Authors of the first-ever global hepatitis C guidelines went big Tuesday, advocating for worldwide use of two of the most expensive specialty drugs in the world.
The new guidelines, from the World Health Organization, give strong endorsement to the two newest medicines. Gilead Science’s Sovaldi costs $1,000 per pill/$84,000 for a 12-week course of treatment and Olysio, Janssen Pharmaceuticals, $66,360 for its three-month course.
The high prices have ignited a firestorm of objection. In the United States, doctors and insurers argue that the cost of the drugs will make their widespread use impossible. And critics say even if the prices are heavily discounted in other countries, the drugs will still be unaffordable in most of the world.
The WHO endorsement of treatment with Sovaldi and Olysio was made without taking the cost of the two drugs into consideration. That’s because the price of the drugs outside the U.S. was unknown in December, when the WHO panel wrapped up its work.
But the price of the drugs isn’t the only issue. The WHO recommends that all 150 million or so people around the globe with chronic hepatitis C infection be assessed for treatment — a gargantuan task in itself. Authors of the report are quick to acknowledge that neither the assessment of people’s health status nor actual treatment will happen anytime soon.
“A lot has to happen for this to really take off in a big way,” says the guidelines’ chief architect, Dr, Stefan Wiktor. “Even if prices came down dramatically tomorrow, that doesn’t mean there would be an immediate rush to treatment.”
Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year.
What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system.
Dr. Karin Rhodes, from the University of Pennsylvania and a lead author on the study published this week in JAMA Internal Medicine, says when researchers said they had insurance, they were able to make an appointment about 85 percent of the time — on the first try, no less.
“Capacity exists. I think this is a very optimistic message,” Rhodes says, adding that researchers were usually able to get scheduled within a week. The median wait in Massachusetts was about two weeks.
Rhodes acknowledges the study did not examine the quality of care received, the accessibility for returning patients or the role of cost in determining patients’ real access to services. Read the rest of this entry »
In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association.
Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals — a tenfold difference.
That’s similar to the mental health system in 1830, before Dorothea Dix and other advocates pushed to shift people with mental illnesses out of the prisons and into hospital care instead, says Dr. E. Fuller Torrey, a psychiatrist and lead author of the report.
“We’ve basically gone back to where we were 170 years ago,” says Torrey, a prominent critic of the widespread effort to deinstitutionalize psychiatric patients beginning in the 1960s. “We are doing an abysmal job of treating people with serious mental illnesses in this country. It is both inhumane and shocking the way we have dumped them into the state prisons and the local jails.”
The report includes a survey of each state’s mental illness treatment laws in prisons, as well as background on the percentage of prisoners with mental illnesses in each state. Since 1970, Torrey says that percentage has risen from an average of about 5 percent to 15-20 percent.
“There is not a single state in the United States where you want to go to a jail or prison and be severely mentally ill,” says Torrey. He adds that many jails and prisons are trying to improve their care of prisoners with mental illnesses, but they are hampered by state laws that make forced treatment difficult.
In 31 states, prisons can administer treatment over a prisoner’s objections by requesting a special treatment review committee, but the process is often difficult and the report calls such efforts “grossly underutilized.” Some people with mental illness refuse treatment, often because they are not aware that they are sick.
“This causes major problems,” the authors write in the report. “Jail officials can thus be legally sued in many states if they forcibly medicate mentally ill prisoners without their consent, yet can also be held legally responsible for the consequences of such prisoners’ psychotic behavior,” including suicide.
Torrey adds that there is often a fundamental mismatch between guards and prisoners with mental illnesses. “People who work in jails and prisons signed up because they wanted to take care of bad people. So you get some personality types that are not compatible with taking care of people with serious mental illnesses,” he says.
The number of low-income people enrolled in Medicaid rose by 3 million to 62.3 million from October through February as more Americans joined the state-federal insurance program through state and federal online insurance marketplaces, according to a report released Friday by the Department of Health and Human Services.
States that expanded Medicaid eligibility under the health law saw an average 8 percent increase in enrollment, with enrollment leaping almost 35 percent in Oregon and almost 34 percent in West Virginia. The health law expanded the program to include all legal residents with incomes under 138 percent of the federal poverty level, or $15,800 for an individual.
States that chose not to expand the program saw an average increase in enrollment of 1.6 percent, the report found. Florida saw the biggest increase – 8.2 percent — as people who were previously eligible but not enrolled signed up. Montana ranked second with a 6.9 percent increase and Idaho was third with a 6.6 percent jump.
A new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere.
Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income.
In addition to the 40 percent of enrollees who move to Medi-Cal or job-based insurance, between 2 and 8 percent of those who sign up for Covered California are estimated to become uninsured, the analysis noted.
This process — “churn” to those who study health insurance — is well-known in the Medi-Cal and individual insurance market.
The Obama administration took a victory lap Tuesday as enrollment through the health law’s exchanges topped 7 million, a goal previously thought untouchable when the website healthcare.gov sputtered and crashed as sign-ups began last fall.
In a statement in the Rose Garden, President Barack Obama, said, “The debate over repealing this law is over. The Affordable Care Act is here to stay.”
But he alluded to continuing political pressure from Republicans and other opponents of the law and acknowledged challenges still remain. Although the law is bringing coverage to millions of Americans, “that doesn’t mean that all the problems in health care are solved forever.”
White House Press Secretary Jay Carney broke the news of the enrollment tally at his daily press briefing, telling reporters that the last-minute surge of traffic to the website and the call center pushed enrollment to 7,041,000, a figure that does not include sign-ups in the past few days through state-based exchanges. Healthcare.gov is managing enrollment in 36 states, while 14 states and District of Columbia are running their own exchanges.
“What was predicted to be a failure has been a success … despite the fact that we basically lost two months because of the troubles with the website,” Carney said, adding later that “we crossed one milestone here but there are many more to cross in the future.”
Carney said it is still too early to know how many enrollees did not previously have health care coverage or how many have paid their first premium, although the “overwhelming majority” of people pay premiums on time, he said. Department of Health and Human Services Secretary Kathleen Sebelius said Monday in a television interview that insurance companies estimate that between 80 and 90 percent of enrollees have paid their premiums.
The Congressional Budget Office originally projected that 7 million people would sign up for the exchanges by the end of the enrollment period. After computer problems botched the Oct. 1 rollout, the CBO revised that estimate down to 6 million. Rightly or wrongly, the ability of the law to hit that target had become a bellwether of the law’s success. But there are practical implications as well. The more enrollees there are, the more likely the risk pool will be balanced between sick and healthy individuals. That calculus will be based on enrollments at the state and local levels where premiums are set, say experts.
“Each state is its own insurance market, whether it uses the federal exchange system or not. These state differences could mean that the Obamacare exchanges are viable in some states and regions of the country, while in other states and regions the numbers remain too low to sustain a stable insurance pool,” James C. Capretta, a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute, wrote in a column published Tuesday in National Review Online.
Democrats hailed the 7 million tally. “Americans have spoken by the millions in their desire for more affordable, comprehensive health insurance,” said Rep. Sander Levin, D-Mich, the ranking member of the House Ways and Means Committee. “Insurance that can’t kick them off when they get sick. Insurance that can’t limit lifetime coverage. Insurance that doesn’t threaten to bankrupt their families when an illness strikes. The amount of interest in the insurance exchanges demonstrates that the reality experienced in health care reform refutes the Republican rhetoric to destroy it.”
House Speaker John Boehner, R-Ohio, said House Republicans would continue with their efforts to repeal the law. “The president’s health care law continues to wreak havoc on American families, small businesses and our economy, and as I’ve said many times, the problem was never just about the website – it’s the whole law,” Boehner said in a statement. “Millions of Americans are seeing their premiums rise, not the lower prices the president promised. Many small businesses are afraid to hire new workers, instead cutting hours and dropping health coverage for existing employees. Many Americans can no longer see their family doctor, despite the pledge no one would lose access to their physician.”
Capretta’s column expressed similar concerns. “The end result will be a reduction in the uninsured of some magnitude, that’s for sure,” he wrote. “But it was never going to be hard to reduce the uninsured if that was all that concerned policymakers. Massive public subsidies and expansion of free public-insurance programs can expand insurance enrollment, so long as others were willing to pay for it.”
Obama acknowledged the health law’s bumpy rollout and warned there may be more days ahead where the website isn’t working and said some parts of the law must be improved. A handful of Senate Democrats – including some facing tough re-election campaigns – have introduced legislation to change some elements of the law, including adding a less generous level of coverage that would be cheaper than those currently on the exchanges and making coverage optional for employers with up to 100 workers.
Addressing an audience that included key congressional Democrats and administration officials, Obama chided Republicans and other critics who have pushed for the law’s repeal without offering alternatives and urged them to work with him and Democrats to make changes. “Why are folks working so hard for people not to have health insurance?” Obama asked, adding later, “there are still no death panels. Armageddon has not arrived. Instead this law is helping millions of Americans and in the coming years it will help millions more.”
Last minute health insurance shoppers nationwide turned up in record numbers online Monday, and they also showed up in person at clinics, county health departments and libraries to sign up for Obamacare on the last official day of open enrollment. Here are dispatches from public radio reporters in Ohio, Pennsylvania and Houston — three of the 36 states that are using healthcare.gov — and Minnesota, which has one of the most troubled state-run marketplaces.
OBSTACLES IN CLEVELAND: A steady stream of people filed through the doors of the Neighborhood Family Practice, a free clinic on Cleveland’s near west side Monday, but Leah Pallant, an outreach and enrollment coordinator at the clinic expected many of them to leave without actually selecting a plan before the midnight deadline.
“The website is already in and out,” Pallant said. “The number of people on the website really made it difficult to keep working, because it basically just shuts you out entirely when they have too many visitors.”
Care coordinators constructed an inspirational billboard for folks signing up at the Neighborhood Family Practice (Photo by Sarah Jane Tribble/WCPN).
Federal officials said more than 1.2 million people from around the country had visited by noon Monday, and the site was handling as many as 125,000 people at a time. The site was down from about 3:20 a.m. until 9 a.m. for maintenance and then again later midday; at other points during the day it shunted people into a “virtual waiting room.”
Coordinators in Ohio and across the country encountered many of the same problems as people trying to sign up at home.
Pallant’s colleague, coordinator Jackie Mostow, was working with Cleveland resident Callie Williams. “We can try,” Mostow told Williams, “but what we might end up doing is trying to create an account and we’ll schedule you an appointment to come back.”
Williams, who hasn’t had insurance since the 1990s, said she is willing to wait a bit longer. “Just schedule me an appointment to come back,” she said.
Uninsured Californians flocked to shopping malls, beauty salons, clinics and libraries Monday to meet the deadline for enrolling in health coverage.
The website of the state-run insurance exchange, coveredca.com, was so inundated that officials directed some consumers who began online applications to return later to complete them.
The state was seeing a “huge surge” in last-minute applications, with more than 150,000 people signing up in the last week, Peter Lee, executive director of the exchange said Monday. More applications were started on Sunday than any other day since Oct. 1, when open enrollment began on the nation’s insurance exchanges.
By 5 p.m., the website had seen 420,000 unique visitors, slowing it down. “That volume of response is unprecedented,” Lee said.
Altogether, more than 1.2 million Californians have enrolled in health insurance through Covered California, according to Lee.
LAKEPORT, Calif.—When we last left Brad Stevens, he was living in Lakeport, Calif., a struggling massage therapist in a struggling town on the southern tip of Clear Lake. Brad has been uninsured his entire adult life and believed firmly that clean living and exercise could stave off any need for medical care. After a bike accident which injured his shoulder and a battle with advanced thyroid cancer, Brad was anxious to enroll in some form of insurance – any kind of insurance – under the Affordable Care Act.
“I talked to an insurance guy who is selling Obamcare and found out I don’t qualify,” Brad said last November. “What I’m going to get is Medi-Cal,” California’s Medicaid program.
Health insurance for Brad Stevens meant taking tons of vitamins and spending three hours at the gym every day. But after hurting his shoulder and a battle with thyroid cancer, the 59-year-old realized he’s not invincible (Photo by Heidi de Marco/KHN).
The insurance broker had warned Brad about long wait times, but when he called the toll-free line for Covered California, the state’s insurance marketplace, Brad said, “I waited four minutes. It was a piece of cake.” The operator didn’t offer to help him apply for Medi-Cal,but instead told Brad to call the social services office in Lake County. “It wasn’t a one-stop shop.”
When Brad finally called the county social services office on January 6, he was worried his two aging cars and the modest home he had bought long ago from his mother would count against him— a common concern. Sure enough, the forms that arrived in the mail asked for details about Brad’s bank account and any cars he owned. “So I called them back up and said, ‘You don’t need half of this stuff that you’re requesting.’ They said, ‘Yes, you’re right. That’s an old form. We haven’t switched over.’”
On January 23, Brad collected his records and made the half hour drive down to the county office. “They were really efficient at the office,” Brad said, sounding surprised. Of the county worker, “She was like, Boom! Boom! Boom! She’s been doing this ten years. I was just signing stuff.” The county worker told him to expect the Medi-Cal enrollment to take 45 days.
When we next talked on February 7, he was anxious to get his insurance card. He needed to refill his thyroid medication—Brad has no thyroid and relies on medication to keep his body functioning. His pharmacist told him that the company that makes his pills had raised the price from $12.99 to $68. “I’m down to 24 pills right now, so I’m counting them daily. If I haven’t gotten my [Medi-Cal] number before I’m out of pills, I’m going to call Walmart to find out what their price is.”
With this year’s deadline to register for individual health insurance just a weekend away, much attention is being lavished on two numbers — the 6 million Americans who have signed up so far, and the percentage of those folks who are (or aren’t) young.
But experts say the national numbers actually don’t mean very much.
“These are really state-based markets,” says Caroline Pearson, vice president at Avalere Health, a consulting firm based in Washington D.C. Because each insurance market is run within each individual state, big numbers in some states can’t make up for shortfalls in others.
Still, much of the debate has centered around 6 million — the nationwide number the Congressional Budget Office estimated would sign up for insurance through the federal and state health exchanges. (That’s indeed about how many have enrolled so far, the Obama administration confirmed Thursday.)