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Health Law Playing Key Role In Virginia Politics

Kaiser Health News - Mon, 07/28/2014 - 9:13am

News outlets examine how the overhaul is factoring into the state's Senate race and changing the political landscape.  

The Richmond Times-Dispatch: Warner-Gillespie Debate Offers Look At The Politics Of Health Care
When Sen. Mark R. Warner faces his Republican challenger Ed Gillespie in their first debate today at The Greenbrier resort in West Virginia, the two are likely to clash over the Democrat’s support for the Affordable Care Act, which Gillespie wants to see repealed. But seven months after entering the race, seven weeks after his nomination as the GOP candidate and three months before the November election, Gillespie, who has repeatedly attacked his opponent for “casting the deciding vote” for the health care law, has yet to roll out his own ideas for policies that would replace the measure. “I do believe there are reforms that would be helpful,” the former GOP strategist and chairman of the Republican National Committee said in an interview last month. “(But) I haven’t finalized or settled on these in terms of the policy moving forward” (Schmidt, 7/25).

The New York Times: In Politics, The ‘Virginia Way’ No Longer Reflects Its Genial Southern Roots
The polarization of Richmond mirrors Washington, part of a nationalization of politics in state capitals with divided government across the country. The Legislative session that recently ended featured teeth-spitting acrimony between Gov. Terry McAuliffe, a Democrat, and Republicans in the General Assembly, which nearly led to a government shutdown. … The issue that nearly ground government to a halt was expanding Medicaid under President Obama’s health care law. Mr. McAuliffe, the most liberal Virginia governor of modern times, favored it. The Republican-led Legislature, influenced by its Tea Party wing, strongly opposed it, even though many of the working poor who would have gained health insurance under the Affordable Care Act were from rural districts represented by Republicans (Gabriel, 7/27).

Categories: Health Care

State Highlights: Va. Lt. Gov. Juggles Politics And Pediatrics; Md. Hospital Error Reporting; Ruling On Fla. 'Docs V. Glocks' Law

Kaiser Health News - Mon, 07/28/2014 - 9:13am

A selection of health policy news from Virginia, Maryland, Florida, New York, Wisconsin, Washington state, New Jersey and Kansas.

The Washington Post: Ralph Northam, Va.’s Low-Key Lieutenant Governor, Juggles Politics And Pediatrics
Ralph S. Northam read Noah’s electroencephalogram and sent the 7-year-old home from the hospital with a dose of powerful anti-seizure medication and instructions to return for more tests. Northam’s work as a doctor is a far cry from his other day job, presiding over the Virginia Senate, where he welcomes visitors to Mr. Jefferson’s Capitol and enforces the chamber’s arcane rules. Most Virginians don’t know that the lieutenant governor spends much of his time treating sick children as a pediatric neurologist. More to the point, most Virginians don’t know who the lieutenant governor is (Portnoy, 7/27).

The Baltimore Sun: Maryland Hospitals Aren’t Reporting All Errors and Complications, Experts Say
While hospitals are supposed to report serious medical errors to state regulators, the mostly confidential system still doesn't capture all of those happening in the Maryland facilities, patient safety experts and regulators acknowledge. Confusion over reporting rules and fear of legal or financial repercussions can thwart disclosure, they say. Details about even the most severe and deadly mistakes, called "adverse events," only become public if someone sues, or if regulators catch a hospital failing to report and launch an inquiry, the results of which are subject to open records laws (Cohn, 7/26).

Reuters: U.S. Appeals Court Backs Florida Law In Barring Docs From Asking Patients About Gun Ownership
A U.S. appeals court ruled on Friday in favor of a Florida law that bars doctors from asking patients about gun ownership, overturning a decision in the so-called "Docs v. Glocks" case by a lower court that had struck it down. Florida's Republican-led legislature passed the law after a north Florida couple complained that a doctor asked them if they had guns, and refused to see them after they declined to answer. A federal judge ruled the law unconstitutional in 2012, and the state swiftly appealed a panel of the 11th U.S. Circuit Court of Appeals, in a 2-1 vote, vacated the federal judge's ruling and described the law as a "legitimate regulation" of professional conduct that simply codified good medical care. Any restrictions it places on physicians' speech was entirely incidental, the appeals court said, since it "was intended to protect patient privacy and curtail abuses of the physician-patient relationship" (7/25).

NPR: New York Debates Whether Housing Counts As Health Care
Brenda Rosen, the director of Common Ground, the organization that manages the building, says The Brook offers a full range of services to keep its residents healthy: social workers, security, a doctor and even an event planner. And while these services don't come without a cost -- an apartment at The Brook runs at about $24,000 a year -- Rosen says they are cheaper than the estimated $56,000 per year that the city spends on the emergency room visits, and stays at shelters and jails, where many people with severe mental illness end up (Aronczyk, 7/28).

The Associated Press: Relatives Run Health Clinic In Madison
Dr. Schenck received his doctorate in 1978 and finished his residency in 1981. He briefly latched on with a practice in Orange before coming to Culpeper to practice, where he was tasked with opening the Culpeper Nursing Home and Rehab. He also set up and ran his practice at the Wilderness Medical Center in Locust Grove from 1982 until 2002. A hospitalist at Culpeper Regional Hospital from 2002 until 2006, he and his wife Lisa -- his registered nurse -- both moved to the Madison practice in 2008 (7/27).

Seattle Times: Becker Slams Insurance Office Report's 'Selective Use Of Facts'
State Sen. Randi Becker, R-Eatonville and chair of the Senate Health Care committee, isn’t going to let go of Insurance Commissioner Mike Kreidler’s tangle with his administrative-law judge, who was placed on leave in May after accusing her supervisor at the insurance office of trying to influence her on insurance cases she adjudicates. Becker, who has been displeased with Kreidler’s office in the past, slammed the investigator’s “selective use of facts,” but said it was “no surprise” (Ostrom, 7/25).

Bloomberg: Christie Call To Cool Abortion Talk Follows Curbs In N.J. 
Chris Christie, who last week prodded Republicans to drop anti-abortion rhetoric to appeal to more voters, has steadily weakened access to the procedure in New Jersey. Even with a Democratic-controlled legislature committed to reproductive rights, the second-term governor’s annual funding cuts for women’s health services have prompted at least six clinics to close since 2010, according to lawmakers. Christie, a possible White House contender in 2016, told Republican leaders in Colorado on July 25 that they need to recast how they promote their views on social issues without altering their positions. The first New Jersey governor to publicly declare himself against abortion since the 1973 Roe v. Wade ruling says he favored the right until he heard his unborn daughter’s heartbeat. Voters whose most important issue is abortion would “look at his record of action,” she said (Young, 7/28). 

The Associated Press: Kansas City Area Clinic to Offer HIV Drug
A Kansas City, Kansas, clinic is offering a medication used to prevent infection in people at high risk of getting the AIDS virus. The U.S. Food and Drug Administration two years ago approved the HIV drug, Truvada, for HIV prevention. The Centers for Disease Control and Prevention issued guidelines in May recommending that doctors offer Truvada to people at substantial risk of HIV infection, such as those in a sexual relationship with someone who is HIV-positive, The Kansas City Star reported (7/26).

Categories: Health Care

Viewpoints: GOP's 'Political Sideshow;' Boehner Says House Must Defend The Constitution; Jonathan Gruber On Center Stage About Subsidies

Kaiser Health News - Mon, 07/28/2014 - 9:12am

USA Today: GOP Lawsuit Looks Like Political Sideshow: Our View
This week, before the House leaves for its August recess, the GOP majority is expected to approve a lawsuit against Obama. Speaker John Boehner, R-Ohio, says it will accuse the president of unconstitutionally abusing his executive power by delaying the Obamacare requirement that larger companies provide health insurance or pay a fine — the so-called employer mandate. ... A fair-minded look at the suit's merits suggests it's really more of a political grudge match, one in which the GOP is seeking an outcome it hasn't been able to achieve at the polls or through the legislative process (7/27). 

USA Today: Boehner: We're Defending The Constitution
President Obama has overstepped his constitutional authority — and it is the responsibility of the House of Representatives to defend the Constitution. ... On the advice of legal experts, the House action will focus on his decision to extend — twice — the deadline to institute the employer mandate in his health care law. We believe this targeted lawsuit offers the best chance of success. ... I oppose the employer mandate in the president's health care law. The House of Representatives has voted to delay or eliminate it (and we will do so again if we prevail in court). But it is the letter of the law that was passed by Congress and signed by President Obama. He simply cannot unilaterally rewrite it (Speaker John Boehner, R-Ohio, 7/27). 

The New York Times: The Fight Over 'Impeachment Lite'
Rather than getting on with the country's business and focusing solely on can't-wait issues before they jet out of town this weekend — like the unfinished bill to fix veterans' health care and the stalled bill to deal with the humanitarian crisis of Central American children arriving at the border — House Republicans are gearing up for a grand maneuver: an apparently unprecedented move by the House to sue the president over his use of executive orders. Talk about misplaced priorities (Charles M. Blow, 7/27). 

Bloomberg: Killing Obamacare Even if It Hurts
I don’t think Republicans believe that damaging Obamacare so that it provides middle-class subsidies in some (mostly blue) states while providing none at all in other (mostly red) states is actually a better policy outcome than the status quo. They just hope that it will weaken the law sufficiently to lead somehow to its collapse and eventual repeal. That's clearly the motivation behind House Speaker John Boehner's proposed lawsuit against President Barack Obama for deferring the law's employer mandate. And we’ve seen the same agenda in other instances as well, including the advertising campaign, sponsored by conservative groups, to convince young people that they are better off without health insurance. It's hard to believe that Republicans think that adding to the numbers of uninsured Americans is actually a desirable policy goal. Yet Republicans are willing to encourage such negative outcomes if that increases the chances of scuttling the law (Jonathan Bernstein, 7/25).

The Wall Street Journal: Obamacare’s Insider Testimony
As Jonathan Gruber will tell you, the MIT economist helped to write ObamaCare and remains one of its fiercest defenders. So it's no surprise that on Friday the Web was full of chatter that Mr. Gruber had at least twice made public assertions that support the latest legal challenge to the health law. The D.C. Circuit Court of Appeals ruled last week in Halbig v. Burwell that the plain language of ObamaCare says that subsidies for health insurance can only be delivered through state, not federal, exchanges. The Administration claims this ignores the clear intent of the law, but someone didn't tell Mr. Gruber (7/27). 

The New Republic: Jonathan Gruber: 'It Was Just A Mistake'
Did the people who designed Obamacare intend to deprive millions of people of health insurance, just because officials in their states decided not to operate their own insurance marketplaces? A lawsuit making its way through the federal judiciary, and perhaps on its way to the Supreme Court, claims the answer is yes. ... now there’s a video from 2012 in which one of the law’s best known advocates and architects—MIT economist Jonathan Gruber—makes the same basic argument that the lawsuit does. Among those who say they are surprised by the statement is Gruber himself, whom I was able to reach by phone. "I honestly don't remember why I said that," he said, attempting to reconstruct what he might have been thinking at the time. "I was speaking off-the-cuff. It was just a mistake" (Jonathan Cohn, 7/25).

Bloomberg: Obamacare's Smoking Gun Fires Again
I believe that Gruber sincerely does not remember making these remarks. Memory is fallible; at some point, Gruber probably changed his mind and forgot that he had ever believed otherwise. ... But though I do not fault his honesty, I also think that in January 2012, Gruber did believe that premium tax credits would only be available on state-created exchanges, and that this would give states a strong incentive to create exchanges. We can draw two conclusions from this: First, the reading of the law by Halbig's plaintiffs is clearly not ridiculous or dishonest; if it is a mistake, it is a mistake that one of the law's chief architects could make. And second, we should be very skeptical of people who are now telling us, four years later, what the legislative intent was. Memory really is extraordinarily unreliable, and as we see here, it's very easy to forget what you believed even a couple of years ago (Megan McArdle, 7/25).

The Wall Street Journal’s Washington Wire: The Stakes Beyond The Halbig Lawsuit
A lot of attention is being paid to the dueling decisions in two U.S. appeals courts about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges. In human terms, the stakes are high: Millions of moderate-income people will not be able to afford health coverage without a subsidy, and a court ruling could gut coverage expansion in the 36 states with federally run insurance exchanges, unless states decide to set up their own exchanges. ... Amid the reaction, little attention has been paid to whether Americans will perceive Halbig as a legitimate legal question or as more inside-Washington politics (Drew Altman, 7/25). 

The Wall Street Journal's Washington Wire: Obamacare Challenges: Where The Conventional Wisdom Falls Short
Since the U.S. Court of Appeals for the D.C. Circuit struck down an Internal Revenue Service regulation implementing Obamacare, some observers have predicted that the IRS rule would ultimately be upheld. The regulation extends federal subsidies to individuals purchasing insurance from federal exchanges and not just state-run exchanges, as the Affordable Care Act specifies. But when it comes to legal challenges regarding the health-care law, the conventional wisdom has sometimes been wrong (Chris Jacobs, 7/25). 

The Chicago Sun-Times: Obamacare’s Never-Ending Story
Obamacare appears headed for another rendezvous with the U.S. Supreme Court. The justices bent over backward, well mainly Chief Justice John Roberts did, to save the Affordable Care Act two years ago. Will similar legal gymnastics be found to rescue President Barack Obama and Democrats from the clear text of the law this time? At issue is explicit language saying that subsidies to purchase health insurance should go only to Americans who buy coverage through "an Exchange established by the State." There’s reason to believe that the law was written this way to compel states to establish exchanges so their citizens would get subsidies. But the law proved so unpopular that 36 states did not set up marketplaces (Steve Huntley, 7/25).

Los Angeles Times: College Campuses Are Fertile Ground For Promoting Obamacare
Much has been made of the need to enroll "young invincibles" under the Affordable Care Act. These are young adults who, according to many, are often uninsured because they think they don't need insurance. They are also critically important to the success of the ACA. Without their participation, state and national insurance pools in the new marketplaces such as Covered California will be older, sicker and costlier. Insurance premiums will be higher (Walter A. Zelman, 7/27). 

In other health care issues -

The Wall Street Journal: Let Patients Decide How Much Risk They'll Take
Earlier this month, at a private conference for the CEOs of his portfolio companies, venture capitalist Vinod Khosla interviewed Google co-founders Sergey Brin and Larry Page, asking them if the company might jump into health care. "It's just a painful business to be in," Mr. Brin replied, later noting that "the regulatory burden in the U.S. is so high that I think it would dissuade a lot of entrepreneurs." Mr. Brin is right. As a neurosurgeon-scientist and entrepreneur who co-founded a bioelectronic medicine company that deploys implantable technology to supplant drugs, I wish he were wrong. But rampant misalignment of incentives is hampering technology in the U.S. health industry (Kevin J. Tracey, 7/27). 

Marketplace: We Really Are Living In The (Medical) Future
We live in the future. That's not my phrase; it is my daughter Madeleine's invention. True, the monorails remain few and far between, but every once in a while I get a reminder that some of what was once science fiction is no longer fiction. Recently, I got to spend a bit of time with a physicist and physician who says she is trying to do for medicine what Google did for information technology. Her idea is democratize healthcare so that the big stuff doesn't always have to go through professional gatekeepers (David Brancaccio, 7/28).

The Boston Globe: Farewell To The Routine Pelvic Exam?
While the American College of Obstetricians and Gynecologists still endorses routine exams, the American College of Physicians, which includes internists like me, does not. Citing 60 years of data from several sources, the ACP last month recommended that doctors stop performing routine annual pelvic exams on women who are not pregnant, not due for a Pap test (which is no longer recommended annually for most women), and who have no history or symptoms of pelvic disorders. The ACP concluded that the low chance of detecting an asymptomatic gynecologic condition — including ovarian cancer, for which no effective screening test exists — doesn’t justify the pain, fear, anxiety, and embarrassment that a high percentage of women report after having a pelvic exam. I’ve been trying to figure out why the ACP’s announcement left me feeling a little sad (Suzanne Koven, 7/27).

Categories: Health Care

Political Cartoon: 'Relapse?'

Kaiser Health News - Mon, 07/28/2014 - 9:12am

Kaiser Health News provides a fresh take on health policy developments with "Relapse?" by Bob Englehart.

Meanwhile, here's today's haiku:

WATCHING THE CALENDAR, AND THE AGREEMENT

It's almost recess...
Countdown hastens lawmakers'
deal for vets' health care.
-Anonymous 

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

Categories: Health Care

Tape Recording Reveals Health Subsidy 'Gotcha Moment' For Health Law Architect

Kaiser Health News - Mon, 07/28/2014 - 9:12am

Tape-recorded comments made by MIT economist Jonathan Gruber in 2012 are being used by backers of the latest legal challenge to the health law to support the argument that the overhaul's subsidies were not intended to be used by consumers shopping for coverage on the federal exchange. 

The Wall Street Journal’s Washington Wire: Health Law Architect's Taped Remarks Fuel Subsidy Debate
Backers of the latest legal challenges to the Affordable Care Act are seizing on comments made in 2012 by an MIT economist, often referred to as the law’s architect, to support their argument that only people who buy health coverage through a state exchange – not exchanges run by the federal government – can get tax credits towards the cost of premiums (Radnofsky and Kendall, 7/25).

Politico: An Obamacare Gotcha Moment
One of Obamacare's chief architects, MIT professor Jonathan Gruber, just handed conservatives a gotcha moment. Health law opponents and conservative academics are highlighting a two-year-old video of Gruber — who has advised both the Obama administration and then-Gov. Mitt Romney’s Massachusetts health reform effort — in which he seems to agree that the law's health insurance subsidies can't be awarded through federal-run exchanges, only through the state-run markets (Winfield Cunningham, 7/25).

The Boston Globe: Health Care Law Debate Heats Up
Jonathan Gruber, a major architect of the Affordable Care Act, twice made comments in 2012 that seem to support legal arguments advanced by opponents who are challenging the federal health insurance law in court. The remarks were captured in two separate recordings, one video and one audio, which bounced around social media Friday after surfacing on conservative websites. But Gruber, a Massachusetts Institute of Technology economics professor, said Friday that it was all a mistake (Freyer, 7/25).

Categories: Health Care

First Edition: July 28, 2014

Kaiser Health News - Mon, 07/28/2014 - 6:45am

Today's headlines include reports about the deal reached by House and Senate negotiators regarding veterans' health care.  

Kaiser Health News: Limitations Of New Health Plans Rankle Some Enrollees
Kaiser Health News staff writer Julie Appleby reports: “Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers. … In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him. Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect” (Appleby, 7/28). Read the story, which also ran in USA Today.

The Wall Street Journal: States Try To Protect Health Exchanges From Court Ruling
A number of states are scrambling to show that they—not the federal government—are or will soon be operating their insurance exchanges under the 2010 health law, in light of two court decisions this week. The efforts are aimed at ensuring that millions of consumers who get insurance through the exchanges would be able to retain their federal tax credits if courts ultimately rule against the Obama administration (Radnofsky, 7/25).

Politico: States Want More Time On ACA Funds
States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer. The states aren’t asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair (Cheney and Wheaton, 7/25).

The Associated Press: Plan To Simplify 2015 Health Renewals May Backfire
If you have health insurance on your job, you probably don’t give much thought to each year’s renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises. Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts (7/27).

The Wall Street Journal: Health-Law Patients Boost Hospital Profits
A wave of newly insured patients helped boost hospitals' earnings in recent months, two hospital operators said Friday, a sign the law's coverage expansion is leading more patients to seek treatment. Universal Health Services Inc. UHS 's revenue rose 10% for the second quarter compared with a year earlier. LifePoint Hospitals Inc.'s profit rose to $39.1 million for the quarter, a 44% increase compared with last year's quarter. Those results arrive on the heels of HCA Holdings Inc. HCA's announcement of strong earnings last week ahead of its July 29 earnings call (Weaver,7/25).

The Wall Street Journal: Universal Health Services Profit Down On Higher Operating Charges
"The reduction in uncompensated care at our acute care hospitals resulting both from healthcare reform and improvements in the underlying economy partially reverses a trend that had been hindering our results for an extended period of time," said Alan B. Miller, the company's chief executive (Armental, 7/24).

The Wall Street Journal’s Washington Wire: Health Law Architect’s Taped Remarks Fuel Subsidy Debate
Backers of the latest legal challenges to the Affordable Care Act are seizing on comments made in 2012 by an MIT economist, often referred to as the law’s architect, to support their argument that only people who buy health coverage through a state exchange – not exchanges run by the federal government–can get tax credits towards the cost of premiums (Radnofsky and Kendall, 7/25).

Politico: An Obamacare Gotcha Moment
One of Obamacare’s chief architects, MIT professor Jonathan Gruber, just handed conservatives a gotcha moment. Health law opponents and conservative academics are highlighting a two-year-old video of Gruber — who has advised both the Obama administration and then-Gov. Mitt Romney’s Massachusetts health reform effort — in which he seems to agree that the law’s health insurance subsidies can’t be awarded through federal-run exchanges, only through the state-run markets (Winfield Cunningham, 7/25).

The Washington Post’s Wonkblog: Q&A: The New $84,000 Hepatitis C Drug
Is $84,000 the final price of Sovaldi? Not necessarily. Insurers have been trying to negotiate with the manufacturer, and U.S. government health programs receive a 23 percent discount. Sovaldi is cheaper in countries where the government sets drug prices, ranging from $900 in Egypt to $66,000 in Germany. And for some patients, Sovaldi has been paired with Johnson and Johnson’s Olysio, another new hepatitis C drug priced at $66,000 in the United States (Millman, 7/25).

The Wall Street Journal: House Tells Court It Can Lawfully Ignore SEC Requests For Records
The U.S. House of Representatives told a federal court Friday it should dismiss a lawsuit filed by the Securities and Exchange Commission because Congress is lawfully allowed to ignore requests to turn over records and testimony to the executive branch agency. "Rather than acknowledge the fool's errand on which it has embarked, the SEC instead invites this court to join it by disregarding fundamental limitations on judicial authority," wrote House attorneys in a new court filing (Ackerman and Mullins, 7/25).

The Wall Street Journal: Congress Set To Leave A Full Plate
Congress loves a deadline. But this year, even that may not be enough. With just a week left before the start of a five-week August recess, it is increasingly likely that Congress will wrap up for the summer having cobbled together only the bare minimum to keep the government functioning without addressing a list of expiring laws and a pileup of potential national crises. … The two chambers, for example, haven't figured out how to respond to the surge of Central American families crossing the southern border. Lawmakers also had struggled over a bill aimed at mitigating mismanagement and long wait times at Veterans Affairs hospitals, though spokesmen for the top negotiators said Sunday that a deal had been reached (Peterson, 7/27).

Politico: Deal Reached On VA Reforms
Sen. Bernie Sanders and Rep. Jeff Miller have reached an agreement to reform the Department of Veterans Affairs, according to an aide briefed on the matter. The legislation, which is to be unveiled Monday, will touch on “both the short-term and long-term needs of the VA,” the aide said (French, 7/27).

The Associated Press: With Deadline Looming, Lawmakers Reach Deal On VA Health Care
The chairmen of the House and Senate Veterans Affairs committees have scheduled a news conference Monday afternoon to unveil a plan expected to authorize billions in emergency spending to lease 27 new clinics, hire more doctors and nurses and make it easier for veterans who can't get prompt appointments with VA doctors to obtain outside care (7/28).

The Washington Post: House, Senator Negotiators Reach Deal On Veterans Bill 
Aides said that Sanders and Miller had worked out final language on the agreement, which would be circulated among lawmakers on Monday ahead of the formal announcement. One House aide, not authorized to speak publicly about the talks, said that the final agreement more closely mirrors a Senate measure overwhelmingly approved by Democrats and Republicans last month (O’Keefe, 7/27).

The Washington Post’s Federal Eye: The New VA-Reform Deal, And How The Costs Shrank Over Time
After a weekend of talks, House and Senate negotiators say they have reached a deal to help the troubled Department of Veterans Affairs address extensive wait times at VA medical centers, one of the root causes of the agency’s recent scheduling scandal. Lawmakers now have about five working days to recommend changes and vote on the agreement before Congress begins its August recess. Sen. Bernie Sanders (I-Vt.) and Rep. Jeff Miller (R-Fla.), who lead the Senate and House veterans affairs committees, respectively, will try to round up support for sending the measure to President Obama before then (Hicks, 7/28).

The New York Times: Lawmakers Reach Deal On A Fix for V.A.’s Health Care System
House and Senate negotiators reached agreement during the weekend on a legislative package intended to stabilize the Department of Veterans Affairs’ sprawling and embattled health care system, according to people briefed on the deal (Oppel Jr., 7/27).

Los Angeles Times: VA Healthcare: Tentative Deal Reached In Congress
Congressional negotiators have reached a tentative agreement on legislation to bolster healthcare funding and reforms at the troubled Department of Veterans Affairs, salvaging a deal after talks imploded last week. The accord comes none too soon: Lawmakers are poised to leave town at the end of the week for the long August break. A stalemate could politically damage the already unpopular Congress (Mascaro, 7/27).

The Wall Street Journal: Congress Reaches Deal To Help Fix VA
Leaders from the House and Senate Committees on Veterans' Affairs announced Sunday they have reached a deal on legislation to help fix the VA that has been bogged down in conference committee for more than a week over partisan bickering and questions of costs (Kesling, 7/27).

The New York Times: In Politics, The ‘Virginia Way’ No Longer Reflects Its Genial Southern Roots
The polarization of Richmond mirrors Washington, part of a nationalization of politics in state capitals with divided government across the country. The Legislative session that recently ended featured teeth-spitting acrimony between Gov. Terry McAuliffe, a Democrat, and Republicans in the General Assembly, which nearly led to a government shutdown. … The issue that nearly ground government to a halt was expanding Medicaid under President Obama’s health care law. Mr. McAuliffe, the most liberal Virginia governor of modern times, favored it. The Republican-led Legislature, influenced by its Tea Party wing, strongly opposed it, even though many of the working poor who would have gained health insurance under the Affordable Care Act were from rural districts represented by Republicans (Gabriel, 7/27).

The Washington Post: Ralph Northam, Va.’s Low-Key Lieutenant Governor, Juggles Politics And Pediatrics
Ralph S. Northam read Noah’s electroencephalogram and sent the 7-year-old home from the hospital with a dose of powerful anti-seizure medication and instructions to return for more tests. Northam’s work as a doctor is a far cry from his other day job, presiding over the Virginia Senate, where he welcomes visitors to Mr. Jefferson’s Capitol and enforces the chamber’s arcane rules. Most Virginians don’t know that the lieutenant governor spends much of his time treating sick children as a pediatric neurologist. More to the point, most Virginians don’t know who the lieutenant governor is (Portnoy, 7/27).

NPR: New York Debates Whether Housing Counts As Health Care
Brenda Rosen, the director of Common Ground, the organization that manages the building, says The Brook offers a full range of services to keep its residents healthy: social workers, security, a doctor and even an event planner. And while these services don't come without a cost — an apartment at The Brook runs at about $24,000 a year — Rosen says they are cheaper than the estimated $56,000 per year that the city spends on the emergency room visits, and stays at shelters and jails, where many people with severe mental illness end up (Aronczyk, 7/28).

The Associated Press: Relatives Run Health Clinic In Madison
Dr. Schenck received his doctorate in 1978 and finished his residency in 1981. He briefly latched on with a practice in Orange before coming to Culpeper to practice, where he was tasked with opening the Culpeper Nursing Home and Rehab. He also set up and ran his practice at the Wilderness Medical Center in Locust Grove from 1982 until 2002. A hospitalist at Culpeper Regional Hospital from 2002 until 2006, he and his wife Lisa — his registered nurse — both moved to the Madison practice in 2008 (7/27). 

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Categories: Health Care

Limitations Of New Health Plans Rankle Some Enrollees

Kaiser Health News - Mon, 07/28/2014 - 5:01am

Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.

“They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, Calif.

In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.

“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”

Consumer groups argue many enrollees were misled. In California, consumers filed class-action lawsuits against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them.

Nationally, regulators and insurance agents are inundated with complaints, while state lawmakers are considering rules to ensure consumers’ access to doctors. For 2015 plans which will be on sale beginning in November, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.

Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn’t let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them -- contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care and limiting coverage outside those networks.

“Obamacare products have lower prices than they would have if they had had [larger] commercial networks,” said Robert Laszewski, an industry consultant and former insurance executive. “They’re one-size-fits-all networks designed for low-income people accessing insurance for the first time.”

Lower Prices, Limited Choice

Lower monthly premiums made such plans attractive to many consumers on the new exchanges. Some chose tightly managed plans -- often called health maintenance organizations (HMOS) or exclusive provider organizations (EPOS) – specifically because of their cost, in some cases, without realizing the tradeoffs.

Others had no choice.

Anthem, one of the biggest sellers of individual insurance, offers only HMO-like plans through the new markets in six of the 14 states it serves, including New Hampshire, where it is the only insurer. In California, where the insurer is the target of two class-action lawsuits, it offers plans with no out-of-network benefits in Los Angeles, San Diego and San Francisco, although another type of plan is available in other counties.

Anthem spokeswoman Kristin Binns said the insurer decided to move heavily into managed care in many of its markets after research showed most consumers, especially those who were uninsured, cared about price first and foremost.

“HMOs give them much more access than they were afforded before,” Binns said.

Still, she said Anthem expects to roll out plans with out-of-network coverage in 2015 in some areas where it does not offer them. She would not specify the regions.

Other insurers made similar decisions, offering managed care plans as the only choice for residents buying through the new marketplaces in entire counties in Indiana, Georgia, South Carolina, Virginia, Florida, Wisconsin and Mississippi, according to government data analyzed by Kaiser Health News. Nationally, 43 percent of mid-level “silver” plans offered in California, New York and 34 states using the federal marketplace have no coverage outside their networks, a study by the American Cancer Society Cancer Action Network found.

“They’re all doing it,” says Wall Street analyst Ana Gupte of Leerink Swann, an investment bank. “Obamacare is putting pressure on their margins, so they’re on the hook to moderate costs.”

But along with consumers, lawmakers and regulators have begun to push back.

In California, managed care regulators are investigating Anthem and another insurer, Blue Shield of California, after receiving numerous complaints about access to doctors and hospitals.

Lawmakers in 22 states debated laws this year and last related to network adequacy, although the vast majority failed to pass, according to the National Conference of State Legislatures. In Washington state, administrative rules announced this spring require insurers to provide enough primary care doctors so enrollees can get an appointment within 10 days and 30 miles of their home or workplace. Directories of participating providers must be updated monthly.

“I have heard from many consumers … who were upset to find their health plan no longer included their trusted doctor or hospital … and some discovered this only after they enrolled,” Washington Insurance Commissioner Mike Kreidler said in an announcement of the rules in April.

Scrambling To Find Doctors

Brian Liechty of TCU Insurance in Plymouth, Ind., said he has helped “hundreds” of clients sign up for tightly managed plans – including Pippenger, when her work-based plan was discontinued.

“For the right person who is willing to go where they must and live with rules, it allows them to buy a health insurance policy they could never touch before,” he said.

Patient advocates agree that managed care can be done well but caution that some policies could leave patients scrambling to find doctors – and on the hook for thousands of dollars if they go out of network.

“If highly specialized care -- an academic medical center or a cancer center -- is not available in a plan’s network … some plans will send you to an out-of-network provider, but it’s not required,” said Laura Skopec, senior policy analyst at the cancer action network.

Going out of a managed care plan’s network often means patients foot the entire bill, which can be financially devastating in cases of serious illness. In other types of insurance plans, a portion of the out-of-network bill might be covered, but consumers still face sharply higher costs than if they see a network provider.

Pippenger said that because she was in pain and knew she might need surgery, she checked the provider directory for her new plan, looking for an orthopedic surgeon within 30 miles. She found five who specialized in hips and knees, but felt anxious because she knew nothing about them.

“I want to go back to the doctor who did my other knee,” she said.

She paid for an initial consultation with him, but realized she couldn’t afford the cost of having him fix her second knee.

Adding to the problem this year were some plans’ incomplete or inaccurate lists of participating doctors and hospitals.

Perez, 46, bought her insurance through California’s state-run website. Before enrolling, the immigration attorney says she was assured by the plan and her doctors that they were in Anthem’s network. Only later did she find out that none of those affiliated with her local hospital, Stanford Medical Center, are in it.

Perez said she was unable to find a doctor affiliated with Stanford or another nearby hospital, so she filed a complaint with state regulators and was  granted a waiver to switch plans.

“I’ve been paying a premium since March for medical care that I’ve never been able to access,” she said.

Categories: Health Care

Masschusetts Enacts Strict Compounding Pharmacy Oversight

Massachsuetts Trial Court Law Library - Sun, 07/27/2014 - 9:00am
Gov. Patrick recently signed Ch. 159 of the Acts of 2014, "An Act Relevant to Pharmacy Practice in the Commonwealth".  It was passed unanimously by both Houses to regulate compounding pharmacies in Massachusetts, after a 2012 meningitis outbreak that killed 64 and sickened hundreds across the U.S., was traced to a compounding pharmacy in Massachusetts.  The now closed Framingham pharmacy was found to be actually operating as a drug manufacturer, rather than a pharmacy filling individual prescriptions.   These large scale operations will now have to register with the federal Food and Drug Administration and follow regulations for drug manufacturers.

The legislation is extensive and charges the Board of Registration in Pharmacy with creating new regulations to implement changes regarding licenses, education, labeling and inspections.  It requires these pharmacies to have staffed consumer hotlines during working hours.  Compounding pharmacies must also eventually report certain information on the Department of Public Health website for viewing by consumers.  The law also cites mandatory compliance with  U.S. Pharmacopeia and National Formulary standards.
Categories: Research & Litigation

New Amendments to Deleading and Lead-safe Renovation Regulations

Massachsuetts Trial Court Law Library - Sat, 07/26/2014 - 7:30am
 454 CMR 22.00 applies to the activities of employers, employees and others engaged in deleading of residences containing dangerous levels of lead, except for the activities of: owners of residential premises and owners' agents who perform deleading work in accordance with regulations promulgated by the Director of the Childhood Lead Poisoning Prevention Program pursuant to M.G.L. c. 111 s. 197(d); and contractors who, pursuant to 105 CMR 460.175(A) or the activities in accordance with 105 CMR 460.15(A) or the activities set forth at 105 CMR 460.100(D) in or on short-term vacation or recreational rentals.   Lead Safe Renovation 454 CMR 22.00 also applies to all renovation work conducted for compensation in Target Housing and Child-Occupied Facilities.

More information can be found at Massachusetts Law About Lead Poisoning and Control 
Categories: Research & Litigation

Pitfalls Emerge in Health Insurance Renewals

Kaiser Health News - Fri, 07/25/2014 - 2:45pm

For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins.

Seems like good news after all the headaches consumers endured after the program’s launch last year. Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances.

“(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop,” said Jenna Stento, a senior manager at Avalere Health, a health care research and consulting firm.

If you made a good choice last year, what could be so wrong about re-upping with the same plan?

Turns out plenty, particularly for those among the 87 percent of enrollees in health insurance exchange plans who received a federal subsidy to help pay for premiums. Understanding why that’s a problem isn’t easy, the result of complicated quirks in the Affordable Care Act, which established the exchanges in the first place.

Premiums Up 8 Percent

Overall, premiums on the exchanges in 2015 may be a bit higher for most people, at least according to one analysis of proposed plans and rates in nine states. Avalere found that the average premiums for Silver plans will climb an average of 8 percent. (There are four grades of plans offered, starting with Bronze plans with the cheapest premiums, but higher deductibles and co-pays, and moving up to Silver, Gold and Platinum.)

The Obama Administration announced last month that consumers who bought their policies on the federal exchange would have them automatically renewed, as well as the amount of their subsidies.  It will be up to each state exchange whether to offer a similar automatic renewal. People whose level of income has changed would need to enroll again since it would affect the amount of their subsidies. 

But consumers who automatically re-up with the plan they already have could face steep and unexpected premiums and out-of-pocket costs, particularly if they received a federal subsidy.

Changing Benchmark Plans

Here’s why. The subsidy people receive is pegged to the second-lowest priced Silver plan, the so-called “benchmark plan,” meaning that the amount of a subsidy any individual receives no matter which plan he or she selects, is based on how much they would receive if they picked that benchmark plan.

In a hypothetical example Avalere provides, “Sue,” a Maryland resident, enrolled in the 2014 benchmark Silver plan in her region – offered by CareFirst Blue Cross -- which had a monthly premium of $214. Based on her income, Sue’s contribution toward her monthly premium was set at $58, so she qualified for a monthly federal subsidy of $156 to make up the difference. If Sue had chosen a plan with a higher premium, her federal subsidy would have remained fixed at $156 and she would have had to pay more out of her own pocket.

However, in 2015, according to Avalere’s analysis of early rate filings, CareFirst Blue Cross will no longer be the second lowest Silver plan in Sue’s region but the ninth lowest out of 18 Silver plans, meaning that it will lose its status as the benchmark plan. CareFirst’s new monthly premium is $267. The new benchmark Silver plan (the Silver plan with the second lowest premium) will be the Kaiser Foundation Health Plan with a monthly premium of $231.

Sue’s contribution remains the same, but she will now qualify for a higher federal subsidy of $173 to make up the difference between her ability to pay $58 per month and the higher $231 monthly premium of the new benchmark.

If she automatically re-enrolls with CareFirst, however, she will have to cough up another $36 a month. By doing nothing, her out-of-pocket contribution will rise by 62 percent.

In another example, “Dave” enrolled in the benchmark Silver plan in Washington state, Group Health Cooperative, which had a monthly premium of $281. He received a federal subsidy of $85 each month, leaving him with a monthly out-of-pocket bill of $196.

In 2015, BridgeSpan Health will replace Group Health as the benchmark plan in Dave’s area, with a premium of $263 a month. Because of that lower premium, Dave will be entitled to only a $67 a month federal subsidy, leaving him again with a $196 monthly out-of-pocket expense if he switched to BridgeSpan. But if Dave sticks with Group Health, which hiked its premiums to $313, he will have to pay $246 each month out of his own pocket, a nearly $600 increase compared to last year.

This is not a theoretical wrinkle. Of the nine states whose 2015 premiums Avalere examined (Connecticut, Indiana, Maryland, Maine, Oregon, Rhode Island, Vermont, Virginia and Washington), all but Vermont appear headed for a new benchmark plan when open enrollment commences. Consumers who live in six of these states may have an unpleasant surprise when they see their bills if they let their policies automatically renew.

In Rhode Island and Virginia, the opposite may be true. Last year’s benchmark plans are expected to become the lowest price Silver plans, instead of the second lowest. Consumers renewing the 2014 benchmark plans in those two states could actually see their out-of-pocket premium costs decrease in 2015.

“There could be significant financial value to take a look at the site and see if there might be more affordable options for you, given the changes since last year,” Steno said.

Website Tools

As re-enrollment approaches, numerous health care advocacy organizations, including Easter Seals, the March of Dimes, the Livestrong Foundation, the National Alliance on Mental Illness, and many others have urged the U.S. Department of Health and Human Services, which operates the federal health exchange, and the states that run their own exchanges to develop tools on their websites that will help consumers identify the plans that best fit their particular circumstances, not only in terms or premium costs, but also their actual usage.

In the first year, all exchanges showed the differences in premiums of the various health care plans as well as their differing cost-sharing formulas. Cost-sharing refers to deductibles, copays and co-insurance. (Copays are a fixed amount you pay for a particular medical service, such as $40 per primary care visit; co-insurance is a percentage that you have to pay for each service, such as 20 percent of a hospitalization.)

The lower the premiums, the higher the cost-sharing burdens on patients. As a result, cost-sharing formulas can result in the difference of thousands of dollars between one plan and the next, depending on an individual’s or family’s specific health care needs.

Those with chronic conditions, for example, who need many doctor visits in the course of a year, would do best to enroll in a higher premium plan with lower co-pays for individual visits. Relatively healthy people, on the other hand, would likely come out ahead by enrolling in a lower premium plan with higher co-pays.

That is why health advocates want all the exchanges to offer calculating tools that would enable customers to plug in information on their actual health care usage from the previous year to get an idea of how much they would be likely to spend in each plan in the year ahead.

“Our goal is that every state website will have the information to help you understand your real out-of-pocket costs,” said Marc Boutin, president of the National Health Council, which offered its own calculating tool for customers during the last enrollment.

But with all the computer mishaps in the first enrollment year, neither the 36 federal nor 15 state exchanges had such a tool in the first year. Colorado tried in the first year, but consumers found the tool confusing and the exchange disabled it, said Adele Work, director of product implementation for Connect for Health Colorado. Consultants are working on a replacement, she said, but it may not be available in time for November. It’s not clear which, if any, other states will have such a tool in place either.

Exchanges also did poorly in providing two other categories of information of great interest to consumers. Many exchange websites were unable to offer up-to-date lists of the medical providers who were in each network plan. And very few exchanges – Colorado and Nevada were exceptions – could tell consumers which medications each health plan covered, information that could make a difference of thousands of dollars.

Because of last year’s disastrous roll-out, most exchanges will have modest ambitions for the second enrollment period. Offering consumers a smooth enrollment experience is the goal of most exchanges. But a smooth experience won’t necessarily be enough to guarantee landing the best policy. 


Categories: Health Care

Improving Direct Certification Will Help More Low-Income Children Receive School Meals

Center on Budget and Policy Priorities - Fri, 07/25/2014 - 12:13pm
The National School Lunch and School Breakfast Programs and the Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp Program) are powerful tools that alleviate child hunger and improve child well-being. To make sure that the most vulnerable children have access to much-needed school meals and to make these programs more efficient, Congress has established automatic eligibility for free school meals for certain categories of children whose families are most likely …
Categories: Benefits, Poverty

My Right Breast: One Man’s Tale Of Lump And Mammogram

CommonHealth (WBUR) - Fri, 07/25/2014 - 11:28am

Journalist B.D. Colen photographed his own mammogram during the procedure. ((c) B. D. Colen, 2014)

By B. D. Colen

It began with an itch I just had to scratch. Doesn’t every adventure begin that way?

I was lying in bed reading on a Saturday evening, and without even looking I idly scratched a spot on the right side of my chest –- at that point I had a chest, not breasts. As I did, my fingers rode over a small something, a little like a speed bump about an inch below and two inches to the left of my right nipple.

I stopped reading and started poking. And prodding. And pushing. And feeling. And manipulating. And panicking.

“That’s a lump!” I thought, and suddenly I had a right breast. With a lump in it.

I spent Sunday attending to the usual chores and pleasures, with a good deal of poking and prodding added in. There was absolutely no question that something was dwelling there, beneath my AAAA right breast. But what was it? And what was I worried about? After all, I’m a man, and men don’t…Well, yes, men do get breast cancer. In fact about one in every thousand men will develop breast cancer during their lifetimes. Granted, that’s barely worth mentioning compared to a woman’s one-in-nine chances, but it still means that the possibility was indeed real that something ugly and malignant was barely hiding beneath my skin.

The following day, I already had an appointment with my primary care physician about something else, and when we were finished I said, “So, Sam, I seem to have this lump in my right breast.”

(Photo (c.) B.D. Colen, 2014)

Suddenly, my normally garrulous physician grew serious. “Let’s take a look,” he said, asking me to lie down on the examining table. He had me show him where I thought the lump was and I instantly isolated it – I’d already felt the damned thing enough times to be able to go right to it.

He felt it, felt around it, poked and prodded, and in less than a minute said, “You’re right, there’s something there.” Then, without further kidding – which I’d expect from him – and without any “Well, it’s probably nothing, but let’s be sure,” he sat down at the computer and started typing. “I’m putting in an order for a ultrasound and a mammogram,” he said. “For tomorrow.”

Mammowhat?! Mammogram? Me? But I’m a man! And at 67? Is this some really, really weird dream I’m about to wake up from? How in God’s name were they going to do a mammogram when there’s practically no mam on my chest?

But into the rabbit hole, through the door marked “Women (almost) Only” I went. Though not before Googling “male breast cancer” and convincing myself that I was going to die: Family history? Check. Average age of 68? Check. Sometimes Google is not your friend.

The nice woman down in radiology scheduled me for 10 the next morning, and told me that I shouldn’t worry. “It’s probably nothing,” she assured me. I thought, “That’s probably what you tell all the guys.”

I don’t need to tell any of you who are women what a painful, essentially degrading experience having a mammogram is. I’ve since read the jokes advising women to prepare for the procedure by placing a breast on the edge of their freezer and slamming the door on it – and that is pretty close to the reality.

I had decided ahead ahead of time that I wanted to photograph the whole thing; I teach documentary photography at MIT. And I was blissfully distracted by trying to hold the camera out with one arm, figure out how to frame my shot semi-blindly, and shoot. But even with that distraction, having a virtually non-existent breast pulled, pushed, stretched, tugged, and crushed was not fun.

(Photo (c) B.D. Colen, 2014)

In fact, it was way beyond not fun. As a female friend said afterwards when she saw my photos, “If men routinely had to have mammograms the entire procedure would have been either eliminated or totally reinvented decades ago.” I agree. It is a somewhat barbaric procedure, as I believe these photos show.

(Photo (c) B.D. Colen, 2014)

After suffering through the indignities of the mammogram, I was taken to another room for my ultrasound. (I should note here that the tech who administered the mammogram, as well as the ultrasound, was quite lovely under the circumstances, and did her best to make the procedure as bearable as it could be.)

The ultrasound was an absolute piece of cake after the mammogram; a couple of squirts of cold jelly on my by then very sore right breast, a few minutes of having the transducer moved back and forth over and around the lump as the tech and a staff radiologist watched the screen, and that was that.

B.D. Colen also photographed his own ultrasound procedure ((c) B.D. Colen, 2014)

“There’s nothing,” the radiologist announced at the end of the procedure. So, much relieved, I gathered up my clothes and camera gear and left.

But wait a minute! “There’s nothing?” Is that a medical term for the lump that I felt and that my primary care physician felt? That “nothing” was most definitely something. Now, it might have been a nothing something, but it was something. And I wanted to know what that something was and whether it was something I should forget about because it was nothing, or whether it was a quietly multiplying collection of deranged cells that were going to take over my body and kill me.

So I sent an email to my primary care doctor, telling him that I had been told the something he had felt was nothing, which, I told him, is not a term in my medical dictionary. “What do we do now?” I asked.

“See a surgeon,” he wrote back, and he put in for a consult.

The surgeon I was sent to was a young general surgeon who spends a few hours a week seeing patients at my HMO. He asked why I was seeing him, and I told him my story. He had me lie down, poked and prodded, said he could definitely feel my nothing, which he didn’t think was much of anything, and told me I had three options:

• I could just watch and wait – “That’s fine for you, fella,” I thought, “but not for me.”

• I could make an appointment to have him cut it out and send it to a pathologist, which I thought was premature.

• Or I could go get a second opinion from a breast surgeon.

Bingo! I’ll take door number three! (Especially when the surgeon acknowledged that not only was he not a breast specialist of any kind, but he had only seen about two cases of male breast cancer in his fairly short career.)

So the process began again. My “films” – CDs – had to be sent to Brigham and Women’s Hospital, where they had to be read by their radiologists before I could get to see a specialist. (I’ll admit I couldn’t really see the point in that, given that the first radiologist said that there was nothing detected by either the ultrasound or the mammogram, but maybe the Brigham radiologists would see something.)

Of course it turned out that someone forgot to send the report over with the “films,” so everything dragged on for weeks. And during those weeks, as I nightly poked and prodded my nothing, convinced that it was growing and changing shape, I, like perhaps every woman who has had a lump, alternated between being convinced that it really was nothing, being terrified that it was malignant and was going to kill me, and thinking that I really didn’t care one way or the other.

Finally, about four weeks after first discovering my lump, I found myself in the Comprehensive Breast Health Center at Brigham and Women’s for an examination by a nurse practitioner. And boy, did I feel out of place. The young women at the front desk did their best to make me feel less uncomfortable, but it’s hard to feel you belong when you’re filling out a form filled with questions clearly written for women. How many pregnancies had I had? Well….

I spent my time trying to guess the stories of the three women waiting to be seen. One was a 30-something – mammogram follow up, I figured. One was a woman in her 70s with a younger woman I assumed was her daughter – not a good sign. And then there was a woman of indeterminate middle age, with her husband, who was alternately rubbing her shoulders and looking concerned as she filled out the forms – I wanted to weep.

The nurse practitioner who examined me was just the kind of person I had hoped for: she was calm, professional, and reassuring. She had been examining breasts for 15 years, she told me, so I was comfortable offering her my right breast and its lump.

Her examination technique was completely different from that of the young surgeon I had seen, who had tapped my breasts as though he was checking the hull of a wooden boat for rot. She gently ran her fingers over my breast – immediately locating the lump, the “nothing.” And other lumps. Uh oh! Then she switched to the left breast, and found a lump almost identical to the first one I had found, in a spot in the left breast that mirrored where I had found the first lump in my right breast. And she found additional lumps in the left breast.

“I think everything’s okay,” she reassured me. “It’s definitely a good sign that these are in both breasts, and in the same place. They’re soft and pliable, and they can be moved.” I think they’re just anomalies, she said. Anomalies I have probably had all my life but — until I went on a diet last year and lost 45 pounds — I had never been able to feel them.

So my lump was indeed something, but the something appears to be nothing to worry about. I am now scheduled for a follow-up exam in September, just to make sure that the something hasn’t changed. At this point I am assuming that my lumps and I will be together for a number of years to come.

But you can rest assured that I will continue to examine my breasts on a regular basis, as every woman, and man, should, I would argue, whether or not the latest recommendation is to forego breast self-examinations.

Granted, self-exams may turn up countless nothings, and their discovery may lead to unnecessary fears, biopsies, and even mastectomies. But will that overtreatment occur because of the discovery of nothings, or because of physician fear of possible lawsuits if they aren’t aggressive enough? And suppose my nothing had indeed been something, and I had not discovered it for, three, six, or 12 more months. Then what?

Frankly, I’d be willing to bet that if one man in nine developed breast cancer, the recommendation would be to do weekly breast self-examinations.

B. D. Colen is a Pulitzer Prize-winning former medical writer and columnist for The Washington Post and Newsday, who teaches science journalism and documentary photography at MIT. You will find more of his photography on his website and at SocialDocumentary.net here, here and here.

Categories: Health Care

Obama Administration Moves Forward On Employer Mandate

Kaiser Health News - Fri, 07/25/2014 - 10:10am

A signal came Thursday when the Internal Revenue Service posted drafts of forms that employers will have to fill out to comply with the requirement that they provide workers with health insurance.

The Wall Street Journal: Obama Administration Moves Ahead With Employer Insurance Forms
The Obama administration on Thursday released draft forms for employers and individuals to use when reporting their health coverage to the Internal Revenue Service starting next year despite calls for delaying the requirement. The Affordable Care Act requires most big employers to offer health benefits that are deemed affordable, or to pay fines starting at $2,000 per worker if they don't (Radnofsky, 7/24).

Politico: IRS Prepping For Obamacare Employer Mandate In 2015
The Obama administration signaled Thursday it’s not backing down from the controversial health law employer mandate that has been delayed twice and is the centerpiece of the House’s lawsuit against the president. The IRS posted drafts of the forms that employers will have to fill out to comply with the Obamacare requirement that employers provide health insurance to workers (Haberkorn and Snell, 7/24).

Categories: Health Care

Health Law's 'Uninsurance' Fine Capped At $2,448 For Individuals

Kaiser Health News - Fri, 07/25/2014 - 10:09am

The cap for a family of five is set at $12,240 -- an amount equal to the national average annual premium cost of a bronze level plan.  

The Hill: Uninsured Face Fine of Nearly $2,500
The Internal Revenue Service said Thursday individuals who fail to get health insurance this year will be fined a maximum of $2,448 and families with five or more members can be fined up to $12,240. Under the Affordable Care Act’s individual mandate, people are either required to obtain health insurance or risk a tax penalty from the IRS (Al-Faruque, 7/24).

The Associated Press: Federal Officials Cap Fines for Not Buying Health Insurance
Federal officials have capped the amount of money scofflaws will be forced to pay if they don't buy insurance this year at $2,448 per person and $12,240 for a family of five. The amount is equal to the national average annual premium for a bronze level health plan. But only those with an income above about a quarter of a million dollars would benefit from the cap. Those making less would still have to pay as much as 1 percent of their annual income (7/24).

Categories: Health Care

For Consumers, Some Pitfalls In Obamacare Coverage Could Lie Ahead

Kaiser Health News - Fri, 07/25/2014 - 9:32am

Stateline reports that automatic re-enrollment of health plans bought through the state and federal exchanges could mean that people pay more than they would if they comparison shopped. In addition, The Associated Press reports that inconsistent subsidy amounts are leading some people to go without insurance.   

Stateline: Pitfalls Emerge In Health Insurance Renewals
For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins. Seems like good news after all the headaches consumers endured after the program's launch last year. Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances. "(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop," said Jenna Stento, a senior manager at Avalere Health, a health care research and consulting firm (Ollove, 7/25).

The Associated Press: Varying Health Premium Subsidies Worry Consumers
Government officials say [Linda] Close — and other consumers who have received different subsidy amounts — probably made some mistake entering personal details such as income, age and even ZIP codes. The Associated Press interviewed insurance agents, health counselors and attorneys around the country who said they received varying subsidy amounts for the same consumers. As consumers wait for a resolution, some have decided to go without health insurance because of the uncertainty while others who went ahead with policies purchased through the exchanges worry they are going to owe the government money next tax season (Kennedy, 7/24).

Meanwhile, in the news from Florida -

Health News Florida: Hispanic Health Advocates Push For Votes
Advocates for health insurance are calling on Hispanics to get insured under the Affordable Care Act. And they're asking those same people to vote against lawmakers who oppose Obamacare. Latino community leaders in Central Florida say more than 200,000 Hispanic Floridians are uninsured. They're urging state lawmakers to accept federal funding and expand health care for all Floridians. Josephine Mercado of Hispanic Health Initiatives called it a human rights issue. Betsy Franceshini, a Florida-based representative of the Puerto Rican government, says many uninsured Hispanics work in industries like hospitality (Green, 7/24).

Categories: Health Care

House Panel Backs Lawsuit Against Obama On Health Law

Kaiser Health News - Fri, 07/25/2014 - 9:30am

The Rules Committee approved a resolution challenging whether the president has constitutional authority to delay provisions of the law. The full House will likely consider it before its August recess begins.

Politico: House Panel Backs Obama Lawsuit
The lawsuit has deepened the tension and mistrust between House Republicans and the White House. Republicans say they’re simply holding the president accountable for circumventing Congress on a major policy change related to the implementation of Obamacare. Obama and congressional Democrats have dismissed the suit as little more than election year theater (French, 7/24).

Modern Healthcare: House Plan to Sue Obama Over Employer-Mandate Delay Moves Forward
A resolution authorizing the U.S. House of Representatives to sue President Barack Obama for exceeding his constitutional authority by delaying the employer mandate in the federal healthcare law, cleared the House Rules Committee Thursday. The legislation passed on a party-line 7-4 vote. The full House is expected to take up the measure next week prior to its August recess (Demko, 7/24).

Meanwhile, what does the public think?

CNN: Majority Say No To Impeachment And Lawsuit
There’s not a lot of public appetite for a Republican push to sue President Barack Obama, or for calls by some conservatives to impeach him, according to a new national survey. A CNN/ORC International poll released Friday morning also indicates that a small majority of Americans do not believe that Obama has gone too far in expanding the powers of the presidency (Steinhauser, 7/25).

Categories: Health Care

Expensive Hepatitis Drug Challenges Medicaid Programs' Funding

Kaiser Health News - Fri, 07/25/2014 - 9:21am

State officials are nervous about how to afford the new medicine, which can run $84,000 for treatment. Also in Medicaid news, federal data show children using emergency room treatment at night or weekends are often on Medicaid.

The Washington Post's Wonkblog: The Drug That's Forcing America's Most Important – And Uncomfortable – Health-Care Debate
Expensive specialty drugs aren't new to health care. But Sovaldi stands out because it is aimed at helping millions of Americans who carry hepatitis C, and a large share of those infected are low-income and qualify for government coverage. Its arrival also coincides with the aggressive expansion of Medicaid and private coverage under the Affordable Care Act, whose purpose was to extend health care to tens of millions Americans who previously couldn't afford it (Millman, 7/24).

CQ Healthbeat:  More Medicaid Families Sought Emergency Room Care, Statistics Show
Three-fourths of children treated in emergency rooms in 2012 were taken at night or on weekends, according to federal statistics released Thursday. The figures also showed that families on Medicaid were more likely than those with private insurance or without any coverage to use the emergency department. The frequency with which people use pricey emergency department care is getting attention as policymakers struggle to find ways to lower federal health spending. Lawmakers want to persuade people to use less expensive outpatient care whenever possible. The Centers for Disease Control and Prevention statistics released Thursday suggests that families still use the emergency room in part because of convenience, and that Medicaid families may need help in finding a primary care physician or understanding when an emergency visit is necessary (Adams, 7/25).

Categories: Health Care

New Mexico Likely To Decide Health Exchange Plan Today

Kaiser Health News - Fri, 07/25/2014 - 9:21am

Also in the news, Colorado's health exchange chief executive announced she will leave her post to become president of Cigna's private exchange business.

The Associated Press: New Mexico Set To Decide On Health Exchange Plan
The governing board of New Mexico's health insurance exchange is to consider Friday whether to continue relying on a federal online system for enrolling individuals in medical plans. Board vice chairman Jason Sandel said Thursday that he expected members to decide at a meeting in Santa Fe how to handle the next round of enrollment, which will start in November (7/24).

The Denver Post: Colorado Health Insurance Exchange CEO Patty Fontneau Leaves for Cigna
The state health insurance exchange's chief executive, Patty Fontneau, announced Thursday she will leave Connect for Health Colorado to take a job as president of Private Exchange Business for Cigna. She will leave her post in mid-August. The exchange's board of directors said they plan to name an interim CEO within a week. (Draper, 7/24).

Health News Colorado: Exchange Boss Resigns To Join Cigna
Patty Fontneau, the executive who has been synonymous with Colorado’s health exchange and both its successes and shortcomings, is leaving to join the insurance industry. Fontneau announced Thursday that she will resign as CEO and executive director of Connect for Health Colorado in mid-August. She plans to join Cigna where she will become president of its private exchange business (McCrimmon, 7/24).

Categories: Health Care

Consumers In States Around The Country To Get Premium Rebates

Kaiser Health News - Fri, 07/25/2014 - 9:20am

Local news outlets report on a federal announcement Thursday showing how much money will be sent back to people and employers under rules that say insurers must spend at least 80 percent of premium payments on medical care.

The Oregonian: Three Health Insurers Will Pay Rebates In Oregon
Three health insurers in Oregon owe rebates to consumers under a federal rule limiting administrative expenses for carriers. According to the U.S. Department of Health and Human Services, 49,412 people will benefit from refunds averaging $101 per family covered. Only about 23,000 people who purchased their own policy directly, in the individual market, will see a check, however. Rebates for employer-provided insurance will be send to the businesses that purchased the policy (Budnick, 7/24).

Georgia Health News: Insurers To Pay $11 Million In Georgia Rebates
A federal rule on health insurers’ spending will bring $11 million in rebates to Georgia individuals and employers this summer. Federal figures released Thursday show that 304,000 Georgians will benefit from the refunds, with an average rebate of $53 per family, as a result of the “Medical Loss Ratio” (MLR) rule on 2013 insurance plans. Created by the Affordable Care Act, the MLR standard generally requires health insurers to spend at least 80 percent of the premium dollars they collect on medical care or activities to improve the quality of health care (Miller, 7/24).

The Denver Post: Coloradans Could See $2.7 Million in Premium Refunds From ACA Rule
Health and Human Services on Thursday announced that 52,277 consumers in Colorado will get $2.7 million in refunds, an average of $93 a family, from insurance companies this summer because of the Affordable Care Act's 80/20 rule (Draper, 7/24).

The Baltimore Sun: Marylanders Received $17M In Insurance Refunds Under Health Reform Rule
Health insurers refunded more than $17 million to Marylanders last year because of a rule in the Affordable Care Act limiting the amounts the companies can spend on overhead costs as opposed to providing care, according to federal data. About 206,000 consumers in Maryland received the refunds, an average of $140 per family, according to a report from the Department of Health and Human Services released Thursday (Dance, 7/24).

Des Moines Register: $1.8M In Health Insurance Rebates Ordered In Iowa
About 3,500 Iowans will receive rebates from their health insurer, thanks to a rule that is part of the Affordable Care Act. Another 11,100 Iowans will have rebates sent to their employers. The consumers receiving direct rebates purchased individual health insurance policies from Wellmark Blue Cross & Blue Shield. The other affected Iowans obtained Coventry Health Care policies via their employers. The rebates, totaling nearly $1.8 million, are going to people whose insurance plans didn't spend as much as required last year on health-care services. The rules, which are part of the Affordable Care Act, require that policies covering individuals or small businesses spend at least 80 percent of premium dollars on medical services instead of on administrative costs or profit. Large-group plans must spend at least 85 percent of premiums on medical care (Leys, 7/24).

Categories: Health Care

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