KHN: Kaiser Health News

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.

Once upon a time, there were the navigators, then the in-person assisters, and the certified application counselors.

Now, add community health centers to the list of individuals and organizations available to help consumers sign up for the new health insurance marketplaces scheduled to open Oct. 1.

On Thursday, the Obama administration pledged $150 million to help community health centers provide in-person enrollment assistance to uninsured patients. There are 1,200 health centers across the country, treating about 21 million patients each year.

“Health centers have extensive experience providing eligibility assistance to patients, are providing care in communities across the nation and are well-positioned to support enrollment efforts,” Health and Human Services Secretary Kathleen Sebelius said in a press release.

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Update 3:45 p.m.:  Speaker Boehner sent a letter to the White House Thursday formally declining to recommend appointments to the panel.

Note to the Obama administration: Don’t wait by the phone for those GOP nominations to the Independent Payment Advisory Board, a panel created in the health law to make recommendations to Congress on how to control Medicare costs.

Speaker Boehner (Photo by Mark Wilson/Getty Images)

House Speaker John Boehner, R-Ohio, made it clear Thursday that neither he nor Senate Minority Leader Mitch McConnell, R-Ky., would be sending in any names for consideration.

“This is the 15 unelected, unaccountable individuals who have the authority to deny seniors’ access to care,” Boehner told reporters. “The American people don’t want the federal government making decisions that doctors and patients should be making.”

Known as IPAB, the panel is charged with making proposals to reduce Medicare spending if government funding of the program grows beyond a target rate. Congress can pass alternative changes of the same size instead, but if it fails to act, the IPAB plans would become law. But recent slowdowns in the growth of Medicare spending means there’s no immediate pressure for the panel, which has not yet been assembled, to make spending recommendations to Congress.

During a news conference, Boehner also defended House Republican leaders’ decision to vote yet again next week to repeal the health law.

While the House has taken similar votes more than three dozen times, “we’ve got 70 new members who have not had the opportunity to vote on the president’s health care law,” Boehner said. “Frankly, they’ve been asking for an opportunity to vote on it and we’re going to give it to them.”

And just to be clear, Boehner says he still hates the law and wants to see it repealed. “Obamacare is going to drive up the cost of health care, drive up the cost of health insurance, and make it harder for small businesses to hire workers,” he said. “I believe that at the core of who I am. And I’m going to do everything I can to make sure that we don’t wreck the best health care delivery system the world has ever known.”

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