Archive for the ‘Short Takes On News & Events’ Category

6 States, D.C. Extending Medicaid Pay Raise Next Year To Primary Care Doctors

Just six states and the District of Columbia will use their own money in 2015 to sustain the federal Medicaid pay raise to primary care doctors, which was a key provision of the Affordable Care Act intended to make sure millions of low-income people enrolling in the expanding insurance program have access to a physician.

Interestingly, two of the states extending the pay raise are Alabama and Mississippi — neither of which expanded Medicaid under the health law. The other states extending the pay raise next year are Colorado, New Mexico, Iowa and Maryland, according to interviews with state officials and the American Medical Association. Those four states expanded their Medicaid eligibility to cover everyone with incomes less than 138 percent of the federal poverty level, or about $15,900 for an individual.

Alaska and North Dakota paid primary care doctors in Medicaid the higher rates even before the health law’s provision took effect in 2013.

The other 42 states will let the Medicaid pay rates revert back to their 2012 levels.

Under the law, Medicaid fees for primary care increased in 2013 and 2014 to the same amount paid under Medicare. While Medicaid fees vary by state, the change meant an average 73 percent pay increase nationally, according to a 2012 study by the Kaiser Family Foundation and the Urban Institute. (Kaiser Health News is an editorially independent program of the foundation.)

Nationally, it’s unclear whether the higher fees attracted more doctors into Medicaid or made doctors more willing to treat more Medicaid patients. The Obama administration is not collecting any data to show the impact of the higher fees, said a spokeswoman for the Centers for Medicare & Medicaid Services. State Medicaid officials also have not studied the impact.

For years, some states have struggled to attract doctors to Medicaid, largely because of their low pay. About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study published in 2012 in the journal Health Affairs. New Jersey had the nation’s lowest rate at 40 percent, while Wyoming had the highest, at 99 percent, according to a survey of doctors by the U.S. Centers for Disease Control and Prevention.

Physician groups, while pleased with the extra funding, have said for years that the two-year cap would limit its impact on persuading more doctors to treat Medicaid patients.  Still, they worry about what happens when the short-lived pay raise goes away in most states.

“Yes, the money has made a difference,” said James Perrin, president of the American Academy of Pediatrics. “Anecdotally we are hearing about more doctors seeing more Medicaid patients and using extra money to add staff.”

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Thursday, July 31st, 2014

Survey Finds 1 In 5 Uninsured Don’t Want Coverage

Though millions of people gained health coverage this year as a result of the Affordable Care Act, millions more remain unaware of their options or have no interest in getting insured, a new survey has found.

Among those who were uninsured last year and remain uninsured, only 59 percent were familiar with the new Obamacare marketplaces and 38 percent were aware of federal subsidies to lower their insurance costs, according to the survey conducted in June by the nonpartisan Urban Institute.

About 60 percent of respondents list cost as the main reason for not having insurance. But 20 percent say they don’t want health insurance or would rather pay the fine for not having coverage.

The survey estimated about 8 million people gained health care coverage since last fall. In the past month, a New England Journal of Medicine study found that 10 million people gained coverage. The Rand Corp. has estimated 9.3 million people gained coverage.

“A lot of people who remain uninsured never looked on the marketplace,” said Stephen Zuckerman, co-director of the Urban Institute Health Policy Center. “If you build it, they do not always come.”

Zuckerman said while many people say health insurance costs are too high, many don’t understand its value. “People are paying for something but not seeing an immediate return,” he said.

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Tuesday, July 29th, 2014

Moving Children From CHIP To Exchange Plans Would Increase Costs: Study

Cost sharing would increase and the  number of child-specific services covered would decline if millions of low-income children now enrolled in the Children’s Health Insurance Program (CHIP) were forced to receive coverage through the health law’s insurance exchanges, according to a study released Tuesday.

CHIP enrollees in some states could see their cost sharing increase 10-fold if they were transitioned to exchange plans, according to the analysis from the Wakely Consulting Group done for the Robert Wood Johnson Foundation. Those costs include substantial increases in estimated out-of-pocket costs, including deductibles, co-pays and co-insurance. The impact could be even more costly for families who have children with special health care needs.

CHIP provides health insurance to an estimated 8 million low-income children who don’t qualify for Medicaid. The study looked at a subgroup of that population — 5.7 million children who were eligible for CHIP in June 2013. The 2010 health care law funded the program through Sept. 30, 2015, and requires states to maintain eligibility thresholds through Sept. 30, 2019, for children under Medicaid and CHIP that were in place in March 2010, when the law was passed. Sen. Jay Rockefeller, D-W.Va., who played a leading role in creating CHIP in 1997, has sponsored legislation to fund the program through 2019.

According to the study, CHIP plans offer richer coverage for key pediatric dental and vision services than most exchange plans. In more than half of the states studied, children moving from CHIP to exchange plans would likely need to purchase stand-alone dental plans in order to have comparable coverage. Those children also would be faced with more cost sharing than was required in CHIP plans.

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Tuesday, July 29th, 2014

Study Estimates 10 Million Americans Gained Health Coverage

About 10.3 million Americans gained health coverage this year, primarily as a result of the Affordable Care Act, according to a study by the federal government and Harvard University, published Wednesday in the New England Journal of Medicine.

The estimate of newly insured adults — the largest to date — is the first published in a major medical journal and authored by some federal health researchers.

The federal government had previously reported that about 8 million people bought private health plans on the state and federal exchanges and 6.6 million additional people enrolled in Medicaid since last October. But it has not estimated how many of those had been previously uninsured.

The Obama administration took pains yesterday to say that the views of the study’s authors are not those of the administration – even as it hailed their findings.

“We are committed to providing every American with access to quality, affordable health services and this study reaffirms that the Affordable Care Act has set us on a path toward achieving that goal,” Health and Human Services Secretary Sylvia Burwell said in a statement. “This study also reaffirms that expanding Medicaid under the Affordable Care Act is important for coverage, as well as a good deal for states.”

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Thursday, July 24th, 2014

Advocacy Groups Say Medicare Should Negotiate With Drugmakers

Medicare could save billions if Congress overcame its reluctance to anger the drug industry and allowed the program to demand rebates or negotiate prices, Rep. Henry Waxman, D-Calif., said Wednesday. He added that’s something polls show many Americans support.

Rep. Waxman (Photo by Jason Merritt/Getty Images for UCLA)

Expensive new blockbuster drugs, such as a $1,000-a-pill hepatitis C treatment called Sovaldi, highlight the need to do something soon, the California Democrat said, backing recommendations made in a report released Wednesday by two advocacy groups, the Medicare Rights Center and Social Security Works.

“We could save money, lower the deficit and not ask seniors to pay more,” said Waxman, a long-standing drug industry critic who is retiring at the end of this session. “The only opposition is from drug companies because they will make a little less money if they have someone negotiating prices with them.”

He spoke just hours before the maker of Sovaldi — Gilead Sciences — reported record sales of $5.7 billion in the first six months of the year.

The drug industry has long opposed price controls, or allowing the government to negotiate for Medicare drug prices.

Imposing price controls on Medicare could hurt seniors by altering “the competitive nature of the program” and “could increase beneficiary premiums, cause job loss, and reduce incentives for innovation,” said Robert Zirkelbach, a senior vice president at  the Pharmaceutical Research and Manufacturers of America.

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Thursday, July 24th, 2014

What’s Next In The Wake Of Conflicting Federal Court Decisions

KHN’s Julie Rovner and SCOTUSblog’s Tom Goldstein joined Gwen Ifill on PBS NewsHour Tuesday to discuss the implications of two federal court decisions that disagreed about the legality of selling subsidized insurance on healthcare.gov.

Watch the video below.

Wednesday, July 23rd, 2014

Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits

The essential health benefits (EHBs) countdown is on for 2016.

That’s when this provision of the Affordable Care Act, which sets out 10 specific health services that must be covered by plans sold on the exchanges, will likely be  reviewed by the Department of Health and Human Services. Business interests and consumer advocates are already making their positions clear – the former pushing for greater consciousness of premium costs and the latter looking to safeguard consumers’ coverage.

During a July 21 Capitol Hill briefing, members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums.

Current policy requires plans cover emergency services, pre- and post-natal care, hospital and doctors’ services, and prescription drugs, among other things. The rule lets states decide how specifically to interpret those categories.

“What I hope is that they tear down the existing EHB and rebuild it from the bottom up,” said Neil Trautwein, employee benefits policy counsel for the National Retail Federation, in an interview. Trautwein said the group would lobby both members of Congress and White House officials starting in 2015, in addition to making sure this issue is part of congressional candidate’s talking points in November’s midterm elections.

But consumer advocates will be working on a separate path in the months ahead.

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Wednesday, July 23rd, 2014

Medicare Modifies Controversial Hospice Drug Rule

In response to strong criticism, Medicare officials are modifying rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care.

Under the rules that took effect in May, hospice patients or their families could not fill prescriptions through their Part D drug plans until first confirming that the prescriptions were not covered by hospice providers.  Drugs related to palliative and comfort care are supposed to be covered under the fixed rate payments to the hospice.

Medicare announced Friday that the rules would be revised so that the additional authorization would be required for only four types of medications:  pain relievers, anti-nauseants, laxatives, and anti-anxiety drugs that are “nearly always” considered hospice-related.

“Medicare really tried to address our concerns quickly and effectively,” said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy. “They really did a good job and even though it’s not perfect, it’s so much better.”

The four drug categories were identified in a 2012 investigation by the Department of Health and Human Services’ inspector general. Investigators found that Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit. Part of those overpayments also were for  prescription drugs used to treat pulmonary problems and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Beneficiaries paid nearly $4 million in copayments, the report by the Department of Health and Human Services’ inspector general found.

“Based on discussions with stakeholders, we are adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications while balancing recommendations by the Inspector General meant to safeguard the Medicare program,” said Medicare spokesman  Raymond Thorn.

Medicare officials revised the rules after meeting in late June with beneficiary advocates, hospice providers, insurers offering Part D drug plans and pharmacists.

Medicare generally pays drugs for diabetes, heart disease or other chronic conditions still used by hospice patients but not directly related to their terminal illness. Those are covered by Medicare Part D prescription drug plans, which are heavily subsidized by Medicare, with beneficiaries picking up roughly 25 percent of the bill.

Contact Susan Jaffe at Jaffe.KHN@gmail.com

Friday, July 18th, 2014

Biggest Insurer Drops Caution, Embraces Obamacare

This KHN story can be republished for free. (details)

UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year.

“We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals.

The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now.

Even analysts who follow the company closely seemed surprised.

“You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in. What’s giving you the confidence … that it’s going to be stable next year?”

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Thursday, July 17th, 2014

Registered Nurses Increasingly Delay Retirement, Study Finds

Despite predictions of an impending nurse shortage, the current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement, a study by the RAND Corp. found.

The study, published online Wednesday by Health Affairs, notes that the RN workforce, rather than peaking in 2012 at 2.2 million – as the researchers predicted a decade ago – reached 2.7 million that year and has continued growing. The trend of nurses delaying retirement accounted for an extra 136,000 RNs in 2012, the study suggests.

Shifts in retirement benefits and “economic uncertainty in general” could have contributed to their decisions to extend their careers, said David Auerbach, the study’s primary author and a policy researcher at RAND.

Furthermore, Auerbach said, some researchers have “found RNs were especially attached to the mission of what they do.”

“They get a lot of satisfaction from their job and don’t want to leave it,” he said.

The surge in RNs, and in particular in RNs working beyond the age of 50, could hold significant implications for how patients receive their health care and how they relate to their health providers.

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Wednesday, July 16th, 2014

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