Short Takes On News & Events

Can Employers Dump Workers To Health Exchanges? Yes, For A Price

How to expand Americans’ health insurance choices under the Affordable Care Act without sabotaging employer coverage? The Obama administration is still working to get the balance right.

The latest tweak from the Internal Revenue Service essentially prohibits employers from giving workers tax-free dollars to buy policies in the online public marketplaces created by the health law. The New York Times first reported the rule. But the Times’s headline, “I.R.S. Bars Employers From Dumping Workers Into Health Exchanges,” overstates the case.

Nothing stops employers from canceling company plans and leaving workers to buy individual policies sold through the exchanges — as long as they pay the relevant taxes and penalties, said Christopher Condeluci, a Venable lawyer specializing in benefits and taxes. Those will vary according to a company’s size and circumstances.

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May 28th, 2014, 5:00 AM by Jay Hancock

Short Takes On News & Events

Minnesota, Not Florida, Not Hawaii, Is Healthiest State For Seniors

“Minnesota Nice” might be the key to good health for seniors.

Photo by Sharyn Morrow via Flickr

America’s Health Rankings Senior Report rated Minnesota the healthiest state in the nation for adults aged 65 and over — beating out Hawaii. And that retiree and snowbird haven, Florida? It came in 28th.

What could put Minnesota, which just weathered arguably the harshest winter in the country, ahead of those sunny climes? Volunteering is one factor. Minnesotans do more of it and it plays a major role in senior vitality, according to Dr. Reed Tuckson, senior medical adviser to the UnitedHealth foundation, which funds the annual rankings.

“There’s a much better chance to be active, to be engaged, to be alive, to feel excited, to be inspired,” said Tuckson, “and therefore to have a good mental attitude.”

The report grades states on 34 individual measures ranging from the amount of physical activity to prescription drug coverage to flu vaccinations. New Hampshire, Vermont and Massachusetts round out the top 5 states.

Tuckson said Minnesota stands out in a number of key indicators beyond volunteering. Seniors in the state have the lowest prevalence of cognitive problems, and they visit the dentist often.

Seth Boffeli, spokesman for AARP Minnesota said the report underscores that decades of proactive efforts have paid off.  He says Minnesota was ahead of the curve in moving towards community-based living for seniors and away from institutionalized nursing home care, when possible.

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May 22nd, 2014, 5:00 AM by Elizabeth Stawicki, Minnesota Public Radio

Short Takes On News & Events

Single-Payer Advocates Hit Capitol With New Sense Of Reality

Advocates for a single-payer “Medicare for all” health system are fanning out across Capitol Hill this week, lobbying members of Congress.

Photo by Karl Eisenhower/KHN

But years of mostly fruitless struggles – and watching the intense opposition to the much less sweeping Affordable Care Act – appears to have left them with a much more clear-eyed view of what it will take for them to accomplish their goal.

“This is tough stuff,” Sen. Bernie Sanders, D-Vt., told a roundtable of advocates he convened in the Dirksen Senate Office Building. “Single-payer health care bills – it ain’t going to take place here in Washington. I suspect it’s going to take place, as it did in Canada, with a state [Saskatchewan] going forward. I hope it will be my state.”

Indeed, Vermont in 2011 passed legislation that would make it the first state to create its own single-payer system, called “Green Mountain Care.” The experiment is set to launch in 2017, the first year that’s allowed under the Affordable Care Act. But key decisions about exactly how the plan would work, in particular how it would be financed, have yet to be made.

Meanwhile, those who have been pushing for a system that would effectively end private insurance say there’s no question they have the facts on their side.

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May 21st, 2014, 2:50 PM by Julie Rovner

Short Takes On News & Events

Study: Limited Competition Raised Obamacare Prices

Many insurers only dipped a toe into the Affordable Care Act’s online marketplaces for their first year.

Cigna, one of the country’s largest insurers, offered 2014 plans to individuals in fewer than half a dozen states. Humana is only in a little more than a dozen states. The biggest health insurer, UnitedHealthcare, didn’t offer any policies through the federally run online portal and only a few elsewhere.

The result: substantially higher premiums than otherwise would have been the case, according to a new paper.

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May 19th, 2014, 2:51 PM by Jay Hancock

Short Takes On News & Events

Survey: Many Women Unaware How Health Law Benefits Them

A large number of women face significant barriers to health care, and while the health law will likely help them get services, some are unaware of the benefits already in effect, according to a new survey from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Intended as a baseline to measure the future impact of the law, the findings identified several key issues.

For instance, 18 percent of women aged 18 to 64 were uninsured, but minorities and low-income women were more likely not to have coverage. Four in 10 low-income women were uninsured at the end of 2013, compared to five percent of higher-income women. Twenty-two percent of black women and 36 percent of Hispanic women were uninsured. Seventeen percent of black women and 14 percent of Hispanic women were covered by Medicaid compared to seven percent of white women.

In addition, out-of-pocket costs were more of a barrier to care for women than men, with 22 percent of women in this age group reporting that they had not filled a prescription or had skipped a dose of medicine in the previous year, compared with 12 percent of men. Twenty-eight percent of women were having problems paying off medical bills compared with 19 percent of men. This may be because women on average earn lower wages, have fewer financial assets, accumulate less wealth and have higher rates of poverty, according to the KFF report. For comparison purposes, the foundation also surveyed men ages 18 to 64.

Amy Allina, deputy director at the National Women’s Health Network, spoke at a briefing on the survey about the hard choices women make. “Postponing or skipping care when you can’t afford costs isn’t a crazy decision — the findings show that a significant number of women that have medical debt reported that they have to use most of their savings [to pay off debt], they have trouble paying for housing, they’re contacted by collection agencies. These are experiences that have lifelong consequences.”

In terms of preventive care, 60 percent of women did not know that insurers must cover at least one preventive visit a year. Fifty-seven percent of women knew that services like mammograms have to be covered, but only 34 percent of women between 18 and 44 were aware that insurers help pay for breast pump rentals, and 33 percent of women were not aware that insurers now cannot charge higher premiums for women than men.

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May 15th, 2014, 4:53 PM by Lisa Gillespie

Short Takes On News & Events

Medicare Reverses Denial Of Costly Treatment For Hepatitis C Patient

Walter Bianco, an Arizona man denied access to new drugs to cure his hepatitis C infection, will get the costly medications after all.

Walter Bianco (Photo by Alexandra Olgin for KHN)

After Kaiser Health News and NPR described his plight in a story that aired Monday, federal Medicare officials said they would look into the case. Bianco’s appeal of an earlier denial had been rejected by WellCare, a private insurer that contracts with the federal program to provide drug coverage.  The insurer rejected coverage saying the combined use of the costly new drugs has not yet been approved by the Food and Drug Administration — even though two doctors’ groups had recommended the protocol in cases like Bianco’s.

Late Tuesday, Bianco’s doctor got word that the earlier denials had been reversed – an unusually fast turnaround for the agency.

“I am very pleased that Mr. Bianco received approval for the treatment he needs,” said Dr. Hugo Vargas of Mayo Clinic in Scottsdale, Ariz. “I hope all patients in similar (or more urgent) circumstances can be given a fair hearing.”

Bianco, whose liver has been severely damaged by the hepatitis C virus, said Medicare’s reversal “is great news for me, and hopefully for many others, since a precedent has been set now.”

In a statement, Medicare officials indicate that the new policy will apply broadly to hepatitis C patients whose doctors prescribe the combined use of the two drugs because they meet certain criteria laid out in January by the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases. Those guidelines recommend the combined use of the two drugs in patients with advanced liver disease who have failed to be cured by earlier drug regimens – even though the FDA has not yet approved the combination.

Medicare officials say that beneficiaries “are required to have access to needed therapies” if they have demonstrated “medical necessity” and have “medically accepted indications” for the treatment.

The agency is reportedly conferring with medical specialty groups on refining the guidelines about when patients should be treated with which regimens.

For now, Medicare’s Part D plans may decide on a case-by-case basis whether to approve payment for the costly drugs. But if the plans deny payment, consumer advocates say patients will now have a good chance of prevailing because of the new stance by federal officials.

There is little doubt that coverage of the drugs will be a substantial financial burden for the program.

Sean Cavanaugh, deputy Medicare administrator, recently told a U.S. Chamber of Commerce summit that the agency hopes to have a handle on potential costs later this year after it receives bids from Part D drug plans which will take the cost of the new treatments into account.

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May 15th, 2014, 3:47 PM by Richard Knox

Short Takes On News & Events

Study: Diabetes Afflicts 1 In 3 Hospitalized Patients Over 34 In California

In California, roughly one in three hospitalized people over 34 years old has diabetes, increasing the complexity and cost of their care, according to a report released Thursday.

Hospitalizations for patients with diabetes on average cost about $2,200 more than for patients who didn’t have the disease, regardless of the reason they were admitted, according to the report by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy.

“Diabetes … affects most body systems in one way or another,” said Harold Goldstein, executive director of the California Center for Public Health Advocacy and one of the authors of the study. “If you have diabetes, it’s more challenging to treat anything.”

The study analyzed all 2011 hospital discharge data and financial reports from the Office of Statewide Health Planning and Development.

One reason cases involving diabetes cost more is that the disease affects the body’s ability to heal, Goldstein said.

The researchers reported that diabetes was listed as the primary cause in only 1.7 percent of all hospitalizations. But patients with diabetes have a higher risk for kidney and heart disease, blindness, and limb amputations–all of which can lead to significant expenses. In 2006, the authors write, two thirds of patients with diabetes were estimated to have had at least one of these complications, resulting in almost $23 billion in medical costs nationally.

The outlook is worse for the elderly and minority groups. Almost 60 percent of hospitalizations for patients with diabetes involved people 65 and older. Non-Hispanic whites still made up the bulk of discharges among patients with diabetes, but the study found that diabetic patients who were African-American, Asian-American, Native American or Latino were more likely to be hospitalized compared to non-Hispanic white patients.

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May 15th, 2014, 7:59 AM by Daniela Hernandez

Short Takes On News & Events

Do Seniors Have Too Many Medicare Plans To Choose From?

Most seniors face a dizzying array of options each year when it comes time to choose a Medicare health or prescription drug plan. Beneficiaries can select from an average of 18 health plans and 31 prescription drug plans. In South Florida, they have 88 plan choices altogether.

While choice may sound like a good thing, many seniors say they find it difficult to compare plans. As  a result, they often stick with the same plan even if it is not best suited to them, according to a new report from the Kaiser Family Foundation based on conversations with beneficiaries in Memphis, Tennessee; Tampa, Florida; Baltimore; and Seattle. (Kaiser Health News is an editorially independent program of the foundation.)

Many seniors said they did not want to switch plans because the process was so frustrating, the report said. That can cost them money because companies change prices and benefits almost every year.

At a briefing on the report Tuesday, Barry Schwartz, a psychology professor at Swarthmore College and author of the book, “Paradox of Choice,” explained that older people tend to make choices that are “good enough,” while younger people often search for the “perfect” choice.

But Judith Stein, executive director of the Center for Medicare Advocacy, a consumer advocacy group, said that Medicare beneficiaries sometimes find that a health plan that is “good enough” when they are healthy does not meet their needs when they are sick. That’s because a plan may not include coverage for the hospital or doctor they want, or may charge too much for the drug their doctor recommends.

Even with so many choices, most seniors flock to a small number of plans, said Joshua Raskin, senior analyst for investment firm Barclays Capital. He said plans with the most market share, including those run by insurer giants, Humana and UnitedHealthcare, have grown the fastest in recent years.

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May 14th, 2014, 5:00 AM by Phil Galewitz

Short Takes On News & Events

Harvard: Overused Medical Services Cost Medicare Billions

Medical overtreatment is the inverse of former Supreme Court Justice Potter Stewart’s definition of pornography: while easy to define in concept, it can be hard to know it when you see it.

A treatment that is appropriate for one patient can also be unnecessary or even counterproductive for another, depending on the patient’s condition. This has been a major obstacle for studies seeking to pinpoint overused services, which by the most expansive estimates may account for as much as a third of the nation’s health spending.

Using a novel method, a study released Monday by researchers from the Harvard Medical School Department of Health Care Policy evaluated the prevalence in Medicare of 26 tests and procedures that have been found to offer little or no clinical benefit. The services were mostly culled from mainstream lists, including studies in medical journals, the Choosing Wisely campaign and the U.S. Preventive Services Task Force. The procedures included a form of back surgery in which collapsed spinal disks are filled with cement, as well as CT scans or MRIs on people with headaches.

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May 12th, 2014, 4:05 PM by Jordan Rau

Short Takes On News & Events

States’ Medicaid Decisions Leave Health Centers, Patients In Lurch

More than 1 million patients who use federally funded community health centers will remain uninsured because they live in one of 24 states that chose not to expand Medicaid under the Affordable Care Act, according to a study released Friday by researchers at George Washington University.

Most of those patients live in the South, because every state in that region except Arkansas and Kentucky opted against expanding the federal-state program for the poor after the Supreme Court ruled in 2012 that it was optional.

“These low-income patients already face significant challenges to obtaining health care,” says lead author Peter Shin, director of the Geiger Gibson Program in Community Health Policy at George Washington University. “Our analysis suggests these patients will remain without access to affordable insurance, which will almost certainly lead to delays in care and the risk of more serious health conditions.”

Health centers in states that have expanded Medicaid are benefiting, as 2.9 million of their uninsured patients were projected to gain coverage in 2014 either through Medicaid or through buying subsidized private coverage on the new health insurance marketplaces, the report found. Officials at health centers in Colorado, Kentucky and other states that expanded Medicaid have seen their rates of uninsured patients fall dramatically this year.

Gaining coverage helps health center patients get access to specialists along with prescription drugs, diagnostic tests and hospital care for little or no out-of-pocket costs. The coverage will also be a financial bonanza for health centers that are paid several times more from Medicaid than from the sliding scale fees they charge the uninsured.

Nationally, about 1,200 community health centers provide primary care services to nearly 21 million patients at 8,000 sites. About 36 percent of their patients in 2012 were uninsured and 39 percent were on Medicaid.

In the states that expanded Medicaid this year, the government and private insurance payments will generate potential revenues of $2.1 billion in 2014 for the centers. That’s money the centers can use to pay for physicians, nurses and to expand services. But in the states that opted against expanding Medicaid, the centers will lose about $569 million in extra Medicaid funding, the study found.

Health centers in nonexpansion states are unlikely to have money to grow and “as a result, access problems are likely to increase as the number of uninsured patients who seek care at health centers increases,” the report said. And this is likely to exacerbate existing access problems, particularly in the South.

The report showed that 35 percent of the 1.1 million community health center patients left struggling without insurance live in just five states —Alabama, Florida, Georgia, Louisiana and Mississippi.

“That is a huge resource loss for them,” Shin said.

If all 50 states had expanded Medicaid as the law’s framers had intended, 5.2 million uninsured community health center patients out of a total of 7.5 million would have been covered, the report projected.  Those that would have remained uninsured could not afford to buy coverage on the exchange, chose not to purchase it or were ineligible for Medicaid because of their immigration status.

 

May 9th, 2014, 2:21 PM by Phil Galewitz