KHN: Kaiser Health News

Listening to recent statements from some congressional Republicans, you might think that the 2010 health law allows the Internal Revenue Service to have access to your medical records.

Not so, says the Department of Health and Human Services. “The Affordable Care Act maintains strict privacy controls to safeguard personal information.  The IRS will not have access to personal health information,” said agency spokeswoman Erin Shields Britt.

Republicans have pounced on news reports that the IRS unfairly targeted conservative groups for greater scrutiny when the groups sought tax-exempt status. Rep. Michele Bachmann, R-Minn., said the health law “will allow bureaucrats access to our most intimate, personal health care information.”  Sen. Rand Paul, R-Ky., a physician, said he was “quite worried about the privacy of medical records. I’m quite worried now that your medical records will be evaluated by the IRS.”

The IRS does play a key role in implementing the 2010 health care law. Those duties include enforcing the law’s requirement that most individuals have health insurance or pay a fine and helping determine whether individuals are eligible for a tax credit to help afford health insurance premiums.

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Somewhere between 13 and 20 percent of kids in the United States experience some sort of mental illness, according to a new report from the Centers for Disease Control and Prevention. That adds up to millions of children suffering from disorders like ADHD, depression, autism and illicit drug use.

The total annual cost of the illnesses? About $247 billion a year.

The study, published as part of the CDC’s weekly journal MMWR, is the first time that federal researchers have sought to compile estimates of how many children have specific mental disorders and describe federal efforts for monitoring the issue.

The prevalence of mental disorders in kids seems to have increased over the past 15 years as well (though the growth could reflect better monitoring and awareness, rather than more kids actually being sick). And they seem to be sicker: inpatient hospital admissions for mental health and substance abuse issues increased by nearly a quarter from 2007-2010. Suicide was the second leading cause of death for kids aged 12-17.

The CDC put together this handy infographic to chart the prevalence of various illnesses. ADHD is the most common diagnosis, followed by behavioral and conduct problems.

As nurse practitioners lobby to expand their authority and scope of practice in many states, a New England Journal of Medicine study released Wednesday documents a deep chasm between how doctors and nurses regard the issue.

The study found the two groups overwhelmingly agreed that nurse practitioners should be able to practice to the full extent of their schooling and training. But doctors were less likely to concur that advanced practice nurses should lead medical homes, which deliver team-based, coordinated care to patients. Only 17 percent of the 505 primary care physicians  surveyed agreed with that notion, compared to 82 percent of the 467 nurse practitioners surveyed.

The two groups also disagreed about whether nurse practitioners should be paid equally for providing the same health services. More than 64 percent of nurse practitioners agreed with the idea of equal pay, as opposed to less than 4 percent of doctors.

The debate over the role of nurse practitioners has intensified as a result of concerns over a shortage of doctors as an estimated 25 million people gain insurance under the health care law.  Nurse practitioners argue they can fill some of those needs if they are granted greater scope of practice.

That debate is reflected in the study’s finding about the groups’ conflicting views about the quality of care provided by doctors versus nurse practitioners. When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

“We’ve done a lot of comparative surveys with health professionals but we’ve just never found gaps this big,” said Dr. Karen Donelan, an assistant professor of medicine at the Harvard School of Medicine and the study’s lead author. “When we get on the ground and we survey the people actually doing the work and working together, we see some of those professionals come closer together. We didn’t observe that here.”

Donelan pointed out that most nurse practitioners in the study — approximately 75 percent — said they are already practicing to the full extent of their training. Survey respondents who did not have this opportunity blamed their limited practice on state restrictions, hospital regulations and work setting.

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As the GOP-controlled House of Representatives prepares again to vote this week on a repeal of the 2010 health law, some key Republican senators have seized on recent news developments to show their ire.

Photo by Karl Eisenhower/KHN

Senate GOP leaders Tuesday took issue with Department of Health and Human Services Secretary Kathleen Sebelius for soliciting money from private groups to implement the law.  Noting the Internal Revenue Service scrutiny of conservative political organizations,  the Republicans also said the IRS can’t be trusted to implement the health law.

“The secretary is out raising money from the private sector, people who are dependent on the government’s regulations, to help the government convince the public that Obamacare is a good measure,” said Senate Minority Leader Mitch McConnell, R-Ky.

A Sebelius spokesman said her actions were legal and that she had not solicited pharmaceutical and insurance companies regulated by the agency.

Sen. Lamar Alexander, R-Tenn., compared the secretary’s actions to the Iran-Contra scandal during the Reagan administration. Alexander is the ranking Republican on the Senate committee overseeing health policy.

Sen. John Barrasso, R-Wyo., dubbed Sebelius’ actions to implement the health care the “Sebelius Shakedown.”

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Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it.

Only three states have implemented the pay raise — Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians.

The two-year pay hike is intended to entice more doctors to treat the millions of residents expected to enroll in Medicaid in 2014 when the federal health law expands eligibility. Critics have said the expansion of the federal-state program for the poor would accelerate the shortage of doctors who treat them.

Most states have not started offering the higher pay rates because the Obama administration did not issue the rules until November, and state officials said they didn’t have time to carry out the change and have the federal government approve the new rates.

All states have applied with the federal government to start offering the higher rates, but the Centers for Medicare & Medicaid Services has approved only seven.

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Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie’s startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie’s mother, actress Marcheline Bertrand, died of cancer at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene.

(Photo by Oli Scarff/Getty Images)

Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie’s decision raises.

Should all women have the genetic test? No, says Brawley, but they should all have a conversation with their doctors.

This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist.

Are insurers required cover the genetic tests? What about the preventive surgery? Brawley says:

Insurance plans created before the passage of the Affordable Care Act are not required to cover the costs of genetic counseling, testing, and any surgery to reduce the risk of breast cancer. Under the Affordable Care Act, new plans are required to cover the costs of counseling and testing for breast cancer risk. There is no such mandate for the coverage of surgery.

Brawley points out that only a small number of breast cancers are linked to genetic risk factors, but women, like Jolie, who are at high risk should know it. He warns women to proceed cautiously and get a second opinion before deciding to have a preventive surgery. “Nonetheless, after careful consideration, this might be the right choice for some women,” Brawley writes.

That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas.

That’s because the Obama administration announced that for the next two years, it doesn’t plan to penalize states that have yet to expand Medicaid coverage under the federal health law by targeting them for reduced Medicaid funding, according to a proposed rule unveiled Monday. That money goes to  hospitals that treat large numbers of poor people.

The health law is funded in part by a gradual reduction in extra Medicaid payments, called disproportionate share hospital, or DSH. Those payments help hospitals that care for a large proportion of poor patients who are covered by Medicaid, or who are uninsured.

The hospital industry agreed to the cuts during the  negotiations over the law on the assumption that expanding coverage to many people who are now uninsured would mean that hospitals would give away less uncompensated care. But since the Supreme Court made the Medicaid expansion voluntary last year, hospitals fear they will lose Medicaid money while at the same time seeing little or no reduction in how much they spend on uncompensated care.

The HHS secretary must come up with a formula that imposes the sharpest cuts on states with the lowest levels of uncompensated care.

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Four states that have snubbed the federal health law by defaulting to the federal government to build new online insurance marketplaces and not agreeing to expand Medicaid are getting new jobs at call centers that will help consumers understand their new coverage options this fall.

Up to 9,000 jobs are expected to be created at call centers to support the new federally run marketplaces. A Department of Health and Human Services spokeswoman said some of them will be added to existing Medicare call centers in Phoenix, Chester, Va., Lawrence, Kan.,  and Tampa, Fla.– all states with Republican leaders who oppose the  law.

A fifth center in Coralville, Iowa and a sixth in Corbin, Ky., will also be expanded, she said. Plans are still being finalized for other locations, she said.

Of those states, only Kentucky is setting up its own online insurance marketplace that will help people shop for individual or small employer coverage. Iowa, will run its exchange in partnership with the federal government.  The other states are relying entirely on the federal government.

Of the six states getting call centers, only Kentucky has committed to expanding Medicaid in 2014, even though governors in Florida and Arizona say they support it. So far, 22 states have agreed to expand Medicaid.

The jobs are through Vangent, a General Dynamics Information Technology subsidiary, which was awarded a $530 million one-year contract  by the federal government to set up call centers to answer inquiries related to the insurance marketplaces in 34 states where they will be run in whole or part by the federal government. The government estimates that next October, when the marketplaces go live, the call centers will be open seven days of the week, 24 hours a day, handling 6.1 million phone calls and 23,000 e-mails. The contract could be renewed for up to nine more years, making it potentially worth more than $5 billion.

States running their own marketplaces will have their own call centers.

The marketplaces are expected to expand health coverage to about 27 million people by 2016. Under the federal contract awarded to Fairfax, Va.-based Vangent, the company will also field inquiries about Medicare, Medicare Advantage and “other relevant programs,” the award announcement stated.