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

Cholesterol Guidelines Could Mean Statins For Half Of Adults Over 40

This story was produced in collaboration with

When sweeping new advice on preventing heart attacks and strokes came out last November, it wasn’t clear how many more Americans should be taking daily statin pills to lower their risk.

A new analysis provides an answer: a whole lot. Nearly 13 million more, to be precise.

If the guidelines were followed to the letter, about half of all Americans over 40 would be on cholesterol-lowering statins — more than double the current level.

Even more striking, the new recommendations would make prescription of the drugs almost universal among older men. “What was personally most surprising to me, is that it turns out the difference between the old and new guidelines is very small in younger adults — 40 to 59,” says Duke University biostatistician Michael Pencina, lead author of the study.

“The vast majority of those affected by the new guidelines are between 60 and 75,” he says. “So much so that 87 percent of men 60 to 75 and 54 percent of women [in that age range] should be on statins.”

The great majority of Americans newly recommended for statin treatment have no known heart disease, Pencina and his colleagues say.

The analysis was published online Wednesday by the New England Journal of Medicine.

Statin drugs are pretty cheap these days. Most are generics. Common doses of atorvastatin, the generic form of Lipitor, can be had for 50 cents a day. Older statins cost even less. Still, the number of potential patients is so huge that the recommended expansion in treatment has major cost implications.

If all those newly recommended for treatment got the drugs, the expansion would cost from $2 billion to $6.6 billion a year more than the price tag under the old guidelines, which is $7.8 billion to $22.4 billion depending on cost assumptions for a year’s worth of the drugs .

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Thursday, March 20th, 2014

Mass. To Drop Contractor Behind Flawed Health Insurance Website

Massachusetts is negotiating an end to its contract with CGI, the Canadian vendor that built the state’s flawed health insurance website while scrambling to fix it.

Photo by naslrogues via Flickr

The site was supposed to be up last October, offering one-stop health insurance shopping for anyone in Massachusetts. But six months later, only a few functions work but have glitches, and a few are not usable at all.

Sarah Iselin, a special assistant to Gov. Deval Patrick hired to oversee the fixing of the website, has been working with a team of outside contractors from the health technology company Optum to determine if the CGI project can be fixed.

“That assessment made clear that based on past performance and our current needs, parting ways with CGI is the right course for the commonwealth moving forward,” Iselin said Monday.

In a statement, CGI said it will “work with the Commonwealth to ensure a smooth transition to the next phase of exchange deployment, allowing for the best use of system capabilities already in place.”

Iselin and her team told the Health Connector board they are reviewing two possible remedies: hiring a new vendor to build on working parts of the current site or buying website elements from other insurance exchange sites. (The Massachusetts Health Connector, which started years ago, is the state’s equivalent of an exchange.)

Iselin cautions that buying elements will be difficult because Massachusetts has many unique insurance rules, including 263 different factors that determine who is eligible for what type of coverage.

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Tuesday, March 18th, 2014

What You Need To Know As Health Care Deadline Looms

KHN’s Mary Agnes Carey was on NPR’s Tell Me More program Tuesday talking about the upcoming deadline for many Americans to buy health insurance or face a fine. Listen below:

Tuesday, March 18th, 2014

Can Congress Put An End To Annual Medicare Payment Ritual?

This story comes from our partner ‘s Shots blog.

Congress is still searching for money to avoid a 24 percent cut in pay for doctors who treat Medicare patients.

But seniors are already paying their share of the cost in premiums, as if the pay cut — scheduled to kick in on April 1 — won’t happen.

Seniors’ premiums cover 25 percent of their Medicare Part B outpatient services, including doctor visits, outpatient lab tests and hospital visits, medical equipment and home health care.

The government picks up the rest of the bill. Federal law requires Medicare number-crunchers to decide on premiums by Oct. 1 for the following year.

On Friday, House Republicans succeeded in passing legislation that would change the formula that Medicare uses to calculate pay for doctors.

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Monday, March 17th, 2014

HHS Says Insurers’ Coverage For Same-Sex Spouses Must Match Other Married Couples

Insurers can’t offer health coverage to a spouse in a traditional marriage if they don’t also make the same coverage available to spouses in same-sex marriages, the federal government announced Friday.

The change means that same-sex married couples who have been unable to buy family policies will be able to do so.

The guidance, presented in an FAQ format from the Department of Health and Human Services, applies to health plans in the group and individual markets that were not in operation before the health law and grandfathered in the federal health law. It clarifies existing federal rules, the guidance said.

Same-sex couples who were married in any of the 17 states and the District of Columbia that authorize same-sex marriage are entitled to equal access to spousal coverage, no matter where they currently live or where the policy is offered.

“It’s a big deal,” says Katie Keith, director of research at the Trimpa Group, a consultancy that works on lesbian, gay, bisexual and transgender issues. “If you identify as married, it’s hard to stomach that you can’t get family coverage.”

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Friday, March 14th, 2014

Federal High Risk Pools Extended For A Month

Participants in the federal high-risk pool created in the health law will have another month to find coverage, the Obama administration announced Friday.

In a notice posted on the Pre-Existing Condition Insurance Plan website, officials announced that program enrollees who have not yet purchased coverage through the health law’s online marketplaces, or exchanges, could keep their current coverage until April 30 while they continue their search. But they must enroll in a new plan by April 15 to avoid any gaps in coverage.

This is the third extension for the program, known as PCIP, which was previously set to close Dec. 31, 2013. Existing funds will be used to cover the extension.

PCIP, which started in 2010, has helped people with pre-existing conditions obtain health coverage. These consumers in the past were often turned away by commercial insurers. Under health law rules that went into effect Jan. 1, insurers can no longer deny coverage based on an individual’s medical record.

Federal officials also said that the remaining seven states still running their own PCIP programs have the option to extend the deadline for a month.

In an email, a Department of Health and Human Services spokesperson said the extension was done “as part of our continuing effort to help smooth consumers’ transition into Marketplace coverage.”

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Friday, March 14th, 2014

California Marketplace Still Lags in Signing Up Latinos and Young Adults


With just a few weeks remaining before the March 31 enrollment deadline, California has signed up more than 923,000 people in its new insurance marketplace—more than a fifth of the national tally, officials announced Wednesday.

But the state’s success story continues to be marred by slow progress in reaching Latinos and young people in general, both considered crucial to the success of Obamacare.

Latinos make up 46 percent of those eligible for subsidies in the marketplace, Covered California, but just 22 percent of those enrolled.

Young adults (ages 18 to 34) account for about 36 percent of those eligible for subsidies yet about 27 percent of those signed up.

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Friday, March 14th, 2014

Insurers May Get Cost Break Thanks To Rocky ACA Rollout

The Obama administration keeps changing the rules on implementing the Affordable Care Act. Insurance companies keep complaining. But they’re unlikely to grouse about the latest adjustment.

On Tuesday the Department of Health and Human Services signaled its intention to temporarily give insurers a break on the portion of premiums they must spend on medical care or return to policyholders. The switch could shrink consumer rebate checks. But considering what insurers have gone through with balky online marketplaces and shifting regulations, even consumer advocates don’t seem to object.

The change, reported Wednesday by InsideHealthPolicy (subscription required), has to do with the ACA’s medical loss ratio, which requires insurers to spend at least 80 percent of the premiums collected for plans sold in the individual and small group markets on medical care or consumer rebates. The idea was to limit what carriers could devote to profits, administrative costs and CEO salaries to 20 percent of the premium pot.

Some insurers say their administrative costs have soared, however, because of the rocky rollout.

Carriers had to scramble when the administration announced that consumers could keep substandard plans that were previously doomed under the health law. The shift required extra mailings and call-center resources for many insurers. Flaws in the government’s online portals also meant insurers had to find and sign up new customers themselves. Maryland and other states directed frustrated consumers to brokers, who charge insurers commissions.

“Health plans made considerable investments in time, resources and manpower to minimize disruption to consumers caused by all the technical problems of healthcare.gov,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry lobby. “Health plans should not be penalized for all the extra work they have done to help consumers through this process.”

As a result, the administration will propose temporarily allowing a higher proportion of premiums to be spent on administrative costs. It’s unclear exactly which expenses will qualify for the exemption and when the rules will be proposed.

“Many in the industry are doing the best they can under very challenging circumstances,” writes Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms and a frequent industry critic. Increased costs for mailings and call centers, she said, “were compounded when the forms insurers received from the federal government with critical data on new enrollees — called 834s — arrived riddled with errors, or did not arrive at all — requiring manual data entry and one-on-one follow up.”

So for insurers participating on the exchanges, she said, “I didn’t have strong objections” to relaxing the rules on costs.

Thursday, March 13th, 2014

Rep. Ryan Quizzes Sebelius On Increased Savings Estimate From IPAB

The panel hasn’t had a meeting and no one’s even been nominated for it yet, but the Obama administration’s fiscal 2015 budget request says the health law’s Independent Payment Advisory Board, also known as IPAB, could save the government triple what officials estimated last year.

Rep. Paul Ryan at a hearing on health care in 2010 (Photo by Alex Wong/Getty Images).

On Wednesday, Rep. Paul Ryan, R-Wis.,  asked Department of Health and Human Services Secretary Kathleen Sebelius how the agency determined that IPAB savings would be $12.9  billion over the next decade and why it was so much higher than the fiscal 2014 budget estimate, which was $4 billion. “The question is, where does it come from?” Ryan asked.

In testimony before the House Ways and Means Committee, Sebelius attributed the increase to actuarial estimates that Medicare costs will rise more rapidly in the later years of the budget’s 10 year window. Nonetheless, she said, HHS officials are not convinced that those estimates are correct since Medicare spending growth has slowed  in recent years and Sebelius said she was hopeful that trend would continue.

One of the most contentious provisions of the health law, IPAB is a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. If Congress chooses not to accept the recommendations, lawmakers must pass alternative cuts of the same size or the IPAB recommendations go into effect.

Some Republicans argue that the board’s efforts would amount to health care rationing, and some Democrats have said that they think the panel would transfer power that belongs on Capitol Hill to the executive branch. The House has voted to repeal IPAB but the Senate did not consider the measure.

Ryan, who also chairs the House Budget Committee,  asked Sebelius when Congress would get more details about who the president has in mind to serve on IPAB. “I think the president intends to submit names,” Sebelius said.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Thursday, March 13th, 2014

Injured Who Lived Near Closed Trauma Centers More Likely To Die

Injured patients who had to travel an average 13 minutes longer to reach a hospital trauma center because a facility nearer to home had closed were more likely to die of their injuries in the hospital, according to a new California study.

The report found their risk of dying was 21 percent higher than that of patients with similar injuries whose average drive time to a trauma center hadn’t changed.

The patients whose trips got longer were also more likely to be younger and poorer, more likely to be black or Hispanic and more likely to be uninsured or covered by Medi-Cal, the government health plan for the poor in California, the study found.

“Hospitals in affluent areas fight to open trauma centers,” because they can charge steep fees for the services and even turn a profit, said Dr. Renee Y. Hsia, lead author of the study and an associate professor of emergency medicine at University of California, San Francisco.

“But if you’re in a poor area with a lot of violence, these trauma patients pour in and you provide a lot of high intensity care and you’re not reimbursed — those hospitals cannot survive.”

The findings suggest that the closing of trauma centers in urban areas in particular may be contributing to racial and economic health disparities, she said.

“Because we have a market-driven approach to health care, certain services and facilities are available to huge segments of the population, while other segments don’t have access to them,” Hsia said. “This is what happens in a market. Everyone thinks health care is a benevolent service, but it is very much a profit-making industry, and hospitals act like economic entities.”

The research, published Thursday in The Journal of Trauma and Acute Care Surgery, was supported by the UCSF Clinical and Translational Science Institute and the Robert Wood Johnson Foundation Physician Faculty Scholars Program.

While trauma center closures have accelerated in recent decades, those operated by public hospitals and urban hospitals are more likely to incur losses because of high operating costs and falling levels of reimbursement, studies have found. Hospitals serving areas with large minority populations were nearly twice as likely to close their trauma centers. In California between 1999 and 2009, the period studied by the researchers, three Level I and Level II trauma centers closed, while 10 centers opened, mostly in affluent areas, Hsia said.

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Thursday, March 13th, 2014

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