Archive for July, 2011

Reinhardt On Medicaid, Medicare And The Default


In our calls for our story on the effect of default on the health care industry, we spent some time talking with Princeton economist Uwe Reinhardt.

He doubts that health care would be affected, unless someone wanted to “make a dramatic statement.”

He believes most doctors’ offices, labs and hospitals could survive a few weeks without Medicare payments with a normal cash cushion. And, he thinks even Medicaid could be safe, because of Obama administration support:

Democrats are a fierce champion of the poor.  The poor is the last group Democrats would pick on.

Then he speculated about what might be happening at the White House:

There probably already exists a list of priorities of whom you will not pay. My hunch is that list will be political. Though I think with President Obama, he wants to [turn] the other cheek, the Christian thing, rather than Reagan who had an amiable smile but knew how to mete out punishment.

In a political list, the first things that wouldn’t get paid would be defense contractors in Republican congressional districts [those that don’t affect the wars]. They could certainly do some damage in Ft. Worth, Texas, before they would pick on health care providers. Obviously the party in power has some ability to use decision-making power as leverage. My hunch is that wouldn’t be the president’s instinct but the people around him.

Friday, July 29th, 2011

Group Seeks A ‘Center-Right’ Consensus To Replace Health Law

Photo by Dru Bloomfield via Flickr

A group of Washington D.C. Republican-leaning former business and government officials have launched a coalition to build support for a policy to replace the sweeping 2010 health law if it were to be repealed through the legislative or judicial process.

Headed by James Wootton, the Partnership for America, is expected to have a budget of about $3 million to $5 million and calls itself a “grassroots organization” that aims to both bolster Republican efforts to repeal the health law and to find “center-right” support for an alternative to the law.

“It would have been harder to get a center-right coalition before this current health law was passed, but I think there is a consensus that has emerged that it is very important to address the concerns of the public” about getting access to affordable health insurance and other problems with the health system, said Wootton, who was previously the founding president of the U.S. Chamber of Commerce’s Institute for Legal Reform.

(more…)

Friday, July 29th, 2011

What Will States Do If Federal Dollars Stop Flowing?

With Congress continuing to struggle to reach a deal to raise the nation’s debt ceiling before the Aug. 2 deadline, speculation abounds about what might happen if the federal government goes into default. Many of the questions have to do with health care spending. The bottom line:  It’s a climate of uncertainty. Gail Wilensky, who ran Medicare and Medicaid during the George H.W. Bush administration told Politico last week,  “we’ve never been through anything like this” (Feder, 7/21).

With very little specific information to go on, news outlets report that state governments, in many respects, are bracing for the worst-case scenarios.

(more…)

Friday, July 29th, 2011

Today’s Headlines – July 29, 2011

Happy Friday! Today’s early morning highlights from the major news organizations, including the latest on the stalled debt-ceiling vote and speculation about how the debate may have altered the discussion regarding changes to Medicare.

The Washington Post: Debt-Limit Vote Is Canceled In House As Boehner, GOP Leaders Struggle To Gain Votes
House Speaker John A. Boehner abruptly canceled a vote on his plan to lift the federal debt limit late Thursday after failing to persuade recalcitrant conservatives to back the measure and help him avert an economy-rattling default. … But with GOP leaders unable to offer assurances that the needed support would materialize, Senate Democrats laid plans to proceed with their own debt-ceiling plan in hopes of pushing a measure through Congress by Tuesday, when the U.S. Treasury says it could begin running short of cash to pay the nation’s bills (Montgomery and Kane, 7/28).

The New York Times: Rival Plans Avoid Tough Decisions
The two main deficit-reduction plans in the House and the Senate, which would tie cuts in federal spending to an increase in the debt limit, both defer tough decisions and rely heavily on procedural steps to impose fiscal discipline. … Savings in entitlement programs and other “mandatory spending” total $20 billion over 10 years under the House bill and about twice that amount under Mr. Reid’s plan. … Both plans would trim mandatory spending by eliminating some overpayments and fraudulent payments in Social Security disability programs, Medicare and Medicaid. The Boehner and Reid plans would both establish a bipartisan committee of House and Senate members to recommend additional deficit reduction measures, which could include changes in entitlement programs and tax law (Pear, 7/28).

For more headlines … (more…)

Friday, July 29th, 2011

Expensive Cities For Health Care; Mapping Medicaid

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

Bundle [a financial-analysis website]: The Most And Least Expensive Cities For Health Care
It’s bewildering for anyone who has ever paid for a health procedure out of pocket when health insurance doesn’t cover the full cost (or when the person is uninsured in the first place): Why does health care cost the way it does, and why do the costs fluctuate depending on where you go and who you see? A colonoscopy, for example, can range from $500 to $3,000 — a large difference depending on how health insurance providers negotiate rates. And when you’re paying out of pocket, every dollar counts (just ask the man who robbed a bank so he could get health care in prison).  … We took a look at the top 100 cities in the U.S. by population to see which cities were spending the most and least on health care (Mike Dang, 7/25).

(more…)

Thursday, July 28th, 2011

$9M Hospital Bill Caps Strange Tale

When Tampa General recently filed a $9.2 million claim against the estate of a penniless woman, it left itself open to criticism. But a look at Hillsborough probate court records offers perspective.

They describe what one court officer described as a “very special case, very difficult.” Among other things, it provides a cautionary tale for those deciding on a health-care surrogate.

Tameka Campbell, in her mid-20s when she was admitted to Tampa General, spent five years there only because the hospital could not find any place that would take her. It couldn’t get financial help from the state, records show, nor cooperation from Campbell’s mother.

The case is a good example of a paradox of the health-care system: A dying patient can be kept alive on a ventilator with a feeding tube almost indefinitely, yet there are few places for such a patient to go for care and often no way to pay for it.

Read more on Health News Florida >>

Thursday, July 28th, 2011

Today’s Headlines – July 28, 2011

Good Morning! Today’s early morning highlights from the major news organizations, including reports about the ever-growing U.S. health care tab and about the petition filed by a conservative legal center to bring their health law challenge to the Supreme Court.

The Washington Post: Boehner, Other GOP Leaders Ramp Up Pressure On Republicans To Pass Debt Plan
House GOP leaders mounted a furious bid Wednesday to win support for legislation designed to ease the nation’s debt crisis, delivering a tongue-lashing to their most conservative lawmakers and casting Thursday’s roll call as nothing less than a vote of confidence in their stewardship of the chamber. … Across the Capitol, Reid continued to oppose Boehner’s two-step approach to lifting the debt ceiling, which would entail expanding the government’s borrowing authority for a few months and then holding another vote early next year on a further increase (Kane and Montgomery, 7/27).

For more headlines … (more…)

Thursday, July 28th, 2011

Medicare Part D Saves Money On Hospital Care

This story comes from our partner NPR‘s Shots blog.

Photo by Paul Pellerito via Flickr

Researchers who analyzed Medicare claims before and after the addition of prescription drug coverage in 2006 found the benefit trimmed about $1,200 a year that would have been spent on care in nursing home and hospitals.

The savings on medical care was calculated by comparing people who had little or no drug coverage before Medicare Part D was offered with those who had pretty good benefits all along.

Add up the savings, and the results suggest that the prescription medicine benefit is trimming around $12 billion a year in spending on medical care, the Associated Press reports. Still, federal spending on the drug benefit is about five times that amount, so it’s not as if the savings on care offset all the drug costs.

The study by researchers from Harvard looked at data for a sample of about 6,000 people age 65 and up from around the nation. The results appear in the latest issue of JAMA, the Journal of the American Medical Association.

The study wasn’t able to figure out which drugs gave the most bang for the buck because of statistical limitations.

Even so, there are hints from previous research, which suggest better drug coverage makes it more likely people with chronic conditions, such as diabetes and high blood pressure, will get prescriptions for medicines that reduce or prevent complications that require additional treatment.

Wednesday, July 27th, 2011

Thomas More Appeals Health Suit to Supremes

The first health care lawsuit that was decided by an appeals court is now at the doorstep of the Supreme Court.

The Thomas More Law Center filed an appeal Wednesday with the high court asking it to overturn the 6th Circuit Court of Appeals June 29 decision upholding the constitutionality of the health law.

“Review is necessary to establish a meaningful limitation on congressional power under the Commerce Clause,” the law center said of its appeal to the high court.

The Cincinnati-based appeals court in a 2-1 decision upheld that the health law was constitutional, because it regulated activity that is economic.

There have been multiple decisions in lower district courts, of which 6 found the law constitutional and 2 found it unconstitutional. (See our lawsuit chart here)

Two appeals courts, the 11th and the 4th, have already heard arguments on the law, and decisions are expected to be issued before the Supreme Court begins its next session in October. If the court decides to hear the cases, it could rule on the constitutionality of the health law before the end of its next term in June 2012.

Wednesday, July 27th, 2011

Study: New Coverage Will Boost Demand For Rural Providers

Source: UnitedHealth Center for Health Reform & Modernization

The percentage of rural Americans with insurance could grow faster than those in urban areas under the federal health care overhaul law, a boon for the newly insured, but one that will put additional pressure on areas already short of doctors, a study out today says.

About 5 million more rural Americans will have coverage by 2019 – either through the insurance exchanges or Medicaid – a 16 percent increase, according to a study by the research arm of insurer UnitedHealth Group. That compares with a 13.5 percent increase in urban areas, where an additional 25 million people will gain coverage, the report says.

The insurer used census data and a simulation model developed by the Lewin Group to arrive at the estimates, cautioning that they are “subject to uncertainty.”

Still, the expansion in rural America would come even as many areas already have below-average availability of primary care doctors – along with higher-than-average rates of chronic health problems, such as heart disease and diabetes.

“This is clearly a major challenge for the next two and a half years,” says Simon Stevens,  executive vice president of UnitedHealth. “On a region by region basis, there needs to be a concerted plan to think about how health care will be organized to react to these expansions.”

Since much of the growth in the insured will be because of coverage expansions in Medicaid, the state-federal program for the poor, United asked doctors if they currently accept new patients in the program and how likely they would be to continue to do so.  Eighty-four percent of rural doctors currently accept new Medicaid patients, compared with 65 percent of urban physicians.   Among rural doctors, 59 percent said they expect to be taking on new Medicaid patients in 2014, the year that the state-federal program for the poor will be expanded to make more Americans eligible, compared with 44 percent of urban doctors.  Thirty percent or more of both groups said they didn’t know what they will do that year.

While the health care law does provide some funding for increased training and pay for primary care physicians, the report says the states also need to act to boost capacity.

States could, for example, allow mobile clinics to count toward requirements that insurers provide adequate networks of doctors. They could also make it easier for doctors to practice “telemedicine,” where patients are seen by doctors via video, telephone and other electronic consultations. One way to do that is to allow multi-state licenses, so a doctor in one state can see patients via telemedicine in another, Stevens said.  The report also suggests that more states should allow nurse practitioners and physician assistants a greater role in seeing patients, offering treatment and prescribing medications. Such changes in “scope of practice,” are controversial – and often fought by doctor associations.

Wednesday, July 27th, 2011

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