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DC Appeals Court Agrees To Rehear Case That Could Cripple Health Law

The controversial federal court decision that threatened the future of the Affordable Care Act is no more.

The full District of Columbia Court of Appeals Thursday agreed to rehear Halbig v. Burwell, a case charging that the federal government lacks the authority to provide consumers tax credits in health insurance exchanges not run by states.

The order agreeing to hear the case technically cancels the three-judge ruling from July that found for the plaintiffs. That ruling, if upheld, could jeopardize the entire structure of the Affordable Care Act by making insurance unaffordable for millions of consumers in the 36 states where the federal government operates the exchange.

The court will hear oral arguments in the case in December. For the time being, the order also eliminates the “circuit split” that could prompt the Supreme Court to take up the case. The same day the panel from the Washington, D.C., circuit decided that tax credits are not allowed in federal exchanges, a three-judge panel from the Fourth Circuit in Richmond, Va., decided exactly the opposite.

The losers in that case, King v. Burwell, appealed the decision to the Supreme Court on July 31.

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Thursday, September 4th, 2014

Indiana, Several Other States Look To Expand Medicaid Next Year

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

Who’s next?

With the long-awaited deal to expand Medicaid finally struck last week between Pennsylvania and the Obama administration, 27 states and the District of Columbia have adopted a key coverage plank of the Affordable Care Act. And the momentum continues to grow in Republican-led states as Tennessee and several others look to expand coverage to low-income residents in 2015.

Indiana has an expansion plan pending with the Centers for Medicare & Medicaid Services. Tennessee Gov. Bill Haslam, a Republican, said he plans to submit a plan later this year, although state Republican leaders warn it will be difficult to win legislative approval. Wyoming Gov. Matt Mead, also a Republican, said he will present an expansion plan to his legislature early next year.

Utah Gov. Gary Herbert, another Republican, is negotiating a deal with CMS, although he would also need to get such a plan past legislators. Finally, Maine lawmakers are poised to expand Medicaid if Republican Gov. Paul LePage is defeated in the November election. LePage has vetoed several bills to expand the program after they were passed by the Democrat-controlled Maine legislature. LePage trails in the latest polls.

The health law had mandated that every state expand eligibility to those making up to 138 percent of the poverty level, or about $16,100 for a single individual. But the Supreme Court’s 2012 decision effectively made the expansion voluntary for adult residents, and 23 states haven’t extended the health insurance program as a result.

Still, the Medicaid expansion program got off to a faster pace than original adoption of the program in 1966.

When Medicaid launched, just six states initially signed up: Hawaii, Illinois, Minnesota, North Dakota, Oklahoma and Pennsylvania. Twenty states followed later that year and 11 more joined in 1967.

Similarly, the Children’s Health Insurance Program started with only nine states in 1997. Another 35 states followed in 1998.

Pennsylvania’s Medicaid expansion will launch Jan. 1 to cover everyone with incomes under 138 percent of the federal poverty level. While Gov. Tom Corbett has called his expansion plan “historic” and defended his one-year delay in adding an estimated  500,000 people to the program, the  plan won’t be dramatically different than what most states are already doing.  Pennsylvania will continue to use Medicaid managed care plans for new enrollees, said Medicaid Director Leesa Allen. Insurers that have submitted bids to the state to cover newly eligible residents, including Aetna and United Healthcare, already provide Medicaid managed care to state residents.

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Tuesday, September 2nd, 2014

Federal Judge Blocks Texas Restriction On Abortion Clinics

This story is part of a partnership that includes Houston Public Media, NPR and Kaiser Health News. It can be republished for free. (details)

In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers. The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities.

Judge Lee Yeakel ruled late Friday afternoon that the state’s regulation was unconstitutional and would have placed an undue burden on women, particularly on poor and rural women living in west Texas and the Rio Grande Valley.

Texas Attorney General Greg Abbott, a Republican running for governor, immediately filed an appeal with the 5th U.S. Circuit Court of Appeals. (more…)

Saturday, August 30th, 2014

Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County

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

Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week.

The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required.

“The quality and integrity of investigations is impaired when surveyors’ conclusions are changed without their knowledge,” according to the audit.

The audit was the latest of several reviews showing problems with how the county Department of Public Health oversees residents’ health and safety at about 385 nursing homes. The county, the most populous in the state, contracts with the state and the federal government to inspect the facilities and to investigate complaints from residents, family members and staff.

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Friday, August 29th, 2014

Urgent Care Centers Opening For People With Mental lllness

LOS ANGELES, Calif. — Hoping to keep more people with mental illness out of jails and emergency rooms, county health officials opened a mental health urgent care center Wednesday in South Los Angeles.

The goal of The Martin Luther King, Jr. Mental Health Urgent Care Center is to stabilize and treat people in immediate crisis while connecting them to ongoing care. Run by Exodus Recovery, it will be open 24 hours a day, seven days a week and can serve up to 16 adults and six adolescents. During their stay of up to one day, patients will undergo a psychiatric evaluation, receive on-the-spot care such as counseling and medication and be referred for longer-term treatment.

The center can take people in severe crisis and expects many will be brought in by police and paramedics, said Connie Dinh, vice president of nursing services for Exodus. But she said it cannot accept people who are incoherent, extremely aggressive or need emergency medical attention. They will still need to be treated at hospitals or inpatient psychiatric facilities.

Staff will be able to place people on 72-hour psychiatric holds if they are a danger to themselves or others.

Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned.

L.A. County’s mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are “more humane” and a smarter approach.

Hospitals statewide saw a 47 percent increase in encounters with patients with mental health needs between 2006 and 2011, compared to a 14 percent increase in all patients, according to the California Hospital Association. Mental health urgent care centers can help relieve the burden on emergency departments, get patients the care they need and reduce health care costs, said Sheree Kruckenberg, vice president of behavioral health at the association.

“As we are trying to bend the cost curve, to me this is a slam dunk,” she said.

Ron Honberg, policy director for the National Alliance on Mental Illness, said that the centers are a great place to respond to crises, but the centers are “just one piece in a more complicated puzzle” and people need to be linked to community services.

(more…)

Thursday, August 28th, 2014

CBO Projects Lower Medicare and Medicaid Costs

Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday.

Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast.

Despite the long-term projected drop, federal spending for major health care programs will jump this year by $67 billion — or about 9 percent —  the agency estimated.  The largest increase will be for Medicaid, which is projected to grow by $40 billion, or 15 percent. Most of this short-term increase is attributable to the Affordable Care Act, including its Medicaid expansion and the financial assistance to help people purchase health insurance.

More than half of the states and the District of Columbia have opted for the health law’s Medicaid expansion. Subsidies to help eligible individuals purchase health on the law’s online marketplaces, or exchanges, and related expenses (mostly grants to states to establish exchanges) would total $17 billion this year, according to CBO.

CBO and the Joint Committee on Taxation’s projections of outlays and revenues arising from the health law’s provisions related to health insurance coverage have not changed substantially since the spring for 2014 or over the 2015–2024 period, according to CBO.

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Wednesday, August 27th, 2014

Report: Health Law Ups Taxes On Insurers With Big Pay Packages

While average compensation for top health insurance executives hit $5.4 million each last year, a little-noticed provision in the federal health law sharply reduced insurers’ ability to shield much of that pay from corporate taxes, says a report out today.

As a result, insurers owed at least $72 million more to the U.S. Treasury last year, said the Institute for Policy Studies, a liberal think tank in Washington D.C.

Researchers analyzed the compensation of 57 executives at the 10 largest publicly traded health plans, finding they earned a combined $300 million in 2013. Insurers were able to deduct 27 percent of that from their taxes as a business expense, estimates the report. Before the health law, 96 percent would have been deductible.

UnitedHealth Group, which paid CEO and President Stephen Hemsley about $28 million in pay and stock options in 2013, had the biggest tax bill among the 10 companies, the report found. Hemsley’s compensation accounted for nearly $6 million of the firm’s estimated $19 million in taxes that the report says it owed on  pay packages for five executives under the health law.

“They’re paying more in taxes just to protect these pay packages,” said Sarah Anderson, global economy project director at the institute.

The insurers’ lobby opposed the provision, saying deductibility rules should be consistent across all industries.

“Requiring plans to pay higher taxes does nothing to make coverage more affordable or accessible,” said Brendan Buck, spokesman for the trade group, America’s Health Insurance Plans, which had not seen the report.

Under the 2010 law, insurers can deduct only the first $500,000 of annual compensation per employee from corporate taxes, down from $1 million allowed before the law’s passage.  The law also requires insurers to include so-called “performance pay,” such as stock options, which often represent a hefty portion of an executive’s pay.

The provision is similar to limits Congress imposed on executives at the banks that took Troubled Asset Relief Program funds.  Most other industries can still deduct the first $1 million in compensation — and can exclude performance pay from their income tallies.

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Wednesday, August 27th, 2014

Has Health Law Helped Young People Get Mental Health Treatment? Maybe

This copyrighted story comes from ‘s Shots blog. All rights reserved.

Mental health issues like depression, anxiety and substance abuse often start in adolescence, then peak in young adulthood. But for young people who don’t have steady jobs or stable paychecks, getting help can be tough.

A popular provision of the Affordable Care Act that took effect in 2010 aimed to make it easier for young adults to get access to health care, by allowing them to stay on their parents’ insurance until they turn 26.

So, are more young adults getting help with mental health issues because of the provision? Maybe, suggests a study published in the September issue of Health Affairs.

Before 2010, just over 30 percent of young adults with mental health issues said they were getting treatment. And that went up by about 2 percent in the two years after the ACA provision took effect, the study found, based on data from the National Survey on Drug Use and Health.

That’s not much of an increase, and researchers can’t say exactly why the rate went up. But, they say, there’s evidence that the ACA provision is at least partly responsible.

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Monday, August 18th, 2014

Wide Variation In Hospital Charges For Blood Tests Called ‘Irrational’

One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more.

For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more.

The wide disparity in hospitals’ listed charges for routine blood tests at California hospitals was revealed in a study published in the August issue of BMJ Open. The study examined the listed charges for routine blood tests performed in 2011.

Researchers said their analysis found no rational explanation for the stark variation in listed prices, though teaching hospitals and government hospitals generally set lower charges than other facilities.

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Friday, August 15th, 2014

If You Have A Stroke, Better It Should Be In Paris

PARIS–I had a stroke last month, oh boy.

It’s just that I didn’t know it. Here’s what happened:

Frank Browning. (Photo by Christophe Sevault)

Only after three days of flashing, floating visual squiggles — commonly known as ocular migraines that usually last 20 minutes — do I email my old friend Dr. John Krakauer, who helps run stroke recovery at Johns Hopkins Hospital in Baltimore.

After a few questions he told me to get an MRI scan as soon as possible. In the U.S. that could involve the emergency room (with its hours-long wait) or a complicated process of getting the referral — and then finding a radiologist who would take my coverage. Here in France, it is so much simpler.

But even here, such a lot of bother, I think. My doctor’s away on vacation. Whom do I call? But since I’m now into my fourth day of rainbow hieroglyphics, I bike down to the renowned emergency eye service at Hospital Hotel Dieu, across from Notre Dame cathedral. It has historically served Paris’ poorest residents.

I offer my national health card, and the receptionist brushes it off. All they want is something with a picture ID. Three hours later I’ve been examined by four separate specialists. “You have no serious eye problem,” the retina specialist advises me, “but I agree with your friend at Hopkins. You should get a brain scan,” which they can’t do there. She scrawls out a note to one of France’s top neurology centers.

Back to the bike. I peddle to the Hopital Ste-Anne, a multi-specialty neurology center close to where France’s last guillotine stood.

Sweating, I climb the stairs directly to the glass reception door on the second floor. The head of the clinic smiles, reads the note I’ve brought from the eye doctor and immediately begins some simple tests to be sure I’m not an emergency case.

She taps my elbow, then asks me extend my hands and slowly draw each index finger to my nose. I pass. She asks me when the rainbow squiggles began as she scrolls down her computer screen. It’s 1:15, but I have a lunch appointment at 1:30.

“Go have lunch and come back at 2:30 for your MRI,” she tells me. “Oh yes,” she adds, “you really ought to check in downstairs first.”

(more…)

Monday, August 11th, 2014

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