Officials with Oregon's exchange say they will choose between repairing the existing system or going to the federal exchange by month's end. In Massachusetts, an executive appointed by Gov. Deval Patrick to fix the problems says she will make recommendations by next month and in Minnesota, Deloitte Consulting has a pending deal to fix that state's exchange.
The Associated Press: Cover Oregon Narrows Exchange Future To Two Options
Officials with Oregon’s troubled health insurance exchange say they’ve narrowed the options for the site’s future to two: switching to the federal exchange, or staying with the current technology and hiring a new contractor to fix it. Cover Oregon’s interim chief information officer Alex Pettit told board members Thursday that a third option -- transferring technology from another state -- would be too expensive and take too long (4/10).
The Oregonian: Cover Oregon: Board Hires 'Turnaround' Expert, Narrows Technology Options
Portland corporate turnaround expert Clyde Hamstreet agreed Thursday to what may be his most challenging assignment: helping solve Cover Oregon's health exchange mess in just a month. Hired Thursday by Cover Oregon's board of directors, Hamstreet takes the helm of an organization facing daunting technological, legal and financial issues. It has just seven months to produce a functional health exchange, something the state has been unable to do in the prior two years despite spending more than $200 million (Manning, 4/10).
The Oregonian: Cover Oregon Health Insurance Exchange: Fix It Or Go Federal, Officials Say
A Cover Oregon advisory committee has narrowed options for whether to scrap or salvage the troubled health insurance exchange, officials announced Thursday. By the end of April the Cover Oregon board will choose between either fixing its existing technology with a new development plan, or going to the federal exchange. The decision had been expected, but now is official. And time is short (Budnick, 4/10).
The Associated Press: Fix for Health Care Website Still Months Away
The board overseeing the Massachusetts’s health care exchange has been told that a long-term fix for the connector's troubled website is still months away, even while the state is reporting progress in clearing the backlog of applicants for subsidized insurance. Sarah Iselin, the health care executive tapped by Gov. Deval Patrick to oversee a solution to the website issues, said she will present the board with recommendations next month for how to achieve a functional system by the next open federal enrollment period that is scheduled to begin Nov. 15 (4/11).
The Star Tribune: Deloitte In Line For MNsure Repair Work
Deloitte Consulting has agreed to general contract terms to help MNsure begin fixing underlying issues with its massive computer system, people with knowledge of the bidding process confirmed Thursday. The agreement is pending, based on federal approval and a more detailed contract that would solidify the scope of the work. Deloitte has built some of the most successful state-based insurance exchanges in Connecticut, Kentucky, Rhode Island and Washington (Crosby and Meitrodt, 4/11).
The Star Tribune: Wider, Deeper MNsure Audit Wins Approval
Legislative Auditor James Nobles won lawmakers’ backing Wednesday for a wider investigation of what led to the troubled rollout of the MNsure health insurance exchange. Nobles said the effort will be extensive and lengthy, and he predicted it won’t be finished and made public until December. “It is going to be broad. It is going to be deep,” Nobles said (Meitrodt, 4/10).
In other news related to the health law's implementation -
Fox News: IRS Prepares To Go After ObamaCare Mandate Fines
With the ObamaCare enrollment deadline in the rearview for most, the IRS is preparing for the next step -- tracking and penalizing those who choose not, or cannot afford, to buy approved health insurance. How aggressive the agency will be in pursuing those fines, though, is an open question. The IRS already is under fire over last year's political targeting scandal and talk of harsh fines on the millions who still do not have insurance is a touchy subject in an election year (4/10).
Viewpoints: Sebelius' Departure Will Not End Health Law Divide; Democrats Losing Voters' 'Trust' On Medicare
The Wall Street Journal’s Capital Journal: Sebelius Exits, But Health-Care War Endures
The resignation of Kathleen Sebelius signals the departure of the official who, fairly or not, had become the face of the deep and bitter partisan divide over Obamacare. But the Health and Human Services secretary's departure won't do much to close that divide. Instead, the Affordable Care Act now is entrenched as the most deeply divisive social program in recent memory, and it figures to stay that way through the November election and beyond (Gerald F. Seib, 4/10).
Vox: Kathleen Sebelius Is Resigning Because Obamacare Has Won
Obamacare has won. And that's why Secretary of Health and Human Services Kathleen Sebelius can resign. Calls for Sebelius's resignation were almost constant after Obamacare's catastrophic launch. The problem wasn't just that Sebelius had presided over the construction of a fantastically expensive web site that flatly didn't work. It was that she didn't know healthcare.gov was going to instantly, systemically fail. ... The White House says Sebelius notified the President in March that "she felt confident in the trajectory for enrollment and implementation," and that once open enrollment ended, "it would be the right time to transition the Department to new leadership." In other words, the law has won its survival (Ezra Klein, 4/10).
The Wall Street Journal: Sebelius And Accountability
It would be nice to think that Kathleen Sebelius's resignation, leaked late Thursday, is a case of accountability in government. But that isn't the way this government now works, if it ever did. The departure of the secretary of Health and Human Services who presided over ObamaCare's rollout debacle is best understood as one more attempt to dodge political responsibility (4/10).
Fox News: Sebelius Resigns: Democrats Have Their Scapegoat, They Can Blame ObamaCare Failures On HHS Chief
Last week, President Obama ran a victory lap claiming seven million signups for ObamaCare. It was the goal they wanted and, to no one's surprise, the White House claims it reached the goal. Outside, objective surveys beg to differ. As the president ran his victory lap, Sebelius was there running with him. Then she resigned — not forced out White House staffers claim. In fact, during the past week it appears the White House has lined up every left wing mouthpiece it could find to spin this news (Erick Erickson, 4/11).
The New York Times: Health Care Nightmares
When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground. Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to "change the subject from the nightmare of Obamacare"; on the same day, the nonpartisan RAND Corporation released a study estimating "a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014" (Paul Krugman, 4/10).
The Wall Street Journal: Live Free Or ObamaCare
The political left favors "single payer" health care, but that concept has new meaning in New Hampshire this year as just one insurer was willing to participate in ObamaCare. Thus the spectacle of Democratic Senator Jeanne Shaheen beseeching the feds to save her re-election from her own law. The Granite State Senator rode the 2008 Obama wave to become the deciding 60th vote for the law's passage, but now Ms. Shaheen must defend the mess it has made of her state's insurance markets. She's cashing in all her government chits amid a statewide uproar as patient access to hospitals and other providers has declined (4/10).
Bloomberg: Medicare Has Become A Problem For Democrats
Voters are used to trusting Democrats on Medicare. But there are signs that this trust is eroding because of Medicare cuts in the Affordable Care Act and Republican efforts to highlight those cuts. The latest evidence of this change came this week, when the Barack Obama administration backed away from its proposal to cut payments to insurers who offer coverage through the Medicare Advantage program. About 14 million seniors participate in this generally popular program, which allows beneficiaries to get their benefits through a private health plan (Lanhee Chen, 4/10).
Houston Chronicle: Hispanics Remain Unequal When It Comes To Health Care
This week's commemoration of the 50th anniversary of the Civil Rights Act at the LBJ Presidential Library in Austin serves as a reminder that politics and history shape the nation's health care delivery system. Our forefathers wrote that "all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness." But does everyone have a right to the same level of "happiness?" And is health security among these unalienable rights? (Jacqueline Angel, 4/9).
Deseret News: Utah's Medicaid Reform Has Been A Quiet Success
Lost in the nearly two-year debate over whether Utah should expand its Medicaid program has been the successful rollout of Utah's Medicaid Accountable Care Organizations (ACOs). The Medicaid ACOs are worth another look (Dan Liljenquist, 4/10).
The (Jackson, Miss.) Clarion Ledger: Republicans Refuse To Acknowledge Obamacare's Success
Republican leadership in Mississippi still seems content to ignore what's happening on the health care reform front. It's as though we live on a different planet, that ACA is for somebody else, not us. We'll see before too long. ... Now it's obvious to thousands of religious leaders and medical professionals in Mississippi that Bryant and his GOP cohorts have failed in their goal to kill President Obama’s signature law. They have succeeded only in denying organized health care coverage to 300,000 of the state’s working poor (Bill Minor, 4/10).
On other health care topics -
The New York Times: Abusing Both Medicare And Politics
Campaign finance reformers have long warned that the growing power of big money in politics would produce a giant scandal. But those scandals happen every day, and the trading of campaign donations for political favors has steadily eroded public trust in Washington. The latest illustration of that can be seen in the connection between Medicare fraud and "super PAC" abuse (4/10).
The New York Times: The Tobacco Ties That Bind
I don't smoke, but if during the day I wanted to buy cigarettes, I could walk into the CVS pharmacy across the street from my office, or the Walgreens two blocks away, and get them. They're kept right behind the cash register. But beginning this fall, that is going to change. CVS pharmacies will stop sales of all tobacco products. Walgreens, well, won't. So, here's a quiz. Which chain do you think is more heavily celebrated on the website of the American Cancer Society? Well, it's not CVS. Instead, testimonials and profiles hailing Walgreens abound. There is a glowing profile of the Walgreens chief executive that focuses on his tireless efforts to promote healthy living in his workplace and stores. There is no mention of the tobacco sales at the front of those stores (Peter B. Bach, 4/10).
The Washington Post: The Truth About Who Really Pays For Medicare
Yes, seniors paid into Social Security and Medicare during the years they worked, if they worked. But they generally receive much more out of the entitlement system than they paid into it (Catherine Rampell, 4/10).
The Washington Post: Gun Violence As A Public Health Issue
With last month’s controversy over Vivek Murthy's nomination for surgeon general still fresh, the nation's second-largest physicians group reaffirmed Thursday that it considers firearm violence a public health issue and issued a wide-ranging set of recommendations to address the deaths and injuries caused by guns. The timing appears to be coincidental. But like Murthy — whose nomination was blocked in large part by a National Rifle Association offensive over his views on guns — the American College of Physicians believes doctors must take action against the 32,000 deaths and 74,000 injuries caused by guns in the United States each year (Lenny Bernstein, 4/10).
WBUR: Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed
The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with "appropriate pain care" and reduce the risk of opioid addiction and diversion. In a recent Boston Globe report they claim "very significant success" with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills. Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program's stated goals? (Daniel P. Alford, 4/10).
The New England Journal of Medicine: Same-Sex Marriage — A Prescription For Better Health
Although the most central issues raised by the public discourse regarding marriage are moral and rights-oriented, there are also health-related issues at stake: legalizing same-sex marriage can improve health and access to health care for LGBT people. A 2011 report by the Institute of Medicine on the health of LGBT persons identified substantial disparities in health and access to health care for sexual and gender minorities. Many LGBT people of all ages report worse physical and mental health outcomes than heterosexual and non-transgender populations, largely as a result of the stress caused by being a member of a stigmatized minority group or because of discrimination due to sexual orientation or gender nonconformity (Gilbert Gonzales, 4/10).
The New England Journal of Medicine: Redesigning Surgical Decision Making For High-Risk Patients
One third of elderly Americans undergo surgery during the last 12 months of their lives, most of them within the last month. Yet three quarters of seriously ill patients say they would not choose life-sustaining treatment if they knew the outcome would be survival with severe cognitive or functional impairment. ... Typically, decisions are made after a discussion between a surgeon and the patient and perhaps the patient's spouse, partner, child, or caregiver. ... Yet this approach may be suboptimal for many high-risk elderly patients facing decisions about major surgery. Patients may not always be presented with all treatment options, including watchful waiting, medical treatment, less invasive surgical options, or percutaneous approaches (Drs. Laurent G. Glance, Turner M. Osler and Mark D. Neuman, 4/10).
The Journal of the American Medical Association: Health Reform And Physician-Led Accountable Care
Physicians see opportunities every day to improve quality and lower costs, but in a recent survey, the vast majority of physicians reported that they should not be expected to play a central role in controlling costs. They expressed this view even though most also reported that the best ways to control health care costs are through promoting continuity of care, using cost-effective treatments, chronic disease care coordination, prevention and adhering to clinical guidelines—all of which are controlled or influenced by physicians (Drs. Farzad Mostashari, Darshak Sanghavi and Mark McClellan (4/10).
The plan would reduce spending by $5.1 trillion over 10 years and includes an overhaul of both Medicare and Medicaid as well as cuts to other government programs. It would also repeal the health law but stands little chance of passing in the Senate.
Los Angeles Times: GOP-Led House Approves Tough Paul Ryan Budget, But Debate Continues
With little drama Thursday, House Republicans easily approved a largely symbolic budget proposal from Rep. Paul Ryan (R-Wis.), closing out a floor debate over spending priorities and opening a new front on the midterm campaign trail. … Ryan's proposal would overhaul Medicare for the next generation of seniors, boost defense spending beyond Obama's levels and slash most other domestic spending on college aid, food stamps and basic government investments. Tax rates for the wealthy would be cut to a top rate of 25 percent (Mascaro, 4/10).
The New York Times: House-Passed Budget Shows Parties' Divergence
The move underscored the different universes the two parties occupy as election season heats up. Democrats see the budget, which passed on Thursday in a 219-to-205 vote, as a political millstone, with brutal cuts to popular government programs, sweeping and controversial changes to Medicare, and tax cuts for the rich. Republicans consider it a modest step (Weisman, 4/10).
The Wall Street Journal: Republican Budget Plan Narrowly Passes House
Under Mr. Ryan's plan, the average annual growth in federal spending would slow to 3.5 percent from its current path of 5.2 percent. To eliminate the annual federal budget deficit, the budget would reduce spending by $5.1 trillion over 10 years and overhaul social safety-net programs, including Medicare and Medicaid. The Ryan plan also would repeal the Affordable Care Act, but it incorporates some $700 billion in Medicare savings and $1 trillion in revenues generated under the 2010 health law (Peterson, 4/10).
Politico: House Passes Ryan Budget
The House approved a fiscal 2015 budget on Thursday that would cut federal spending by $5 trillion and significantly revamp social welfare programs. The measure, which cleared the House 219-205, is essentially a political document that has no chance of being passed in the Democratic-controlled Senate. House Budget Committee Chairman Paul Ryan (R-Wis.) is expected to relinquish his gavel at the end of this Congress and his final budget is seen as more of an outline of Republican priorities, including the repeal of Obamacare (French, 4/10).
In other news from Capitol Hill --
NBC News: Boehner: GOP Still 'Building Consensus' On Obamacare Alternative
House Speaker John Boehner says Republicans are still "building a consensus" about an alternative to the Affordable Care Act passed in 2010. Asked by NBC News when House Republicans might unveil the long-awaited substitute, Boehner replied: "We're building a consensus, we'll see." Many of Boehner's fellow Republicans have been calling for leaders to move a bill on the floor in advance of the looming midterm elections (Russert, 4/10).
Politico: Vulnerable Democrats Wait Out Obamacare Hits
Conservative outside groups have pummeled Senate Democrats over their support for Obamacare, spending millions on attack ads from Louisiana to Montana. But many of the most endangered Democratic incumbents have decided it's better to wait out the barrage than to respond in-kind (Raju, 4/11).
State Highlights: Cash-Only Docs In Texas; Medicaid Funding In La.; Over-The-Counter Syringe Sales In Calif.
A selection of health policy stories from Texas, Louisiana, California, Maine, Pennsylvania, New Jersey, Vermont, Virginia, Georgia, Iowa and New York.
The Texas Tribune: Giving Up on Red Tape, Doctors Turn to Cash-Based Model
For 12 hours a day, the waiting room at Dr. Gustavo Villarreal’s family practice is often packed with patients, people who will pay a flat $50 fee for the convenience -- or necessity -- of a walk-in, quick-turn doctor’s visit. Villarreal’s practice, which does not accept any form of health insurance, has thrived despite its location in a city where nearly one-third of the population lives below the federal poverty line. At both the state and federal level, efforts are underway to decrease Texas' sky-high rate of residents without health coverage. But Villarreal is among a rising number of primary care practitioners who have given up on the red tape of filing insurance claims, switching to a cash-based model that is growing in popularity among Texas’ insured and uninsured patients (Ura, 4/11).
The Associated Press: Federal Medicaid Funding Could Be Delayed During Review Of LSU Hospital Deals
Federal officials have warned Gov. Bobby Jindal's administration that they will withhold $307 million in Medicaid money from the state if no agreement is soon reached on whether the state's financing plans for the privatized LSU hospitals meet federal guidelines. The U.S. Centers for Medicare and Medicaid Services, or CMS, notified Gov. Bobby Jindal's administration about the payment delay this week. The state Department of Health and Hospitals released the notice when questioned by The Associated Press (4/10).
Los Angeles Times: Assembly Backs Permanently Allowing Over-The-Counter Sale Of Syringes
The Assembly approved a measure Thursday that would permanently extend a provision allowing pharmacists to sell syringes without a prescription. Assemblyman Phil Ting (D-San Francisco), the bill's author, said expanding access to sterile needles is "the best way to stop the spread of some very deadly diseases." Public health experts say the use of shared needles among intravenous drug users contributes to the spread of HIV, hepatitis B and hepatitis C (Mason, 4/10).
The Associated Press: Maine Medicaid Rules Reduce Narcotic Prescriptions
Maine’s severe restrictions on opioid painkillers for Medicaid patients, requiring many to instead seek alternative pain management treatment for the past year, have sharply reduced the number of people obtaining highly addictive medications blamed for drug abuse and deaths around the nation (4/10).
The Texas Tribune: Abortion Providers Petition 5th Circuit to Review Decision
Abortion providers filed a petition on Thursday asking the full 5th Circuit Court of Appeals to reconsider the constitutionality of new abortion regulations passed by the Republican-led Texas Legislature in July. The petition, filed on behalf of a coalition representing the majority of abortion providers in Texas, comes on the heels of a unanimous decision made by the court's three-judge panel in March to uphold two requirements recently implemented in the state. Those rules require physicians to obtain hospital admitting privileges within 30 miles of an abortion facility and to follow the U.S. Food and Drug Administration’s protocol for drug-induced abortions rather than a common, evidence-based protocol (Ura, 4/10).
The Associated Press: Nemours Foundation Sues United Health Care Entities
The foundation that owns the Alfred I. du Pont Hospital for Children in Delaware and various pediatric physician practices in the region is suing United Healthcare entities in three states for unpaid bills. Lawyers for the Nemours Foundation filed lawsuits in federal court in Delaware on Wednesday against United Healthcare of Pennsylvania, United Healthcare of the Mid-Atlantic, and United Healthcare Community Plan of New Jersey (4/10).
The Associated Press: Judge: California Mistreating Mentally Ill Inmates
A federal judge ruled Thursday that California’s treatment of mentally ill inmates violates constitutional safeguards against cruel and unusual punishment through excessive use of pepper spray and isolation. U.S. District Court Judge Lawrence Karlton in Sacramento gave the corrections department time to issue updated policies on the use of both methods but did not ban them (4/10).
Kaiser Health News: L.A. County Nursing Home Inspections Chief Reassigned
The Los Angeles County Department of Public Health supervisor in charge of nursing home inspections has been moved to another job days after the release of a highly critical audit of his division. Ernest Poolean, who has been a county employee since 1968 and became the head of the Health Facilities Inspection Division in 2011, has been reassigned to the Baldwin Park headquarters, according to a memo sent to the staff Thursday (Gorman, 4/10).
The Associated Press: Vt. Senate Advances Lyme Disease Bill
Doctors and other health professionals would be immune from professional conduct charges if they pursued a hotly debated course of treatment for Lyme disease under a bill given preliminary approval Thursday by the Vermont Senate. The Senate’s 27-0 vote in support came after an impassioned speech by Sen. David Zuckerman, a Chittenden County Progressive who said his wife, Rachel Nevitt, had suffered from the tick-borne illness for about a dozen years and had also struggled to get medical professionals to recognize and diagnose the disease (Gram, 4/11).
The Richmond Times-Dispatch: Psychiatric Admissions Spike After Deeds Tragedy
State mental hospitals and private psychiatric facilities have experienced a surge in emergency admissions since Jan. 1 in the aftermath of the attack last fall on Sen. R. Creigh Deeds, D-Bath, by his son, who then killed himself. Austin C. “Gus” Deeds, 24, had been released from an expired emergency custody order just 13 hours before he stabbed his father and shot himself at their Millboro home on Nov. 19. At Western State Hospital in Staunton, the closest state institution to Bath County, 23 people have been admitted under temporary detention orders since Jan. 1, compared with six in the previous six months (Martz, 4/11).
Georgia Health News: Report: Developmentally Disabled Need Better Care
An independent reviewer reports that Georgia is failing to provide adequate supervision of individuals with developmental disabilities who are moved from state hospitals to community group homes. The reviewer, in a report dated March 23, says there is an “urgent need to ensure competent and sufficient health practitioner oversight of individuals who are medically fragile and require assistance with most aspects of their daily lives.” The reviewer, Elizabeth Jones, notes in the report that two individuals with developmental disabilities died shortly after being moved from Southwestern State Hospital in Thomasville, which recently closed, to community settings (Miller, 4/10).
The California Health Report: Nurses Becoming A Rarity In California Public Schools
Each school day, about a fifth of the children in California schools attend class without a nurse in the building. If they get sick during the day, the schools call parents, or in an emergency, 911. ... Researchers conducting a large-scale study from the California State University-Sacramento School of Nursing have released preliminary findings showing that 57 percent of California public school districts have no school nurses whatsoever (Jones, 4/11).
The Des Moines Register: House Approves Health, Welfare Funding
Iowa House lawmakers on Thursday set aside controversial proposals restricting abortion to approve $1.86 billion in spending on health and welfare programs for the coming year. The chamber passed House File 2463 on a 51-47 vote, funding the state's Medicaid health care program for the poor among many other state agencies and services. (Noble, 4/11).
Modern Healthcare: N.Y. Incubator Startup Health Adds 16 Companies
The New York-based incubator StartUp Health admitted 16 new companies to its current class, the company announced this week. The incubator runs a three-year program that helps healthcare startups develop their products and raise venture capital. The program saw about 350 applicants for the current round, said Unity Stoakes, Startup Health's founder (Ivanova, 4/10).
Research Roundup: Financial Protections For Medicare Patients; Medicaid Beneficiaries At FQHCs; Prevalence Of Alzheimer's In African Americans
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Urban Institute: The Availability Of New Patient Appointments For Primary Care At Federally Qualified Health Centers: Findings From An Audit Study
This brief compares the availability of primary care appointments for new patients at Federally Qualified Health Centers (FQHCs) and other non-FQHC providers using data from an experimental simulated patient (audit) study that was conducted in late 2012 and early 2013. ... we find that 80 percent of FQHCs and 56 percent of non-FQHCs scheduled appointments for Medicaid callers—a difference of 24 percentage points. ... FQHCs were more willing than other non-FQHC providers to accommodate new Medicaid patients, but that FQHC wait times were slightly longer. ... even with enhanced funding, it is uncertain how well they will be able to absorb new patient demand caused by the Affordable Care Act’s (ACA) Medicaid expansion and other provisions (Saloner et al., 4/7).
Urban Institute: Financial Burden Of Medical Spending By State And The Implications Of The 2014 Medicaid Expansions
Among the top 25 states with the largest shares of their population attributable to low-income, high burden individuals without Medicaid/CHIP coverage, there is almost an equal divide in the number that have committed to expand or not expand their Medicaid program. ... the choice to participate will affect states differently. States that participate in the expansions have an opportunity to significantly decrease financial burdens for a high-need segment of their population (Caswell, Waidmann and Blumberg, 4/3).
Annals Of Family Medicine: Joint Principles: Integrating Behavioral Health Care Into The Patient-Centered Medical Home
The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. ... The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element ... Principles: Personal physician .... Physician directed medical practice ... Whole person orientation (Baird et al., March/April 2014).
Health Affairs: Alzheimer's Disease In African Americans: Risk Factors And Challenges For The Future
As the US elderly population continues to expand rapidly, Alzheimer’s disease poses a major and increasing public health challenge, and older African Americans may be disproportionately burdened by the disease. Although African Americans were generally underincluded in previous research studies, new and growing evidence suggests that they may be at increased risk of the disease and that they differ from the non-Hispanic white population in risk factors and disease manifestation. This article offers an overview of the challenges of Alzheimer’s disease in African Americans (Barnes and Bennett, 4/7).
Health Affairs: Preparing The Health Care Workforce To Care For Adults With Alzheimer's Disease And Related Dementias
The number of cases of Alzheimer's disease is projected to triple by 2050, from 5.0 million in 2013 to 13.8 million. ... We assessed what is likely to be an increasing shortage of physicians, nurses, and social workers with specialized training in geriatrics and, more specifically, in the care of people with dementia. ... To address these shortfalls, we recommend the dissemination of team-based models of care ...; expansion of education loan forgiveness and faculty development programs ...; inclusion of curricula specific to the disease in all health professions training; expansion of federal programs to train existing workers; and increased compensation for the direct care workforce (Warshaw and Bragg, 4/7).
The Kaiser Family Foundation: Paying A Visit To The Doctor: Current Financial Protections For Medicare Patients When Receiving Physician Services
Congress will likely return within the year to the question of whether and how to replace the widely-criticized formula that Medicare uses to calculate payments for physician services, called the Sustainable Growth Rate (SGR) system. For the most part, recent proposals on reforming the physician payment system leave intact current financial protections ... [which] include the participating provider program, limitations on balance billing, and conditions on private contracting. This issue brief describes these three protections, explains why they were enacted, and analyzes the implications of modifying them for beneficiaries, providers, and the Medicare program (Boccuti, 4/7).
The Kaiser Family Foundation: How Will The Uninsured Fare Under The Affordable Care Act?
Nationally, 4.8 million uninsured adults (10% of the nonelderly uninsured) who would be eligible for Medicaid if their states were to expand, fall into the coverage gap. ... Because they do not gain an affordable coverage option under the ACA, they are most likely to remain uninsured. Two other groups of uninsured individuals are outside the reach of financial assistance for health coverage under the ACA. First, 21% of uninsured people have incomes above the limit for premium tax subsidies or have an affordable offer of coverage through their employer are thus ineligible for financial assistance. ... Second, uninsured undocumented immigrants (about 13% of uninsured) are ineligible for assistance under the ACA and barred from purchasing coverage through the Marketplace. This group is likely to remain uninsured, though they will still have a need for health care services (4/7).
JAMA Surgery: Colorectal Cancer Resections In The Aging US Population
In this extensive review of national trends of CRS, we observed that, despite the improvements in mortality and a decrease in the incidence of CRS, older patients continue to have worse risk-adjusted outcomes compared with those who are younger. A clear association between worse outcomes and age was established. Even patients aged 65 to 69 years have poorer outcomes than those younger than 65 years. Since most (63.8%) procedures in the United States are performed on patients 65 years and older, measures to improve outcomes need to be implemented in all settings. The higher percentage of patients requiring nursing facilities for rehabilitation postoperatively reiterates the importance of outcomes as well as the social impact of age (Jafari et al., 4/9).
American Journal Of Medicine: Treat Or Eat: Food Insecurity, Cost-Related Medication Underuse, And Unmet Needs
[N]o study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. ... There were 9696 adult 2011 National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. ... Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic, non-Hispanic black, and have more chronic conditions than patients reporting neither. ... WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse (Berkowitz, Seligman and Choudhry, April 2014).
Rand Corp.: How Will The Patient Protection And Affordable Care Act Affect Liability Insurance Costs?
The Patient Protection and Affordable Care Act (ACA) will greatly expand private coverage and Medicaid while making major changes to payment rates and the health care delivery system. These changes will affect traditional health insurers, individuals, and government payers. In addition, a considerable amount of health care is paid for directly by or is indirectly paid for via legal settlements after the care occurs, by liability insurers. This report identifies potential mechanisms through which the ACA might affect claim costs for several major types of liability coverage, especially auto insurance, workers' compensation coverage, and medical malpractice (Auerbach, Heaton and Bradley, 4/9).
University of Minnesota State Health Access Data Assistance Center/RWJF: For Kids' Sake: State-Level Trends in Children's Health Insurance
This 50-state analysis shows that the U.S. has made significant progress toward ensuring all kids have health insurance. The report finds that the percentage of children without insurance fell from 9.7 percent in 2008 to 7.5 percent in 2012 (Sonier and Fried, 4/3).
Here is a selection of news coverage of other recent research:
Medscape: Choosing Wisely Lists Dominated By Cost Considerations
Healthcare costs figured highly in specialty medical societies' decision-making processes in determining what to include in their Choosing Wisely Top 5 lists, according to a research letter published in the April 9 issue of JAMA. Choosing Wisely is an initiative of the American Board of Internal Medicine Foundation to get specialty societies to develop lists of medical services that do not provide broad overall patient benefits but that still may be performed often. The goal is to phase out unnecessary use of these procedures or tests (Hand, 4/9).
The New York Times: Many Drug Prescriptions Go Unfilled
A Canadian study has found that almost one-third of patients never fill the prescriptions for the medicines they are told to take. The analysis, published online in The Annals of Internal Medicine, was conducted in Quebec, where all residents are covered by health and drug insurance. There were 15,961 patients in the study. Over all, 31.3 percent of prescriptions were never filled. But some types were filled more often than others. Prescriptions for headaches and migraines were filled more than half the time, but only 20 percent for bronchitis, and 25 percent for skin irritations. The more often a patient saw the doctor, the more likely the prescriptions would be filled, but medicines with high co-pays were less likely to be bought (Bakalar, 4/7).
MedPage Today: Fewer Americans Struggling With Medical Debt
The percentage of people in families having problems paying their medical bills continues to tick downward, according to a CDC report. The percentage of people under age 65 who were in families having problems paying medical bills fell to 19.8% in the first 6 months of 2013, Robin A. Cohen, PhD, and Whitney K. Kirzinger, MPH, of the National Center for Health Statistics in Hyattsville, Md., wrote in a report released Wednesday (Pittman, 4/9).
NPR SHOTS blog: Avoiding The Nursing Home Ups The Risk Of Unwanted Medical Care
Most older people suffer from cognitive impairment or dementia in the year before death, making it more likely that they will get aggressive medical treatments that they don't want. And people with dementia who are cared for at home are more likely to get unwanted treatment than if they are in a nursing home, a study finds. That could be because medical personnel are less likely to know a person's end-of-life wishes of someone who isn't in a facility ... Among patients with normal or less impaired cognitive function, having an advanced directive did not limit the treatment that they needed, according to results published Monday in the journal Health Affairs (Poon, 4/8).
Kaiser Health News provides a fresh take on health policy developments with "Truth And Consequences?" by Steve Sack.
Here's today's health policy haiku:
NUMBERS CHANGE; POLITICS DON'T
And another one -- straight from the headlines:
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.
Q. I understand that I won't have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment. But what about my kids? Their CHIP coverage didn’t start until April.
A. As long you signed them up before the end of the open enrollment period—March 31 in most cases, although it was extended for some people into April—you shouldn’t owe a penalty for your kids. The Department of Health and Human Services made that clear in guidance it released recently.
In the CHIP program, coverage doesn’t necessarily become effective immediately when someone applies. The problem that needed to be addressed was that people who applied for and were found eligible for Medicaid or CHIP during open enrollment this year might be uninsured for three months or more if their coverage didn’t start until April 1 or later. Under the health law, a coverage gap of that length could open them up to a penalty for not having insurance.
Applicants for private coverage on the health marketplaces had faced the same timing problem: If they applied for a plan after Feb. 15, their coverage wouldn’t become effective until at least April 1, potentially leaving them with a coverage gap longer than the “less than three months” allowed under the law.
Last October, HHS clarified that anyone who applied for coverage through the health insurance marketplace during the open enrollment period wouldn’t be subject to the penalty for not having insurance. But the guidance didn’t spell out whether the same rules applied to people who signed up for Medicaid or CHIP during open enrollment. This new information makes it clear that it does.
“People may not have realized that they would face a penalty,” says Brian Haile, senior vice president at Jackson Hewitt Tax Service. “By being proactive, HHS avoided compounding people’s frustration.”Please send comments or ideas for future topics for the Insuring Your Health column to firstname.lastname@example.org.
The Los Angeles County Department of Public Health supervisor in charge of nursing home inspections has been moved to another job days after the release of a highly critical audit of his division.
Ernest Poolean, who has been a county employee since 1968 and became the head of the Health Facilities Inspection Division in 2011, has been reassigned to the Baldwin Park headquarters, according to a memo sent to the staff Thursday.
Terri Williams, the assistant deputy director of environmental health division of the department, has taken over Poolean’s responsibilities.
"As I become familiar with the program, I have full confidence that solutions can be identified during this difficult media time to make Health Facilities shine,” Williams wrote in the staff memo.
Poolean will be working on a “special assignment” under Williams’ direction, the memo said.
Poolean’s reassignment comes after the Los Angeles County Auditor-Controller found that there were more than 3,000 open investigations into nursing homes, including 945 that have been open for more than two years. The audit, released last Friday, also determined that there is no central management of the investigations and that the inspectors do not have set deadlines for completing cases.
“Without time frames/benchmarks to complete investigations, HFID is not conveying expectations to their staff and cannot hold them accountable for their performance,” the audit stated.
The L.A. County Board of Supervisors ordered the audit following a report about the backlog by Kaiser Health News, published by the Los Angeles Newspaper Group. The report found that supervisors had instructed staff members to close cases without a complete investigation in an attempt to whittle down the backlog -- a finding disputed by the department.
Dr. Jonathan Fielding, who heads the public health department, said Thursday he couldn’t comment on personnel matters. But he said the department was working diligently to close the open cases.
“We’re committed to maximizing the efficiency of this important division and to eliminating the backlog, but we need additional resources from the state to accomplish the latter,” Fielding said.
The county audit found the department was not using all the funds at its disposal, leaving $2 million in each of the last two fiscal years unused.
The California Department of Public Health, which contracts with the county to oversee nursing home safety, is also conducting an inquiry into the county’s Health Facilities Inspection Division.
The division is responsible for overseeing 385 nursing homes in the county, with about 56 staff members assigned to conduct investigations and routine surveys, according to the email@example.com
This article was produced by Kaiser Health News with support from The SCAN Foundation
After a five-year tenure that included the flawed rollout of the health care law and stormy relations with Capitol Hill Republicans, Department of Health and Human Services Secretary Kathleen Sebelius is resigning, a White House official said late Thursday.
President Barack Obama plans to nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace Sebelius, the official said. Obama will make the announcement Friday at an 11 a.m. event at the White House where he will be joined by Sebelius and Burwell.
Sebelius, a former Kansas governor and insurance commissioner, was an early supporter of Obama’s, endorsing him during his hard-fought Democratic primary campaign against Hillary Rodham Clinton. The president turned to her to run the massive federal agency after his first choice for the job, former Sen. Tom Daschle, ran into confirmation problems. Sebelius became the face of the administration’s relentless campaign to reform the country’s health care system, appearing regularly before Capitol Hill panels and traveling the country seeking to win converts to the effort.
But she also became the face of the health law’s troubled rollout last October when the federal online insurance marketplace, healthcare.gov, suffered numerous technological problems that stymied enrollments and frustrated millions of potential customers. The administration eventually had to call in technology experts, who spent more than a month working around the clock to retool the site, which was relaunched in early December. But the catastrophic rollout threatened to undermine Obama’s legacy program. It also spurred numerous congressional oversight hearings at which Sebelius was called in to explain what went wrong to both exasperated Republicans and Democrats.
Still, after the recovery of the website, Obama was able to announce this month that more than 7 million people had enrolled in health plans on the marketplaces, the same number that the Congressional Budget Office had predicted before the website problems. Sebelius said Thursday enrollment had grown to 7.5 million.
That did not diminish Republican complaints. Sebelius testified before the Senate Finance Committee Thursday, and Republicans expressed frustration over her inability to provide more data about the people who have signed up for coverage through the marketplaces, or exchanges, and they were angry at the administration’s decision to postpone key implementation deadlines. Some Republicans, including Sen. Pat Roberts, from her home state of Kansas, have demanded she resign.
Comedians took aim as well, including Daily Show host Jon Stewart. In an Oct. 7 appearance – when the website was faltering, Stewart pulled a laptop out onto his desk and told Sebelius: "We're going to do a challenge. I’m going to try and download every movie ever made and you are going to try to sign up for Obamacare — and we’ll see which happens first."
The White House official said Sebelius notified the president in early March of her decision. “She believed that once open enrollment ended it would be the right time to transition the Department to new leadership,” the official said.
"Through the passage and implementation of the Affordable Care Act, Secretary Sebelius has overseen one of the most consequential initiatives of this Administration; under her leadership, 7.5 million people have selected plans," the official said. "Sebelius has also fought to improve children’s health, expand mental health care, reduce racial and ethnic disparities, bring us closer to the first AIDS-free generation, and promote women’s health. The president is deeply grateful for her service."
In an interview Thursday with The New York Times, Sebelius said she knew that she would not "be here to turn out the lights in 2017."
"My balance has always been, when do you make that decision?" she added.
Burwell, Obama's nominee to succeed Sebelius, helped the administration navigate the government shutdown in October. She served in the Clinton administration, worked for the Bill & Melinda Gates Foundation and is the former president of the Walmart Foundation.
Almost one year ago, the Senate voted 96-0 to confirm Burwell, which may help her chances for Senate confirmation to head HHS. In a tweet, Sen. John McCain, R-Ariz., said that Burwell "is an excellent choice to be the next #HHS Secretary."
Republican reaction to Sebelius' departure was mixed. Some lawmakers said the secretary's task was difficult from the start while others welcomed her exit.
"Anybody put in charge of Obamacare would be set up to fail. Secretary Sebelius was asked to promote something unready, poorly structured, and unpopular," said Sen. Charles Grassley, R-Iowa. "She was given a law that was just about written in pencil the way the deadlines changed all the time. That put her in a position of having a strained relationship with Congress. It’s disingenuous for the White House to distance itself from the problems and attribute them to partisan sniping at one member of the Administration. The next secretary might have a fresh start with the public and Congress but the flawed law is still the law."
Senate Minority Leader Mitch McConnell, R-Ky., said, "Secretary Sebelius may be leaving, but the problems with this law and the impact it’s having on our constituents aren’t. Obamacare has to go, too."
But her service was applauded by Democrats. In a statement Thursday night, Sen. Jay Rockefeller, D-W.Va., said, "For the past five years, I have marveled at Secretary Sebelius's grace under pressure. She never backed down from the tremendous responsibilities of her position, which were of a magnitude no other cabinet secretary has ever had to face with regard to domestic policy. … Not once did she let attacks from both the left and the right deter her from the goal of bringing health care to millions of uninsured Americans, and working to improve the health of people across the nation."