Health Care In The States

Colorado Redraws ACA Map To Cut Sky-High Ski Town Rates

Relief is in sight – and it won’t involve a lawsuit – for the four counties in Colorado that have the highest Obamacare health insurance premiums in the country.

Local officials in the ski resort region in the mountains west of Denver had threatened to sue over the high rates. But on Friday Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw those boundaries, making the resort counties part of a much larger 22-county pool.

The Affordable Care Act sets a lot of limits on what insurers can do – they can’t charge sick people more, for instance – but one thing that still counts is location, location, location. Premiums can be higher or lower based on how much doctors and hospitals cost in a specific area. And states get to draw those geographic boundaries. When Colorado lumped together Garfield, Pitkin, Eagle and Summit counties — an area that includes the towns of Aspen and Vail — the state created the most expensive insurance market in the U.S., almost by accident.

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May 5th, 2014, 4:21 PM by Eric Whitney

Short Takes On News & Events

Hospitals’ Purchase Of Doctors Leads To Higher Prices, Spending, Study Finds

A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.

The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007.  The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.

Hospitals have increasingly bought physician practices over the past decade, arguing it helps them coordinate care and control costs. But insurers and many economists say hospitals’ main motivation is negotiating higher prices with insurers and building referrals to grow admissions.

The Affordable Care Act has accelerated the trend by encouraging the establishment of Medicare accountable care organizations that pay large groups of providers based on how well they control costs and improve quality.

The Federal Trade Commission has been watching the growing collaborations between hospitals and physicians, and until now has intervened to stop them only when one organizations controls so many physicians in one community that it is considered anti-competitive. Experts say the Stanford study could give the FTC ammunition to more closely examine and potentially block future hospital purchases.

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May 5th, 2014, 4:00 PM by Phil Galewitz

Short Takes On News & Events

Study: Illegal Immigration Doesn’t Cause Overuse Of Health Care

Even before the Affordable Care Act was close to passing, it was clear that immigrants illegally living in the country would not be part of many of the law’s benefits. They are not allowed to buy health insurance from the online marketplaces, at least in part because opponents argued that these immigrants overburden emergency rooms and hospitals. But a study released Monday finds that they’re less likely to use health services than U.S. citizens and other immigrants here legally.

Using 2009 data from the California Health Interview Survey,  the researchers found that 11 percent of adults living illegally in California had visited a hospital emergency room in the past year, a rate significantly lower than the 20 percent of U.S. born adults in California. That “negates the myth that undocumented immigrants are responsible for [emergency department] overcrowding,” the researchers wrote in the latest issue of the journal Health Affairs. They noted little difference among children’s ER visits.

However, that was not true about children’s doctor visits. Ninety percent of U.S.-born children had at least one doctor visit in the preceding year, while only 78 percent of the children in the state illegally did. Naturalized citizens and immigrants in the state legally also had significantly higher rates than those without proper authority.

The survey “does not explicitly inquire about undocumented status,” researcher write, so they “developed a model to estimate California’s “undocumented immigrant population.”

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May 5th, 2014, 4:00 PM by Marissa Evans

Short Takes On News & Events

Doctors Think Others Often Prescribe Unnecessary Care

Three out of four physicians believe that fellow doctors prescribe an unnecessary test or procedure at least once a week, a survey released Thursday finds. The most frequent reasons that physicians order extraneous—and costly—medical care are fears of being sued, impulses to be extra careful and desires to reassure their own assessments of the patient, the survey said.

The survey was commissioned for Choosing Wisely, a two-year old campaign devised by a foundation created by internal medicine doctors that has persuaded nearly 60 medical societies to identify overused tests and procedures. The goal is to cut back on needless medical care, which by some estimates may waste a third of the $2.8 trillion the country spends on health each year.

The campaign focuses on encouraging conversations between patients and doctors about the suspect treatments it identifies. In the survey, 47 percent of doctors said one patient a week requests something unnecessary. While most doctors believe they are most responsible for interceding, 48 percent said that when facing an insistent patient, they advise against it but still order the test. Another 5 percent said they just order the test.

“I think we’re afraid of not being liked,” said Dr. Donald Ford, a vice president at Hillcrest Hospital, which is part of the Cleveland Clinic Health System and located in Mayfield Heights, Ohio. “We want to be the hero to the patient.”

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May 1st, 2014, 2:54 PM by Jordan Rau

Short Takes On News & Events Finished Strong Despite Rocky Start, Enrollment Data Show

Obama administration officials on Thursday predicted health insurance premiums would be stable next year despite concerns that not enough young and healthy people signed up through the online insurance exchanges.

“The risk pool is fundamentally large and varied to support that kind of pricing…in every state,” said Mike Hash, director of the office of health reform for the Health and Human Services Department. “We believe … premiums will be stable.”

The upbeat assessment came as the administration offered the broadest glimpse yet of the demographics of the 8 million Americans who enrolled in health insurance through the health law’s online marketplaces through mid-April. Open enrollment for this year has ended in nearly all states and will re-open in November.

About 28 percent of enrollees nationwide were the coveted 18- to 34-year-olds, the group least likely to need health services. Analysts have debated whether enough young and healthy people have enrolled to ensure that premiums don’t spike in 2015 because of the significant number of older enrollees, many of them with expensive health issues. Insurance premiums for next year won’t be known until fall.

The report details the scope of the last-minute surge –about 900,000 people, or 12 percent of the more than 8 million enrollees, signed up after March 31.

Florida enrolled nearly 1 million people, far more than any federal exchange state – and about 250,000 more people than Texas, which has a larger population and more uninsured residents. Both Florida and Texas were among a handful of states whose enrollment doubled since March 1.

More than 4.8 million additional individuals enrolled in Medicaid and the Children’s Health Insurance Program through the end of March, compared to enrollment before the marketplace opened last October. About half the states expanded Medicaid under the law to cover everyone with incomes under 138 percent of the federal poverty level, or $15,800 for an individual.  Some of those new Medicaid enrollees were previously eligible but not enrolled in the program. Read the rest of this entry »

May 1st, 2014, 2:42 PM by Phil Galewitz

Short Takes On News & Events

WellPoint Softens Forecast For Obamacare Rate Hikes

Welcoming a surge of young, last-minute enrollees, the biggest player in the health law’s insurance marketplaces on Wednesday tempered its prediction for substantial 2015 rate increases.

Five weeks ago WellPoint executive Ken Goulet told analysts that premium increases for 2015 plans “will probably be in double-digit plus.”

On Wednesday’s conference call to discuss first-quarter results, WellPoint bosses talked less about price hikes and more about the surprising number of young adults they signed at the March 31 enrollment deadline for plans sold through the online exchanges.

The volume of last-minute enrollment “was not only substantial vs. our expectations,” said Wayne DeVeydt, WellPoint’s chief financial officer, but “we saw in each day’s applications the average age coming down in meaningful fashion.”

For insurance pools in which the healthy subsidize the sick, analysts watch the age of enrollees carefully. Younger members are typically healthier than older ones and are seen as an important stabilizer — even though their premiums are lower.

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April 30th, 2014, 12:18 PM by Jay Hancock

Short Takes On News & Events

Public Overwhelmingly Supports Law’s Contraceptive Mandate, Poll Finds

By a nearly two-to-one margin, the public supports the health law’s requirement that private health plans cover prescription birth control without cost-sharing, according to a poll released Tuesday.

The provision, which is at the heart of a case being weighed by the Supreme Court, was endorsed 61 to 32 percent and was most popular among women, younger adults, Democrats and independents, according to the Kaiser Family Foundation’s monthly tracking poll. (Kaiser Health News is an editorially independent program of the foundation.)

In addition, the poll found that 55 percent of those surveyed say that for-profit companies whose owners have religious objections to birth control  should still be required to cover it.  The high court is expected to rule by June on whether for-profit employers are entitled to a religious exemption from the mandate.

The poll also asked people who did not sign up for health insurance why they haven’t gotten coverage.  More than a third said it was too expensive.  Fourteen percent said they didn’t think the law’s requirement to get coverage or pay a fine applied to them personally, while 13 percent said they were unaware of the requirement.  Twelve percent said they tried to get coverage but were unable to do so, and 7 percent said they would rather pay the fine than buy insurance. Nearly half the people did not know what the fine would be for not getting insurance.

The poll found no change in the public’s overall assessment of the law, with 46 percent holding an unfavorable view and 38 percent supporting it, unchanged from the foundation’s  March poll. That said, 58 percent of those surveyed said they want their congressional representative to work to improve the law, while 35 percent want lawmakers to repeal the law and replace it with something else.

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April 29th, 2014, 5:36 AM by Mary Agnes Carey

Short Takes On News & Events

Study: Costly Breast Cancer Treatment More Common At For-Profit Hospitals

Older breast cancer patients who received radiation treatment after surgery were more likely to undergo a more expensive and somewhat controversial type of radiation called brachytherapy if they got their care at for-profit rather than nonprofit hospitals, a new study reports.

Among the oldest group studied – women in their 80s and early 90s who are least likely to benefit from the regimen – the odds of receiving the more expensive brachytherapy were significantly higher at for-profit hospitals, the study found.

The research, funded by the National Cancer Institute and the Robert Wood Johnson Foundation, was published Monday in the May issue of the journal Surgery.

“We wanted to see whether for-profit hospitals, which arguably have a greater incentive to provide returns to their shareholders, would be more likely to adopt a higher-reimbursement therapy than a nonprofit hospital — and that’s exactly what we found,” said Dr. Cary P. Gross, a professor of medicine at Yale University School of Medicine and the paper’s senior author.

“This reinforces the idea that reimbursement is a significant driver of the adoption of new cancer therapies, which is a shame,” Gross said. “Evidence should be the main driver.”

Brachytherapy is a newer type of radiation therapy for breast cancer that involves implanting a radiation source into the lumpectomy cavity of the breast. It is a shorter course of treatment than standard radiation and can be completed in one week instead of four to six weeks. But it costs about twice as much as the standard treatment, and recent studies have questioned its effectiveness and whether its harms may outweigh its benefits.

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April 28th, 2014, 6:51 AM by Roni Caryn Rabin

Health Care In The States

Oregon Raises White Flag Over Its Health Exchange

Oregon has been “all in” on health reform. Its embrace of the Affordable Care Act includes a very successful Medicaid expansion, a $2 billion federal experiment to show the state can save money by managing patients’ care better, and, of course, the state’s own online marketplace to sell Obamacare insurance.

But that last point has been a huge problem.

The Cover Oregon board decided on Friday to ditch its troubled website and join up with the federal exchange instead.

The Oregon site launched with high expectations to the tune of quirky, whimsical folk songs by local musicians. But after six months and about $250 million spent, Oregonians still can’t use the website to sign up for coverage on their own. They have to use a navigator.

The reasons for the problems are multiple: The state wanted a website that could enroll everyone from individuals to businesses owners, Medicaid recipients and even children.

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April 28th, 2014, 5:00 AM by Kristian Foden-Vencil, Oregon Public Broadcasting

Short Takes On News & Events

First-Aid Training For Mental Health Could Aid At-Risk Veterans

When done right, first aid quickly identifies a problem and triages patients so the more urgent cases get treated first and followed up on. Now, with federal aid, that same strategy will apply to the pressing problem of veterans’ mental health.

A push for new funding — and the use of existing funds — may soon make more resources available to help identify vets who need help with depression or other mental illness through the National Council for Behavioral Health’s “Mental Health First Aid training.”

NCBH estimates that less than 50 percent of veterans who need mental health care actually seek and receive treatment.

“The one thing we don’t learn to identify are mental health injuries. If you had a hole in your chest, you wouldn’t walk around with that. This is the same thing,” said Tom Tarantino, chief policy director for the Iraq and Afghanistan Veterans of America, which is teaming up with NCBH.

Training programs like the one supported by NCBH are designed to educate people on the front lines about how to identify early warning signs and how to refer people for necessary treatment.

NCBH and other mental health advocates are seeking part of the at least $15 million allocated to train first responders, which include police, nurses and college administrators, to identify the warning signs of mental illness among veterans, teaching “de-escalation” techniques and referring people at risk to mental health care providers. The president’s budget could provide another $5 million for these grants.

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April 25th, 2014, 12:38 PM by Lisa Gillespie