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Health Expert Urges States To Slow The Move To Medicaid Managed Care

As more states turn to managed care to reduce Medicaid costs, Judy Feder is urging caution.

Feder

Feder, a  professor at and former dean of the Georgetown University’s Public Policy Institute , is worried that officials’ enthusiasm for managed care in Medicaid “might get out of hand,” and she is urging them to move slowly when it comes to caring for the nearly 9 million “dual eligibles,”  Medicaid enrollees who also qualify for Medicare. These are some of the poorest and sickest enrollees. About 40 percent of Medicaid spending is on duals.

Medicare, rather than private insurers, should take the lead in improving health care for duals, Feder said at a Friday forum sponsored by the Alliance for Health Reform and the insurer Centene Corp., which operates Medicaid managed care programs in more than a dozen states. Feder, who is also a fellow at the Urban Institute, said Medicare should conduct aggressive oversight of the Medicare Special Needs Plans, which are private insurers in the Medicare Advantage program that care for duals and other beneficiaries with chronic health needs. Medicare must also conduct better oversight of skilled nursing facilities to prevent unnecessary hospitalizations  for nursing home residents, Feder said.

Matt Salo, executive director of the National Association of Medicaid Directors, said that expecting Medicare to manage duals would be a mistake.  “If we’re going to sit around and wait for Medicare to fix this problem, we’re all going to die in that waiting room,” he said.

(more…)

Monday, October 31st, 2011

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Today’s Headlines – Oct. 31, 2011

Happy Halloween! Today’s early morning highlights from the major news organizations, including reports about a key medical group’s take on accountable care organizations and how a “merger wave” is hitting the health care sector.

Los Angeles Times: Deficit Reduction Panel Reaches Crucial Juncture
The super committee has until Thanksgiving to reach an accord. A deal to reduce the deficit has eluded Congress this year because of a simple stalemate: Republicans refuse new taxes and Democrats will agree to cut federal programs only if new revenues are in the mix. If the committee fails, a series of automatic spending cuts is set to kick in to reduce military and domestic spending. Lawmakers from both parties also fear that a failure could cause turmoil in financial markets (Mascaro, 10/29).

For more headlines … (more…)

Monday, October 31st, 2011

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Medical Schools Say Magazine’s Ratings Get An Incomplete

Deans from some of the nation’s top medical schools met Thursday — not to talk about training doctors or weathering economic challenges — but to size up the people who grade them.

The sit-down between editors at U.S. News & World Report and the top brass at Harvard, Yale, Columbia and several other schools showed how seriously those in medicine’s ivory tower take the magazine’s annual rankings.

The ratings count when it comes to marketing to prospective students, staff recruits and philanthropists, the deans acknowledged. But if their comments at the conference — marking the 20th anniversary of the rankings — are any guide, the deans take them less seriously as a scientific gauge of what actually goes on at their schools.

“It’s just not measuring how we educate our students,” said Dr. Dennis Charney, dean of Mount Sinai Medical School (No. 18 on the U.S. News list, for what it’s worth), which hosted the event in New York. But, he acknowledged, the schools need “to come up with better ways” of appraising educational performance.

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Friday, October 28th, 2011

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Doctor-Patient Relationship Has Starring Role In AMA Ad

Keep an eye out during the evening news, or even your favorite show on Lifetime, because the American Medical Association is taking to primetime news and cable to fight Medicare physician payment cuts.

Doctors face a 29.5 percent payment cut Jan. 1 if Congress doesn’t intervene. The AMA ran ads explicitly against the cut in a campaign that ended last week, but now the group is running a different, much-less-direct campaign through Nov. 20. The currently running ad focuses on the “essential partnership between patients and their doctors.”

“The ads reflect the reality that while AMA advocacy addresses issues like Medicare cuts specifically, our overall objective is more global: protecting the essential partnership between patients and their physicians,” AMA President Peter Carmel wrote in an email.

The spot will air on “60 Minutes,” Sunday news programs and national nightly news, as well as during both daytime and primetime shows on cable channels like CNN, Lifetime and Hallmark.

Here’s a transcript:

From an ear ache, to the flu; an accident, to asthma; a new heartbeat, to a heart condition: When you see your doctor, you don’t face any medical issue alone — you do it together. At the American Medical Association, we’re committed to preserving that essential partnership between patients and their doctors, because when it comes to your health, you need someone you trust. The AMA — protecting the relationship between patients and physicians.

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Friday, October 28th, 2011

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Looking For The Inventor Of The Individual Mandate

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

The Atlantic: Did A Conservative Think Tank Really Invent The Individual Mandate?
In the course of defending the health care bill he passed in Massachusetts, Mitt Romney told Newt Gingrich that he got the idea for the individual mandate — a rule dictating that everyone must buy health insurance or pay a penalty — from the Heritage Foundation, a conservative Washington, D.C. think tank. Is it really responsible for creating the policy that is now so anathema to conservatives? (Conor Friedersdorf, 10/21).

Time: Mammograms Only Occasionally Save Lives, Analysis Finds
Some doctors and public-health experts have stirred controversy in recent years by arguing that aggressive breast-cancer screening does more harm than good. Many health professionals disagree, but perhaps the most compelling critics of the less-is-more philosophy are the many breast cancer survivors who claim that a routine mammogram saved their lives. These survivor anecdotes — which often turn up in the media — may be causing the public to overestimate the true value of mammograms, a new study suggests. In an analysis published this week in the Archives of Internal Medicine, researchers at Dartmouth estimate that only about 1 in 8 women whose breast cancer was identified during a routine mammogram actually owe their lives to the screening (Anne Harding, 10/25).

(more…)

Friday, October 28th, 2011

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Today’s Headlines – Oct. 28, 2011

Happy Friday! Today’s early morning highlights from the major news organizations, including reports about the health law’s public support, the latest on the super committee and news about the cost of Medicare Part B premiums.

The Wall Street Journal: Repeal Health Law? It Won’t Be Easy
Every Republican presidential candidate has promised to repeal the Obama administration’s health-care overhaul. But despite full-throated criticism, it’s going to be hard for any of them to fulfill that pledge if elected. Standing in the way of that seemingly simple campaign promise—an article of faith among GOP voters—is a welter of practical and political obstacles (Radnofsky, 10/29).

Politico: Kaiser Poll Finds Drop In Democratic Support For Law
The health care reform law’s popularity hit an all-time low this month, largely driven by Democrats’ eroding confidence in the historic overhaul, according to a new poll released Friday. Just 34 percent of those surveyed said they have a favorable view of the Affordable Care Act, the lowest ranking in Kaiser Family Foundation’s monthly Health Tracking Poll since the law passed in March 2010. By contrast, 51 percent said they have an unfavorable view (Millman, 10/28).

For more headlines … (more…)

Friday, October 28th, 2011

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A Tweak To Health Law Would Eliminate Medicaid For Some

Should the middle class be eligible for Medicaid?

The health program, funded jointly by the feds and the states, was devised to cover the poor. But if a provision in last year’s health law isn’t changed that could be the case for people with pretty healthy incomes.

Photo by Andreas Praefcke via Wikimedia Commons

So today, the House approved a bill that would make the change. The bill is backed by President Obama, among others, and it passed relatively easily in a vote of 262-157.

But, as usual with things related to health and tax policy, nothing is quite as simple as it seems.

The “glitch,” if it is one, refers to the fact that under the health law, most Social Security benefits are not taxed. And the untaxable portions of those benefits aren’t counted to determine eligibility for Medicaid. Same goes for the State Children’s Health Insurance Program, and for other income-tested provisions of the law, including subsidies for private health insurance premiums.

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Thursday, October 27th, 2011

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Today’s Headlines – Oct. 27, 2011

Good morning! Today’s early morning highlights from the major news organizations, featuring details of the super committee’s latest action — the Dems’ $3 trillion debt deal, which includes a $400 billion Medicare plan; and the GOP counter approach.

The Washington Post: Congressional Democrats Offer $3 Trillion Debt Deal
Congressional Democrats are urging the debt-reduction supercommittee to pursue a far-reaching agreement to slice $3 trillion from the federal budget over the next decade through significant cuts to federal health programs, including Medicare, and as much as $1.3 trillion in new taxes. At a closed-door meeting Tuesday, Sen. Max Baucus (D-Mont.) told his colleagues on the panel that they should pick up where President Obama and House Speaker John A. Boehner (R-Ohio) left off in negotiations this summer during a bitter battle to raise the federal debt limit, according to congressional aides in both parties familiar with the meeting. Obama and Boehner were discussing a plan that included provisions to raise taxes, raise the Medicare eligibility age and use a less generous measure of inflation to calculate Social Security benefits (Montgomery and Helderman, 10/26).

For more headlines … (more…)

Thursday, October 27th, 2011

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Harvard Study Highlights Wide Range Of Medicaid Expansion Estimates

If one thing is certain about the 2010 health law, it’s that almost nothing about it is certain. And according to a newly released report, one of the major unknowns involves the law’s expansion of Medicaid, the federal-state health insurance program for the poor.

In a Health Affairs article released Wednesday, researchers at the Harvard School of Public Health say the expansion of Medicaid under the Affordable Care Act  (ACA) could add between 8.5 million and 22.4 million people to the rolls by 2019. It could also drive up annual federal spending on the program by anywhere from $34 billion to $98 billion.

Medicaid expansion begins in 2014, when the threshold for eligibility will be raised nationwide to 133 percent of the federal poverty level. Currently, eligibility varies widely among the states once certain federal minimums have been met.

In 2010, 69 million Americans were enrolled in Medicaid, which provides health insurance to low-income children and adults, including 9 million people who also qualify for Medicare.

In the Harvard study, the researchers’ best estimate is that 13.4 million more people will enroll in Medicaid by 2019 as a result of the law’s expanded eligibility, with annual federal spending going up $58 billion as a result. In March, the Congressional Budget Office estimated that 16 million will enroll by 2019 if the health law is implemented. The CBO did not offer a range for its enrollment estimate, nor did it estimate the increase in annual federal spending in its most recent analysis.

(more…)

Wednesday, October 26th, 2011

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High-Deductible Health Plans More Common On Employers’ Menus

Health plan deductibles keep inching up.

When employees sign up for coverage this fall during their company’s annual enrollment period, nearly a quarter will face annual deductibles of at least $1,000, according to a recent employer survey by the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

At small companies, the high-deductible option, often served with a tax-preferred savings account, may be the only choice. But larger firms are more likely to offer at least one traditional PPO or HMO plan alongside a high-deductible choice.

Now, though, even very big companies are beginning to move all their employees into high-deductible coverage, perhaps signaling even wider adoption of these types of plans.

(more…)

Wednesday, October 26th, 2011

Posted in Insuring Your Health | Comments Off

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