KHN Original Reporting & Commentary
Kaiser Health News staff writer Phil Galewitz writes: "Elective abortions will be prohibited and people with pre-existing conditions will be able to get comprehensive benefits without paying any more than healthy people, under new federal regulations for high-risk health insurance pools released today by the Obama administration" (Galewitz, 7/30).
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Health Reform
"Elective abortions will be prohibited and people with pre-existing conditions will be able to get comprehensive benefits without paying any more than healthy people, under new federal regulations for high-risk health insurance pools released ... by the Obama administration," according to Kaiser Health News. "The state-based pools provision is one of the high-profile features of the new health law taking effect this year. It allocates $5 billion to create plans to cover people who have been uninsured for at least six months and have a pre-existing health condition" (Galewitz, 7/29).
Politico: Abortion-rights groups were "caught completely off-guard" last month when Republicans and anti-abortion groups successfully mobilized to pressure on the Obama administration to keep states from allowing abortion coverage in the insurance pools they were setting up for people with pre-existing conditions. The administration responded within a day, assuring the groups that the high-risk insurance pools would be banned from covering elective abortions, "a position reaffirmed in a Health and Human Services regulation released on Thursday. ... Planned Parenthood and NARAL didn't publicly petition HHS until after the new ban was imposed. And it took sympathetic Democrats on the Hill a full 10 days to write a letter expressing disappointment with the HHS" (Kliff, 7/30).
Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote about the abortion policy on the White House blog Thursday, saying that "federal dollars would not be used to pay for abortion services except in the rarest of instances under a newly created health insurance program aimed at covering the sick and uninsured ...," Modern Healthcare reports, adding that the "pre-existing condition program will operate until 2014, when a new marketplace for health plans, called an exchange, will kick into effect" (DoBias, 7/29).
Meanwhile, in other news coverage of developments related to the new health law:
McKnight's Long-Term Care News: Senate Republicans "have introduced legislation that would repeal the Independent Payment Advisory Board (IPAB) that is part of the healthcare reform law." Sen. John Cornyn, R-Texas, said the board would have too much independence and power to make decisions about Medicare payments. Supporters of the board say it would have "the authority to make politically difficult decisions regarding healthcare costs to independent agents who would be less likely to be swayed by interest groups or the possibility of losing an election" (McKnight's, 7/30)
The Washington Post: A new analysis by the Commonwealth Fund finds that the law "Congress adopted this spring to reshape the nation's health-care system will be especially beneficial to women, because they traditionally have relied on health care more than men, faced more insurance problems and had greater difficulty paying medical bills" (Goldstein, 7/30).
The Wall Street Journal: The health overhaul included new requirements for businesses to file a 1099 form to the Internal Revenue Service each time it pays a supplier or service provider more than $600 in a year. The provision has drawn strong protests from business groups and Republicans and "House Democrats were forced to postpone a vote late Thursday on a GOP motion calling for repeal of the reporting requirement. That, in turn, delayed action on an $11 billion bill that expands federally-subsidized bonds for infrastructure projects. House lawmakers may add language to the infrastructure bill to weaken or repeal the IRS reporting regime, Democratic aides said." The provision would have raised $16 billion to help pay for the health law (Vaughan, 7/29).
The Hill: Advocates for children's issues "are pushing back this week" against new rules from the Department of Health and Human Services that will "allow private insurers to deny children trying to enroll in coverage outside of specified open enrollment periods." The new government rule came after some state insurance commissioners noted that plans might be pulling out of their states because of a provision in the law that required them to cover children with pre-existing conditions. "Many private insurers, however, said the provision would simply discourage parents from enrolling healthy children" and seek coverage only when a child was sick (Lillis, 7/29)
Los Angeles Times: And in California, as health care costs continue to soar, lawmakers struggle to take action to control insurance premium increases before adjourning Aug. 31. "August will be a key month as state officials try to forge a strategy to comply with the nation's new healthcare law. Among the law's far-flung provisions is a call for states to develop plans for reviewing 'unreasonable' increases in health insurance premiums."
"Under a provision of the new federal healthcare law that takes effect in September, insurers will have to devote at least 80% of their premiums to medical care. Schwarzenegger says the requirement will dramatically curb the insurance industry's ability to raise rates. Still, advocates of strict rate regulation believe that California needs additional protections. They say the only sure way is to force insurers to ask permission before raising premiums" (Helfand, 7/30).
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Health News Florida: "A Leon County circuit judge today blocked a proposed [state] constitutional amendment that targets the federal health-reform law, saying Florida Republican lawmakers included wording in the proposal that would mislead voters. Judge James O. Shelfer said the proposal --- dubbed by lawmakers as the 'Health Care Freedom' amendment --- should not go on the November ballot. He described wording in a ballot summary as 'manifestly misleading.' The amendment, which would require voter approval to take effect, would try to prevent Floridians from being forced by law to 'participate in any health-care system.' It is an attempt to allow people to opt out of a new federal requirement that they eventually buy health insurance or face financial penalties. The state appears virtually certain to appeal Shelfer's ruling" (Saunders, 7/29).
The [Fort Myers] News-Press: "Circuit Judge James Shelfer on Thursday ruled in favor of the plaintiffs - two voters from Palm Beach County, one from Orange County and another from Pinellas - who filed suit against the state May 20. The four women alleged the title and summary of Amendment 9 were likely to confuse voters. … They also said the summary language included issues not addressed in the bill, including that the amendment 'will ensure access to health care services without waiting lists,' and 'protect the doctor-patient relationship' as well as 'guard against mandates that don't work.' Shelfer ruled that the amendment's ballot language could make voters think they would never have to wait in a doctor's office if it passed" (Harpster, 7/30).
The Miami Herald: "Critics and even one of its proponents acknowledged at the time that the amendment likely would not affect the national law because U.S. Constitution also contains a 'Supremacy Clause' that largely allows federal laws to trump state statutes. But it could have prohibited Florida from enacting a Massachusetts-style healthcare system" (Logan, 7/30).
The Associated Press: "Attorney General Bill McCollum, who is also suing the federal government to block Obama's federal plan, was responsible for keeping the state health care amendment on the ballot" (7/29).
Sarasota Herald-Tribune reports that the amendment concerning health insurance mandates was one of "nine constitutional amendments [that] were approved for the November ballot. But six face lawsuits, including three that have been tossed from the ballot" (Kennedy, 7/30).
Meanwhile, and in a separate story, The Associated Press reports: "Missouri on Tuesday will become the first state to the test the popularity of President Barack Obama's top policy accomplishment with a statewide ballot proposal attempting to reject its core mandate that most Americans have health insurance. The legal effect of Missouri's measure is questionable, because federal laws generally supersede those in states. But its expected passage could send an ominous political message to Democrats seeking to hang on to their congressional majority in this year's midterm elections. The Missouri measure, shepherded to the ballot by Republican state lawmakers, is a glaring example of the twisting, troubled politics surrounding the health overhaul."
"In the swing state of Missouri, where Obama narrowly lost to Republican Sen. John McCain in the 2008 presidential elections, the federal health care law appears particularly unpopular. Sixty-one percent of respondents to a Mason-Dixon poll conducted this month for the St. Louis Post-Dispatch and TV station KMOV said they opposed the federal health care law" (Lieb, 7/29).
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Capitol Hill Watch
The Associated Press: "A bill that would have provided up to $7.4 billion in aid to people sickened by World Trade Center dust fell short in the House on Thursday, raising the possibility that the bulk of compensation for the ill will come from a legal settlement hammered out in the federal courts." The measure failed to draw the necessary two-thirds majority. Democrats had opted for this procedural route rather than a simple majority because it blocked potential GOP amendments. Ultimately, 12 Republicans crossed party lines to vote with Democrats for passage. "For weeks, a judge and teams of lawyers have been urging 10,000 former ground zero workers to sign on to a court-supervised settlement that would split $713 million among people who developed respiratory problems and other illnesses after inhaling trade center ash." Republicans opposing the bill branded it as "another big-government 'massive new entitlement program' that would have increased taxes and possibly kill jobs" (Miga and Caruso, 7/29).
The New York Times: The bill would have provided "billions of dollars for medical treatment to rescue workers and residents of New York City who suffered illnesses from the toxic dust and debris at ground zero." Its GOP opponents were concerned about the program's price tag -- $7.4 billion. "But Democrats accused Republicans of being callous and vowed to bring the bill back for another vote in the fall." So far, the federal government has provided funds on an annual basis "to monitor the health of people injured at ground zero and to provide them with medical treatment" but the measure's supporters wanted to remove the assistance from the problems that accompany year-to-year appropriations (Hernandez, 7/29).
The Hill: Meanwhile, Senate Majority Leader Harry Reid is setting up a show-down vote next week "on a $26.1 billion package of education funding and Medicaid assistance to states." The measure's entire cost is paid for with offsets, "such as a provision to end tax credits on corporate foreign-earned income," as well as other rescissions and program cuts. It is viewed as a difficult choice for centrist Republican members because the proposals are popular with many GOP governors. Dems tried to attach the state Medicaid assistance to the small business legislation currently pending on the Senate floor, but Republicans "balked at the linkage" (Bolton, 7/29).
The Hill's Healthwatch Blog: On Thursday, a bipartisan group of senators announced legislation "designed to cut healthcare costs by offering legal services to patients in public health settings." The measure is sponsored by Sens. Tom Harkin, D-Iowa, Evan Bayh, D-Ind., and Kit Bond, R-Mo. The bill, with a $10 million price tag, "would create a federal demonstration project to test the cost effectiveness of medical-legal partnerships (MLPs), which encourage preventive care by bringing attorneys into hospitals and other public health centers." Examples that supporters cite include a disabled patient who needs a lawyer's help to access Medicaid benefits or a patient with chronic conditions who needs legal assistance to address his or her housing issues. A similar pilot program in Boston has "reduced expensive emergency room visits by 50 percent" (Lillis, 7/29).
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Coverage & Access
The Christian Science Monitor: A continuation of the subsidy for health insurance for newly laid-off workers was not included in the six-month extension of unemployment insurance that recently became law. "That means that as of June 1, thousands of workers are either paying out most of their unemployment checks for health coverage under 'COBRA,' or just not getting covered." The COBRA subsidy's advocates "say Congress' decision not to help out those who have lost their employer-subsidized health care is forcing families to put off getting health care if they need it, and is putting even greater pressure on emergency room facilities. Opponents say the benefits extension is expensive if not paid for, and it doesn't fix the underlying problem – getting people a stable source of health-care insurance." Meanwhile, for many who qualify, COBRA is too expensive without the subsidy (Scherer, 7/29).
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Several news outlets look at different models for medical care.
"An initiative designed to transform health care on Chicago's South Side ... has linked 5,600 people to a 'medical home' since 2005, University of Chicago executives said Thursday," The Chicago Tribune reported. "Five years after the Urban Health Initiative was launched as a way to educate patients on the best use of the emergency room, the program has grown into a network of 25 community-based clinics and other medical care providers on a budget of more than $6 million a year. It is now poised to escalate research initiatives and teaching opportunities for physicians in hopes of becoming a national model for medical care in urban areas." But officials "acknowledge that these patients are not consistently maintaining a relationship with a doctor after they are guided by U. of C. to its vast network of primary care providers" (Japsen, 7/29).
Chicago Sun-Times: One of the big challenges for Chicago's Urban Health Initiative "has been getting people who schedule appointments through the U. of C. program to keep them. Since the initiative was launched in 2005 with help from first lady Michelle Obama, then U. of C.'s vice president for community and external affairs, only about 35 percent of the almost 16,000 appointments made as of January had been kept, hospital executives said Thursday" (Thomas, 7/30).
The Denver Post: Meanwhile, health care leaders met this week in Denver and heard that the "future of health care is a patient-centered system with one-stop shops for medical, mental and dental care, and health care teams to handle middle-of-the-night e-mails." But physicians are reluctant to move to such a system, experts said. "The setup of the future, where patients have 'medical homes,' will rely on doctors delegating more of their duties to nurses, physicians' assistants and other health care workers. Many doctors say they don't want to lose patients, yet they cannot become 'medical homes' with such heavy workloads. 'The physician can't be everything,' said John Rother, AARP's executive vice president of policy and strategy. 'It has to be about the team.'" Experts speaking at the conference urged states to "re-examine scope-of-practice and minimum-education laws that limit nurses and physicians' assistants" (Brown, 7/30).
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Health Care Marketplace
The Associated Press: "In a defeat for the powerful drug lobby, a Senate panel approved legislation to prohibit drug companies from paying generic drug makers to delay bringing less costly products to market. … The measure would ban a 'pay-to-delay' practice — opposed by the [Federal Trade Commission] in a series of lawsuits brought since 2001 — in which brand-name drug companies and generic drug makers both profit. Brand-name drug makers get higher prices while the generic companies are paid to stay out of the market." The language was inserted into a spending bill in the FTC's budget and approved by the Senate Appropriations Committee (Taylor, 7/29).
The Wall Street Journal: "Under the legislation, a drug patent settlement would be presumed unlawful when a brand company pays a generic company to drop a patent challenge that could lead to early market entry of a competing generic medicine." Backers of the measure "say the drug settlements are anticompetitive and hold up the entry of low-cost drugs that could save consumers billions of dollars. Opponents say the drug settlements are pro-competitive because they often allow generic drugs on the market before a branded drug maker's patent ends, while also removing the uncertainty of patent litigation" (Kendall, 7/29).
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News outlets report on hospital issues in the Nashville area and San Francisco.
"Over the past year and a half, keeping costs in check has helped the large hospital chains based in the Nashville area to increase quarterly earnings, even when seeing fewer patients come through their doors,"
The Tennessean reports. "The recent second quarter was no different. Cost controls fueled an 18 percent increase in net income at Franklin-based Community Health Systems, despite a decline in the number of patients. HCA Inc. saw fewer inpatient visits, and higher interest expense kept its pre-tax profits flat. But the Nashville-based industry leader reported an increase in overall volumes, including outpatient visits and improvements in its operating margins."
Analyst Sheryl R. Skolnick of CRT Capital in Stamford, Conn., said that the earnings report suggests "the pressure on hospitals' volumes from economic headwinds has increased. That puts more pressure on the chains to find additional ways to reduce costs, having already used most of the easier cost-reduction measures" (Ward, 7/30).
The New York Times, on St Luke's hospital in San Francisco's Mission district: "The hospital is run down and lacks air conditioning. It is licensed to support 229 beds, but on an average day just 130 are filled. … California Pacific Medical Center, which operates St. Luke's, once planned to shutter the 139-year-old hospital and turn it into an outpatient facility. But California Pacific — a not-for-profit affiliate of Sutter Health, a Northern California hospital network — is keeping St. Luke's open, using it as a bargaining chip in an ambitious strategy to overhaul how it offers medical care in San Francisco. … The center's plan has led to a fierce debate about where hospitals should be located in San Francisco, and about whether California Pacific's strategy to consolidate many services at one primary location would ultimately limit services for patients now served by hospitals like St. Luke's, where almost 90 percent of all patients are on Medi-Cal or Medicare" (Mieszkowski, 7/29).
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Health Information Technology
David Blumenthal, the national coordinator for health information technology for the U.S. Department of Health and Human Services, "defended the administration's new plans against critics who say the watered-down rules miss an opportunity to lower costs and improve patient care,"
The Salt Lake Tribune reports.
"The recently released rules dictate what qualifies as 'meaningful use' of electronic medical records, the standard providers must adopt to access the billions in grants available to help them go paperless. The standards seek to strike a balance between encouraging the change without expecting too much from health providers," Blumenthal told Utah health officials. There is little agreement in Utah, however, about what that balance should be. "Republican state legislators and John T. Nielsen, health adviser to Utah Gov. Gary Herbert, urged Blumenthal to give states flexibility to innovate their own health reform solutions. Meanwhile, software developers are pleading for more standards to ensure that the e-health systems they create can talk to one another, Blumenthal said" (Stewart, 7/29).
Deseret News: "Regarding the security of sensitive individual medical information, Blumenthal said every measure will be taken to guarantee the confidentiality of everyone's private information. 'We're working with a whole bunch of different programs to make sure that the security of health information in electronic form is strong and continually improves,' he said. 'We're working with the president's cyber security coordinator to make sure that the most advanced security techniques … are brought to bear.' [Executive director of the Utah Department of Health and state HIT coordinator] Dr. David Sundwall said patients will eventually have the final say about how much of their private medical information is exchanged between providers. He also said that Utah will be the primary regulator of HIT for residents within its borders, while taking some cues from the federal government" (Lee, 7/29).
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Health Policy Research
Archives of Internal Medicine: Racial Differences In Admissions To High-Quality Hospitals For Coronary Heart Disease – "Racial disparities in the management of coronary heart disease (CHD) are widely documented, yet the reasons behind persistent gaps in quality of care are not fully understood," write the authors, who examined "Medicare patients with acute myocardial infarction and coronary artery bypass grafting (CABG) admitted during 2002 through 2005 to hospitals located in markets with top-ranked cardiac hospitals, as ascertained from the US News and World Report 'America's Best Hospitals' annual rankings." They report: "black patients are equally or more likely to be admitted to high-quality cardiac hospitals compared with white patients with similar geographic access to these facilities, with the notable exception of patient undergoing CABG who reside in communities with marked social disadvantage."
"Given the proximity of high-quality hospitals to this segment of the black population, our study suggests an inequity in the use of such hospitals by underprivileged black patients undergoing CABG. Future research should focus on the complexity of geographical and social factors driving hospital choices for vulnerable populations in order to develop effective local interventions aimed at reducing racial disparities in health care delivery," the authors conclude (Popescu et al., 7/26).
Urban Institute: Federal Subsidy For Laid-Off Workers' Health Insurance: A First Year's Report Card For The New COBRA Premium Assistance – This brief examines the impact of COBRA subsidies, made possible through the American Recovery and Reinvestment Act (ARRA), on the number of people who sought coverage, and whether "the subsidy reduced 'adverse selection' of older, sicker people into COBRA coverage."
"The ARRA subsidies have increased participation in COBRA, but to different extents in different populations," the authors write, pointing to a Hewitt Associates study that found the "average take-up among involuntarily laid-off people doubled [from 19 percent] to 39 percent after ARRA. … The biggest jump by percentage points occurred in industrial manufacturing, which rose by 60 percentage points—from 7 to 67 percent. … The smallest increase was reported for financial services, where enrollment rose only 7 percentage points to 34 percent." The authors also add that the COBRA subsidy reduced adverse selection, though they note "much more and more detailed information is needed to fully assess the impact of subsidy selection." The brief also examines the implications for COBRA policy under the new health law (Bovbjerg, Dorn, Macri and Meyer, July 2010).
Kaiser Family Foundation: Health Coverage Of Children: The Role Of Medicaid And CHIP – "During the current recession, Medicaid and the Children's Health Insurance Program (CHIP) have served as an important safety-net for children in low or moderate income families," together insuring around one-third of all children, according to this fact sheet: "In 2008, despite a recession and a resulting decline in employer-sponsored coverage, the uninsured rate for children continued to drop and nearly 800,000 fewer children were uninsured than in 2007. That decline was caused by an increase in public coverage, with 1.7 million children gaining coverage through Medicaid or CHIP in 2008. In contrast, from 2004 to 2006, public coverage rates for children did not increase as private coverage rates fell." The fact sheet provides detail on children's coverage by income and race as well as uninsured rates by state (7/26).
Urban Institute: Dental Care In The Los Angeles Healthy Kids Program: Successes And Challenges – This brief examines the successes and challenges in dental care faced by the Los Angeles Healthy Kids Program – a public insurance program implemented in 2003 to "address unmet health care needs among children, and provide comprehensive, affordable health care coverage to uninsured children from families with incomes under 300 percent of the federal poverty level (FPL), who are not eligible for the Healthy Families or Medi-Cal programs."
Drawing upon the results of a five-year evaluation as well as analyses of "encounter data from SafeGuard Dental, the program's dental plan," the authors report: "Overall, our study finds that the L.A. Healthy Kids program has greatly improved coverage and access to dental care services for tens of thousands of poor, largely immigrant, Latino children." But some families experienced "delays in initiating dental care" or reported being "inappropriately charged copayments for covered dental care services not subject to cost sharing." The paper ends with a list of recommendations for how to improve the program (Hogan, Hill and Howell, July 2010).
Annals of Family Medicine: Evaluation Of The American Academy Of Family Physicians' Patient-Centered Medical Home National Demonstration Project – This supplement features a series of articles examining the outcomes, lessons and implications of the National Demonstration Project (NDP) of the patient-centered medical home (PCMH).
"The articles in this supplement demonstrate that it is possible for highly motivated, largely independent practices to implement most of the predominantly technological components of the PCMH," write the authors of an introduction to the supplement. "This implementation results in improved indicators of chronic disease care as assessed from medical records, but at the cost of reducing the quality of key attributes of primary care as rated by patients" (Stange, 2010).
Commonwealth Fund: Health Care Opinion Leaders' Views On Delivery System Innovation And Improvement – This report, based on the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey conducted online between June 8 and July 7, examines 225 leaders' views on barriers to delivery system innovation and thoughts on how to strengthen accountability and coordination among health care providers: "a majority of respondents feel that integrated delivery systems (64%) and accountable care organizations (54%) will be either effective or very effective or extremely effective reform models."
"Sixty-five percent of survey respondents believe that providing special payment arrangements to accountable care systems and giving providers financial incentives to practice in ACOs will be very or extremely effective strategies to foster accountability, coordination, and integration in care delivery. About half of opinion leaders feel that giving patients incentives to join accountable care systems (51%) and providing infrastructure support to spur development of ACOs (50%) will be effective strategies; only one-third of leaders believe requiring patients (34%) or providers (33%) to join or practice in accountable care systems will be effective strategies for fostering more accountability in care delivery" (Stremikis, Davis and Audet, 7/26).
Archives of Internal Medicine: National Quality Forum Performance Measures For HIV/AIDS Care – Using electronic data for HIV patients who received care at the Department of Veteran Affairs, this analysis of more than 21,000 patients who were treated in 2008 revealed that the treatment of more than 80 percent of patients included six of the 10 National Quality Forum performance recommended measures. In addition, the study found that "African Americans and hard drug users were less likely to access care and less likely to receive HIV-specific care but more likely to receive indicated general medical care.
Although "the national VA rates for many of the NQF measures for HIV/AIDS care are generally high," the numbers vary by facility, "which indicates room for improvement," the study authors write. "The ability to measure performance should aid quality managers, health care providers, and administrators in identifying best practices from high-performing facilities and in assisting low-performing facilities to improve care" (Backus et al., 7/26).
Annals of Family Medicine: Gradual Electronic Health Record Implementation: New Insights On Physician and Patient Adaptation – Researchers "observed [170] clinical encounters and conducted patient interviews" over a 22-month period at one family medicine outpatient clinic in Rhode Island. They report: "Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. ... Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information," they conclude (Shield et al., July/August 2010).
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State Watch
Chicago Tribune: Illinois Gov. Pat Quinn Thursday signed a law establishing new nursing home safety measures "aimed at ending chronic violence in the facilities. Work already has begun on hiring dozens of additional nursing home inspectors, as well as writing rules that will increase licensing fees and nursing staff levels in the homes. State authorities also say they are tackling one of the thorniest issues: finding ways to fund the law's multifaceted provisions even as Illinois faces a $13 billion budget deficit" (Jackson and Marx, 7/29).
News Service of Florida/Health News Florida: Mike Haridopolos, the president-designate of the Florida Senate, "unveiled plans Wednesday for a multi-city tour of health care roundtables that would revive the Legislature's push to overhaul Medicaid, which now commands about one-quarter of the state's $70.2 billion budget. ... At the stops, Haridopolos and local legislators will huddle with health care officials and seek what he called 'patient-centered solutions to Florida's Medicaid crisis'" (7/28).
Kansas Health Institute: "Kansas Department on Aging officials say a bed tax on nursing homes will be less than initially projected and, in turn, will draw down fewer federal dollars. Throughout much of this year's legislative session, the tax was expected to generate an additional $30 million which would then be used to draw down $56 million in additional federal Medicaid funding. At first, the $86 million was thought to be the amount needed to restore recent cuts in nursing home funding. The cuts were calculated using a formula that's tied to nursing home expenditures. These expenditures turned out to be less than projected, lowering the amount that needed to be raised" (Ranney, 7/29).
San Francisco Chronicle: "More than one fifth of Californians went without health insurance in 2007, with Bay Area counties having some of the lowest rates of uninsured people in the state, according to statistics released this week by the U.S. Census Bureau. The Small Area Health Insurance Estimates, which looked at every county in the nation, found that 20.2 percent of Californians were uninsured in 2007. The counties in California with the highest rates of residents without health insurance -- Mono, Colusa, Monterey -- tended to be smaller, rural or more reliant on agriculture than other regions" (Colliver, 7/30).
Philadelphia Inquirer: "In a rare about-face, [N.J. Gov. Chris Christie's] administration announced Thursday that it would help pay for AIDS medications for nearly 1,000 New Jersey residents who were expecting to lose their coverage through a state program Aug. 1. Under Gov. Christie's first budget, the state tightened the income requirements for the AIDS Drug Assistance Program to save an estimated $7.4 million. The allowable income for assistance was cut from $54,150 annually to $32,490 for a single person with no children. At the same time, the state increased appropriations for the program from $9.8 million to $17.2 million in anticipation of increased enrollment and rising pharmaceutical costs. On Thursday, the state announced that those who would have lost coverage will be enrolled immediately in a new program specifically for residents at higher income levels, between 300 and 500 percent of the federal poverty level" (Lu, 7/30).
Bloomberg BusinessWeek: "Republican gubernatorial candidate Charles Baker blamed the influence of unions Thursday for the Massachusetts Legislature's failure to address vital reforms he says could help alleviate some of its budget woes. … The Republican said lawmakers should have passed a measure to allow municipalities to change their health care plans without union approval. That plan is one of 13 Baker has offered in a series of proposal he says would save the state $1 billion" (Moran, 7/29).
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Bloomberg BusinessWeek /The Associated Press: "The rates paid to many of the private health providers in Louisiana's Medicaid program will fall Sunday to trim spending by $168 million in the program that provides care to the poor, elderly and disabled. The latest cuts to private hospitals, home- and community-based care providers, doctors and specialty service providers are the final piece of balancing this year's $6.5 billion Medicaid budget. Department of Health and Hospitals Undersecretary Jerry Phillips said Medicaid funding was cut by $277 million in the 2010-11 fiscal year that began July 1." Some health providers say these reductions -- combined with others in the last 18 months -- are taking a toll on patients' access to care "by chasing some providers away from treating Medicaid patients, even as more people move onto the Medicaid rolls. More than 1.2 million Louisiana residents are enrolled in the state's Medicaid program, Phillips said" (Deslatte, 7/29).
St. Louis Post-Dispatch: "The State of Missouri has received a 'Gateway to Better Health' Demonstration Project from the Centers for Medicare and Medicaid Services (CMS). The Demonstration will allow the redirection of $25 million in annual Medicaid funding to preserve and expand important community health center services in St. Louis' urban core. These funds will assist in the transition to expanded coverage under the new Federal Patient Protection and Affordable Care Act (PPACA). … The St. Louis Regional Health Commission will coordinate, monitor and report on the Demonstration Project, continuing its work of the last 10 years. Since the region formed the Commission, access to community health center services has dramatically increased by more than 120,000 additional annual visits, and St. Louis has become a national model for innovative ways to improve safety net health care services" (Goodhart, 7/29).
Pittsburgh Business Journal: "Nearly 46,000 Pennsylvanians enrolled in Pennsylvania's adultBasic subsidized health insurance plan could lose their coverage next year if an agreement with the state's Blue Cross and Blue Shield providers is not renewed, according to a report issued Wednesday by the Pennsylvania Budget and Policy Center and the Pennsylvania Health Access Network. The Blue Cross and Blue Shield plans, including Pittsburgh-based Highmark Inc., agreed in 2005 to help fund adultBasic, which provides basic health care to uninsured adults earning up to 200 percent of the poverty level. ... That agreement expires in December. According to the report, the Blue Cross and Blue Shield plans in Pennsylvania have surpluses that are more than $1 billion larger now than when that agreement was signed five years ago. … The organizations also want the Blue plans to agree to make adultBasic contributions through the agreement until 2014, when health insurance exchanges — part of the national health-care reform legislation approved earlier this year — will begin operation in Pennsylvania" (George, 7/29).
Fort Worth Star-Telegram: "Fewer Texans with drug and alcohol addictions will be getting publicly financed help because of a $7 million decrease in funding to treatment centers, providers say. In Tarrant County, Mental Health Mental Retardation may have to reduce admissions into its residential treatment program and end services it offers at the Tarrant County Jail, said Stevie Hansen, MHMR chief of addiction services. The agency will also likely run out of money for outpatient treatment services by May or June, she said. … The reduction in funding contracts, which were announced last week, is due to a rollback in reimbursements. In 2008, the state boosted the rate it pays agencies for treating patients by 7 percent, the first increase since 2001, said Chris Van Deusen, spokesman for the Texas Department of State Health Services. The hike was paid for with federal funds left over from a past year, he said. That money has now been spent" (Branch, 7/29).
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Editorials and Opinions
Securing Medicare's Future Yahoo
Forty-five years ago today, the creation of Medicare transformed our health-care system and our nation. It helped to make us a stronger and more prosperous country by freeing older Americans from the fear that sickness or injury would cost them their lifetime savings and security. ... The reason we have the Medicare we have today is that over the last 45 years, we have repeatedly acted to strengthen and update it for changing times (Kathleen Sebelius, 7/29).
After 45 Years, Medicare Needs Support Houston Chronicle
Rather than cut Medicare, if we want to dramatically reduce health care costs and thus lower our national debt, we need to build on what works and expand to a "Medicare for All" national health insurance program. Every other industrialized nation has some form of national health insurance. They pay half as much per person, cover everyone and have as good or better overall medical outcomes than we do (Christine Adams, 7/29).
Who Decides On Health-Care Value The Wall Street Journal
The most important element in implementing ObamaCare will be the requirement for health insurers to meet what is called a medical loss ratio. This requires health-insurance plans to split the dollars they receive from insurance premiums into two buckets. Depending on the type of insurance coverage, 80% to 85% of premiums must be spent on either medical services or 'activities that improve health care quality.' … This kind of governmental micromanaging of health care—seen nowhere else in our business sector—is anathema to the free market. More importantly, it endangers the lives and well-being of millions of Americans (Newt Gingrich and David Merritt, 7/29).
Facing Up To Bringing Down Entitlement Spending The Washington Post
The need for entitlement reform is almost universally conceded. … According to the Congressional Budget Office, spending on mandatory health programs and Social Security is expected to grow from about 10 percent of gross domestic product today to roughly 16 percent in 2035. … Properly understood, the budget battle is not between big spenders and budget hawks. It is between those who want to spend larger and larger portions of the budget on health care and transfers to the elderly, and those who want to use budget resources for anything else (Michael Gerson, 7/30).
Health Law Needs Repeal Bloomberg
The new health-care law is a threat to the health of small businesses. Its heavy dosage of mandates and penalties will be a financial burden, and the law is riddled with hidden barriers to stronger job growth. … The law flunks the test of real health-care reform. Real reform would: encourage providers to offer higher-quality care at lower costs; reduce the cost pressures that underlie the bankrupt Medicare and Medicaid entitlements; and give every American access to more options for quality insurance. The health-care overhaul law is bad medicine and bad economic policy. From either perspective, the debate now moves to repeal, replace, retreat, repair and -- certainly – regret (Douglas Holtz-Eakin and Michael Ramlet, 7/29).
Health Care Reform Ultimately Helps Missourians The Missourian
It's a truism: A rising tide lifts all boats. The same idea holds true for health care reform; if we participate, all Missourians can benefit. ... almost everyone will have access to affordable health coverage and will be required to maintain health coverage by 2014. This last part, what is also called an 'individual mandate,' remains controversial. ... On Aug. 3, Missourians will be asked to vote on whether they agree with the individual mandate. ... as a doctor, I am constantly reminded that Missouri's health indicators (rates of smoking, obesity, diabetes, etc.) are bad and getting worse. I don't know how it will all play out, but I am willing to give this a chance (Karen Edison, 7/29).
Make Hospitals Report Medical Problems The Des Moines Register
More than half of states require hospitals to report certain medical errors or criminal events - such as use of contaminated drugs or a patient abduction - to a state agency for further review or investigation. Iowa isn't one of them. It should be. And the Iowa Hospital Licensing Board should vote to support such a requirement at its next meeting in November (7/30).
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