Health Reform
News outlets are following the politics and rhetoric surrounding the new health law.
NPR reports on six myths perpetuated by some critics of the law. They include: the law helps President Barack Obama raise a private army and that those who want public coverage have to have a microchip implanted. That began with a provision in House-passed bill, which was not in the final bill. "It called for the Food and Drug Administration to create a registry of medical devices that could be implanted in people. 'We're talking about things like pacemakers, hip implants — things like that,' [Washington and Lee University Professor Timothy Jost] says. So 'that when they fail, we know what's going on, we know the incidence of it and we know how serious the failures are.'" Other myths: the law will require 16,500 new, "armed" IRS agents, thatyou will have to pay taxes on your health insurance next year, that it dictates what you can and can't eat and that hospitals must fire obese employees (Rovner, 9/3).
PolitiFact Florida rates as "False" charges by Florida Republican gubernatorial candidate Rick Scott that "his opponent Alex Sink wants to cut Medicare benefits for the country's seniors. Sink says Scott is making that up. … Scott's basis for claiming that Sink supports cuts is that she supported the 2010 federal health care legislation that implemented a number of changes to the Medicare program. There are potential cuts coming to the extra benefits received by Medicare Advantage enrollees. But the law does not alter basic Medicare benefits, and actually increases some prescription drug benefits. Because she was not a member of Congress, Sink did not cast a vote for or against the new health law" (9/1).
National Journal reports that "some Democrats" would like President Obama to be more vocal on the health law. "At the very least, they would like to hear Obama talk about health care as part of the larger case that he makes for himself and fellow Democrats. … Still, some Democrats argue that a little high-powered help from the president would be useful in framing the health care debate with the GOP. 'Those who are adamantly opposed to health care reform are not going to be voting for Democrats no matter what we do,' said targeting expert Ken Strasma. … For their part, many Democratic candidates [worried about ties to the establishment in Washington] are simply not interested in linking themselves to any national message" (Barnes, 9/3).
The Associated Press: "An anti-abortion group plans to air radio ads in three congressional races calling for the defeat of Democratic incumbents, among the first ads to capitalize on a Supreme Court ruling this year that freed corporations to directly influence elections. ... The group, [Americans United for Life] AUL Action, is targeting Democratic Reps. John Boccieri of Ohio, Christopher Carney of Pennsylvania and Baron Hill of Indiana. … They criticize Boccieri, Hill and Carney for voting for President Barack Obama's health care law. In a statement, AUL Action President Charmaine Yoest said the vote amounted to 'the largest expansion of federal funding of abortion ever'" (Kuhnhenn, 9/2).
Minnesota Gov. Tim Pawlenty, considered a possible 2012 Republican presidential contender, is "likening the federal government to a drug dealer," The Associated Press reports in a separate story. "In an interview Thursday with Fox News' 'Your World With Neil Cavuto,' Pawlenty defended his order that seeks to limit his state's participation in the new health care overhaul law that makes available funds for states to try new medical models. …'The federal government is basically a drug dealer trying to give out free samples, or give people a taste, get them further addicted,' Pawlenty said" (Elliot, 9/3).
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Health Care Marketplace
The Washington Post: "Amid high unemployment and a weak economy, employers have been shifting health care costs to workers, according to a study released Thursday. The premiums that employees pay for employer-sponsored family coverage rose an average of 13.7 percent this year, while the amount that employers contribute fell by 0.9 percent, the survey found. For family coverage, workers are paying an average of $3,997, up $482 from last year, while employers are paying an average of $9,773, down $87, according to the survey by the Kaiser Family Foundation and the Health Research & Educational Trust" (Hilzenrath, 9/2).
The Wall Street Journal: "But total insurance premiums paid by the employer and the employee rose just 3% for a family plan—the slowest rate of growth in 10 years, according to the data. The nonprofit research groups surveyed about 2,000 large and small companies between January and May" (Johnson, 9/3).
Kaiser Health News: "Thirty percent of employers reported reducing the health benefits they offered or increasing the employees' share of the cost. Paul Fronstin, senior research associate with the Employee Benefit Research Institute, a nonprofit, nonpartisan organization, said employers increase workers' share of premiums only if they are desperate -- because it can drive the healthiest employees to drop coverage, resulting in higher premiums for everyone else. 'Raising the employees' share of the premium really makes no sense,' he said. Yet, it's likely to keep happening. A survey released in August by the National Business Group on Health, an employer coalition, found 63 percent of large employers planned to increase the proportion that employees contribute to their premiums next year" (Galewitz, 9/2). (KHN is a program of the foundation.)
The New York Times: Businesses may "have felt less need to protect their workers because the increase in the cost of premiums was modest, said Nancy-Ann DeParle, who oversees health care for President Obama. 'It's the lowest increase in many years,' she said. And Ms. DeParle pointed to a number of initiatives under the health care legislation that were likely to help companies better afford insurance, including $40 billion in tax credits for small businesses and $5 billion to help companies pay for retiree health benefits" (Abelson, 9/2).
Los Angeles Times: The shift to workers "could further complicate the Obama administration's efforts to rally support for the [new health] law, which is expected to do relatively little in the short term to contain rising medical bills. 'There have been times when employers have been able to absorb costs. This is not one of those times,' said James Gelfand, health policy director at the U.S. Chamber of Commerce, a leading critic of the new law. ... Administration officials Thursday pointed to two new studies from the Rand Corp. and the Commonwealth Fund that predicted small businesses in particular would probably expand coverage in coming years, in part with help from billions of dollars of in new tax credits" (Levey, 9/2).
Bloomberg: "Total premiums for family policies, including both worker and employer contributions, increased 3 percent to $13,770" (9/2).
The Associated Press: "Researchers found that businesses still pay at least 70 percent of the total premium, on average, for their workers ... A growing percentage of workers are covered by health insurance that requires them to pay a deductible of $1,000 or more before most coverage starts. The increase is most striking with smaller companies, where 46 percent of workers are enrolled in high-deductible plans, up from 16 percent in 2006. At companies with 200 or more employees, 17 percent of covered workers had high-deductible plans, up from 6 percent four years ago" (Murphy, 9/2).
CNN: "Over the past five years, employees' share of insurance premiums have risen 47%. ... Deborah Chollet, senior fellow and health economist with Washington-based Mathematica Policy Research, said the recession and a turbulent job market are key catalysts for rising insurance costs. 'Employers are struggling to keep their head above water. They're cutting costs just to maintain employment,' Chollet said. 'One way to do that is to make workers pay more'" (Kavilanz, 9/2).
NPR: "Altman says the upward creep of all sorts of health costs for employees, including deductibles and copayments, raises a more ominous question about affordability of health care for the majority of Americans who still get their insurance on the job. 'While we were all focused on expanding coverage in the health reform debate, I think what we missed is that while that debate was going on, what we call health insurance in the country has actually been changing an awful lot,' he said. 'So what most people get as health insurance today just doesn't look very much like the more comprehensive health insurance their parents got'" (Rovner, 9/2).
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Nearly half of all Americans used at least one prescription drug per month in 2008, according to a study by the Centers for Disease Control and Prevention,
Bloomberg reports. That's a 10 percent increase over the preceding decade. Over that time, yearly spending by Americans on drugs doubled to $234 billion. "The two biggest-sellers last year were Pfizer Inc.'s Lipitor for high cholesterol and Bristol-Myers Squibb Co.'s clot-buster, Plavix. The rise of such medicines may continue as insurers add as many as 32 million customers through the U.S. health-care overhaul, according to the Congressional Budget Office" (Olmos, 9/2).
HealthDay adds some details: "Use of two or more drugs [per month] increased from 25 percent to 31 percent, and the use of five or more drugs increased from 6 percent to 11 percent, according to the analysis of data from the National Health and Nutrition Examination Survey (NHANES). The study also found that 20 percent of children and 90 percent of adults aged 60 and older reported using at least one prescription drug in the past month, said the [CDC] researchers" (9/2).
The Wall Street Journal's Health Blog notes the drug industry's reaction to the study: "The Pharmaceutical Research and Manufacturers of America (PhRMA), the trade association for drug makers, said in a statement that 'as we learn more about disease, prescription medicines are justifiably playing an increasingly important role. … The best solution for all patients is to strike the right medical balance between proper and effective use of prescription medicines and other therapies and interventions'" (Hobson, 9/2).
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Coverage & Access
As many as 5 million uninsured kids are eligible for Medicaid or the Children's Health Insurance Program, according to a report published Friday in the journal Health Affairs,
Reuters reports. "An estimated 7.3 million children were uninsured on an average day in 2008 and 65 percent of them were eligible for Medicaid or CHIP coverage, the report said. … Thirty-nine percent of eligible uninsured children live in just three states — California, Texas and Florida, the report by the Washington-based Urban Institute Health Policy Center said. It added that more than half of the nation's children live in these states." Health and Human Services Secretary Kathleen Sebelius said in a statement that the finding would help focus efforts to expand insurance coverage (9/3).
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Capitol Hill Watch
Politico reports that as "Congress prepares to return for a limited pre-election agenda, Rep. Diana DeGette (D-Colo.) said she has picked up wide support for her bill to permit embryonic stem-cell research and expects it will pass this month. Although it has been strongly opposed by anti-abortion activists, she voiced confidence that the measure will be a political boost for its backers as well as good policy. … Her proposal has gained additional urgency following the Aug. 23 ruling by U.S. District Court Judge Royce Lamberth that temporarily blocked President Barack Obama's March 2009 executive order that expanded federal funding for human stem-cell research" (Cohen, 9/3).
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Administration News
USA Today reports that food safety groups are slamming how well U.S. Department of Agriculture regulated the farms implicated in the salmonella outbreak. "Though USDA says its authority was limited, the agency's egg graders were at Wright County Egg and Hillandale Farms at least 40 hours a week — including before the outbreak — inspecting the size and quality of eggs inside processing buildings. … Food safety watchdogs question whether USDA egg graders should have noticed the vermin problems cited by the FDA, potentially preventing the recall of a half billion eggs and an outbreak that is linked to about 1,500 reported illnesses" (Young, 9/2).
"The criminal division of the Food and Drug Administration and the Justice Department have joined the probe of the Iowa farm at the heart of the recent egg recall linked to an outbreak of salmonella, according to FDA Commissioner Margaret Hamburg," The Wall Street Journal reports. "'There is a formal investigation going on that extends beyond the FDA inspections that are focused on farm practice,' Dr. Hamburg told reporters Wednesday. 'It is the case that an investigation is under way. We are pursuing it with our partners in law enforcement'" (Mundy, 9/2).
Meanwhile, for "the first time in this country, public health officials have linked ground beef to illnesses from a rare strain of E. coli," The New York Times reports. "Cargill Meat Solutions recalled 8,500 pounds of hamburger on Saturday after investigators determined that it was the likely source of a bacterial strain known as E. coli O26, which had sickened three people in Maine and New York. Under federal rules, it is illegal to sell ground beef containing a more common strain of the bacteria, E. coli O157:H7, which has been responsible for thousands of illnesses, many deaths and the recall of millions of pounds of beef over the years. But federal regulators are now considering whether to give the same illegal status to at least six other E. coli strains, including O26" (Neuman, 9/2).
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State Watch
The Columbus Dispatch: "Gov. Ted Strickland's administration announced today that nearly $200 million in recently freed up state funds will go to Ohio hospitals, community mental health services, and a program which provides medication to low-income residents with HIV/AIDS. … The state money became available after Congress agreed to continue paying a higher share of the cost of state Medicaid programs that provide insurance coverage to the poor. The higher federal contribution which had been set to expire Dec. 31 will continue through June 30" (Candisky, 9/2).
Florida Tribune: "Gov. Charlie Crist may be wrestling with his position on federal health care reform but Florida's state agencies are not. The Agency for Health Care Administration worked on a $1 million planning grant for a health insurance exchange, a centerpiece of the Affordable Care Act that has been labeled 'Obamacare' by critics. It is one of roughly $11 million in grants under the new federal health care law that Florida agencies have requested to date, according to information collected from AHCA, the Office of Insurance Regulation and the Florida Legislature" (Sexton, 9/2).
The Boston Globe: "In a unanimous ruling, the [Massachusetts] Supreme Judicial Court held that a psychiatrist identified only as John Doe had the right to defy a subpoena by the state Board of Registration in Medicine for the records of two dozen of his patients. The board had argued that the records were not protected by confidentiality law because the psychiatrist devotes most of his practice to pain management. ... The justices said that the Legislature has carved out limited exceptions to the psychotherapist-patient privilege for matters such as suspected child abuse or neglect and that the court did not have the power to extend exceptions" (Saltzman, 9/3).
The New York Times: "New York City's public hospital system is embarking on a long-term attempt to gain more control over running its 11 hospitals by renegotiating longstanding affiliation contracts with some of the city's most powerful medical schools. ... officials from the Health and Hospitals Corporation believe that to a large degree the public hospital system has outgrown the need to cede control over its physicians to universities" (Hartocollis, 9/2).
Los Angeles Times: "A Los Angeles physician was arrested Thursday for allegedly prescribing pain medication to homeless people who didn't need the drugs, according to records and authorities. Dr. Zhiwei Lin is set to be arraigned Friday on five counts of illegally prescribing drugs, misdemeanors each punishable by up to a year in County Jail and a $20,000 fine, according to the arrest warrant filed in Los Angeles County Superior Court. Lin, 52, a board-certified neurologist, declined to comment. ... Authorities believe the homeless 'patients' were brought to the doctor by recruiters, [who] would pay the homeless people for their prescriptions and turn them over to dealers who sold them by the pill at a huge mark-up" (Girion and Glover, 9/3).
Los Angeles Times, in a separate story: "Flu season may be a bad time to check into a California hospital ... only slightly more than half of healthcare workers in California hospitals received a flu shot last year, despite the dangers that presents for patients. The vaccination rate was less than 25% in 3.3% of the hospitals, according to data compiled by the state health department and obtained by Consumers Union through a Public Records Act request (Maugh, 9/2).
Five Detroit-area communities will get a total of $16.2 million in federal grants to improve diabetic care, the Detroit Free Press reports. "Hospital systems in Detroit, Dearborn, Dearborn Heights, Hamtramck and Highland Park -- as well as doctor networks and federally funded clinics in the region will use the three-year grant to create an electronic network that gives them access to medical information about diabetic patients and to better coordinate their care." The top federal health IT official, David Blumenthal, said, "information is the lifeblood of medicine." The hospitals will use the network to follow up on diabetic patients after ER visits, among other things. Currently, when diabetics receive care at ERs, providers at other hospitals are unable to access that information (Anstett, 9/3).
The Detroit News adds, "Metro Detroit is one of 17 communities across the country to receive $265 million in federal funding for the health care initiative. The region's award was one of two announced Thursday; the other, $13.8 million, went to greater Cincinnati, Ohio." Also, "[s]ome 93,000 people in those areas have diabetes -- a disease that leads to many hospitalizations a year, the collaborative said. Diabetes occurred in 23 percent of Detroit hospital discharges in 2009, according to hospital data" (Burden, 9/3).
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Health Policy Research
Urban Institute/Robert Wood Johnson Foundation: The Health Status Of New Medicaid Enrollees Under Health Reform – Using the Medical Expenditure Panel Survey, authors of this paper found "strong evidence that those who will enroll [in Medicaid after 2014] are likely to be healthier than nondisabled adults currently enrolled in Medicaid ... There is, however, a high likelihood of adverse selection – the least healthy and older among the new eligibles will be more likely to enroll. … A high rate of adverse selection is especially likely in the initial period following implementation of the Medicaid expansion and the other major policy changes associated with health reform, as we expect that those with the greatest health needs will be among the first to enroll" (Holahan, Kenney and Pelletier, August 2010).
Mathematica: How Are the Experiences Of Individuals With Severe Mental Illness Different From Those Of Other Medicaid Buy-In Participants? – The Medicaid Buy-In [MBI] program "allows states to extend Medicaid coverage to workers with disabilities whose income and assets would ordinarily make them ineligible for Medicaid." About a third of the program's participants have a mental illness. The study "linked state-level data on program participation to demographic and diagnosis information" from Medicare and Medicaid data files and found that "compared with other MBI participants, participants with[severe mental illness [SMI] had lower medical expenditures and were more likely to be employed and to increase their earnings over time. These findings suggest that for relatively lower expenditures, participants with SMI have better employment outcomes than other participants, at least in the short to medium term" (Liu and Croake, August 2010).
Commonwealth Fund: Realizing Health Reform's Potential: Small Businesses And The Affordable Care Act Of 2010 – This issue brief notes that the new health law has provisions designed to help small businesses afford health insurance, starting with a tax credit this year. And, "beginning in 2014, the ACA will create new insurance exchanges with standardized and comprehensive health benefits, new market rules, and greater federal and state oversight of the individual and small-group markets. In addition, the value of the small business tax credit will increase to half of an employer's premium contribution, starting in 2014. The CBO estimates that the credits will reduce premiums for eligible small firms by 8 percent to 11 percent, providing savings of up to $40 billion over the next 10 years" (Collins et al., 9/2).
KHN summarized news coverage of the brief: Study: Health Overhaul's Tax Credit For Small Business Could Affect Millions
Institute of Medicine: Cardiovascular Disability: Updating The Social Security Listings – "As medical knowledge continues to advance—and as the U.S. government seems likely to face continuing financial pressures—improving the Social Security Administration's (SSA) capacity for determining disability benefits more efficiently assumes ever greater importance," according to the summary of this IOM report. The report features the agency's recommendations for how to enhance SSA's cardiovascular system listings that are used to determine disability benefits. The authors found "a number of knowledge gaps that SSA should address in order to improve the quality of the current Listings" and recommend "that SSA revise most Listings to require evidence of serious functional limitations in addition to appropriate measures of cardiovascular impairment" (8/27)
Government Accountability Office: VA Drug Formulary: Drug Review Process Is Standardized At The National Level, But Actions Are Needed To Ensure Timely Adjudication Of Nonformulary Drug Requests – Although the Department of Veteran Affairs (VA) "provides drugs on its national formulary … all VA medical centers must have a nonformulary drug request process that is overseen by their regional Veterans Integrated Service Network (VISN)," according to the highlights of this report. The GAO "recommends that VA establish additional mechanisms to ensure nonformulary drug requests are adjudicated in a timely fashion. VA concurred with this recommendation" (August 2010).
Institute of Medicine: A Summary Of The February 2010 Forum On The Future Of Nursing: Education – During a recent Robert Wood Johnson Foundation Initiative on the Future of Nursing forum, designed to examine challenges and opportunities associated with nursing education, "experts considered innovations and strategies in three areas: what to teach, how to teach, and where to teach," according to an IOM summary which adds that the findings from the forum will help inform a final report to be released in October 2010 (8/31).
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Editorials and Opinions
Surer Footing For Medicare The Washington Post
Under the act, Medicare is stronger than it has been in years, and seniors will get new benefits. That's no illusion; that's progress (Dr. Donald Berwick, 9/3).
Shifting The Health Cost Burden The New York Times
In other words, employers shifted virtually all of the increased premium costs to their hapless workers, who were in a weak position to resist in an economy where there were few other jobs to jump to (9/2).
Wyden Defects On ObamaCare The Wall Street Journal
One of the Democratic Party's leading experts on health care wants his state to dump the individual mandate that is among ObamaCare's core features (9/3).
On Health Care, The Devil's In The Details The New York Times
If there is competition, and if the price for a clearly-defined benefit package is competitive, it is not clear why patients would care about the medical-loss ratio or its details (Uwe Reinhardt, 9/3).
Repealing ObamaCare Spells Problems For Medicare, Medicaid The (Grand Junction, Colo.) Daily Sentinel
Indeed, rhetoric and rabble rousing is easy. On the other hand, policy development and management relies on a few more functional brain cells (Dr. Michael Pramenko, 9/2).
Health Law's Retiree Perk Won't Last Long MarketWatch
Still, it's not as if this program does the greatest good for the greatest number of people. In fact, it doesn't do anything to help pre-Medicare retirees who don't have employer-sponsored health insurance (Robert Powell, 9/3).
Your Stake In Electronic Medical Records CNBC
The use of EMR as a standard way to exchange healthcare information will lower the costs of healthcare delivery and let physicians get back to the basics — thoughtful, holistic patient care (Rob Merkel, 9/2).
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KHN Original Reporting & Commentary
Kaiser Health News provides a fresh take on health policy developments with "Health Care Inflation" by Nick Anderson.
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