KHN Original Reporting & Guest Opinion
Kaiser Health News staff writer Mary Agnes Carey reports: “After a five-year tenure that included the flawed rollout of the health care law and stormy relations with Capitol Hill Republicans, Department of Health and Human Services Secretary Kathleen Sebelius is resigning, a White House official said late Thursday” (Carey, 4/10). Read the story.
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Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: “The Los Angeles County Department of Public Health supervisor in charge of nursing home inspections has been moved to another job days after the release of a highly critical audit of his division. Ernest Poolean, who has been a county employee since 1968 and became the head of the Health Facilities Inspection Division in 2011, has been reassigned to the Baldwin Park headquarters, according to a memo sent to the staff Thursday” (Gorman, 4/10). Read the story.
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Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (4/11). Read her response.
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Here’s a collection of comments from Kaiser Health News readers to a range of recent stories (4/10). Read what our readers think.
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Now on Kaiser Health News
' blog, Lisa Gillespie reports: "The Obama administration is touting the success of the health law’s open enrollment, which signed up at least 7.5 million Americans for health coverage through the online insurance marketplaces. But the experience varied according to states and Families USA brought together five state exchange directors Thursday to talk about what they’ve seen so far. These states – Kentucky, New York, Washington, California and Connecticut — all had functioning exchanges and pursued that health law’s Medicaid expansion" (Gillespie, 4/11). Check out what else is on the blog
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Kaiser Health News provides a fresh take on health policy developments with "Truth And Consequences?" by Steve Sack.
Here's today's health policy haiku:
NUMBERS CHANGE; POLITICS DON'T
Meet the goal, get the numbers...
House repeals again.
And another one -- straight from the headlines:
Seven million plus...
That's the new sign-up count, but
now she's out the door.
If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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After holding the post for five years, and overseeing the flawed rollout of healthcare.gov, the White House said Thursday that Kathleen Sebelius will leave her post as chief of the Department of Health and Human Services.
The New York Times: Sebelius Resigns After Troubles Over Health Site
Kathleen Sebelius, the health and human services secretary, is resigning, ending a stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act. Mr. Obama accepted Ms. Sebelius’s resignation this week, and on Friday morning, he will nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace her, officials said (Shear, 4/10).
Kaiser Health News: Sebelius Resigns; Obama To Name OMB Chief Burwell To Head HHS
After a five-year tenure that included the flawed rollout of the health care law and stormy relations with Capitol Hill Republicans, Department of Health and Human Services Secretary Kathleen Sebelius is resigning, a White House official said late Thursday (Carey, 4/10).
The Washington Post: Kathleen Sebelius To Step Down As HHS Secretary, OMB Director Will Take Her Place
Sebelius entered the Cabinet in 2009, three months into Obama’s presidency, as a well-regarded former governor of conservative Kansas. She is leaving after months of intense criticism over the botched rollout in the fall of the insurance marketplace. During the firestorm, Obama made clear to his aides that he would not seek the resignation of his health secretary, and her departure is timed to brighter news for the White House as enrollment soared late last month. Still, some White House allies said Thursday night that the troubled launch of HealthCare.gov had heightened tensions between Sebelius and the president’s staff members, who had become increasingly mistrustful of the department she led (Eilperin and Goldstein, 4/10).
Los Angeles Times: Health Chief Kathleen Sebelius, Who Oversaw Obamacare Rollout, Resigns
Sebelius was not pressured to resign, the official said. But she leaves after presiding over the disastrous launch of the health law's online insurance marketplaces last fall. That failure threatened to unravel what was supposed to be Obama's signature domestic policy achievement and has endangered Democrats who face elections in November (Levey and Parsons, 4/10).
The Wall Street Journal: Kathleen Sebelius To Resign Health Post
She informed Mr. Obama in early March of her decision to resign, a White House official said. "At that time, Secretary Sebelius told the president that she felt confident in the trajectory for enrollment and implementation of the Affordable Care Act, and that she believed that once open enrollment ended it would be the right time to transition the department to new leadership," the official said (Radnofsky and Lee, 4/10).
The Associated Press: Sebelius, A Lightning Rod For Critics, Resigns
The opening weeks of the enrollment period were marred by website woes, straining ties between Sebelius and officials in the West Wing. Though the administration rebounded strongly and exceeded expectations by enrolling 7.1 million people by the March 31 deadline, the comeback wasn’t enough to tamp down Republican criticism of Sebelius or boost the public’s perception of the federal health care overhaul (4/11).
USA Today: HHS Secretary Kathleen Sebelius Resigns
In recent months, Sebelius has faced heavy scrutiny after the troubled launch of the federal online insurance marketplace and has been deluged with Republican attacks over the costs of the Affordable Care Act. During the first difficult weeks of the federal marketplace, Sebelius proved to be an unsteady administration spokeswoman for the health care law (Schouten, Kennedy and Madhani, 4/10).
NBC News: Sebelius: Face Of Obamacare, But Snubbed By Obama
Health and Human Services Secretary Kathleen Sebelius was the icy and determined face of Obamacare from the beginning. But she was always President Barack Obama's second choice for the job, and before she resigned on Thursday after overseeing the rocky rollout of his signature health reform law, he snubbed her. When he announced enrollment on the exchanges had surpassed 7 million — far more than anyone expected when the exchanges failed badly for the first two months, it was Vice President Joe Biden, not Sebelius, who stood victoriously at his side (Fox, 4/10).
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The announcement that Kathleen Sebelius will leave her post at the Department of Health and Human Services has reignited the politics surrounding the overhaul for both Democrats and Republicans. It has also triggered questions about her legacy.
Politico: Website Fiasco Will Taint Kathleen Sebelius’ Legacy
Kathleen Sebelius waited as long as she could. She waited until the Obamacare enrollment season was over, and the once-broken website was so firmly back on track it held up under the last-minute surge. She even waited for one last high point: her announcement at a Senate Finance Committee hearing Thursday that sign-ups had risen to 7.5 million, thanks to the extra time the Obama administration had granted to people who said they couldn’t finish their enrollments on time (Nather, 4/10).
The Wall Street Journal: Health Law Draws Fresh GOP Fire As Sebelius Resigns
Republicans seized on news of Health and Human Services Secretary Kathleen Sebelius's resignation as a fresh opportunity to push for further-reaching changes to President Barack Obama's embattled health-care law, while Democrats praised her for her commitment under fire. In the four years since it was passed, widespread congressional anger and frustration over the Affordable Care Act was often trained on the secretary as she oversaw its implementation. On Thursday, critics largely avoided personal attacks on Mrs. Sebelius, 65 years old, and instead sought to use her resignation to shift attention back to the law's problems and advocate for its repeal (Peterson, 4/10).
Politico: Republicans Pile On At News Of Sebelius’s Exit
The reaction of GOP lawmakers to news of HHS Secretary Kathleen Sebelius’s resignation played on a very narrow band Thursday evening: Muted thanks to outright disdain. Capitol Hill Republicans have long bludgeoned Sebelius for her role overseeing the failed rollout of Obamacare’s enrollment website, HealthCare.gov. Their response to her exit started coming in immediately (Cheney, 4/10).
Fox News: Republicans Renew Fight Against ObamaCare As Sebelius Resigns
Republicans responded to news of Health and Human Services Secretary Kathleen Sebelius' resignation from the Obama administration on Thursday with fresh calls to repeal the president's health care law. Sebelius leaves the administration after the tumultuous launch of the Affordable Care Act exchanges last fall. Despite calls for her ouster from Republicans at the time, she stayed on until the enrollment period ended at the end of March. A White House official said President Obama will formally make the announcement on Friday, and nominate White House budget office director Sylvia Matthews Burwell to replace the outgoing secretary (4/11).
Politico: Sebelius Exit Opens New Obamacare Front
Democrats will be hoping Health and Human Services Secretary Kathleen Sebelius’s resignation — kept tightly under wraps since the one-on-one meeting in early March when she gave Obama the news — will finally force the president closer to the offensive, aggressive position on Obamacare that they’d been begging for (Dovere and Budoff Brown, 4/11).
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Burwell is currently the director of the White House Office of Management and Budget. Her experience includes budget oversight for the major entitlement programs, like Medicare and Medicaid.
The New York Times: Budget Chief Is Obama’s Choice As New Health Secretary
On Friday, President Obama is to nominate Ms. Burwell, currently director of the White House Office of Management and Budget, to take over one of the largest and most unwieldy parts of the federal bureaucracy as secretary of health and human services. If confirmed, Ms. Burwell would replace Kathleen Sebelius, who is resigning (Shear, 4/10).
The Washington Post’s Wonkblog: Meet The Nominee To Lead HHS
Sylvia Mathews Burwell is about to become the biggest name in health care after news broke Thursday night that she will be the nominee to replace the resigning Health and Human Services Secretary Kathleen Sebelius. … Burwell has extensive administration experience that includes budget oversight for major entitlement programs, like Medicare and Medicaid. Last summer, Burwell and White House chief of staff Denis McDonough led negotiations with a group of Senate Republicans who hoped to forge a grand bargain with the administration to raise taxes and rein in spending on health and retirement programs (Millman, 4/10).
Politico: Sylvia Mathews Burwell’s Next Marathon
Intentionally or not, Burwell, who served every single day of the Clinton administration, now finds herself facing another test of endurance and determination: replacing Kathleen Sebelius as secretary of Health and Human Services, the department responsible for implementing Obamacare, in a midterm election year (White and Epstein, 4/10).
The Wall Street Journal: Who Is Sylvia Burwell, HHS Secretary Sebelius’ Expected Replacement
Ms. Burwell, a veteran of the Clinton White House and Treasury Department who has held senior roles at the Bill & Melinda Gates Foundation and the Walmart Foundation, will face close scrutiny because the agency she has been tapped to run oversees some of the most polarizing and expensive parts of the federal budget. A senior administration official said Ms. Burwell, 48 years old, was the only person Mr. Obama considered, saying he placed a premium on her management skills, which was one thing he wanted in Mrs. Sebelius' replacement (Paletta, 4/10).
Politico: Sylvia Mathews Burwell’s Hurdles
Burwell is going to have to make fast allies on Capitol Hill, but don’t count on outgoing Secretary Kathleen Sebelius to leave her any pointers. The former Kansas governor didn’t have any public friends within the GOP — a problem stemming from the intense politics around Obamacare and Republicans’ feelings that the secretary didn’t try to work with them (Haberkorn, 4/10).
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The number rose 400,000 since last week because of updated figures from states and an extension that allowed some to enroll until April 15.
Los Angeles Times: Health Official Says 7.5 Million Americans Now Signed Up For Obamacare
[Secretary of Health and Human Services Kathleen] Sebelius' announcement marks a 400,000-person uptick since Obama announced last week that 7.1 million Americans had signed up for coverage through marketplaces on the final day of open enrollment. The administration's original tally didn't include Americans who, because of issues signing up, received an extension until April 15 (Rothberg, 4/10).
The Wall Street Journal: Health Insurance Enrollment Has Hit 7.5 Million, Sebelius Says
Mrs. Sebelius provided the new figures in testimony before the Senate Finance Committee about the agency's 2015 budget request. Last week the White House announced that at least 7.1 million Americans signed up for health insurance through the end of March, which is when open enrollment for health plans created by the Affordable Care Act formally ended. The federal government and states running their own health-insurance exchanges are continuing to complete enrollments for people who started their insurance applications on or before March 31 (Corbett Dooren, 4/10).
Politico: Kathleen Sebelius: 7.5 Million Signed Up In Obamacare Exchanges
Questions remain about how many people who sought coverage in the exchanges were previously uninsured,and how many had their old coverage cancelled because it didn’t meet Affordable Care Act requirements. Sebelius said she didn’t have clear numbers on either of those points. "I do not have data to give you right now in terms of who exactly was previously uninsured," she said in response to a question. She said the agency is collecting that data from insurers and will share it at a future date (Haberkorn, 4/10).
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Officials with Oregon's exchange say they will choose between repairing the existing system or going to the federal exchange by month's end. In Massachusetts, an executive appointed by Gov. Deval Patrick to fix the problems says she will make recommendations by next month and in Minnesota, Deloitte Consulting has a pending deal to fix that state's exchange.
The Associated Press: Cover Oregon Narrows Exchange Future To Two Options
Officials with Oregon’s troubled health insurance exchange say they’ve narrowed the options for the site’s future to two: switching to the federal exchange, or staying with the current technology and hiring a new contractor to fix it. Cover Oregon’s interim chief information officer Alex Pettit told board members Thursday that a third option -- transferring technology from another state -- would be too expensive and take too long (4/10).
The Oregonian: Cover Oregon: Board Hires 'Turnaround' Expert, Narrows Technology Options
Portland corporate turnaround expert Clyde Hamstreet agreed Thursday to what may be his most challenging assignment: helping solve Cover Oregon's health exchange mess in just a month. Hired Thursday by Cover Oregon's board of directors, Hamstreet takes the helm of an organization facing daunting technological, legal and financial issues. It has just seven months to produce a functional health exchange, something the state has been unable to do in the prior two years despite spending more than $200 million (Manning, 4/10).
The Oregonian: Cover Oregon Health Insurance Exchange: Fix It Or Go Federal, Officials Say
A Cover Oregon advisory committee has narrowed options for whether to scrap or salvage the troubled health insurance exchange, officials announced Thursday. By the end of April the Cover Oregon board will choose between either fixing its existing technology with a new development plan, or going to the federal exchange. The decision had been expected, but now is official. And time is short (Budnick, 4/10).
The Associated Press: Fix for Health Care Website Still Months Away
The board overseeing the Massachusetts’s health care exchange has been told that a long-term fix for the connector's troubled website is still months away, even while the state is reporting progress in clearing the backlog of applicants for subsidized insurance. Sarah Iselin, the health care executive tapped by Gov. Deval Patrick to oversee a solution to the website issues, said she will present the board with recommendations next month for how to achieve a functional system by the next open federal enrollment period that is scheduled to begin Nov. 15 (4/11).
The Star Tribune: Deloitte In Line For MNsure Repair Work
Deloitte Consulting has agreed to general contract terms to help MNsure begin fixing underlying issues with its massive computer system, people with knowledge of the bidding process confirmed Thursday. The agreement is pending, based on federal approval and a more detailed contract that would solidify the scope of the work. Deloitte has built some of the most successful state-based insurance exchanges in Connecticut, Kentucky, Rhode Island and Washington (Crosby and Meitrodt, 4/11).
The Star Tribune: Wider, Deeper MNsure Audit Wins Approval
Legislative Auditor James Nobles won lawmakers’ backing Wednesday for a wider investigation of what led to the troubled rollout of the MNsure health insurance exchange. Nobles said the effort will be extensive and lengthy, and he predicted it won’t be finished and made public until December. “It is going to be broad. It is going to be deep,” Nobles said (Meitrodt, 4/10).
In other news related to the health law's implementation -
Fox News: IRS Prepares To Go After ObamaCare Mandate Fines
With the ObamaCare enrollment deadline in the rearview for most, the IRS is preparing for the next step -- tracking and penalizing those who choose not, or cannot afford, to buy approved health insurance. How aggressive the agency will be in pursuing those fines, though, is an open question. The IRS already is under fire over last year's political targeting scandal and talk of harsh fines on the millions who still do not have insurance is a touchy subject in an election year (4/10).
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While the state's Republican legislators have opposed the federal effort to expand the program for low-income people, many Florida residents are learning -- to their surprise -- that they already qualified for Medicaid, the Associated Press reports. In other Medicaid news, Ohio reports more than 100,000 new enrollees and Maine's governor vetoes legislation to expand the program.
The Associated Press: Medicaid Enrollment Rises 8 Percent In Florida
Florida's Republican lawmakers remain staunchly opposed to expanding Medicaid -- a system they've repeatedly said is too expensive and doesn't improve health outcomes. Yet Florida's Medicaid rolls are expanding under the Affordable Care Act. That's because people trying to sign up for health insurance under Obama's new health law are finding out -- to their surprise -- that they qualify for Medicaid, the federal health insurance program for the poor (Kennedy, 4/10).
The Associated Press: About 106,000 Ohioans Enroll In Expanded Medicaid
More than 106,000 Ohioans have signed up for Medicaid under an expansion of the taxpayer funded health program, while thousands of others are waiting to hear whether they are deemed eligible. Republican Gov. John Kasich’s administration moved forward with extending Medicaid eligibility last fall under President Barack Obama’s health care overhaul. Coverage took effect Jan. 1. The safety-net program for the poor and disabled provides coverage for one of every five Ohioans (Sanner, 4/10).
The Fiscal Times: Obamacare Battle In Virginia Mirrors National Fight
There's a Democrat at the head of the executive branch, Democrats in charge of the Senate, and a strong Republican majority in the lower house. A budget battle, sparked by disagreements over the Affordable Care Act, threatens to shut down the government. If you assumed this was a story about Washington, DC, you can be excused, but it isn’t. The scenario is currently playing out about 100 miles south of the nation’s capitol, in Richmond, where the Virginia legislature is now a month past the deadline for approval a budget for the coming fiscal year (Garver, 4/11).
Bangor Daily News: LePage Vetoes Medicaid Expansion, Calls The Effort 'Ruinous' For Maine's Future
As expected, Gov. Paul LePage on Wednesday vetoed a bill that would expand Medicaid coverage to roughly 70,000 low-income Mainers and dramatically overhaul the administration of the program by outsourcing it to managed care organizations. The Legislature gave final enactment to the bill on March 28, starting a countdown for LePage to sign the bill, veto it or let it go into law without his signature. Wednesday was the deadline day. It was the third time LePage has vetoed Medicaid expansion in the 126th Legislature (Moretto, 4/9).
CQ RollCall: Negotiations Over Pennsylvania Medicaid Expansion Plan Intensify
The public has until early Friday to comment on a controversial Medicaid expansion plan in Pennsylvania. After the comment period closes, intense discussions between federal and state officials will determine whether the state will become the 28th jurisdiction, including the District of Columbia, to broaden eligibility under the health care law. A review of some of the 740 comments filed by Thursday afternoon shows that consumer activists and medical providers are actively lobbying the Centers for Medicare and Medicaid Services to make changes to Corbett’s plan. The comment period closes at 6 a.m. on Friday (Adams, 4/10).
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Capitol Hill Watch
The plan would reduce spending by $5.1 trillion over 10 years and includes an overhaul of both Medicare and Medicaid as well as cuts to other government programs. It would also repeal the health law but stands little chance of passing in the Senate.
Los Angeles Times: GOP-Led House Approves Tough Paul Ryan Budget, But Debate Continues
With little drama Thursday, House Republicans easily approved a largely symbolic budget proposal from Rep. Paul Ryan (R-Wis.), closing out a floor debate over spending priorities and opening a new front on the midterm campaign trail. … Ryan's proposal would overhaul Medicare for the next generation of seniors, boost defense spending beyond Obama's levels and slash most other domestic spending on college aid, food stamps and basic government investments. Tax rates for the wealthy would be cut to a top rate of 25 percent (Mascaro, 4/10).
The New York Times: House-Passed Budget Shows Parties' Divergence
The move underscored the different universes the two parties occupy as election season heats up. Democrats see the budget, which passed on Thursday in a 219-to-205 vote, as a political millstone, with brutal cuts to popular government programs, sweeping and controversial changes to Medicare, and tax cuts for the rich. Republicans consider it a modest step (Weisman, 4/10).
The Wall Street Journal: Republican Budget Plan Narrowly Passes House
Under Mr. Ryan's plan, the average annual growth in federal spending would slow to 3.5 percent from its current path of 5.2 percent. To eliminate the annual federal budget deficit, the budget would reduce spending by $5.1 trillion over 10 years and overhaul social safety-net programs, including Medicare and Medicaid. The Ryan plan also would repeal the Affordable Care Act, but it incorporates some $700 billion in Medicare savings and $1 trillion in revenues generated under the 2010 health law (Peterson, 4/10).
Politico: House Passes Ryan Budget
The House approved a fiscal 2015 budget on Thursday that would cut federal spending by $5 trillion and significantly revamp social welfare programs. The measure, which cleared the House 219-205, is essentially a political document that has no chance of being passed in the Democratic-controlled Senate. House Budget Committee Chairman Paul Ryan (R-Wis.) is expected to relinquish his gavel at the end of this Congress and his final budget is seen as more of an outline of Republican priorities, including the repeal of Obamacare (French, 4/10).
In other news from Capitol Hill --
NBC News: Boehner: GOP Still 'Building Consensus' On Obamacare Alternative
House Speaker John Boehner says Republicans are still "building a consensus" about an alternative to the Affordable Care Act passed in 2010. Asked by NBC News when House Republicans might unveil the long-awaited substitute, Boehner replied: "We're building a consensus, we'll see." Many of Boehner's fellow Republicans have been calling for leaders to move a bill on the floor in advance of the looming midterm elections (Russert, 4/10).
Politico: Vulnerable Democrats Wait Out Obamacare Hits
Conservative outside groups have pummeled Senate Democrats over their support for Obamacare, spending millions on attack ads from Louisiana to Montana. But many of the most endangered Democratic incumbents have decided it's better to wait out the barrage than to respond in-kind (Raju, 4/11).
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Media outlets continue to analyze which doctors receive the largest payments from the government insurance program for the elderly and disabled as they parse the massive database released Wednesday by the Centers for Medicare & Medicaid Services.
The Fiscal Times: Medicare By The Numbers
For the first time ever, the public finally caught a glimpse of how the massive Medicare program pays its doctors. The Centers for Medicare and Medicaid Services released a massive database on Wednesday revealing how Medicare doled out $77 billion to some 880,000 providers in 2012. The data shows that just a sliver of providers -- about 2 percent earned roughly a quarter the overall fees (Ehley, 4/11).
St. Louis Post-Dispatch: How Much Does Your Doctor Get From Medicare?
The following database contains newly released Medicare billing data for Missouri and Illinois healthcare providers. Across the U.S. in 2012, Medicare made nearly $80 billion in payments to more than 800,000 providers. Roughly $5 billion of that went to Missouri and Illinois providers. To find the dollar amounts providers received in Medicare reimbursements in total and by type of service, search by the last name of a doctor or care organization, or by specialty or location. In the results page, click "details" for more information about a particular provider (Moskop, 4/10).
The Boston Globe: 30 Mass. Doctors Split Up $45 Million From Medicare
Just 30 Massachusetts physicians -- mostly ophthalmologists, oncologists, and dermatologists -- were paid more than $45 million in a single year by Medicare, according to detailed new data intended to provide consumers, researchers, and fraud investigators with unprecedented information about the practices of individual doctors. These 30 doctors received between $1 million and $3.1 million each in 2012 for treating elderly Medicare recipients. The amounts exclude what they were paid by private insurers and other government programs. More than half of these doctors are ophthalmologists, who accounted for less than 2 percent of providers in the state but received nearly 9 percent of the Medicare payments that year (Kowalczyk and Tran, 4/10).
The Atlanta Journal Constitution: Georgia Doctors: Medicare Payments Don’t Tell Whole Story
Two of Atlanta’s top eye specialists found themselves Wednesday on a list of Georgia doctors who received more than $1 million in payments from Medicare in 2012, as did several of the state’s cancer doctors and pain management specialists. The doctors quickly pointed out that the long-awaited release of $77 billion worth of Medicare payment records didn’t tell the whole story, though. Dr. Robert Halpern, an ophthalmologist, said $3 million he was paid for treating Medicare patients was driven largely by the cost of $2,000 injections that are administered repeatedly to stave off blindness among patients with macular degeneration. Halpern said he gets paid about $100 for giving the injection and makes virtually no profit on the medication itself (Teegardin, 4/10).
The Dallas Morning News: 340 Texas Doctors Among Medicare's Millionaires
More than 340 doctors and other care providers in Texas received over $1 million each in 2012 under the government’s Medicare health insurance program, according to data released Wednesday that provides the public its first inside look at physician billing practices. About a fifth, or 69, of those providers practice in Dallas County and four neighboring counties. A Dallas internist took in the second-highest Medicare revenue statewide at $5.1 million — 50 times the average payout for that specialty nationally, according to the data. A Tyler ophthalmologist topped the list of Texas providers with $6.8 million in Medicare payouts, about 20 times the U.S. average (McClure, Moffeit and Lathrop, 4/10).
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Health Care Marketplace
The Wall Street Journal
: Sensitive Market Data Leaked After Government Phone Call
Market-sensitive information vitally important to health-insurance companies has once again reached Wall Street before the public, and this time it appears to have come from the government itself. On Dec. 3, an official with the agency in charge of Medicare spending held a conference call for industry officials. During the call, he provided data suggesting that federal funding for private Medicare plans would likely fall more than expected. Word soon reached Wall Street, prompting a selloff in insurance shares (Mathews and Mullins, 4/10).
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Coverage & Access
Also, a new poll examines if Americans think they'll need long-term care as they age.
Marketplace: When Rural Hospitals Close, Towns Struggle To Stay Open
There’s a health care crisis in America that you might not have heard about: Rural hospitals are closing at a rate that’s starting to get some politicians’ attention. Republicans blame Obamacare, while Democrats blame some states’ refusal to expand Medicaid. In reality, the problem started years before all that. What's clear is that rural hospitals and the rural economy rise and fall together (Ragusea, 4/10).
The Associated Press: Poll: Aging In U.S. In Denial About Long-term Care Need
We’re in denial: Americans underestimate their chances of needing long-term care as they get older -- and are taking few steps to get ready. A recent poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they’ve done little to no planning (Neergaard and Agiesta, 4/11).
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A selection of health policy stories from Texas, Louisiana, California, Maine, Pennsylvania, New Jersey, Vermont, Virginia, Georgia, Iowa and New York.
The Texas Tribune: Giving Up on Red Tape, Doctors Turn to Cash-Based Model
For 12 hours a day, the waiting room at Dr. Gustavo Villarreal’s family practice is often packed with patients, people who will pay a flat $50 fee for the convenience -- or necessity -- of a walk-in, quick-turn doctor’s visit. Villarreal’s practice, which does not accept any form of health insurance, has thrived despite its location in a city where nearly one-third of the population lives below the federal poverty line. At both the state and federal level, efforts are underway to decrease Texas' sky-high rate of residents without health coverage. But Villarreal is among a rising number of primary care practitioners who have given up on the red tape of filing insurance claims, switching to a cash-based model that is growing in popularity among Texas’ insured and uninsured patients (Ura, 4/11).
The Associated Press: Federal Medicaid Funding Could Be Delayed During Review Of LSU Hospital Deals
Federal officials have warned Gov. Bobby Jindal's administration that they will withhold $307 million in Medicaid money from the state if no agreement is soon reached on whether the state's financing plans for the privatized LSU hospitals meet federal guidelines. The U.S. Centers for Medicare and Medicaid Services, or CMS, notified Gov. Bobby Jindal's administration about the payment delay this week. The state Department of Health and Hospitals released the notice when questioned by The Associated Press (4/10).
Los Angeles Times: Assembly Backs Permanently Allowing Over-The-Counter Sale Of Syringes
The Assembly approved a measure Thursday that would permanently extend a provision allowing pharmacists to sell syringes without a prescription. Assemblyman Phil Ting (D-San Francisco), the bill's author, said expanding access to sterile needles is "the best way to stop the spread of some very deadly diseases." Public health experts say the use of shared needles among intravenous drug users contributes to the spread of HIV, hepatitis B and hepatitis C (Mason, 4/10).
The Associated Press: Maine Medicaid Rules Reduce Narcotic Prescriptions
Maine’s severe restrictions on opioid painkillers for Medicaid patients, requiring many to instead seek alternative pain management treatment for the past year, have sharply reduced the number of people obtaining highly addictive medications blamed for drug abuse and deaths around the nation (4/10).
The Texas Tribune: Abortion Providers Petition 5th Circuit to Review Decision
Abortion providers filed a petition on Thursday asking the full 5th Circuit Court of Appeals to reconsider the constitutionality of new abortion regulations passed by the Republican-led Texas Legislature in July. The petition, filed on behalf of a coalition representing the majority of abortion providers in Texas, comes on the heels of a unanimous decision made by the court's three-judge panel in March to uphold two requirements recently implemented in the state. Those rules require physicians to obtain hospital admitting privileges within 30 miles of an abortion facility and to follow the U.S. Food and Drug Administration’s protocol for drug-induced abortions rather than a common, evidence-based protocol (Ura, 4/10).
The Associated Press: Nemours Foundation Sues United Health Care Entities
The foundation that owns the Alfred I. du Pont Hospital for Children in Delaware and various pediatric physician practices in the region is suing United Healthcare entities in three states for unpaid bills. Lawyers for the Nemours Foundation filed lawsuits in federal court in Delaware on Wednesday against United Healthcare of Pennsylvania, United Healthcare of the Mid-Atlantic, and United Healthcare Community Plan of New Jersey (4/10).
The Associated Press: Judge: California Mistreating Mentally Ill Inmates
A federal judge ruled Thursday that California’s treatment of mentally ill inmates violates constitutional safeguards against cruel and unusual punishment through excessive use of pepper spray and isolation. U.S. District Court Judge Lawrence Karlton in Sacramento gave the corrections department time to issue updated policies on the use of both methods but did not ban them (4/10).
Kaiser Health News: L.A. County Nursing Home Inspections Chief Reassigned
The Los Angeles County Department of Public Health supervisor in charge of nursing home inspections has been moved to another job days after the release of a highly critical audit of his division. Ernest Poolean, who has been a county employee since 1968 and became the head of the Health Facilities Inspection Division in 2011, has been reassigned to the Baldwin Park headquarters, according to a memo sent to the staff Thursday (Gorman, 4/10).
The Associated Press: Vt. Senate Advances Lyme Disease Bill
Doctors and other health professionals would be immune from professional conduct charges if they pursued a hotly debated course of treatment for Lyme disease under a bill given preliminary approval Thursday by the Vermont Senate. The Senate’s 27-0 vote in support came after an impassioned speech by Sen. David Zuckerman, a Chittenden County Progressive who said his wife, Rachel Nevitt, had suffered from the tick-borne illness for about a dozen years and had also struggled to get medical professionals to recognize and diagnose the disease (Gram, 4/11).
The Richmond Times-Dispatch: Psychiatric Admissions Spike After Deeds Tragedy
State mental hospitals and private psychiatric facilities have experienced a surge in emergency admissions since Jan. 1 in the aftermath of the attack last fall on Sen. R. Creigh Deeds, D-Bath, by his son, who then killed himself. Austin C. “Gus” Deeds, 24, had been released from an expired emergency custody order just 13 hours before he stabbed his father and shot himself at their Millboro home on Nov. 19. At Western State Hospital in Staunton, the closest state institution to Bath County, 23 people have been admitted under temporary detention orders since Jan. 1, compared with six in the previous six months (Martz, 4/11).
Georgia Health News: Report: Developmentally Disabled Need Better Care
An independent reviewer reports that Georgia is failing to provide adequate supervision of individuals with developmental disabilities who are moved from state hospitals to community group homes. The reviewer, in a report dated March 23, says there is an “urgent need to ensure competent and sufficient health practitioner oversight of individuals who are medically fragile and require assistance with most aspects of their daily lives.” The reviewer, Elizabeth Jones, notes in the report that two individuals with developmental disabilities died shortly after being moved from Southwestern State Hospital in Thomasville, which recently closed, to community settings (Miller, 4/10).
The California Health Report: Nurses Becoming A Rarity In California Public Schools
Each school day, about a fifth of the children in California schools attend class without a nurse in the building. If they get sick during the day, the schools call parents, or in an emergency, 911. ... Researchers conducting a large-scale study from the California State University-Sacramento School of Nursing have released preliminary findings showing that 57 percent of California public school districts have no school nurses whatsoever (Jones, 4/11).
The Des Moines Register: House Approves Health, Welfare Funding
Iowa House lawmakers on Thursday set aside controversial proposals restricting abortion to approve $1.86 billion in spending on health and welfare programs for the coming year. The chamber passed House File 2463 on a 51-47 vote, funding the state's Medicaid health care program for the poor among many other state agencies and services. (Noble, 4/11).
Modern Healthcare: N.Y. Incubator Startup Health Adds 16 Companies
The New York-based incubator StartUp Health admitted 16 new companies to its current class, the company announced this week. The incubator runs a three-year program that helps healthcare startups develop their products and raise venture capital. The program saw about 350 applicants for the current round, said Unity Stoakes, Startup Health's founder (Ivanova, 4/10).
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Health Policy Research
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Urban Institute: The Availability Of New Patient Appointments For Primary Care At Federally Qualified Health Centers: Findings From An Audit Study
This brief compares the availability of primary care appointments for new patients at Federally Qualified Health Centers (FQHCs) and other non-FQHC providers using data from an experimental simulated patient (audit) study that was conducted in late 2012 and early 2013. ... we find that 80 percent of FQHCs and 56 percent of non-FQHCs scheduled appointments for Medicaid callers—a difference of 24 percentage points. ... FQHCs were more willing than other non-FQHC providers to accommodate new Medicaid patients, but that FQHC wait times were slightly longer. ... even with enhanced funding, it is uncertain how well they will be able to absorb new patient demand caused by the Affordable Care Act’s (ACA) Medicaid expansion and other provisions (Saloner et al., 4/7).
Urban Institute: Financial Burden Of Medical Spending By State And The Implications Of The 2014 Medicaid Expansions
Among the top 25 states with the largest shares of their population attributable to low-income, high burden individuals without Medicaid/CHIP coverage, there is almost an equal divide in the number that have committed to expand or not expand their Medicaid program. ... the choice to participate will affect states differently. States that participate in the expansions have an opportunity to significantly decrease financial burdens for a high-need segment of their population (Caswell, Waidmann and Blumberg, 4/3).
Annals Of Family Medicine: Joint Principles: Integrating Behavioral Health Care Into The Patient-Centered Medical Home
The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. ... The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element ... Principles: Personal physician .... Physician directed medical practice ... Whole person orientation (Baird et al., March/April 2014).
Health Affairs: Alzheimer's Disease In African Americans: Risk Factors And Challenges For The Future
As the US elderly population continues to expand rapidly, Alzheimer’s disease poses a major and increasing public health challenge, and older African Americans may be disproportionately burdened by the disease. Although African Americans were generally underincluded in previous research studies, new and growing evidence suggests that they may be at increased risk of the disease and that they differ from the non-Hispanic white population in risk factors and disease manifestation. This article offers an overview of the challenges of Alzheimer’s disease in African Americans (Barnes and Bennett, 4/7).
Health Affairs: Preparing The Health Care Workforce To Care For Adults With Alzheimer's Disease And Related Dementias
The number of cases of Alzheimer's disease is projected to triple by 2050, from 5.0 million in 2013 to 13.8 million. ... We assessed what is likely to be an increasing shortage of physicians, nurses, and social workers with specialized training in geriatrics and, more specifically, in the care of people with dementia. ... To address these shortfalls, we recommend the dissemination of team-based models of care ...; expansion of education loan forgiveness and faculty development programs ...; inclusion of curricula specific to the disease in all health professions training; expansion of federal programs to train existing workers; and increased compensation for the direct care workforce (Warshaw and Bragg, 4/7).
The Kaiser Family Foundation: Paying A Visit To The Doctor: Current Financial Protections For Medicare Patients When Receiving Physician Services
Congress will likely return within the year to the question of whether and how to replace the widely-criticized formula that Medicare uses to calculate payments for physician services, called the Sustainable Growth Rate (SGR) system. For the most part, recent proposals on reforming the physician payment system leave intact current financial protections ... [which] include the participating provider program, limitations on balance billing, and conditions on private contracting. This issue brief describes these three protections, explains why they were enacted, and analyzes the implications of modifying them for beneficiaries, providers, and the Medicare program (Boccuti, 4/7).
The Kaiser Family Foundation: How Will The Uninsured Fare Under The Affordable Care Act?
Nationally, 4.8 million uninsured adults (10% of the nonelderly uninsured) who would be eligible for Medicaid if their states were to expand, fall into the coverage gap. ... Because they do not gain an affordable coverage option under the ACA, they are most likely to remain uninsured. Two other groups of uninsured individuals are outside the reach of financial assistance for health coverage under the ACA. First, 21% of uninsured people have incomes above the limit for premium tax subsidies or have an affordable offer of coverage through their employer are thus ineligible for financial assistance. ... Second, uninsured undocumented immigrants (about 13% of uninsured) are ineligible for assistance under the ACA and barred from purchasing coverage through the Marketplace. This group is likely to remain uninsured, though they will still have a need for health care services (4/7).
JAMA Surgery: Colorectal Cancer Resections In The Aging US Population
In this extensive review of national trends of CRS, we observed that, despite the improvements in mortality and a decrease in the incidence of CRS, older patients continue to have worse risk-adjusted outcomes compared with those who are younger. A clear association between worse outcomes and age was established. Even patients aged 65 to 69 years have poorer outcomes than those younger than 65 years. Since most (63.8%) procedures in the United States are performed on patients 65 years and older, measures to improve outcomes need to be implemented in all settings. The higher percentage of patients requiring nursing facilities for rehabilitation postoperatively reiterates the importance of outcomes as well as the social impact of age (Jafari et al., 4/9).
American Journal Of Medicine: Treat Or Eat: Food Insecurity, Cost-Related Medication Underuse, And Unmet Needs
[N]o study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. ... There were 9696 adult 2011 National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. ... Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic, non-Hispanic black, and have more chronic conditions than patients reporting neither. ... WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse (Berkowitz, Seligman and Choudhry, April 2014).
Rand Corp.: How Will The Patient Protection And Affordable Care Act Affect Liability Insurance Costs?
The Patient Protection and Affordable Care Act (ACA) will greatly expand private coverage and Medicaid while making major changes to payment rates and the health care delivery system. These changes will affect traditional health insurers, individuals, and government payers. In addition, a considerable amount of health care is paid for directly by or is indirectly paid for via legal settlements after the care occurs, by liability insurers. This report identifies potential mechanisms through which the ACA might affect claim costs for several major types of liability coverage, especially auto insurance, workers' compensation coverage, and medical malpractice (Auerbach, Heaton and Bradley, 4/9).
University of Minnesota State Health Access Data Assistance Center/RWJF: For Kids' Sake: State-Level Trends in Children's Health Insurance
This 50-state analysis shows that the U.S. has made significant progress toward ensuring all kids have health insurance. The report finds that the percentage of children without insurance fell from 9.7 percent in 2008 to 7.5 percent in 2012 (Sonier and Fried, 4/3).
Here is a selection of news coverage of other recent research:
Medscape: Choosing Wisely Lists Dominated By Cost Considerations
Healthcare costs figured highly in specialty medical societies' decision-making processes in determining what to include in their Choosing Wisely Top 5 lists, according to a research letter published in the April 9 issue of JAMA. Choosing Wisely is an initiative of the American Board of Internal Medicine Foundation to get specialty societies to develop lists of medical services that do not provide broad overall patient benefits but that still may be performed often. The goal is to phase out unnecessary use of these procedures or tests (Hand, 4/9).
The New York Times: Many Drug Prescriptions Go Unfilled
A Canadian study has found that almost one-third of patients never fill the prescriptions for the medicines they are told to take. The analysis, published online in The Annals of Internal Medicine, was conducted in Quebec, where all residents are covered by health and drug insurance. There were 15,961 patients in the study. Over all, 31.3 percent of prescriptions were never filled. But some types were filled more often than others. Prescriptions for headaches and migraines were filled more than half the time, but only 20 percent for bronchitis, and 25 percent for skin irritations. The more often a patient saw the doctor, the more likely the prescriptions would be filled, but medicines with high co-pays were less likely to be bought (Bakalar, 4/7).
MedPage Today: Fewer Americans Struggling With Medical Debt
The percentage of people in families having problems paying their medical bills continues to tick downward, according to a CDC report. The percentage of people under age 65 who were in families having problems paying medical bills fell to 19.8% in the first 6 months of 2013, Robin A. Cohen, PhD, and Whitney K. Kirzinger, MPH, of the National Center for Health Statistics in Hyattsville, Md., wrote in a report released Wednesday (Pittman, 4/9).
NPR SHOTS blog: Avoiding The Nursing Home Ups The Risk Of Unwanted Medical Care
Most older people suffer from cognitive impairment or dementia in the year before death, making it more likely that they will get aggressive medical treatments that they don't want. And people with dementia who are cared for at home are more likely to get unwanted treatment than if they are in a nursing home, a study finds. That could be because medical personnel are less likely to know a person's end-of-life wishes of someone who isn't in a facility ... Among patients with normal or less impaired cognitive function, having an advanced directive did not limit the treatment that they needed, according to results published Monday in the journal Health Affairs (Poon, 4/8).
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Editorials and Opinions
The Wall Street Journal’s Capital Journal: Sebelius Exits, But Health-Care War Endures
The resignation of Kathleen Sebelius signals the departure of the official who, fairly or not, had become the face of the deep and bitter partisan divide over Obamacare. But the Health and Human Services secretary's departure won't do much to close that divide. Instead, the Affordable Care Act now is entrenched as the most deeply divisive social program in recent memory, and it figures to stay that way through the November election and beyond (Gerald F. Seib, 4/10).
Vox: Kathleen Sebelius Is Resigning Because Obamacare Has Won
Obamacare has won. And that's why Secretary of Health and Human Services Kathleen Sebelius can resign. Calls for Sebelius's resignation were almost constant after Obamacare's catastrophic launch. The problem wasn't just that Sebelius had presided over the construction of a fantastically expensive web site that flatly didn't work. It was that she didn't know healthcare.gov was going to instantly, systemically fail. ... The White House says Sebelius notified the President in March that "she felt confident in the trajectory for enrollment and implementation," and that once open enrollment ended, "it would be the right time to transition the Department to new leadership." In other words, the law has won its survival (Ezra Klein, 4/10).
The Wall Street Journal: Sebelius And Accountability
It would be nice to think that Kathleen Sebelius's resignation, leaked late Thursday, is a case of accountability in government. But that isn't the way this government now works, if it ever did. The departure of the secretary of Health and Human Services who presided over ObamaCare's rollout debacle is best understood as one more attempt to dodge political responsibility (4/10).
Fox News: Sebelius Resigns: Democrats Have Their Scapegoat, They Can Blame ObamaCare Failures On HHS Chief
Last week, President Obama ran a victory lap claiming seven million signups for ObamaCare. It was the goal they wanted and, to no one's surprise, the White House claims it reached the goal. Outside, objective surveys beg to differ. As the president ran his victory lap, Sebelius was there running with him. Then she resigned — not forced out White House staffers claim. In fact, during the past week it appears the White House has lined up every left wing mouthpiece it could find to spin this news (Erick Erickson, 4/11).
The New York Times: Health Care Nightmares
When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground. Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to "change the subject from the nightmare of Obamacare"; on the same day, the nonpartisan RAND Corporation released a study estimating "a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014" (Paul Krugman, 4/10).
The Wall Street Journal: Live Free Or ObamaCare
The political left favors "single payer" health care, but that concept has new meaning in New Hampshire this year as just one insurer was willing to participate in ObamaCare. Thus the spectacle of Democratic Senator Jeanne Shaheen beseeching the feds to save her re-election from her own law. The Granite State Senator rode the 2008 Obama wave to become the deciding 60th vote for the law's passage, but now Ms. Shaheen must defend the mess it has made of her state's insurance markets. She's cashing in all her government chits amid a statewide uproar as patient access to hospitals and other providers has declined (4/10).
Bloomberg: Medicare Has Become A Problem For Democrats
Voters are used to trusting Democrats on Medicare. But there are signs that this trust is eroding because of Medicare cuts in the Affordable Care Act and Republican efforts to highlight those cuts. The latest evidence of this change came this week, when the Barack Obama administration backed away from its proposal to cut payments to insurers who offer coverage through the Medicare Advantage program. About 14 million seniors participate in this generally popular program, which allows beneficiaries to get their benefits through a private health plan (Lanhee Chen, 4/10).
Houston Chronicle: Hispanics Remain Unequal When It Comes To Health Care
This week's commemoration of the 50th anniversary of the Civil Rights Act at the LBJ Presidential Library in Austin serves as a reminder that politics and history shape the nation's health care delivery system. Our forefathers wrote that "all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness." But does everyone have a right to the same level of "happiness?" And is health security among these unalienable rights? (Jacqueline Angel, 4/9).
Deseret News: Utah's Medicaid Reform Has Been A Quiet Success
Lost in the nearly two-year debate over whether Utah should expand its Medicaid program has been the successful rollout of Utah's Medicaid Accountable Care Organizations (ACOs). The Medicaid ACOs are worth another look (Dan Liljenquist, 4/10).
The (Jackson, Miss.) Clarion Ledger: Republicans Refuse To Acknowledge Obamacare's Success
Republican leadership in Mississippi still seems content to ignore what's happening on the health care reform front. It's as though we live on a different planet, that ACA is for somebody else, not us. We'll see before too long. ... Now it's obvious to thousands of religious leaders and medical professionals in Mississippi that Bryant and his GOP cohorts have failed in their goal to kill President Obama’s signature law. They have succeeded only in denying organized health care coverage to 300,000 of the state’s working poor (Bill Minor, 4/10).
On other health care topics -
The New York Times: Abusing Both Medicare And Politics
Campaign finance reformers have long warned that the growing power of big money in politics would produce a giant scandal. But those scandals happen every day, and the trading of campaign donations for political favors has steadily eroded public trust in Washington. The latest illustration of that can be seen in the connection between Medicare fraud and "super PAC" abuse (4/10).
The New York Times: The Tobacco Ties That Bind
I don't smoke, but if during the day I wanted to buy cigarettes, I could walk into the CVS pharmacy across the street from my office, or the Walgreens two blocks away, and get them. They're kept right behind the cash register. But beginning this fall, that is going to change. CVS pharmacies will stop sales of all tobacco products. Walgreens, well, won't. So, here's a quiz. Which chain do you think is more heavily celebrated on the website of the American Cancer Society? Well, it's not CVS. Instead, testimonials and profiles hailing Walgreens abound. There is a glowing profile of the Walgreens chief executive that focuses on his tireless efforts to promote healthy living in his workplace and stores. There is no mention of the tobacco sales at the front of those stores (Peter B. Bach, 4/10).
The Washington Post: The Truth About Who Really Pays For Medicare
Yes, seniors paid into Social Security and Medicare during the years they worked, if they worked. But they generally receive much more out of the entitlement system than they paid into it (Catherine Rampell, 4/10).
The Washington Post: Gun Violence As A Public Health Issue
With last month’s controversy over Vivek Murthy's nomination for surgeon general still fresh, the nation's second-largest physicians group reaffirmed Thursday that it considers firearm violence a public health issue and issued a wide-ranging set of recommendations to address the deaths and injuries caused by guns. The timing appears to be coincidental. But like Murthy — whose nomination was blocked in large part by a National Rifle Association offensive over his views on guns — the American College of Physicians believes doctors must take action against the 32,000 deaths and 74,000 injuries caused by guns in the United States each year (Lenny Bernstein, 4/10).
WBUR: Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed
The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with "appropriate pain care" and reduce the risk of opioid addiction and diversion. In a recent Boston Globe report they claim "very significant success" with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills. Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program's stated goals? (Daniel P. Alford, 4/10).
The New England Journal of Medicine: Same-Sex Marriage — A Prescription For Better Health
Although the most central issues raised by the public discourse regarding marriage are moral and rights-oriented, there are also health-related issues at stake: legalizing same-sex marriage can improve health and access to health care for LGBT people. A 2011 report by the Institute of Medicine on the health of LGBT persons identified substantial disparities in health and access to health care for sexual and gender minorities. Many LGBT people of all ages report worse physical and mental health outcomes than heterosexual and non-transgender populations, largely as a result of the stress caused by being a member of a stigmatized minority group or because of discrimination due to sexual orientation or gender nonconformity (Gilbert Gonzales, 4/10).
The New England Journal of Medicine: Redesigning Surgical Decision Making For High-Risk Patients
One third of elderly Americans undergo surgery during the last 12 months of their lives, most of them within the last month. Yet three quarters of seriously ill patients say they would not choose life-sustaining treatment if they knew the outcome would be survival with severe cognitive or functional impairment. ... Typically, decisions are made after a discussion between a surgeon and the patient and perhaps the patient's spouse, partner, child, or caregiver. ... Yet this approach may be suboptimal for many high-risk elderly patients facing decisions about major surgery. Patients may not always be presented with all treatment options, including watchful waiting, medical treatment, less invasive surgical options, or percutaneous approaches (Drs. Laurent G. Glance, Turner M. Osler and Mark D. Neuman, 4/10).
The Journal of the American Medical Association: Health Reform And Physician-Led Accountable Care
Physicians see opportunities every day to improve quality and lower costs, but in a recent survey, the vast majority of physicians reported that they should not be expected to play a central role in controlling costs. They expressed this view even though most also reported that the best ways to control health care costs are through promoting continuity of care, using cost-effective treatments, chronic disease care coordination, prevention and adhering to clinical guidelines—all of which are controlled or influenced by physicians (Drs. Farzad Mostashari, Darshak Sanghavi and Mark McClellan (4/10).
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