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

Short Takes On News & Events

Some Surprising Findings About Young Adults And Health Care

Insured or uninsured, young adults seem to spend about the same out-of-pocket for health care over the course of a year.

With 2009 federal data on patient spending, researchers examined how often adults up to age 25 used and paid for health care.  While an awful lot has changed since then – the Affordable Care Act became law in 2010, young adults can stay on family insurance plans until age 26, they can get subsidies to buy insurance – this study in the Journal of Adolescent Health could be a baseline to see whether the ACA makes a difference in the behavior, coverage or spending of this important age group.

The study compared many variables, including age, ethnicity, ability to speak English, visits to doctors and hospitals, individual and overall expenses, as well as employment, insurance and poverty status.

At the time, 21 percent of adults ages 18 to 25 had health insurance part of the year and 27 percent were completely uninsured.

Lead author Dr. Josephine Lau, an assistant professor of adolescent and young adult medicine at University of California, San Francisco, said she and her co-authors were surprised that young adults insured part of the year still had higher emergency room costs than those uninsured for the whole year.

She said job loss, money woes and other situations could have created an unstable environment for receiving care from a doctor’s office.

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April 25th, 2014, 9:37 AM by Marissa Evans

Short Takes On News & Events

Consumers In Federal High-Risk Pools Get Special Enrollment Option For Marketplace

Participants in the federal high-risk health insurance pool who haven’t yet signed up for other coverage can qualify for a 60-day special enrollment period that begins May 1, the Obama administration announced late Thursday.

In a notice posted on the Pre-Existing Condition Insurance Plan website, officials said that participants in the high-risk program who have not yet purchased coverage through the health law’s online marketplaces, or exchanges, can qualify for the new enrollment period. These people have until June 30 to pick a plan through the federal exchange,,  or their state marketplace, if their state runs one. No matter when they enroll in that time frame, benefits will be effective back to May 1, officials said. State-based marketplaces are adopting a similar special enrollment period.

On three separate occasions, administration officials have extended the enrollment deadline for the program, known as PCIP, which is now set to close April 30.

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

This is not the first time that the administration has extended enrollment deadlines. As the March 31 end to the open enrollment for the marketplaces loomed, officials also established special enrollment periods that gave people who experienced technical difficulties with additional time to sign up for coverage. That ended April 15 for the federal marketplace.

April 25th, 2014, 6:57 AM by Mary Agnes Carey

Short Takes On News & Events

RAND: Medicare Should Weigh Cost In Coverage Decisions

The agency that oversees the Medicare program should be able to consider the cost effectiveness of drugs and medical devices when making coverage determinations, according to a new report by the RAND Corporation.

But study authors acknowledge that this recommendation — a significant change from current practice in which the Centers for Medicare & Medicaid Services is barred from considering cost – has little chance of being implemented because it would require Congressional action.

“My impression is that changing Medicare will be very difficult. It may have to wait until more people believe we’re in a crisis,” said Steve Garber, a RAND senior economist.

The report, Redirecting Innovation in U.S. Health Care, explores options to decrease spending and increase value within the American health system. Other suggestions include the creation of a Food and Drug Administration public-interest investment fund to support research that could produce less costly drugs and devices.

“The interest shouldn’t be if a product is profitable — that’s a big problem with vaccines and orphan drugs,” said Sara Rosenbaum, a professor of health policy at The George Washington University, who reviewed the report for RAND. Read the rest of this entry »

April 24th, 2014, 3:45 PM by Lisa Gillespie

Short Takes On News & Events

How Are Insurers Responding To New Health Law Enrollees?

KHN’s Jay Hancock was on C-SPAN’s Washington Journal Monday morning to talk about how insurers are responding to the health law. Hancock said the 8 million new customers have insurers pondering who they, how sick they are and how the new enrollees may affect insurance rates in 2015.

April 21st, 2014, 1:37 PM by KHN Editors

Short Takes On News & Events

Incomplete Face-To-Face Doctor Exams Put Home Health Agencies In Tight Spot

Medicare is paying billions of dollars to home-health providers without adequate documentation of patients’ needs by doctors, according to a new report by the Department of Health and Human Services Office of Inspector General.

The cost of caring for homebound patients is rising, and the government is trying to get a better grip on spending by requiring doctors to certify — with face to face examinations — Medicare beneficiaries’ eligibility for home health services, including intermittent skilled nursing care, physical therapy, speech therapy and part-time home health aide services. The OIG estimated that $2 billion in inappropriate payments were made in 2011 and 2012 because of inadequate compliance with the rule.

But home health agencies, which billed Medicare $19.5 billion for these services in 2010, view the rule as burdensome and vague, and worry it will impede in their ability to deliver care.

Beatriz Lamb, regional director of home health care and hospice for Franciscan St. Elizabeth Health in Indiana, said that they give care to around 120 patients and juggle documentation from about 80 doctors. “It does create delays in care, we can’t afford to go out without a face-to-face [certification] in hand and I don’t have leverage to get it done if I’m already seeing the patient,” Lamb said.

The face-to-face rule results from a provision of the Affordable Care Act and is designed to reduce inappropriate Medicare payments for home health services. The OIG’s assessment found that of the claims that required face-to-face encounters, 32 percent did not meet the Centers for Medicare & Medicaid Services rules on what doctors must document, and should not have been paid. Home health providers worry that CMS could later try to recover these overpayments.

The rule requires that certifying physician must fill out documentation that includes the physician’s title, signature and date of the face-to-face encounter. It must also include a brief narrative that describes that patient’s clinical condition and the way in which the patient’s clinical condition supports his/her home-bound status and the need for care.

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April 18th, 2014, 5:00 AM by Lisa Gillespie

Short Takes On News & Events

Biggest Insurer Shocked With Hepatitis C Costs

UnitedHealth Group spent $100 million on hepatitis C drugs in the first three months of the year, much more than expected, the company said Thursday. The news helped drive down the biggest insurance company’s stock and underscores the challenge for all health care payers in covering Sovaldi, an expensive new pill for hepatitis C.

“We’ve been surprised on the volume — the pent-up demand across all three businesses” — commercial insurance and private Medicare and Medicaid plans, said Daniel Schumacher, chief financial officer of UnitedHealth’s insurance wing. Schumacher and other executives discussed the company’s first-quarter results on a call with financial analysts.

Made by Gilead Sciences, Sovaldi costs more than $80,000 per treatment and is seen as highly effective against hepatitis C, a chronic virus infection that often leads to liver failure. But the high cost, and what increasingly looks like high demand, is straining budgets for the government-financed Medicare and Medicaid programs as well as for private insurers that had not priced the drug into this year’s premiums.

UnitedHealth bosses discussed other pressures on first-quarter profits, especially from customers who renewed 2013 policies for 2014. To avoid premium increases associated with Affordable Care Act rules that became effective this year, many customers extended their plans late last year.

President Obama also expanded the ability of policyholders to keep their plans. The result is that UnitedHealth has many more customers than expected on older plans at lower rates, squeezing profits.

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April 17th, 2014, 12:11 PM by Jay Hancock