Kaiser Health News - Uninsured

Viewpoints: Real 'Doc Fix,' Saint Santorum And Why Supreme Court TV Is 'A Bad Idea'

Wed, 22 Feb 2012 14:52:43 GMT

The New York Times: A Real 'Doc Fix'
In last week's flurry of budget deals, Congress patched together yet another temporary fix for a flawed formula used to calculate the fees paid to doctors by Medicare. It will hold payments flat for the next 10 months instead of cutting them by 27 percent as the formula required, and the $18 billion to pay for it will be taken from other health care programs. But the fix only lasts until the end of the year. On Jan. 1, doctors will face another big cut unless Congress again steps in (2/21).

The New York Times: Contraception, Against Conscience
EWTN cannot comply with the recent mandate from the Department of Health and Human Services requiring the insurance plans of all employers, with the exception of some houses of worship, to cover the contraceptives and sterilization procedures approved by the Food and Drug Administration. These include emergency contraceptives like Plan B and Ella that can destroy human embryos — an act that we consider a violation of church teaching that all life is a sacred gift that begins at conception (Michael P. Warsaw, 2/21).

McClatchy: Obama Boosted By GOP Birth-Control Stance
I've been puzzled for weeks by all the talk about how Obama has supposedly blown it with Catholic voters after requiring that many Catholic institutions offer free birth control in their employee insurance plans. Church leaders are naturally upset, but they don't speak for most Catholics on the issue of contraception. And Republicans, eager to gin up anything against Obama now that the economy is improving, are naturally cranking up the hyperbole about a supposed "war on religion," but they too seem blind to how most Catholic women conduct their private lives (Dick Polman, 2/21).

The Washington Post: The Trials Of Saint Santorum
You've likely heard by now that the presidential election may pivot on the unlikely "controversy" of birth control. This is the latest trope to evolve from a campaign that is already two years too long. A conspiracy-minded person might imagine that this faux battle over reproductive rights was designed to distract from other more pressing concerns and to demonize — or would that be angelize? — Republicans who, we’re also told, want to turn back the clock to the 1950s (Kathleen Parker, 2/21).

WBUR's CommonHealth blog: Religious Exemption For Contraception Is Bad Medicine
The message from Washington politicians that contraception access has nothing to do with medicine is news to the 99 percent of women in the U.S. who are or have been sexually active. ... It is news to the women who use contraceptives to manage menstrual complications, avoid unintended pregnancy, and ensure the social and economic stability of their families. ... It is bad news for the 1.5 million women nationwide who use contraceptives only as treatment for serious medical conditions (Dr. Paula A. Johnson, 2/21).

Los Angeles Times: Health Care Reform's Missing Link – Nurse Practitioners
Within the next two years, if federal health care reforms proceed as expected, roughly 30 million of the estimated 50 million uninsured people in the United States — 6.9 million in California — will be trying to find new health care providers (Patricia Dennehy, 2/22).

USA Today: Televise Supreme Court's Health Care Case? Bad Idea
Not since Bush v. Gore has a U.S. Supreme Court case roused as much public interest as next month's highly anticipated review of the 2010 health care law. It would make a spectacular TV show and lift the curtain on the workings of the nation's highest court. But cameras in the high court are a bad idea (Peter Funt, 2/21).

Des Moines Register: Rhode Island Health Plan Reform Good Model For Iowa
Health insurance is expensive because medical care is expensive. Medical care is expensive because the prices we pay are too high and the numbers of services are too numerous. We will never fully recover if higher insurance premiums and fewer benefits remain the new normal. And, more affordable rates will not occur until we change the way our medical care is organized and delivered. This is the reason Democrats are introducing a proposed Iowa Health Insurance Affordability Reform (Iowa HIAR) program. It is modeled after Rhode Island’s successful reform, which is considered one of the most innovative methods developed to tackle the high costs of health care insurance (Iowa state Sen. Jack Hatch, 2/21).

Des Moines Register: Bill Would Redesign Iowa's Mental Health And Disability Services
After months of public discussion and interim committee meetings, the House Human Resources Committee has begun work on three pieces of the legislation that will redesign Iowa’s mental health and disability services system. ... The group put together a series of recommendations ranging from ongoing mental health and disability services training for law enforcement officers, the ability of residential care facilities to determine whether to accept people referred to them by the court, and clearing up conflicts within the law on which mental health professionals may be involved in the commitment process (Iowa state Rep. Scott Raecker, 2/21).

Chicago Sun-Times: Hospitals' Impact
So when government at the state and national levels begin talking about Medicaid cuts and property taxes on hospitals, not only health-care officials are taking notice, but so should Illinois residents and taxpayers. Such actions would harm one of the few sectors that has been creating jobs and could damage the state’s health-care system as well (2/21).

Minneapolis Star Tribune: Overpaying On Health? Let's Really Find Out
A truly independent third-party audit is important to gain the information we need to better oversee this large expenditure of $3.8 billion. I now encourage the Republicans to work in bipartisan fashion with those of us who have been pushing for more transparency for a long time. Republicans and Democrats may disagree about how best to reform our health care system, but neither side can promote effective change without this accurate information (Carolyn Laine, 2/21).

Detroit Free Press: A Cruel, Costly Restriction On Certain Mental Health Drugs
But the new budget also includes some misfires — and none more off-target than a shortsighted plan to restrict mental health drugs to Medicaid patients. Legislators ought to remove this proposal from the budget. Efforts to undo Public Act 248 of 2004, which has protected access to brand-only medication for some of the state's poorest patients, are especially troubling coming from a governor who has supported improving Michigan's anemic mental health care system (2/22).

State Roundup: Calif. Expands Uninsured Access, Gives Adult Day Care Reprieve

Tue, 21 Feb 2012 15:16:00 GMT

A selection of stories from Arizona, California, Virginia, Iowa, Georgia, Maryland, Connecticut, Massachusetts, Kansas and Oklahoma.

Los Angeles Times: 10 Counties Expand Medical Coverage For Low-Income Residents
Nearly two years before the federal health reform law kicks in, 10 California counties have expanded medical coverage to more than 250,000 people who were previously uninsured, according to new state data (Gorman, 2/18).

The Associated Press/Washington Post: Women Protest Anti-Abortion Bills In Va. By Locking Arms, Standing Mute Outside State Capitol
Hundreds of women locked arms and stood mute outside the Virginia State Capitol on Monday to protest a wave of anti-abortion legislation coursing through the General Assembly (2/20).

Arizona Republic: Arizona Legislature Releases Budget
Senate Appropriations Committee Chairman Don Shooter, R-Yuma, said the budget is a continuation of last year's efforts to balance the state's budget without gimmicks or borrowing. He said while the state is now in the black, it still needs to prepare for three possible looming financial cliffs: the sunset of the sales-tax increase, state costs related to the national health-care law and a double-dip recession (Ray and Pitzl, 2/20).

Des Moines Register: Wellmark Gives Up Some Tax Credits
Wellmark will give up $5 million in tax credits the state provided as incentives for its new $240 million headquarters in downtown Des Moines. The state, in return, will cut the number of jobs Iowa’s largest health insurer is required to create by 10 to 53... The agreement outlines penalties — repayment of the loan and tax credits — if Wellmark fails to maintain the promised number of workers, which it should reach by month's end, it said. Wellmark cited the recession, uncertainty over federal health care rules, and difficulty finding "qualified professionals" for failing to meet the job-creation goal (Eller, 2/20).

The Atlanta Journal-Constitution: Drug Tests, 'Personal Growth' For Those Who Need Help
Proposed mandates requiring drug tests and "personal growth" activities for parents and others who apply for public assistance in Georgia ran into resistance Monday in the state Senate, although not enough to derail them. The bills' sponsoring lawmakers made their pitch before a packed conference room, as the Senate Health and Human Services Committee heard testimony by more than a dozen people concerned about the cost of the mandates and how they would be implemented. The drug-test mandate of Senate Bill 292 would be for anyone applying for Medicaid or for the federal Temporary Assistance for Needy Families (TANF) program (Torres, 2/20).

The Atlanta Journal-Constitution: Federal Government Questions Move Of Georgia Rehabilitation Services
Georgia must hold hearings across the state before it can go forward with a plan to transfer from one state agency to another services that help disabled adults, according to the U.S. Department of Education. In response to issues raised by the federal government, a Georgia council that advocates for adults with disabilities is calling on the state to retract House Bill 831. The bill, which would move the division of rehabilitation services from the Department of Labor to the Department of Human Services, was approved by a House committee Feb. 7 and is expected to go before the full House (Diamond, 2/20).

San Francisco Chronicle: Adult Day Health Care End To Cut Off Frail Seniors
Chan Soon Fong suffers from dementia, memory loss, hypertension, osteoporosis, anemia, arthritis, ulcers, a compressed lumbar spine and diabetes….She's one of thousands of elderly and disabled low-income adults who have been or are expected to be deemed ineligible to participate in a new program that will replace Adult Day Health Care this year. The transition was scheduled to take place March 1, but on Friday, state officials announced it will be delayed for another month to give the federal government, which helps fund the Medi-Cal program, more time to process the paperwork associated with the change (Lagos, 2/19).

California Healthline: Adult Day Care Transition Gets Another Month
The state's move on Friday to shift the transition date for Adult Day Health Care elimination by a month was borne of a request by CMS, according to officials from the Department of Health Care Services. Advocates say the delay may be due to the scattered nature of the state's transition so far. "It's been a royal mess," Corinne Jan of the Family Bridges ADHC in Oakland said (Gorn, 2/21).

Baltimore Sun: Maryland Hospitals Share Data On Patients Electronically
Maryland's 46 acute care hospitals can now all share information electronically on patients admitted, discharged for transferred. The "encounter level" data can be passed along in real time via the Maryland Health Information Exchange, a statewide system of secure information sharing among hospitals, doctors' offices and health organizations, according to Lt. Gov. Anthony Brown, who announced the system recently. Some hospitals also are sharing lab and radiology reports, consult notes and other clinical data. Brown said Maryland is ahead of other states in its level of connectivity, which should help doctors' better coordinate care and improve outcomes (Cohn, 2/20).

Georgia Health News: Struggling Rural Hospital Seeks Partner
Like other small hospitals, Elbert Memorial has been struggling financially for several years. Many of the hospital's patients are uninsured or covered by Medicare or Medicaid, while an increasing number of better-insured and private-pay patients travel to Athens for their care (Cai, 2/20).

The Connecticut Mirror: After Years Of Debate, Health Care Pooling Ready To Become Reality -- For Some
The state is poised to open its employee health plan to municipalities and school districts, a controversial concept long advocated by labor unions, town officials and Democratic legislators. ... A health care "pooling" bill that would have allowed municipalities, nonprofits and small businesses to participate in the state employee plan passed the legislature in 2009, but Gov. M. Jodi Rell vetoed it (Levin Becker, 2/20).

Modern Healthcare: There Was A High Wage In Nantucket …
HHS Secretary Kathleen Sebelius weighed in for the first time publicly this week on an ongoing battle between hospitals in Massachusetts' and those in at least 19 other states. Sebelius told the Senate Finance Committee on Wednesday that the Patient Protection and Affordable Care Act required her to change Medicare's reimbursement of employee wages at all hospitals in Massachusetts to match the rate it pays for those at Nantucket Cottage Hospital. The wage match to a 19-bed hospital located in one of the wealthiest localities in the nation had the effect of increasing Medicare wage reimbursements for all state hospitals by $275 million annually (Daly, 2/17).

Kansas Health Institute News: Doctors Serve As Laboratory For Medical Homes In Kansas
Larry Rahn had never heard of a "patient-centered medical home," though his doctor's practice here is one of a handful certified in Kansas. Nonetheless, the 49-year-old John Deere mechanic said he had noticed something different about Dr. Jerad Widman's approach to medicine and that his health has improved in seven years under Widman's care (Cauthon, 2/21).

KQED's State of Health blog: Law Seeks to Stop Fake Prescription Drugs
The announcement by the Food and Drug Administration last week that sixteen California clinics and physicians were sold bogus vials of the cancer drug Avastin did not surprise regulators and researchers who study the counterfeit drug trade. Indeed, it was after fake AIDS drugs were discovered in California that state legislators passed the "e-pedigree law" mandating that all prescription drugs carry an electronic tag (Varney, 2/20).

Stateline: Business Gets Its Way In Republican Oklahoma
Oklahoma, ranked as one of the most pro-life states, enacted three abortion-related measures last year, including one that bans abortions after 20 weeks of pregnancy. But social conservatives have made it clear they want to go further ... on the fiscal front, Tea Party conservatives ... are livid that the state even considered accepting $54 million in federal funds to create a state-based health care exchange system under the federal health care law (Prah, 2/21).

WBUR's CommonHealth blog: Gov. Patrick Addresses Children's, Dana-Farber Controversy
There's been a lot of grumbling around the health care water cooler in Massachusetts lately about "favoritism" for Children's Hospital Boston and Dana-Farber Cancer Institute. The grumbling is based on an exemption that would let patients with tiered or limited network plans receive care at these two high-cost, specialized hospitals without paying higher co-payments or deductibles (Bebinger, 2/17).

Boston Globe: Health Aid Urged For Low-Wage Workers
Thousands of uninsured Massachusetts workers in low-wage jobs are ineligible for state-subsidized health coverage, but they will qualify for these low-cost plans under the new national health care overhaul — in 2014. Now, some consumer advocates, arguing that the wait is unfair and a black eye for the state, want the Patrick administration and legislators to launch a program to cover at least part of this group. Administration officials, already facing huge budget deficits, say the state can't afford the tens of millions of dollars it would cost to subsidize additional workers' insurance (Lazar, 2/17).

California Watch: Lack Of Primary And Preventative Care Sends Thousands To Hospitals
According to new data released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner. ... The latest figures are based on an analysis of 2009 hospital inpatient discharges by state-licensed facilities of 13 "prevention quality indicators," or readily treatable medical conditions such as chest pains and dehydration (Yeung, 2/20).

State Roundup: U.S. Senators Demand More Medical Board Oversight; Californians Losing Coverage; Arizona's Prison 'Quandary'

Fri, 17 Feb 2012 15:02:00 GMT

The Connecticut Mirror: Connecticut Insurers Wary Of Obama's Contraceptive Plan
"The administration never consulted us," said Susan Millerick, spokeswoman for the Hartford-based Aetna. Other Connecticut health insurers are letting the American Health Insurance Plans, a Washington-based trade association, voice their concerns. ... "We are concerned about the precedent this proposed rule would set," [AHIP spokesman Robert] Zirkelbach said (Radelat, 2/16).

Minneapolis Star Tribune: U.S. Senators Ask For More Oversight Of Medical Boards
Three U.S. Senators have asked federal health officials to review the way state medical boards regulate the nation's physicians. The request was prompted by recent reports from a citizen's watchdog group and three newspapers, including the Star Tribune, that "highlighted disturbing failures of state medical boards to discipline physicians," the senators said (Meryhew and Howatt, 2/16).

California Healthline: More Uninsured Could Put Pressure on State
A UCLA Center for Health Policy Research report showed that 670,000 Californians lost employer-based health insurance in 2008 and 2009. That is a far cry from the earlier estimate of 2 million newly uninsured in the state. ... A majority -- if not all -- of those working-age Californians who lost coverage over that two-year period could have been considered residents of "Main Street" (Gorn, 2/17).

Chicago News Cooperative/The New York Times: Illinois Medicaid Cuts Will Hit a System Already in Crisis
Dental services are among the benefits lawmakers are considering cutting as they look for ways to reduce the cost of the state’s health care system for the poor. ... From the enrollment of patients through treatment and payment, the Medicaid program in Illinois has been plagued by fraud, inefficiency, unsustainable costs and a paralyzing political climate with often-competing doctor, hospital and health care lobbies (McQuery, 2/17).

Stateline: Illinois Tightens Medicaid Without Federal Approval
The 2010 federal health law has a so-called “maintenance of effort” requirement, which expressly prohibits states from doing anything that would reduce the number of people who qualify for Medicaid. But it’s not clear whether the ban includes measures aimed at winnowing out people whose incomes are too high or who don’t actually live within the state’s borders (Vestal, 2/17).

Arizona Republic: Arizona Prisons In Health-Care Quandary
[The Arizona Department of Corrections] is expected shortly to award a three-year contract to provide medical and mental-health care for the nearly 34,000 inmates in Arizona's 10 state-run prisons. Lawmakers adopted legislation two years ago and revised it last year, requiring Corrections to privatize the health-care system regardless of whether it saves money. But the choices are between two companies with checkered records and a third company that has no track record in correctional health care (Ortega, 2/16).

The Associated Press/Boston Globe: Vt. Health Bill Builds Risk Pool, Limits Choice
Business lobbyists are turning up the heat on the administration of Gov. Peter Shumlin to detail the costs of the governor's ambitious health insurance plan, now that three possible benefit packages have been made public. "You should be as transparent as you can so that we can understand the changes that may be coming," said Jim Harrison, president of the 600-member Vermont Grocers' Association (Gram, 2/16).

Denver Post: Colorado Senate Hearing On Medical Debt Packed
Consumer advocates and patients buried by towering medical bills called for transparency in hospital costs and limits on charges to those lacking insurance at a Colorado Senate hearing Thursday. Patient advocates cited heart attack sufferers refusing ambulance transport to avoid sticking family members with bills, and hospitals alternating harsh debt collections with mysterious, arbitrary discounts (Booth, 2/16).

WBUR's CommonHealth blog: Must-See Video: What If Your Hotel Bill Was Like A Hospital Bill?
A month after his stay, the hotel guest has just gotten a horrifying bill in the mail for $20,000. He reaches Paolo, chief financial manager of “Hotel Hopital, where you let us care for you,” and demands to know how the bill could be so high ... It’s a delicious and enlightening five minutes, this new video (Goldberg, 2/16).

Georgia Health News: Health Proposals: For Some, They're Personal
Nine years ago, Carla Harrison of Augusta weighed 381 pounds. ... Then, in 2003, she had gastric bypass surgery, paid for by her health insurance. ... In all, she lost about 200 pounds. ... Harrison came to the state Capitol on Wednesday to testify to lawmakers about the state’s removal of bariatric surgery as a covered benefit in the state employees’ health plan (Miller, 2/16).

Minnesota Public Radio: HMO Enters Market In Southeastern Minn.
The first HMO to enter the Minnesota market since 1998 will offer health coverage in four southeastern counties. The Minnesota Department of Health certified Wisconsin-based Gunderson Lutheran Health Plan to operate in Fillmore, Houston, Olmsted and Winona counties. Minnesota's Department of Commerce must review and approve Gunderson's insurance (Baier, 2/16).

The Lund Report (Oregon): DOJ Memo Reveals Constitutional Concerns About Medical Liability Amendments The vote of Sen. Betsy Johnson (D-Scappoose), a crucial swing vote when the Senate decided to allow the Oregon Health Authority to move ahead with creating coordinated care organizations (CCOs) and overhauling the Oregon Health Plan’s delivery system, changed at the last moment because memos from the Department of Justice and Oregon Health & Science University (OHSU) revealed serious constitutional concerns about the proposed medical liability language (Waldroupe, 2/17).

Kansas Health Institute News: Committee Votes To Cut Tobacco Program Spending
A House budget committee has recommended spending an additional $635,000 on the state’s safety-net clinics. To pay for the increase, the committee voted to cut funding for smoking prevention and cessation programs by almost 64 percent (Ranney, 2/16).

Related, earlier KHN story: Kansas Tobacco Prevention Funds Diverted To Other Uses (Thompson, 1/20)

Minneapolis Star Tribune: Clinic Mergers Shaking Up The Medical Office Market
Independent clinics are integrating into larger systems in an era of tighter federal reimbursement dollars. That means there will be greater cooperation among health care providers, real estate brokers say. "I'm not surprised when the bigger systems acquire general practices, but I didn't think I'd see as many higher-end specialty practices being acquired as I did last year," said Jill Rasmussen of the Davis Group (Jacobson, 2/16).

The Washington Post: Maryland Hospitals To Share Patient Data
Maryland’s 46 acute-care hospitals will soon be able to share basic patient information among themselves and with credentialed doctors, a key step that health officials and clinicians say will improve patient care and cut costs (Sun, 2/16).

Chicago Tribune: Health Officials Backtrack, Say Nursing Home Did Notify Them About Death
The Illinois Department of Public Health made a mistake when it said Wednesday that an Oak Park nursing home failed to notify the state about an altercation between two residents that left an Alzheimer’s patient dead, an official said today (Meyer, 2/17).

The Washington Post: United Medical Center Seeks $15 Million From The D.C. Government
United Medical Center is requesting an additional $15 million from D.C. taxpayers to help finance a turnaround, likely renewing debate about whether the city should own a cash-starved hospital (Craig, 2/16).

Hospital News: Colorado Legislature Considers Limits On Charges, Philly Children's Hospital Apology, Mass. Facility Closure

Thu, 16 Feb 2012 14:45:00 GMT

Colorado Public Radio: Colorado Senator Wants To Limit Hospital Bills
Colorado's legislature is taking up a bill Thursday that would limit how much hospitals can charge people without insurance. ... The lawmaker who wrote it is trying to reduce the number of Coloradans bankrupted by medical bills (Whitney, 2/15).

Denver Post: Proposal At Capitol Today Limits Financial Pain On Colorado's Medically Uninsured
Easing the pressure on beleaguered patients ... is the primary push by consumer advocates at the state Capitol this year. They will pack a hearing today on a proposal to limit hospital bills to actual costs for the uninsured, delay medical-debt collectors and require hospitals to highlight charity policies in plain language at every turn. ... Hospital advocates say the sticker-price charges are nearly meaningless, since almost no one pays that full amount. They say they write off hundreds of millions of dollars a year in charity care and bad debt from the uninsured (Booth, 2/16).

Boston Globe: Taunton State Hospital Closing Opposed
Patient advocates and officials in communities south of Boston are lobbying to block the state Department of Mental Health’s plan to close Taunton State Hospital, saying it would leave Southeastern Massachusetts without a single bed for the mentally ill. Taunton State Hospital, which opened its doors in 1854, has 169 beds and 410 employees (Legere, 2/16).

The Dallas Morning News: Parkland Chief Tries To Encourage Employees After Report Exposing Widespread Problems
Parkland's interim CEO stood before hundreds of people from the hospital on Wednesday in an attempt to blunt the impact of a sweeping report that exposed widespread threats to patient safety. ... [Dr. Thomas] Royer said the hospital has been making improvements. But on the same afternoon he was speaking, Texas health officials said the state is considering whether to fine Parkland (Jacobson, 2/15).

Des Moines Register: Independence Hospital To Pay U.S. $406,030 For Employing Barred Nurse
A Buchanan County hospital has agreed to pay $406,030 to the federal government to settle allegations that it employed a nurse who was barred from working there because of past allegations of drug use and theft from patients. State and federal records show that in January 2007 Buchanan County Health Center in Independence hired Stephanie Davison of Mitchellville to work in the hospital. She continued to work there through May 2011 (Kauffman, 2/16).

The Philadelphia Inquirer: Children's Hospital Apologizes To Family Of Disabled Girl For Insensitive Statement
Children's Hospital of Philadelphia apologized Wednesday for the way it had communicated with the parents of Amelia Rivera, the 3-year-old disabled girl whose quest for a kidney transplant has garnered national attention. ... the hospital said it was reviewing its processes to ensure that it was "sensitive to the needs of all families." In January, Joe and Chrissy Rivera said that a hospital physician had told them the girl should not have a transplant because of her mental disability (Avril, 2/16).

Research Roundup: Predicting The Health Law's Effects On Small Business, Uninsured, Disparities

Fri, 10 Feb 2012 13:17:04 GMT

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Health Affairs: Small Firms’ Actions In Two Areas, And Exchange Premiums And Enrollment Impact -- Using a RAND assessment tool, researchers aimed to "predict the effects of self-insurance and grandfathering exemptions on coverage and premiums available" on policies for small businesses sold in the insurance exchanges (which the health law requires in 2014). They conclude: "The Affordable Care Act regulations restricting employers’ ability to offer grandfathered plans will result in lower premiums on plans available through the exchanges and will have small negative effects on enrollment in the exchanges. Our results suggest that these regulations are essential to keeping premiums on the Small Business Health Options Program (SHOP) exchanges affordable" (Eibner et al., February 2012).

New England Journal of Medicine: Sources of Regional Variation in Medicare Part D Drug Spending -- The authors analyzed 2008 Medicare spending on three types of drugs for 4.7 million beneficiaries to see if regional variation in spending reflected "differences in health status, use of effective treatments, or selection of branded drugs over lower-cost generics." The found that the average adjusted per capita pharmaceutical spending ranged from $2,413 in the lowest to $3,008 in the highest quintile of hospital referral regions and concluded that the variation "results largely from differences in the cost of drugs selected rather than prescription volume. A reduction in branded-drug use in some regions through modification of Part D plan benefits might lower costs without reducing quality of care" (Donohue et al., 2/9).

Kaiser Family Foundation: Income-Relating Medicare Part B and Part D Premiums Under Current Law And Recent Proposals: What Are The Implications For Beneficiaries? -- In light of "proposals to raise premiums for higher-income Medicare beneficiaries" currently being discussed in Washington, this issue brief "describes current law with respect to the income-related Medicare premiums ... as well as how the new proposals would increase the number and share of beneficiaries who would pay the higher premium, and the amounts that they would pay." The authors raise concerns that "given the relatively low incomes of most people on Medicare, significant savings from such proposals are only possible by going relatively far down the income scale at which point the affordability of these additional costs could be called into question" (Cubanski, Neuman, Jacobson and Smith, 2/8).

Commonwealth Fund: The Income Divide In Health Care: How The Affordable Care Act Will Help Restore Fairness To The U.S. Health System -- "Nearly three of five (57 percent) adults with income below 133 percent of poverty were uninsured for some time during the past year," according to the authors who write that "uninsured lower-income adults were more likely than insured adults in the same income group to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug, not having a regular doctor, or saying that other places cost too much." They conclude that the Affordable Care Act will "substantially narrow these inequities through an extensive set of affordable coverage options starting in 2014" (Collins et. al., February 2012).

Related KHN story: Nowhere To Go But Up For The Poor Lacking Insurance, Says Study (Rau, 2/7)

UCLA Center For Health Policy Research: The State Of Health Insurance In California: Findings From The 2009 California Health Interview Survey -- This report found that 7.1 million Californians were uninsured in 2009, more than 21 percent of nonelderly Californians. The authors focused on medical debt, which was "was highest among those uninsured all of the year (of whom 18.4 percent had debt) and among those uninsured for part of the year (23.2 percent). But even 9.1 percent of those with employment-based coverage reported some kind of medical debt." The authors noted that Latinos and African Americans will have more access to health services after the implementation of the ACA, though "only three-fourths of uninsured Latinos will be able to gain coverage ... The rest will be ineligible to participate in the coverage expansions due to their citizenship status" (Lavarreda et. al., 2/6).

Obama Administration Rejects Calif. Medicaid Co-Pay Proposal

Tue, 07 Feb 2012 05:00:00 GMT

The Obama administration said "no" Monday to a California proposal designed to help close a budget gap. Elsewhere, Texas is planning a change to how it pays for charity care in its Medicaid program.

The Associated Press/San Francisco Chronicle: Obama Administration Rejects Medi-Cal Copayments Federal health officials on Monday said California cannot force Medi-Cal recipients to make a co-pay for doctor visits and prescription drugs, a decision that brings relief to low-income patients but complicates the state's effort to close a $9.2 billion budget deficit. A letter from the Centers for Medicare & Medicaid Services said agency officials were "unable to identify the legal and policy support" for the state's request (Lin, 2/6).

Bloomberg: Obama Blocks California From Charging For Care In Medicaid
California’s co-payments would have ranged from $3 to $5 for drugs to $100 per day for hospital stays. Doctor visits would have been $5, and emergency room treatment $50. Medicaid, the U.S. health insurance program for the poor, is run by states and the federal government, with the U.S. approving changes in eligibility standards by granting waivers from national law. The program is among the biggest expenses for states (Wayne, 2/6).

The Sacramento Bee: Federal Officials Reject California's Plan To Charge Medi-Cal Co-Payments
Gov. Jerry Brown and lawmakers relied on mandatory Medi-Cal co-payments to save $511 million in last year's state budget and presumed that the state would continue saving in future years. The plan to charge low-income Medi-Cal patients and let doctors refuse care for nonpayment was unprecedented for a state on such a wide scale (Yamamura, 2/7).

Houston Chronicle: Medicaid Changes Challenge Hospitals To Do Things Differently
The goal is lofty: improve and expand health care for millions of Texans. But with billions of dollars at stake and the new project under way before the rules are even written, decisions made over the next few months are causing anxiety in many Harris County hospitals. The new rules - part of a complicated, first-of-its-kind project approved by the federal government - will determine who gets paid for providing charity care, and how much (Kever and Ackerman, 2/6).

New Survey Highlights Health Insurance Gaps Faced By Poor

Tue, 07 Feb 2012 14:31:00 GMT

According to the Commonwealth Fund, low-income adults who were surveyed were less likely to have insurance and to receive medical care including preventive screenings.

Modern Healthcare: Survey Highlights Gaps In Care Faced By Poor
Low-income adults surveyed by the Commonwealth Fund last summer were less likely to have insurance and receive needed medical care than adults with higher incomes, newly released results show. Low-income adults were less likely to receive preventive screening and more likely to visit the emergency room at night or on weekends than those with higher incomes, the survey found (Evans, 2/7).

Kaiser Health News: Capsules: Nowhere To Go But Up For The Poor Lacking Health Insurance, Says Study
In anticipation of the expansion of health insurance that will start in 2014 under the federal health care law, the Commonwealth Fund has begun tracking coverage of low-income Americans. .. A third of low-income Americans (under 133 percent of poverty, or $29,726 for a family of four) have lacked insurance for at least two years–10 times the rate of higher earners (Rau, 2/7).

National Journal: Survey Documents Uninsured Families—And Offers Hope
The Commonwealth report says the expansion of Medicaid and other provisions of the health reform law will help connect low- and moderate-income Americans with a regular source of health care. Adults with moderate household incomes—between 133 and 249 percent of the poverty level— also lacked health insurance coverage last year, the survey found: 36 percent of adults with family incomes at that level didn’t have health insurance in 2011 (Quinton, 2/7).

States Roundup: Health Exchange Planning Left To Gov. In Minn.

Mon, 30 Jan 2012 14:31:00 GMT

A selection of health policy stories from around the United States.

Boston Globe: Cost-Controlled Health Coverage Gaining Ground
In just three years, a new way of paying for medical care has spread rapidly across Massachusetts, and now more than 1.2 million people are covered by plans that put providers on a budget in an effort to restrain health spending. This means that about one in five Massachusetts residents are being treated by doctors working under these new cost-conscious arrangements, a Globe survey of insurers found — even before state lawmakers begin debating legislation to address soaring health insurance premiums by, in part, encouraging such plans (Kowalczyk, 1/30).

(St. Paul) Pioneer Press: Divided GOP Has Left Health Exchange Planning To Dayton
From a drab and windowless office in downtown St. Paul, a group of nine state workers is trying this year to develop a new way for Minnesotans to buy health insurance. The bland surroundings and seemingly mundane task contrast with a hot political reality — the essence of the work going on in the Golden Rule Building is so controversial that it has divided not just Republicans and Democrats, but even Republicans themselves. The state workers are planning what's called a health exchange, a new marketplace — largely online — for individuals and small employers to purchase insurance coverage beginning late next year (Snowbeck, 1/28).

McClatchy/The Kansas City Star: Two Kansas Judges Contributed To Anti-Abortion PAC
Campaign finance records show that at least two sitting Sedgwick County, Kan., judges have made contributions to the state's leading anti-abortion political action committee — after hearing cases involving abortion-related issues. Judges Eric Yost and Jeffrey Goering each gave $100 to the Kansans for Life PAC in 2011, according to the group's finance disclosure statement. In January 2011, Goering issued a temporary order prohibiting a Wichita doctor from using her office for abortions because her landlord believed it would create a nuisance (Helling, 1/30).

Texas Tribune: For Abortion Providers, Sonogram Law Is A Complication
This past fall, doctors were required to start performing a transvaginal sonogram at least 24 hours ahead of an abortion, a shift they say has had frustrating consequences for clinics and patients. Abortion opponents say the rationale behind the 24-hour delay is simple: Abortion should not be held to a lower standard than any other surgical procedure — where patients have a doctor's visit to learn the explicit details of their condition one day, and have the medical procedure on another (Ramshaw, 1/29).

McClatchy/The Anchorage Daily News: Alaska Medicare Clinics Are Seeing A Patient Shortage
Medicare patients flooded two new clinics targeting the older population when they opened in Anchorage last year — most other primary care doctors wouldn't take the federal insurance for seniors because they say Medicare pays too little. Recently, the demand to get into the clinics has eased, and clinic officials are beginning to wonder, what happened to the rest of the Medicare patients? (Shinohara, 1/30).

The CT Mirror: Wanted: 9,000+ Home Care Workers
The state has a massive need for more home care workers, but the lack of clear standards for the jobs makes it difficult for the work force development system to create training programs, an education and work force expert said Friday. … The state is expected to need more than 9,000 additional home care workers by 2016, and officials say meeting the demand is critical to meeting the state's goal of allowing significantly more people to receive long-term care at home or in community-based settings, rather than in institutions. By 2030, the population of Connecticut residents aged 65 and older is expected to grow by 64 percent, while the population under 65 is projected to shrink (Levin Becker, 1/27).

St. Louis Beacon: Medical Program Is A Pipeline To Rural Practice
At first, it sounds like a put-down when Dr. Angela Whitesell describes Lockwood, Mo., the place where she grew up. … Her decision to return to Lockwood, which has nearly 1,000 residents, is welcomed not only by the town but by the University of Missouri School of Medicine. For 16 years, the school has run the Rural Track Pipeline Program to boost the number of physicians serving rural parts of the state. Whitesell is an example of the program's success. So far, more than 450 medical students have taken part in the program, and many of the 108 graduates have chosen to practice medicine in rural areas of Missouri (Joiner, 1/27).

Houston Chronicle: Budget Cuts Spell Fewer Inspections At Assisted Living Facilities
The number of assisted living facilities in Texas is growing even as state budget cuts have reduced the number of inspectors, prompting concerns about the quality of care. Advocates of long-term-care residents say the cuts, which have led to less frequent inspections, are worrisome. … Industry representatives also are nervous. Annual state inspections, they say, are a good way to catch problems and fix them sooner (Lee, 1/29).

San Francisco Chronicle: Kaiser Workers Plan 1-Day Strike Tuesday
Thousands of Kaiser Permanente workers are expected to walk off the job Tuesday over contract disputes involving the health maintenance organization's mental health and optical employees. … Union leaders said that while they continue to negotiate with Kaiser, the main sticking points persist. They say they're striking over proposed cuts to health and retirement benefits, and what they describe as exceptionally long wait times for patients to receive individual psychiatric care (Colliver, 1/30).

The Sacramento Bee: Urgent Care Clinics Offer ER Option
Health care providers are increasingly using alternative primary care settings, especially urgent care clinics, to capture an after-hours market and divert traffic from emergency rooms to control rising medical costs. In the Sacramento region, Sutter Health is currently opening a network of urgent care clinics that offer after-hours care, while Kaiser Permanente is performing triage treatment in its waiting rooms and beefing up its advice phone line. Mercy hospitals have started a pilot program to refer emergency room patients to a primary care doctor or clinic (Anne Gonzales, 1/29).

Boston Globe: Tufts Seeks Top Trauma Label; Rivals Want Delay
Tufts Medical Center is seeking to become a level one trauma center, an elite designation that would bring more prestige and potentially more patients to the Boston teaching hospital. But the surgery chiefs at four of Tufts’ competitors are questioning whether the city needs another top trauma center and have asked public health officials to delay their decision (Kowalczyk, 1/30).

State Roundup: Uninsured Not The Usual Suspects In Texas, Calif.

Fri, 27 Jan 2012 14:54:00 GMT

A selection of health care news from Texas, California, New York, Maine, Maryland, Georgia and Virginia.

Texas Tribune: Interactive: Who Are The Uninsured In Texas?
Nearly a quarter of the Texas population lacked health insurance in 2010, according to the most recent data released by the American Community Survey, which the U.S. Census Bureau conducted. That's more than 5.7 million Texans. ... More than half of the uninsured are employed. More than a third have an annual household income above $50,000 (Aaronson, 1/26).

Texas Tribune (Video): Texas Tribune Weekend Insider, January 26, 2012
Until courts can hash out the state's abortion sonogram law, Texas must begin enforcing the new regulations. Emily Ramshaw explains how family planning clinics are complying (Dehn and Ramshaw, 1/26).

KQED's State Of Health blog: Without Individual Mandate, Fewer Californians with Health Insurance
In a new study, researchers at the UCLA Center for Health Policy Research and UC Berkeley crunched the numbers and determined that without the individual mandate, more than one million Californians would put off buying health insurance (Aliferis, 1/26).

New York Times/The Bay Citizen: Nursing Home Investigation Finds Errors By Druggists
Pharmacists responsible for reviewing the medication of patients in California nursing homes routinely allowed inappropriate and potentially lethal prescriptions of antipsychotic medications, and failed to correct other potentially dangerous drug irregularities, according to recent state investigations (Udesky, 1/27).

California Healthline: L.A. Senior Advocates Stand Up To Budget Cuts
L.A. County's low-income, at-risk seniors who are trying to stay in their homes rather than live in institutions must rely on a system of publicly supported programs that the UCLA Center for Health Policy Research has called "fragmented" and "often uncoordinated." If Medi-Cal eligible seniors enter nursing homes or arrive at emergency departments and hospitals, taxpayers still foot the bill. And that bill is projected to increase, particularly as services to keep seniors at home decrease (Stephens, 1/26).

The Washington Post: Virginia To Transform System Of Caring For Developmentally Disabled
Virginia will close all but one of its large institutions for the developmentally disabled and move thousands of people into their own homes, their family’s homes or group homes as part of a 10-year, $2.1 billion settlement announced Thursday with the U.S. Justice Department. ... Virginia is one of the few states that still place people with developmental disabilities in large institutions (Kumar, 1/26).

The Baltimore Sun: Johns Hopkins Unveils New Hospital
At the new $1.1 billion Johns Hopkins Hospital there will be Xboxes and a basketball court for kids, sleeper-sofas for families, single rooms for all patients, an improved dining menu and extensive soundproofing. It's part of an effort to make the hospital experience more patient-focused, Hopkins officials said Thursday on the first tour given to the news media since construction began five years ago on the 1.6 million-square-foot building, which will replace aging facilities on the East Baltimore medical campus (Cohn, 1/26).

Minneapolis Star Tribune: Health Beat: Retail Clinics Aren't Just An Rx Fad
MinuteClinic — a darling of health care reform when it introduced retail clinics a decade ago — is running strong despite retailers and family doctors copying its storefront brand of care. A new market report found that MinuteClinic still is the nation's top provider of retail clinics with 549 in operation (Olson, 1/26).

Georgia Health News: State Discusses Ideas On New Medicaid Design
David Cook, commissioner of the Department of Community Health, told reporters in a media briefing that while people often have a negative impression of managed care, they generally agree with its principles of coordinating a patient's treatment. The Georgia Hospital Association recently criticized the state's current HMO-like set-up. It called instead for a Medicaid system similar to North Carolina's "patient home" model, which is run by physicians, not insurers (Miller, 1/26).

Bangor Daily News: Bill Seeks To Limit Higher Prices For Specialty Drugs
In an effort to control spending, some insurers are passing along more costs for expensive drugs to consumers and employers. ... A bill sponsored by Rep. Stacey Fitts, R-Pittsfield, would prevent private insurers from charging Maine consumers more for specialty drugs than for other medications. The bill, LD 1691, would not apply to government-subsidized plans or self-funded health insurance used by some employers (Farwell, 1/26).

Modern Healthcare: N.Y. Hospital To Settle False Claims Charges
Cayuga Medical Center, a 209-bed hospital in Ithaca, N.Y., will pay about $3.6 million to settle False Claims Act allegations with the U.S. attorney general in New York. The attorney general's office alleges that the hospital had "improper physician recruitment agreements" with some referring physicians, and then submitted those false claims to Medicare and Medicaid from July 2004 to December 2006 (Lee, 1/26).

Survey: Mass. Health Law Increased Coverage, But Struggles On Cost

Thu, 26 Jan 2012 14:43:38 GMT

The journal Health Affairs has a new study analyzing the effects of the 2006 Massachusetts health insurance law.

Boston Globe: Mass. Health Insurance Law: More Coverage, More Expensive
The state's landmark health insurance law, passed in 2006, significantly increased the number of residents ages 19 to 64 with coverage — now at 94.2 percent. A survey released today found that it also is starting to produce results by keeping patients healthier and out of emergency rooms and hospitals. Unfortunately, as many probably suspect, it has done little to control costs (Kowalczyk, 1/25).

National Journal: Massachusetts Health Experience: What The Nation Can Expect?
Mitt Romney may not like to hear it, but if you want to know what health reform will look like for the United States, look to what's happening in Massachusetts, a team of experts said on Wednesday. .. "Despite the 2010 gains in access relative to 2006, 22.8 percent of nonelderly adults in Massachusetts reported that they did not get needed care in 2010," Long’s team wrote. "It is likely that the economic downturn and the continuing increase in health care costs, in particular, dampened any gains in coverage and affordability that might otherwise have been achieved under health reform in the state" (Fox, 1/25).

Poll: Many Think Justices' Ideologies Will Affect High Court's Health Law Decision

Thu, 26 Jan 2012 14:40:00 GMT

According to a Kaiser Family Foundation January tracking poll, a majority of Americans believe the Supreme Court's health law ruling will result from the justices' own ideology rather than legal analysis. The poll also found that the public believes the uninsured will benefit most from the overhaul.

Politico Pro: Public Thinks Ideology Will Drive ACA Ruling
The American public has little faith that partisan politics can be put aside when the Supreme Court decides on the Affordable Care Act this year, a new survey finds. Seventy-five percent said they think ideological beliefs influence decisions made by the Supreme Court justices, while just 17 percent think pure, nonpartisan legal analysis drives their decisions, according to the January Kaiser Health Tracking Poll. Further, 60 percent believe the justices will inject personal politics into their decision on health care reform's individual mandate, while 28 percent said politics won't factor into their decision on the provision (Millman, 1/26).

Kaiser Health News: Majority Of Americans Think Ideology Will Affect High Court's Ruling On Health Law
With the Supreme Court just two months away from hearing a historic legal challenge to the 2010 health law, nearly 60 percent of the public expects the justices to depend more on personal ideology than a legal analysis of the individual mandate, according to the Kaiser Family Foundation's January health tracking poll (Carey, 1/26).

Modern Healthcare: Most People Believe Reform Law Will Help Uninsured The Most: Poll
The public believes the uninsured will benefit the most from the 2010 federal healthcare overhaul, while physicians will suffer its most detrimental impacts, according to a recent public poll by the Kaiser Family Foundation. The monthly Kaiser Health Tracking Poll released Thursday found 53% expected the law to benefit people without insurance, while 25% expected it to leave them worse off (Daly, 1/26).

GOP: Survey Showing Increase In Uninsured Is Proof Of Health Law's Failure

Wed, 25 Jan 2012 14:30:00 GMT

Some House Republicans circulated this new Gallup data yesterday, before President Barack Obama's State of the Union address.

The Hill: GOP Cites New Survey Showing Rising Number Of Uninsured Under Obama
House Republicans seized on new data Tuesday showing that the number of uninsured adults has risen steadily during the Obama administration. Republicans on the Ways and Means Committee circulated the Gallup data ahead of President Obama's State of the Union address to argue that his healthcare law has failed (Baker, 1/24).

CQ HealthBeat: Parties Trade Barbs Over Decline In Health Insurance Coverage
Republicans and Democrats agree on one thing: The number of people without health insurance has grown during the Obama administration. But as they prepared to listen to the president give his State of the Union address Tuesday night, they disagreed sharply about what that means. Republicans pointed out Tuesday that a series of Gallup polls show that the number of people without insurance has increased from 14.8 percent in 2008 to 17.1 percent in 2011 (Adams, 1/24).

Meanwhile, the Fiscal Times takes a look at what formerly unemployed workers are finding -- once they find jobs and return to work -- in terms of health benefits.

The Fiscal Times: After the Layoff: Congrats on Your New, Worse Job
As thousands of formerly unemployed workers dust off their ties and Oxfords and head back to the office, what are they finding? ... Neil Provo, 39, from Microsoft project manager to technical project manager at a small consulting company.: ... His new 401(k) has no matching program and his health benefits were cut back significantly. "I like that it's a small company instead of the large corporation I was used to, and I feel like my opinion matters more here," says Provo. "What I miss the most are the health benefits" (Briody, 1/25).

Viewpoints: Health Care Is MIA In The State Of The Union; Gingrich's Earnings For Health Views

Wed, 25 Jan 2012 14:29:00 GMT

Forbes: State Of The…Health Care Reform
President Obama's largest legislative accomplishment to date was the passage of the health care reform law, which has been going into effect in stages, with regulations currently being written for the most substantial changes due to take effect in 2014. So it is odd the President mentioned health care only briefly, and in passing, in his State of the Union address last night. Perhaps this has something to do with the fact that the law remains deeply unpopular with a skeptical public, or the fact that despite some provisions "to increase coverage" have already gone into effect, the percentage of American adults without health coverage has increased to an all-time high of over 17% (Robert Book, 1/25).

The Washington Post: Newt In Wonderland
Yet another mother lode for (Newt) Gingrich has been the health care industry. Various companies paid Gingrich $55 million between 2001 and 2010, according to Bloomberg News. When asked what the companies received in return, Gingrich told The Post that they got to visit with "a really important guy who really knows a lot and who really has lots of information." That person would be Gingrich's Holy Trinity — Me, Myself and I (Kathleen Parker, 1/24).

Bloomberg: To Shop Smart, Patients Need To Know Price Of Care
Another initiative, one that's typically promoted by conservatives, is increased price transparency. For consumers to be able to play their role in keeping costs down, they need to know what those costs are…. In addition, private health-consulting companies have begun promoting transparency in ways that may work better than the state government efforts (Peter Orszag, 1/24).

Politico: Roberts To America: Trust Us
(Chief Justice John) Roberts's biggest problem is that it is not clear how some justices' conduct squares with the law. For example, we need a reasoned explanation — much as Justice Antonin Scalia attempted to explain his duck hunting boondoggle with then-Vice President Dick Cheney — of the propriety of the recent decision by Justices Clarence Thomas and Scalia to headline a fundraiser for The Federalist Society, where law firms bought tables for thousands of dollars. Some of these lawyers were participating in the health care litigation the court agreed that day to hear (William Yeomans and Herman Schwartz, 1/24).

Journal of the American Medical Association: Affordable Care Act Litigation
The legal, political, and policy stakes of the Supreme Court's decision are vast. The ACA will achieve near universal coverage, something that seemed unimaginable just a short time ago. Health reform envisages a social contract in which everyone shares the cost, recognizing that virtually everyone will become ill one day. The ACA and its individual mandate are not unjustified limits on freedom, but rather are vital to a decent society (Lawrence O. Gostin and Kelli K. Garcia, 1/25).

The Wall Street Journal: ObamaCare And Religious Freedom
Religious freedom is the lifeblood of the American people, the cornerstone of American government. ... Yet the Obama administration has veered in the opposite direction. It has refused to exempt religious institutions that serve the common good—including Catholic schools, charities and hospitals—from its sweeping new health-care mandate that requires employers to purchase contraception, including abortion-producing drugs, and sterilization coverage for their employees (Timothy M. Dolan, 1/25).

Boston Globe: Patrick's Call For Courage Goes Far, But Not Far Enough
After years of disturbing increases in health care costs, the recent news has been more encouraging. State insurance regulators' refusal to approve higher rates has given insurers a push to drive harder bargains with health care providers. Insurance companies are developing tiered plans that reward more cost-effective providers. Yet over the long term, health care costs can't be clubbed down by regulatory fiat; the rules of the market have to be reshaped so that consumers can exert downward pressure on costs, and so that providers are paid for maintaining patients' health rather than for providing more services (1/24).

Journal of the American Medical Association: Physician Autonomy and Health Care Reform
Many physicians are distressed as they look toward the future. ... Part of this malaise is driven by concerns that reforms contained in the Affordable Care Act (ACA) will further erode physicians' autonomy. On the contrary, the ACA has provisions that will mitigate the long-standing concern that payers determine what physicians can and cannot do and will instead enhance the role and authority of the medical profession(Dr. Ezekiel J. Emanuel and Dr. Steven D. Pearson, 1/25).

Journal of the American Medical Association: Science, Politics, and Over-the-Counter Emergency Contraception
In his inaugural address in January 2009, (President Barack) Obama heralded a new era that would "return science to its rightful place" in government. ... Less than 3 years later, (Health and Human Services Secretary Kathleen Sebelius) rejected Plan B One-Step for nonprescription use without an age restriction because of a lack of confidence that the youngest girls of reproductive age could use the medication properly. Sebelius's decision renewed concerns about the relation between science and politics in the federal government, regardless of the party in office (Dr. Robert Steinbrook, 1/25).

Health Policy Solutions (a Colorado news service): A Healthy Mouth Means A Healthier Colorado Economy
Diseases of the mouth get little attention compared to the many other medical issues, but these diseases directly impact the economic health of our state. In 2010, Americans spent an estimated $108 billion on dental services. Oral diseases, pain and infections account for 164 million lost work hours nationally ... Because oral diseases are almost entirely preventable, this is a public health and finance battle we can and must win (Dr. Chris Urbina and Kate Paul, 1/24).

Percentage Of Americans Who Lack Health Coverage Up For Fourth Straight Year

Tue, 24 Jan 2012 14:54:00 GMT

Politico reports on this new finding from Gallup, which is being released today.

Politico: Survey: Uninsured Rose In 2011
The percentage of Americans lacking health insurance coverage rose for the fourth straight year in 2011 to 17.1 percent, a new survey showed Tuesday. The climb has been steady since Gallup began tracking whether adults have health insurance in 2008. Four years ago, only 14.8 percent of adults lacked health insurance (Mak, 1/24).

Here's the Gallup story: More Americans Uninsured In 2011 (Mendes, 1/24).

In related news, Modern Healthcare reports on research from the Archives of Internal Medicine concluding that research regarding the overuse of health care in the U.S. is limited, and the Associated Press takes a look at the overuse of screening tests.

Modern Healthcare: Little Research On Overuse Of Health Care In U.S., Study Says
Despite concerns about the high cost and inefficiency associated with the overuse of health care, research is limited and often addresses only a few medical interventions, according to an article published in the Archives of Internal Medicine. ... The authors emphasized the need for better guidelines on a wider range of health care interventions as a way to boost research on overuse, particularly in areas such as preventive diagnostic services (McKinney, 1/23).

The Associated Press: Too Many Tests? Routine Checks Getting Second Look
Chances are you've heard that many expert groups say cancer screening is overused, too, from mammograms given too early or too often to prostate cancer tests that may not save lives. It's not just cancer. Now some of the nuts-and-bolts tests given during checkups or hospital visits are getting a second look, too — things like routine EKGs to check heart health, or chest X-rays before elective surgery. Next under the microscope may be women's dreaded yearly pelvic exams (Neergaard, 1/23).

State Roundup: Calif. Fights Feds On Mental Hospital Oversight

Tue, 24 Jan 2012 14:47:00 GMT

News outlets report on a variety of health issues around the country.

Los Angeles Times: Officials Oppose Extended Federal Oversight Of 2 Mental Hospitals
California officials Monday filed documents in U.S. District Court opposing extended federal oversight of two state mental hospitals, arguing that new leaders have already taken measures to improve patient care and safety. The state attorney general's filing came in response to a scathing U.S. Justice Department portrayal last month of Napa State Hospital and Metropolitan State Hospital in Norwalk (Romney, 2/24).

Georgia Health News: Not Just Shelter, But A Lifeline For Those With Mental Illness
[According to] a housing initiative agreed to by the state of Georgia in a 2010 settlement with the U.S. Justice Department, ... 2,000 individuals with serious and persistent mental illness will be placed in state-funded "supported housing" by 2015 ... Such housing programs are designed for people with disabilities, mental illness or addictive disease (Miller, 1/23).

The Associated Press/CBS New York: Art For Health Program Offered At NYC Hospital
Tony-Award winning actor Lin-Manuel Miranda and rapper and radio personality Roxanne Shante helped launch the "Lincoln Art Exchange" at Lincoln Hospital in the Bronx on Monday. They were joined by hospital officials and arts organizations including the Actors' Fund and the Bronx Museum. Organizers said the program addresses the growing number of freelance and independent artists who can't afford health insurance (1/23).

HealthyCal: Salinas Hospital To Train Indigenous-Language Interpreters
A new training program for medical interpreters is giving low-income women the skills needed for a hard-to-fill job – working as medical interpreters in indigenous languages. Six medical interpreters will be taught to work with patients who speak indigenous languages from the Oaxacan region of Mexico (Flores, 1/23).

California Single-Payer System Has Another Go Before Senate Committee

Tue, 17 Jan 2012 14:53:26 GMT

A proposal to institute a single-payer health care system in California has found its way to a key state Senate committee. The proposal, which would cover all Californians through a state-run health insurance program, died in the Senate Appropriations Committee in California last year.

The Sacramento Bee: California Lawmakers Try Another 'Single-Payer' Health Care Bill
California's "Medicare for all" bill goes before a key Senate committee today, the latest chapter in a long-running battle between universal health insurance supporters and business. Senate Bill 810, introduced by San Francisco Democrat Sen. Mark Leno, would establish a California Healthcare Agency to run a single-payer health care system that would pool employer and employee payments. It would administer the money and negotiate rates with doctors, hospitals and other medical providers (Ortiz, 1/17).

MSNBC: Single-Payer Health Care Bill Faces Big Hurdle: Appropriations Committee
The California Universal Health Care bill didn't make it past the Senate Appropriations Committee last year. Tuesday more than 100 advocates plan to present the bill to the committee and are hoping for a better outcome. Under the single-payer bill, Californians would pay the state, instead of private insurance, to negotiate health care. The bill would cover any resident, including the estimated seven million Californians that don't have health insurance now (1/17).

Insurance In The States: New York Retailers Often Don't Cover Employees

Tue, 17 Jan 2012 14:44:00 GMT

In New York City, a new study has found only three of 10 retail workers get health insurance through their job. In the meantime, the federal government is stepping up scrutiny of health insurers in Arizona, and Connecticut considers changes to appeal insurance company coverage denials.

The New York Times: Study Of Retail Workers Finds $9.50 Median Pay
Retail workers in New York City earn a median of $9.50 an hour, most are part-time or temporary, and just 3 in 10 receive health insurance through their jobs, according to a new study of the city's larger retailers (Greenhouse, 1/16).

Arizona Republic: Arizona Health Insurance Companies Targeted
The federal government has stepped up scrutiny of health insurance companies in Arizona, with regulators calling one company's most recent rate increase "unreasonable" and vowing thorough reviews of 32 other health insurance plans that are pursuing double-digit rate increases. The U.S. Department of Health and Human Services said last week that Trustmark Life Insurance Co.'s plan to raise health-insurance rates on Arizona consumers by 13 percent is unreasonable and called on the company to rescind, refund or justify the rate increase (Alltucker, 1/16).

The Connecticut Mirror: State's Failure To Appeal Health Insurance Denials Cost Millions
Connecticut's child welfare agency spends $16.4 million a year on mental and behavioral health services ... one of every five children has private health insurance that is not covering what their doctors say is needed, leaving the state to pick up the tab. That's about to change. ... In an attempt to save money and force insurance companies to cover their clients, [the Connecticut Department of Children and Families] is hiring an expert to appeal insurance company denials (Rabe Thomas, 1/13).

WBUR: Confusion About Tiered Health Plans
The next time you sign up for health insurance, the cheapest option may well be a "tiered" plan, insurance that rates doctors and hospitals based on the cost and quality of their care and then charges you based on your provider's rating. Would this kind of coverage make sense for you and your family? ... The state's top three insurers say they are concerned about confusion as members get used to their new type of insurance (Bebinger, 1/17).

Research Roundup: Raising Medicare's Eligibility Age

Fri, 13 Jan 2012 14:33:00 GMT

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Congressional Budget Office Director's blog: Raising The Ages Of Eligibility For Medicare And Social Security -- The authors analyzed a scenario in which the eligibility age - current 65 - would be increased by two months every year until it reached 67 in 2027. They found that would cut Medicare expenditures by 5 percent but many people between the ages of 65 and 67 would pay more for health care. "CBO expects that most people affected by the change would obtain health insurance from other sources, primarily employers or other government programs, although some would have no health insurance. Federal spending on those other programs would increase, partially offsetting the Medicare savings. Many of the people who would otherwise have enrolled in Medicare would face higher premiums for health insurance, higher out-of-pocket costs for health care, or both" (Meyerson and Manchester, 1/10).

National Bureau Of Economic Research: Does Retiree Health Insurance Encourage Early Retirement?
The health law, the researchers write, "will considerably weaken the link between employment and health insurance by making group coverage available to all individuals regardless of employment." By investigating employee-level data from 64 different companies which are clients of Towers Watson, researchers determined that "retiree health coverage has its strongest effects at ages 62 and 63 resulting in a 3.7 percentage point (21.2 percent) increase in the probability of turnover at age 62 and a 5.1 percentage point (32.2 percent) increase in the probability of turnover at age 63" (Nyce et. al., December 2011).

Journal Of The American College Of Radiology: Imaging And Insurance: Do The Uninsured Get Less Imaging In Emergency Departments? – Using data from the 2004 National Hospital Ambulatory Medical Care Survey, researchers compared treatment among patients who were uninsured, those covered by Medicaid and those with other types of insurance and found that the uninsured patients received 8 percent fewer imaging tests than patients with non-Medicaid insurance and that Medicaid enrollees received 10 percent fewer than those with other insurance. They conclude: "Further research is needed to understand whether insured patients receive unnecessary imaging or if uninsured and Medicaid patients receive too little imaging" (Moser and Applegate, January 2012).

Archives Of Pediatrics And Adolescent Medicine: The Interplay Of Outpatient Services And Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders -- For children with Austism Spectrum Disorders (ASD), barriers to care -- such as lack of qualified practitioners and poor insurance coverage -- increase the chances that they will be hospitalized for psychiatric reasons. The researchers looked at a large national sample of Medicaid-covered children with ASD to see if "increasing outpatient services results in reduced use of costly and restrictive service." The researchers found that each $1,000 increase in spending on outpatient services like respite care over 60 days "resulted in an 8% decrease in the odds of hospitalization" (Mandell et. al., 1/2)

New England Journal Of Medicine: Fitness Memberships And Favorable Selection In Medicare Advantage Plans -- Researchers used national figures from the Centers for Medicare and Medicaid Services to see what kind of changes occurred when 11 Medicare Advantage plans incorporated a gym membership as a part of their covered benefits: "Persons enrolling in plans after the addition of a fitness-membership benefit reported significantly better general health, fewer limitations in moderate activities, less difficulty walking." The authors noted that creating an insurance risk pool for Medicare Advantage plans, as well as for small business and individual plans, violates the 2010 health law. However, a benefits package that caters to a healthier subset of seniors may have the same effect as creating a risk pool (Cooper and Trivedi, 1/11).

Related, from KHN: Gym Memberships In Medicare Advantage Plans Cater To Healthy Seniors (Kulkarni, 1/11)

Archives Of Ophthamology: The Cost-Effectiveness Of Welcome To Medicare Visual Acuity Screening And A Possible Alternative Welcome To Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus -- Medicare currently offers new beneficiaries the opportunity for a visual acuity screening, which is generally done by a primary care professional using eye charts. The researchers looked at simulated data to see if eye care professionals conducting dilated eye evaluations would find more vision problems, provide better treatments and save the patients and the government money over time compared to no screening at all. They found that for asymptomic patients with no diabetes, there is "little evidence that the current policy of visual acuity screening" is cost-effective but "dilated eye examinations at Medicare entry are likely to be cost-effective" (Rein et al., 1/9).

State Roundup: Ore. Lawmakers Consider Medical Liability Reforms

Thu, 12 Jan 2012 14:26:00 GMT

A selection of health policy stories from around the United States.

Modern Healthcare: SEC Pursues Former WellCare Execs In Civil Court
The U.S. Securities and Exchange Commission is going after some former WellCare Health Plans executives in federal civil court regarding their alleged actions concerning WellCare's managed-care contracts for behavioral health in the state of Florida. In 2010, WellCare agreed to pay about $334 million to settle legal actions with various entities related to an alleged $40 million, five-year pattern of fraud in those contracts without admitting or denying any wrongdoing (Barr, 1/11).

Associated Press/(St. Paul) Pioneer Press: Emergency Medical Assistance Program Ends
Hundreds of people in Minnesota who aren't U.S. citizens will no longer receive most health care services from a program of last resort. The state Department of Human Services mailed letters to 2,300 people last month informing them that much of their coverage would lapse on Jan. 1. They would still receive emergency care at a hospital but would no longer be eligible for chemotherapy, dialysis or other services (1/11).

The Lund Report (an Ore. news service): Legislators Expect To Consider Reforms In February Session
In Oregon, three consultants from Harvard have been hired to research solutions and make recommendations to the February legislative session on the benefits and consequences of reforming the state's medical liability laws. … The benefits and impacts of liability reform will become part of their report along with how medical liability cases have been handled. The consultants will also determine if Oregon should alter the amount of non-economic damages someone could receive in a malpractice lawsuit. That recommendation would require legislative approval. Currently, Oregon has a $500,000 limit on non-economic damages (Thomas, 1/12).

The Wall Street Journal: Appellate Ruling Upholds Texas Abortion Law
The Fifth U.S. Circuit Court of Appeals on Tuesday upheld a Texas law that requires women seeking an abortion to have a sonogram exam and to listen to a physician's detailed description of the fetus, including whether it has developed limbs or internal organs. Supporters of the law, enacted last year, say it is designed to ensure that women are fully informed about abortions and, ultimately, to discourage them from undergoing the procedure (Koppel, 1/12).

HealthyCal: Aging In A Land Of Youth
As the birthplace of the computer revolution, Silicon Valley vigorously celebrates innovation and youth culture. In the shadow of the digital age, however, older adults in Santa Clara county echo a similar concern: they are second-class citizens when it comes to financial support from government agencies and high-tech foundations. … Last spring, older adults rallied at meetings of the county's Board of Supervisors and the San Jose City Council, demanding to retain critical services that included adult day health care, transportation to adult community centers, and senior nutrition programs. In a well-orchestrated effort by local nonprofits, seniors first addressed government officials, then pulled out a paper heart and ripped it in half (Perry, 1/11).

The Philadelphia Inquirer: Nurse Layoffs Already Putting Phila. Students At Risk, Protesters Say
Laying off 47 Philadelphia School District nurses has caused children to suffer and is endangering their health, a group of nurses said Wednesday. One diabetic student had to transfer from her school because it had no full-time nurse, they said. At another school, they added, the principal erroneously administered a medication without doctor's orders. … For the third week in a row, dozens gathered outside the School District headquarters on North Broad Street to protest the nursing cuts, which were made to help bridge a budget shortfall of more than $629 million (Graham, 1/12).

MinnPost: As Recession Holds Down Health Spending, Have You Made Choices To Forgo Or Delay Treatment?
On Monday, the U.S. Department of Health and Human Services reported that health-care spending, as a share of the overall economy, stabilized in 2010. People may be using less care for a variety of reasons, including more prevalent cost-shifting provisions in insurance policies, job loss and greater awareness of the true cost of care. ... According to Minnesota Compass, a social indicators tracking project spearheaded by Wilder Research, average spending on health care by household in the 13-county Twin Cities metro area fell from $3,834 in 2007 to $3,354 in 2008 and $3,314 in 2009. At the national level, household spending on health care rose from $2,952 in 2007 to $2,966 in 2008 and $3,126 in 2009 (Hawkins, 1/11).