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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.”

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Monday, August 11th, 2014

Exchange Assisters Want More Training To Help Consumers — Even After They Enroll

With the Nov. 15 kick-off for this year’s health law enrollment season fast approaching, the need for more training for the  people who help consumers navigate the health insurance marketplace is growing increasingly clear.

Affordable Care Act navigator Adrian Madriz (R) speaks with Lourdes Duenas, who is looking for health insurance, during a navigation session in October 2013 in Miami, Florida (Photo by Joe Raedle/Getty Images)

For example, 92 percent of health insurance marketplace assister programs say they want more preparation than they received last year, according to survey findings released last month by the Kaiser Family Foundation.

This figure, highlighted during an Aug. 5 briefing, came out of a larger survey  conducted after the first open enrollment period concluded last spring. The survey polled people who supervised assistance efforts by navigators, in-person assisters, certified application counselors, federally qualified health centers and federal enrollment assistance programs which were promoting federal and state-based health care exchanges.

Out of 843 respondents, 41 percent indicated a desire for more training about how to help consumers after they enrolled in health plans. The same proportion wanted more support in addressing “tax filing issues,” according to the report. About 39 percent of respondents indicated the need for further training in distinguishing between qualified health plans. The same figure wanted more training in interpreting how immigration status shaped eligibility.

These numbers do not come as a surprise to people already involved in trying to help consumers use the health law’s online marketplaces.

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Thursday, August 7th, 2014

First Look At Medicare Quality Incentive Program Finds Little Benefit

One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found.

The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving.

The program is one of several payment initiatives instituted by the health law. Others include penalties for hospitals that have high rates of Medicare patients readmitted within 30 days and penalties that will go into effect this fall for hospitals with high rates of patient injuries or infections.

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Wednesday, August 6th, 2014

Smokers Paying Less For Some Health Plans Than Expected

The health law allows insurance plans to charge tobacco users as much as 50 percent more for their premiums, but plans on average increased costs for these consumers by significantly less, according to a new study published in Health Affairs.

Researchers found the median surcharge amount to be about 10 percent. Close to 90 percent of plans stayed well below the maximum surcharge, according to the study’s authors. But even still, because tobacco users were still charged more than others, they more frequently could not access affordable health insurance, a situation that the authors said could deter tobacco users from purchasing insurance at all.

Affordable coverage is defined as “access to at least one plan with premiums of less than 8 percent of income after subsidies,” according to the study.  The authors used that standard because the health law exempts from the requirement to buy insurance individuals who do not have at least one insurance option that costs less than 8 percent of income.

Insurers’ pricing may be based on the use of health care services by tobacco users. “It seems as if smokers don’t actually – at least in the age range that the health insurance exchanges are targeting – use 50 percent more in terms of costs for health care,” said Cameron Kaplan, an assistant professor of preventive medicine at the University of Tennessee Health Science Center and the study’s lead author.

On average, smokers appear to use about 10 percent more health care, Kaplan said, so plans for the most part have reflected that in their pricing, a strategy he said makes sense if insurers “want to attract people into their plan.” Though smokers have more health problems than do non-smokers, Kaplan added, tobacco users in the exchange appear, for whatever reason, “to be the people who avoid using health services.”

The surcharges have drawn criticism from groups such as the American Lung Association. It argues that higher costs will discriminate against smokers and preclude them from obtaining coverage.

“No one wants tobacco users to be uninsured – we know they have health consequences,” said Jennifer Singleterry, the lung association’s director of national health policy.  “We certainly want someone who has lung cancer to have insurance.”

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Monday, August 4th, 2014

Study: ER Closures Raise Death Rates At Nearby Hospitals

Emergency patients who are admitted to the hospital are at greater risk of dying if another emergency room at a hospital nearby has closed its doors, a new study of California hospitals has found.

The analysis is believed to be the first to examine the impact that emergency department closures have on the quality of patient care at other hospitals within the same service area.

Six percent of the nation’s emergency rooms have closed their doors in recent years, including many that serve poor inner-city and rural communities. At the same time, the number of emergency visits throughout the country has increased by 51 percent, a combination of developments that has led to more overcrowding and longer waits for emergency care.

The study was published Monday in the August issue of the journal Health Affairs.

“Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals,” said the senior author, Dr. Renee Y. Hsia, an associate professor in the department of emergency medicine and the Institute of Health Policy Studies at the University of California, San Francisco.

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Monday, August 4th, 2014

Unfavorable Views Of Health Law Spike In July: Poll

The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago.

The poll from the Kaiser Family Foundation found that 53 percent of the public had an unfavorable view of the law in July, the highest level since the law was passed in 2010. It was up from 45 percent in June. (KHN is an editorially independent program of the foundation.)  The law’s unpopularity hit similar levels several times since passing, most recently in January when 50 percent of people disliked it.

Support for the law in July remained about the same as in June, with 37 percent supporting it. The change came from the number of people who had previously told pollsters they did not know or refused to discuss their opinions: while 16 percent fell into that group in June, only 11 percent did in July.

The poll did not provide any definitive answers for the change but noted that people reported that their informal chatter with friends and family was more than four times as likely to be negative as supportive toward the law.

Public opinion was evenly divided on the Supreme Court’s decision that closely held companies such as the Hobby Lobby craft stores could refuse to provide workers with birth control through their insurance because it violated the religious beliefs of the company. Women and men also saw things pretty much the same. Seven of 10 Republicans hailed the decision, and Democrats disliked it just as strongly. The public was split about whether the decision will make it harder for women to get prescription birth control. Few people said the court’s action would make them more likely to vote in the fall mid-term elections.

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Friday, August 1st, 2014

6 States Extending Medicaid Pay Raise Next Year To Primary Care Doctors

Correction: This story has been updated to note that the District of Columbia in 2015 is not extending the Medicaid pay increase for physicians. The story originally listed D.C. with the six states that are keeping doctor pay higher next year. The District will allow Medicaid pay rates to fall back to earlier levels.

Just six states 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 and the District of Columbia 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

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