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Obama Vows Better Health Care, Other Initiatives, For Vets, Military

Kaiser Health News - Wed, 08/27/2014 - 9:31am

Addressing the American Legion’s national convention, the president announced steps to expand access to mental health care and an initiative to lower home loan costs for military families. He also promised a new "culture of accountability' at the Department of Veterans Affairs.

The New York Times: Obama Tells Veterans He Will Fix Health System, As New Report Lists Lapses
President Obama on Tuesday promised several thousand military veterans that he would fulfill his “sacred trust” to those returning from America’s wars by overhauling a dysfunctional health care system, even as a new report documented “unacceptable and troubling lapses” in medical treatment (Baker and Philipps, 8/26).

Los Angeles Times: Obama Tells American Legion He's Working To Regain Veterans' Trust
The list included seemingly straightforward changes, such as making it easier for veterans to earn commercial driver's licenses, and new funding for complex research. The Pentagon and the National Institutes of Health have launched a study on early detection of suicide risk, post-traumatic stress disorder and traumatic brain disorder, while the VA will invest $34.4 million in a national clinical trial on suicide prevention involving 1,800 veterans at 29 hospitals, the White House said (Hennessey, 8/26).

The Washington Post: Obama Pledges Better Mental Health Services, Other Initiatives For Military, Vets
Heralding a new "culture of accountability" at the Department of Veterans Affairs, President Obama Tuesday announced a number of executive actions to help active-duty military members, their families and veterans, ranging from strengthening access to mental health care to making it easier for troops to reduce mortgage payments. Speaking at the American Legion’s annual convention in the wake of a scandal involving falsified records and long wait times at VA facilities, Obama reaffirmed his support for America's veterans and said his administration will do all it can to ensure current and former members of the military receive the full benefits they deserve (Zezima, 8/26).

Reuters: Obama Tells Veterans Better Mental Health Care On The Way
President Barack Obama sought to make amends with veterans on Tuesday, announcing steps to expand their access to mental health care and an initiative with financial companies to lower home loan costs for military families. The president was embarrassed earlier this year when it was revealed that the Department of Veterans Affairs (VA) had been covering up lengthy delays in providing health care to former military personnel (8/26).

The Associated Press: Obama Defends Handling Of Veterans Affairs Issues
His standing with veterans damaged by scandal, President Barack Obama on Tuesday defended his administration’s response to Veterans Affairs lapses that delayed health care for thousands of former service members, but conceded more needed to be done to regain their trust. His appearance also had deep political overtones in a state where the Democratic senator, Kay Hagan, is facing a difficult re-election and has sought to distance herself from Obama’s policies, declaring as recently as Friday that his administration had not “done enough to earn the lasting trust of our veterans” (8/26).

Categories: Health Care

State Highlights: Calif. Hospital Chain Sues Union; Texas Sues Xerox Again; La. Employees Face Higher Health Care Costs

Kaiser Health News - Wed, 08/27/2014 - 9:31am

A selection of health policy stories from California, Texas, Louisiana, North Carolina and Colorado.

San Jose Mercury News: Hospital Bidder Sues Union, Alleging Extortion
In a surprising move, an anti-union Southern California hospital chain hoping to buy the struggling Daughters of Charity Health Care System is suing employee unions under the federal RICO Act, saying the unions are trying to thwart that deal and others by using extortionist tactics aimed at forcing it to cave into union demands. The lawsuit filed Monday in U.S. District Court in San Francisco by Prime Healthcare Services accuses Service Employees International Union and SEIU-United Healthcare Workers West; the union federation Change to Win; and three union leaders of conspiring to "target and attack Prime with the ultimate objective of either unionizing Prime, thereby altering its cost structure and business model, or eliminating Prime from the market altogether'' (Seipel, 8/26).

Dallas Morning News: Janek Accuses Xerox Of “Reckless” Misuse Of Medicaid Data
Texas Medicaid officials, already in a legal battle with Xerox Corp. over the company’s alleged failure to prevent widespread dental fraud, filed another lawsuit Tuesday accusing Xerox of improperly taking large quantities of medical records and not protecting patients’ confidentiality. The state Health and Human Services Commission said it filed a lawsuit in state district court in Austin seeking return of the patient data. ... Xerox spokesman Kevin Lightfoot, though, said in an email that “the data represents proprietary Xerox information and was retained with the state’s knowledge” (Garrett, 8/26).

The Texas Tribune: Texas Files Second Lawsuit Against Xerox
The state of Texas on Tuesday announced a second lawsuit against former contractor Xerox, alleging the company failed to turn over client health records relating to its operation of the state Medicaid program. The announcement comes three months after the state announced it was suing the company over allegedly misspent money, after thousands of requests for medically unnecessary braces were approved (Walters, 8/26).

The Associated Press: Health Benefits Changes Planned for Louisiana State Workers
Louisiana's state government employees and retirees face increased out-of-pocket costs, higher deductibles and new health service limitations as Gov. Bobby Jindal's administration reworks state insurance plans to keep the program from financial disaster. Financial analysts say those in the insurance program in many instances will be paying more and getting less. Critics of the changes say workers and retirees are being held responsible for the Jindal administration's mismanagement of their program (8/26).

Raleigh News & Observer: DHHS Medicaid Planner Leaves Highly Paid Job
A woman state health officials hired a year ago to work on Medicaid alternatives -- a new position that paid $95,000 annually despite her thin resume -- is resigning. Margaret “Mardy” Peal will leave Sept. 19, to take advantage of an opportunity that will allow her, a single mother, to be at home with her children more often, according to her resignation letter. ... Her hiring at DHHS drew criticism because it fit into a pattern of controversial personnel decisions by Secretary Aldona Wos, including high pay for young, inexperienced officials, and a contract with someone who works for her husband’s company (Jarvis, 8/26).

The Denver Post: Colorado Not Monitoring Psychotropics For Imprisoned Youths
Colorado has poor controls over the administration of powerful psychotropic medication to youths in corrections facilities, with state officials unable to show they are doing enough to monitor for harmful side effects, according to a state report released Tuesday. The report, which focused on the state's Division of Youth Corrections, sampled the medical records of 60 youth offenders, 57 of whom were prescribed psychotropic medication (Osher, 8/26).

Categories: Health Care

Ariz. GOP Primary For Governor Won By Treasurer

Kaiser Health News - Wed, 08/27/2014 - 9:30am

Doug Ducey defeated Scott Smith, who had the backing of Gov. Jan Brewer after supporting her Medicaid expansion proposal. Also, other Arizona Republicans who backed the Medicaid expansion there withstand challenges from more conservative candidates. Elsewhere, former GOP Florida Gov. Charlie Crist won a Democratic primary to challenge Republican Gov. Rick Scott.

The New York Times: Arizona Treasurer Wins G.O.P. Primary For Governor
With 83 percent of the precincts reporting, Mr. [Doug] Ducey was ahead with 37.3 percent of the vote, or about 59,000 more votes than his closest rival, Scott Smith, who had 22.4 percent. Mr. Smith, the former mayor of Mesa, was considered the most moderate among the Republicans running for governor. He focused his campaign less on border security, a prime theme for his opponents, and more on the economy, which is still suffering from the aftereffects of the recession. Gov. Jan Brewer, a Republican, lent him her endorsement and financial support, in part because he backed her decision to expand Medicaid coverage, a move opposed by most Republicans in the state because of its perceived connection to President Obama’s health care overhaul (Santos, 8/26).

The Wall Street Journal: Charlie Crist Wins Democratic Primary In Florida Governor's Race
Former Florida Gov. Charlie Crist won his first race as a Democrat Tuesday night, securing the party's nomination to challenge current Republican Gov. Rick Scott in what will be one of the nation's premier gubernatorial contests this fall. … In Arizona, Republican Doug Ducey won his party's primary and will face Democrat Fred DuVal this fall in the race to succeed Republican Gov. Jan Brewer, who isn't seeking a third term. Mr. Ducey, Arizona's state treasurer, was endorsed by Texas Sen. Ted Cruz, who called his plan for addressing illegal immigration "the most serious and credible plan to address the border crisis." … The former CEO of ice-cream chain Cold Stone Creamery, Mr. Ducey has … pledged to rein in the costs of Medicaid expansion -- a law signed by Ms. Brewer that has proved controversial among Republican state legislators and has been a hallmark of her tenure. Ms. Brewer had endorsed another candidate, former Mesa, Ariz., Mayor Scott Smith, in the race (Ballhaus, 8/27).

Arizona Republic: Incumbents Withstand Pro-Medicaid Vote
The Legislature's vote in 2013 to expand Arizona's Medicaid program got a welcoming reception from voters Tuesday, as most of the Republican incumbents who supported it appeared to be withstanding challengers on their right. That issue, combined with a contentious decision to adopt Common Core standards for Arizona's schools, drew sharply defined battle lines in the Republican primaries. The policy moves also served as a referendum on Gov. Jan Brewer's legacy. She supported both initiatives and candidates who said they would defend the decisions (Pitzl and Lee, 8/27).

Categories: Health Care

Minn. Home Health Care Workers Vote To Unionize

Kaiser Health News - Wed, 08/27/2014 - 9:29am

The Service Employees International Union will represent about 27,000 home health care workers -- many of whom care for relatives -- who are paid through Medicaid.

The Wall Street Journal: Minnesota Home-Care Workers Say Yes To Union
The Service Employees International Union scored a victory Tuesday as home health care workers in Minnesota voted to be represented by the labor group, even as it faces a legal challenge from opponents who say the 27,000 workers involved shouldn't be forced to join a union. The SEIU is slated to represent Minnesota home health-care workers who are paid through Medicaid. Many of them care for their own relatives (Maher, 8/26).

Pioneer Press: Minnesota Home Care Workers Approve Union
Thousands of Minnesota home care workers have voted to create their own union, the state said Tuesday after counting results. The union will represent about 27,000 workers who are paid by the state to care for disabled or elderly patients (Snowbeck, 8/26).

Minneapolis Star-Tribune: In Historic Vote, Minnesota Home Health Care Workers Unionize
In one of Minnesota’s largest labor organizing efforts since the Depression, home care workers across the state on Tuesday voted to join the Service Employees International Union, giving that organization the power to bargain on their behalf. The vote is the culmination of one of the most sweeping union expansion efforts in Minnesota history and represents a victory for Gov. Mark Dayton and the DFL-controlled Legislature, who pushed through legislation that enabled the certification vote (Simons, 8/27).

Minnesota Public Radio: Minnesota Personal Care Aides Back Statewide Union
Government-subsidized personal care assistants -- people who work with the elderly and disabled in their homes -- have voted to form a union. Labor organizers billed it as the largest union vote in Minnesota history, though only 22 percent of the nearly 27,000 eligible home health workers mailed in their ballots this month, according to data released Tuesday by the state Bureau of Mediation Services (Pugmire, 8/26).

Categories: Health Care

Conn. Exchange Chief To Run Healthcare.gov

Kaiser Health News - Wed, 08/27/2014 - 9:28am

Federal officials tap Kevin Counihan, who helped launch Connecticut's successful online health insurance marketplace, to oversee the federal exchange, which is used by residents of three dozen states, and to prevent the problems that plagued it last fall.

Connecticut Mirror: Access Health's Counihan To Run Federal Obamacare Marketplace
Kevin Counihan is resigning as the chief executive of Connecticut's health insurance exchange to lead the once-troubled federal Obamacare marketplace, officials announced Tuesday. As CEO of the federal exchange, Counihan will assume responsibility for the HealthCare.gov insurance marketplace, a crucial piece of the Affordable Care Act that is used to enroll people in coverage in nearly three dozen states. The federal exchange's launch last fall was considered disastrous, and Counihan's appointment comes less than three months before the Nov. 15 start of the second open enrollment period for private insurance (Levin Becker, 8/26).

The New York Times: Leader Of Connecticut's Health Marketplace Is Named To Run Federal Program
Mr. Counihan will start on Sept. 8, a little more than two months before the next sign-up period for health insurance begins on Nov. 15. Sylvia Mathews Burwell, the secretary of Health and Human Services, hired Mr. Counihan for the new position of chief executive as part of an effort to improve management of the federal marketplace and to avoid the technological failures that paralyzed its website, HealthCare.gov, last fall (Goodnough, 8/26).

Kaiser Health News: New Head Of Healthcare.gov Is Connecticut's Counihan
Kevin Counihan, the head of Connecticut's health insurance marketplace, will be the new CEO of healthcare.gov, the website that 36 states use to sell insurance under the Affordable Care Act, the administration announced Tuesday. Department of Health and Human Services Secretary Sylvia Burwell tapped Counihan to lead the site as part of a revamped management structure that aims to have the second year of Obamacare run more smoothly than the first (Cohen and Webber, 8/26).

The Wall Street Journal: Connecticut Exchange CEO To Run HealthCare.gov
The health law called for the setting up of online exchanges where consumers can compare insurance plans and apply for tax credits toward the cost of coverage. HealthCare.gov is the platform the federal government uses to run exchanges on behalf of more than 30 states unable or unwilling to run their own. … HHS said Tuesday that as well as being in charge of the federally run exchanges, Mr. Counihan's responsibilities would include working with the states that run their own exchanges, and running the Center for Consumer Information and Insurance Oversight, the unit in charge of regulating health plans under the 2010 health law (Radnofsky, 8/26).

The Washington Post's Wonkblog: There's Finally Someone In Charge Of Healthcare.gov
The idea of a single point person to oversee the law's implementation originally generated interest among some of the law's advocates in early 2010 and top administration officials. More talk resurfaced after the failed launch of HealthCare.gov last year, when it became clear there was a management problem at the Centers for Medicare and Medicaid Services, the agency overseeing the law's implementation. It's easy to see why CMS saw Counihan as the right person to run the enrollment Web site serving 36 states (Millman, 8/26).

San Francisco Chronicle: Health Exchange Head Named To Federal Post
The head of the state's health insurance exchange is leaving the post to head the federal and state marketplace in Washington. While he predicts the impact of his departure will be "minimal," some advocates aren't so sure. On Tuesday, Access Health CT CEO Kevin Counihan announced he had accepted a position as the federal marketplace CEO. Counihan will be responsible for leading the federal marketplace, managing relationships with state marketplaces and running the Center for Consumer Information and Insurance Oversight, which regulates health insurance at the federal level. During open enrollment this year, the federal marketplace website, healthcare.gov, was plagued with glitches and shutdown (Cuda, 8/26).

NBC News: Connecticut Health Honcho Named Healthcare.gov CEO
Kevin Counihan, who headed up Connecticut’s successful health insurance exchange, has been named CEO of Healthcare.gov. It’s a new job, one that the new Health and Human Services Secretary Sylvia Matthews Burwell promised to create when she was named earlier this year (Fox, 8/26).

Politico also notes an interim appointment for another job.

Politico: Connecticut Exchange Leader Named CEO Of Healthcare.Gov
HHS is still looking for a permanent chief technology officer for HealthCare.gov, but the agency announced Tuesday that Tim Hughey of Accenture will effectively fill that role in the interim. Accenture is the lead contractor on the federal exchange now, having replaced CGI, which was fired in January. Hughey will provide technology support to CMS through the next open enrollment season, which kicks off Nov. 15, federal health officials said (Wheaton, 8/26).

Categories: Health Care

VA Watchdog Stops Short Of Tying Deaths To Delayed Care

Kaiser Health News - Wed, 08/27/2014 - 9:27am

In a report released Tuesday, the VA's Office of Inspector General criticized a Phoenix VA hospital for "troubling lapses in follow-up, coordination, quality and continuity of care." Investigators said that numerous veterans died after receiving substandard care, but they could not substantiate allegations that delays had caused at least 40 deaths.

Los Angeles Times: VA Inquiry Stops Short Of Linking Deaths To Delays In Care In Phoenix
On the same day President Obama pledged to regain veterans’ trust, Department of Veterans Affairs investigators reported that they had been unable to prove that delays in medical care caused any deaths at the VA medical center in Phoenix, epicenter of a national scandal over mismanagement in the veterans healthcare system. In a report released Tuesday, however, the VA’s Office of Inspector General criticized the Phoenix VA for “troubling lapses in follow-up, coordination, quality and continuity of care” (Carcamo and Hennessey, 8/26).

The Washington Post: VA Watchdog Confirms Patients Died After Receiving Poor Care
The Department of Veterans Affairs’ watchdog confirmed Tuesday that numerous veterans died after receiving poor care in a VA hospital in Phoenix, Ariz., but stopped short of substantiating widely reported allegations that at least 40 veterans died while awaiting care. The VA inspector general’s office said in a report that it reviewed the records of 3,409 veterans and found 45 cases where patients experienced “unacceptable and troubling lapses” in care. Of those, 28 experienced long delays in care, and six died, the report said. Seventeen other patients experienced care that “deviated from the expected standard independent of delays,” and 14 of them died, the IG found (Lamonthe, 8/26).

The Associated Press: IG: Shoddy Care By VA Didn’t Cause Phoenix Deaths
Investigators uncovered large-scale improprieties in the way VA hospitals and clinics across the nation have been scheduling veterans for appointments, according to a report released Tuesday by the VA’s Office of Inspector General. The report said workers falsified waitlists while their supervisors looked the other way or even directed it, resulting in chronic delays for veterans seeking care (8/26).

Politico: VA Report: Deaths Not Linked To Wait Times
The final report aligns with previous investigations from the watchdog office, which helped launch a scandal that cost former VA Secretary Eric Shinseki his post. The inspector general said in May it found evidence that employees, including senior level managers, manipulated wait times to hide the delays faced by veterans seeking medical treatment (French, 8/26).

NPR: VA Deputy Secretary On Wait Times: 'We Owe The American People An Apology'
Melissa Block talks with Sloan Gibson, the deputy secretary of the Veterans Affairs Department, about the results of a recent probe into wait times at VA facilities (8/26).

CNN: Scathing Report Slams Veterans' Care But Says No Definite Link To Deaths
A lengthy report on wait times at VA health care facilities in Phoenix found that 28 veterans had "clinically significant delays" in care, and six of them died, but investigators couldn't conclusively link their deaths to the delays. The scathing report, released Tuesday by the Department of Veterans Affairs' Office of Inspector General, said the delays were because of scheduling issues. There were also 17 patients -- 14 of whom died -- in the review who received poor care but not as a result of access or scheduling issues (Fantz, Griffin, Black and Bronstein, 8/26).

NBC News: VA: No Proof Delayed Medical Care Caused Deaths In Phoenix
Investigators found no conclusive proof that delays in medical care caused patient deaths at the Phoenix VA Health Care System, even though some patients died while waiting for appointments and delays “adversely affected” the quality of care, according to a report released Tuesday by the VA’s inspector general. Dr. Sam Foote, a whistleblower at the Phoenix VA, had charged in February that up to 40 patients may have died waiting for appointments (Gardella, 8/26).

Categories: Health Care

Political Cartoon: 'The Check Up Is In The Mail?'

Kaiser Health News - Wed, 08/27/2014 - 9:24am

Kaiser Health News provides a fresh take on health policy developments with "The Check Up Is In The Mail?" by Steve Kelley and Jeff Parker.

COUNIHAN TAKES CHARGE OF HEALTHCARE.GOV

Impossible job?
Or not? His track record's good
in Connecticut.
-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

An Interview with Ann Hemmens, Legal Reference Librarian

In Custodia Legis - Wed, 08/27/2014 - 8:44am

This week’s interview is with Ann Hemmens, a legal reference librarian with the Public Services Division of the Law Library of Congress.

Describe your background.

I grew up in Chapel Hill, North Carolina. My parents were transplants from Illinois and I inherited their interest in travel and living in different parts of the country. I’ve lived in Illinois, Georgia, Washington, New Mexico and now the District of Columbia.

What is your academic/professional history?

Photograph by Donna Sokol

I attended college at the University of Illinois  and worked as a looseleaf filer and paralegal at law firms in Atlanta, Ga. and Chapel Hill, N.C. After earning a law degree at UNC-Chapel Hill, I decided to try my hand at public health education and worked at the CDC National HIV/AIDS Hotline responding to questions from people around the country about transmission, prevention, treatment, and support services. After a time working at the NC Division of Medical Assistance, which manages the Medicaid program, I found my way back to law through law librarianship. I earned a library degree at UNC and worked in the Law Library as a graduate assistant. I have worked in reference and public services at three academic law libraries: University of Washington, University of New Mexico, and Georgetown.

How would you describe your job to other people?

I assist congressional staff members and members of the public  in answering their legal research questions by helping them locate the resources from the Library’s vast print and online collections.  I help patrons in person, at the reference desk in the Law Library Reading Room, as well as online via our Ask A Librarian service.  I assist my colleagues in maintaining our government documents collection, including our United States Supreme Court Records and Briefs collection.  As one of only ten depositories of printed U.S. Supreme Court briefs, this is a very unique and heavily used collection.

Why did you want to work at the Law Library of Congress?

While I was in library school at UNC, I spent a summer working at the Law Library of Congress. I worked on the Century of Lawmaking website and a project to compile the legislative history of the Library. It was a great experience, introducing me to the Library’s tremendous collection, learning vital research skills related to congressional materials, and working with a wonderful team of people. It has been a dream of mine to return to the Library.

What is the most interesting fact you’ve learned about the Law Library?

In addition to providing access to materials (print, online, microform) and helping patrons locate what they need, the Law Library provides important instructional sessions. For example, the Orientation to Legal Research and the Use of Law Library Collections session is conducted in the Law Library and provides an overview of statutory, regulatory, and case law research. An introduction to Congress.gov, which is the successor to THOMAS.gov, is offered as a webinar. Through these sessions attendees develop a better understanding of the intricacies of legal research and the various resources available in print or online.

What’s something most of your co-workers do not know about you?

I love jazz. I was introduced to the music of Billie Holiday, Sarah Vaughan, Ella Fitzgerald and others by my family and have continued to enjoy the many styles of jazz whether captured on vinyl/CD or in live performances. One of my most treasured experiences was seeing Nina Simone perform at Benaroya Hall in Seattle on July 23, 2001. The D.C. area is steeped in the history of jazz, including being the birthplace of Duke Ellington.  I’ve enjoyed performances at a few of the many local D.C. venues including HR-57, Bohemian Caverns, and Jazz Night in Southwest.

Categories: Research & Litigation

First Edition: August 27, 2014

Kaiser Health News - Wed, 08/27/2014 - 7:25am

Today's headlines include reports about Kevin Counihan, the person who take on the challenge of running healthcare.gov.

Kaiser Health News: New Head Of Healthcare.gov Is Connecticut's Counihan
Reporting for Kaiser Health News, in partnership with NPR, WNPR’s Jeff Cohen and KHN’s Diane Webber write: “Kevin Counihan, the head of Connecticut's health insurance marketplace, will be the new CEO of healthcare.gov, the website that 36 states use to sell insurance under the Affordable Care Act, the administration announced Tuesday. Department of Health and Human Services Secretary Sylvia Burwell tapped Counihan to lead the site as part of a revamped management structure that aims to have the second year of Obamacare run more smoothly than the first” (Cohen and Webber, 8/26). Read the story.

Kaiser Health News: Operator? Business, Insurer Take On End-of-Life Issues By Phone
WHYY’s Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: “Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings. ‘My name is Kate. I'm a health care counselor,’ the gentle voice says from her cubicle in Cherry Hill, N.J.. This is no telemarketing call … it’s about the end of your life. Kate Schleicher, 27, is a licensed clinical social worker, who knows almost as little about you as you do about her. Except she’s got your phone number, your insurance provider and that you are pretty sick” (Gordon, 8/27). Read the story.

Kaiser Health News: Capsules: Report: Health Law Ups Taxes On Insurers With Big Pay Packages
Now on Kaiser Health News’ blog, Julie Appleby reports: “While average compensation for top health insurance executives hit $5.4 million each last year, a little-noticed provision in the federal health law sharply reduced insurers’ ability to shield much of that pay from corporate taxes, says a report out today” (Appleby, 8/27). Read the story.

The New York Times: Leader Of Connecticut’s Health Marketplace Is Named To Run Federal Program
Mr. Counihan will start on Sept. 8, a little more than two months before the next sign-up period for health insurance begins on Nov. 15. Sylvia Mathews Burwell, the secretary of Health and Human Services, hired Mr. Counihan for the new position of chief executive as part of an effort to improve management of the federal marketplace and to avoid the technological failures that paralyzed its website, HealthCare.gov, last fall (Goodnough, 8/26).

The Wall Street Journal: Connecticut Exchange CEO To Run HealthCare.gov
The health law called for the setting up of online exchanges where consumers can compare insurance plans and apply for tax credits toward the cost of coverage. HealthCare.gov is the platform the federal government uses to run exchanges on behalf of more than 30 states unable or unwilling to run their own. … HHS said Tuesday that as well as being in charge of the federally run exchanges, Mr. Counihan's responsibilities would include working with the states that run their own exchanges, and running the Center for Consumer Information and Insurance Oversight, the unit in charge of regulating health plans under the 2010 health law (Radnofsky, 8/26).

The Washington Post’s Wonkblog: There’s Finally Someone In Charge Of Healthcare.Gov
The idea of a single point person to oversee the law's implementation originally generated interest among some of the law's advocates in early 2010 and top administration officials. More talk resurfaced after the failed launch of HealthCare.gov last year, when it became clear there was a management problem at the Centers for Medicare and Medicaid Services, the agency overseeing the law's implementation. It's easy to see why CMS saw Counihan as the right person to run the enrollment Web site serving 36 states (Millman, 8/26).

The Associated Press: CEO Named For Healthcare.Gov
Kevin Counihan leads Access Health CT, a health insurance marketplace seen as a national model. As CEO of the federal exchange, Counihan’s challenge will be far bigger. Connecticut enrolled about 80,000 people, while more than 5 million signed up in the 36 states served by the federal marketplace (8/26).

Politico: Connecticut Exchange Leader Named CEO Of Healthcare.Gov
HHS is still looking for a permanent chief technology officer for HealthCare.gov, but the agency announced Tuesday that Tim Hughey of Accenture will effectively fill that role in the interim. Accenture is the lead contractor on the federal exchange now, having replaced CGI, which was fired in January. Hughey will provide technology support to CMS through the next open enrollment season, which kicks off Nov. 15, federal health officials said (Wheaton, 8/26).

The Washington Post: Federal Auditors Sought Documents Related To Troubled Md. Health Exchange Launch
Noridian Healthcare Solutions, the company fired by Maryland officials after the disastrous launch of the state’s health insurance exchange, received a request from federal auditors last month to turn over documents related to the troubled project, chief executive Tom McGraw said Tuesday. McGraw said in a statement that Noridian was “cooperating fully” with the July 30 request by the inspector general’s office for the Department of Health and Human Services, which has been auditing the use of federal funds in creating the Maryland Health Benefit Exchange (Johnson and Flaherty, 8/26).

The New York Times: Nonprofit Hospitals’ 2013 Revenue Lowest Since Recession, Report Says
Nonprofit hospitals last year had their worst financial performance since the Great Recession, according to a report released on Wednesday. The poor operating performance of many hospitals underscored some of the changes in the health care system as the federal government and private health plans became less willing to pay for hospital care and changed the way they paid hospitals in an effort to reduce costs (Abelson, 8/27).

The Wall Street Journal: Nonprofit Hospitals' Earnings Fall As Costs Outrun Revenue
Nonprofit hospitals' income declined for a second straight year in 2013 and their median rate of revenue growth fell to an all-time low, Moody's Investors Service said, a trend the credit rater's analysts say likely will continue this year. The nonprofit hospitals' performance contrasts with the rising profits and patient volumes reported by publicly traded hospital operators in recent weeks (Weaver, 8/27).

The New York Times: Arizona Treasurer Wins G.O.P. Primary For Governor
With 83 percent of the precincts reporting, Mr. Ducey was ahead with 37.3 percent of the vote, or about 59,000 more votes than his closest rival, Scott Smith, who had 22.4 percent. Mr. Smith, the former mayor of Mesa, was considered the most moderate among the Republicans running for governor. He focused his campaign less on border security, a prime theme for his opponents, and more on the economy, which is still suffering from the aftereffects of the recession. Gov. Jan Brewer, a Republican, lent him her endorsement and financial support, in part because he backed her decision to expand Medicaid coverage, a move opposed by most Republicans in the state because of its perceived connection to President Obama’s health care overhaul (Santos, 8/26).

The Wall Street Journal: Charlie Crist Wins Democratic Primary In Florida Governor's Race
Former Florida Gov. Charlie Crist won his first race as a Democrat Tuesday night, securing the party's nomination to challenge current Republican Gov. Rick Scott in what will be one of the nation's premier gubernatorial contests this fall. … In Arizona, Republican Doug Ducey won his party's primary and will face Democrat Fred DuVal this fall in the race to succeed Republican Gov. Jan Brewer, who isn't seeking a third term. Mr. Ducey, Arizona's state treasurer, was endorsed by Texas Sen. Ted Cruz, who called his plan for addressing illegal immigration "the most serious and credible plan to address the border crisis." … The former CEO of ice-cream chain Cold Stone Creamery, Mr. Ducey has … pledged to rein in the costs of Medicaid expansion—a law signed by Ms. Brewer that has proved controversial among Republican state legislators and has been a hallmark of her tenure. Ms. Brewer had endorsed another candidate, former Mesa, Ariz., Mayor Scott Smith, in the race (Ballhaus, 8/27).

NPR: VA Deputy Secretary On Wait Times: 'We Owe The American People An Apology'
Melissa Block talks with Sloan Gibson, the deputy secretary of the Veterans Affairs Department, about the results of a recent probe into wait times at VA facilities (8/26).

The New York Times: Obama Tells Veterans He Will Fix Health System, As New Report Lists Lapses
President Obama on Tuesday promised several thousand military veterans that he would fulfill his “sacred trust” to those returning from America’s wars by overhauling a dysfunctional health care system, even as a new report documented “unacceptable and troubling lapses” in medical treatment (Baker and Philipps, 8/26).

Los Angeles Times: Obama Tells American Legion He's Working To Regain Veterans' Trust
The list included seemingly straightforward changes, such as making it easier for veterans to earn commercial driver's licenses, and new funding for complex research. The Pentagon and the National Institutes of Health have launched a study on early detection of suicide risk, post-traumatic stress disorder and traumatic brain disorder, while the VA will invest $34.4 million in a national clinical trial on suicide prevention involving 1,800 veterans at 29 hospitals, the White House said (Hennessey, 8/26).

The Washington Post: Obama Pledges Better Mental Health Services, Other Initiatives For Military, Vets
Heralding a new "culture of accountability" at the Department of Veterans Affairs, President Obama Tuesday announced a number of executive actions to help active-duty military members, their families and veterans, ranging from strengthening access to mental health care to making it easier for troops to reduce mortgage payments. Speaking at the American Legion’s annual convention in the wake of a scandal involving falsified records and long wait times at VA facilities, Obama reaffirmed his support for America's veterans and said his administration will do all it can to ensure current and former members of the military receive the full benefits they deserve (Zezima, 8/26).

The Associated Press: Obama Defends Handling Of Veterans Affairs Issues
His standing with veterans damaged by scandal, President Barack Obama on Tuesday defended his administration’s response to Veterans Affairs lapses that delayed health care for thousands of former service members, but conceded more needed to be done to regain their trust. His appearance also had deep political overtones in a state where the Democratic senator, Kay Hagan, is facing a difficult re-election and has sought to distance herself from Obama’s policies, declaring as recently as Friday that his administration had not “done enough to earn the lasting trust of our veterans” (8/26).

Los Angeles Times: VA Inquiry Stops Short Of Linking Deaths To Delays In Care In Phoenix
On the same day President Obama pledged to regain veterans’ trust, Department of Veterans Affairs investigators reported that they had been unable to prove that delays in medical care caused any deaths at the VA medical center in Phoenix, epicenter of a national scandal over mismanagement in the veterans healthcare system. In a report released Tuesday, however, the VA’s Office of Inspector General criticized the Phoenix VA for “troubling lapses in follow-up, coordination, quality and continuity of care” (Carcamo and Hennessey, 8/26).

The Washington Post: VA Watchdog Confirms Patients Died After Receiving Poor Care
The Department of Veterans Affairs’ watchdog confirmed Tuesday that numerous veterans died after receiving poor care in a VA hospital in Phoenix, Ariz., but stopped short of substantiating widely reported allegations that at least 40 veterans died while awaiting care. The VA inspector general’s office said in a report that it reviewed the records of 3,409 veterans and found 45 cases where patients experienced “unacceptable and troubling lapses” in care. Of those, 28 experienced long delays in care, and six died, the report said. Seventeen other patients experienced care that “deviated from the expected standard independent of delays,” and 14 of them died, the IG found (Lamonthe, 8/26).

The Associated Press: IG: Shoddy Care By VA Didn’t Cause Phoenix Deaths
Investigators uncovered large-scale improprieties in the way VA hospitals and clinics across the nation have been scheduling veterans for appointments, according to a report released Tuesday by the VA’s Office of Inspector General. The report said workers falsified waitlists while their supervisors looked the other way or even directed it, resulting in chronic delays for veterans seeking care (8/26).

Politico: VA report: Deaths Not Linked To Wait Times
The final report aligns with previous investigations from the watchdog office, which helped launch a scandal that cost former VA Secretary Eric Shinseki his post. The inspector general said in May it found evidence that employees, including senior level managers, manipulated wait times to hide the delays faced by veterans seeking medical treatment (French, 8/26).

The Wall Street Journal’s Pharmalot: Pharma Tells The Federal Government: Transparency Works Both Ways
File this under ‘how ironic.’ Drug makers are asking for more transparency from the government agency that is requiring them to be more transparent about how much they pay doctors. The Pharmaceutical Research and Manufacturers of America, or PhRMA, is calling on the Centers for Medicare and Medicaid Services to further explain why the agency has removed one-third of the payment information from an online database that is due to be made public by Sept. 30 (Loftus, 8/26).

The Wall Street Journal: Minnesota Home-Care Workers Say Yes To Union
The Service Employees International Union scored a victory Tuesday as home health-care workers in Minnesota voted to be represented by the labor group, even as it faces a legal challenge from opponents who say the 27,000 workers involved shouldn't be forced to join a union. The SEIU is slated to represent Minnesota home health-care workers who are paid through Medicaid. Many of them care for their own relatives (Maher, 8/26).

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Categories: Health Care

Operator? Business, Insurer Take On End-of-Life Issues By Phone

Kaiser Health News - Wed, 08/27/2014 - 6:45am

Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings.

From her cubicle at Vital Decisions in Cherry Hill, N.J., Kate Schleicher counsels people with terminal illnesses. (Photo by Emma Lee/WHYY)

"My name is Kate. I'm a health care counselor," the gentle voice says from her cubicle in Cherry Hill, N.J..

This is no telemarketing call …  it’s about the end of your life.  

Kate Schleicher, 27,  is a licensed clinical social worker, who knows almost as little about you as you do about her. Except she knows your phone number, your insurance provider and that you are pretty sick.

Schleicher is one of 50 social workers at a company called Vital Decisions. After sending a letter (people rarely respond) counselors essentially cold-call to offer what they describe as “nondirected” end-of-life counseling. The company gave a reporter permission to listen to and record the social workers' side of some of these calls.

 "When you say that getting better is the most important thing on your mind, what does that look like for you?" Schleicher asks a man in Rhode Island.

"Breathing. Ok," she repeats back, as he describes what a struggle it has become for him. "I also hear concern from you that I don't think that's necessarily going to happen," Schleicher continues. "Has someone told you that, or is that your own feeling?"

The call lasts about 15 minutes. Schleicher asks if it's ok to follow up, in a month or so. The hope of this program, she says, is to build a relationship over the phone, so he might be comfortable discussing his situation and his goals. Then he’ll be empowered to communicate those things with others, including his family and his doctors. He could also choose to allow the counselor to talk to his doctors or family directly. It’s paid for by insurers and federal privacy rules permit this for business purposes.  

An Often-Avoided Topic 

CEO Mitchell Daitz believes critical conversations about end-of-life care just aren't happening enough and the company's goal is to foster them.

"The accepted norm in terms of the role of the individual who's going through this advanced illness experience is to be passive and be along for the ride, not to take charge, not to take control and ask for help," says Daitz, adding that navigating care and an individual's priorities can become increasingly difficult as a disease progresses. "So when you're faced with a set of choices, that none of which represent a really good choice, you become ambivalent."

To underscore this reality, here’s a partial transcript of another patient-counselor conversation. In this case, the patient gave permission for a reporter to hear and broadcast his side of the conversation:   

"I have a malignant brain tumor. I've been fighting it for over a year now," the man tells Ariana Noto. "The meds make me dizzy and when I'm that dizzy I can't drive, I'm trapped in the house, I'm going nuts."

"That's a lot. I'm so sorry to hear that," she responds.

Over the course of minutes the conversation goes from one between complete strangers to one of raw intimacy. The man confides information he may not have told anyone else. His meds make it difficult to function and do simple things like sitting around a table with friends, having a beer.

The two talk about what whether he understands about the effectiveness of his medicine. He's not sure. They go over what he might want to clarify with his doctor.

"... You can control how much treatment you want and how you want symptoms to be managed as it does get worse," Noto says.

"But I can't talk that way with my son in the room," he tells her.

CEO Daitz says jumpstarting unbiased, honest discussions around end-of life care, early on, could improve the quality of life for patients with advanced illnesses and their families in those final weeks and months together.

Such topics are still sensitive, but Daitz says insurers and patients are more open to addressing this now. The effort to reimburse doctors for these end of life conversations recently made a comeback in Congress.

That's the thinking behind the company, formed in 2008, and a wave of other similar initiatives. It wasn't popular at first, says Daitz, recalling the uproar over unsuccessful attempts to add to the health law payments to doctors for advanced-planning and end-of-life conversations and false rumors of “death panels.”

"No one ever accused me of having good timing," he says.

Talking Freely About What You Want

The goal is for patients to receive care in those final months that aligns with what the patient wants, even if that's the most aggressive treatment available. But it "turns out when you're able to have more effective decision making amongst the family and physicians, an individual often has values and priorities” that are met by palliative care instead of more treatment, according to Daitz.

And when these conversations do happen, there’s can be another byproduct: reduced costs. Research is finding that when patients fully understand aggressive care, many choose less of it. By Daitz’ own rough estimate, the company’s services have resulted in about $10,000 less in health care spending per patient, “$100 million to the health care system in 2014.” 

But some people are wary of the company’s approach. Dr. Lauris Kaldjian, professor of bioethics at the University of Iowa, has concerns about the social worker, patient and family never actually meeting. “Because if you don’t have enough knowledge about what’s actually going on with the patient, it would actually be irresponsible to pretend to have discussion that depends upon such knowledge.” 

End-of-life decisions are hard to keep totally neutral, he says, so that’s why he’d want full transparency from insurers and the company to guard against bias in the sessions.

Dr. Robert Arnold, who heads the palliative care division at the University of Pittsburgh Medical Center, says insurers may be well situated to address the communication disconnect, at least while providers work through their own discomfort and improve their skills. He sees companies like Vital Decisions as part of a larger trend.

“Would I prefer that we live in a health care systems where doctors, nurses, nurse practitioners and social workers who knew the patient were having these conversations? Yes,” he says. “This is better than what patients have currently been getting.”

Meanwhile, Vital Decisions’ Daitz says he looks forward to the day when these conversations are taking place and his company is no longer needed.

Categories: Health Care

ACLU of Louisiana Statement in Response to MCC Report on Orleans Parish Jail Size

ACLU -- Criminal Justice News - Wed, 08/27/2014 - 12:00am

FOR IMMEDIATE RELEASE
CONTACT: 212-549-2666, media@aclu.org

NEW ORLEANS — Today the New Orleans Metropolitan Crime Commission has released a report advocating for building a larger Orleans Parish jail, recommending a final capacity of 2,500 beds. The ACLU of Louisiana is strongly opposed to such an increase, and remains in support of the cap of 1438 beds as adopted by the New Orleans City Council.    The inmate data from the MCC report, covering the first six months of 2014, shows a population of 1679 pretrial inmates. Over 400 of those are being held for minor, nonviolent offenses such as drug possession, probation and parole violations, and traffic offenses, and could easily be released with no risk to public safety. Many of the remaining pretrial detainees are only being held because of their inability to make bail. If they had been ruled a danger to public safety, bail would not have been set in the first place.    The practice of incarcerating nonviolent offenders is wasteful and senseless.  All of the evidence shows that incarcerating nonviolent offenders actually increases crime, by giving people criminal records and making it harder for them to obtain employment, and by forcing them into situations with more dangerous people.  It also destabilizes families, costs taxpayer funds in incarceration and in public assistance for the families while the person is incarcerated. The jail should be reserved for people who truly pose a threat to the community, rather than nonviolent offenders or people who are simply too poor to post bail.    The MCC report data was gathered over too short a period to be of real use in making recommendations on future jail  population trends. Instead of looking for ways to increase the jail size, what the parish should be doing is finding ways to reduce the jail population — as the ACLU and dozens of other advocacy groups have recommended all along. 
Categories: Prisoners Rights

Affordable Care Act Exemptions Mean Millions Don't Have To Sign Up

Kaiser Health News - Tue, 08/26/2014 - 1:07pm

When she was eight weeks old, Ashlyn Whitney suffered a severe respiratory-tract infection that put her in an intensive care unit for 12 days.

Nicole Whitney with her 1-year-old daughter, Ashlyn, whose 12-day hospital stay when she was eight weeks old was covered by a medical bill-sharing plan. (Photo courtesy of Whitney family)

“Because she was so young, she couldn’t handle it,” Ashlyn’s mother, Nicole Whitney, recalled. “They had to give her oxygen.”

The baby, now a year old, recovered from her illness, known as respiratory syncytial virus.The bill for her treatment at the West Boca Medical Center in Palm Beach County came to about $100,000 — a sum that included almost $4,000 in fees for her birth and pre- and post-natal care — but every dime of the tab was picked up by a medical bill-sharing organization set up for its Christian membership.

Such religious groups are exempt from the Affordable Care Act’s mandate that most Americans obtain health insurance or pay a penalty. Although as many as 30 million Americans will remain without health insurance by 2016, despite the best efforts of the ACA’s proponents, all but about seven million of them will be spared having to join the new system because of exemptions created by the act itself, according to an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation.

The exempted religious organizations generally pool their members’ money to pay the medical expenses of anyone in the group who gets sick, injured or becomes pregnant. Also exempted from the law are members of federally recognized religious sects who have religious objections to insurance or to such systems as Social Security or Medicare.

Exemptions from the Affordable Care Act

You are exempt from ACA coverage if you:

  • Are a member of a recognized healthcare sharing ministry or a religious sect with objections to insurance;
  • Are homeless or have suffered recent eviction, foreclosure, bankruptcy or a disaster that caused substantial damage to your property;
  • Recently experienced domestic violence or the death of a close relative;
  • Had medical expenses in the last year, for yourself or a family member, that you could not pay and which resulted in substantial debt or which were unexpected;
  • Received a shut-off notice from a utility company;
  • Are incarcerated or in the United States illegally.

SOURCE: Centers for Medicare & Medicaid Services

Most of the other 20 exemptions address circumstantial situations such as homelessness, eviction, foreclosure, bankruptcy, the death of a close family member or an experience with domestic violence. Members of Native American tribes are also free to not sign up for health insurance, as are those whose income is too low or who are serving a prison sentence.

The organization that Nicole Whitney and her husband, Jonathan, joined two years ago was Medi-Share, a program set up in 1993 by the Melbourne-based, not-for-profit Christian Care Ministry, which says on its website that its members “make the rules — and their dollars don’t support unbiblical choices such as abortion, or drug or alcohol abuse.”

The ministry’s medical director, Dr. Andrea Miller, who also holds the title of Vice President of Sharing, said its members were “believers who just wanted to share each other’s burdens and didn’t want to deal with health insurance.” If a member of the group got sick, she said, “they could all help out.”

Of Medi-Share’s 100,000 members nationwide — a number that reflects an increase of about 30,000 since the ACA’s open enrollment began last fall — 7,700 are in Florida, according to the group’s public-relations representative. She said an additional 200,000 people are members of two other national organizations with similar programs.

Joining such plans, Miller said, is often as much a philosophical decision as it is a financial one.

“People are looking to take care of themselves and each other,” said Miller, who was the medical director of a hospice before she was hired by the Christian Care Ministry two years ago. “They want to be connected, and they don’t want to pay for things that are immoral.”

By immoral she meant abortion, Miller said, but not necessarily contraception, which she said some of Medi-Share’s members probably support.

“The other piece of this is living a biblical lifestyle and a healthy lifestyle,” Miller noted, referring to the fact that the ministry provides “health coaches” who contact members suffering from health problems such as obesity — and attendant issues with high blood pressure and excessive cholesterol levels — and “advise them on how to get healthier.”

In practical terms, Medi-Share members contribute to each other’s care by depositing an agreed-upon amount — the Whitneys pay $1,250 a year, although some families pay more than twice that — into an account at America’s Christian Credit Union. The deposits act as deductions, meaning that once a family has used that money for its healthcare bills, any new family medical expenses are covered by Medi-Share’s fellow members.

Medi-Share negotiates with providers to obtain an average of 30 percent in discounts on medical bills incurred by its members. In the past 21 years, Miller said, the organization has “shared” about $750 million, including the discounts.

The system is not open to just anyone. “You have to be a Christian,” Nicole Whitney said. “You have to show regular church attendance, that you lead a religious life.”

Carol and Paul White, in the living room of their Miami home, are exempt from enrolling in the Affordable Care Act on religious grounds. (Photo by Emily Michot/Miami Herald)

Before giving birth to her son, Sebastian, in 2011, Whitney had worked for six years as a fifth-grade teacher at a Christian school in Deerfield Beach, and had been covered by that institution’s insurance plan. When she left the school and bought a plan for herself and her newborn, she was suddenly paying a premium of about $900 a month.

“I couldn’t afford it,” Whitney said. But a friend told her “good things” about the Medi-Share program, and she was able to join. Whitney said she “didn’t really consider” signing up for a plan under the ACA’s insurance marketplace.

“I felt like I didn’t know enough about Obamacare,” said Whitney, who is 33 and lives in Boca Raton. “I’m glad I had an alternative.”

A fellow Medi-Share member, Paul White, who signed up in 2005, said he will never drop the religious group’s plan in favor of one established by the ACA.

“I didn’t want all the hassles,” said White, 63, a father of three who lives with his wife, Carol, in Miami’s Sunset Pines neighborhood. He had been covered by a corporate insurance plan for 28 years as an employee of a commercial real estate company before retiring in 2001.

A few years ago, after joining Medi-Share, White broke his left leg in what he called “a silly household accident.” He wore a cast for three months, but his medical expenses were covered.

When he was first asked to pay $1,250 as an annual deductible for his family, White recalled being taken aback. “At that point, it sounded like a lot,” he said. “But now it seems cheap. I have no worries.”

Categories: Health Care

New Head of Healthcare.gov Is Connecticut’s Counihan

Kaiser Health News - Tue, 08/26/2014 - 12:04pm

Kevin Counihan, the head of Connecticut’s health insurance marketplace, will be the new CEO of healthcare.gov, the website that 36 states use to sell insurance under the Affordable Care Act, the administration announced at noon today.

Department of Health and Human Services Secretary Sylvia Burwell tapped Counihan to lead the site as part of a revamped management structure that aims to have the second year of Obamacare run more smoothly than the first.

Kevin Counihan (Photo by Jeff Cohen/WNPR)

Access Health CT, under Counihan’s leadership, is one of the more successful state-run exchanges. About 79,000 people signed up for coverage through Connecticut’s exchange, and another 120,000 gained Medicaid coverage. Surveys show that about half the people who gained coverage in the state were previously uninsured.

"One of the most important things we did is we showed that government can work," Counihan said at a press conference in Hartford Tuesday. "It can take on a highly complex social program and succeed."

But taking the reins of healthcare.gov will be a much tougher job. Connecticut has a Democratic governor and legislature, and it embraced the law early, including the expansion of Medicaid. Healthcare.gov serves states that are actively hostile to the law in the Deep South, states that are embracing the law to some minimal degree and states that are active partners in running the exchange.

At the press conference, Connecticut Gov. Dannel Malloy said Burwell had called him to discuss Counihan. The governor joked that Counihan should have his head examined for agreeing to go to Washington.

Burwell, in a press release, said that Counihan “will be a clear, single point of contact for streamlined decision-making.” The release announced several other hires as well.

Obamacare Year 2 starts with enrollment opening on Nov. 15, and the challenges are many. In addition to making sure the technical glitches stay in the rearview mirror, Counihan will be responsible for keeping people who are already signed up satisfied, as well as reaching out to the millions of Americans who are eligible for coverage but not yet insured.

Counihan said he's optimistic that it can be done. "People understand intuitively that having people uninsured is not right for them or right for the country," he said. "Now, how we go about doing it -- people can debate and there can be solid policy differences.  But I'm fundamentally very optimistic that, even though there are some big ideological schisms, that those can be bridged."

Counihan’s exchange excelled at marketing Obamacare insurance – taking the pitch to Lil Wayne concerts, jazz festivals and a storefront on a city street. And he credits some of that success to the pool of executive talent he was able to draw on in Hartford, an insurance capital.

Counihan has several decades of experience in healthcare, including launching complex new coverage programs. After a career in the private insurance industry (Tufts Health Plan, Cigna), he helped launch Massachusetts’ successful health exchange starting in 2006. He also helped launch a private insurance exchange in California.

Counihan is the second high-profile addition to the Healthcare.gov second year team. Earlier this summer HHS brought on Andy Slavitt, who helped fix the site’s initial problems as an executive with contractor Optum.

Julie Rovner contributed.

Categories: Health Care

Second Magna Carta Lecture Series Program Shines a Light on Primary Sources

In Custodia Legis - Tue, 08/26/2014 - 11:12am

We hosted our second program in the Magna Carta lecture series, “Selecting and Conserving Primary Sources,” on Wednesday, August 20. William “Jake” Jacobs, chief of the Library’s Interpretive Programs Office, the division charged with managing exhibitions, moderated a panel of Library specialists who discussed the methods by which they prepare and select materials for Library exhibitions and educational outreach curricula.

Panelists included Nathan Dorn, rare book curator in the Law Library of Congress and fellow blogger; Holly Krueger, head of the Paper Conservation Section in the Preservation Directorate; and Stephen Wesson, an educational resource specialist in the Office of Strategic Initiatives.

Panelists from Left to Right: Stephen Wesson, Holly Krueger, and Nathan Dorn. Photo Source: Amanda Reynolds.

The lecture series, cosponsored by the American Bar Association Standing Committee on the Law Library of Congress, is being held in conjunction with the upcoming exhibition, “Magna Carta: Muse and Mentor.” The exhibition is set to open on November 6 and run through January 19, 2015. The intent of the lecture series is to provide further context on how Magna Carta fits into expansive historical and contemporary topics, such as legal representation and the status of women.

The program emphasized the unique resources of the Library of Congress, one of the largest repositories of primary sources in the world, to offer treasures to a large and varied audience through exhibitions and educational outreach efforts. The panelists relayed a first-hand look at some of the great skill and detailed professional methodologies in building exhibitions.

Nathan began by describing why the 1215 Lincoln Cathedral Magna Carta, which will arrive at the Library this November, should be celebrated. For instance, “The Lincoln Magna Carta is robust in its physical condition and its legibility.” What makes it exceptional is that it was addressed on the back by a script for Lincoln Cathedral and has remained in their custody ever since. Forty-one copies of Magna Carta were produced and sent to all the counties and port cities of England. After 800 years, only four copies from 1215 exist. Two are held at the British Library, one is held at Salisbury Cathedral and the other at Lincoln Cathedral.

Nathan addressed the factors that one considers in choosing themes and artifacts for an exhibition, noting that a balance has to be struck between the strengths of the collection and the requirements of good story telling. He walked the audience through the series of considerations that led him and exhibition directors Martha Hopkins and Cheryl Regan to focus on the interpretation of Magna Carta over time, and the history of select constitutional principles.

Holly Krueger described the role of conservators in developing exhibitions, including screening proposed exhibition items for stabilization and treatment and determining levels of lights appropriate for the artifacts to be displayed. At any given time, there are six to eight exhibitions underway containing 10-250 objects along with a very active loan program that shares exhibit items with other institutions, there is a potential for 1-2,000 Library objects to be on active display daily throughout the world.

Stephen Wesson discussed his office’s guidelines for selecting primary sources for inclusion in educational materials for grades K-8. He showed how primary sources can help students engage with complex subject matter and guide students in developing critical skills, allowing them to evaluate evidence and construct new knowledge.

The potential impact of primary sources on today’s students is directly relevant to the Magna Carta exhibition since “Muse and Mentor” could very well make the 800 year old Magna Carta, “real” for students and adults alike.

Categories: Research & Litigation

When Medical Care Is Futile, Other Patients Pay The Hidden Price

CommonHealth (WBUR) - Tue, 08/26/2014 - 10:16am

(U.S. Navy via Wikimedia Commons)

By Richard Knox

Every day in intensive care units across the country, patients get aggressive, expensive treatment their caregivers know is not going to save their lives or make them better.

California researchers now report this so-called “futile” care has a hidden price: It’s crowding out other patients who could otherwise survive, recover and get back to living their lives.

Their study, in Critical Care Medicine, shows that patients who could benefit from intensive care in UCLA’s teaching hospital are having to wait hours and even days in the emergency room and in nearby community hospitals because ICU beds are occupied by patients receiving futile care. Some patients die waiting.

On one day out of every six, the researchers found, UCLA’s intensive care units contain at least one patient receiving useless care while other patients are unable to get into the ICU.

More than half the time, over a three-month period the researchers examined, the hospital’s intensive care units had a least one patient receiving futile care. The study shows the ripple effects of that futile care within the UCLA hospital and in surrounding hospitals where patients were waiting to be transferred.

“It is unjust when a patient is unable to access intensive care because ICU beds are occupied by patients who cannot benefit,” the authors write.

“The ethic of ‘first come, first served,’” they say, “is not only inefficient and wasteful, but it is contrary to medicine’s responsibility to apply health care resources to best serve society.”

But the concept of “futile” care raises touchy questions. Who decides when care is futile? What if the patient’s family disagrees? What can doctors and hospitals do to avoid futility? Might efforts to avoid futile care slide toward the big R – rationing?

I talked about the study’s implications with its senior author, Dr. Neil Wenger, a UCLA professor of primary care medicine and head of the university’s ethics center. Here’s a lightly edited transcript of our conversation.

Why did you decide to study futile care?

It’s been recognized before that patients receiving treatment that doctors don’t think is of any value are taking up places while other patients are not receiving care, but it’s always been a theoretical construct. We’d juggle beds and carry on. We were never able to quantitate whether the mechanism of triage was working or not working in everyday life.

How did you pin it down?

We surveyed every critical care doctor every day on every patient on whether they were treating someone they didn’t think would benefit. Or whether they thought the patient would never wake up, not survive ICU stay, the patients’ goals could never be met, or that the burden of care grossly outweighed the potential benefit. It turned out that 11 percent of the patients were getting futile care.

I gather another 9 percent of patients were getting “probably futile” care, although you didn’t count those as part of the so-called “opportunity cost” — ICU care not provided to patients who could benefit.

It’s hard to know what “probably futile” means. Even the doctors had trouble defining it. But when we did our focus groups they said they wanted a “probably futile” category because they often categorize patients that way and then the patient goes one way or the other. Sometimes the patient gets worse and sometimes the patient, surprisingly, gets better.

You report that the ICUs were much more likely to have patients receiving futile care when they weren’t full. What is this telling you?

That doctors have the hard conversations more often and work harder at reducing the amount of inappropriate treatment when there’s a crunch on resources.

And when there’s slack in the system, futile care is more likely?

Yes. Part of the reason is that it takes a lot of time to get consensus to stop futile care. If you talk with doctors about providing futile treatment, they will say to you, “I can only fight so many battles in one day. To stop providing futile treatment to patient number 1 means I would spend less time on patients 2 through 10. So some patients continue to get futile care, but I’ll be providing better care to others.”

How could you tell if the doctors were right when they determined care of a patient was “futile”?

If we’d followed up these patients and found they went back to work or to school or could function in some way, it would really call into question these estimates of futility. But we didn’t find any of that. Two-thirds of the patients who received futile care died in the hospital. Eighty-five percent were dead within six months. The rest were in states that most patients, if they could talk with you, would say they wouldn’t want to be kept alive for. They were in a long-term care facility, severely demented, not able to recognize others, on a ventilator.

If a patient gets admitted to an ICU with the hope she might benefit and then deteriorates to the point of futility, how do you discontinue care?

Optimally, you have conversations with decision-makers to recognize what’s happening clinically and make the appropriate decision. You bring in social workers and try to make everyone understand. You provide support for those who are grieving. One tries as much as possible to have a coherent group decision to use treatment appropriately. It’s only when those fail that you get into these situations when doctors rate the care they’re providing as futile.

There’s a case here right now – someone is dying of liver disease, their kidneys have failed and the family is demanding dialysis, which will only prolong the dying process. The ICU staff doesn’t want to do it. The goal is to get consensus, to get understanding that dialysis will only provide a little extension of life. If there is no resolution, then we have a policy where you can override a family. There’s a lot of due process involved. We don’t override families without making absolutely sure that we’re doing it right.

How often does that process get invoked at UCLA?

Well, it comes close to getting invoked several times a week. But it actually gets invoked pretty rarely. I think we’ve only had two times this year. The goal is to never use that policy. First, it’s a whole lot of effort. And it takes a lot out of you. Tisha Wang, one of our ICU docs, went up against a family in order to stop providing treatment. She wrote a piece saying that the experience “took away a piece of my soul.”

Really, in the end, it’s the family that’s left and they have to be left intact and whole, feeling they did their best for their loved one. But you just can’t allow that at the expense of other patients.

What are you hoping will come out of this paper?

I’m hoping this will stimulate an open debate about whether we as Americans want our health care resources used in such a way that they sometimes don’t benefit patients while others are not receiving treatment that might help them.

This is a third-rail kind of issue. Some might say we dare not touch it. How do you confront that?

The only solution I can think of is to shed as much light on it as possible and allow the warts to show. Be very explicit about what we’re talking about – using a machine to keep someone alive who will never wake up or leave the ICU. And let the public decide if they believe that medicine should use resources toward that end, especially if there’s an opportunity cost to others. Maybe these conversations on futility are all wrong, that’s what medicine should be doing. Let’s discuss that out loud and not pretend we’re not using resources in this way.

Categories: Health Care

Report Tallies Funds Committed To Federal Insurance Exchange

Kaiser Health News - Tue, 08/26/2014 - 9:45am

The federal government has committed nearly $800 million to the project, according the Health and Human Services' inspector general. Also in the news, Washington state will have a special limited enrollment period for people who want to shop for coverage outside the marketplace as a result of continuing exchange problems. Meanwhile, Idaho is setting up its own marketplace.

Politico Pro: First IG Report Coming Tuesday On Federal Exchange Contracts
The HHS Inspector General’s Office will release a report Tuesday that CMS spent $500 million on the federal Obamacare exchange through February and committed nearly $800 million to the project. The total cost is in line with other recent estimates. Last month, the Government Accountability Office reported that CMS had obligated about $840 million to the exchange through March (Norman, 8/25).

Seattle Times: Health Exchange Problems Prompt Special Enrollment Period
Responding to ongoing problems at the Washington Healthplanfinder insurance exchange, state Insurance Commissioner Mike Kreidler on Monday instituted a limited special enrollment period for consumers who want to obtain coverage outside the exchange. From Aug. 27 to Nov. 14, those who have had problems with enrolling or making payments through Healthplanfinder can enroll in coverage outside the exchange either by selecting a different plan with the same carrier or by changing carriers. “This is a problem that has been around since the end of December,” Kreidler said in an interview (Marshall, 8/25).

McClatchy: Idaho Preps For Obamacare Re-Enrollment
As federal officials wrestle over whether HealthCare.gov will withstand the weight of millions of new customers and re-enrollees this fall, state brass with Your Health Idaho are looking to detach from the federal health insurance portal. But they’re going to need help from Idahoans. The state-run insurance marketplace has begun setting up state-based accounts through its own technology for the 76,000 residents who signed up for health care last year, said spokeswoman Jody Olson (Smith, 8/25).

Meanwhile, coverage continues about Oregon's lawsuit against Oracle, and The New York Times reports on Todd Park's expected departure as the White House's top technology adviser -   

Oregonian: Court Filings Show Oracle America Stymied Oregon DOJ Demand For Documents
The Oregon Department of Justice jousted for nearly two months with Oracle America over the state's demand for documents from the California software giant relating to the health exchange debacle. In fact, Oracle flouted state law and stymied the demand, according to DOJ. The state filed papers in federal court Friday that provide a glimpse into high-stakes jockeying that for months took place largely out of public view (Budnick 8/25).

Oregonian: Feds Back Down From Directive That Undermined Oregon Health Plan Reforms
The federal government says that executives of organizations serving the Oregon Health Plan should not overreact to a recent letter from the Centers for Medicare and Medicaid Services that demanded changes in how the state accounts for its payments to provider organizations under recent reforms. On Aug. 7, the federal agency that holds the purse strings for care of nearly 1 million low-income Oregon Health Plan members harshly criticized the state's system for distributing money to regional coordinated care organizations set up by state changes. The groups, which act like insurance plans, are known as CCOs. The Aug. 7 letter from CMS said the state is employing "high-risk practices" in setting its payment rates, and using projections that "differ greatly" from those used by the care organizations themselves (Budnick, 8/25).

The Washington Post: Oregon Files Suit Against Oracle, Developer Of Faulty Health Exchange
The Oregon Department of Justice on Friday filed suit against the developer of its catastrophically broken health-care exchange, accusing Oracle America Inc. of false statements, fraud and racketeering, among other misdeeds. In a 126-page filing, Oregon Attorney General Ellen Rosenblum (D) in a Marion County court, says Oracle fraudulently induced Oregon and its health-care exchange, Cover Oregon, into contracts worth hundreds of millions of dollars. In total, the state spent more than $240 million on Oracle; Cover Oregon, a disaster from the start, failed to sign up a single person for health-care coverage through its Web site (Wilson, 8/25).

The New York Times: Technology Adviser Expected To Leave White House Post
Todd Park, President Obama’s top technology adviser and an important figure in the emergency effort last year to fix the federal government’s online health care marketplace after a disastrous beginning, is leaving the White House, a person familiar with the matter said Monday (Joachim, 8/25).

Categories: Health Care

Who Is Exempt From Health Law's Mandate To Have Insurance?

Kaiser Health News - Tue, 08/26/2014 - 9:44am

The Miami Herald looks at the religious groups that pool their money to pay medical expenses and whose members are therefore exempt from the law's requirement to carry insurance. Other stories look at the "drafting error" that is the basis of a legal challenge to the law's subsidies and the administration's latest accommodation on the contraceptive mandate.

Miami Herald: Affordable Care Act Exemptions Mean Millions Don’t Have To Sign Up
Although as many as 30 million Americans will remain without health insurance by 2016, despite the best efforts of the ACA’s proponents, all but about seven million of them will be spared having to join the new system because of exemptions created by the act itself, according to an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation. The exempted religious organizations generally pool their members’ money to pay the medical expenses of anyone in the group who gets sick, injured or becomes pregnant. Also exempted from the law are members of federally recognized religious sects who have religious objections to insurance or to such systems as Social Security or Medicare (Madigan, 8/25).

Los Angeles Times: Could A Wording 'Glitch' Doom Obama's Healthcare Law?
In 2009, they had spent months piecing together a compromise that sought to create a national system of subsidized insurance -- but one run by the states. Now, they fear their work could be undone by what some call a "drafting error" and others portray as a political miscalculation. The judges from the U.S. Court of Appeals for the District of Columbia Circuit based their ruling on language saying that subsidies would be offered for health policies bought through an "exchange established by the state." That wording meant only marketplaces established by 14 states, including California, would qualify, the three-judge panel ruled; 5 million people in 36 states where consumers used the federal government's exchange should not get subsidies (Savage, 8/25).

Kaiser Health News: New Birth Control Rules Appear To Track Supreme Court Suggestion
Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month (Rovner, 8/25).

Kaiser Health News: FAQ: Administration’s New Contraception Rules Explained
The regulations unveiled Friday would allow religiously affiliated employers to notify the government -- rather than their insurer -- of their objections to the law’s coverage of birth control. The government will then notify the insurer to provide the contraception coverage. A second rule suggests the administration will allow the same mechanism for some businesses that object to contraception on religious grounds but seeks public comment on how to identify businesses to be included (Carey, 8/26).

Categories: Health Care

State Highlights: Minn. Vaccine Requirements; Sovaldi in Calif. Prisons; Ga. Rural ERs

Kaiser Health News - Tue, 08/26/2014 - 9:14am

A selection of health policy stories from Minnesota, California, Georgia, Kansas, Arkansas and Maryland.

Minneapolis Star-Tribune: New Minnesota Vaccine Requirement Inspires Pro-Vaccination Effort
For the first time in a decade, Minnesota schoolchildren are required to receive additional vaccines this fall. Seventh-graders now must get the meningococcal vaccination and an additional pertussis (whooping cough) booster. And younger children in day care and early-childhood programs must get hepatitis A and B shots. For most parents, complying is not a problem. Vaccination rates in Minnesota top 90 percent for almost all immunizations required by law, according to the state Department of Health. Less than 2 percent of the state’s more than 70,000 kindergartners enter school unvaccinated under Minnesota’s conscientious-objection exemption, the agency says (Prather, 8/25).

California Healthline: High-Priced Drug Makes Its Way Into California Prisons
While lawmakers in Congress and policymakers in Sacramento grapple with how to pay for -- and perhaps regulate the cost of -- high priced new drugs, an effective and expensive new treatment for hepatitis C continues to make inroads in California. California Correctional Health Care Services, which oversees clinical care and drug prescriptions for 125,000 inmates at 34 prisons, began using Sovaldi last month. Made by Gilead Sciences of Foster City, Sovaldi has become part of the "community standard" for medical professionals treating patients with hepatitis C, according to prison officials. The high cost of the drug -- $1,000 per pill, about $84,000 for a full course of treatment -- sparked a congressional investigation after objections from several corners of the health care industry (Lauer, 8/25).

Georgia Health News: Freestanding ERs Target Suburbs, Rural Panel Told
Freestanding emergency departments have been proposed in Georgia as a potential solution for struggling rural hospitals, or newly closed ones, that want to remain operational in downsized form to help patients in need. But the trend toward such standalone emergency rooms nationally is totally different from that picture, members of the Georgia Rural Hospital Stabilization Committee were told Monday. Freestanding EDs are actually proliferating in suburban areas, targeting high-income patients who have private insurance, said Charles Horne of accounting firm Draffin & Tucker. The prevailing emphasis is on patient convenience, not need, he told committee members at a meeting in Cordele (Miller, 8/25).

Kansas Health Institute News Service: Overuse Of Antipsychotic Drugs In Some Kansas Nursing Homes Endangering Patients
Experts say powerful antipsychotic drugs -- sometimes given in combination -- are used too much and often inappropriately as “chemical restraints” or sedatives to control the behavior of Kansas nursing home residents suffering from Alzheimer’s or other dementias, and that efforts to curb the practice so far are showing weak results compared with other states (Shields, 8/25).

Modern Healthcare: Another Rural Hospital Succumbs To Mounting Financial Pressures
Rural hospitals are about to lose another comrade. Crittenden Regional Hospital, a 142-bed facility in West Memphis, Ark., said Monday that it has stopped admitting patients and will permanently shut down by Sept. 7. The hospital has been facing a host of financial and operational challenges. It lost almost $3 million on $55 million in revenue in 2012, according to Crittenden Regional's latest Form 990. That came one year after the hospital lost $1.3 million on $57 million in revenue. Reimbursement cuts and sharp declines in patient volumes led to those troubles. Also, hospital officials said outgoing physicians and two fires negatively affected its outlook. Most recently, a fire kept the hospital closed for more than six weeks (Herman, 8/25).

Baltimore Sun: Agency Strips Shuttered Health Clinic Group Of Funding
Nearly two months after People's Community Health Centers shut the doors to five low-income health clinics in Baltimore city and Anne Arundel County, a federal agency confirmed it is no longer providing critical grant money to the nonprofit group. People's had received $2.4 million a year from the Health Services Resources Administration to treat uninsured patients -- its largest source of revenue. That loss comes as the organization faces a new federal tax lien nearly that doubled the amount it owes the Internal Revenue Service and mounting claims from employees seeking backpay (Wood, 8/25).

Categories: Health Care

Vermont GOP Candidates For Governor Blast State's Move Toward Single Payer System

Kaiser Health News - Tue, 08/26/2014 - 9:11am

The criticism of Gov. Peter Shumlin's push for a publicly funded health care system came during a debate on the eve of the primary. Also, in Virginia, Republican Senate candidate Ed Gillespie unveils a tax plan that would repeal taxes in the health law.

The Associated Press: Health Care Focus As Vermont Governor Candidates Debate
Three Republicans and one Libertarian vying for the GOP gubernatorial nomination ... faced each other in a primary-eve debate Monday with the main fireworks coming over health policy. All four voiced disagreement with incumbent Democrat Gov. Peter Shumlin's push for a universal, publicly funded health care system, though GOP businessman Scott Milne was more muted in his criticism than the others. The debate, during a class led by Johnson State College Professor William Doyle -- a state senator and political historian -- included strong criticism of the universal health plan from Republican Steve Berry of Wolcott and from Dan Feliciano, a Libertarian who is seeking enough write-in votes in Tuesday's primary to garner the Republican nomination. (Gram, 8/26).

Richmond Times-Dispatch: Gillespie Introduces Tax Reform Plan
Republican U.S. Senate candidate Ed Gillespie on Monday introduced his tax reform plan, pushing to lower the corporate tax rate to 25 percent, do away with sales taxes on health insurance under the Affordable Care Act and replace the Earned Income Tax Credit with one that encourages people to stay employed (Schmidt, 8/25).

Categories: Health Care

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