Archive for July, 2011

Today’s Headlines – July 27, 2011

Good morning! Today’s early morning highlights from the major news organizations, including the latest developments related to efforts to raise the debt ceiling, as well as reports about health policy news from the states.

The New York Times: Vote On Boehner Plan Delayed Amid Opposition
House Republican leaders were forced on Tuesday night to delay a vote scheduled on their plan to raise the nation’s debt ceiling, as conservative lawmakers expressed skepticism and Congressional budget officials said the plan did not deliver the promised savings (Steinhauer and Hulse, 7/26).

For more headlines … (more…)

Wednesday, July 27th, 2011

Medicare To Examine Quality Of Care At Outpatient Surgery Centers

The quality of care at outpatient surgical centers has remained a mystery even as their number has swelled to more than 5,000. But as Medicare moves toward taking quality into account in setting payments, it’s going to start looking at the rates of problems at these facilities, formally known as ambulatory surgery centers, or ASCs.

Starting in October 2013, Medicare’s ASCs payments would be affected by how they score on these measures. The initial quality measures that the Centers for Medicare & Medicaid Services proposed earlier this month for evaluating individual ASCs include:
(more…)

Tuesday, July 26th, 2011

Today’s Headlines – July 26, 2011

Good morning! Today’s early morning highlights from the major news organizations, including reports about Washington’s debt-celing showdown, and news that the federal government will conduct health insurance rate reviews in 10 states.

The Washington Post: President Obama, House Speaker Boehner Present Dueling Debt-Limit Plans To Nation
As Boehner tried to rally support for his two-step plan to cut $3 trillion in spending, Senate Majority Leader Harry M. Reid (D-Nev.) offered a strikingly similar proposal for increasing the debt limit before the Aug. 2 deadline. The two leaders, however, remained bitterly divided over Boehner’s demand to hold another vote next year to further expand the government’s borrowing authority (Kane and Montgomery, 7/25).

For more headlines … (more…)

Tuesday, July 26th, 2011

Some Small Businesses Say Health Insurers Are Dropping Their Coverage

One in eight small businesses told the National Federation of Independent Business that since the health law passed in 2010, their health insurer had either terminated their plan or notified them it is going to be eliminated.

The NFIB said it couldn’t say for certain that small businesses were losing their insurance because of the health law, but the organization is “pretty sure” that costs related to the health law were the cause, said Denny Dennis, a senior fellow at the NFIB and author of the report released today.

Dennis said the NFIB was “not aware of any data that suggested” insurers had dropped coverage of small businesses in such large numbers in years before the passage of the health law. For this reason, they felt confident the health law was the cause, he said. The NIFB opposed passage of the final health reform law over concern about its costs, though it had initially supported the legislative effort toward health reform. It also is a plaintiff in the Florida vs. HHS lawsuit that seeks to overturn the law.

The NFIB developed today’s report from a survey of 750 small employers with 50 or fewer employees conducted by polling firm Mason-Dixon during April and May 2011.

As part of the health law, businesses employing 25 people or fewer are eligible for a tax credit to help them offset the costs of insurance. The NFIB said it doesn’t know just how many small businesses have applied for the small business tax credit, but it estimates that 245,000 businesses are eligible for a full tax credit and 1.165 million are eligible for a partial credit.

The White House said in 2010 that it estimated 4 million businesses would be eligible for the tax credit.

Monday, July 25th, 2011

New Health Agency Asks Public “Who Are We?”

The Patient-Centered Outcomes Research Institute, one of the new entities created by the 2010 health law, asked the public last week to help them define the organization’s mission.

Photo by gonzales2010 via Flickr

The move follows the controversy that arose around comparative effectiveness and health care rationing during the 2009 health care debate, which led Congress to add a provision into the health law limiting the institute’s mandate. Under the law, PCORI cannot produce research that mandates “practice guidelines, coverage recommendations, payment, or policy recommendations.” What PCORI should research was left vague enough that the group has spent much of its first year seeking a definition.

(more…)

Monday, July 25th, 2011

Louisiana Medicaid Moves To Managed Care

Louisiana health officials announced Monday that five health plans won bids to manage care for 892,000 low-income Medicaid patients — a first for the state that will be worth an estimated $2.2 billion in new revenues for the companies.

Louisiana Capitol (Photo by nsub1 via Flickr)

The announcement is the latest step in a four-year march to managed care. “This has been a long time in the making,” said Bruce Greenstein, secretary of the Department of Health and Hospitals and a former Microsoft executive, in a call with reporters.

The state chose plans that had “significant experience” running Medicaid plans in other states and that had succeeded in changing “the behavior of enrollees” and doctors to drive costs down, he said.

Managed-care companies could save the Louisiana Medicaid program as much as $135 million a year compared to current spending.

The companies, which can accept patients statewide, are Centene, AmeriHealth Mercy of Louisiana and AmeriGroup. All three specialize in treating Medicaid patients. Also, UnitedHealthcare and Community Health Solutions won bids to run managed-care plans under a different set of rules that would limit their financial risk  in caring for patients.

(more…)

Monday, July 25th, 2011

Today’s Headlines – July 25, 2011

Good morning! It’s a big week for a debt ceiling deal, and we’re following it every step of the way. Today’s early morning highlights from the major news organizations, including reports on the status of efforts to reach a debt-ceiling deal.

The New York Times: Rival Debt Plans Being Assembled By Party Leaders
The House speaker, John A. Boehner, and the Senate majority leader, Harry Reid, were preparing separate backup plans to raise the nation’s debt ceiling on Sunday after they and the White House were unable to form a bipartisan plan that would end an increasingly grim standoff over the federal budget (Steinhauer and Cooper, 7/24).

For more headlines … (more…)

Monday, July 25th, 2011

History Shows Medicare Can Be Cut While Sparing Beneficiaries

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

Lately you’d think President Obama was threatening to push Granny off the cliff.

That’s pretty much been the reaction of liberal Democrats to even the hint that the president might consider reductions in spending for Medicare as part of a deal to raise the nation’s debt ceiling.

“Any cuts to Social Security, Medicare and Medicaid should be taken off the table,” the Congressional Progressive Caucus wrote in a letter to the president. “These cuts would hurt households and damage the country’s economic recovery as well.”

But most of the outrage assumes — incorrectly — that any cuts would necessarily be aimed directly at Medicare patients. History suggests otherwise. (more…)

Monday, July 25th, 2011

Medical Loss Ratio Deadline Extended For Two States

Iowa and Kentucky late Friday joined the list of states granted extra time for health insurers to meet rules requiring at least 80 percent of revenue on medical care. North Dakota’s request was rejected.

That brings to five the number of state granted more time by Health and Human Services Secretary Kathleen Sebelius.

Photo by Leo Reynolds via Flickr

The health care overhaul law requires insurers selling policies to individuals or small businesses to spend at least 80 percent of premium revenue on medical care or quality improvements, starting this year. Those that don’t must issue rebates to policyholders. The idea is that most of a policyholders’ premium should be spent on medical care, leaving the rest for administrative costs, profits, advertising, broker commissions and executive pay.

But states can ask for leniency if they can show that meeting that 80 percent spending target might cause insurers to pull out of markets or limit sales of policies sold to individuals. Maine, Nevada and New Hampshire had previously been granted waivers.  Still waiting on their requests: Florida, Louisiana, Georgia, Kansas, Indiana and the territory of Guam.

In a letter sent Friday, federal regulators told Iowa regulators that their original request “exceeds that which is necessary’ to prevent destabilization.”  Nonetheless, three of the state’s seven major insurers were below the target and might leave the market without an adjustment, the regulators said, in granting the state a waiver that would allow insurers to meet a 67 percent target this year, a 75 percent target in 2012 and 80 percent in 2013.  The state had requested 60 percent this year, building to 75 percent by 2013.

In Kentucky, regulators sought a 65 percent target, building to 75 percent by 2013.  However, the state’s major insurer was unlikely to leave the market, HHS said, leaving only three smaller ones at risk. It granted a 75 percent target for this year, going to 80 percent in 2012.

North Dakota regulators did not show a “reasonable likelihood” that the 80 percent target would be a problem, so the request was rejected.

The spending requirement, called the “medical loss ratio,” applies to all health plans, except those offered by self-insured employers, such as companies with thousands of employees. However, the exceptions sought by the states would affect only individual policies bought by people who don’t get coverage through their jobs.  Nationwide, more than 18 million Americans purchase their own policies.

Up to 9 million Americans with individual policies and in group plans could be eligible for rebates, according to government estimates.

Friday, July 22nd, 2011

Restricting Medigap Coverage; Hospital-Acquired Infections

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs for Kaiser Health News’ Daily Report.

This week in Research Roundup:

  • Archives of Surgery looks at the clinical and economic burden of hospital-acquired infections.
  • Health Affairs weighs the effects of California’s minimum nurse-to-patient ratio.
  • Health Affairs also examines the relationship between public health spending and mortality rates.
  • The Annals of Internal Medicine conducts a review of health literacy research.
  • The Kaiser Family Foundation compares three potential changes to Medigap coverage.

Read more in the Daily Report.

Friday, July 22nd, 2011

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