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How Sunday Came to be Established as a Day of Rest in France

In Custodia Legis - 7 hours 32 min ago

The following is a guest post by Nicolas Boring, foreign law specialist at the Law Library of Congress.  Nicolas has previously contributed guest posts on French Law – Global Legal Collection Highlights and Napoleon Bonaparte and Mining Rights in France.

It is no secret that French workers benefit from a generous amount of vacation time.  Indeed, employees accrue 2.5 days of paid leave per month worked – which adds up to 30 days, or six weeks, per year.

However, it was not always thus, as I was reminded by a recent research assignment about the history of Sabbatarian laws in France.  Indeed, while some might debate the amount of vacation time that employees should be legally entitled to, we usually take it for granted that most workers should be entitled to a weekend.  But the story of the French law prohibiting employers from making employees work more than six days a week [Code du Travail (Labor Code), art. L3132-1], is quite tortuous.

Cover of a practical guide, published two years after the law establishing a mandatory weekly day of rest, to help employers and employees understand their rights and obligations under that law. Photo Source: Bibliothèque nationale de France [http://gallica.bnf.fr/ark:/12148/bpt6k6121420f/f1.image]

Before the Industrial Revolution, people generally did not work on Sundays for religious reasons.  This tradition was given force of law by several French kings:  Charles VI in 1388, Louis IX in 1461, and Henry IV in 1598 [Gérard Vachet, Repos hebdomadaire (Weekly Rest), in Antoine Lyon-Caen (ed.), RÉPERTOIRE DE DROIT DU TRAVAIL (LABOR LAW REFERENCE), Vol. IV, (Dalloz, 2006), p.2].

These laws fell by the wayside after the French Revolution, when the Napoleonic regime re-established the Gregorian calendar. For a few years, the revolutionaries implemented a new calendar in which the traditional seven-day week was replaced by ten-day “décades” – Napoleon did away with that and returned to the standard Gregorian calendar.  It was generally believed that the old tradition of using Sunday as a day of rest would resume.  This did not happen, however, as the technological and economic changes brought about by the rise of industrialism encouraged many employers to require their employees to work throughout the week.  An 1814 law made it illegal to work on Sundays and on legal holidays, but this law fell into disuse during the time of the July Monarchy (1830) when Catholicism ceased to be France’s official state religion.

After 1830, a vast number of French workers had to be at their jobs every day, seven days a week.  There was growing awareness and concern for the social and public health consequences of this state of affairs.   But change was very slow in coming.  A few laws were passed in 1841, 1851, and 1892, instituting a mandatory day of rest for children, apprentices, and women, respectively.  But it was not until 1906 that the concept of a mandatory day of rest was expanded to all salaried employees of commercial and industrial establishments by the Loi du 13 juillet 1906 établissant le repos hebdomadaire en faveur des employés et ouvriers (Law of July 13, 1906, Establishing Weekly Rest for the Benefit of Employees and Workers), which also set Sunday as the normal day of rest.  A copy of this 1906 law can be found on the website of the French Ministry of Labor and Employment.

Categories: Research & Litigation

State Highlights: Mass. Health Care Costs Grow Smaller 2.3 Percent; New Rules In Calif. For Inmates With Mental Illness

Kaiser Health News - 7 hours 33 min ago

WBUR:  A First-Year Victory In The Mass. Fight To Control Health Costs
Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate. The magic number, the one that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth (Bebinger, 9/2).

Boston Globe: Spending On Health Care Rises In Mass.
Spending at Massachusetts’ biggest health insurer and health care provider helped drive overall health care spending well above inflation last year, as the state’s efforts to control rising costs met mixed success, according to a report to be released Tuesday. Spending at Blue Cross Blue Shield of Massachusetts jumped 3.65 percent, and as much as 4 percent for some Partners HealthCare patients last year, compared with an inflation rate of 1.4 percent in the Boston metropolitan area (McKluskey, 9/2).

Los Angeles Times: New Cells Will Lessen Solitary Confinement For Mentally Ill Inmates
State prison officials plan to open special solitary confinement units for the mentally ill as part of an effort to comply with court orders to improve their care. The cellblocks -- while still isolating prisoners from the rest of the population and largely from one another -- will increase the time those inmates are allowed outside their cells and the amount of treatment they receive (St. John, 8/29).

The New York Times: Federal Judge Approves California Plan To Reduce Isolation Of Mentally Ill Inmates
The revised policies, filed in Federal District Court on Friday by the California Department of Corrections and Rehabilitation, were drafted in response to an order issued by Judge Lawrence K. Karlton last April. When put in place, they should greatly reduce the number of mentally ill prisoners held in so-called Security Housing Units, where prisoners remain in their cells for 23 or more hours a day, and in several other types of isolation units throughout the state (Goode, 8/29).

Los Angeles Times: Ventura County Medi-Cal Health Plan Probed
California officials are investigating financial dealings between Ventura County's Medi-Cal health plan and a key outside contractor, Xerox Corp., The Times has learned. The California attorney general's office has issued a subpoena to Gold Coast Health Plan for records related to its work with a Xerox unit, Affiliated Computer Services. Xerox is a major government contractor for Medicaid and other health programs nationwide (Terhune, 8/29).

Los Angeles Times: Despite Fractures Among Labor, Paid Sick Days Bill Clears Legislature 
A bill that would significantly expand working Californians' access to paid time off for sick leave cleared the Legislature early Saturday morning. The measure by Assemblywoman Lorena Gonzalez (D-San Diego) would require employers to give their workers at least three paid sick days per year. Supporters say it would provide paid leave to approximately 6.5 million workers in the state (Mason, 8/30).

Reuters: California Governor Lauds Passage Of Historic 'Sick Leave' Bill
If Brown signs the measure into law, California will join Connecticut as the only states mandating paid sick leave, according to the National Conference of State Legislatures (O'Brien, 8/30). 

Kaiser Health News: Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County
Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week. The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required (Gorman, 8/29).

USA Today: U Of Oregon Grads Plot The Future Of Rural Health Care 
While many college graduates spent their summer looking for entry-level work, two recent graduates of the University of Oregon -- Oliver Alexander, 22, and Orion Falvey, 24 -- were getting ready to open their own business. The duo are co-founders of Orchid Health, which opened its first clinic in the rural town of Oakridge, Ore. this August. ... Orchid Health offers memberships to patients for a monthly free. For non-members the company accepts patients with Medicare and Medicaid and offers cash walk-in prices (Maiman, 8/30).

The Associated Press: Indiana Hospitals Fight State's Salary Disclosure Law
Indiana county hospitals are seeking an exemption from a requirement that they make the salaries of doctors and staff public, saying doing so puts them at a disadvantage with their private counterparts. State law requires that salaries of public employees be made public. They can be accessed through the Indiana Gateway for Government Units (9/1). 

The Seattle Times: As Newly Insured Seek Care, Rural Doctor Shortage Worsens
As more people get health-insurance coverage through the Affordable Care Act, the doctor shortage in rural areas is worsening. In Port Angeles, for example, a local clinic is turning away 250 callers a week (Stiffler, 9/1).

The Seattle Times: New WSU Health Clinic Won't Be Restricted By Catholic Directives
Bylaws for a new health clinic that will open on the campus of Washington State University Spokane will be changed to ensure that care provided at the clinic isn’t restricted by Catholic health-care directives. The announcement Friday comes two days after the American Civil Liberties Union expressed concern about the clinic’s bylaws and asked Washington State University regents to address the matter at their Sept. 11 meeting (Hatch, 8/29).

The Denver Post: Saline IV Shortage: Searching For A Solution
Colorado hospitals are working overtime to find stock and are changing their daily practices to protect patients in the wake of an urgent national shortage of normal saline. Normal saline, the single most-used medicine, is little more than salty water that closely matches blood serum's natural salt levels, according to Dr. Eric Lavonas, the chairman of the Pharmacy and Therapeutics Committee at Denver Health (Mocine-McQueen, 8/31).

Earlier, related KHN story: Shortage Of Saline Solution Has Hospitals On Edge (Dembosky, 6/25)

The Denver Post: Colorado Medical-Marijuana Caregiver Rules Could Pinch Young Patients
Dozens of families who moved to Colorado to treat their severely disabled children with a special kind of marijuana could lose access to the treatment under new rules proposed by the state health department. The proposed rules would stop medical marijuana caregivers from serving more than 10 patients at a time (Ingold, 9/2). 

Charlotte Observer: Putting Teeth In Health Reform: Dental Clinics Aren't Enough 
When hundreds of desperate dental patients converge on the Charlotte Convention Center next week, it will be a testament to civic generosity and systemic failure. Over the past decade, North Carolina’s Missions of Mercy program has become one of the nation’s largest providers of free mobile dental clinics (Doss Helms, 9/1). 

Categories: Health Care

More Big Firms Shifting To High-Deductible Health Plans

Kaiser Health News - 7 hours 43 min ago

The New York Times examines the movement among large employers towards high-deductible plans that shift more health care costs to workers. Meanwhile, The Wall Street Journal looks at how the ACA may affect job-based plans next year.

The New York Times: High-Deductible Health Plans Weigh Down More Employees
Just as employers replaced pensions with retirement savings plans, more large companies appear to be in the midst of a similar cost-sharing shift with health plans. Besides making workers responsible for more of their care, employers hope these plans will motivate employees to comparison-shop for medical services — an admirable goal but one that some say is hard to achieve. ... With high-deductible health plans, consumers pay for all their medical services — at the insurer's negotiated rate — until they meet their deductible. After that, consumers typically pay coinsurance, which is a percentage of each service — say 10 to 35 percent — until they reach the out-of-pocket maximum (Siegel Bernard, 9/1).

The Wall Street Journal: Get Ready For Health-Insurance Enrollment 
If you get health insurance through your workplace, you'll probably have a chance this fall to make important decisions about your coverage and costs. Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act (Johnson, 8/30). 

Categories: Health Care

Viewpoints: Medicaid Expansion Spreading; 'GOP's Woman Problem;' Praising Medicare

Kaiser Health News - 7 hours 50 min ago

The New York Times: Endless Assault On Health Care Reform
The latest jerry-built effort to destroy health care reform could be defeated in the full federal appeals court in the District of Columbia. In July, a three-judge panel of that court — taking a ridiculously crabbed view of a section in the law — ruled 2-to-1 that tax-credit subsidies are allowed only for those buying insurance on a health exchange "established by the state." Therefore, it said, no subsidies for people in 36 states where the federal government set up the exchange because the states refused to do so. There is no evidence that Congress intended to make this distinction, which defies the law's central purpose (8/30).

The Washington Post: Playing Politics With Health Care
We would congratulate Pennsylvania Gov. Tom Corbett (R), if it were seemly to commend public officials for doing the obvious. On Thursday, Mr. Corbett finalized a bargain with federal officials to expand Medicaid, the state-federal program that provides health-care coverage to low-income Americans, in Pennsylvania. Five hundred thousand needy Pennsylvanians stand to get care at almost no price to the state. Reform may even be revenue positive. It should not have taken this long (8/31).

The Washington Post: When Robert Bork Called Congress Suing The President A 'Monstrosity'
Before leaving for its August recess, the Republican-led House of Representatives voted to sue President Obama over his failure to fully implement a provision of the Affordable Care Act. Some Democrats have characterized this legal action as unprecedented, frivolous and even outrageous. But it brings back a lot of memories for me, some of which may be uncomfortable for my fellow Democrats and some of which ought to give pause to conservative Republicans rushing to support the lawsuit. In the 1980s, the tables were turned (Michael D. Barnes, 8/29).

The Wall Street Journal: Morning After In America
On Wednesday the Congressional Budget Office updated its fiscal and economic outlook for the next decade, and to adapt Ronald Reagan for a new era, the report could be called the Morning After in America. ... Entitlements will cruise on autopilot by 4% this year, despite an historically low increase of 2% in Medicare that could be temporary. The major budget driver now is Medicaid, which will surge by 15% on ObamaCare's expansion of that program. The figure would be still higher had not 23 states opted out to protect the integrity of their own budgets. Some 85 cents of every increased dollar of spending over the next 10 years will flow to entitlements, mainly health care (8/29).

Politico: The GOP's Woman Problem
The GOP's autopsy, trainings and memos made one thing very clear: The party does not understand that its problem with female voters has nothing to do with presentation, rhetoric or outreach. The problem is, and has always been, Republican policies. Policies that prevent us from moving closer to equal pay for women, policies that would make it more difficult for women to exercise their right to vote, policies that would allow insurance companies to discriminate against women and policies that would allow politicians and employers to get involved in medical decisions that belong between a woman and her doctor (Rep. Debbie Wasserman Schultz, D-Fla., 8/31).

The New York Times' Upshot blog: What Happens When Health Plans Compete
As a candidate in 2008, President Obama promised that health reform would reduce family premiums by up to $2,500, equivalent today to about a 15 percent reduction from the 2013 level. Though Mr. Obama might have been including the effects of premium subsidies in his calculation, a key premise of the Affordable Care Act is that competition among health insurers will drive premiums downward. So it’s worth asking: How much savings can additional competition produce? (Austin Frakt, 9/1).

The New York Times: The Medicare Miracle
For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all. When it comes to ensuring that Americans have access to health care, the message of the data is simple: Yes, we can (Paul Krugman, 8/31).

The New York Times: Ways To Reduce The Kidney Shortage
While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways to increase the supply without paying for human organs, which is prohibited by the 1984 National Organ Transplant Act and generally opposed by the World Health Organization (9/1).

The Wall Street Journal: Why Doctors Are Sick of Their Profession
All too often these days, I find myself fidgeting by the doorway to my exam room, trying to conclude an office visit with one of my patients. When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I'd be: impatient, occasionally indifferent, at times dismissive or paternalistic. Many of my colleagues are similarly struggling with the loss of their professional ideals (Dr. Sandeep Jauhar, 8/29).

Los Angeles Times: Fines Alone Won't Fix 'Patient Dumping' Of Homeless
Los Angeles City Atty. Mike Feuer announced on Wednesday that his office had reached an agreement with Glendale Adventist Medical Center over allegations that the respected hospital had improperly discharged a homeless patient to the streets of skid row. ... Feuer is to be commended for his efforts to thwart a vile practice .... But if it's challenging for outreach agencies to find the right services and housing for the homeless, it's just as daunting, if not more so, for hospitals required to do it as a condition for discharging homeless patients (8/31).

The Wall Street Journal: Heading Off A Bigger Ebola Catastrophe
[T]he Obama administration has stressed that the disease is highly unlikely to spread inside America. Given international travel, we will certainly see cases diagnosed here, and perhaps even experience some isolated clusters of disease. For now, though, the administration's assurances are generally correct: Health-care workers in the U.S. and other advanced Western nations maintain infection controls that can curtail the spread of non-airborne diseases like Ebola. Yet our ability to prevent an epidemic here doesn't reduce our obligations abroad (Dr. Scott Gottlieb and Tevi Troy, 9/1).

The Washington Post: The Lessons Of The Ebola Outbreak Suggest A Larger, Faster Response Is Needed
West African nations, with fragile health-care systems and weak governments, had no experience in fighting the disease. Panic, suspicion and fear have overrun public health concerns. The lesson is that health authorities and governments need to pay attention to the attitudes of everyone, not just the infected. To calm the affected regions in the months ahead will require delivery of massive humanitarian aid to the living above and beyond the medical supplies required to treat the sick (9/1).

Categories: Health Care

Bypassing Politics, Insurers Pay For End Of Life Talks

Kaiser Health News - 7 hours 52 min ago

These doctor-patient conversations had been labeled "death panels" by opponents of the Affordable Care Act. Meanwhile, in a bid to reduce backlogs, Medicare offers a deal to hospitals to pay 68 percent of short-term stay medical claims that were rejected by outside auditors.

The New York Times: End-Of-Life Talks May Finally Overcome Politics
Five years after it exploded into a political conflagration over "death panels," the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year. Bypassing the political process, private insurers have begun reimbursing doctors for these "advance care planning" conversations as interest in them rises along with the number of aging Americans (Belluck, 8/29).

The New York Times: Medicare Will Settle Short-Term Care Bills
Sharply criticized by Congress and others, Medicare quietly announced on Friday that it would settle hundreds of thousands of hospital appeals over bills for short-term care, by offering deals that could add up to several hundred million dollars (Abelson, 8/29).

Modern Healthcare: CMS Offers Holiday Sale On Audit Appeals
In a pre-Labor Day weekend bid to lower its backlog of contentious payment disputes, the CMS late Friday offered to pay hospitals 68 percent of all medical claims appealed by the service providers after having been rejected by outside auditors (8/30).

And some treatments continue to get scrutiny -

Kansas Health Institute: Physician Payment Data Put Costly Eye Treatments Under The Microscope
To [retina specialist Dr. Ajay] Singh, drugs like Lucentis represent the biggest breakthrough in ophthalmology since the advent of safe cataract surgery three or four decades ago. … But the therapeutic benefits of the drugs have, to a certain extent, been clouded by a long-running debate about the cost effectiveness of Lucentis in comparison with a closely related drug called Avastin. Genentech, a biotechnology company based in San Francisco, manufactures both. At stake are potential savings to Medicare  (Sherry, 9/1).

Categories: Health Care

Exchange Roundup: MNSure Bogs Down; Maryland Consumers Drop Coverage

Kaiser Health News - 7 hours 52 min ago

Marketplace developments across the country, including in Minnesota, Maryland, Georgia and California.

Pioneer Press: MNsure Struggles To Keep Up With 'Life Event' Changes
When a new baby arrives, parents want the infant quickly added to their health insurance. But for 78 new moms in Dakota County this year, the process bogged down for months because of a change to Minnesota's new MNsure health insurance exchange (Snowbeck, 9/1).

The Baltimore Sun: Some Drop Maryland Exchange Programs During Last Month
Maryland's health exchange reported Friday a decline in the number of people who were covered by private plans through the online insurance portal created by the Affordable Care Act. But the total number of people obtaining coverage through the exchange still grew to 433,947 because of people signing up for Medicaid (Cohn, 8/29).

Georgia Health News: Another Insurance Deadline Only Days Away
More than 20,000 Georgians have until next Friday to provide missing information or they will lose their insurance exchange coverage Sept. 30. The regional administrator of the federal Centers for Medicare and Medicaid Services told GHN on Friday that most of the data discrepancies involve immigration or citizenship issues (Miller, 8/29).

Los Angeles Times: Shelley Rouillard Checks Up On Health Plans In California
As director of the California Department of Managed Health Care, Shelley Rouillard is the chief regulator for health plans that cover more than 21 million Californians. She's also a major player in the state's implementation of the federal health law. ... Her agency is currently investigating whether two of the state's largest health insurers, Anthem Blue Cross and Blue Shield of California, violated state law in connection with their provider networks on Obamacare policies. "This department wants to make sure health plans are following the law and patients are getting care when they need it," Rouillard said (Terhune, 8/31).

Categories: Health Care

Doctors, Retail Clinics Adopt New Business Models

Kaiser Health News - 7 hours 54 min ago

The financial ground is changing for doctors in private practice and for patients seeking care.

Los Angeles Times: Doctors Are Shifting Their Business Models 
Being a doctor in private practice today is more complicated than it used to be, with growing financial pressures, more government regulation, greater oversight by insurers, rapid developments in medicine and pressure to keep up with technology. ... Experts outline a few common ways doctors are shifting the way they do business and how they're likely to affect your care and your wallet (Zamosky, 8/31).

NBC News: Are You Ready For Walmart Care Clinics?
Wal-Mart has played it safe when it comes to retail clinics, partnering with regional hospitals to offer services like flu shots. But now, the retailer is taking a more aggressive tack, with in-store branded clinics offering primary care at a price competitors may find hard to match (Coombs, 8/29).

Kaiser Health News: Infertility Patients Finding Creative Financing Help 
Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk for procedures that can run tens of thousands of dollars. Some even offer a money-back guarantee if patients don't conceive (Andrews, 9/2).

Categories: Health Care

Nomination Signals New Approach To Drug Abuse Policy

Kaiser Health News - 7 hours 55 min ago

The nomination of Michael Botticelli to head the Office of National Drug Control Policy symbolizes the shift toward dealing with drug use as a public health rather than as a criminal justice issue, writes The Washington Post. Reuters looks at how opioid abuse fears keep cancer patients from getting pain relief.

The Washington Post: The White House Is Spending Billions To Combat Drugs But Drug Use Keeps Rising
The White House officially nominated Michael Botticelli on Thursday to lead the Office of National Drug Control Policy, the office charged with overseeing and administering federal drug policy. The White House has been moving toward dealing with drug use as a public health issue, rather than a criminal justice one. The nomination of Botticelli, himself a recovering alcoholic, might be the most significant concrete sign of that shift to date (Ingraham, 8/29).

Reuters: Fears Of Addiction Keep Cancer Patients From Getting Pain Relief
Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say. “At the end of life, we should feel comfortable providing whatever necessary to control pain,” said Joel Hyatt, assistant regional director at Kaiser Permanente (Belisomo, 8/29).

Categories: Health Care

Tenn., Utah Exploring Medicaid Expansion Options

Kaiser Health News - 7 hours 56 min ago

Tenn. Gov. Bill Haslam says state may soon send a proposal to Washington while Utah Gov. Gary Herbert said he is hopeful about expansion for his state.

The Washington Post: 23 States Still Haven’t Expanded Medicaid. Which Could Be Next?
Thursday's announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court's 2012 decision making the expansion a voluntary program, there are still 23 states that haven't expanded public health insurance to all of their low-income residents. ... There are other states, though, that appear to be on the cusp of following in Pennsylvania's footsteps (Millman, 8/29).

The Tennessean/The Associated Press: Haslam May Submit Medicaid Expansion Plan In The Fall
In a move that could mean health coverage for thousands of Tennesseans, Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee's Medicaid program but did not release any new details on how it might work (Wilemon, 8/28).

The Salt Lake Tribune: Utah’s Alternative To Medicaid Expansion Still Stalled
There's a persistent snag preventing federal health officials from agreeing, in concept, to Gov. Gary Herbert’s Healthy Utah plan: the work requirement. Herbert said Thursday during his monthly KUED news conference that he’s "cautiously optimistic" that he and the Obama administration’s Health and Human Services will resolve their differences over that final stumbling block when he’s in Washington next month (Moulton and Gehrke, 8/28).

In other state Medicaid news -

St. Louis Post-Dispatch: Call Center Wait Times Climb In Missouri As Medicaid Applicants Seek Answers
When Deborah Weaver, 28, had issues enrolling in the state’s Medicaid coverage for pregnant women, a switch from her Medicaid disability coverage, she was directed to use a toll-free number, 1-855-373-4636. When she called, Weaver endured long waits and received no guidance. ... The call center, run by a private company based in Mississippi, handles hundreds of thousands of calls from Missourians ... Recent records obtained from the Missouri Department of Social Services by the St. Louis Post-Dispatch show that nearly half of the individuals that phoned the call center ended up hanging up, or "abandoning" the call (Liss, 9/1).

The Tennessean: U.S. Attorney: Tenncare Has 'Ultimate Responsibility' For Medicaid Applications
The U.S. Attorney’s office is rejecting assertions by TennCare that the federal government is to blame for a bungled Medicaid application process in Tennessee that has spawned a lawsuit. ... The lawsuit has nothing to do with Medicaid expansion. The controversy centers around how the state is processing and determining eligibility for people who might qualify for coverage under Tennessee’s existing rules (Wilemon, 8/29).

Categories: Health Care

Do Small Military Hospitals Meet The Grade?

Kaiser Health News - 7 hours 59 min ago

The New York Times takes a critical look at small military hospitals where the limited number of patients may compromise doctors' ability to treat serious problems. Other stories look at a surge in surgery prices and at programs to standardize children's surgical care.

The New York Times: Smaller Military Hospitals Said To Put Patients At Risk
Mrs. Smith underwent hernia surgery at Winn Army Community Hospital in Fort Stewart, Ga., one of 40 hospitals across the country run by the armed forces. Her case illustrates what outside experts and dozens of current and former military hospital workers interviewed by The New York Times call a signal failing in a system that cares for 1.35 million active-duty service members and their families, among others. Put simply, they say, many of the hospitals are so small and the trickle of patients so thin that it compromises the ability of doctors and nurses to capably diagnose and treat serious illnesses. ... Two-thirds of the hospitals last year served 30 or fewer inpatients a day (LaFraniere and Lehren, 9/1). 

NBC News: Surgery Prices Surge With Innovation And Consolidation Under Obamacare
The price to remove a gall bladder or replace a hip has spiked more than 20 percent during the past five years, according to an analysis of data collected for NBC News. Surgery has bloomed into a $500 billion industry in the United States, where 80 to 100 million procedures are performed annually -- a per-capita rate that’s some 50 percent higher than in the European Union, said Dr. John Birkmeyer, a researcher and adjunct professor at the Dartmouth Institute and in the university's Community & Family Medicine program. The reason? Expensive yet safer technologies and hospital consolidations that create medical monopolies, according to doctors and researchers (Briggs, 8/31).

The Wall Street Journal: Programs Aim To Standardize Surgical Care For Children
For parents, the prospect of a child's surgery can be frightening, with little information on how to pick the best hospital or understand complex procedures. To help, surgeons have developed a new classification system for pediatric surgical centers according to the level of care they provide, similar to the one that classifies trauma centers. Meanwhile, hospitals are offering new programs to help demystify the risks and benefits of pediatric surgery (Landro, 9/1).

Dallas Morning News: Baylor, Methodist Hospital Systems Aligning With Elite
Two of the largest health care systems in North Texas are aligning with two of the best-known national providers, part of ongoing efforts to improve quality and control the cost of care. Baylor Scott & White Health said it is about to complete an agreement that will make three of its Dallas-area hospitals part of the Cleveland Clinic’s national cardiology network. And Methodist Health System plans to partner with the Mayo Clinic, The Dallas Morning News has learned. Citing nondisclosure agreements, Methodist did not offer details. But it appears that Methodist will join Mayo’s expanding network of affiliates across the country. Affiliates can consult with Mayo specialists, share Mayo know-how and get advice on improving operations (Jacobson, 8/29).

Categories: Health Care

Obamacare Questions: What About Taxes? Will Employer Insurance Last?

Kaiser Health News - 8 hours 53 sec ago

News outlets focused on varying aspects of the health law's costs to consumers.

Kaiser Health News: States To Help Pay Obamacare Tax On Insurers
When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers (Galewitz, 9/2).

The Associated Press: Tax Forms Could Pose Challenge For Healthcare.gov
If you got health coverage through President Obama's law this year, you'll need a new form from your insurance exchange before you can file your tax return next spring. Some tax professionals are worried that federal and state insurance marketplaces won't be able to get those forms out in time, creating the risk of delayed tax refunds for millions of consumers (Alonso-Zaldivar, 8/30).

Kaiser Health News: Consumers Will Owe Uncle Sam If They Got Health Insurance Subsidies Mistakenly 
Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department. The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies (Appleby, 8/29).  

Fox News: Will Obamacare Mean The End Of Employer-Provided Insurance?
President Obama's famous promise that “you can keep your plan and your doctor, no matter what” was not the only misleading argument he made for his health care plan. There is yet another controversy, with even bigger consequences, brewing for Americans who already have health care. Analysts predict that as ObamaCare takes hold, it will mean the end of employer-provided insurance, with former Obama adviser Zeke Emanuel predicting that 80 percent of such plans will disappear within ten years. "It's going to actually be better for people," Emanuel argued (Angle, 8/29).

St. Louis Post Dispatch: Critics Take Aim At New Contraception Rule
The Obama administration’s latest attempt to end the contentious battle over contraception coverage is facing resistance, as expected, from some of the most vehement opponents of the federal health law requirement. New rules, announced last week by the U.S. Department of Health and Human Services, would allow religious nonprofits and some companies with religious owners to opt out of paying for birth control for female employees while ensuring that those employees still have access to contraception (Shapiro, 8/29).

Meanwhile -- 

The Wall Street Journal: GOP Eyes Agenda For Senate
One area likely to foster some internal GOP divisions is how to approach the Affordable Care Act. Some Republicans think seeking narrow changes would be most effective. In addition to repealing the medical-device tax, some Republicans aim to change the definition of a full-time worker under the health law to ease the law's requirements on businesses. Others say that voting on a wholesale scrapping of the law is crucial to establishing a GOP agenda (Peterson, 9/1). 

 

 

 

Categories: Health Care

Federal Judge's Ruling Blocks Shutdown Of Texas Abortion Clinics

Kaiser Health News - 8 hours 3 min ago

Another ruling in Louisiana also puts on hold a restrictive law in that state -- one that would require abortion providers have admitting privileges at nearby hospitals.

The New York Times: Judge Rejects Texas Stricture On Abortions
A federal judge in Austin, Tex., blocked a stringent new rule on Friday that would have forced more than half of the state's remaining abortion clinics to close, the latest in a string of court decisions that have at least temporarily kept abortion clinics across the South from being shuttered. The Texas rule, requiring all abortion clinics to meet the building, equipment and staffing standards of hospital-style surgery centers, had been set to take effect on Monday (Eckholm and Fernandez, 8/29).

Los Angeles Times: Federal Judge Strikes Down Key Part Of Restrictive Texas Abortion Law
Proponents of abortion rights, noting that Texas had 40 clinics before HB 2 was passed, cheered [Judge Lee] Yeakel's ruling. They said it was the third decision in a month that knocked down the requirement on admitting privileges after judges in Alabama and Mississippi reached similar conclusions (La Ganga and Hennessy-Fiske, 8/29).

Politico: Federal Judge Blocks Texas Abortion Clinic Law
U.S. District Judge Lee Yeakel said a provision requiring the clinics to meet the same building requirements as ambulatory surgical centers would impose "an unconstitutional undue burden on women throughout Texas and must be enjoined." The requirement, which was to take effect Monday, would have forced at least a dozen clinics to shut down. Fewer than seven facilities would then have remained, with much of the state left without any abortion provider (Villacorta, 8/29).

The Washington Post: Federal Court Blocks Tex. Rule That Could Have Closed Most Of State's Abortion Clinics
A federal judge Friday blocked a Texas restriction set to take effect Monday that could have led to the closure of most of the abortion clinics in the state. ... Lauren Bean, a spokeswoman for the Texas attorney general’s office, said the state would appeal. "The State disagrees with the court's ruling and will seek immediate relief," she said in a statement (Somashekhar, 8/29).

Kaiser Health News: Federal Judge Blocks Texas Restriction On Abortion Clinics
In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers. The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion -- all in major cities (Feibel, 8/30).

Dallas Morning News: Judge Tosses Out New Requirements For Abortion Clinics In Texas
A federal judge threw out new Texas abortion restrictions Friday that would have effectively closed more than a dozen clinics statewide in a victory for opponents of tough new anti-abortion laws sweeping across the U.S. U.S. District Judge Lee Yeakel sided with clinics that sued over one of the most disputed measures of a sweeping anti-abortion bill signed by Republican Gov. Rick Perry in 2013. The ruling stops new clinic requirements that would have left seven abortion facilities in Texas come Monday, when the law was set to take effect (Martin, 8/29).

Reuters: U.S. Judge Halts Major Part Of Texas Law Restricting Abortions
A U.S. judge struck down parts of a law restricting abortions in Texas, saying in a decision on Friday that a provision requiring clinics to have certain hospital-like settings for surgeries was unconstitutional. U.S. District Judge Lee Yeakel said the so-called "ambulatory surgical center requirement" was unjust because it placed an undue burden on women by reducing the number of clinics where they could seek abortions and the regulations had no compelling public health interests (Herskovitz and Garza, 8/29).

The Wall Street Journal: Judge Blocks Enforcement Of New Louisiana Abortion Law
A federal judge in Baton Rouge, La., issued a temporary restraining order Sunday night, blocking the enforcement of a Louisiana abortion law just hours before it was to take effect. The law, passed overwhelmingly this year by the state legislature, requires all abortion doctors in the state to have admitting privileges at a hospital within 30 miles of the clinic where they work. If doctors at clinics don't comply, the clinic can be closed. In his order, U.S. District Judge John deGravelles allowed the law to technically be enacted Monday but blocked for the time being any punishments or penalties for abortion clinics and their doctors (McWhirter, 8/31).

Politico: Louisiana Abortion Law Temporarily Blocked
A federal judge has temporarily blocked a Louisiana law that would have required abortion providers to secure admitting privileges at a local hospital. The law, signed by Gov. Bobby Jindal in June, would have gone into effect today. The Center for Reproductive Rights, which brought the case on behalf of Louisiana health care providers, argued that they were not given enough time to obtain admitting privileges (Villacorta, 9/1).

The Associated Press: US Judge Blocks Enforcement Of New LA Abortion Law
A federal judge has temporarily blocked enforcement of Louisiana's restrictive new abortion law. But lawyers disagree about whether his order covers doctors at all five of the state's clinics or only two doctors and three clinics. District Judge John deGravelles says the law can still take effect Monday. But he says officials cannot penalize the doctors and clinics that sued for breaking it until after a hearing on a broader pretrial order (McConnaughey, 8/31).

The Associated Press: Louisiana Following Judge's Order On Abortion Law
The Louisiana health department will follow a federal judge's order and refrain from immediately penalizing doctors who are trying to comply with a new abortion law that requires them to obtain admitting privileges at a local hospital, a spokeswoman said Monday. U.S. District Judge John deGravelles issued a temporary restraining order late Sunday that blocked enforcement of the new law that took effect Monday (Deslatte, 9/1).

Categories: Health Care

A First-Year Victory In Fight To Control Mass. Health Costs

CommonHealth (WBUR) - 10 hours 13 min ago

Personal health care expenditures relative to size of economy (Health Policy Commission report)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like … the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?”

Premiums are up for many individuals and small businesses this year, and expected to rise next year, because of new requirements under the Affordable Care Act, because patient demand for care is picking up again and because of a few new, expensive drugs.

Rick Lord, president of Associated Industries of Massachusetts, says his members continue to rate health care costs as their top concern.

“That’s not a big surprise,” Lord says, “because even though we came off a year where increases were pretty modest, “we also know that health care costs on a per-capita basis are the highest in the country, so that puts [employers in Massachusetts] at a competitive disadvantage.”

Massachusetts residents spent $50.5 billion on health care last year, or $7,550 per person. That does not include a lot of dental, vision, over-the-counter medicines and other care not covered by health insurance, or all the money invested here in medical research and public health.

All in all, “we have to be impressed with the numbers,” says Stuart Altman, who chairs the Health Policy Commission, the group created to monitor health care spending.

“What is of concern, though, is that Blue Cross [Blue Shield], which is our largest insurer, seems to be significantly higher in terms of the rate of growth than the others,” Altman says.

Blue Cross Blue Shield of Massachusetts said in a statement that while it had not seen the report, the numbers are not an accurate reflection of the year-over-year increase in health care spending. Blue Cross said that its own calculation, using numbers that are not adjusted for patient health status, shows a 2.1 percent increase. CHIA used data that is adjusted for health status.

Among providers, Altman and Boros point out the state’s largest group of physicians, those tied to Partners HealthCare hospitals, were among the highest paid and had the greatest increase in spending last year.

“We’re going to be looking at that to see to what extent it could be justified or whether it reflects the fact that they are continuing to use their market power to get higher rates,” Altman says.

“Partners experienced great success in 2012, actually lowering the cost of care for our patients by nearly a percent[age point],” says Partners spokesman Rich Copp. “In 2013, trend did grow faster than expected and we know that there is more work to do in the coming years. But over the long term, our approach to the delivery of health care services, delivering more coordinated care in community settings will make care more affordable for patients.”

Partners, Blue Cross and any other parties who want to contest the findings in this report will have a chance at a briefing today where Boros is expected to highlight a few other findings:

• Public spending comprised 60% of Total Health Care Expenditures (THCE). This is money that flows through Medicare, Medicaid and the Veterans Administration.

• Commercial member enrollment with primary care providers paid under alternative payment methodologies (such a global budgets) decreased slightly to 34.3% in 2013.

• There was slow but steady growth in enrollment in self-insured plans from 2012 to 2013, contributing to a decrease in HMO enrollment.

Categories: Health Care

First Edition: September 2, 2014

Kaiser Health News - 10 hours 21 min ago
Today's early morning highlights from the major news organizations, including an analysis of care at small military hospitals and a look at the $8 billion in health law taxes that come due Sept. 30.

Kaiser Health News: States To Help Pay Obamacare Tax On Insurers
Kaiser Health News staff writer Phil Galewitz reports: "When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers" (Galewitz, 9/2). Read the story, which also ran in USA Today.

Kaiser Health News: Infertility Patients Finding Creative Financing Help 
Kaiser Health News consumer columnist Michelle Andrews reports: "Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk for procedures that can run tens of thousands of dollars. Some even offer a money-back guarantee if patients don't conceive" (Andrews, 9/2). Read the story.

Kaiser Health News: Consumers Will Owe Uncle Sam If They Got Health Insurance Subsidies Mistakenly 
Kaiser Health News staff writer Julie Appleby reports: "Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department. The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies" (Appleby, 8/29). Read the story

Kaiser Health News: Capsules: Federal Judge Blocks Texas Restriction On Abortion Clinics; Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County
Now on Kaiser Health News' blog, KUHF’s Carrie Feibel reports on a federal judge's ruling about Texas' abortion law: "In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers. The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities" (Feibel, 8/30). 

Also on Capsules, Anna Gorman reports on the probe of nursing home inspections in Los Angeles: "Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week. The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required" (Gorman, 8/29). Check out what else is on the blog.

The New York Times: Smaller Military Hospitals Said To Put Patients At Risk
Mrs. Smith underwent hernia surgery at Winn Army Community Hospital in Fort Stewart, Ga., one of 40 hospitals across the country run by the armed forces. Her case illustrates what outside experts and dozens of current and former military hospital workers interviewed by The New York Times call a signal failing in a system that cares for 1.35 million active-duty service members and their families, among others. Put simply, they say, many of the hospitals are so small and the trickle of patients so thin that it compromises the ability of doctors and nurses to capably diagnose and treat serious illnesses. ... Two-thirds of the hospitals last year served 30 or fewer inpatients a day (LaFraniere and Lehren, 9/1). 

The Washington Post: 23 States Still Haven’t Expanded Medicaid. Which Could Be Next?
Thursday's announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court's 2012 decision making the expansion a voluntary program, there are still 23 states that haven't expanded public health insurance to all of their low-income residents. ... There are other states, though, that appear to be on the cusp of following in Pennsylvania's footsteps (Millman, 8/29). 

The Associated Press: Tax Forms Could Pose Challenge For Healthcare.gov
If you got health coverage through President Obama's law this year, you'll need a new form from your insurance exchange before you can file your tax return next spring. Some tax professionals are worried that federal and state insurance marketplaces won't be able to get those forms out in time, creating the risk of delayed tax refunds for millions of consumers (Alonso-Zaldivar, 8/30).

The Wall Street Journal: GOP Eyes Agenda For Senate
Republican senators say the emerging plans aim to show voters that the party can successfully govern—enacting GOP policy while avoiding a sharply confrontational tone that some Republicans fear could endanger the party's electoral prospects in 2016. Some of the top goals include approving the Keystone XL pipeline, passing accelerated rules for overseas trade agreements, speeding up federal reviews of natural-gas exports and repealing the 2010 health law's medical-device tax (Peterson, 9/1). 

The New York Times: End-Of-Life Talks May Finally Overcome Politics
Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year. Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans (Belluck, 8/29).

The Wall Street Journal: Get Ready For Health-Insurance Enrollment 
If you get health insurance through your workplace, you'll probably have a chance this fall to make important decisions about your coverage and costs. Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act (Johnson, 8/30). 

The New York Times: Increasingly, High-Deductible Health Plans Weigh Down Employees
Just as employers replaced pensions with retirement savings plans, more large companies appear to be in the midst of a similar cost-sharing shift with health plans. Besides making workers responsible for more of their care, employers hope these plans will motivate employees to comparison-shop for medical services — an admirable goal but one that some say is hard to achieve. Several big companies started offering consumer-driven plans as their only option in the last couple of years, including JPMorgan, Wells Fargo, General Electric and Honeywell, among others; it is the only choice for Bank of America employees earning more than $100,000 (Siegel Bernard, 9/1).

The New York Times: Judge Rejects Texas Stricture On Abortions
A federal judge in Austin, Tex., blocked a stringent new rule on Friday that would have forced more than half of the state’s remaining abortion clinics to close, the latest in a string of court decisions that have at least temporarily kept abortion clinics across the South from being shuttered. The Texas rule, requiring all abortion clinics to meet the building, equipment and staffing standards of hospital-style surgery centers, had been set to take effect on Monday (Eckholm and Fernandez, 8/29).

Los Angeles Times: Federal Judge Strikes Down Key Part Of Restrictive Texas Abortion Law
A federal judge late Friday struck down two provisions of a Texas law that has already forced the closure of half the state’s abortion clinics, granting at least a temporary reprieve to nearly a dozen more facilities that would have otherwise gone out of business Monday. ... Proponents of abortion rights, noting that Texas had 40 clinics before HB 2 was passed, cheered Yeakel’s ruling. They said it was the third decision in a month that knocked down the requirement on admitting privileges after judges in Alabama and Mississippi reached similar conclusions (La Ganga and Hennessy-Fiske, 8/29).

The Wall Street Journal: Judge Blocks Enforcement Of New Louisiana Abortion Law
A federal judge in Baton Rouge, La., issued a temporary restraining order Sunday night, blocking the enforcement of a Louisiana abortion law just hours before it was to take effect. The law, passed overwhelmingly this year by the state legislature, requires all abortion doctors in the state to have admitting privileges at a hospital within 30 miles of the clinic where they work. If doctors at clinics don't comply, the clinic can be closed. In his order, U.S. District Judge John deGravelles allowed the law to technically be enacted Monday but blocked for the time being any punishments or penalties for abortion clinics and their doctors (McWhirter, 8/31).

The New York Times: Medicare Will Settle Short-Term Care Bills
Sharply criticized by Congress and others, Medicare quietly announced on Friday that it would settle hundreds of thousands of hospital appeals over bills for short-term care, by offering deals that could add up to several hundred million dollars (Abelson, 8/29).

Los Angeles Times: New Cells Will Lessen Solitary Confinement For Mentally Ill Inmates
State prison officials plan to open special solitary confinement units for the mentally ill as part of an effort to comply with court orders to improve their care. The cellblocks — while still isolating prisoners from the rest of the population and largely from one another — will increase the time those inmates are allowed outside their cells and the amount of treatment they receive (St. John, 8/29).

The New York Times: Federal Judge Approves California Plan To Reduce Isolation Of Mentally Ill Inmates
Corrections officials in California will make significant changes in the use of solitary confinement for mentally ill prisoners, revising decades-old policies that have kept thousands of inmates who have psychiatric disorders in isolation. The revised policies, filed in Federal District Court on Friday by the California Department of Corrections and Rehabilitation, were drafted in response to an order issued by Judge Lawrence K. Karlton last April (Goode, 8/29).

Los Angeles Times: Ventura County Medi-Cal Health Plan Probed
California officials are investigating financial dealings between Ventura County's Medi-Cal health plan and a key outside contractor, Xerox Corp., The Times has learned. The California attorney general's office has issued a subpoena to Gold Coast Health Plan for records related to its work with a Xerox unit, Affiliated Computer Services. Xerox is a major government contractor for Medicaid and other health programs nationwide (Terhune, 8/29).

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

Categories: Health Care

Magna Carta on Tour

A year before the 800thanniversary of King John’s issuance of the Magna Carta, one of four of the surviving copies of the document has gone on tour.

Lincoln Cathedral’s copy of the Magna Carta has been on view at the Boston Museum of Fine Arts this summer in an exhibit called “Magna Carta: Cornerstone of Liberty.” “Focusing on Massachusetts’ and American’s ongoing relationship with Magna Carta, additional objects [in the exhibit included] the MFA’s Sons of Liberty Bowl (1768) by Paul Revere – engraved with the words ‘Magna/Charta’ and ‘Bill of Rights’ – and two manuscripts copies of the Declaration of Independence” and John Singleton Copley’s portrait of “a steely-eyed Samuel Adams defiantly pointing to the 1691 Charter of Massachusetts Bay on the eve of the American Revolution.” *

"In September, Magna Carta moves to the Sterling and Francine Clark Art Institute in Williamstown, Massachusetts for an exhibition from September 6 until November 2. Michael Conforti, director of the Clark, said, 'We are delighted to have the opportunity to bring the Magna Carta to Williamstown . . . We are planning an exhibition that underscores the document’s importance as the foundation of the principles that shaped our nation and inspires our visitors to consider anew the notions of democracy and freedom.' ”
Two copies of the parchments sealed by King John at Runnymede in 1215 are owned by the British Library, and the fourth copy belongs to the Salisbury Cathedral. As the 800th anniversary year approaches, many events and celebrations are being planned in the UK and across the globe, with these four documents as their focal point.
The British Library has created a mini-website, one of its series of “Treasures in Full” that detail the history surrounding the signing of the document, provide a translation into modern English, and allow you to view one of its copies of the document in great detail with its “Magna Carta Viewer.”  
King John, hunting with his dogs: Cotton MS Claudius d.ii.f.116r (detail), 14th-century **What is the significance of the Magna Carta?Robert Brink in his opinion piece in the August 18, 2014 edition of Mass. Lawyers Weekly, “History on Display: One Lawyer’s Musings on the Magna Carta” quotes Sir Frederick Pollock and Frederic William Maitland, authors of The History of English Law before the Time of Edward I:“[I]t means this: that the king is and shall be below the law.”Read Brink’s article to see its significance for those of us who live in Massachusetts.*Robert Brink, “History on Display: OneLawyer’s Musings on the Magna Carta”, Mass. Lawyers Weekly, 8/18/14.

** The British Library: http://www.bl.uk/whatson/exhibitions/magna-carta/ 
Categories: Research & Litigation

States To Help Pay Obamacare Tax On Insurers

Kaiser Health News - 12 hours 15 min ago

When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. 

But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers.

States and the federal government will spend at least $700 million this year to pay the tax for their Medicaid health plans. The three dozen states that use Medicaid managed care plans will give those insurers more money to cover the new expense. Many of those states – such as Florida, Louisiana and Tennessee – did not expand Medicaid as the law allows, and in the process turned down billions in new federal dollars.

Other insurers are getting some help paying the tax as well. Private insurers are passing the tax onto policyholders in the form of higher premiums. Medicare health plans are getting the tax covered by the federal government via higher reimbursement.

State Medicaid agencies say they have little choice but to pay the tax for health plans they hire to insure their poorest residents. That’s because the tax is part of the health plans’ costs of doing business. Federal law requires states to pay the companies adequate rates.

“This situation results in the federal government taxing itself and taxing state governments to fund the higher Medicaid managed care payments required to fund the ACA health insurer fee,” said a report by Medicaid Health Plans of America, a trade group.

Meanwhile, many Medicaid managed care companies have seen their share prices – and profits -- soar this year as they gained thousands of new customers through the health law in states the expanded Medicaid. Over half of the 66 million people on Medicaid are enrolled in a managed care plans.

A KHN survey of some large state Medicaid programs found the tax will be costly this year. The estimates are based in part on number of Medicaid health plan enrollees in each state and how much they are paid in premiums. States split the cost of Medicaid with the federal government, with the federal government paying on average about 57 percent.

-- Florida anticipates the tax will cost $100 million, with the state picking up $40 million and the federal government, $60 million.

-- Texas estimates the tax at $220 million, with the state paying $90 million and federal government, $130 million.

-- Tennessee anticipates it will owe $160 million, with the state paying $50 million and the federal government, $110 million.

-- California has budgeted $88 million, with the state paying $40 million and the federal government, $48 million.

-- Georgia estimates the tax on its plans at $90 million, with the state paying $29 million and the federal government, $61 million.

-- Pennsylvania predicts the tax will cost $139 million, with the state paying $64 million and the federal government, $75 million.

-- Louisiana estimates the tax will cost $27 million, with the state paying $10 million and the federal government, $17 million.

Texas is believed to be the only state that has not yet agreed to cover the tax for its health plans, according to state Medicaid and health plan officials.  “The premium tax is just another way that the costs of the Affordable Care Act are pushed down to states and families,” said Stephanie Goodman, spokeswoman for the Texas Medicaid program.

Medicaid officials in other states complain that paying the tax reduces money they could have spent on covering more services or paying providers.

“I do not feel I am getting anything in return for this,” said Tennessee Medicaid Director Darin Gordon.

Officials won’t know exactly how much states owe until the Internal Revenue Service sends bills to insurers at the end of August, and the Medicaid plans submit those to states.

The health insurer tax is estimated to bring in at least $100 billion over the next decade from all insurers, government auditors estimate.

Most non-profit Medicaid health plans are exempt from the tax, which the trade group says gives the nonprofits a competitive edge vying for state contracts.  “We consider this tax so badly construed that it should be reconsidered because it makes no public policy sense,” said Jeff Myers, CEO of Medicaid Health Plans of America.

The trade group, which represents both nonprofit and for- profit Medicaid plans, also opposes the tax because it takes money from Medicaid programs that could be used to pay plans to improve care, he said.

The Centers for Medicare & Medicaid Services declined to comment on how states and the federal government are covering part of the tax.

Timothy Jost, a consumer advocate and law professor at Washington & Lee University in Virginia, said the lawmakers intended to cover the costs of the law by including as many groups paying in as possible. 

While it may be unusual for the federal government to essentially tax itself, Jost said the situation is no different from the federal government paying a contractor to provide a service, then having that contractor use some of those dollars to pay state sales tax or federal income tax.

“This tax should not have surprised anyone, and it should have been worked into contract prices,” he said.

Paul Van de Water, senior fellow with the left-leaning Center for Budget and Policy Priorities, said neither health plans nor states should be complaining about the taxes because both are benefiting from the law.

“States are benefitting from the Affordable Care Act because with more people getting insured, it is driving down their uncompensated care costs,” he said. He noted that is true even in states that did not expand Medicaid under the health law.

“People always like to get a benefit and not have to pay for it,” he said. “If we did not have this tax, we would have had to raise the money somewhere else.

Categories: Health Care

Infertility Patients Finding Creative Financing Help

Kaiser Health News - 12 hours 15 min ago

Infertility treatment is a numbers game in some respects: How many treatments will it take to conceive a child? And how much can you afford?

Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk  for procedures that can run tens of thousands of dollars. Some even offer a money-back guarantee if patients don't conceive.

Shady Grove Fertility, a large center with sites in Maryland, eastern Pennsylvania and Washington, D.C., has a number of programs to help people afford infertility treatment. The center pioneered a "shared-risk" program for in vitro fertilization (IVF) treatment years ago that offered a 100 percent refund if a couple didn’t have a baby. Now the center offers a similar program for couples who use donor eggs to conceive. Other fertility centers offer versions of these programs.

Both Shady Grove shared-risk programs allow couples to try up to six cycles of IVF or donor eggs for a flat fee. If they don’t have a baby, they get the full amount back; couples can also stop at any point in the process and get a full refund. The program costs twice as much as a single cycle--$20,000 for shared-risk IVF and $30,000 for shared-risk egg donor.

"In reality, patients who get a baby on the first cycle are subsidizing those who don't get a baby," says Michael Levy, president and IVF director at Shady Grove. "We see this as an opportunity to give patients security regarding the financial risk that they face."

Tina and Jimmy Stone opted for the $30,000 shared-risk egg donor program. Tina's uterus was healthy but her ovaries weren’t producing viable eggs. The Hollywood, Md., couple became pregnant with twins on the third try. The twin boys are now 2, and their daughter, who is adopted, is 8.

More From This Series Insuring Your Health

"For us, it was worth it," says Tina, 35, who says the couple financed the shared-risk program through a private personal loan. "It kept our options open if it didn’t work, whereas if you pay per cycle, you’ve paid for nothing if it doesn’t work."

A report by the ethics committee at the American Society for Reproductive Medicine found that shared-risk programs can be acceptable if patients are fully informed about the criteria for success and program costs, among other things.

Shared-risk and other programs are popular in part because health insurance coverage for infertility treatment, while slowly improving, is still sparse. Fifteen states require insurers to cover infertility treatment to varying degrees, according to Resolve, an infertility advocacy group. Among employers with more than 500 workers, 65 percent cover a specialist evaluation, 41 percent cover drug therapy and 27 percent cover in vitro fertilization, according to human resources consultant Mercer’s 2013 employer benefits survey. Thirty-two percent of large companies don’t cover infertility services at all.

Glow is one of the most recent companies to offer a program to help address the financial uncertainties around infertility and treatment. The company, which is best known for an app that helps women track ovulation and other pregnancy-related health data, started Glow First last August for couples worried about infertility.

Participants pay $50 monthly for up to 10 months. The money is pooled with contributions from people who also started the program that month. At the end of 10 months, those who haven’t become pregnant split the pot of money; Glow will pay their share to an accredited infertility clinic once they submit their bills for fertility testing or other services.

The program isn't open to people who've already received treatment for infertility.

The first group that began contributing in October 2013 has just ended. Roughly 50 people participated, according to the company. The average age was 34, and the typical participant had been trying to get pregnant for a year. The payout to those who didn’t become pregnant was $1,800.

"This relatively minimal contribution will help to offset those downstream and very high costs" of fertility testing and treatment, says Jennifer Tye, Glow’s head of marketing and partnerships.

There are other ways to manage the cost of infertility treatment. In addition to shared-risk programs, many fertility clinics offer other discounts and financing options to help couples afford treatment. Other companies also offer financing and/or infertility insurance to help cover the costs for couples who are working with a surrogate to have a baby, for example, or for IVF treatments.

"I think it can be confusing for people," says Barbara Collura, president and CEO of Resolve. "There's no one place to go to learn all the different financing options."

Most fertility clinics have someone on staff who will sit down and and talk with prospective patients about the costs they’ll be responsible for and financing options that are available, says Collura.

"Exhaust all the obvious choices with your insurance and whatever financing programs the clinic might participate with," says Collura. "Then do research to fill in."

Categories: Health Care

From Pimples To Desire, What Might Happen When You Ditch The Pill

CommonHealth (WBUR) - Mon, 09/01/2014 - 12:23pm

 

(Becca Schmidt via Compfight/Flickr)

By Veronica Thomas
Guest Contributor

So you’re thinking about going off the pill. Maybe you’ve been feeling depressed, getting headaches, or keep forgetting to pop the tiny tablet. Perhaps you’ve been experiencing some really strange stuff that didn’t happen before you started the pill—like inflamed, bleeding gums or cringing at another person’s touch.

Both personal anecdotes and research studies have linked these and other side effects, such as breast tenderness and nausea, to the pill. (One study suggested it might even make you pick the “wrong” partner by altering your chemical attraction to a man’s scent.)

Most randomized control trials haven’t actually found any real difference in the frequency of side effects among women taking the pill versus those taking a placebo. “It’s an interesting phenomenon,” says Dr. Alisa Goldberg, the director of clinical research and training at the Planned Parenthood League of Massachusetts. “Clearly some women are sensitive to the pill and experience these things, but when you try to study it scientifically on a population basis, there’s really no difference.”

Still, while four out of five American women have used the pill at some point, 30 percent have discontinued its use due to dissatisfaction—most commonly because of its side effects. The latest federal statistics on contraception use are due this fall, and experts expect trends from recent years to continue: IUD use will continue to rise, while pill use seems to have plateaued.

The issues a woman experiences—or whether she has any at all—vary greatly based on the specific dosage of hormones and the unique individual swallowing them every day. Personally, I got migraines with an aura, or what felt like a laser light show in my left eyeball. Twice I had to retreat to my office’s “Pump and Pray Room”—reserved for new mothers and religious employees—to lie down and recover.

Finally, I gave up on it—only to be blindsided by a whole new challenge: the unexpected side effects of going off the pill. To help others avoid similar unpleasant surprises, I spoke with three experts about what to expect when you ditch the pill for another birth control method.

Of course, just as each woman has a unique reaction to the pill, she’ll also have a unique reaction to going off. According to Our Bodies, Ourselves, there is “enormous variability in any individual’s response to her own hormones or any synthetic hormones she takes.” One woman’s skin may break out in pimples, while the other’s clears up completely. With this disclaimer in mind, here are eight possibly unexpected changes you might experience when you cancel your monthly refill of that crinkly foil packet:

1. Most of the side effects should disappear in a few days.

First off, while many women decide to have their period before pitching the pack, it’s safe to stop taking the pill at any point. However, you should stop immediately if experiencing any serious side effects, like headaches or high blood pressure, says Dr. Jennifer Moore Kickham, the Medical Director of a Massachusetts General Hospital outpatient gynecology clinic.

Because they are taken daily, the synthetic hormones from oral contraceptives leave your system in a couple days. This is why you have to use another form of birth control after missing more than two doses of the pill. But it’s also why most acute side effects, like nausea, will go away pretty soon after giving the pill the boot. Other issues, such as mood swings or irregular bleeding, may take a bit longer. If they persist, you should visit your doctor to investigate possible other causes, Dr. Kickham says.

In addition to migraines, I had major stomach bloating while on the pill—a side effect so perpetual that I came to view it as normal. I also experienced anxiety and a general irritability that I’m sure my family and boyfriend didn’t particularly enjoy. Eventually, after six years of being on and off the pill, I couldn’t tolerate it anymore. I decided to ditch it for good. I felt better almost immediately. After a month, my headaches and bloating vanished. (I had no idea I could eat without my stomach inflating like a balloon!) My mood issues took a bit longer, but eventually faded away, too.

When you stop the pill after a few years, you may actually realize you were experiencing mild side effects the entire time, like bloating or breast tenderness. According to Dr. Kickham, “Some women come off and say, ‘I didn’t realize I had a low-level headache the whole time I was on the pill, and now it’s gone.’”

2. But some of the pill’s benefits will go too.

Though I may have started this story with a little pill-bashing party, oral contraceptives do have major benefits that usually outweigh any negative side effects. “The pill is an effective form of contraception with a lot of great benefits,” Dr. Kickham says. “So as long as it’s safe for patients to use and they’re not having horrible side effects, it can be a really great option.”

While about half of my friends are dumping the pill in favor of IUDs, the other half have had serious commitments with the same oral contraceptives for years with little or no side effects. “There are some women who are very sensitive to the hormones and switch a variety of times and always have some type of side effect,” says Dr. Goldberg of Planned Parenthood. “Then, other women can tolerate most formulations without much difficulty.”

Because most versions of the pill include both estrogen and progestin, it also has a number of health perks that you can’t get from progestin-only or hormone-free methods, like IUDs or condoms. In fact, many women who don’t actually need birth control take the pill for its other health benefits, like lighter periods and reduced cramping. Other benefits of the pill include some protection against: acne, PMS symptoms, iron deficiency anemia, endometrial and ovarian cancer, and additional health problems. 

When you stop taking the pill, you may lose these benefits. It’s like flipping a coin. The benefits you got on the pill morph into the new side effects of being off it, whereas the side effects you had turn into benefits. The light, regular periods you had on the pill may be replaced by spotting and cramping, and your porcelain skin may turn into a pimply mess. But, on the flip side, your sex drive may return and your irritability may evaporate.

“All these choices are a balance of risks and benefits,” Dr. Kickham explains. Do the benefits tip the scale in the pill’s favor, or are the side effects weighing you down like a bag of bricks? “For any medication, if the risks or negative side effects are outweighing the benefits, then they should consider other options,” she says.

3. You’ll need to use another form of birth control. Immediately.

Protection from an unwanted pregnancy is one crucial—and obvious—benefit of the pill that will vanish almost instantly. Just as acute side effects should stop in a couple days, the contraception will too.

“Most women resume ovulation pretty quickly after stopping the pill,” Dr. Goldberg explains. “So, the most important thing for women to know is that when they stop the pill they are at risk for pregnancy almost immediately.” It’s crucial to find a new method as soon as possible without any gaps in coverage, she says.

4. Your normal period might not return for a while.

Although my teenage self would hate me for saying this, I actually looked forward to having a regular period when I went off the pill. The low-dose oral contraceptive that I had taken for the past three years made me stop having one all together. I waited for eight months. No period. I had no idea this wasn’t normal at first. I just thought it was part of transitioning off the pill.

After a number of doctor visits, blood tests, and even a rather uncomfortable ultrasound, I was diagnosed with secondary amenorrhea—the absence of menstruation. I had to take two weeks of progestin-only pills, then restart the pill for a month in order to “jump start” my hormones and ensure my body could cycle.

I dropped the pill last September without knowing what changes to anticipate in my body. I eagerly welcomed most of them, but my unexpectedly absent period made me worry about fertility and my future. In fact, this surprising change was my impetus for writing this story.

According to the experts I spoke with, if your period hasn’t returned for three months after stopping the pill, you should visit your doctor, who can investigate other potential causes. I’m not alone in my post-pill amenorrhea. It took one of my friends nine months to regain her period after stopping the pill.

But for most women, ovulation should resume in a few days and periods should return within a couple of months.  “If you stop the pill and you don’t get a regular period for a month or two, it’s just a delayed menses—give it a little more time,” Dr. Goldberg says.

Even if your period does return right away, it might be different. The pill often lightens bleeding and reduces cramping, while also making your periods more regular and predictable. According to Dr. Kickham, this is why many women love the pill.

When you stop taking the pill, you may experience irregular periods for a few months or even years, especially if you had erratic menstruation pre-pill, says Judy Norsigian, Executive Director of the feminist women’s health organization Our Bodies, Ourselves. If you had heavy, crampy periods before the pill, they might also return when you go off.

5. You may find yourself more interested in sex.

Lying down with a heating pad on your stomach is not the only thing you might be doing more of in bed. After discontinuing the pill, you may also find yourself wanting to get sexually intimate more often. The combination pill limits the amount of free testosterone in the blood, which creates anti-androgenic (“anti-masculine”) symptoms in some women, including lower libido and sexual dysfunction.

“Where the pill helps with acne and hair growth, some of my patients will come back saying ‘I don’t have the desire I used to and I don’t know why, I’ve noticed a difference,’” Dr. Kickham explains. Other women may actually experience increased libido while on the pill because it reduces their anxiety about getting pregnant. 

Several studies over the past 30 years have found that oral contraceptives hinder sexual function by decreasing sexual interest and arousal, as well as the frequency of sexual intercourse and enjoyment. When you stop taking the pill there is more free testosterone in your system, so don’t be surprised if you notice a big boost in your sex drive. Reminder of #3 above: You need new protection right away.

6. Your skin may break out like a prepubescent teenager’s.

For the first time in a while, you’re not bloated or moody, and you’re the one initiating sex. You’re feeling confident and sexy—like a million bucks. But then, a pimple pops up on your chin. Then, a few more. Soon, you feel like a prepubescent teen desperately trying every acne face wash and zit-zapper from the drugstore. So much for that boost in libido.

This is exactly what happened to me. After years of clear skin and a mostly pimple-free adolescence, a painful mess of cystic acne covered my chin and jaw—often where hormonal acne appears in adults. The pill can help mitigate hormone-related symptoms like acne and hair growth, so when you stop taking it, these issues may, literally, surface.

Cue a visit to the dermatologist. After a couple months of very unsexy, painful acne, I finally got my skin under control with salicylic acid and spironolactone (a medication that reduces circulating androgens), but I’m left with red acne marks and blotchy skin.

Some women with post-pill acne may actually find out they have Polycystic Ovary Syndrome—a common hormonal disorder often accompanied by acne. “If a woman has been on the pill for a long time, like ten years, other pathologies could have developed and be unmasked when she comes off,” says Dr. Goldberg. Say a woman had mild PCOS before going on the pill but wasn’t diagnosed. The pill may help improve or control the symptoms of acne and irregular periods so much that the PCOS doesn’t become apparent until she stops taking it a decade later, Dr. Goldberg explains.

For many women, cystic acne is worse than any side effect they experience while taking the pill. For me, I’d still rather apply an extra coat of concealer every morning than risk ruining my relationships because of my erratic mood swings and irritability.

7. Your emotions and mood swings might get better—or worse.

Although this change is difficult to prove and slightly resembles a daytime talk-show confession, I finally feel like “myself” since ditching the pill. I have more energy and excitement about school and my relationships, and don’t find myself wanting to strangle a friend who asks about my day.

According to Judy Norsigian, mood swings, depression, and general brain “fogginess” are some major reasons women go off the pill and use other birth control methods.

On the other hand, women who use the pill to treat severe PMS or premenstrual dysphoric disorder may actually experience improvements in their mood while taking it. If they have mood fluctuations related to their natural cycle, the balancing effect of the pill’s synthetic hormones can help, so mood issues may return when they go off, Dr. Kickham explains.

“It is hard to predict who will respond in what way to the variety of pills,” she says. “For instance, I’ve definitely had people call me a couple weeks after starting the pill saying, ‘I’m crying all the time, I’ve noticed a huge change in my mood.’ So we have them come off it right away, immediately.”

Since the hormones metabolize out of the system within a couple days, your mood issues should improve once you go off the pill—if it was actually to blame.

8. You might still have side effects with your new method. (Sadly, it turns out there is no perfect birth control.)

If you’re going off the pill and still need a birth control method, there are a number of other options to choose from. “I usually just go through the whole list of contraceptives and try to decide with my patients what they’re looking for based on their goals and their response to the pill,” Dr. Kickham says.

Regardless of the new method you’re choosing, sadly, no birth control is perfect. Since both the patch and the vaginal ring contain a combination of estrogen and progestin, you might have similar side effects with these that you had on the pill, like breast tenderness and nausea.

The birth control shot, which injects progestin every three months, is associated with irregular bleeding and weight gain. And the biggest drawback is the inability to take the hormones back out once they’re injected. Unlike the pill, the hormones will not metabolize out of the system until after the three months.

The implant, which is a matchstick-sized rod placed in your arm for up to three years, also releases only progestin. Since both the shot and implant don’t release estrogen, you might miss out on some of its perks. For instance, you won’t have the benefits of more regulated periods, reduced acne, or protection against reproductive organ diseases, like endometrial cancer.

Though it has its own cult following, even the IUD—a T-shaped device placed in the uterus—is also not without fault. The ParaGard, which does not release any hormones and works for up to ten years, is associated with heavier and crampier periods. The hormonal IUDs, Mirena and Skyla, release progestin and last for 3-5 years. Unlike the ParaGard, they may lighten your period and actually get rid of it entirely. But on the flip side, IUDs don’t provide the benefits linked to estrogen.

As with the pill, experts say you should stick with your new birth control method for at least three months as long as you’re not experiencing any severe side effects, since it can take that long for your body to adjust.

Bottom line: It may take some trial and error to find the birth control method that works best for you. Next up for me: I’m giving the Mirena IUD a shot. Maybe one day there will be a perfect birth control that works for everyone—perhaps even one that’s remote-controlled. Until then, it’s all about weighing the costs and benefits, finding the best personal fit—and being aware that side effects can crop up both when you start a method and when you stop.

Readers, what has been your experience of going off the pill? Please share in the comments below.

Veronica Thomas is a master’s candidate at the Harvard School of Public Health studying health communication and maternal and child health. 

 

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