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Washington State Exchange Confronts Persistent Technical Problems

Kaiser Health News - 2 hours 35 min ago
Officials for the state's online health marketplace also ask lawmakers to increase the cap on general fund money they can use for marketing.

The Seattle Times: As Many As 1 in 5 Exchange Enrollees Affected By Technical Problems, Staff Concedes
A lack of transparency in describing and fixing technical problems became an issue in Thursday’s Washington Health Benefit Exchange Board meeting. Board member Bill Hinkle grew testy at what he said was mutual staff back-patting and excuses for the problems still plaguing thousands of accounts (Ostrom, 8/28).

The Seattle Times: Health-Benefit Exchange Budget Grows; Will More Spending Mean More Revenue? 
Washington’s exchange will ask the state Legislature to lift its cap on allocations from the general fund, hoping for a budget that avoids cutting allocations for in-person assisters and advertising. Because revenue generated by the exchange goes into the state's general fund, to be doled out later by the Legislature, the $59.2 budget approved by the exchange board Thursday will require lawmakers to lift a $40 million cap established early on in the Affordable Care Act's history (Ostrom, 8/28).

And exchange news from Oregon, California and Florida --

The Oregonian: Cover Oregon Turnaround Consultant's Bills Grew To $600,000-Plus As Exchange Obstacles Multiplied
The price tag of the Cover Oregon health insurance exchange fiasco continues to grow. As Clyde Hamstreet, the corporate turnaround expert hired to lead Cover Oregon in April, wraps up his work he leaves behind a stabilized agency -- and a hefty bill. Initially signed to a $100,000 contract, Hamstreet ended up staying longer than expected, with two associates joining him at Cover Oregon after Gov. John Kitzhaber essentially forced out three top officials there in a public display of house-cleaning (Budnick, 8/28).

California Healthline: Narrow Networks Bill Passes Floor Vote
The Assembly this week approved a bill to limit narrow networks in California's health plans. The legislation already passed a Senate vote and is expected to get concurrence today on the Senate floor and move to the governor's desk for final approval (Gorn, 8/28).

Tampa Bay Times: Florida Website Aimed At The Uninsured Draws Little Interest
Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website. At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans. Six months after the launch of the state's effort, called Florida Health Choices ( myfloridachoices.org), just 30 people have signed up. Another seven plans were canceled either because consumers changed their minds or didn't pay for services. ... But Health Choices doesn't sell comprehensive health insurance to protect consumers from big-ticket costs such as hospitalization. Instead, it has limited benefit options and discount plans for items like dental visits, prescription drugs and eyeglasses (Mitchell, 8/28).

Categories: Health Care

Pennsylvania's Corbett Becomes 9th GOP Governor To Expand Medicaid

Kaiser Health News - 2 hours 47 min ago

Gov. Tom Corbett reached a deal with the Obama administration to use federal funds to put about 500,000 low-income residents into managed care plans already used by the state. There were conflicting reports about the details of the federal waiver, but Corbett's original plan to include work incentives was not approved.

The New York Times: Pennsylvania To Purchase Private Care For Its Poor
Pennsylvania will become the 27th state to expand Medicaid under the Affordable Care Act, the Obama administration announced Thursday, using federal funds to buy private health insurance for about 500,000 low-income residents starting next year. Gov. Tom Corbett, a Republican, had proposed the plan as an alternative to expanding traditional Medicaid under the health care law, which he opposes. Now that federal officials have signed off, Pennsylvania will join Arkansas and Iowa in using Medicaid funds to buy private coverage for the poor (Goodnough, 8/28).

The Wall Street Journal: Obama Administration, Pennsylvania Governor Reach Deal To Expand Medicaid
Pennsylvania Gov. Tom Corbett reached a deal with the Obama administration to extend the state's Medicaid program to half a million low-income residents under the Affordable Care Act, officials said Thursday. Pennsylvania is now the 27th state to agree to broaden Medicaid to include everyone earning up to a third more than the federal poverty level, or around $16,000 for a single adult. The agreement makes Mr. Corbett, a Republican, the ninth GOP governor to go along with a central part of the 2010 health-care law (Radnofsky, 8/28).

The Washington Post: Pennsylvania's Republican Governor Expands Medicaid
Pennsylvania Gov. Tom Corbett had sought the Obama administration's permission to use money authorized by the Affordable Care Act to purchase private health insurance for poor adults. With Thursday's announcement, Corbett and the federal Centers for Medicare and Medicaid Services instead agreed to a plan to expand the program through managed care organizations. ... Medicaid coverage for Pennsylvania adults earning below 133 percent of the federal poverty line, or about $15,500, will begin in January. Starting in 2016, adults earning above the federal poverty line will have to pay premiums worth no more than 2 percent of household income. Those adults can be dropped from the program for failing to pay premiums, but they can also receive discounts for healthy behaviors, like going for a check-up (Millman, 8/28).

Philadelphia Inquirer: Feds Approve Corbett's Pa. Medicaid Expansion Proposal
In what was described as a five-year demonstration project, Pennsylvania got the go-ahead to use federal money to pay private insurers to provide health care to uninsured individuals -- many in low-wage jobs. ... But whether the Healthy PA program will roll out Jan. 1 as scheduled could depend on voters. Polls show Corbett facing a double-digit deficit in his bid for reelection. His Democratic challenger, Tom Wolf, has said he supports the traditional Medicaid expansion that 26 states and the District of Columbia have already approved (Worden, 8/28).

Reuters: US Officials Reach Deal With Pennsylvania On Medicaid
Federal officials have reached an agreement with Pennsylvania Gov. Tom Corbett over his plan to use federal funds to pay for private health insurance coverage for up to 600,000 residents, the governor said on Thursday. The deal highlights a growing number of Republican governors who are finding ways to accept money under President Barack Obama's Affordable Care Act, despite political opposition that has so far prevented nearly half of U.S. states from moving forward with the Medicaid expansion plan (Russ and Morgan, 8/28).

Vox: Pennsylvania Is Expanding Medicaid. Here's How.
Pennsylvania's expansion doesn't look terribly different from their standard Medicaid program. The state is not pursuing the "private option" model being implemented in Arkansas; beneficiaries will get Medicaid coverage, not a marketplace plan. Unlike Arkansas, Pennsylvania already relies on managed care, meaning the state uses private intermediaries to run its Medicaid program. There's already overlap in the insurers participating in Medicaid and the state marketplace (McIntyre, 8/28).

Meanwhile, Tennessee's GOP governor says he will soon make a Medicaid expansion proposal, while South Carolina groups organize low-income groups to vote -

Chattanooga Times Free Press: Gov. Haslam Says Medicaid Expansion Proposal Going To Feds Soon
A long-expected plan for a Medicaid expansion in Tennessee could be placed before federal officials soon, Gov. Bill Haslam said Thursday. If the feds approve, an estimated 180,000 low-income state residents could be eligible for subsidized health insurance. "I think we'll probably go to them sometime this fall with a plan … that we think makes sense for Tennessee," the Republican told reporters in response to questions (Sher, 8/28).

The Associated Press: Advocates Urge Governor To Expand Medicaid
The state chapter of the NAACP and other advocates for health care on Thursday urged Gov. Bill Haslam to expand Medicaid in Tennessee, and the Republican governor says he's considering a plan. About 50 protesters gathered on the War Memorial Plaza across the street from the state Capitol (8/28).

The [South Carolina] State: Medicaid Expansion Effort Focuses Appeal On Low-Income Voters
The South Carolina Progressive Network plans to focus its get-out-the-vote efforts this year on the 176,530 people who didn’t get health care coverage because the state’s political leaders turned down federal Medicaid expansion. Using voter registration information and census data, the network came up with estimates on the number of registered voters in each county denied government-provided health care because the state turned down Medicaid expansion (Holleman, 8/28).

A Missouri program to expand Medicaid for pregnant women takes effect, but without sufficient funding -

St. Louis Post Dispatch: Program To Boost Insurance For Pregnant Women Takes Effect, But Lacks Funding
A Missouri program to expand Medicaid to more pregnant women officially took effect Thursday, but in the absence of state funding, it could be months before people can take advantage of the health plan. The Show-Me Healthy Babies program was passed by the Legislature this year and signed by Gov. Jay Nixon in July. It is designed to provide insurance for pregnant women who earn too much to currently qualify for Medicaid, but not enough for a private health plan (Shapiro, 8/29).

And Fox News reports on safety net benefits -

Fox News: Census Figures Show More Than One-Third Of Americans Receiving Welfare Benefits
Fifty years after the "war on poverty" was first waged, there are signs a new offensive is needed. Newly released Census data reveals nearly 110 million Americans – more than one-third of the country – are receiving government assistance of some kind. The number counts people receiving what are known as "means-tested" federal benefits, or subsidies based on income. This includes welfare programs ranging from food stamps to subsidized housing to the program most commonly referred to as "welfare," Temporary Assistance for Needy Families. At the end of 2012, according to the stats, 51.5 million were on food stamps, while 83 million were collecting Medicaid – with some benefitting from multiple programs (Emanuel, 8/29).

Categories: Health Care

CBO Chief Says Obamacare Is Reducing Deficit

Kaiser Health News - 2 hours 53 min ago

News outlets also look at a looming court decision on the health law's subsidies and the potential impact of big data on health outcomes.

The Wall Street Journal: CBO Director: Political Divide Makes Fiscal Progress 'Very Hard'
[Congressional Budget Office Director Douglas] Elmendorf said it was impossible to tell whether his agency’s 2009 and 2010 assessments of the Affordable Care Act were – in retrospect – accurate, because parts of the law are only beginning to take effect ... He said CBO’s projections for the number of people who would enroll in insurance exchanges established by the ACA have turned out to be very accurate. He also said they stand by their estimate that the law – in its entirety – will reduce the government’s deficit over its first two decades (Paletta, 8/28).

Bloomberg: Obamacare's Latest Threat Nears Turning Point In Court
Two years after a single vote on the U.S. Supreme Court saved a core part of Obamacare, opponents are trying to topple the measure again, this time using a four-word phrase in the law. A disputed provision in the Affordable Care Act suggests that millions of Americans can’t get the tax subsidies created by the law to reduce the cost of health insurance. All sides are now waiting for a federal appeals court in Washington to make a procedural decision that will have outsize implications. The announcement could come any time (Stohr, 6/29).

USA Today: If 'Clean,' Big Data Can Improve U.S. Health Care
Less medical privacy may be good for your health. A growing body of research has found that information Americans share on social media websites about their health and lifestyle is more up to date and accurate than what they share with doctors, employers, insurance companies and government agencies. ... With the federal government now requiring all patient data to be digital, there's a big opportunity for companies that can integrate health data from a variety of sources and ensure its accuracy, says [Eva] Ho, a co-founder of Applied Semantics (Shinal, 8/28).

Categories: Health Care

State Highlights: States Seek Health Care Autonomy; L.A. Nursing Home Audit; Promoting Overdose-Reversal Drug

Kaiser Health News - 2 hours 56 min ago

McClatchy: 9 States Sign Compact To Run Health Care Without Congress
Kansas, Missouri and seven other states have signed on to a movement that would wrest regulation of most of the nation's health care insurance systems from the federal government. Those state legislatures want to be part of a proposed interstate Health Care Compact. The compact would let participating states use federal funds -- in the form of block grants -- to design and operate their own Medicare, Medicaid and other health care programs, except the military's (Stafford, 8/28).

Earlier KHN coverage: Some States Seeking Health Care Compact (Gugliotta, 9/18/11).

Los Angeles Times: Audit Finds Some L.A. County Nursing Home Cases Prematurely Closed
Los Angeles County auditors have found problems with the way the public health department investigates nursing home complaints involving issues of safety, neglect and other problems that could jeopardize the well-being of residents. After reviewing a sampling of cases from 2012 to this year, they found that some were "inappropriately" closed without a full investigation, according to an audit report released this week. In others -- including five that involved patient deaths -- inspectors wrote up problems or issued citations, but the findings were downgraded by department supervisors, sometimes without discussing the changes with the issuing inspector (Sewell and Brown, 8/28).

California Healthline: Statewide Rural Health Association Returns
The numerous far-flung health care providers and community organizations that make up California's rural health landscape may soon once again have a single, integrated association working to bring a cohesive voice to all. After closing last year with insufficient funding and soaring debt, the California State Rural Health Association is slowly becoming active again. A website was launched this week, a 13-member board has been established and the group is planning a conference by the end of the year (Mack, 8/28).

PBS NewsHour: On The Front Lines Of Care For Undocumented Children Who Cross The Border
The U.S. Border Patrol has apprehended nearly 63,000 unaccompanied children at the southwest border just this year.  Many of them are then relocated to various cities across the country, creating a growing need for health care and education (8/28).

Kaiser Health News: Calif. Bill Would Protect Estates Of Many Who Received Medicaid
A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents (Bartolone, 8/28).

Kaiser Health News: Capsules: In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday
A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers. The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions" (Feibel, 8/28).

The Wall Street Journal: States Expand Access To Overdose-Reversal Drug
Faced with an unrelenting epidemic of heroin and pain-pill deaths, many states are pushing to make more widely available a drug called naloxone that can reverse overdoses from such opioid drugs within minutes. ... There are now 24 states, along with the District of Columbia, that have passed laws expanding access to naloxone, 17 of them in the last two years, said Corey Davis, deputy director of the Network for Public Health Law's Southeastern region, who tracks such policies. The measures vary, but common provisions include allowing doctors to prescribe naloxone to a drug user's friends and family members, and removing legal liability for prescribers and those who administer the medication (Campo-Flores and Elinson, 8/28).

The Washington Post: Justice Officials Call For Release Of Monitoring Of St. Elizabeths
The Justice Department said Thursday that St. Elizabeths Hospital has made "significant improvements" in the care of its patients and asked a federal judge to discontinue the agency's monitoring of the facility (Alexander, 8/28).

Miami Herald: Low-Income Patients Face Hurdles To Care At Public Hospital In Miami
Demanding onerous paperwork from low-income applicants is just one way that Jackson has barred eligible Miami-Dade residents from accessing the charity care program, according to administrative complaints filed this week with the Internal Revenue Service and the U.S. Department of Health and Human Services. The complaints lodged by Florida Legal Services and the National Health Law Program, nonprofit groups that provide civil legal help to the indigent, allege that Jackson fails to meet new requirements for nonprofit hospitals under the Affordable Care Act and other laws (Chang, 8/28).

Georgia Health News: State Health Agency Outlines Spending Increases
A state health agency is budgeting an extra $24 million this fiscal year, and a similar amount next year, to pay for costly hepatitis C drugs in Georgia's Medicaid program. The state is also expected to pay $14.1 million more this year, and $37.9 million in fiscal 2016, for lengthening the time between eligibility reviews for Medicaid and PeachCare beneficiaries, as required by the Affordable Care Act (Miller, 8/28).

Boston Globe: Boston EMS Workers OK Pay Raise
Workers in Boston's Emergency Medical Services will receive a pay raise of nearly 15 percent over six years under a newly settled contract with Mayor Martin J. Walsh. The deal will cover roughly 315 paramedics, emergency medical technicians, and their supervisors. It includes 14 percent in raises spread over six years in addition to a 0.75 percent increase in weekly compensation for hazardous duty pay in July 2016 (Ryan, 8/29).

Categories: Health Care

Viewpoints: GOP's 2015 Obamacare Plan; The Need For Community Health Workers

Kaiser Health News - 2 hours 57 min ago

The Washington Post's Plum Line: Another Big Boost For Obamacare
In another sign that the politics of Obamacare continue to shift, the Medicaid expansion is now all but certain to come to another big state whose Republican governor had previously resisted it: Pennsylvania. ... The details of the final deal will matter. But broadly speaking this looks like another sign of just how hard it is for Republican governors in non-deep-red states to resist the expansion — and of how the politics of this issue continue to change (Greg Sargent, 8/28).

Bloomberg: The Republican Obamacare Battle Plan For 2015
Public opinion suggests people are more interested in "fixing" Obamacare than in completely scrapping it; and by 2015, almost 25 million Americans will be relying on it for health coverage. Those are reasons Republicans should aim to reform or replace portions of the Affordable Care Act .... At the end of the day, congressional Republicans have a chance to show they are prepared not just to oppose Obamacare but also to pass policies to help lower health-care costs, expand access to affordable private coverage and improve the system generally. All of these efforts should begin with the states (Lanhee Chen, 8/28).

The New York Times: Is 'Obamacare' No Longer A Big Deal?
It looks as though Republicans are no longer betting on the Affordable Care Act as a surefire political weapon. The Upshot reported on Wednesday that, in the summer of 2013, lawmakers churned out 530 news releases using the term "Obamacare." So far this summer, in advance of the mid-terms when one might expect that number to go up, it's fallen dramatically, to 138 (Juliet Lapidos, 8/28).

The New York Times: What Doctors Can't Do
Many poor countries use [community health workers] on an enormous scale — in rural areas, where doctors and nurses are scarce, a C.H.W. often serves as the doctor. In the United States, their role is different. ... They're chosen for their ability to listen, support and encourage, without judgment. ... This is a crucial role in a country where vast numbers of people are sick with chronic lifestyle-related diseases. Doctors can't help patients change their behavior in the 15 minutes they spend with each patient. But community health workers can (Tina Rosenberg, 8/28).

The New York Times: An Ominous Ebola Forecast
The World Health Organization warned on Thursday that the Ebola epidemic in West Africa, already the largest outbreak ever recorded, is going to get much worse over the next six months, the shortest window in which it might conceivably be brought under control. By then, the organization said, the virus could infect more than 20,000 people, almost seven times the current number of reported cases. It is a frightening prospect that requires an urgent infusion of aid from public and private donors around the world (8/28).

Los Angeles Times: WHO's Misplaced Ebola Priority
The World Health Organization is nothing if not opportunistic, impulsively jumping on every public health issue that makes the front page. And, of course, it always calls for lots more money to throw at the disease-of-the-month. The latest on WHO's radar is the Ebola virus outbreak in West Africa, which has tallied about 1,500 cases. To address it, WHO wants more than $430 million ... in a world of limited healthcare resources, we need to make hard decisions that will deliver high-impact outcomes for the most people at the least cost (Dr. Henry I. Miller, 8/28).

The Washington Post's Federal Diary: VA Is Looking For A Few Good Doctors And Nurses
One of the first steps to rebuilding confidence in the scandal-plagued Department of Veterans Affairs is getting enough of the right people to do the job. VA Secretary Robert A. McDonald is trying to do that by launching a new recruitment effort to boost the number of medical professionals. ... Working against him is an agency image that has been battered by a series of congressional hearings and reports about employees gaming the system to make it appear vets were getting care much sooner that they really did (Joe Davidson, 8/28).

JAMA: The PCORI Perspective On Patient-Centered Outcomes Research  
The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the US Patient Protection and Affordable Care Act of 2010 to fund patient-centered comparative clinical effectiveness research, extending the concept of patient-centeredness from health care delivery to health care research. In the United States, patient-centered outcomes research is new and not defined in the legislation, and the rationale is unclear to many. In this Viewpoint, we address 2 related questions: What does patient-centeredness in research mean? Why conduct patient-centered outcomes research? (Lori Frank, Drs. Ethan Basch and Joe V. Selby, 8/28)

Categories: Health Care

Research Roundup: Benefits Of Hip Surgery; Preventing Surgical Infections

Kaiser Health News - 3 hours 4 min ago

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Clinical Orthopaedics And Related Research: Surgery For Hip Fracture Yields Societal Benefits That Exceed The Direct Medical Costs
Surgical treatment of hip fractures can achieve better survival and functional outcomes than nonoperative treatment, but less is known about its economic benefits. ... We estimated the effects of surgical treatment for displaced hip fractures through a Markov cohort analysis of patients 65 years and older. ... Estimated average lifetime societal benefits per patient exceeded the direct medical costs of hip fracture surgery by $65,000 to $68,000 for displaced hip fractures. With the exception of the assumption of nursing home use, the sensitivity analyses show that surgery produces positive net societal savings (Gu, Koenig, Mather and Tongue, 8/5).

JAMA Surgery: The Preventive Surgical Site Infection Bundle In Colorectal Surgery
Surgical site infections (SSIs) are associated with increased morbidity, length of hospitalization, readmission rates, and health care costs. They represent a particularly important problem in colorectal surgery, for which SSI rates are disproportionately high, ranging from 15% to 30%. ... To a large degree, the focus [of reducing SSIs] has been on improving adherence to evidence-based practices ... The preventive SSI [systemic, evidence-based measures called] the bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs (Keenan et al., 8/27).

Medicare and Medicaid Research Review: Financial And Quality Impacts Of The Medicare Physician Group Practice Demonstration
[The health law's Accountable Care Organization program] was built directly on its predecessor, the Medicare Physician Group Practice (PGP) demonstration .... This article presents the results of the comprehensive CMS-funded evaluation of the PGP demonstration ... The overall impact ... was a savings of $171 per assigned beneficiary person year during the demonstration performance period .... This represents a savings of 2.0 percent of assigned beneficiary expenditures. CMS paid performance bonuses to the participating PGPs that averaged $102 per assigned beneficiary person year across the five demonstration years (Pope et al., 8/28).

Medical Care: The Intended And Unintended Consequences Of Quality Improvement Interventions For Small Practices In A Community-based Electronic Health Record Implementation Project
Despite the rapid rise in the implementation of electronic health records (EHR), commensurate improvements in health care quality have not been consistently observed. ...  The study included 143 practices that implemented EHRs .... 71 practices were randomized to receive financial incentives and quality feedback and 72 were randomized to feedback alone. ... Technical assistance and financial incentives—alongside EHR implementation—can improve quality of care. Financial incentives for quality may not result in similar improvements for incentivized and unincentivized measures (Ryan et al., 8/27).

Infection Control and Hospital Epidemiology/Rand Corp.: The Association Of State Legal Mandates For Data Submission of Central Line–Associated Bloodstream Infections In Neonatal Intensive Care Units With Process And Outcomes Measures
[This cross sectional study was designed] to determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures. ... Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). ... Mandates were predictors of ≥95% compliance with all practices (Zachariah et al., 8/22).

Here is a selection of news coverage of other recent research:

MedPage Today: Surgery No Help For Mild Knee OA
Arthroscopic surgery for degenerative meniscal tears in patients with mild knee osteoarthritis had no benefit for function or pain, a meta-analysis determined. In randomized trials that included 805 patients, the standardized mean difference for function at 6 months was 0.25, which was converted to a Knee Injury and Osteoarthritis Outcome Score of 5.6. That did not reach the minimally important difference of 10 (Walsh, 8/27).

Fox News: Teens With Depression Benefit From 'Collaborative Care'
For teenagers with depression, finding and sticking with an effective treatment strategy can be an uphill battle. Their families often struggle to find a professional who can treat depression in adolescents, is accepting new patients and is covered by their insurance. ... But an idea called "collaborative care" — which increases communication between families and doctors — may help bridge that gap, said [Dr. Laura Richardson, a professor of pediatrics at Seattle Children's Hospital and the University of Washington in Seattle], who co-authored a new study detailing the findings, published today (Aug. 26) in the journal JAMA (Geggel, 8/26).

MinnPost:  Study Links Early-To-Midlife Obesity To Increased Risk Of Dementia
People who are obese in their early to midlife adult years have an increased risk of developing dementia, and the risk is especially high for people who are obese in their 30s, according to a study published [last] week. The study also found that people who become obese late in life have a decreased risk of developing dementia, particularly Alzheimer’s disease (Perry, 8/22).

Reuters: More Parents Think Their Overweight Child Is 'About Right'
Between 1988 and 2010, the number of parents who could correctly identify their children as overweight or obese went down, according to a new study. ... In the 1988 to 1994 data set, 78 percent of parents of an overweight boy and 61 percent of parents of an overweight girl, identified the child as "about the right weight." That number increased to 83 percent for boys and 78 percent for girls in the 2005 to 2010 period (Doyle, 8/26).

Reuters: Medicaid Payouts For Office Visits May Influence Cancer Screening: Study
In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study. “States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others,” said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International (Doyle, 8/26).

Medscape: Futile Treatment Delays Care For Others Waiting For ICU Beds
Patients in intensive care units (ICU) receiving futile treatment delayed or prevented ICU treatment for others in need of intensive care, a study published in the September issue of Critical Care Medicine has revealed (Laidman, 8/28).

Categories: Health Care

NIH To Begin Trials For Experimental Ebola Vaccine

Kaiser Health News - 3 hours 7 min ago

The announcement about the testing comes as the outbreak in West Africa grows. The World Health Organizations says it could have infected more than 20,000 people.

The Wall Street Journal: Testing On Experimental Ebola Vaccine To Begin in U.S.
The National Institutes of Health said Thursday it will begin testing an experimental Ebola vaccine in humans next week, accelerating research as an epidemic caused by the deadly virus continues to ravage West Africa (McKay, 8/28).

Los Angeles Times: NIH To Launch Ebola Vaccine Trials In Humans
The National Institutes of Health has announced the first clinical trial of a vaccine to protect healthy people from infection by the Ebola virus, which is responsible for an estimated 1,550 deaths throughout West Africa. NIH director Francis Collins on Thursday called the human safety trials, which are to start next week in Bethesda, Md., the latest in a series of the "extraordinary measures to accelerate the pace of vaccine clinical trials" for the public health emergency in Africa (Healy, 8/28).

The Hill: NIH Accelerates Ebola Vaccine Development
The government is speeding up its development of several potential Ebola vaccines in response to the largest ever outbreak of the virus in West Africa. The National Institutes of Health (NIH) confirmed Thursday that it will start testing a vaccine candidate on humans next week for the first time ever (Viebeck, 8/28).

The New York Times: Ebola Could Strike 20,000, World Health Agency Says
The World Health Organization said on Thursday that the Ebola epidemic was still accelerating and could afflict more than 20,000 people -- almost seven times the current number of reported cases -- before it could be brought under control (Cumming-Bruce and Cowell, 8/28).

Categories: Health Care

FDA Plan To Diversify Clinical Trials Raises Some Concerns

Kaiser Health News - 3 hours 19 min ago

Women's advocacy groups complain that the plan doesn't have "teeth" needed to make a change.

The Wall Street Journal: FDA Is Chastised Over Its 'Action Plan' To Diversify Clinical Trial Participation
In response to a law passed two years ago, the FDA was directed to assess the extent to which women and minorities are represented in clinical trials and also devise a plan to bolster their participation. ... the FDA released its plan the other day and it was met with what could best be described as faint praise. In particular, a pair of women's advocacy groups says the biggest issue is that the so-called Action Plan lacks the sort of teeth needed to generate real change. They also complain the plan fails to require drug and device makers to contain specific demographic information in product labeling (Silverman, 8/28).

Categories: Health Care

Texas Hospitals Complain Insured Patients Moving To Urgent Care Centers

Kaiser Health News - 3 hours 23 min ago

The hospitals complain that the shift is a problem because they are getting less funding for the uninsured.

The New York Times/Texas Tribune: Texas Hospitals Say They've Lost Insured Patients To Urgent Care
Opting to skip the wait at hospital emergency rooms, an increasing number of Texans are choosing to use urgent care centers that are popping up in strip malls and shopping districts. ... The increasing number of urgent care centers is problematic for Texas hospitals. Hospitals say they are competing with the clinics for the same pool of insured Texans, at a time when they are also getting less money to cover the cost of treating uninsured patients (Ura, 8/28).

Also, KHN examines a change mandated by the health law on ER services.

Kaiser Health News: Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room
When you need emergency care, chances are you aren't going to pause to figure out whether the nearest hospital is in your health insurer's network. Nor should you. That's why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. ... But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect (Andrews, 8/29).

Categories: Health Care

Medical Marijuana on Campus

Effective January 1, 2013, Massachusetts passed St.2012, c.369 allowing the use of marijuana for medical purposes.  However it may not be legal at some college campuses.  UMass Amherst along with Amherst and Smith Colleges are barring the use on campus.

Pursuant to UMass Code of Student Conduct Trustee Doc. # T-94-059 Although Massachusetts law permits the use of medical marijuana, federal laws prohibit the use, possession, and/or cultivation of marijuana at educational institutions. Federal laws also require any institution of higher education which receives federal funding to have policies prohibiting the possession and use of marijuana on campus. The use, possession, or cultivation of marijuana for medical purposes is therefore not allowed in any University housing or on any other University property.

UMass has not been informed of any students who need access to the drug according to UMass Amherst Spokesman Ed Blaguszewski, “If a case comes up we will certainly review and discuss it. An arrangement between a doctor and a patient is a private matter so if this occurs in the privacy of someone’s home off campus, that, as far as we know is perfectly fine,”

The use of marijuana is illegal under federal law said Blaguszewski and federal law is tied to federal dollars. The University says many of their students receive federal grant money and that a policy of accepting medical marijuana could jeopardize that funding.

Read more about medical marijuana at our page Massachusetts Law About Prescription Medication  


Categories: Research & Litigation

First Edition: August 29, 2014

Kaiser Health News - 4 hours 38 min ago

Today's early morning highlights from the major news organizations, including reports about the Obama administration and Pennsylvania reaching an agreement to expand Medicaid in that state.

Kaiser Health News: Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room
Kaiser Health News' consumer columnist Michelle Andrews reports: "When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. ... But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect" (Andrews, 8/29). Read the story.

Kaiser Health News: Calif. Bill Would Protect Estates Of Many Who Received Medicaid
Capital Public Radio’s Pauline Bartolone, working in collaboration with Kaiser Health News and NPR, reports: "A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents (Bartolone, 8/28). Read the story.

Kaiser Health News: Capsules: In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday
Now on Kaiser Health News' blog, KUHF's Carrie Feibel, working in collaboration with Kaiser Health News and NPR, reports: "A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers. The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions" (Feibel, 8/28). Read the story.

The New York Times: Pennsylvania To Purchase Private Care For Its Poor
Pennsylvania will become the 27th state to expand Medicaid under the Affordable Care Act, the Obama administration announced Thursday, using federal funds to buy private health insurance for about 500,000 low-income residents starting next year. Gov. Tom Corbett, a Republican, had proposed the plan as an alternative to expanding traditional Medicaid under the health care law, which he opposes. Now that federal officials have signed off, Pennsylvania will join Arkansas and Iowa in using Medicaid funds to buy private coverage for the poor (Goodnough, 8/28).

The Wall Street Journal: Obama Administration, Pennsylvania Governor Reach Deal To Expand Medicaid
Pennsylvania Gov. Tom Corbett reached a deal with the Obama administration to extend the state's Medicaid program to half a million low-income residents under the Affordable Care Act, officials said Thursday. Pennsylvania is now the 27th state to agree to broaden Medicaid to include everyone earning up to a third more than the federal poverty level, or around $16,000 for a single adult. The agreement makes Mr. Corbett, a Republican, the ninth GOP governor to go along with a central part of the 2010 health-care law (Radnofsky, 8/28).

The Washington Post: Pennsylvania's Republican Governor Expands Medicaid
Pennsylvania Gov. Tom Corbett had sought the Obama administration's permission to use money authorized by the Affordable Care Act to purchase private health insurance for poor adults. With Thursday's announcement, Corbett and the federal Centers for Medicare and Medicaid Services instead agreed to a plan to expand the program through managed care organizations. ... Medicaid coverage for Pennsylvania adults earning below 133 percent of the federal poverty line, or about $15,500, will begin in January. Starting in 2016, adults earning above the federal poverty line will have to pay premiums worth no more than 2 percent of household income. Those adults can be dropped from the program for failing to pay premiums, but they can also receive discounts for healthy behaviors, like going for a check-up (Millman, 8/28).

Philadelphia Inquirer: Feds Approve Corbett's Pa. Medicaid Expansion Proposal
In what was described as a five-year demonstration project, Pennsylvania got the go-ahead to use federal money to pay private insurers to provide health care to uninsured individuals - many in low-wage jobs. ... But whether the Healthy PA program will roll out Jan. 1 as scheduled could depend on voters. Polls show Corbett facing a double-digit deficit in his bid for reelection. His Democratic challenger, Tom Wolf, has said he supports the traditional Medicaid expansion that 26 states and the District of Columbia have already approved (Worden, 8/28).

The Wall Street Journal: CBO Director: Political Divide Makes Fiscal Progress 'Very Hard'
[Congressional Budget Office Director Douglas] Elmendorf said it was impossible to tell whether his agency’s 2009 and 2010 assessments of the Affordable Care Act were – in retrospect – accurate, because parts of the law are only beginning to take effect and also because it is difficult to measure what programs like Medicare would look like without the ACA changes. “We don’t know, and I think in some important ways, we will never know,” Mr. Elmendorf said. He said CBO’s projections for the number of people who would enroll in insurance exchanges established by the ACA have turned out to be very accurate. He also said they stand by their estimate that the law – in its entirety – will reduce the government’s deficit over its first two decades (Paletta, 8/28).

The New York Times/Texas Tribune: Texas Hospitals Say They've Lost Insured Patients To Urgent Care
Opting to skip the wait at hospital emergency rooms, an increasing number of Texans are choosing to use urgent care centers that are popping up in strip malls and shopping districts. ... The increasing number of urgent care centers is problematic for Texas hospitals. Hospitals say they are competing with the clinics for the same pool of insured Texans, at a time when they are also getting less money to cover the cost of treating uninsured patients (Ura, 8/28).

USA Today: If 'Clean,' Big Data Can Improve U.S. Health Care
Less medical privacy may be good for your health. A growing body of research has found that information Americans share on social media websites about their health and lifestyle is more up to date and accurate than what they share with doctors, employers, insurance companies and government agencies. In other words, we're more honest with our friends than we are with those who control our access to medical care (Shinal, 8/28).

The Wall Street Journal: States Expand Access To Overdose-Reversal Drug
Faced with an unrelenting epidemic of heroin and pain-pill deaths, many states are pushing to make more widely available a drug called naloxone that can reverse overdoses from such opioid drugs within minutes. ... There are now 24 states, along with the District of Columbia, that have passed laws expanding access to naloxone, 17 of them in the last two years, said Corey Davis, deputy director of the Network for Public Health Law's Southeastern region, who tracks such policies. The measures vary, but common provisions include allowing doctors to prescribe naloxone to a drug user's friends and family members, and removing legal liability for prescribers and those who administer the medication (Campo-Flores and Elinson, 8/28).

The New York Times: Ebola Could Strike 20,000, World Health Agency Says
The World Health Organization said on Thursday that the Ebola epidemic was still accelerating and could afflict more than 20,000 people — almost seven times the current number of reported cases — before it could be brought under control (Cumming-Bruce and Cowell, 8/28).

The Wall Street Journal: Testing On Experimental Ebola Vaccine To Begin in U.S.
The National Institutes of Health said Thursday it will begin testing an experimental Ebola vaccine in humans next week, accelerating research as an epidemic caused by the deadly virus continues to ravage West Africa (McKay, 8/28).

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

Categories: Health Care

Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room

Kaiser Health News - 6 hours 58 min ago

When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network.  (Plans that are grandfathered under the law don’t have to abide by these provisions.)

That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect. 

Although the law protects patients from higher out-of-network cost sharing in the emergency room, if they’re admitted to the hospital, patients may owe out-of-network rates for the hospital stay, says Angela Gardner, an associate professor of emergency medicine at the University of Texas Southwestern in Dallas who is the former president of the American College of Emergency Physicians.

“Even if the admission is warranted, you are subject to those charges,” she says

More From This Series Insuring Your Health

If you live in a state that permits balance billing by out-of-network providers, your financial exposure could be even greater. In a balance-billing situation, a hospital may try to collect from the patient the difference between what the hospital billed and what the health plan paid for care. Such practices aren’t generally allowed if a consumer visits an in-network provider.

Consumers shouldn’t expect that the hospital will inform them of potential out-of-network coverage issues, so they need to inquire, says Gardner.

“At least being informed and knowing what you’re getting into can set you up to handle it with your insurer,” she says.

And while you’re at it check into being transferred to an in-network facility if it’s feasible.

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

Categories: Health Care

Family Reunification Laws

Law Library of Congress: Research Reports - Thu, 08/28/2014 - 8:00pm
The Law Library of Congress is proud to present a new report, Family Reunification Laws.

This report surveys 71 foreign countries, plus the United States and the European Union, on the issue of whether their laws permit legal immigrants to bring family members into the country for purposes of residence. For many of the jurisdictions covered, the information provided focuses exclusively on family reunification for permanent residents. However, for a number of jurisdictions, information is also provided on family reunification for citizens/nationals or temporary residents.

A bibliography of selected international and comparative law sources is provided.

Visit http://www.loc.gov/law/help/family-reunification/index.php to read the entire report.

This report is one of many prepared by the Law Library of Congress available at http://www.loc.gov/law/help/current-topics.php.
Categories: Research & Litigation

Pennsylvania, CMS Agree On 'Healthy PA' Medicaid Exansion Plan

Kaiser Health News - Thu, 08/28/2014 - 4:05pm

The Centers for Medicare & Medicaid Services released a press statement Thursday announcing that CMS and Pennsylvania officials. have agreed to expand Medicaid in Pennsylvania.

Philadelphia Inquirer: Feds Approve Corbett's Pa. Medicaid Expansion Proposal
Ending a year-long series of negotiations, the Obama administration on Thursday approved Gov. Corbett's Medicaid expansion alternative proposal to extend health care benefits to as many as 600,000 uninsured Pennsylvanians. In what is described as a five-year demonstration project, Pennsylvania received the go-ahead to use federal funds to pay private insurers. The decision by the Department of Health and Human Services means Pennsylvania joins Arkansas and Iowa, which also received waivers to provide alternatives to Medicaid expansion under the Affordable Care Act (Worden, 8/28).

Harrisburg Patriot-News: Corbett Gains Approval To Use Obamacare Funds To Expand Health Insurance
The expanded coverage, to become available Jan. 1, is for people earning up to 138 percent of the federal poverty level, which is about $16,000 for a single person and $32,000 for a family of four. It's Corbett's version of the Medicaid expansion called for in Obamacare and now available in more than half the states. Corbett's version of the plan will use the federal funds to buy private coverage which administration officials say will give incentives toward healthy behavior and other measures intended to lead to greater self-sufficiency (Wenner, 8/28).

Pittsburgh Post-Gazette: Corbett's 'Healthy PA' Medicaid Overhaul Appoved By Federal Regulators
Mr. Corbett’s plan, submitted to the federal government in February, would not directly expand the state’s Medicaid program, but would offer federal subsidies to about 500,000 low-income Pennsylvanians to purchase private insurance. “From the beginning, I said we needed a plan that was created in Pennsylvania for Pennsylvania — a plan that would allow us to reform a financially unsustainable Medicaid program and increase access to health care for eligible individuals through the private market,” Mr. Corbett said in a prepared statement (Giammarise, 8/28).

Wall Street Journal: Obama Administration, Pennsylvania Governor Reach Deal to Expand Medicaid
The Obama administration has reached a deal with Pennsylvania Gov. Tom Corbett to expand the state's Medicaid program to half a million low-income residents under the Affordable Care Act, state officials said. The deal makes Pennsylvania the 27th state to agree to participate in a provision of the federal health law. It also marks a win for the federal government in its efforts to coax reluctant states to grow their Medicaid programs to include everyone earning up to a third more than the federal poverty level, in the wake of a Supreme Court decision in June 2012 that allowed states to opt out (Radnofsky, 8/28).

Washington Post:  Pennsylvania’s Republican Governor Expands Medicaid
Medicaid coverage for Pennsylvania adults earning below 133 percent of the federal poverty line, or about $15,500, will begin in January. Starting in 2016, adults earning above the federal poverty line will have to pay premiums worth no more than 2 percent of household income. Those adults can be dropped from the program for failing to pay premiums, but they can also receive discounts for healthy behaviors, like going for a check-up. “Like we are doing in Pennsylvania, [the Department of Health and Human Services] and CMS are committed to supporting state flexibility and working with states on innovative solutions that work within the confines of the law to expand Medicaid to low-income individuals," said CMS Administrator Marilyn Tavenner in a statement. "But, unfortunately, millions of Americans are still without Medicaid coverage because their state has yet to act" (Millman, 8/28)

Categories: Health Care

Calif. Bill Would Protect Estates Of Many Who Received Medicaid

Kaiser Health News - Thu, 08/28/2014 - 3:49pm

A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents.

Anne-Louise Vernon from Campbell, Calif. recently enrolled in Medi-Cal, but then found out the state could use proceeds from her home to recover costs of her health care. (Photo by Pauline Bartolone/Capital Public Radio)

The governor typically does not comment on bills until he receives the actual text from the legislature. His Department Of Finance, however, opposes the bill, pointing out that the recovered assets help the state provide services to others."

The bill that just passed the legislature this week, would prohibit the state from trying to recoup some of the money spent on older Medicaid enrollees for ordinary health coverage by recovering assets after they die.

Federal law requires states to recoup money spent on institutional care, such as nursing homes, by Medicaid, the state-federal health care program for low-income people. But it also allows states to recover costs from people after they die if they received basic medical services through Medicaid at the age of 55 or older. 

In California, advocates of the bill say the current law is complicating enrollment in Medi-Cal, the state’s Medicaid program, with some people refusing to sign up, and others terminating enrollment for fear of not being able to pass on their estate. The state has enrolled 2.2 million people into Medi-Cal under the Affordable Care Act.

According to Consumer Reports, California is one of 10 states that recovers funds from estates of Medicaid beneficiaries 55 and older for basic health services. The other states are Colorado, Iowa, Massachusetts, Nevada, New Jersey, New York, North Dakota, Ohio and Rhode Island.

Consumer Reports names an additional 11 states, including Washington, where Medicaid beneficiaries “don’t need to worry” because officials have decided not to pursue the asset recovery. Washington state officials had been planning to do asset recovery but backed off after a Seattle Times story last winter stirred public complaints.

Anne-Louise Vernon had been looking forward to signing up for health insurance under Covered California. She hoped to save hundreds of dollars a month. But when she called to enroll, she was told her income wasn’t high enough to purchase a subsidized plan.

“It never even occurred to me I might be on Medi-Cal, and I didn’t know anything about it," said Vernon.

She said she asked whether there were any strings attached.

"And the woman said very cheerfully, "Oh no, no, it’s all free. There's nothing you have to worry about, this is your lucky day.'” she recounted.

Vernon signed up for Medi-Cal on the phone from her home in Campbell, Calif. Just months later, she said she learned online about a state law that allows California to take assets of people who die if they received health care through Medi-Cal after the age of 55.

“So I called Medi-Cal and asked specifically, 'Does this mean what I think it means?'” she said.

It means Medi-Cal managers can take part of her estate later for health care costs she’s accruing now. Vernon said she’s panicked and worried. She doesn’t get a monthly bill – so she’s not sure what she’ll be accountable for.

“I feel as though right now, if I could go to do the doctor and I felt I knew where I stood, there are a number of appointments that I’d be making right now," said Vernon. "But I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor."

The California law has been on the books for two decades. Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it's modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publically-subsidized health coverage have no worries,” said Landsberg.

During the past 20 years, the state of California has recovered almost a billion dollars that paid for long-term care and basic health services through Medi-Cal.

Categories: Health Care

Low-Income Patients Face Hurdles To Care At Public Hospital In Miami

Kaiser Health News - Thu, 08/28/2014 - 2:58pm

With a part-time job that pays about $10,000 a year and no health benefits, Jacqueline Samuel of Miami has relied on Jackson Health System, the county's public hospital network, to manage her chronic kidney disease at reduced rates since last year.

Through Jackson's charity care program, Samuel said, she was paying about $70 to see a nephrologist each month, $50 for routine blood tests and $22 a month for four prescriptions. But in June, Samuel failed to renew her membership in the Jackson program - and that's when the trouble began.

She had an appointment for a blood test and kept it, at the suggestion of a Jackson financial assistance counselor, because her renewal application was being processed.

A few days later, Samuel got a bill for the blood test: $1,640. She couldn't pay it. She stopped going to the doctor and refilling prescriptions. "I can't see the doctor," Samuel said in early August, "unless I have the money to pay them."

Samuel, 50, said Jackson officials did not re-enroll her in the charity care program in June because - despite providing utility bills, paycheck stubs, a property tax receipt and bank statements - she did not produce signed, notarized affidavits from one of her adult sons, and from family friends in St. Kitts, attesting that they have provided her with financial support in the past.

Demanding onerous paperwork from low-income applicants is just one way that Jackson has barred eligible Miami-Dade residents from accessing the charity care program, according to administrative complaints filed this week with the Internal Revenue Service and the U.S. Department of Health and Human Services.

The complaints lodged by Florida Legal Services and the National Health Law Program, nonprofit groups that provide civil legal help to the indigent, allege that Jackson fails to meet new requirements for nonprofit hospitals under the Affordable Care Act and other laws.   

The groups say Jackson has not widely publicized its charity care program as required under the health law and has put up eligibility barriers such as "unduly burdensome verification requirements."

The complaints also say Jackson subjected uninsured patients to harsh debt-collection tactics without telling them about financial assistance, and the hospital system had failed to produce a required "community health needs assessment" to help Jackson design a charity care program.

Miriam Harmatz, a health law attorney with Florida Legal Services, said Samuel could not afford to pay $25 a page to produce the notarized affidavits Jackson wanted - documentation that Harmatz calls excessive, since state and federal officials don't request such records from people who apply for Medicaid or a subsidized health plan under the ACA.

"It bothers us that this is how they're treating people," Harmatz said. "We don't think Jackson is taking the necessary steps to ensure that people really have access."

As a county resident who meets low-income criteria, Samuel should qualify for charity care from Jackson, Harmatz said, noting that the public hospital system with a mission to treat Miami-Dade's uninsured and indigent receives more than $350 million a year in local property and sales taxes.

Jackson offers charity care on a sliding scale, with residents who earn less than the federal poverty level receiving the most generous benefits, such as free primary care visits and nominal copayments for prescription drugs.

After Florida Legal's intervention in Samuel's case, Jackson officials rescheduled a financial-assistance interview - approving her for the charity care program on Aug. 19 without requiring the notarized affidavits, Samuel said.

"I went to the doctor yesterday," Samuel said last week, noting that she qualified for the neediest category. "It's actually cheaper than the one I had first." She has not received a second bill for the $1,640 blood test.   

Jackson officials declined to comment on Samuel's case. But Myriam Torres, vice president of revenue cycle management, said "no special treatment" was given to any applicant, including Samuel.

"Maybe circumstances for that patient changed from last time to this time," Torres said, "and now the attestation is no longer needed."

Jackson officials say they request notarized affidavits to safeguard taxpayer funds, though Samuel said the hospital system had not requested the documents in 2013.

"We're not denying care," said Mark Knight, Jackson's chief financial officer. "We're merely asking for validation of what [applicants] are telling us."

Jackson officials said 29,176 individuals are enrolled in charity care. Knight said that in 2013 the program cost the hospital system $365 million for 212,294 separate medical encounters, ranging from emergency room care to doctors' visits and outpatient surgeries.   

Knight said Jackson has an obligation to screen uninsured residents for eligibility in Medicaid or other public-assistance programs, such as the Cuban Haitian Entrant Program.

"We have to ensure that those people don't have any other available venues," Knight said.

Jackson aggressively screens all uninsured patients for some form of coverage, he added. In 2013, hospital system counselors converted 29,746 previously uninsured patients to Medicaid. So far this year, Jackson has converted 22,950 uninsured patients to Medicaid.   

Knight said county residents typically have to wait three weeks to meet with a counselor and apply for charity care, but that applicants can schedule a doctor's visit or other care while waiting for the financial-assessment interview.

However, Samuel's experience suggests that those patients also risk incurring debt if their applications are denied.

"They get these really   high bills," Harmatz said. "They don't know what for. . . and they don't go back. They feel it's just going to create more medical debt."

Still, Knight noted, "Billing the patient doesn't always mean they're paying it."

As for the complaints that Jackson has failed to widely publicize its charity care program, including eligibility criteria and debt-collection policies - by not posting the information online, neglecting to post signs in emergency rooms, and failing to insert notices in debt-collection letters - Knight said that the information is available by request.

"We are looking to post those policies online," he said. "There's not any concerted effort [not to publicize the information]. It's just that we haven't historically done that."

Matt Pinzur, a Jackson spokesman, disputed the allegation that the program is not widely publicized, given that Jackson treats more uninsured patients than any hospital in the state.

While the health law requires that nonprofit hospitals make their written charity care policies widely available, it does not specify the criteria hospitals must use to determine eligibility for care.

Nor does it offer any guidance on a fundamental question that many safety-net hospitals like Jackson struggle with every day: Are some patients unable to pay, or just unwilling?   

That's not an easy question to answer, said Rick Gundling, a vice president of the Healthcare Financial Management Association, which represents healthcare finance workers.

Gundling noted that safety-net hospitals have to balance a community's health needs with their resources and mission.

"There's far more demand than they have resources to do," he said. "So they're always trying to figure out the right balance."

Jackson serves a community with the state's greatest number of uninsured residents: The U.S. Census estimates that about 744,000 people, or about 34 percent of Miami-Dade's population, lacked health insurance in 2011.

And while the debut of the ACA's health insurance exchanges in January provided almost a million Floridians with coverage - federal officials have not provided county-level breakdowns of enrollment - advocates for low-income residents say the need is still great, and probably much greater than Jackson alone can meet.   

Samuel, a night-shift custodian at Miami Dade College, is one of an estimated 800,000 Floridians, including about 165,000 in Miami-Dade, who remain uninsured in the so-called "coverage gap" because their annual income is too low to qualify for government help buying a plan under the ACA - and they are ineligible for Medicaid, the federal-state healthcare program for the poor.

Harmatz acknowledges that there is a scenario under which Florida Legal's complaints would "go away," but it's not something under Jackson's control - expansion of Medicaid eligibility to cover all Floridians, including childless adults currently excluded from the program.   

The Florida Legislature has refused to expand Medicaid, though, turning down an estimated $66 billion in federal funding over the next decade.

"If the Florida Legislature would just accept federal funding and provide healthcare coverage for low income adults," Harmatz said, "then these problems would be wonderfully diminished. All these people would be covered."   

Categories: Health Care

The National Book Festival: New Time, New Place, New Gavel Pencils

In Custodia Legis - Thu, 08/28/2014 - 1:34pm

Photograph by Andrew Weber

It is that time of year again – the National Book Festival!    This year the Festival will be taking place on Saturday, August 30th at the Washington National Convention Center.  Once again, Law Library staff are participating in the Book Festival with six staff members manning our booth.  We will have some familiar faces at our table including Elizabeth Moore, Jeanine Cali, Emily Carr and Peter Roudik as well as first timers Nicolas Boring and Dante Figueroa.  Staff will be available to talk about the Law Library’s products such as the Guide to Law Online, the Global Legal Monitor which covers legal developments around the world, and Congress.gov.  We will have handouts which list our various websites and social media outlets and we will have a new handout this year with resources for teachers and students.

Staff at the Book Festival will also be working to stoke enthusiasm for the Library’s upcoming Magna Carta exhibit opening on November 6, 2014.  And to help fire up your enthusiasm we will be giving away some of our famous gavel pencils.   This year the legend on the pencils commemorates the upcoming Magna Carta: Muse and Mentor exhibit to serve as a reminder to visit the Library this November when one of the great historical treasures of the Western World will be on view.  The 1215 Lincoln Cathedral Magna Carta starring in this exhibit will be on loan from the Lincoln Cathedral but the supporting cast of books will be drawn from the Law Library and Library’s own collections.  Nathan Dorn, who is curating the exhibit for the Law Library, will be on hand at the Book Festival to give a talk about the material he has selected from the Library’s collections.

Categories: Research & Litigation

Health Law May Benefit More Small Businesses In The Fall

Kaiser Health News - Thu, 08/28/2014 - 12:31pm

Unhappy with the choices her insurance broker was offering, Denver publishing company owner Rebecca Askew went to Colorado’s small business health insurance exchange last fall. She found exactly what she’d been hoping for: affordable insurance options tailored to the diverse needs of her 12 employees.

But Askew is in a tiny minority. Only 2 percent of all eligible businesses have checked out so-called SHOP (Small Business Health Options Program) exchanges in the 15 states where they have been available since last October under the Affordable Care Act. Even fewer purchased policies.

In November, three more state-run SHOP exchanges are slated to open, and the federal government will unveil exchanges for the 32 states that chose not to run their own.  

SHOP exchanges were supposed to open nationwide on Oct. 1, the same day as exchanges offering health insurance for individuals. But the Obama administration postponed the SHOP launch, citing the need to fix serious technical problems with the exchanges for individuals, which it said were a higher priority.

So far, only the District of Columbia and 15 states – California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Massachusetts, Minnesota, Nevada, New Mexico, New York, Rhode Island, Utah, Vermont and Washington – have launched small business exchanges. Three more – Maryland, Mississippi and Oregon – will also start their own exchanges. 

“It’s easy to explain why (small business exchanges) have gotten off to a slow start,” said Linda Blumberg, a researcher with the Urban Institute who is tracking their development with support from health care advocates, the Robert Wood Johnson Foundation. The delay of small business exchanges in most states confused business owners in the few states that actually offered exchanges, she said.

Also, insurance companies encouraged business owners to renew their plans before the October 2013 deadline to avoid having to sign up for a new policy during the first year of the controversial ACA rollout. The Obama administration allowed even noncomplying plans to be renewed, after complaints from individuals and business owners who had received cancellation notices.

As a result, not as many businesses needed to look for new policies for their employees as was originally projected. To be successful, SHOP exchanges must attract a large pool of businesses that can exert market pressure on insurance carriers and ultimately bring down prices. Whether that will happen remains to be seen.

How It Works

The ACA offers businesses with fewer than 50 employees the opportunity to purchase health insurance coverage for their workers through a SHOP, but it does not require them to do so.

These firms comprise 5.8 million of the 6 million firms in the U.S. and employ at least 37 million Americans. More than 96 percent of larger corporations cover their employees, while only 59 percent of very small companies provide insurance for their workers. As a result, nearly half of the nation’s 47 million uninsured people are self-employed or work for a small company, according to 2012 data from the Kaiser Family Foundation.

Under the health law, a federal tax credit that can cover up to half the cost of an employer’s share of premiums is available to businesses that have fewer than 25 employees and average annual wages of less than $50,000. The federal government estimates 4 million small businesses will qualify, resulting in $40 billion in subsidies over the next 10 years.

But so far, not many companies have taken advantage of the offer, according to a report by the Government Accountability Office. In the 2010 tax year, only 170,300 businesses received a credit, amounting to just $428 million, according to the report.

“A lot of folks complained that they needed to hire an accountant to figure it out,” Blumberg said. “You couldn’t even get a rough idea whether you qualified.” Insurance brokers have also complained about how difficult it is to determine eligibility for a credit, and suggest the federal government should create some kind of easy-to-use calculator.

In Colorado, the percentage of people employed by small businesses is even higher than in much of the rest of the country. “There aren’t exactly a lot of corporate headquarters here,” said the state exchange’s chief strategy officer, Marcia Benshoof.  “Colorado is a state of small business. We have some very passionate folks here who care about this market,” she said. 

A few other states have entered partnerships with the federal government to use the federal website but plan to provide their own marketing and outreach. All states regulate the insurance companies that offer their policies on and off the exchange.

Over the past decade, insurance premiums for small firms have increased 123 percent. Currently, small businesses pay up to 18 percent more than larger businesses for health insurance, according to the Council of Economic Advisers.

The health law requires SHOP exchanges to include a feature known as “employee choice,” in which individual workers can pick from a variety of policies offered by different insurance companies, similar to the menu of health benefit options larger companies offer employees. 

“When we talk about why they should use the exchange, choice is the meaningful part of that conversation. That’s the moment of truth with employers,” Benshoof said. Besides creating goodwill, studies show that offering employees a choice of health plans often results in lower overall health care costs, because employees tend to choose the lowest-priced plans that offer the most value for their individual needs, according to the National Bureau of Economic Research.

Employee Choice 

In Askew’s case, allowing her employees to choose a health plan resulted in an overall decrease in her monthly premium bill. Two of them had chronic conditions and needed more expensive policies that covered the doctors they had been seeing for years. The rest were relatively young and healthy. 

“I set a contribution limit (from the company) based on the cost of the most expensive policy and let the staff choose the policy they wanted,” Askew said.  Out of 47 choices on the exchange, she said 10 of her employees chose a plan that was cheaper than the $300 per month per person limit she set. Overall, she will pay a total of about $400 per month less than she did last year.

Before Colorado opened its exchange, Askew, like most small employers, could qualify only for one insurance policy for all of her employees. That’s because commercial carriers set a threshold number of employees that must sign up to get a plan. As a result, companies with fewer than 50 employees usually qualify for only one plan.

In June, the Obama administration allowed 18 mostly Republican-led states using the federal exchange to temporarily opt out of employee choice, because they argued it could cause overall insurance rates to rise. Alabama, Alaska, Arizona, Delaware, Illinois, Kansas, Louisiana, Maine, Michigan, Montana, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota and West Virginia will not offer the feature until 2016 at the earliest.

A small business advocacy group, the liberal-leaning Small Business Majority, criticized the administration for putting off employee choice, which they say is critical to the exchanges’ success. Without it, state and federal small business exchanges may not offer businesses any distinguishing advantages over self-insuring or purchasing a policy outside of the exchange, said David Chase, the group’s health policy analyst.

With employee choice, he explained, carriers are selling directly to employees, giving small insurance companies a chance to compete with established carriers. That alone, Chase said, could contribute to eventually dragging down prices on the exchange.

Business Opposition

The National Federation of Independent Business (NFIB), one of the groups that sued the administration over the federal health law’s so-called individual mandate requiring nearly everyone to purchase health insurance or pay a tax fine, currently advises its member companies to consider canceling their group health policies and instead help employees apply for insurance subsidies on the individual exchange.  According to the NFIB, the total cost to business owners who are now offering workers’ coverage may be lower if they simply give employees a salary boost to purchase insurance on their own.

If a company’s average wages are low enough to qualify for the small business tax credit, chances are its workers would have incomes low enough to qualify for substantial subsidies on the individual exchange. If workers have an employer offer of affordable insurance, however, they lose their eligibility for premium tax credits.    

When it comes to health insurance, the biggest issue for small businesses is cost, according to a recent survey published in the journal Health Affairs. More than 92 percent of small firms that don’t offer employee coverage said that costs would need to be lower than they are today for them to do so. The catch for SHOP exchanges is that until a large number of businesses start purchasing policies on them, they likely will not create enough new competition to push down prices. Other features and extensive marketing will have to drive businesses there in the meantime.

In general, insurance agents and brokers, who have an equal financial incentive to help businesses purchase policies on the exchange as from the outside market, say exchanges have required nearly twice as much of their time. Colorado exchange officials admitted they were surprised that Askew had successfully navigated the exchange without the help of a broker.

“Granted I’m a lawyer,” Askew said. “But it seemed to me to be a much easier way to manage it all.”

Categories: Health Care

How to Complain to Medicare

Medicare -- New York Times - Thu, 08/28/2014 - 12:28pm
Revealed: the semi-secret phone numbers that beneficiaries are supposed to use to complain to Medicare.
Categories: Elder, Medicare

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