Kaiser Health News - Uninsured

Texas Scrambles To Find Money For Approved Health Care Projects

Fri, 14 Jun 2013 13:14:00 GMT

In Texas, revenue woes are hampering a series of health care experiments, including ones for its poor and uninsured. Federal approval for the projects came in May. In California, lawmakers get set to add some dental coverage for the state's poorest residents.

The Texas Tribune: Lack Of Revenue Limits Experimental Health Projects
Texas received federal approval in May to begin more than 1,100 experimental projects that could transform the way health care is delivered to the state's poor and uninsured. But there is a catch: To receive billions of dollars in federal financing, health care providers across 20 Texas regions must start the projects using local financing and meet some performance benchmarks (Aaronson, 6/14).

The Texas Tribune: Interactive: Financing Health Care Transformation Across Texas
This interactive shows the regional distribution of $3.2 billion for projects the federal government approved in May and the percent of each region that is uninsured. Underneath the map is a detailed description of the approved projects from the Health and Human Services Commission (Aaronson, 6/14).

California Healthline: Medi-Cal Dental Coverage Partially Restored
Legislative leaders and Gov. Jerry Brown (D) agreed on a budget plan this week that restores partial funding for dental services in Medi-Cal, California's Medicaid program. … Although not the complete restoration of $131 million sought, the state plans to spend about $16.9 million this fiscal year and $77 million next year on dental coverage. The money will provide preventive care, dental restorations and full dentures for adult beneficiaries of Medi-Cal (Edlin, 6/13).

But in North Carolina --

North Carolina Health News: Health Issues Absent From House Budget Debate
The House tentatively approved its biennial budget Wednesday afternoon after a marathon session. But health and human services were hardly mentioned throughout the seven-hour debate (Hoban, 6/13).

Calif. Regulator Seeks To Bar Anthem From Small Business Health Exchange

Fri, 14 Jun 2013 13:13:00 GMT

Meanwhile, Minnesota officials announce the opening of a call center Sept. 3 to answer consumer questions about the state's online insurance marketplace, which will begin enrolling people a month later.

Los Angeles Times: Regulator Wants To Bar Anthem From Small-Business Health Exchange
California Insurance Commissioner Dave Jones wants industry giant Anthem Blue Cross barred from the state's new health exchange for small businesses because he says the company imposes excessive rate hikes. Jones said the state's largest for-profit health insurer should be denied access to the state-run market where thousands of small employers will purchase health coverage for their workers (Terhune, 6/13).

Kaiser Health News: Capsules: California Insurance Chief Wants To Bar Anthem From Selling Small Business Coverage
Citing a pattern of 'unreasonable rate increases' for small business customers by Anthem Blue Cross, California Insurance Commissioner Dave Jones said Thursday he will recommend that the state's new online insurance marketplace exclude the firm from selling small business coverage (Appleby, 6/13).

The Associated Press: Minn. Health Insurance Call Center Opens In Sept.
The call center for Minnesota's new health insurance marketplace will be operational Sept. 3 to help prepare consumers for buying coverage when open enrollment begins a month later, officials said Wednesday. MNsure's executive director, April Todd-Malmlov, updated board members on customer assistance plans for the exchange, where starting Oct. 1 about 1.3 million Minnesotans are expected to get their coverage, including 300,000 who don't currently have health insurance (Karnowski, 6/13).

Kaiser Health News: Capsules: Preparing For Flood Of Consumer Questions On Insurance Exchanges
On Oct. 1, individual consumers and small businesses will be able to enroll in the online health insurance marketplaces known as exchanges. Minnesota, where the state is running the exchange, and Florida, where the federal government will be in charge, are preparing in different ways. Under the Affordable Care Act, most Americans who don't already have health insurance through employers, Medicare or some other source are required to get it as of Jan. 1 or pay a fine. Subsidies will be available for people who earn up to 400 percent of the federal poverty level to buy insurance (Girshman, 6/13).

In other news related to health exchanges -

Health News Florida: Prepare For Launch Of 'Get Covered' Campaign
On June 22, consumer-health groups across the nation will launch what they hope will be a massive education and enrollment campaign to find uninsured people and get them ready to sign up for health coverage. The campaign will be called “Get Covered, America!” Its official launch is June 22 because that marks 100 days until the opening of state and federal online “marketplaces” where the uninsured can shop for coverage (Gentry, 6/13).

Weekend Reading: Seeking Better Health Outcomes For Homeless People; What Becomes Of The Women Denied Abortions?

Fri, 14 Jun 2013 13:11:44 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Nation: Revealed: Letters From Republicans Seeking Obamacare Money
Even before President Obama signed the Affordable Care Act into law, Republicans were vowing to repeal it. It's no wonder, because polls showed that the basic elements of the ACA were quite popular, and there was a real danger that it would become more so as people found out that the plan denounced as a "monstrosity" by the National Republican Senatorial Committee would not trample on their liberties so much as help protect their health. ... Now letters produced by a Freedom of Information Act request reveal that many of these same anti-Obamacare Republicans have solicited grants from the very program they claim to despise (Lee Fang, 6/5).

Forbes: Why Conservatives Shouldn't Cheer The Cadillac Tax (And Neither Should Anyone Else)
Jonathan Cohn would like you to believe that conservatives are so irrational in their hatred of Obamacare that they even despise parts of the law that should make them cheer, such as the Cadillac tax on high cost health plans. Mr. Cohn is correct in asserting that “writers like James Capretta and Robert Moffit have long called for reducing or eliminating the tax breaks for employer sponsored insurance.” But there’s a world of difference between how conservatives would cap or eliminate the current employer tax exclusion and the Cadillac tax (Chris Conover, 6/5).

The New York Times Magazine: What Happens To Women Who Are Denied Abortions?
S. arrived alone at a Planned Parenthood in Richmond, Calif., four days before Christmas. As she filled out her paperwork, she looked at the women around her. Nearly all had someone with them; S. wondered if they also felt terrible about themselves or if having someone along made things easier. … When Diana Greene Foster, a demographer and an associate professor of obstetrics and gynecology at the University of California, San Francisco, first began studying women who were turned away from abortion clinics, she was struck by how little data there were. A few clinics kept records, but no one had compiled them nationally. And there was no research on how these women fared over time (Joshua Lang, 6/12).

The Atlantic: When People Seem To Want To Be Sick
Münchausen syndrome is sometimes referred to as "hospital addiction syndrome" or "thick chart syndrome," because patients present again and again to physicians' offices and hospitals. ... We usually suppose that no one would ever want to be sick, but this is clearly not the case. Some patients with Münchausen syndrome fake laboratory test results by contaminating blood and urine samples, and others are so desperate that they will actually inject themselves with urine or feces in order to make themselves sick. Such extraordinary acts remind us that the role of patient offers many rewards in addition to attention, including relaxed responsibilities in work and family life, and for some, perverse enjoyment at fooling others (Dr. Richard Gunderman, 6/11).

Los Angeles Times: Experts Seek Better Health Outcomes For Homeless
Years after facing patient dumping allegations and hefty legal settlements, Southern California hospital executives have begun working with advocates for the homeless to improve the health of homeless patients and to reduce their use of area hospitals. Hospital administrators are driven by the national healthcare law, which offers incentives to provide better care at lower cost and imposes penalties when patients are unnecessarily readmitted to hospitals. Homeless patients are among the most frequent users of the region's medical centers, often because they lack regular medical care (Anna Gorman, 6/10).

Research Roundup: Studying States' Readiness For Insurance Exchanges

Fri, 14 Jun 2013 13:10:00 GMT

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Unauthorized Immigrants Spend Less Than Other Immigrants And US Natives On Health Care – Unauthorized immigrants' options for health care generally consist of hospital emergency rooms and community health centers. Using nationally representative survey data from 2000 to 2009, researchers compared medical spending for unauthorized immigrants, legal residents, naturalized citizens, and natives of the United States and found that "unauthorized immigrants have lower health care spending overall but higher rates of receiving uncompensated care than legal immigrants and US natives." They note: "Just 7.9 percent of unauthorized immigrants benefited from public-sector health care expenditures (receiving an average of $140 per person per year), compared to 30.1 percent of US natives (who received an average of $1,385). Policy solutions could include extending coverage to unauthorized immigrants for the prevention and treatment of infectious diseases or granting them access to the Affordable Care Act’s insurance marketplaces, which start in 2014" (Stimpson, Wilson and Su, 6/12).

The Dartmouth Atlas Project: Tracking Improvement In The Care Of Chronically Ill Patients: A Dartmouth Atlas Brief On Medicare Beneficiaries Near The End Of Life – According to the authors, the quality and efficiency of care given to patients during the last six months of life improved from 2007 to 2010. "Overall, patients spent fewer days in the hospital and more received hospice services in 2010 compared to 2007," they report, adding the "changes reflect the preferences of most patients to spend their last weeks and months in a home-life environment whenever possible, avoiding procedures that have little chance of improving the quality or length of their lives. But the pace of change varied across hospitals, with some experiencing rapid change while other health systems showed little improvement." They conclude: "Less intensive and expensive care can both save money and improve quality, satisfaction, and outcomes for many Medicare beneficiaries" (Goodman et al., 6/12).

Centers For Studying Health System Change/California HealthCare Foundation: Ready Or Not: Are Health Care Safety-Net Systems Prepared For Reform? – When it comes to implementing the Affordable Care Act, safety-net providers – public hospitals and community health centers – are falling behind, according to the authors: "Almost all safety-net providers in the study reported concerns about sufficient funding and workforce to care for newly insured people and for those who remain uninsured." They add that "at the same time, these safety-net providers are bracing for potential competition for insured patients from other providers and a consequence reduction in revenue." They studied six California communities in 2011 and 2012. "The findings ... indicate that community activities to prepare for health care reform can help mitigate the stress on the health care system to enroll and care for people come 2014," they conclude (Felland and Cross, 6/12).

Centers For Studying Health System Change/Robert Wood Johnson Foundation: Denver: Competitive Insurance Market Awaits National Health Reform – The authors note that Colorado is a leader compared to other states in preparing for the health law's insurance marketplaces. Based on interviews, they write that "Denver-area health plan executives, benefits consultants, brokers and others expressed concerns about the market’s readiness for open enrollment in the exchange on Oct. 1. Top concerns include the uncertainty about the impact of health reform on risk selection and premium costs." Respondents expected "most of the major Denver carriers –Anthem, United and Kaiser – to participate in the exchange," the authors write and also highlight other top concerns including uncertainties in setting premiums and possible rate shock (Felland, Carrier, Lechner and Gourevitch, 6/13).

Counting Down To Online Insurance Marketplaces

Mon, 10 Jun 2013 13:33:00 GMT

The Wall Street Journal reports that consumers should start investigating the health law's insurance exchange options.

The Wall Street Journal: Prepare For Big Piece Of Health Law
It's time to get ready to buy insurance. The biggest part of the health-care law—online exchanges that offer insurance to individuals—kicks in next year. And beginning this October, states will start selling those health-care plans, which adhere to a new set of standards, though online marketplaces. But there already are many ways that you can start investigating options ahead of the rollout. This summer is prime time to educate yourself about your options, say health-insurance experts (Johnson, 6/8).

Meanwhile, news outlets provide health law implementation news from D.C., California and Massachusetts -

The Washington Post: D.C. Offers A Peek At The Health Insurance Prices Proposed For New Exchange
In the first glimpse of what District residents and small business owners can expect to pay for health-care coverage under Obamacare, officials on Friday released a snapshot of the proposed plans from four major insurance companies. ... officials say a preliminary look reveals a large range of options at prices consistent with current rates (Vargas, 6/7).

Los Angeles Times: Town Hall Explains Healthcare Reform To Los Angeles Residents
Hundreds of L.A. County residents attended a town hall meeting at Cal State L.A. on Friday afternoon to learn about the state’s new insurance exchange, which will begin enrolling people this fall. Peter Lee, executive director of the health exchange called Covered California, explained what health plans were participating, what benefits were covered and how the enrollment would occur before taking dozens of questions from audience members (Gorman, 6/7).

Boston Globe: State May Fill Gap In Federal Health Care Coverage
A congressional mistake that could cause nearly 4 million people to be ineligible for federal subsidies in President Obama's health care law has prompted Massachusetts officials to launch a new effort to try to close the gap. Under what has become known as a "glitch" in Obama’s health plan, eligibility for insurance subsidies will be based on how much it costs workers who buy an individual plan, not the far more expensive family plan. ... Governor Deval Patrick’s administration has proposed a pilot program to allow workers at small businesses who cannot afford family coverage under their employer-sponsored health plans to qualify for subsidies (Jan, 6/10).

In other state news related to the health law -

Arizona Republic: Medicaid Expansion Gets Hearing In House
Facing a looming budget deadline and a bitterly divided Republican caucus, the state House today takes up Gov. Jan Brewer’s plan to expand Medicaid along with a controversial abortion bill some say is designed to kill the governor’s top legislative priority. The House Appropriations Committee will hold what is expected to be a contentious hearing on the two bills, likely ending with the defeat of Senate Bill 1492, which outlines Brewer’s plan to broaden Medicaid eligibility under the federal health-care overhaul (Reinhart, 6/10).

Lawsuits, Congressional Charges And Questions About Health Law Initiatives

Mon, 03 Jun 2013 14:10:00 GMT

News outlets explore a range of issues related to the health law's implementation.

Los Angeles Times: Affordable Care Act's Challenge: Getting Young Adults Enrolled
The success of the healthcare law "depends on reaching everyone who is uninsured, but particularly young people who may feel like they don't need insurance," said Larry Levitt, a senior vice president at the Kaiser Family Foundation. Convincing them to spend money on insurance, he said, will be a "marketing challenge" (Gorman, 6/2).

Kaiser Health News: Will Consumers Sign On For Health Law's Co-Ops?
People in the market for health insurance in Oregon want to know what their out-of-pocket expenses will be -- down to the dollar. They want doctors who reply to email. They want the option to see alternative practitioners. ... That’s what focus groups have told Oregon’s first consumer-owned and operated health plan. And that’s what the fledgling co-op is promising to deliver later this year when it begins enrolling its first members. ... But will customers buy insurance from upstart nonprofits? And will the co-op plans be competitive with those offered by industry giants like UnitedHealthcare and Aetna which have the clout to exact big discounts from hospitals and doctor groups (Rabin, 6/2)?

The Hill: House Republicans Renew Effort To Gut Obama's Healthcare 'Slush Fund'
House Majority Leader Eric Cantor (R-Va.) told his GOP colleagues in a Friday memo that leaders will try again in June to pass a bill that would gut what they call a multi-billion dollar "slush fund" in ObamaCare. Republican leaders tried in April to kill the Prevention and Public Health fund, as part of a bill that also sought to boost funding for a Pre-existing Conditions Insurance Plan (PCIP). But rank-and-file Republicans rebelled against boosting the PCIP, which was also part of ObamaCare. ... According to Cantor, the Helping Sick Americans Now Act, H.R. 1549, has been retooled so that it will still repeal the slush fund, but will not boost funding for the PCIP. Instead, the bill will fund state-based high-risk pools (Kasperowicz, 5/31).

The Hill: Court Challenges Could Tear Down Major Pieces Of ObamaCare
Despite surviving a stiff challenge at the Supreme Court last year, some of the law’s biggest provisions remain at risk from legal challenges. One set of lawsuits accuses the Internal Revenue Service of illegally implementing new subsidies to help people buy insurance. Separately, more than 60 lawsuits have been filed challenging the law’s mandate for health plans to cover birth control. A loss for the administration on the contraception mandate would undermine a key selling point for the law that Democrats used to court women in the 2012 elections. The challenge to the law's insurance subsidies, while more obscure, poses a far bigger and more dangerous threat to the Affordable Care Act (Baker, 6/2).

Politico: Innovation Director Of CMS Is Moving On
The innovation center charged by the health reform law with finding solutions to the toughest questions in health care — how to reduce costs and change the way health care is delivered — is losing its first leader (Haberkorn, 6/3).

Politico: How Well Do You Know Kathleen Sebelius?
Department of Health and Human Services Secretary Kathleen Sebelius has spent much of her career in politics, and has been in the headlines as the next stages of President Barack Obama's Affordable Care Act are implemented. But how well do you know her? Take POLITICO'’s quiz to find out (Cirilli and Gold, 6/3).

Research Roundup: Questioning Money-Saving Value Of Kids' Preventive Dentistry, Weight Loss

Fri, 31 May 2013 12:35:50 GMT

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Pediatrics: Effectiveness Of Preventive Dental Visits In Reducing Nonpreventive Dental Visits And Expenditures – Although early preventive dental visits are widely recommended for children, it is unclear whether they reduce future dental visits or costs. Using 1998 to 2010 data from Alabama’s Children’s Health Insurance Program (CHIP) and other state health care programs, researchers found that "children require fewer nonpreventive dental services when they have more preventive visits, indicating that preventive services do improve oral health." But they also note that "more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures" (Sen et al., 5/27).

American Public Health Association's Medical Care Journal: The Effect Of Weight Loss On Health, Productivity, And Medical Expenditures Among Overweight Employees – More than 28.5 percent of full-time employees are currently obese in the United States. Another 38 percent are overweight. The authors analyzed data from employees of community colleges and universities and found that significant weight loss of 5 percent or more prevented short-term deterioration in employees’ health-related quality of life and reduced absenteeism, and "there is some evidence that employee productivity is increased." But, they add: "We find no evidence of a quick return on investment from reduced medical expenditures, although this may occur over longer periods" (Bilger et al., June 2013).

Annals Of Emergency Medicine: The Relationship Between Emergency Department Use And Cost-Related Medication Nonadherence Among Medicare Beneficiaries – According to the authors, "despite improved coverage and associated declines in out-of-pocket spending, 11 percent of Medicare beneficiaries continue to report skipping doses, splitting pills, or not filling medications because of cost." They used 2006 and 2007 survey data to evaluate the relationship between beneficiaries’ self-reported nonadherence to prescription drugs and emergency department (ED) use. “Our results show that severe cost-related medication nonadherence is associated with a statistically significant increased risk of ED use," the authors report, and conclude: "Specific policies that aim to decrease cost-related medication nonadherence are likely needed for disabled Medicare beneficiaries, who represent a high-risk, high-use population" (Blanchard et al., 5/30).

JAMA Ophthalmology: Surgical Outcomes And Cost Basis For Resident-Performed Cataract Surgery In An Uninsured Patient Population – Cataract surgeries involve the removal of a clouded lens in the eye. Using medical records of 143 uninsured patients who had such procedures from 2005 to 2011, University of Washington researchers measured the clearness of vision before and after surgery performed by residents. “As in other studies, we found that cataract surgeries remained a cost-effective intervention in patients with modest levels of preoperative visual impairments,” the authors report. "As the nature of surgical training evolves, our study provides evidence of the success and cost-effectiveness of resident-performed cataract surgery in an underserved patient population," they conclude (Moore and Slabaugh, 5/30).

Here is a selection of news coverage of other recent research:

Reuters: 'Workplace Wellness' Fails Bottom Line, Waistlines - RAND
According to a report by researchers at the RAND Corp, programs that try to get employees to become healthier and reduce medical costs have only a modest effect. Those findings run contrary to claims by the mostly small firms that sell workplace wellness to companies ranging from corporate titans to mom-and-pop operations. ... The report found, for instance, that people who participate in such programs lose an average of only one pound a year for three years (Begley, 5/24).

Forbes: RAND Corporation (Briefly) Publishes Sobering Report On Workplace Wellness Programs
For a short period of time last Friday, the RAND Corporation’s much anticipated final report on Workplace Wellness was available online. At least Reuters managed to snag a copy before RAND withdrew it. RAND’s website now says: "This document was posted in error and has been withdrawn pending completion of contractual obligations to the project sponsor" (Munro, 5/28).

The Washington Post: Simple Strategy Works Best To Reduce Infections, Study Finds
Using germ-killing soap to wash the sickest patients every day and applying antibacterial ointment inside their noses turns out to be the most effective way to reduce deadly hospital bloodstream infections, according to a study published Wednesday that has broad implications for practical use. The findings suggest the simple strategy could save lives, researchers said. ... The study [was] published in the New England Journal of Medicine (Sun, 5/29).

The Washington Post: Study: TV And Movie Characters Are Smoking Less But Still Drinking Heavily
The tobacco industry really took a beating in 1998. The Master Settlement Agreement (MSA) they signed with state attorneys general required them to give states $206 billion in compensation for the Medicaid and other costs of treating sick smokers. ... You’d expect to see fewer cigarettes in movies after a deal like that. But the size of the decline may surprise you. A new study in JAMA Pediatrics by Elaina Bergamini, Eugene Demidenko and James Sargent at the Norris Cotton Cancer Center and the Geisel School of Medicine at Dartmouth College finds that the MSA led to an exponential decline in the appearance of tobacco brands in movies. ... But the portrayal of alcohol didn’t change much at all (Matthews, 5/29).

Modern Healthcare: Chains Have Best Effect On Acquired Hospitals, Survey Says
Multistate chains do a better job at improving the financial performance of acquired hospitals than local or regional systems, according to a Deloitte analysis. The survey — which included 77% of hospital deals forged in 2007 and 2008 — looked at the financial performance of acquired hospitals through 2010. It found that national chains take better advantage of workforce, supply chain and payer synergies, and they're also more effective at increasing volume (Kutscher, 5/30).

Modern Healthcare: Medicare Readmission Rate Falls, But Cause Unclear, Study Says
A new study finds that U.S. hospitals recorded about 70,000 fewer cases than expected of Medicare patients being readmitted for inpatient care last year. That finding is likely to hearten policymakers and health system leaders who have pushed for financial incentives and procedures to improve post-discharge care and coordination as a way to avoid readmissions. But the study does not definitively show the decline in readmission rates was directly caused by those payment and quality reforms (Carlson, 5/30).

Obamacare Partisan Fights Affecting Public Opinion, Capitol Hill, Health Coverage For Poor

Mon, 27 May 2013 19:54:23 GMT

News outlets report that as the health law comes closer to full implementation in 2014, the political parties are far apart and likely to stay there, which could affect who gets coverage and how.

CNN: Poll: Do You Support Or Oppose The Health Care Law?
A majority of Americans still oppose the nation's new health care measure, three years after it became law, according to a new survey. But a CNN/ORC International poll released Monday also indicates that more than a quarter of those who oppose the law, known by many as Obamacare, say they don't support the measure because it doesn't go far enough. ... The wide partisan divide over the law remains (5/27).

The Associated Press: Republicans See 'Obamacare' Issues As Key To 2014
If Republicans were writing a movie script for next year's congressional elections, the working title might be "2014: Apocalypse of Obamacare." The plot: The rollout of President Barack Obama's health care law turns into such a disaster that enraged voters rebuke him by rewarding the GOP with undisputed control of Congress. But there's a risk for Republicans if they're wrong and the Affordable Care Act works reasonably well, particularly in states that have embraced it. Republicans might be seen as obstinately standing in the way of progress (Alonso-Zaldivar, 5/27).

The New York Times: Partisan Gridlock Thwarts Effort to Alter Health Law
Almost no law as sprawling and consequential as the Affordable Care Act has passed without changes — significant structural changes or routine tweaks known as “technical corrections” — in subsequent months and years. ... But as they prowl Capitol Hill, business lobbyists like [Scott] DeFife, health care providers and others seeking changes are finding, to their dismay, that in a polarized Congress, accomplishing them has become all but impossible. ... As the clock ticks toward 2014, when the law will be fully in effect, some businesses say that without changes, it may be their undoing (Weisman and Pear, 5/26).

The Hill: Sebelius On Hot Seat Amid Rising Angst Over ObamaCare Rollout
The Health and Human Services (HHS) secretary is implementing the biggest change to the nation’s healthcare system in decades, and the stakes couldn’t be higher. ObamaCare will be a top issue for voters, if not the top issue, in the 2014 election. ... ObamaCare has always been controversial, routinely blasted by the GOP. But now, Sebelius is taking some friendly fire. A liberal lawmaker who requested anonymity said, “She's been terribly defensive, terribly slow to react" (Vieback, 5/27).

The New York Times: States’ Policies on Health Care Exclude Some of the Poorest
The refusal by about half the states to expand Medicaid will leave millions of poor people ineligible for government-subsidized health insurance under President Obama’s health care law even as many others with higher incomes receive federal subsidies to buy insurance. ... People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance (Pear, 5/24).

Tensions, Threats Emerge In Ariz. Medicaid Expansion Debate

Fri, 24 May 2013 13:41:00 GMT

In addition, the legislative debate continues in Texas while in Florida there's speculation about what's to become of the state's uninsured population now that the legislature didn't take action.

Arizona Republic: Threat, Vetoes Fly As Tensions Rise Over Medicaid Expansion
Gov. Jan Brewer sent five bills to the scrap heap Thursday in a pointed gesture intended to prod lawmakers into a deal on the budget and her plan to expand Medicaid. The five vetoes, follow-through on Brewer’s promise to block legislation until her top priorities move forward, capped a tense day that saw some lawmakers receive threats over their support for the plan to provide health care for more of the state’s poor (Pitzl, 5/23).

The Associated Press/Washington Post: Republican Arizona State Representative Says She got Threatening Message Over Medicaid Support
A Republican member of the Arizona House who supports GOP Gov. Jan Brewer's push to expand Medicaid received an obscene and threatening voicemail at her office, a sign that the rancorous debate over embracing a signature component of President Barack Obama's health care overhaul in the state is far from over (5/23).

The Texas Tribune: Amendment On Medicaid Expansion Unlikely To Stick
An amendment that blocks Texas from expanding Medicaid without legislative approval doesn’t seem likely to stick. The House on Thursday knocked down a nonbinding motion to instruct conferees to keep the "anti-Medicaid expansion" amendment when they meet with Senate members to work out the final language of Senate Bill 7 (Aaronson, 5/23).

Health News Florida: Left Out: FL's Poorest Uninsured
At 7 a.m. on a Monday morning, poor people who don't qualify for government health programs such as Medicaid are lined up outside a health department building on a busy street in St. Petersburg…These are some of the people who will not gain health insurance when the federal health law kicks into high gear on Jan. 1. They'll be left out because they are in Florida, one of the states that turned down federal funds to cover adults below the poverty level – people with incomes under about $11,500 (Gentry, 5/23).

Health Care Issues Become Hurdle For Immigration Reform Measure

Fri, 24 May 2013 13:10:00 GMT

The key question that seems to have stalled progress for House lawmakers is how to handle immigrants who do not have health insurance.

Los Angeles Times: Immigrant Health Care Bills Stump House Group
Differences over whether immigrants should be deported for failing to have health insurance or pay their health care bills have stalled a bipartisan group of House lawmakers, who blew past a self-imposed Thursday deadline as they pressed forward on a sweeping immigration overhaul (Mascaro, 5/23).

The Wall Street Journal: House Immigration Effort Hits Bump In The Road
Last week, a bipartisan group of House lawmakers thought they had a broad deal on how to overhaul the immigration system. This week, they don't. The eight House lawmakers were forced to backtrack from the "agreement in principle" reached last Thursday after House Democratic leaders objected to a provision dealing with health care coverage for illegal immigrants living in the U.S., according to aides from both parties. The group continued to meet this week, and its members remained hopeful they would be able to strike a deal that passes muster among all involved (Peterson, 5/23).

Modern Healthcare: Taxpayers Won't Pay Health Care Costs For Undocumented Immigrants
Two days after the Senate Judiciary Committee passed a comprehensive immigration reform bill, House Minority Leader Nancy Pelosi (D-Calif.) promised that U.S. taxpayers would not bear the cost of health care coverage for undocumented immigrants who are on the path to citizenship. Earlier reports had hinted that the coverage provisions under the Patient Protection and Affordable Care Act might be a sticking point as House members draft their own immigration-reform legislation (Zigmond, 5/23).

State Roundup: Okla. Gov. Pushes Funding Fix To Cover 9,000 On Medicaid

Mon, 20 May 2013 04:00:00 GMT

A selection of health policy stories from Oklahoma, Texas, California and Massachusetts.

The Associated Press: Fallin Urges Last-Minute Health Care Fix
Gov. Mary Fallin proposed a last-minute legislative change Friday to the state's Insure Oklahoma program that would direct $50 million in state tobacco taxes to pay for more than 9,000 people who are expected to lose their health insurance under the program. Insure Oklahoma currently uses federal Medicaid funding, state tobacco tax revenue and payments from workers and employers to provide health insurance to about 30,000 low-income Oklahomans, but the federal government notified Oklahoma last week that the program must change in order to qualify for federal funding (Murphy, 5/18).

The Associated Press: Legislators Devote New Funding To Mental Health
For the first time since (Texas) state lawmakers made historic budget cuts a decade ago, legislators are dedicating hundreds of millions more dollars to mental health care. (Haven for Hope in Bexar County) serves as a model of the services and success they aim to accomplish. ... As Republicans and Democrats in the Texas House and Senate hash out the details of the state’s 2014-15 budget — there are fights over water, roads and education — one issue they are not arguing about is support for mental health. "One thing we could all agree on was mental health was, to a large extent, a driver of crime," said state Rep. John Zerwas, R-Simonton (Grissom and Rocha, 5/19).

The Texas Tribune: House OKs Bill To Expand Mental Health In Managed Care
Managed care plans would be required to offer more mental health services to Medicaid recipients under a bill tentatively approved by the House on Friday. … The majority of mental health services -- such as medication management and counseling -- are already provided to Medicaid recipients through managed care (Aaronson, 5/17).

Los Angeles Times: City Of San Francisco, Worker Unions Protest Kaiser Premium Hike
It's a trend many public employees can relate to: Health insurance premiums climb year after year, while at the bargaining table workers have agreed to kick in more for pensions, take salary cuts and sign on to furlough days. But when Kaiser Permanente -- which insures 45,000 public workers here -- proposed another hike for 2014, San Francisco's Health Service System teamed up with labor unions to say "no more" (Romney, 5/19).

Los Angeles Times: St. John's Picks Providence Health & Services In Bidding War
After months of controversy, the owner of St. John's Health Center said it plans to sell the landmark Santa Monica hospital to Catholic chain Providence Health & Services. The hospital has been at the center of an intense competition that featured bids from UCLA Health System, other Catholic hospital chains and Los Angeles billionaire Patrick Soon-Shiong (Terhune, 5/17).

The Texas Tribune: Texas On Track To Restore Cancer Research Funding
The Legislature is on track to restore financing for the Cancer Prevention and Research Institute of Texas. In an effort to restore public trust in the beleaguered agency, budget negotiators made the agency's financing for 2014-15 biennium -- $595 million -- contingent upon the passage of Senate Bill 149, which the House tentatively approved on Friday (Aaronson, 5/17).

Medpage Today: No Hike In Mass. Hospital Use Post Health Reform
Health care reform in Massachusetts did not increase overall use of inpatient resources, but other states may not be so lucky, researchers found. Before and after a reform, the average number of quarterly admissions per hospital was 1,502 and 1,557, respectively -- translating into a nonsignificant net change of 0.3 percent when compared with controls, according to Amresh D. Hanchate, PhD, an economist at the Veterans Affairs Boston Healthcare System, and colleagues (Kaiser, 5/17).

California Healthline: Assembly Approves Race, Ethnicity In Quality Reporting
The Assembly yesterday passed a bill that requires state officials to include race and ethnicity when compiling health care quality data. AB 411 by Assembly member Richard Pan (D-Sacramento) would not create any kind of difficulty for state officials, since that data already exists, according to Pan. The point is to make state officials use it, Pan said. … The information is already being collected by the state Department of Health Care Services so it's not really much more work to mine that data for health disparities by race or ethnicity, Pan said (Gorn, 5/17).

State Roundup: N.D. Abortion Clinic Sues To Stop New Law

Thu, 16 May 2013 13:42:00 GMT

A selection of health policy stories from North Dakota, Connecticut, California, Massachusetts, Texas, Oregon, Oklahoma and North Carolina.

The New York Times: North Dakota's Sole Abortion Clinic Sues To Block New Law
The running battle over the regulation of abortions entered a North Dakota courtroom on Wednesday, as the state’s sole abortion clinic sued to block a new law that it says could force it to shut down. The law, requiring doctors performing abortions to have admitting privileges at a nearby hospital, was promoted by anti-abortion legislators, who argued that it would mean better care for women who suffer medical emergencies (Eckholm, 5/15).

CT Mirror: Big Health Care Savings Help Counter Shrinking State Budget Revenues
State officials trying to close a last-minute hole in the next budget got some good news Wednesday in the form of major savings in health care costs for retired state employees. The Legislature’s nonpartisan Office of Fiscal Analysis issued a memo indicating it has reduced its projected cost of providing health care to retired state workers in the fiscal year that begins July 1 by $140.6 million, and in 2014-15 by $166.5 million. The nonpartisan office is boosting the projected health care costs for current employees by $46.7 million in the next budget and by $36.4 million in 2014-15, but the net savings over the next two years still totals $224 million (Phaneuf, 5/15).

HealthyCal: Counties Still Not Prepared To Offer Expanded Mental Health Care
More than one million people in California suffer from mental illness -- the largest number of any state. When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder. But mental health providers in the state’s Central Valley are unprepared for an influx of thousands of patients (5/16).

Boston Globe: State Health Insurers Post Mixed Financial Results
The state’s biggest health insurers reported mixed first-quarter financial results Wednesday, with two notching income gains, one registering lower earnings, and one posting a loss. While all of the health insurance companies said they were working to hold down premiums as they rolled out new products and shifted doctors and hospitals to risk-sharing payments, each cited unique factors influencing financial performance in the three months ending March 31 (Weisman, 5/15).

Los Angeles Times: 13 Health Care Workers Arrested In Protest At UC Regents Meeting
Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by health care workers threatening to strike at the system's medical centers. The University of California regents left during the protest while UC police cleared the room, handcuffing the protesters and leading them out of the hall at the Sacramento Convention Center (Gordon, 5/15).

The Texas Tribune: Senate Backs Bill On Psychotropic Drugs For Foster Kids
Lawmakers in both chambers have now endorsed legislation that would require guardians of foster children to take greater caution before giving psychotropic drugs to the children. The Senate on Wednesday approved a version of the "informed consent" measure that is slightly different than the one approved by the House in April (Aaronson, 5/15).

Lund Report: Oregon House Passes Assessments For Hospitals And Nursing Facilities
The House passed assessment taxes on hospitals and long-term care facilities by a wide 54-5 margin Tuesday, ensuring Oregon’s health and human service budgets will raise over a billion dollars from providers in coming years and leverage $1.4 billion from the federal government next biennium for Medicaid. Hospitals are compensated for their assessments with higher reimbursements for the Oregon Health Plan while nursing homes are paid for the use of their beds by Medicaid patients. … House Bill 2216 extends an expanded hospital assessment of 5.32 percent for two years. A previous bill, House Bill 2056, was attached to that version, which extends the long-term care facility assessment for six years, while expanding it to include all nursing homes except the Oregon Veterans Home (Gray, 5/15).

Lund Report: Single-Payer Activists Keep Dream Of Universal Health Care Alive In Oregon
Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield. But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn't submitted his driver's license. … Eventually, his policy was approved. He paid $2400 -- three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization (Gray, 5/15).

Stateline: Oklahoma's "Life-Preserving" Law Raises Questions For Doctors
University of Tulsa law professor Marguerite Chapman has been studying end-of-life issues in Oklahoma for three decades and has come to a conclusion: "It's getting almost to the point that you need a government permit in order to die in this state." Certainly, dying has gotten a lot more complicated here, the result of a unique measure passed by the Oklahoma legislature and signed into law last month by Republican Gov. Mary Fallin. Modeled after legislation written by the National Right to Life Committee, the law says that patients who are disabled, elderly or terminally ill cannot be denied life-preserving treatments if they or their health proxies want it (Ollove, 5/16).

North Carolina Health News: Bill To Compel Insurers To Cover Autism Treatment Advances
For kids with autism in North Carolina, it’s possible to get insurance coverage for the process of diagnosing the developmental disorder. But for the bulk of those kids, getting an insurance company to cover treatment is another matter (Hoban, 5/15).

Oregonian: Mental Health Staff In Oregon Prison System Push For Big Raises
A group of unionized mental health workers in the Oregon state prison system wants a pay raise that even they acknowledge is big enough to cause a public relations problem. About 50 mental health specialists who handle inmates with addictions and other mental health problems want to be reclassified because their job descriptions have changed, including a requirement of a master's degree. Under their current proposal, they're seeking raises between 25 percent and 26 percent, which would result in a maximum salary of more than $80,000, according to a memo obtained by The Oregonian (Esteve, 5/15).

State Roundup: Miss. Gov. Says Medicaid Can Go On Without Reauthorization

Thu, 09 May 2013 13:30:00 GMT

A selection of health policy news from Mississippi, Kansas, California, Georgia, Minnesota, Wisconsin, Massachusetts and Colorado.

The Associated Press: Miss. Governor Says He Could Run Medicaid Program
Mississippi Gov. Phil Bryant says he thinks he can run Medicaid even if lawmakers don't reauthorize the program or set its budget by the time the state's new fiscal year starts July 1. The Northeast Mississippi Daily Journal reported Bryant's remarks and said he spoke about Medicaid after taking part in a tourism event at the state Capitol (5/9).

Kansas Health Institute: More Than 1,000 Rally At Statehouse For DD Carve-Out
A Statehouse rally today that coincided with the start of the Legislature's wrap-up session drew about 1,100 people from across the state to protest Gov. Sam Brownback's plan to include long-term supports for the developmentally disabled in KanCare. ... [Protestors] at the rally did not believe that the insurance companies hired by the state to manage its Medicaid program had the experience to handle long-term services for the developmentally disabled (Shields, 5/8).

Los Angeles Times: California Ranks 11th In Hospitals With A Grades For Safety
Ronald Reagan UCLA Medical Center improved slightly from an F to a D in a national hospital safety report released Wednesday, while Cedars-Sinai Medical Center stayed at a C grade. Leapfrog Group, a nonprofit health care quality organization, based the scores on an analysis of infections, injuries, medication errors and other problems that cause patient harm or death. The organization publicizes the scores in an effort to inform patients and reduce safety problems, said Leah Binder, its president and chief executive (Gorman, 5/8).

The Associated Press: SF Eateries Pay $845K To Settle Health Care Claims
San Francisco's city attorney says his office has recovered nearly $845,000 from 19 restaurants that allegedly charged customers for the cost of complying with the city's universal health care law but did not use most of the money for that purpose. City Attorney Dennis Herrera said Wednesday that the money had come from eateries that took advantage of a one-time amnesty program his office announced in January (5/8).

Georgia Health News: A Prescription To A Fun Place Could Be A Lifesaver
Overweight patients are being encouraged to take a walk, if not a hike. A unique collaboration between the Georgia Association of Physician Assistants (GAPA) and Georgia State Parks seeks to promote physical fitness in a fresh-air way. For a day trip to one of Georgia’s state parks, there’s normally a $5 parking fee. But nowadays, physician assistants in the state can hand out "Rx For Fitness" prescriptions that allow that charge to be waived (Kanne, 5/8).

MPR News: Growth Continues At Mayo Clinic's Three Campuses
In his pitch to state legislators for $500 million to help Mayo Clinic with its $5 billion expansion, Mayo Clinic President and CEO Dr. John Noseworthy has repeatedly said if Minnesota does not provide a taxpayer subsidy, other states would be eager for Mayo Clinic to expand. Two of the most logical places would be Florida and Arizona, where existing Mayo Clinic campuses are growing steadily. Mayo Clinic is investing hundreds of millions of dollars at all three of its campuses to strengthen each as a major regional medical hub (Baier, 5/8).

HealthyCal: Ballot-Mandated Drug Treatment Cut, Despite Success
In 2000, California voters overwhelmingly approved Prop 36, a ballot measure that offers non-violent drug offenders treatment instead of jail. But now the Substance Abuse and Crime Prevention Act is on life support, if not altogether dead, despite data that shows it has saved taxpayers money and tamped down recidivism among its participants (Urevich, 5/9).

Milwaukee Journal Sentinel: Wisconsin Assembly Passes Measure That Changes What Doctors Must Tell Patients For Diagnoses
The Assembly approved a bill Wednesday changing the standard for what doctors must tell patients when they diagnose them, which Republicans said was necessary in light of a state Supreme Court decision that they see as creating too many problems. Also, the Assembly passed a bill that would delay trials in cases where people are exposed to asbestos. Both measures now go to the Senate, which like the Assembly is controlled by Republicans (Marley, 5/8).

Boston Globe: Massachusetts To Require Labs To Test Marijuana For Medicinal Use
Massachusetts is the first state that will require independent labs to test the safety and quality of marijuana sold for medical use, under final rules that regulators unanimously approved Wednesday. The tests will screen for contaminants such as heavy metals, pesticides, and mold. They will also identify and measure the active chemical compounds in the marijuana (Lazar, 5/9).

Health Policy Solutions (a Colo. news service): Pedaling For Health
In an ambitious new health agenda, Gov. John Hickenlooper is pledging to cut the number of uninsured people in Colorado by 520,000, prevent 150,000 Coloradans from becoming obese and reduce Medicaid costs by $280 million. Hickenlooper this week released a report called The State of Health as part of his commitment to make Colorado the healthiest state in the nation. … The report centers on four key areas of focus: wellness and prevention, expanding health access and coverage, improving health systems and boosting value while cutting costs (Kerwin McCrimmon, 5/8).

Study: Almost Half Of Working-Age Adults Have Inadequate Health Coverage

Fri, 26 Apr 2013 13:52:56 GMT

The Commonwealth Fund concluded that, while the number of uninsured adults dropped during the past two years, a large number of working-age adults had little or no coverage.

Kaiser Health News: Capsules: Survey Finds Rate For Young Adult Coverage Improves While Others Decline
While the number of medically uninsured young adults dropped over the past two years, coverage of the overall working age population failed to improve, according to the findings of the Commonwealth Fund's 2012 biennial health insurance survey released Friday (4/25).

Bloomberg: Uninsured Population Swells In Advance Of U.S. Health Law
Almost half of working-age adults in the U.S. had inadequate health insurance or no coverage at all last year, a widening deficit that the Affordable Care Act should mitigate, according to data from the Commonwealth Fund. About 84 million were uninsured or underinsured, 3 million more than when the 2010 health law was signed and 20 million more than in 2003, the New York-based nonprofit group, which advocates for better health care, said today in a report (Wayne, 4/26).

State Roundup: Calif. Lawmakers Push For Health Plan For Immigrants In U.S. Illegally

Mon, 22 Apr 2013 13:15:00 GMT

A selection of health policy stories from Massachusetts, California, Michigan, Texas, the District of Columbia, Pennsylvania, South Carolina and Tennessee.

Los Angeles Times: Boston Bombing Amputees Face Tough, Costly Recovery
For many of the injured, even those who have health insurance, the process may also be costly. Health insurance plans often restrict coverage for therapy and prosthetics. But a decade of wars has helped fuel breakthroughs that could help many Boston victims -- including those with amputated limbs -- live full, active lives (Levey, 4/21).

Sacramento Bee: Some California Leaders Want Low-Cost Health Care For Undocumented Immigrants
About a million of California's poorest undocumented immigrants would have access to basic low-cost health care under a plan being pushed at the Capitol. President Barack Obama's federal health care overhaul excludes undocumented immigrants, but some California leaders want to fill that gap by offering a safety net of primary and preventive care that does not consider immigration status. The county-run program would give undocumented immigrants – and legal residents who can't afford health insurance but don't qualify for Medi-Cal – the ongoing opportunity to see a doctor, get tested and receive treatment before minor health problems become severe (Sanders, 4/19).

The Associated Press: Bill Allows Refusal Of Health Care On Moral Basis
For 35 years, Michigan law has protected health care providers who refuse to perform an abortion on moral or religious grounds. … Legislation that could be voted on as early as this week in the Republican-led Legislature would extend the same legal protections for any medical service such as providing contraception or medical marijuana, or taking someone off life support. Employers and health insurers -- not just medical providers -- also could opt out of paying for services as a matter of conscience (Eggert, 4/21).

The Texas Tribune/New York Times: Optometrists Seek Negotiating Power With Insurers
A group of Texas optometrists is lobbying the State Legislature for more power to negotiate contracts with health insurance companies, and the measure they are supporting could hit consumers' wallets, some business advocates say (Aaronson, 4/20).

The New York Times: California Tries To Regain Fuller Control Of Prisons
In 1995, a federal court appointed a special master to carry out reforms in mental health care [at California's prison system], which it found inadequate at the time and in violation of the Constitution. The court ruled this month that the federal overseer was necessary to remedy continuing constitutional violations behind problems like the high suicide rate. The state is arguing that mental health care meets or exceeds constitutional standards. It is spending $400 million a year on mental health care in its prisons, and a dozen new facilities valued at a total of $1.2 billion have been built in the past three years or are under construction (Onishi, 4/20).

The Washington Post: Chartered Could Owe D.C. Health Providers $85 Million
The city's doctors, clinics and hospitals could be owed a combined $85 million from the soon-to-be-defunct D.C. Chartered Health Plan, and it remains unclear how the once-dominant city health contractor will be able to pay the vast majority of those claims. ... The $85 million figure, which is about double previous estimates of Chartered's potential liabilities to providers, represents about $60 million in Medicaid claims that have been incurred but have yet to be paid. An additional $25 million could be owed to providers due to litigation -- likely related to a pending battle between Chartered and the MedStar hospital chain (DeBonis, 4/19).

The Washington Post: Problems At Pa. Abortion Clinic Point To Lack Of Facilities Oversight
There was no shortage of red flags about what was allegedly going on in the three-story brick building on a bustling stretch of Lancaster Avenue in West Philadelphia. A routine inspection of Kermit Gosnell's abortion clinic had turned up problems as early as 1989, according to official reports. ... The case has captivated and repulsed a nation where back-alley abortion clinics have become a rarity since 1973, when the Supreme Court legalized abortion. The catalogue of horrors delineated by prosecutors has raised questions about whether there is adequate inspection and regulation of the 1,800 facilities nationwide that provide abortions (Dennis and Somashekhar, 4/20).

Boston Globe: New Spaulding Hospital Is Rehab Rethought
David Estrada, paralyzed from the chest down in a motorcycle accident 18 years ago, remembers well his miserable three months in a rehabilitation hospital room he shared with three other patients. That experience inspired him to help others with disabilities, which is why Estrada stopped short as he rolled his wheelchair through the new Spaulding Rehabilitation Hospital in Charlestown during its construction last winter. He'd heard there was a panoramic water view from the hospital's third-floor gymnasium, but he was not seeing it. The sills blocked the view of anyone in a wheelchair. ... Estrada's observation prompted the lowering of the sills. Price tag for the redo: $300,000 (Lazar, 4/22).

Modern Healthcare: HCA To Grow Presence In Behavioral Health, Official Says
HCA, the Nashville-based hospital giant, is building its presence in the behavioral health space at a time when the field is poised to grow. The publicly traded company has been a "re-start-up" in the sector since late 2009, said Terry Bridges, president of behavioral health care services, who spoke at an Avondale Partners' behavioral health conference this week in Nashville. Bridges joined HCA that year from Psychiatric Solutions, where he was co-chief operating officer. Universal Health Solutions bought Psychiatric Solutions in 2010, and Bridges' arrival at HCA was seen as sign that it planned to boost its own mental health services (Kutscher, 4/19).

California Healthline: Attorney: Decision Overdue In Suit Challenging Medi-Cal Disabled Cuts
A federal judge is "about to decide" a case with large ramifications for the developmentally disabled community. William McLaughlin, an attorney representing The Arc of California, a national disabled-rights group, said a final ruling from U.S. District Court judge Morrison England is coming "any time now." In a Jan. 24 hearing, McLaughlin argued for a preliminary injunction to halt the rate reductions. He contends a decision is overdue (Gorn, 4/19).