Archive for February, 2012

Wash. Senate Nears Vote To Require Abortion Coverage

While lawmakers in Washington clash over birth control, lawmakers in Washington state are close to passing a first-of-its-kind law that would require insurers to cover abortion services.

If passed, the Reproductive Parity Act would make the Evergreen State the first in the country to require public and private insurers to cover abortion if the plan covers maternity services. The bill has already made it through the House, and it was passed by a Senate committee on Tuesday. Advocates expect the measure to pass the full Senate within the next couple days and go on to receive Governor Christine Gregoire’s signature.

That doesn’t mean, however, that the legislation sailed through without opposition. Since being introduced in January, it was amended to exempt insurers who have a religious or conscience exception to abortion coverage. According to Melanie Smith, a lobbyist with NARAL Pro-Choice Washington, a religion/conscience exemption was already on the state’s books in other contexts, and the addition in this case was made to reaffirm insurers’ ability to opt out. Smith said the amendment wasn’t a response to the national debate over religion and birth control.

Photo by Tony Swartz via Flickr

Another amendment to the Reproductive Parity Act seeks to ensure that it doesn’t come into conflict with federal law, specifically the long-standing Hyde amendment, which prohibits discrimination against an insurer for not providing abortion coverage. Washington lawmakers added language Feb. 13 to stipulate that federal law supersedes state law, but concerns remain. On Feb. 16, six members of Congress – four Republicans and two Democrats, including Rep. Cathy McMorris Rodgers, R-Wash. – sent a letter to President Barack Obama to send a strong message. They wrote that the Reproductive Parity Act “would have far reaching and alarming consequences for the citizens of Washington state who embrace life” and “be a direct violation of federal law” and, therefore, jeopardize federal funding.

According to Smith, the bill’s current language has addressed their concerns about federal law. She added that “neither of the two amendments undermines the intent or the outcome of the bill,” which is to ensure abortion coverage in Washington.

And while insurers who disagree on conscience could indeed opt out, the Reproductive Parity Act would at least make abortion coverage the default, as opposed to an add-on, said Elizabeth Nash, a state issues manager with the Guttmacher Institute.

Wednesday, February 29th, 2012

Today’s Headlines – Feb. 29, 2012

Good morning! Half way through the week! Here are your morning headlines:

Politico: Who’s Health Care’s Key SCOTUS Vote?
Administration lawyers have peppered their briefs with citations to opinions written by Anthony Kennedy and Antonin Scalia, they’ve seized on the arguments made by one of Scalia’s most beloved former clerks and their allies in legal circles have talked up how a decision upholding the Affordable Care Act would play into John Roberts’s legacy as chief justice (Haberkorn, 2/28).

Los Angeles Times: States Should Study Spending Before Picking Benefits, Report Says
California and other states should consider the medical care used by the highest-cost patients who battle cancer and other chronic conditions when setting essential benefits under federal reform, according to a study. The report issued Tuesday by the IMS Institute for Healthcare Informatics found that the under-65 population, which will be affected the most by the federal healthcare overhaul, has very different medical spending patterns than Medicare beneficiaries that policymakers should take into account as they prepare to extend coverage to millions of the uninsured (Terhune, 2/28).

For more headlines … (more…)

Wednesday, February 29th, 2012

Maine’s Top Court Backs State Authority To Limit Health Plan’s Profits

In a case closely watched by the insurance industry, Maine’s top court Tuesday upheld state regulators’ authority to hold down rate increases sought by Anthem Health Plans of Maine.

In its ruling, the Supreme Judicial Court said that Maine’s insurance superintendent had “properly balanced the competing interests” in arriving at an approved rate increase of 5.2 percent. The insurer, a unit of Wellpoint, the nation’s largest insurer, had sought a 3 percent profit margin as part of an overall 9.2 percent increase in health insurance rates for policies sold to individuals in 2011. It argued that state regulators’ decision to grant a 1 percent profit margin violated state law and the U.S. Constitution by depriving the company of a “fair and reasonable return.”

Wellpoint spokeswoman Kristin Binns said in an e-mail statement that the company had not decided on its next step. “We stand by our position that filed rates need to both cover the medical costs for our members and allow for an adequate risk margin to cover unanticipated costs,” she said.

Legal experts say the company has several options, including asking the state court to reconsider its decision, or seeking to appeal the ruling to the U.S. Supreme Court.

Maine law, like that in many states, says premium increases cannot be excessive, inadequate or unfairly discriminatory. In October, the National Association of Insurance Commissioners filed a brief with Maine’s top court, saying that if the court sided with Anthem, the decision “has the potential to destabilize a key aspect of insurance regulation and will have far reaching effects impacting all states.”

Tuesday’s decision pleased Mila Kofman, Maine’s insurance superintendent at the time Anthem made the requests.

“This is great news for consumers because it reaffirms that a state insurance regulator, when they have the authority, can do a balanced, comprehensive review of rates,” Kofman, now a researcher at Georgetown University’s Health Policy Institute.


Tuesday, February 28th, 2012

More Americans Head To The ER For Dental Emergencies

Americans who turn up in the emergency room to get dental care aren’t lost, they’re probably just running out of options.

According to a new report from the Pew Center on the States, more than 800,000 visits to the ER in 2009 were for toothaches and other avoidable dental ailments.

“People showing up at emergency rooms for dental is really your sign that your system is breaking down,” Shelly Gehshan, director for the Pew Center’s Children’s Dental Campaign says. “It’s just not serving enough people. This is your symptom of a system in crisis.”

During times of economic crisis, state Medicaid programs often target dental benefits as their first budgetary cut, pushing low-income patients from the dentist office to the emergency room. But the shift from Medicaid reimbursements to hospitals is still costly to states. Dental groups have long since said that ERs only provide temporary relief for dental emergencies and lead to reoccurring hospital visits, which burden taxpayers. “We’re spending in the worst possible way,” Gehshan says.

For example the report shows that in 2002 Maryland had a 12 percent increase in the rate of ER dental visits once the state stopped Medicaid reimbursements for private practice dentists treating adult emergencies. Florida reported more than 115,000 dental-related ER visits in 2010, and in Oregon a 31 percent hike of ER cases among Medicaid enrollees over a three-year-period. (more…)

Tuesday, February 28th, 2012

Today’s Headlines – February 28, 2012

Good morning! Here are your early-morning headlines:

The New York Times: At-Risk Patients Gain Attention Of Health Insurers
One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs. And they are not always the end-of-lifers. They are people who suffer from chronic and increasingly common diseases like diabetes and high blood pressure (Abelson, 2/27).

The Associated Press/Washington Post: More Americans Seek Dental Treatment At The ER; Costs Can Be 10 Times More Than Checkups
More Americans are turning to the emergency room for routine dental problems — a choice that often costs 10 times more than preventive care and offers far fewer treatment options than a dentist’s office, according to an analysis of government data and dental research (2/28).

For more headlines … (more…)

Tuesday, February 28th, 2012

Pediatricians Recommend HPV Vaccination For Boys

The leading group of U.S. pediatricians says it’s now time for boys, as well as girls, to be vaccinated against human papillomavirus.

The American Academy of Pediatrics has updated its guidance to parents and doctors in favor of routine immunization for boys against the virus.

Connor Perruccello-McClellan, a senior at Providence Country Day School in Rhode Island, has been vaccinated against HPV, something less than 1 percent of U.S. males can say (Photo by Richard Knox/NPR).

Previously, the group had said it was OK to vaccinate boys against the HPV, but it only became part of the pediatricians’ official schedule of recommended vaccines this month.

HPV can cause cervical cancer. And girls have been the prime focus for vaccination, though that has stirred controversy almost from the start.

But the sexually transmitted virus also causes genital warts and anal cancers. It’s also been implicated in the recent increase in oral cancers, though the HPV vaccines aren’t approved to reduce that risk.

The vaccine is most potent if given before the onset of sexual activity. Boys and girls should be vaccinated when they’re 11 or 12, the doctors say. Older boys and young men, ages 13-21, should get the vaccine, if they weren’t immunized earlier.


Monday, February 27th, 2012

Today’s Headlines – February 27, 2012

Good morning! Get your week started with these headlines:

The New York Times: A Measure Of Change: Obama’s Deficit Dilemma
Yet starting with that April speech, Mr. Obama has come to adopt most of the major tenets supported by a majority of the commission’s members, though his proposals do not go as far. He has called for cutting deficits more than $4 trillion over 10 years by shaving all spending, including for the military, Medicare and Social Security; overhauling the tax code to raise revenues and lower rates; and writing rules to lock in savings (Calmes, 2/27).

The New York Times: Many States Take A Wait-And-See Approach On New Insurance Exchanges
States are lagging in the creation of health insurance exchanges, the supermarkets where millions of consumers are supposed to buy subsidized private coverage under President Obama’s health care overhaul (Pear, 2/27).

For more headlines … (more…)

Monday, February 27th, 2012

By The Numbers: Wisconsin’s High Risk Pool

This week the federal government touted the number of people who have enrolled in the high risk insurance pools created in every state. After a slow start, some 50,000 people with serious illnesses nationwide have signed up for the insurance plans created by the federal health law.

But in Wisconsin and elsewhere that statistic doesn’t tell the whole story. The number of people who have signed up are far fewer than expected, but the costs of their health care per person has been about double what was projected.

Low participation in Wisconsin has eased concerns that the program will run out of money, but high health costs mean there probably won’t be any funds left over.

In 2010, Wisconsin got $73 million from the federal government to set up a high risk pool. One of the biggest concerns was making the money last. It had to be stretched out until people could buy insurance in the exchanges, the online marketplaces coming in 2014. It was estimated 8,000 people with pre-existing conditions would apply; two years later, only 1,100 have.


Monday, February 27th, 2012

Electronic Health Records Program Advances to ‘Stage 2′

It’s time to take electronic health records to the next level. Federal officials on Thursday released their second-stage guidelines for “meaningful use” of electronic records, which advocates say have the potential to reduce medical errors and streamline care. The proposed rules require doctors and hospitals to significantly step up their usage, as well as better engage patients and improve the transferability of records.

Photo by Waleed Alzuhair via Flickr

The 2009 federal stimulus provided $30 billion as an incentive for health care providers nationwide to implement electronic records for their Medicare and Medicaid patients. Officials established the “meaningful use” program, which provides financial rewards in three stages if certain standards are met. The first stage requires providers to begin setting up an electronic system and to record basic information including diagnoses and prescriptions for a portion of patients.

The rules proposed Thursday start off by extending Stage 1; providers who began compliance in 2011 would now have until 2014 to move on to Stage 2. Many of the objectives of the second stage will be the same — ordering prescriptions electronically and so forth — but the minimums for “meaningful usage” will go higher. For example, at least 60 percent of patients must have their medications and lab tests ordered electronically during Stage 2, instead of the 30 percent required during Stage 1.


Friday, February 24th, 2012

Today’s Headlines – February 24, 2012

Happy Friday, world! Here are your headlines:

Los Angeles Times: Debt Would Grow Under Most GOP Candidates’ Plans, Report Says
The sober analysis shows how difficult it will be for any new inhabitant in the White House to shift the nation’s debt trajectory, and the need for long-term and bipartisan efforts to gain revenues and curb spending — particularly at a time of rising Medicare costs for the aging population, the budget watchdog group said (Mascaro, 2/23).

The Associated Press/Washington Post: Study Finds That Budget Plans Proposed By Gingrich And Santorum Lead To Huge Deficits
Huge tax cuts in the budget plans of Newt Gingrich and Rick Santorum would produce the kinds of trillion-dollar-plus deficits that the GOP candidates are blaming on President Barack Obama. That’s the finding by the nonpartisan Committee for a Responsible Federal Budget, a Washington-based budget watchdog group (2/24).

For more headlines … (more…)

Friday, February 24th, 2012

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