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Good News and Gloom for Medicare, Wrapped in a Mystery

Medicare -- New York Times - Tue, 07/29/2014 - 12:00am
Health care experts can’t explain the encouraging spending slowdown, but the long-term outlook remains bleak.
Categories: Elder, Medicare

Outlook for Medicare Trust Fund Improves, Though Shortfall Looms, Report Finds

Medicare -- New York Times - Tue, 07/29/2014 - 12:00am
Spending on hospital care was lower than expected, but trustees say Medicare and Social Security funds need shoring up.
Categories: Elder, Medicare

When Hand, Foot And Mouth Disease Sweeps Through: What To Know

CommonHealth (WBUR) - Mon, 07/28/2014 - 6:33pm

Veronica Thomas
CommonHealth Intern

Summer is not only the season for watermelon and zucchini. It’s also the time for Hand, Foot, and Mouth Disease. Typically found in younger kids, it’s a contagious viral illness marked by a fever and rash—either skin or mouth blisters.

Hand, Foot, and Mouth swept through several WBUR employees’ families recently, so we checked in with an expert: Dr. Clement Bottino, a pediatrician at Boston Children’s Hospital in the Division of General Pediatrics who sees a lot of the illness in the Primary Care Center. “Nothing unusual,” he says, “just the summertime viruses.”

“Viruses are kind of like vegetables,” he explains. “There are winter and summer varieties. The winter ones cause illnesses like the common cold, while those in the summer cause fever-plus-rash type illnesses, like Hand, Foot, and Mouth.”

Hand, Foot, and Mouth typically affects children under the age of 5, but older children and even adults can catch it as well. Symptoms can vary – some children may only have a fever and mouth blisters, while others have the characteristic rash without other symptoms. The rash may present with classic red bumps on a child’s hands and feet, or a more diffuse rash that includes the diaper area.

Some people — particularly adults — may show no symptoms at all, but they can still spread the illness to others. Hand, Foot, and Mouth is transmitted through direct contact with saliva, mucus, or feces. Daycare is notorious as a hotbed of activities for spreading infection: hugging, sharing cups, coughing and sneezing, and touching infected objects. While patients are most contagious during their first week of illness, they can spread the virus for weeks after the symptoms fade.

According to Dr. Bottino, the most important thing for parents to know is that the virus is mild and “self-limited,” meaning it usually goes away on its own, causing no scars or lasting problems. Most patients feel better in 7 to 10 days without any treatment at all. I asked Dr. Bottino what else parents should know about Hand, Foot, and Mouth Disease. Our conversation, edited:

The CDC outlines the basic steps to prevent the spread of Hand, Foot, and Mouth. What else can parents do to protect their children?

Since these viruses enter and exit our bodies through our digestive system, I recommend optimizing a child’s “gut health” to maximize their defense. This means eating plenty of leafy green vegetables—organic and locally farmed if possible—which help support the gut’s innate immune system. Spending time outdoors in the sun helps boost vitamin D levels, which we have learned are also crucial for a healthy immune system. Vitamin D, along with vitamins A, E, and K, are fat soluble, meaning they are best assimilated in the presence of healthy fats. I recommend whole and full-fat meat and dairy foods – grass fed and locally farmed if possible – for their omega-3s and other healthy fat content. Finally, and perhaps most important, is to eat foods containing probiotics – “good bacteria” – that help support healthy digestion and a healthy immune system. Fermented foods, like yogurt and sauerkraut, are excellent sources of probiotics that are relatively inexpensive and easy to make at home.

What about hand sanitizer and anti-bacterial hand soaps?

I talk to many parents who feel quite anxious about sanitizing everything and washing their kids’ hands with antibacterial soaps. I recommend hand washing, but not with heavy-duty or anti-bacterial cleansers containing harsh chemicals. These products may actually kill the good bacteria naturally living on our skin and create opportunities for more virulent strains to take their place.

We know there’s no treatment for Hand Foot and Mouth Disease. But should parents give their kids any medication for the pain or fever?

If the child is uncomfortable with fever or is very fussy, then an over-the-counter fever reducer or pain reliever like acetaminophen or ibuprofen, can be helpful. But if the child is acting well and drinking fluids, then parents shouldn’t feel obliged to give any medicines. I tell parents that all medicines carry the possibility of adverse, or negative, effects. Fortunately, with Hand, Foot, and Mouth, kids are almost always playful and running around. In short, if it doesn’t look like a child needs medication, then they most likely don’t.

Complications of Hand Foot and Mouth Disease are extremely rare. When should parents start worrying that something else might be wrong?

Like the common cold, most cases of Hand, Foot, and Mouth, will resolve within a week. Some may last a little longer. On day 1-2 there is usually a fever. Often the temperature is so mild that parents aren’t even aware of it. As the fever resolves, the skin and/or mouth symptoms emerge. Usually it’s the rash and mouth blisters that bring parents to the pediatrician. These tend to resolve over the next 5 days or so. The rash and blisters may change in appearance or migrate – this is all normal. The main thing I counsel parents is to monitor their child’s intake of fluids. Oftentimes, if the blisters in the mouth are painful, then intake of fluids may decrease. Giving cold liquids, slush, or frozen liquids can be helpful. Medications like acetaminophen or ibuprofen can help take the edge off if the child is very uncomfortable. A good way to measure fluid intake is urine output — no wet diapers in 6-12 hours is a good reason to call the pediatrician.

Parents are often worried by the height of their child’s fever. Seeing a temp of 103 can be scary. However, it’s not the height of the fever but rather the duration that is most concerning. Viral infections can routinely cause fevers of 104 degrees. We become more concerned if fevers have been persisting for more than five days in a row. Most viruses “burn themselves out” after five days. Once a fever (which we define as 38 degrees celsius, or 100.4 degrees farenheit or higher) has been persistent – meaning it hasn’t come down – but has stayed elevated for more than five days, we start to consider other sources for the fever. These include bacterial infections that may be “hiding” in a child’s body, such as a urinary tract infection or pneumonia. Fever for more than five days is certainly a reason to call the pediatrician.

Categories: Health Care

Statement of Paul Van de Water, Senior Fellow, on the 2014 Medicare Trustees' Report

Center on Budget and Policy Priorities - Mon, 07/28/2014 - 3:57pm
Medicare has grown somewhat stronger financially in both the short and long term since last year but continues to face long-term financing challenges, today’s report from its trustees shows. The projected date of insolvency for Medicare’s Hospital Insurance (HI) trust fund is 2030 — four years later than projected last year. Health reform, along with other factors, has significantly improved Medicare’s financial outlook, boosting revenues and making …
Categories: Benefits, Poverty

Statement of Robert Greenstein, President, on the 2014 Social Security Trustees' Report

Center on Budget and Policy Priorities - Mon, 07/28/2014 - 3:56pm
Social Security can pay full benefits for close to two decades, the new trustees’ report shows, but will then face a significant, though manageable, funding shortfall that the President and Congress should address in the near future. Specifically, the trustees estimate that Social Security can pay full benefits until 2033, at which point its combined trust funds will be exhausted. After 2033, even if policymakers failed to act, Social Security would pay about 75 percent of …
Categories: Benefits, Poverty

Good News For Boomers: Medicare’s Hospital Trust Fund Appears Flush Until 2030

Kaiser Health News - Mon, 07/28/2014 - 2:53pm

Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act.

Unlike Medicare, however, the part of Social Security that pays for people getting disability benefits is in far more immediate danger. The Disability Insurance Trust Fund is projected to run out of money in 2016, just two years from now, unless Congress intervenes, the trustees said.

On Medicare, the news was mostly positive. “Medicare is considerably stronger than it was just four years ago,” said Health and Human Services Secretary Sylvia Burwell. She noted that the recent slow growth of the program’s spending will likely mean that the Medicare Part B premium charged to beneficiaries – currently $104.90 per month – will remain the same for the third year in a row. “That’s a growth rate of zero percent,” she noted.

All the trustees, however, including the secretaries of HHS, Treasury, and Labor and two public members, stressed that Medicare’s financial problems are far from fixed, particularly as 78 million baby boomers are on the precipice of joining.

“Notwithstanding recent favorable developments, both the projected baseline and current law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation,” the report said.

And “the sooner lawmakers face that reality, the better,” said Public Trustee Robert Reischauer, a longstanding Medicare expert and former head of the Congressional Budget Office.

A major change from previous years is that for the first time the Medicare report deviates from current law and does not assume that scheduled deep cuts to physicians who treat Medicare patients will occur. Congress has suspended the cuts each year since 2003, and the trustees assume that will continue until Congress fixes the formula, known as the sustainable growth rate, or SGR.

 The change “should make the Part B cost projections more useful than they have been in the past,” said Reischauer. Part B is the part of Medicare that pays for most physician and outpatient costs. Part B does not technically have a trust fund, because it is financed by a combination of general tax revenues and beneficiary premiums, but the trustees make projections for its spending each year.

The trustees opted not to wade into the ongoing debate over the extent to which Medicare’s spending slowdown can be attributed to changes to the program made in the 2010 health law.

“No one knows and certainly there is an active debate,” said Charles Blahous, the other public trustee and lone Republican on the panel. “And that’s not something the trustees are going to settle,” said Blahous, a fellow at the conservative Hoover Institution.

But whatever the reason, no one contests the slowdown has been dramatic. Medicare, which covered an estimated 52.3 million people in 2013, spent $582.9 billion, “and, for the second year in a row, per beneficiary costs were essentially unchanged,” the report said.

The financial picture for Social Security’s disability insurance fund, by contrast, is much more dire.

“The projected reserves of the DI Trust Fund decline steadily from 62 percent of annual cost at the beginning of 2014 until the trust fund reserves are depleted in the fourth quarter of 2016,” the Social Security report said. After that, the program would be able to pay only 81 percent of scheduled benefits.

The disability program has seen a dramatic increase in enrollment in recent years, yet Congress has not taken any action to change its financing, which currently is 1.8 percentage points of the overall 12.4 percent Social Security payroll tax paid by employers and workers.

Categories: Health Care

Trustees: Medicare Now Projected To Remain Solvent Until 2030

Kaiser Health News - Mon, 07/28/2014 - 2:14pm

The new projections give Medicare an additional four years of solvency compared to last year's report by the trustees for Medicare and Social Security.

The full trustees' report is available online.

Washington Post: Medicare Finances Improve Partly Due To ACA, Hospital Expenses, Trustee Report Says
Medicare’s financial health is improving, according to a new official forecast that says that the program will remain solvent until 2030 — four years later than anticipated a year ago — because of the Affordable Care Act and lower-than-expected spending on hospital stays (Goldstein, 7/28).

New York Times: Outlook for Medicare Trust Fund Improves, Though Shortfall Looms, Report Finds
The financial condition of Medicare has benefited from a remarkable slowdown in national health spending, attributed in part to the Affordable Care Act, which curbed Medicare payments to many health care providers and encouraged them to find more efficient ways of delivering care. Slow growth of wages and prices, following the recession of 2007-9, has also been cited by the trustees as a factor restraining the growth of Medicare (Pear, 7/28).

Wall Street Journal: Medicare, Social Security Disability Fund Headed in Different Directions
A few years ago, the trustees projected Medicare's primary trust fund would exhaust all of its reserves by 2016. Once the trust fund runs out of reserves, the government can only pay benefits based on the amount of money it receives, largely from tax revenue, which would represent a cut from current levels. The trustees said Medicare would only be able to pay 85% of benefits after the trust fund is exhausted in 2030, a level that would fall over time (Paletta, 7/28).

Reuters: Slower U.S. Healthcare Cost Rise Extending Life Of Medicare Fund: Trustees
At a news conference, the trustees called for congressional action to address both Medicare and Social Security. "Both of these vitally important programs are fiscally unsustainable over the long run and will require legislative intervention to correct," said trustee Robert Reischauer. "The sooner the policymakers address these challenges, the less disruptive the unavoidable adjustments will be ... The sooner the lawmakers act, the broader will be the array of policy options that they can consider" (Lange and Morgan, 7/28).

CNN Money: Medicare's Outlook Improves As Health Spending Slows
On Medicare, the trustees now project that the trust fund for Part A, which covers hospital costs for seniors, will run dry by 2030. Thereafter, it would only be able to pay out 85% of projected benefits -- a figure that would fall to 75% by 2050. That's an improvement of four years over last year's projection. What's more, if Congress wanted to raise taxes to close the 75-year shortfall, the increase needed would be a little less painful than the trustees estimated a year ago: They now say the 2.9% Medicare payroll tax would have to go to 3.77% (Sahadi, 7/28).

The Hill: Medicare, Social Security Head Toward Insolvency, At Slower Rate
But the trustees for both Medicare and Social Security also continue to paint a dire long-term picture for programs that will come under more strain, when it faces a flood of retirees in the coming years.
"The Trustees Reports underscore the importance of making reforms to Social Security and Medicare," Treasury Secretary Jack Lew said. "As the largest generation in American history enters retirement, the pressure on our social insurance programs is growing, and we must make manageable changes now, so we do not have to make drastic changes later" (Becker, 7/28).

Vox: The Big Health Wonk News In Today's Medicare Report
But there's a nugget buried in the report that will be especially interesting to the health wonk crowd: it seems that, for the first time ever, Medicare is assuming that Congress passes a doc-fix. ... In previous Medicare Trustees' reports, the authors would never assume that they would pass this fix — they would only operate on the baseline of what law is standing right now (that would be the law that funds doctors at a lower rate). After 12 years of watching doc-fixes pass and pass again, the group has changed its stance (Kliff, 7/28).

Categories: Health Care

Police K9 Siren

Massachsuetts Trial Court Law Library - Mon, 07/28/2014 - 1:56pm
It might be considered widely known that provisions under the law for the protection and safety of our beloved pets and domesticated animals  have been in place for some time.
Violation of MGL Ch. 272 §77 'Cruelty to Animals'  is punishable both by imprisonment and/or a fine of not more than $2,500.
Perhaps a little less known is that an additional layer of legal protection is afforded police horses and K9 officers.  Violation of MCL Ch. 272 §77A 'Willfully Injuring Police Dogs and Horses' is also punishable by a fine and/or imprisonment.
In addition to risking their lives while protecting our cities and towns, these animals often
become targets for retaliation as noted by WCVB's  Reward Offered in Poisoned K9's Death.
Siren, a 5 year old Westport Police K9, had to be put down after ingesting rat poison which his handler believes was planted in his yard for retaliation for his own years as a police officer.  The Westport Police Department is seeking help from anyone who has information that might lead to a suspect. Siren's partner is offering a $1,000 reward for information that helps track down the person behind the alleged poisoning.

Categories: Research & Litigation

Project Louise: Exercise Every Single Day? Says Who?

CommonHealth (WBUR) - Mon, 07/28/2014 - 11:32am

(Bjørn Giesenbauer via Compfight)

This is getting interesting. One week into the challenge laid down by Editor Carey and Coach Allison — to exercise every single day before 7 p.m., and to post a comment reporting that I did so before 11 p.m. — I have made several discoveries.

  1. Carey was right. Exercising every day makes you feel better.
  2. The sweatier the exercise is, the better you feel.
  3. I hate being told what to do.

Let’s focus for now on No. 3, because we all know that Nos. 1 and 2 are true. Right? We do know that, yes? We just don’t do it because … well, because of No. 3.

At least that’s what I’m concluding about myself. Even though I signed up for Project Louise of my own free will, and even though I did it because I really, truly want to change my habits for good and live a longer and healthier life, and even though I know that Carey Goldberg, Allison Rimm and all the other wonderful people who are helping me on this journey are truly here to help, not to push me around, a huge part of my brain reacts to all this support and encouragement and expert advice with a simple, all-too-familiar refrain:

You’re not the boss of me.

Yes, this is the week when I’ve been getting in touch with my inner child. Or, more precisely, my inner brat.

As soon as I wrote that, I realized that I have heard that phrase before — from a wonderful woman named Pam Young, who has written a lot about this idea that we all have an inner “brat” whom we need to learn to love. Because it’s that little bratty voice that keeps us from doing all the good, mature, responsible things we all know we should do. And as long as you keep fighting the brat, you’re going to lose — as any mother of a 2-year-old can tell you.

Likewise, as that same mother can tell you, the secret to success is to persuade the 2-year-old that what you’re telling her to do is actually fun — to make her want to do it, and even to make her think that it’s her own idea.

You don’t argue about why she has to put on her shoes; you ask her whether she wants to wear the pink ones or the sparkly silver ones. You don’t make her clean her plate; you put a lot of delicious, healthy food in front of her and let her choose what she wants.

And you don’t make her exercise every day. You tell her she gets to choose whether she wants to go for a nice long walk with the dog or ride her bike. Or maybe she’d like to go swimming instead? Or maybe, if she doesn’t get around to any of that, you’ll let her watch TV while she walks on the treadmill.

Or, as Pam’s website puts it, “Make it fun and it will get done.”

So, what do you know: This week I’ve gone swimming, and I’ve walked the dog, and I’ve watched some really silly TV on the treadmill. And it all got fairly simple, once I realized what I really wanted to post each time, and what I’ll be saying from now on:

I’m doing it because I want to, and not because you told me to.

It may not be the most mature response I’ve ever had. But as long as it’s working, I don’t really care.

Readers, what keeps you from exercising or practicing other healthy habits? Do you have any tricks for keeping your inner brat at bay?

Categories: Health Care

July 28, 1914 – State of War with Serbia Declared

In Custodia Legis - Mon, 07/28/2014 - 10:04am

This is a guest post by Jim Martin, senior legal information analyst at the Law Library of Congress.  Jim has written some of our most popular posts over the years including The Articles of Confederation

On June 28, 1914, Archduke Franz Ferdinand, the Hapsburg presumptive heir to the throne of the Austro-Hungarian Empire, and his wife Sophie, Duchess of Hohenberg, were assassinated in the city of Sarajevo by Gavrilo Princip, a member of a Serbian backed secret para-military organization.  This event followed several years of tensions between the governments of Austria-Hungary and Serbia after the former’s annexation of Bosnia-Herzegovina in 1908.

As a result of the shootings the government of Austria-Hungary communicated a list of demands to the government of Serbia.  The Serbian government agreed to comply wholly, or in part, with most of the ultimatum, but, after obtaining guarantees from the Russian government that it would receive support against Austria-Hungary, it rejected the last demand that would have resulted in a major infringement of its sovereignty.    The government in Vienna broke diplomatic relations and announced a mobilization of the army against Serbia.  On July 28, 1914, after a report of an unverified incident involving Hapsburg and Serbian troops, the government of Austria-Hungary declared war on Serbia.

This image is taken from a July 28, 1914, extra edition of the Wiener Zeitung, the official newspaper of the Austrian government, announcing that a state of war exists with Serbia.  It is printed in both German and French.  A similar announcement was published on August 6, 1914, the day that war was declared on Russia.  The Wiener Zeitung is one of the oldest official newspapers published.

Image by Jim Martin

Princip was tried by Haspburg authorities for his role in the assassinations.  He was convicted of the crimes, but due to his age at the time of their commission he escaped the death penalty and was instead sentenced to 20 years imprisonment.  He died in prison in 1918 of complications from tuberculosis.

World War I was fought on three continents and across the world’s major oceans.  Four empires ended as a result of the war:  the German; Austro-Hungarian; Russian; and Ottoman. Approximately 8.5 million combatants died during the course of World War I.

Selected bibliography:

Williamson, Samuel R., Jr., Austria-Hungary and the origins of the First World War (1991).

Herwig, Holger H., The First World War: Germany and Austria-Hungary, 1914-1918 (1997).

Owings, W.A. Dolph,  Trans. & Ed. Elizabeth Pribic and Nikola Pribic, The Sarajevo Trial (1984).

Categories: Research & Litigation

Plan Renewals, Narrow Networks Draw Scrutiny

Kaiser Health News - Mon, 07/28/2014 - 9:54am

Some industry officials say the automatic renewal of some health law insurance plans could have a negative impact on the financial aid that consumers receive. Meanwhile, narrow networks continue to be the subject of backlash.   

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

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

Des Moines Register: Few Take Chance To Gripe About Health Insurance
Public hearings over proposed premium increases by three health insurers drew a grand total of two Iowans who wanted to take the microphone to gripe Saturday morning. "I figured there'd be more people. Evidently, people don't care about this," said Ed Tiernan of Des Moines, one of the two consumers who bothered to speak. In past years, dozens of Iowans took the chance to complain publicly about large rate increases proposed by the state's dominant health insurer, Wellmark Blue Cross & Blue Shield. But that was not the case Saturday morning, when state Insurance Commissioner Nick Gerhart presided over hearings centering on proposed premium increases from Coventry Health Care, CoOportunity Health and Assurant Health. About 24,000 Iowans would be affected by the three companies' rate increases. Most of them are covered by Coventry or CoOportunity, which are the main Iowa carriers selling policies on the new electronic marketplace set up under the Affordable Care Act (Leys, 7/26). 

Denver Post: Coloradans Could Lose Medical Choices, But Save Money
Consumers might not like the trend among insurance carriers to control costs and reduce premiums by narrowing their choices of doctors and hospitals, but it's one of the few tools that payers have left. Under the Affordable Care Act, insurers can't cut costs by discriminating against people with pre-existing conditions. They can't offer spare coverage because health care reform mandates minimum essential elements. Instead, insurers or payers are turning to narrow or "high value" networks to reduce escalating health care costs. The narrow network gives insurers greater leverage in negotiating prices with providers. ... United Healthcare, the largest Medicare provider in the country, said it is reducing its Medicare physician network in the Denver market — letters went out last week telling customers they might need to select a new physician (Draper, 7/27). 

Categories: Health Care

States Explore Strategies To Protect Exchanges, Subsidies From Court Decisions

Kaiser Health News - Mon, 07/28/2014 - 9:20am

News outlets report that states are working hard to demonstrate that they are now or will soon be operating their own online insurance marketplaces. Meanwhile, states are pushing for more time and support from the federal government for exchange planning and construction.  

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

Modern Healthcare: States Will Face Pressure To Keep Subsidies Jeopardized By Ruling
The ramifications of this week's federal appellate court ruling in Halbig v. Burwell—assuming the decision is upheld by the U.S. Supreme Court—could be immense. If individuals in states that haven't established their own exchanges can't access subsidies, more than 7 million people would lose access to $36 billion in healthcare subsidies, according to a study by the Urban Institute. That has the potential to fatally undermine the fledgling exchanges and the entire Patient Protection and Affordable Care Act. (Demko, 7/25).

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

And, from New Mexico -

The Associated Press: New Mexico to Continue With Federally Operated Health Insurance Exchange
New Mexico decided Friday to stick with a federal online system for another year to enroll individuals in health insurance plans. The state's health insurance exchange governing board voted 11-1 to continue using the federal computer system for determining eligibility and to enroll individuals starting in November when the next open enrollment begins (7/25).

Categories: Health Care

Vets' Health Care Deal Said To Touch On 'Short-Term And Long-Term Needs' Of The VA

Kaiser Health News - Mon, 07/28/2014 - 9:19am

Negotiators on Sunday reported reaching an agreement, which is expected to authorize billions of dollars in emergency spending to bring more physicians, nurses and clinic sites to the Veterans Affairs system. The deal is to be unveiled today. Lawmakers have only about five working days before the August break to finalize the agreement.  

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

The Associated Press: After 6 Weeks, Finally A Deal On VA Health Care
The chairmen of the House and Senate Veterans Affairs committees have scheduled a news conference Monday afternoon to unveil a plan expected to authorize billions in emergency spending to lease 27 new clinics, hire more doctors and nurses and make it easier for veterans who can't get prompt appointments with VA doctors to obtain outside care (Daly, 7/28).

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

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

The New York Times: Lawmakers Reach Deal On A Fix for V.A.’s Health Care System
Talks on the legislation had grown acrimonious last week, particularly over the amount of spending that would be required, but lawmakers were also under enormous pressure to reach a deal before Congress begins a monthlong recess later this week. Officials on Sunday did not outline specific details of the agreement, or the cost, which is expected to be in the tens of billions of dollars (Oppel Jr., 7/27).

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

The Wall Street Journal: Congress Reaches Deal To Help Fix VA
One primary disagreement stemmed from the aspect of the bills that would provide an injection of funding to the VA to make other immediate fixes at the department, including expanding allowances for veterans to receive care from non-VA doctors. Mr. Miller said last Thursday he was willing to provide $10 billion, while Mr. Sanders said he wanted the bill to authorize as much as $25 billion. Funding became an even more central topic to the negotiations when Sloan Gibson, the acting VA secretary said last Wednesday at a House hearing the department needs $17.6 billion over the next three years to address issues like hiring more doctors and nurses (Kesling, 7/27).

Bloomberg: Veteran Hospital Aid Deal Said To Be Reached By Lawmakers
Sanders on July 24 accused Republicans of being "not serious about negotiations," while Miller said Sanders had "moved the goal posts." The VA has a $160 billion budget and runs the nation’s largest integrated health-care system. An internal audit in June showed that more than 120,000 veterans hadn’t received a medical appointment or were waiting more than 90 days for care. That number was cut to about 42,400 by July 1, VA data show (Wallbank and Bender, 7/28). 

The VA deal is only one of the challenges facing Congress before its five-week recess:

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

Categories: Health Care

Medicare Turns Up Heat On Fraud Investigations

Kaiser Health News - Mon, 07/28/2014 - 9:17am

One U.S. attorney in South Dakota says such cases will be one of the fastest-growing areas of criminal investigations, while some providers are crying foul.

Philadelphia Inquirer: Costs Of Expanded Audits Aimed At Medicare Fraud Hit Health Care Firms
In a bid to cut Medicare spending and help pay for health-care changes, the Obama administration has significantly expanded audits designed to recover improper payments from health care providers. "We are taking, I would say, a brutal spanking, those that are fully compliant and within regulation," said Tim Fox, founder and chief executive of Fox Rehabilitation, a Cherry Hill company that provides physical therapy and other services to the elderly. The government has to "recoup those dollars from somewhere, so what they're going to do is fight and recoup dollars in fraud and abuse," said Fox, whose firm employs 905, including 709 clinicians who visit patients in their homes in eight states. The experience at Fox Rehab, founded in 1998, is just one example of how the Affordable Care Act is roiling the industry, forcing providers to find new ways to do things with less (Brubaker, 7/27). 

The Associated Press: U.S. Attorneys Turn Up Heat on Health Care Fraud
The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight health care fraud. U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote "significant time" to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing "complex and egregious" cases (7/27).

Categories: Health Care

New Wave Of Patients Boosting Hospital Earnings

Kaiser Health News - Mon, 07/28/2014 - 9:14am

Earnings reports offered last week by two hospital operators offer evidence that the health law's coverage expansion is leading more patients to seek treatment.

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

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

Categories: Health Care

Ga. Working Through Medicaid Application Backlog After Federal Scrutiny

Kaiser Health News - Mon, 07/28/2014 - 9:14am

In the meantime, some in Alabama say no Medicaid expansion there is hurting economic development in rural parts of the state.

Georgia Health News: State Says It’s Hard At Work On Medicaid Backlog
A state health agency says it’s working though the application backlog for Medicaid that recently provoked federal scrutiny. The Department of Community Health has made decisions on eligibility for up to 70 percent of the 88,854 “account transfers” from Georgia’s insurance exchange, the agency said Friday. The backlog in Georgia is linked to the thousands of people expected to join Medicaid and PeachCare this year as a result of the Affordable Care Act (Miller, 7/25). 

AL.com: Lack Of Medicaid Expansion Hampers Economic Development In Rural Alabama, Official Said
Alabama's unwillingness to expand Medicaid is adding to the economic distress of the state's rural communities and further impeding their economic development efforts, officials said today. Danne Howard, senior vice president of government relations and emergency preparedness for the Alabama Hospital Association, was the lead speaker of a rural economic development session to kick off the Economic Development Association of Alabama's summer 2014 conference. She said a dozen rural hospitals have closed across the state and more than a dozen more could be lost over the next two years (Tomberlin, 7/27).

Categories: Health Care

Hardship Exemptions Allow Some To Continue To Buy Coverage On Health Law's Marketplaces

Kaiser Health News - Mon, 07/28/2014 - 9:14am

Elsewhere, the San Jose Mercury News examines who can opt out of the health law's mandate to have insurance on religious grounds.

Philadelphia Inquirer: Medical-legal Alliances Help Low-income Patients
It took Sheena Sheard two hours on two buses, towing two children and a three-wheeled stroller, to get to St. Christopher's Hospital for Children. It would have been three buses but the trio legged out the final stretch to ensure Sheard could see her lawyer. That's right, her lawyer. Sheard was going to see Eileen Carroll at St. Christopher's to determine whether she qualified for a hardship exemption that would allow her to buy health insurance on the now-closed Affordable Care Act marketplace (Calandra, 7/27). 

The San Jose Mercury News: Obamacare: 'Health Care Sharing Ministries' Increase Membership In Wake Of New Law
Go to church, be faithful to your spouse and shun tobacco, booze and drugs. Promising to adhere to that "biblical lifestyle," more than 300,000 Americans are taking advantage of a little-known provision in the nation's health care law that allows them to avoid the new penalties for not having health insurance. Long before Christian groups and Obamacare opponents cheered last month's Supreme Court ruling that allows many private businesses to stop offering certain types of birth control they find immoral, the 4-year-old law gave its blessing to Americans to opt out of the insurance mandate if they object on religious grounds (Seipel, 7/26).

Categories: Health Care

Health Law Playing Key Role In Virginia Politics

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

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

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

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

Categories: Health Care

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

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

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

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

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

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

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

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

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

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

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

Categories: Health Care

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