grow, we’re essentially in uncharted territory, and current treatment options aren’t working,” said Leominster Sen. Jennifer Flanagan, one of the bill’s co-sponsors. “If people want inpatient treatment or medication maintenance, they should be able to decide that with their doctors.”

At the same time, a new report contains some surprising findings about medication maintenance addiction treatment. It says that methadone, long used to treat heroin addiction, may be the most effective and cheapest treatment.

The report, from The New England Comparative Effectiveness Public Advisory Council, found that when comparing methadone with suboxone (Buprenorphine) or naltrexone (Vivitrol), more patients stayed in treatment longer if they were taking methadone.

In follow-ups with patients three to 12 months after they first started taking medication, 63 percent of methadone patients were still in treatment, compared with 52 percent of those taking suboxone and 28 percent on naltrexone.

Methadone also appears to be the cheapest maintenance medication, despite the requirement of having a health care facility daily distribute the drug to patients.

The council report said that because methadone patients tend to stay in treatment longer, the social costs are lower. So, the council says, over two years, methadone maintenance therapy ends up having the lowest average cost per patient.

Many addiction specialists and patients are wary of methadone, because it’s not very convenient to have to get it every day and it’s reported to be as difficult to stop using as opioids.

Flanagan says the bill does not address any specific type of medication management; it just says that treatment decisions are made by patients, their doctors and their insurers.

“We’re not endorsing one form of treatment over another,” Flanagan said. “We just believe patients should have a choice. Ten years ago eating disorders weren’t covered by insurance. In the same way, we’re evolving on this.”

The council report warns that treatment costs are substantially lower than the the total costs to society of a patient who is not in treatment at all. It says about 133,000 New Englanders are opioid-dependent and under a third of them are now in maintenance treatment. If 50 percent more patients are brought into treatment in New England over the next two years, the council says 700 lives would be saved, including more than 100 adolescents.

Flanagan expects that any differences in the bill will be worked out and lawmakers will approve a bill before the legislative session ends on Thursday.

Categories: Health Care

International Arbitration Law in Mexico – Global Legal Collection Highlights

In Custodia Legis - 7 hours 59 min ago

This is a guest post by Dante Figueroa, a senior legal information analyst at the Law Library of Congress.  Dante is a frequent contributor to In Custodia Legis. His recent posts include Introduction to Roman Law – Global Legal Collection Highlights, Introduction to Canon Law – Global Legal Collection Highlights, Resources and Treasures of the Italian Parliamentary Libraries, and A Fresh Update on the Canonical Rules on the Election of a New Pontiff.

January 1 of this year marked the twentieth anniversary of the entry into force of the North American Free Trade Agreement (NAFTA) signed between the United States, Mexico and Canada. While there are conflicting views on the overall economic impact of NAFTA, I believe that NAFTA had a great impact on Mexico’s culture regarding international commercial and investment arbitration. From a historic reluctance to international arbitration embedded in the Commerce Code of 1889 and the Constitution of 1917, Mexico has witnessed a growing openness to international arbitration.

Growing Openness towards Arbitration in Mexico

During the last two decades, commercial arbitration, both domestic and international, has experienced rapid development in Mexico. The underlying rationale behind the efforts to promote arbitration in commercial matters is to reduce the workload of the Mexican judiciary and the costs associated with judicial adjudication, as well as to provide an expedited and specialized solution to commercial disputes.

North American Free Trade Agreement (NAFTA), Office of the United States Trade Representative Website

The arbitration of international disputes received an important boost in 1994 with the passage of NAFTA. In 1993, in preparation for NAFTA, the Mexican Congress amended Article 14 of the Organic Law of PEMEX  (Mexico’s state-owned petroleum company), allowing contracts involving PEMEX to be subject to arbitration.  PEMEX became the only Mexican government entity allowed to use arbitration at that time. Later, in 2009, when the Mexican legislature amended the Law for Public Works and Services and the Law for Acquisitions, Leases and Services of the Public Sector, works contracts, particularly long-term acquisition contracts executed by all federal agencies, were allowed to contain arbitration clauses. Then, in 2012, another amendment to the Public-Private Partnerships Law (PPPL) removed the long-term requirement previously prohibiting arbitration in government acquisition. Consequently, to date all federal acquisition contracts may be subject to domestic or international arbitration.

It should be noted, however, that several restrictions concerning the termination and rescission of administrative contracts remain in place. Specifically, the PPPL excludes “acts of authority” and “administrative acts” from arbitration.  Recent academic and judicial debate in Mexico has focused on whether the administrative termination or rescission of an administrative contract qualifies as an act of authority or administrative act and is therefore, as a matter of public policy, not subject to arbitration.

Litigation Involving U.S.-Mexico International Commercial Arbitration

This debate is reflected in the case of Corporación Mexicana de Mantenimiento Integral (Commisa) v. Pemex, recently decided by a U.S. district court. In this case, the U.S. court confirmed an International Court of Arbitration arbitral award against PEMEX, a decision that was later overturned by a Mexican federal district court on several grounds.   In general, the Mexican appellate court found that “administrative rescissions were not arbitrable,” and that “it was unacceptable for arbitrators to resolve a matter of public policy.”  Behind the Mexican court’s decision lies the centuries-old French doctrine of “Le Contrat administratif” (administrative contract) that applied in Latin America during the nineteenth century based on the Napoleonic Civil Code. This doctrine recognized the public policy character of contracts where the government was involved and in practice, prohibited or greatly restricted arbitration.

Commisa v. Pemex is a highly complicated case that highlights the changing attitudes toward international commercial arbitration in Mexico, from a historic reluctance, to a growing openness followed by this recent reversal in trend. Among the myriad of relevant legal issues discussed in this case are: the arbitrability of government contracts in two different jurisdictions, the retroactive application of foreign laws to U.S. litigation, the effects of a foreign court decision on litigation held in the United States, as well as issues of international comity, reciprocity, and enforcement of international arbitral awards.

General Resources on International Commercial Arbitration

The Law Library of Congress holds a vast collection of resources on international commercial arbitration, including several recent publications:

In addition, we have numerous bibliographical resources available that deal with the topic of international arbitration with a focus on Mexico:

The Law Library of Congress Reading Room is open to the public six days a week.  To access materials you will need a Library of Congress Reader Identification Card.  You can also submit questions to our legal reference specialists through the Ask a Librarian form on our website.

Categories: Research & Litigation

Legal Experts Call For More Regulation Of Mobile Health Apps

CommonHealth (WBUR) - 8 hours 52 min ago

(Stephan Geyer/Flickr)" href="http://media.wbur.org/wordpress/15/files/2012/02/smartphone.jpg">

(Stephan Geyer/Flickr)

Veronica Thomas
CommonHealth Intern

Want to hypnotize yourself thin? There’s an app for that. Want to monitor your heart rate without buying another gadget? There’s an app for that too. With the emergence of countless mobile health applications, smartphones are quickly transforming health care at our fingertips.

Mobile health—“mHealth”—apps have the potential to help promote healthy behaviors, expand health care access, and manage costs. But in order to protect the safety of consumers, health law experts say there needs to be more regulation by the Food and Drug Administration.

According to the new report, just published in the New England Journal of Medicine, only about 100 out of 100,000 mHealth apps available on the market have been FDA-approved.

Many mobile health developers, however, worry that FDA oversight will hinder creativity and growth. The FDA approval process can cost tens of thousands of dollars and take months or even years to complete. Before committing time and money to FDA endorsement, many developers first look to consumers for a stamp of approval.

From the study’s press release:

“Consumers will be spending a lot of money on these products, and venture capital is flying into the industry,” says the article’s lead author, SMU Dedman School of Law Associate Dean of Research Nathan Cortez, adding that by 2017 mHealth apps are expected earn $26 billion— up from $2.4 billion in 2013.

The FDA needs “additional funding and in-house technical expertise to oversee the ongoing flood of mHealth products,” the authors note. An under-regulated mobile health industry could create “a Wild West” market, says Cortez, who has conducted extensive research into FDA regulation of mobile health technologies.

While consumers might trust that iTunes and Android would only sell legitimate health apps cleared by the FDA, that just typically isn’t the case, Cortez says. As with drugstore vitamins and weight-loss products claiming to “shrink your waist in 7 days,” most of these products have not been thoroughly tested and evaluated by outside experts.

Also from the press release:

“Although the vast majority of mHealth products are very low-risk, some apps make promises they can’t fulfill, and others make errors that could harm patients,” Cortez notes, pointing out that life-threatening technical mistakes are not only possible – they also have occurred.

The authors note that Congress has introduced many bills to strengthen FDA control over mHealth apps, including the proposed creation of a new Office of Wireless Health Technology. On the other hand, there are also more conservative bills that limit the authority of the FDA in the mHealth market.

In the press release, Cortez responds to opponents’ concerns that increased FDA oversight will inhibit innovation and growth:

The conventional wisdom is that FDA regulation will stifle innovation, and that’s a very short-term way to think about this,” Cortez says. “Most Silicon Valley firms aren’t used to much federal regulation, and Internet technologies have been subject to very little federal oversight.”

If dangerous errors and disproven product benefits are allowed to proliferate, “some very useful products will be undermined by widespread consumer distrust,” Cortez contends.

Related posts:

Categories: Health Care

Expert Panel Recommends Sweeping Changes To Doctor Training System

Kaiser Health News - 9 hours 47 min ago

An expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation needs.

“We recognize we are recommending substantial change,” said health economist and former Medicare Administrator Gail Wilensky, co-chairwoman of the nonpartisan Institute of Medicine panel that produced the report. “We think it’s key to justifying the continued use of public funds.”

The federal government, mostly via the Medicare program, currently provides more than $11 billion per year in payments to support the training of doctors who have graduated medical school. Most of that goes to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually.

“The scale of government support for this phase of physician education is unlike that given to any other profession in the nation,” said the report, which was funded by a dozen foundations with the support of a bipartisan group of members of Congress.

But there are little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed for the 21st century. Despite a growing public investment in graduate medical education (GME) support, there are persistent problems with uneven geographic distribution of physicians, too many specialists and not enough primary care providers, and a lack of cultural diversity in the physician workforce, the report found.

Not only that, the authors note, “a variety of surveys indicate that recently trained physicians in some specialties cannot perform simple procedures often required in office-based practice and lack sufficient training and experience in care coordination, team-based care, and quality improvement.”

All of the changes proposed in the report would have to be made by Congress, because government support for graduate medical education is written into Medicare and other laws. The politics, however, are unclear because the changes would produce winners and losers among those programs currently training interns and residents. 

The Association of American Medical Colleges was sharply critical of the report. Its recommendations would “threaten the world’s best training programs for health professionals and jeopardize patients, particularly those who are the most medically vulnerable,” said AAMC President Darrell G. Kirch, whose group represents the nation’s top teaching hospitals.

“By proposing as much as a 35 percent reduction in payments to teaching hospitals, the IOM’s recommendations will slash funding for vital care and services available almost exclusively at teaching hospitals, including Level 1 trauma centers, pediatric intensive care units, burn centers, and access to clinical trials,” Kirch said. “In addition to hurting patient care, these cuts will limit critical training settings for future physicians, nurses, and other health professionals.”

The committee proposes a sweeping overhaul of the entire financing program for graduate medical education, with the goal of shifting the program “to a performance-based system,” rather than one that merely funnels money to any facility with an accredited training program.

The current Medicare medical education payment system would be phased out over 10 years. At the end of the phase-out, policymakers would reassess whether Medicare should continue to subsidize doctor training at all, and if so, to what extent.

The panel calls for spending the same overall funding from Medicare over the decade, adjusted for inflation. But it would be distributed much differently, with a declining share providing direct subsidies to teaching programs. An increasing share would go instead to a “GME transformation fund” that would finance new ways to provide and pay for training and fund training positions “in priority disciplines and geographic areas.”

The funds would still be distributed through the Medicare program, but a new “GME Policy Council” would be created under the office of the Secretary of Health and Human Services to oversee workforce issues and commission research on how well the federal dollars are being spent. The committee recommended that states impose similar requirements for Medicaid training funds.

Among those that would be most immediately affected are major teaching hospitals in the Northeast, which currently account for a disproportionate amount of Medicare medical education funding and number of doctors-in-training. The panel called for an end to the current system of payments that favor those hospitals, and instead for Medicare to make a flat “per resident” payment to training sponsors based on the national per-resident amount, adjusted for geography.

It’s time to close the open checkbook for teaching hospitals, the panel said. “The statutes governing Medicare’s GME financing were developed at a time when hospitals were the central – if not exclusive – site for physician training,” the report said. But by doing that, “the Medicare payment system discourages physician training outside the hospital, in clinical settings where most health care is delivered.”

Members stopped short, however, of recommending that Medicare stop funding graduate medical education altogether, at least for the near future.

The rapid evolution of the health care sector, said Wilensky, “was an important rationale for potentially using the leverage provided by government funding  to try to train the health care workforce we needed for a 21st century delivery system.”

But the panel also did not recommend lifting the current cap on the number of residencies that Medicare currently supports. That cap was imposed in the 1997 Balanced Budget Act.

“Increasing the number of physicians per se is not likely to solve important workforce issues,” Wilensky said, “particularly with regard to specialty distribution or geography.”

Categories: Health Care

Dueling Long-Term Projections Highlight Uncertain Trajectory for Health Care Costs

Brookings Institute -- Medicare - 9 hours 53 min ago

Recent projections for Medicare spending from the Centers for Medicare and Medicaid Services (CMS) and Congressional Budget Office (CBO) are virtually identical through 2040, and both agencies’ projections for spending have fallen dramatically in recent years. But beyond 2040, the projections diverge. CBO, for example, projects that health spending will reach 10.5 percent of GDP in 2080, a full 3.7 percentage points higher than in CMS’s baseline projections.

What explains these dramatically different projections? Simply put: different assumptions. Both agencies assume that private health spending will slow over time, reflecting the notion that households will not want to forever curtail other types of consumption in order to afford ever-greater health consumption. But CBO and CMS make very different assumptions about Medicare over the long run. CBO assumes that without changes to Medicare policy, Medicare will be unable restrain health spending growth as effectively as the private sector. Hence, CBO assumes that Medicare will grow faster than private health spending in the long run. CMS, on the other hand, assumes that the ACA’s cuts are deep enough that Medicare spending will rise slower than private health spending.  

It is impossible to know which of these projections is “better.” Health economists know that health spending can’t rise faster than GDP forever, but we know little about how much health spending will be viewed as “too much.” Thus, we have no way to pin down the trajectory of private health spending over the long run. And the idea that we can say something useful about Medicare spending vs private health spending over 75 years is fanciful at best.

It’s not that CBO and CMS are doing bad projections—it’s that it is impossible to do a meaningful 75-year projection for health spending. CBO’s recent emphasis on the 25-year outlook, and its de-emphasis on the longer-run outlook, makes a lot of sense.

Authors         
Categories: Elder

Conference Call: Understanding the Annual Reports of the Social Security and Medicare Trustees

The Center on Budget and Policy Priorities held a conference call briefing on Monday, July 28 at 4:00 p.m. (ET) to discuss the annual reports that the Social Security and Medicare Trustees released earlier that day. Paul Van de Water, Senior Fellow at the Center and one of Washington’s leading experts on both Social Security and Medicare, led the discussion of what the reports say about the long-term financial status of Social Security and Medicare. With CBPP staff: …
Categories: Benefits, Poverty

Lawmakers Announce $17 Billion Deal To Overhaul VA Health Care

Kaiser Health News - 11 hours 10 min ago

The overhaul makes it easier for veterans waiting a long time to see a VA doctor to get care from a private doctor's office. It also includes money to hire new doctors and lease new clinic space. Negotiators are confident of the bill's smooth passage through Congress.

NPR: After 5 Weeks Of Haggling, Congress Inks Bipartisan VA Bill
Congress has reached a bipartisan deal to reform the Department of Veterans Affairs, after nearly two months of tense negotiations (Lawrence, 7/28).

The New York Times: Deal Allots $17 Billion For Overhaul of V.A. Health Care System
House and Senate negotiators announced an agreement Monday on legislation that would allocate about $17 billion to overhaul the Department of Veterans Affairs’ sprawling and beleaguered health care system. But the deal does not give the department everything that officials there have said is needed to fix its problems (Schleifer and Oppel Jr., 7/28).

The Wall Street Journal: Lawmakers Unveil $17 Billion Fix For Veterans Affairs
The agreement still needs the green light from a committee of House and Senate lawmakers, after which it will need to be approved by both chambers before being sent to the White House for the president's signature. About $12 billion of the total is considered emergency funding, which doesn't need to be offset by cuts elsewhere in the budget -- a decision that could still bring objections from more conservative Republicans. Mr. Miller said he was optimistic Congress would act this week to pass the bill (Kesling and Crittenden, 7/28).

The Washington Post: Negotiators Predict Easy Passage Of Bill To Overhaul Department Of Veterans Affairs
A sweeping proposal to revamp the Department of Veterans Affairs and the nation’s medical care for military veterans should have enough support to pass the House and Senate this week before lawmakers leave town for a summer recess, lead negotiators said Monday. The assurances provided a hopeful start to a week in which congressional leaders are expected to resolve several lingering issues before lawmakers head home for their five-week summer break. In addition to approving changes to veterans’ medical care, negotiators are working on deals to continue federal funding for the nation’s major road projects and whether to grant President Obama’s request for billions of dollars to deal with the historic influx of illegal immigrants along the U.S.-Mexico border (O’Keefe, 7/28).

The Associated Press: Deal To Improve Veterans’ Health Care Costs $17B
The bill includes $10 billion in emergency spending to make it easier for veterans who can’t get prompt appointments with VA doctors to obtain outside care; $5 billion to hire doctors, nurses and other medical staff; and about $1.5 billion to lease 27 new clinics across the country, lawmakers said. The bill also would expand a scholarship program for veterans, allow all veterans to qualify for in-state college tuition and grant the VA secretary authority to immediately fire senior executives, while providing employees with streamlined appeal rights (7/28).

Politico: How The VA Deal Came Together
Top negotiators on a deal to reform the Department of Veterans Affairs turned to an unusual strategy that helped them arrive at Monday’s agreement: knock-down, drag-out arguing. Just last week, talks appeared on the verge of collapse as the leaders of a conference committee -- Sen. Bernie Sanders (I-Vt.) and Rep. Jeff Miller (R-Fla.) -- publicly slugged it out over differences on how to pay for the bill. Miller said Sanders was hurling “grenades” at Republicans rather than negotiating while Sanders called the GOP’s behavior “sad” (French and Everett, 7/28).

USA Today: Bipartisan Deal Would Add Billions For Veterans’ Care 
Key members of Congress have reached a bipartisan deal to use $10 billion in emergency money to allow veterans to seek private care if they face long wait lines at facilities run by the Department of Veterans Affairs. The deal opens the door for Congress to pass a bill this week before departing for a month-long recess (Kennedy, 7/28).

Categories: Health Care

Report: The Forecast For Medicare Trust Fund Is Flush 'Til 2030

Kaiser Health News - 11 hours 11 min ago

The Medicare trustees added four years to the solvency of the trust fund as Medicare's financial circumstances experienced a slight improvement due in part to the continued slowdown in health care spending and, some say, elements of the health law.   

The New York Times: Gains Seen From Medicare, But Social Security Holds Steady
Medicare’s financial condition improved significantly in the last year, thanks in part to the Affordable Care Act, but the outlook for Social Security is basically unchanged, the Obama administration said Monday (Pear, 7/28).

Kaiser Health News: Good News For Boomers: Medicare’s Hospital Trust Fund Appears Flush Until 2030
Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act (Rovner, 7/28).

The Washington Post: Medicare Finances Improve Partly Due To ACA, Hospital Expenses, Trustee Report Says
The annual report, issued Monday by trustees overseeing the government’s two largest entitlement programs, found little change overall in the finances of Social Security. The trustees warned, however, that the part of Social Security that pays monthly benefits to people with disabilities is especially fragile and, without changes, will start to run short of money for benefit checks in 2016 (Goldstein, 7/28).

Los Angeles Times: Medicare Finances Improve As Healthcare Inflation Slows, Trustees Say
Medicare Part B premiums are expected to remain the same through 2015 because of that improvement, Health and Human Services Secretary Sylvia Burwell told reporters as the report was released. Medicare is "considerably stronger than it was just four years ago," she said (Lauter, 7/28).

The Wall Street Journal: Medicare, Social Security Disability Fund Headed In Different Directions
The slowdown in Medicare spending over the past few years—mirroring slower growth in health costs reported by private insurers—has stumped economists, lawmakers and hospital administrators. Many believe it stems from the recent economic downturn, but the lower spending growth has persisted throughout the recovery. Sylvia Mathews Burwell, secretary of the Department of Health and Human Services, said Medicare's rapid improvement since the 2010 passage of the Affordable Care Act suggests a direct link to the health law. Her agency cited provisions of the law that give hospitals incentives to avoid readmitting patients, saying that led to 150,000 fewer readmissions in 2012 and 2013 (Paletta, 7/28).

The Associated Press: Medicare’s Own Health Looking Better, Report Says 
Trustees issued their annual report Monday on the financial health of the government’s two largest benefit programs, which together accounted for 41 percent of all federal spending last year. Though both are “fundamentally secure,” said Treasury Secretary Jacob Lew, “The reports also remind us of something we all understand: We must reform these programs if we want to keep them sound for future generations” (7/28).

Reuters: Slower U.S. Health Care Cost Rise Extending Life Of Medicare Fund
Tamer spending at U.S. hospitals and expected savings from President Barack Obama's healthcare overhaul are shoring up the funding outlook for the Medicare program for the elderly, trustees of the program said on Monday. Medicare's trust fund for hospital bills will run out of money in 2030, four years later than previously estimated, the trustees said in a report. The trustees, however, reiterated a warning that the Social Security program would run out of money to fully pay disability benefits by 2016 and could not meet all of its obligations on pensions after 2033 (Morgan and Lange, 7/28). 

Politico: Medicare Financial Outlook Brightens
White House officials emphasized the importance of cost-control measures woven into Obamacare, though the trustees said they weren’t prepared to say which of the factors was most important (Faler, 7/28).

The Hill: Medicare, Social Security March Toward Insolvency
Social Security and Medicare are marching steadily toward insolvency, according to a report released Monday by the trustees for the two entitlement programs. While the report found some improvement for Medicare, which will now be able to meet its obligations until 2030, four years later than projected a year ago, the overall message continued to paint a dire long-term picture for the two programs (Becker, 7/28).

Modern Healthcare: Medicare Trustees’ Report Finds ‘Cautious Optimism’
The Medicare trustees say there are reasons for “cautious optimism” about Medicare's financial outlook, and that Obamacare deserves at least some credit for that. The depletion date for the Part A hospital insurance trust fund is now projected at 2030, compared with last year's projection of 2026, and initial projections show unchanged Part B premiums in 2015, the trustees said in their annual report Monday (Tahir, 7/28).

The Washington Post’s The Fact Checker: Would Boosting The Eligibility Age For Medicare Save It From Bankruptcy?
Rep. Scalise made these remarks in response to host Chris Wallace’s observation that House Republicans have proposed to raise the eligibility age for Medicare over the next 10 years from 65 to 70. We’ve explained to readers before about the error—by politicians in both parties—of saying Medicare is going “bust” or into “bankruptcy.” Let’s have a refresher course on that, and also explore Scalise’s suggestion that boosting the eligibility age would save the program, “for future generations” (Kessler, 7/29).

Categories: Health Care

States Wrestle With Medicaid Expansion Challenges

Kaiser Health News - 11 hours 37 min ago

Application backlogs are an issue in Missouri and South Carolina. In Florida, a medical association makes clear its support for expanding the low-income health insurance program, and in Georgia, Gov. Nathan Deal carves out a limited exception to his opposition to expanding Medicaid.

St. Louis Post-Dispatch: Missourians Still Face Delays Seeking Medicaid Coverage
More than 12,000 applications transferred to Missouri’s Medicaid program from the federal health insurance exchange are still being processed. In February, the Post-Dispatch first reported on the difficulties facing Missourians who were trying to enroll in Medicaid through HealthCare.gov. A deluge of applications as well as software compatibility issues between the federal exchange and the state’s Medicaid computer systems created a huge backlog (Liss, 7/29).

Charleston Post and Courier: South Carolina Medicaid Backlog Leaves Thousands In Insurance Limbo
Thousands of South Carolina residents who filed for Medicaid between October and mid-July are still waiting to find out if they qualify for the government's low-income health insurance program. While most Medicaid applications are typically approved or denied within six days, the state agency responsible for processing the paperwork hasn't been able to keep pace with an influx from healthcare.gov. More than 43,000 South Carolina Medicaid applications were submitted through the new federal health insurance marketplace between Oct. 1 and July 13, but the S.C. Department of Health and Human Services has only managed to make its way through 25 percent of them (Sausser, 7/28).

Health News Florida: Florida Medical Association Supports Medicaid Expansion
The Florida Medical Association's House of Delegates overwhelmingly adopted a resolution supporting Medicaid expansion to cover uninsured low-income adults at FMA's annual meeting on Sunday, according  to doctors who were there. FMA issued a statement on Monday, quoting General Counsel Jeff Scott, confirming passage of the resolution but adding that support for Medicaid expansion is contingent on the state providing enough pay for doctors who treat Medicaid patients to make such care possible (Gentry, 7/28). 

Tampa Bay Times: Florida Medical Association Members Vote To Support Medicaid Expansion
For the first time, members of the Florida Medical Association have approved a resolution endorsing Medicaid expansion, a politically contentious issue that the group's leaders have generally avoided in the past two legislative sessions. But the FMA's full-throated support for expansion comes with a caveat: Medicaid reimbursement rates must be increased to attract more doctors to the program (Tillman, 7/28).

Atlanta Journal Constitution: Gov. Nathan Deal Makes A (Very Limited) Exception To His Stance Against Medicaid Expansion
Gov. Nathan Deal has gone to great lengths to assure his supporters that he’s against the expansion of Medicaid under the Affordable Care Act. But he carved out one exception this week. It has to do with the more than 1,100 unaccompanied immigrant children transferred by the feds this year to the care of sponsors living in Georgia. The influx comes amid a surge of Central American children fleeing instability and violence at home to illegally cross the southwest border (Bluestein, 7/29).

Categories: Health Care

Aetna Quarterly Profits Up Amid Record Membership And Revenue

Kaiser Health News - 11 hours 38 min ago

The insurer's bottom line was helped by its acquisition of Coventry Health Care. Meanwhile, HealthSouth reported that its second-quarter profits were cut nearly in half.

The Wall Street Journal: Aetna Beats Estimates, Raises Outlook
Aetna Inc. said its second-quarter profit rose as the insurer posted record medical membership and revenue, while it continued to enjoy benefits from its acquisition of Coventry Health Care Inc. The results surpassed analysts' expectations (Calia, 7/29).

The Wall Street Journal: HealthSouth Profit Nearly Halved, But Beats Expectations
HealthSouth Corp.'s second-quarter profit was cut nearly in half, but results beat expectations as the provider of rehabilitative and surgical health care benefited from an expanded ownership stake in UMass Memorial Health Care and a settlement with the Internal Revenue Service. … HealthSouth, like other health-care companies, is expected to benefit from an improving economy and a wave of newly insured patients who have begun to seek treatment. … Under the Affordable Care Act, up to 26 million people are expected to gain coverage over the next few years through expanded state-run Medicaid programs and through the new, online marketplaces that allow consumers to buy coverage. Many who were previously uninsured already received hospital care, but sometimes racked up bills that were never paid (Armental, 7/28).

In other industry news, doctors' groups are pressuring the government to add more detail when it releases data about how much drug makers pay physicians.

The Wall Street Journal's Pharmalot: Docs Complain To CMS About 'Sunshine' Data Disclosures
A group of medical societies and pharmaceutical industry trade groups is pushing the government to flesh out data that will be published next month showing how much drug makers pay doctors. They sent a letter today to the Centers for Medicare and Medicaid Services to ask the agency to explain what context will be provided to help the public understand the justification for payments, such as speaking fees and grants used to bankroll clinical research (Loftus, 7/28).

Categories: Health Care

State Highlights: Calif. Insurance Commissioner Asks For Premium Power

Kaiser Health News - 11 hours 39 min ago

A selection of health policy stories from California, Georgia, North Carolina, Florida, New Mexico, Kansas and New York.

The Sacramento Bee: Obamacare At Center Of Debate Over California Health Insurance Initiative
As state insurance commissioner, Dave Jones has the power to regulate rates for car and homeowner insurance. He can halt an insurer’s proposed increase if the company can’t justify the higher cost. Health insurance is another matter. The former Democratic lawmaker has spent years working to give elected commissioners regulatory authority over health insurance rates. He’s asking voters in November to give him that ability with Proposition 45, asserting it’s the only way to slow down spiraling premium costs (Cadelago, 7/29).

Georgia Health News: The PA Pipeline: More Trained To Fill Georgia’s Growing Need 
Over the past decade, both Georgia and the nation have seen a surge of PAs. The higher demand comes from several factors: the growth in outpatient clinics; the shortage of primary care physicians; and the added emphasis on cost-effective, team-based medical care. A physician assistant is a health care professional who has the training to perform many of the duties that doctors routinely handle. PAs must be licensed and each must work under the direction of a physician. About 95,000 PAs are practicing across the country, up from 43, 500 in 2003. The number of PAs in Georgia has increased by 67 percent over the past 10 years, now surpassing 3,000. Still, experts say there’s a shortage of them in the state (Miller, 7/28).

The Associated Press: NC Mayor Walks To DC To Protest Hospital Closure
A North Carolina mayor fighting for the hospital that closed in his rural North Carolina town finished his two-week protest march to the nation’s capital, where he told a crowd that his community’s problems are part of a larger health care struggle. “The story of Belhaven is bigger than the trials of a single small town,” Mayor Adam O’Neal said at a news conference Monday in Washington, D.C. The 45-year-old registered Republican started his two-week march of more than 200 miles to protest the closing of Vidant Pungo Hospital in Belhaven on July 1 (Dalesio and Waggoner, 7/28). 

McClatchy: An N.C. Mayor Treks 273 Miles to Help Rural Hospitals
(Adam) O’Neal’s two-week trek was equal parts politics and public relations. In a long-shot bid to reopen Pungo, he was hoping that his shoe-leather odyssey and (Portia) Gibbs’ compelling story would help him get a meeting with, and assistance from, the Obama administration. The White House did contact O’Neal, but no meeting has been scheduled (Pugh, 7/28).

The Wall Street Journal: Court Ruling Discouraging Doctors From Asking About Guns Sparks Concerns
A court ruling upholding a Florida law that discourages doctors from asking patients about gun ownership is stoking alarm among some medical professionals, who view such questions as part of basic patient care. Last Friday, in a 2-1 ruling, the 11th U.S. Circuit Court of Appeals in Atlanta reversed a federal judge in Miami, who struck down the law in 2012 saying that the statute infringed on doctors' free-speech rights (Jones, 7/28).

The Associated Press: Retiree Health Care Agency Proposes Solvency Plan
Taxpayers and public employees would pay an extra $45 million annually under a proposal to improve the finances of a program providing subsidized health care for retired state and local government workers. The Retiree Health Care Authority executive director Mark Tyndall said Monday the Legislature will be asked to phase in the increases in payroll contributions over three years starting in mid-2016. Lawmakers convene in January (Massey, 7/28).

Kansas Health Institute: Five Seek GOP Nomination For Insurance Commissioner
Five candidates are seeking the Republican nomination for Kansas insurance commissioner, an office that has been dominated by Republicans since its creation in 1871. In the 20th century, only one Democrat has held the office, Kathleen Sebelius, who used it as a springboard to become Kansas governor in 2003 and, in 2009, Secretary of Health and Human Services in the Obama administration. It was Sebelius who oversaw the rollout of the signature legislative achievement of the administration’s first term, the Affordable Care Act, or, as it has become known, Obamacare. Not surprisingly in one of the reddest of red states, all five Republicans oppose the health reform law (7/28).

Albany Times Union: A $200M Medicaid Bill
The federal government overpaid New York's Medicaid program at least $200 million and the money should be refunded to Washington, according to findings of a new audit to be unveiled Tuesday. The U.S. Department of Health and Human Services audit focused on the past three years of reimbursements for various services provided under New York's $56 billion Medicaid program (Odato, 7/28).

Categories: Health Care

Consumers Who Receive Insurance Subsidies Will Be Asked To Verify Income, Other Information

Kaiser Health News - 11 hours 39 min ago

Meanwhile, news outlets report the latest on health exchanges in New Mexico, Oregon, Minnesota and Illinois.   

Miami Herald: Consumer Asked to Verify Income, Other Information – Or Risk Losing Government Subsidies For Health Insurance
About eight million people signed up for a health plan through the ACA exchanges. According to the Kaiser Family Foundation, 85 percent of them were eligible for financial aid, and the government is expected to deliver about $10 billion in subsidies during the first year. Healthcare analysts say some consumers will end up paying higher monthly premiums as a result of the verification process, while others may have to repay some or all of their subsidies if they are found to be ineligible. But for some, like (Luis) Martinez, the verification process has become a maze of red tape (Chang and Madigan, 7/28).

Modern Healthcare: Under Pressure To Run Insurance Exchanges, States Wary Of Glitches
New Mexico has decided to stick with HealthCare.gov for 2015. Given the vast technology problems many state-based exchanges experienced during the first open-enrollment period, state officials there and elsewhere remain wary of running their own websites. New Mexico's exchange board voted 11-1 on Friday to delay enrollments in the state's website for another year (Demko, 7/28).

The Oregonian: Cover Oregon Gave Ex-Technology Director Aaron Karjala A $70,000 Contract After Resignation Under Pressure
Cover Oregon has given a $70,000 contract to Aaron Karjala, the health insurance exchange's former top technology official, to assist with litigation against Oracle Corp. Clyde Hamstreet, formerly the exchange's acting executive director, signed the contract with Karjala June 3, less than three months after Gov. John Kitzhaber publicly called for his firing. Oregon is exploring a lawsuit against Oracle over state officials' complaints that the exchange's main technology vendor delivered shoddy work and didn't keep promises (Budnick, 7/28).

The Star Tribune: State Issues Apology For MNcare Error
The state of Minnesota is contacting nearly 9,000 recipients of MinnesotaCare health insurance to clarify a letter that incorrectly stated they would lose their subsidized coverage for at least four months if they didn’t re-enroll by July 31. Minnesota used to make new or tardy MinnesotaCare enrollees wait four months for benefits, but that waiting period went away this year as part of federal health changes and the introduction of the MNsure online health insurance marketplace. The affected recipients will lose their benefits for August if they don’t renew by July 31, but they could get them back by September if they enroll sometime in August (Olson, 7/28).

Chicago Tribune: Local Health Care Outreach Program To Muslims Ends With Ramadan
As the holy month of Ramadan comes to a close on Monday, an annual outreach program aimed at educating Chicago-area Muslims about the importance of health care is finishing up as well. "Ramadan is not just about prayer. It's about community service,"said Abrar Quader, who attended services at different mosques each night with his father, Azher Quader, executive director of the Compassionate Care Network to help inform people about their coverage options under the Affordable Care Act. The program, called "30 Mosques in 30 Days," was the combined effort of the Compassionate Care Network, Get Covered America and Heartland Health Center. Over the last four weeks, volunteers spoke to thousands of Muslims, encouraging them to enroll if they have not already and answering questions about how coverage works (Baer, 7/28). 

Meanwhile, in other implementation policy news -

Los Angeles Times: Employer Health Insurance Mandate A Political Orphan
When President Obama signed the Affordable Care Act, its requirement that large employers provide health coverage or pay a penalty seemed to many supporters a key pillar of the effort to guarantee health coverage to Americans. Four years later and after repeated delays, the so-called employer mandate has become something of an orphan, reviled by the law's opponents and increasingly seen as unnecessary by many of its backers. Twice in the last two years, the Obama administration has put off the penalties, citing difficulties enforcing the mandate (Levey, 7/28).

Categories: Health Care

Viewpoints: Medicare's Future Finances; 'Promising Deal' On VA; Texas 'War On Abortion'

Kaiser Health News - 11 hours 40 min ago

The New York Times’ The Upshot: Good News And Gloom For Medicare, Wrapped In A Mystery
Medicare got some good news Monday, when the trustees who oversee its finances announced that the fund that pays for hospital care will remain solvent until 2030, four years longer than its forecast from last year. But that good news came wrapped up in the usual long-term bad news: The aging of baby boomers means that Medicare’s long-term finances are in trouble, even if the next decade is looking much better (Margot Sanger-Katz, 7/28). 

Los Angeles Times: Good News And Warnings In The Social Security And Medicare Reports
The release of the annual trustees reports for Social Security and Medicare customarily give rise to an outburst of disinformation from the enemies of these social insurance programs -- that comes with the territory when you're putting out documents of hundreds of pages densely packed with graphs, charts and statistics. There may be less of that with the release of both reports Monday (months after the statutory deadline). That's because "the news is essentially that there is no news" in the reports, as Kathy Ruffing of the Center on Budget and Policy Priorities, a leading expert on Social Security, said during a conference call Monday on the Social Security report (Michael Hiltzik, 7/28). 

The Wall Street Journal: A Promising Deal On Reforming Veterans Affairs
Veterans across the nation are waiting too long for the care they need, and some of them are dying while awaiting treatment. Far-reaching efforts to establish public-private partnerships are needed to meet the challenges facing the Department of Veterans Affairs. On Monday, the chairmen of House and Senate committees announced a deal to provide $10 billion in emergency funding for veterans to obtain care outside the VA system. The draft bill is a step in the right direction and should be approved by the joint conference committee and passed by Congress before the August recess (Robert Morgenthau, 7/28). 

The Wall Street Journal’s Political Diary: The Veterans Affairs Deal
House and Senate negotiators haven't released all the details of a plan to overhaul the Department of Veterans Affairs. But we're happy to see that a draft bill leaked over the weekend does include a provision that would allow veterans to receive care from a non-VA facility. News earlier this year that patient wait lists at VA facilities were being doctored to reflect shorter wait times and enable managers to earn performance bonuses produced a national outcry and cost Veterans Affairs Secretary Eric Shinseki his job. Never mind that at least three inspector general reports between 2005 and 2012 highlighted the very same waitlist problems, as did a Government Accountability Office report released way back in 2000 (Jason L. Riley, 7/28).

Los Angeles Times: The Genesis Of Obamacare’s Disputed Provision On Insurance Subsidies
The Times ran multiple opinion pieces last week -- by me, by the editorial board and by op-ed contributors -- arguing that, contrary to what the U.S. Circuit Court of Appeals for D.C. ruled, the 2010 healthcare law makes insurance subsidies available in every state, not just the 14 that established their own insurance exchanges. To which some readers have asked, reasonably enough, why does the text of the law seem so clearly to say otherwise? For example, Michael Robertson, a tech entrepreneur who's no fan of Obamacare, asked via Twitter, "Why mention 'state exchanges' in the context of subsidies if everyone gets them? That's highly illogical" (Jon Healey, 7/28). 

Politico: The Flip-Flopping Architect Of The ACA
The administration's defenders responded to the Halbig case by insisting that Congress never intended to withhold subsidies from residents of states that did not establish exchanges. Like the Obama administration, [Jonathan] Gruber told the D.C. Circuit that this idea is "implausible." ... Gruber then became part of the story on Thursday when a video surfaced in which he espouses the very interpretation of the law he now publicly derides .... When the chief architect of the PPACA admits it withholds tax credits in uncooperative states, that establishes that the plaintiffs' interpretation of the statute in Halbig was not only plausible but that it had currency among the law’s authors (Michael Cannon, 7/28).

Los Angeles Times: Here's The Single Best Analysis Of The Halbig Anti-Obamacare Ruling
Northwestern University law and political science professor Andrew Koppelman moves past the absurd legal theory underlying the Halbig ruling on the Affordable Care Act -- in which a federal appeals court invalidated subsidies provided to insurance buyers on federal, as opposed to state, insurance exchanges -- to ask why the lawsuit's backers brought the case in the first place (Michael Hiltzik, 7/28).

The Washington Post: North Carolina Republicans Put Ideology Above Lives
On July 1, the hospital in rural Belhaven, N.C., closed — a victim, in part, of the decision by the state’s governor and legislature to reject the expansion of Medicaid under Obamacare. Six days later, 48-year-old Portia Gibbs, a local resident, had a heart attack. The medevac to take her to the next-nearest hospital (as many as 84 miles away, depending on where you live) didn’t get there in time (Dana Milbank, 7/28). 

The Washington Post: Texas’s War On Abortion Is Shuttering Clinics Throughout The Lone Star State
Abortion remains legal in the United States, but states such as Texas are erecting legal impediments before clinics that perform the procedure. In effect, 40 years after the Supreme Court's decision in Roe v. Wade established the right to first-trimester abortion, pro-life groups and lawmakers are negating its effects. Last year, lawmakers in Texas forced through legislation that amounts to a frontal assault on the state's abortion providers. More than 40 clinics around the state performed the procedure legally and safely when the law took effect a year ago. Today fewer than half of those clinics are still in business in a state where the population has more than doubled over four decades (7/28). 

The New York Times' The Upshot: The Problem With 'Pay for Performance' In Medicine
"Pay for performance" is one of those slogans that seem to upset no one. To most people it's a no-brainer that we should pay for quality and not quantity. ... So it's no surprise that pay for performance has been an important part of recent reform efforts. But in reality we’re seeing disappointingly mixed results. Sometimes it's because providers don't change the way they practice medicine; sometimes it's because even when they do, outcomes don't really improve (Aaron E. Carroll, 7/28). 

The Washington Post: Sick? Now You Can Stay Home.
Something strange is about to happen [in New York] on Thursday: Lots of workers who've never done so before are probably going to call in sick. And that's a good thing. The Big Apple, you see, is joining a handful of other trailblazing cities such as Washington, San Francisco and Newark in guaranteeing workers what Congress has not: mandatory sick days. Thursday will represent the first day that the newly covered workers can use the sick leave hours they have legally accrued (Catherine Rampell, 7/28). 

Reuters: Want To Avoid A Pandemic? Here’s A Good Way To Start
Over the past two months, a series of mishaps at the CDC and NIH — involving mishandled anthrax, mislabeled influenza and misplaced smallpox — has alarmed the scientific community. The common theme surrounding all of them is human error. ... These mishaps show why we need to stop conducting certain types of research on strains of flu virus that could cause worldwide epidemics, or pandemics. In these types of research — which involve live, intact viruses that can spread from person to person — the risks outweigh the benefits (Carlos Moreno, 7/28).

Journal of the American Medical Association: Quantifying A Nonnotifiable Disease In The United States
In the United States, public health surveillance has evolved from a focus on monitoring infectious diseases to also tracking injuries, chronic diseases, birth defects, environmental and occupational exposures, and risk factors. Despite this evolution of surveillance topics, many conditions still are not notifiable to federal public health officials nor are there surveillance systems in place to capture such conditions. The lack of morbidity data for nonnotifiable conditions makes it difficult to access accurately the populations at greatest risk and the true economic and societal burden of such diseases. New approaches are needed to more accurately quantify nonnotifiable conditions of interest in the United States, such as amyotrophic lateral sclerosis (ALS) (D. Kevin Horton, Paul Mehta and Vinicius C. Antao, 7/24).

Categories: Health Care

Political Cartoon: 'Juris Doctor?'

Kaiser Health News - 11 hours 41 min ago

Kaiser Health News provides a fresh take on health policy developments with "Juris Doctor?" by Gary Varvel.

Meanwhile, here's today's haiku:

THE QUESTION REMAINS...

One court, it rules "yea"
While another, it says "nay"
So what happens now?
-Joseph Steinbock 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

First Edition: July 29, 2014

Kaiser Health News - 13 hours 23 min ago

Today's headlines include coverage of the latest Medicare trustee report and the details of the veterans care legislation on Capitol Hill.

Kaiser Health News: Good News For Boomers: Medicare’s Hospital Trust Fund Appears Flush Until 2030
Kaiser Health News staff writer Julie Rovner reports: “Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act” (Rovner, 7/28) Read the story.

Kaiser Health News: Insuring Your Health: Medicare Experiment Could Signal Sea Change For Hospice
Kaiser Health News consumer columnist Michelle Andrews writes: “Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited version of that conversation” (Andrews, 7/29). Read the column.

The New York Times: Gains Seen From Medicare, But Social Security Holds Steady
Medicare’s financial condition improved significantly in the last year, thanks in part to the Affordable Care Act, but the outlook for Social Security is basically unchanged, the Obama administration said Monday (Pear, 7/28).

The Washington Post: Medicare Finances Improve Partly Due To ACA, Hospital Expenses, Trustee Report Says
The annual report, issued Monday by trustees overseeing the government’s two largest entitlement programs, found little change overall in the finances of Social Security. The trustees warned, however, that the part of Social Security that pays monthly benefits to people with disabilities is especially fragile and, without changes, will start to run short of money for benefit checks in 2016 (Goldstein, 7/28).

Los Angeles Times: Medicare Finances Improve As Healthcare Inflation Slows, Trustees Say
Medicare Part B premiums are expected to remain the same through 2015 because of that improvement, Health and Human Services Secretary Sylvia Burwell told reporters as the report was released. Medicare is "considerably stronger than it was just four years ago," she said (Lauter, 7/28).

The Wall Street Journal: Medicare, Social Security Disability Fund Headed In Different Directions
The slowdown in Medicare spending over the past few years—mirroring slower growth in health costs reported by private insurers—has stumped economists, lawmakers and hospital administrators. Many believe it stems from the recent economic downturn, but the lower spending growth has persisted throughout the recovery. Sylvia Mathews Burwell, secretary of the Department of Health and Human Services, said Medicare's rapid improvement since the 2010 passage of the Affordable Care Act suggests a direct link to the health law. Her agency cited provisions of the law that give hospitals incentives to avoid readmitting patients, saying that led to 150,000 fewer readmissions in 2012 and 2013 (Paletta, 7/28).

The Associated Press: Medicare’s Own Health Looking Better, Report Says 
Trustees issued their annual report Monday on the financial health of the government’s two largest benefit programs, which together accounted for 41 percent of all federal spending last year. Though both are “fundamentally secure,” said Treasury Secretary Jacob Lew, “The reports also remind us of something we all understand: We must reform these programs if we want to keep them sound for future generations” (7/28).

Politico: Medicare Financial Outlook Brightens
White House officials emphasized the importance of cost-control measures woven into Obamacare, though the trustees said they weren’t prepared to say which of the factors was most important (Faler, 7/28).

The Washington Post’s The Fact Checker: Would Boosting The Eligibility Age For Medicare Save It From Bankruptcy?
Rep. Scalise made these remarks in response to host Chris Wallace’s observation that House Republicans have proposed to raise the eligibility age for Medicare over the next 10 years from 65 to 70. We’ve explained to readers before about the error—by politicians in both parties—of saying Medicare is going “bust” or into “bankruptcy.” Let’s have a refresher course on that, and also explore Scalise’s suggestion that boosting the eligibility age would save the program, “for future generations” (Kessler, 7/29).

Los Angeles Times: Employer Health Insurance Mandate A Political Orphan
When President Obama signed the Affordable Care Act, its requirement that large employers provide health coverage or pay a penalty seemed to many supporters a key pillar of the effort to guarantee health coverage to Americans. Four years later and after repeated delays, the so-called employer mandate has become something of an orphan, reviled by the law's opponents and increasingly seen as unnecessary by many of its backers. Twice in the last two years, the Obama administration has put off the penalties, citing difficulties enforcing the mandate (Levey, 7/28).

NPR: After 5 Weeks Of Haggling, Congress Inks Bipartisan VA Bill
Congress has reached a bipartisan deal to reform the Department of Veterans Affairs, after nearly two months of tense negotiations (Lawrence, 7/28).

The New York Times: Deal Allots $17 Billion For Overhaul of V.A. Health Care System
House and Senate negotiators announced an agreement Monday on legislation that would allocate about $17 billion to overhaul the Department of Veterans Affairs’ sprawling and beleaguered health care system. But the deal does not give the department everything that officials there have said is needed to fix its problems (Schleifer and Oppel Jr., 7/28).

The Wall Street Journal: Lawmakers Unveil $17 Billion Fix For Veterans Affairs
The agreement still needs the green light from a committee of House and Senate lawmakers, after which it will need to be approved by both chambers before being sent to the White House for the president's signature. About $12 billion of the total is considered emergency funding, which doesn't need to be offset by cuts elsewhere in the budget—a decision that could still bring objections from more conservative Republicans. Mr. Miller said he was optimistic Congress would act this week to pass the bill (Kesling and Crittenden, 7/28).

The Washington Post: Negotiators Predict Easy Passage Of Bill To Overhaul Department Of Veterans Affairs
A sweeping proposal to revamp the Department of Veterans Affairs and the nation’s medical care for military veterans should have enough support to pass the House and Senate this week before lawmakers leave town for a summer recess, lead negotiators said Monday. The assurances provided a hopeful start to a week in which congressional leaders are expected to resolve several lingering issues before lawmakers head home for their five-week summer break. In addition to approving changes to veterans’ medical care, negotiators are working on deals to continue federal funding for the nation’s major road projects and whether to grant President Obama’s request for billions of dollars to deal with the historic influx of illegal immigrants along the U.S.-Mexico border (O’Keefe, 7/28).

The Associated Press: Deal To Improve Veterans’ Health Care Costs $17B
The bill includes $10 billion in emergency spending to make it easier for veterans who can’t get prompt appointments with VA doctors to obtain outside care; $5 billion to hire doctors, nurses and other medical staff; and about $1.5 billion to lease 27 new clinics across the country, lawmakers said. The bill also would expand a scholarship program for veterans, allow all veterans to qualify for in-state college tuition and grant the VA secretary authority to immediately fire senior executives, while providing employees with streamlined appeal rights (7/28).

Politico: How The VA Deal Came Together
Top negotiators on a deal to reform the Department of Veterans Affairs turned to an unusual strategy that helped them arrive at Monday’s agreement: knock-down, drag-out arguing. Just last week, talks appeared on the verge of collapse as the leaders of a conference committee — Sen. Bernie Sanders (I-Vt.) and Rep. Jeff Miller (R-Fla.) — publicly slugged it out over differences on how to pay for the bill. Miller said Sanders was hurling “grenades” at Republicans rather than negotiating while Sanders called the GOP’s behavior “sad” (French and Everett, 7/28).

USA Today: Bipartisan Deal Would Add Billions For Veterans’ Care 
Key members of Congress have reached a bipartisan deal to use $10 billion in emergency money to allow veterans to seek private care if they face long wait lines at facilities run by the Department of Veterans Affairs. The deal opens the door for Congress to pass a bill this week before departing for a month-long recess (Kennedy, 7/28).

The Wall Street Journal: Aetna Beats Estimates, Raises Outlook
Aetna Inc. said its second-quarter profit rose as the insurer posted record medical membership and revenue, while it continued to enjoy benefits from its acquisition of Coventry Health Care Inc. The results surpassed analysts' expectations (Calia, 7/29).

The Wall Street Journal: HealthSouth Profit Nearly Halved, But Beats Expectations
HealthSouth Corp.'s second-quarter profit was cut nearly in half, but results beat expectations as the provider of rehabilitative and surgical health care benefited from an expanded ownership stake in UMass Memorial Health Care and a settlement with the Internal Revenue Service. … HealthSouth, like other health-care companies, is expected to benefit from an improving economy and a wave of newly insured patients who have begun to seek treatment. … Under the Affordable Care Act, up to 26 million people are expected to gain coverage over the next few years through expanded state-run Medicaid programs and through the new, online marketplaces that allow consumers to buy coverage. Many who were previously uninsured already received hospital care, but sometimes racked up bills that were never paid (Armental, 7/28).

The Wall Street Journal’s Pharmalot: Docs Complain To CMS About ‘Sunshine’ Data Disclosures
A group of medical societies and pharmaceutical industry trade groups is pushing the government to flesh out data that will be published next month showing how much drug makers pay doctors. They sent a letter today to the Centers for Medicare and Medicaid Services to ask the agency to explain what context will be provided to help the public understand the justification for payments, such as speaking fees and grants used to bankroll clinical research (Loftus, 7/28).

The New York Times: Advocates Shun ‘Pro-Choice’ To Expand Message
That shift might seem surprising in this political season, when there has been a renewed focus on reproductive issues like access to abortion and birth control. Yet advocates say that the term pro-choice, which has for so long been closely identified with abortion, does not reflect the range of women’s health and economic issues now being debated (Calmes, 7/28).

The Wall Street Journal: Court Ruling Discouraging Doctors From Asking About Guns Sparks Concerns
A court ruling upholding a Florida law that discourages doctors from asking patients about gun ownership is stoking alarm among some medical professionals, who view such questions as part of basic patient care. Last Friday, in a 2-1 ruling, the 11th U.S. Circuit Court of Appeals in Atlanta reversed a federal judge in Miami, who struck down the law in 2012 saying that the statute infringed on doctors' free-speech rights (Jones, 7/28).

The Associated Press: NC Mayor Walks To DC To Protest Hospital Closure
A North Carolina mayor fighting for the hospital that closed in his rural North Carolina town finished his two-week protest march to the nation’s capital, where he told a crowd that his community’s problems are part of a larger health care struggle. “The story of Belhaven is bigger than the trials of a single small town,” Mayor Adam O’Neal said at a news conference Monday in Washington, D.C. The 45-year-old registered Republican started his two-week march of more than 200 miles to protest the closing of Vidant Pungo Hospital in Belhaven on July 1 (7/28). 

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

Categories: Health Care

Sales of Alcohol on Sunday Mornings

On July 23, 2014, Governor Deval Patrick signed into law House Bill 228, "An Act Permitting Sales of Alcohol on Sunday Mornings."  Chapter 182 of the Acts of 2014, amends Chapter 136, Section 6, Paragraph 52 by striking out the words "12:00 noon" and inserting the following words: "10:00 a.m."

The bill allows Massachusetts liquor store owners to sell alcohol to patrons before noon on Sundays.  However, it won't take effect for another three months.

Steve Annear, staff digital writer at Boston Magazine, posted on their Boston Daily blog on July 25, 2014, an overview of the law in an article entitled, "Massachusetts Liquor Stores Can Soon Sell Alcohol Before Noon on Sundays: Homemade Bloody Marys and Mimosas Have Never Sounded So Enticing".

For additional information, see the Massachusetts Alcoholic Beverages Control Commission (ABCC) website.

Categories: Research & Litigation

Medicare Experiment Could Signal Sea Change For Hospice

Kaiser Health News - 15 hours 46 min ago

Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited  version of that conversation.

Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean. 

A. The short, quick elevator answer is that all hospice care is palliative care -- but not all palliative care is hospice. Palliative care is a team-based type of care focused on maximizing the quality of life for people and their caregivers at any stage of illness. It focuses on treating the pain, stresses and symptoms of serious illness. The emphasis is on need, not prognosis or how long you might have to live.

In contrast, the hospice benefit, which was written into the Medicare statutes about 25 years ago, had a number of limits in it to control spending. 

Diane Meier (Photo courtesy of Mount Sinai Hospital)

First, two physicians have to certify that the patient will likely be dead in six months if the disease follows its natural course. Second, the patient or family members need to sign a paper giving up regular insurance coverage for disease treatment in order to get access to hospice, a forced either/or choice between life-prolonging treatment and palliative care. It was an attempt to save money. Most people need—and want—both types of treatment.

But we can’t predict who’s going to die in six months, in part because of the variation in people. We can’t really tell if someone is going to keep motoring along. The other thing is that many people want to keep receiving disease treatment, because it is helping them to get along and keeping up their quality of life. As someone who has counseled many people with serious illnesses, I can tell you it is very painful to tell people they have to sign away their rights to treatment. It’s like hitting a man when they’re down.

Q. The Centers for Medicare & Medicaid Services recently announced that the agency is launching the Medicare Care Choices Model, a program created under the health law that allows hospice patients with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS to receive not only hospice care but also curative care.

More From This Series Insuring Your Health

Does this experiment signal a noteworthy change in approach toward caring for dying patients?

A. I think it does. I think it's a recognition that this forced choice between palliative care and life-prolonging treatment is irrational.

Unfortunately the way the new benefit was written is that the only people who can be eligible [for the pilot] are those who would be eligible for hospice, that is, people very likely to be dead within a few months. People tend to be pretty damn sick by the time they become eligible for hospice. I’m not really sure what access to curative care means in that context. If these patients could have been "cured" they wouldn't be eligible for hospice.

It’s a misnomer to say they’re going to be cured. There are very few diseases that we cure in U.S.medicine. In most cases what we’re talking about is life-prolonging treatment, and in most cases that’s palliative treatment. It makes people feel better. If you have emphysema and I give you broncodilators and steriods to open up your airways, it will prolong your life, and it will also make you feel better.

Q. I understand that some hospices say they won’t participate in the new program because the CMS payment rate of $400 per beneficiary per month isn’t enough cover their costs, which include coordinating beneficiaries' care with curative and other providers, and providing counseling and support services for beneficiaries and their families (curative care services are covered by the regular Medicare program). Is that rate too low to provide the necessary services? 

A. You can do something that’s fairly telephone intensive for $400. You can have staff get training in symptom management and have them talk to family members, which are usually the ones who are calling with questions. The problem is if you have to dispatch a human being to the person’s home. It’s difficult to do that for $400. And when someone calls after hours you often need to do that. It’s really hard to provide 24/7 visiting capacity with that amount of money.

Remember: These patients are not stable, they are the sickest patients in our health care system. They need a lot of hand holding. Availability and responsiveness are key and  that’s expensive.

The patients in this demonstration project may be much more complicated to take care of than regular hospice patients. Not only are they dealing with the conseqences of disease but with the consequences of treatment, the side effects of chemo, for example. Hospice staff are not accustomed to working with patients who want continued disease treatment.

I think it’s going to be challenging but I think it will lead to some really creative solutions. Hospice organizations may look to build out a more comprehensive safety net by partnering with other community providers like Meals on Wheels or local aging services or transportation providers. And that would be really good.

Q. What does the research show about people who receive both hospice or palliative care and life-prolonging treatment?

A. There are now several studies that show that patients who receive both palliative care and life-prolonging care actually live longer than those who receive life-prolonging treatment alone.It makes sense. People aren’t in excruciating pain, they’re not depressed, their families feel confident in their ability to care for their loved one. And if, very importantly, people are able to avoid the very real risks of hospitals, it’s no surprise that they live longer.

They’re not getting less life-prolonging treatment with palliative care, they’re having less crisis. They reduce emergency care use because they don’t need it and that saves money.

If palliative care were a drug, I’d be rich.

Q. What could that mean for this new CMS pilot program?

A. Let’s say hospices can do this for $400. Think about the pressure to scale that up to people whose prognosis is two years or three years or even longer.

So I can see why CMS is being really cautious. It’s going to be important to demonstrate that if you take people and do this, that it won’t break the bank. My prediction is that it will actually be less expensive to provide both approaches at the same time precisely because it will lead to less need for costly emergency and crisis care.

Q. What’s next on the horizon for palliative care?

A. We’ve gotten pretty far with integrating palliative care into hospitals. More than 60 percent of hospitals with more than 50 beds nationwide have programs. But most people are living at home. Right now it’s very hard to access palliative care if you’re not on hospice or in the hospital. In the next 10 years, we need to integrate palliative care into home care, cancer center care, dialysis units, nursing homes and other settings.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Care

Good News and Gloom for Medicare, Wrapped in a Mystery

Medicare -- New York Times - 20 hours 55 min ago
Health care experts can’t explain the encouraging spending slowdown, but the long-term outlook remains bleak.
Categories: Elder, Medicare

Outlook for Medicare Trust Fund Improves, Though Shortfall Looms, Report Finds

Medicare -- New York Times - 20 hours 55 min ago
Spending on hospital care was lower than expected, but trustees say Medicare and Social Security funds need shoring up.
Categories: Elder, Medicare

Pages

Subscribe to Mass Legal Services aggregator