Short Takes On News & Events

Study: ER Closures Raise Death Rates At Nearby Hospitals

Emergency patients who are admitted to the hospital are at greater risk of dying if another emergency room at a hospital nearby has closed its doors, a new study of California hospitals has found.

The analysis is believed to be the first to examine the impact that emergency department closures have on the quality of patient care at other hospitals within the same service area.

Six percent of the nation’s emergency rooms have closed their doors in recent years, including many that serve poor inner-city and rural communities. At the same time, the number of emergency visits throughout the country has increased by 51 percent, a combination of developments that has led to more overcrowding and longer waits for emergency care.

The study was published Monday in the August issue of the journal Health Affairs.

“Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals,” said the senior author, Dr. Renee Y. Hsia, an associate professor in the department of emergency medicine and the Institute of Health Policy Studies at the University of California, San Francisco.

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August 4th, 2014, 4:01 PM by Roni Caryn Rabin

Short Takes On News & Events

Unfavorable Views Of Health Law Spike In July: Poll

The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago.

The poll from the Kaiser Family Foundation found that 53 percent of the public had an unfavorable view of the law in July, the highest level since the law was passed in 2010. It was up from 45 percent in June. (KHN is an editorially independent program of the foundation.)  The law’s unpopularity hit similar levels several times since passing, most recently in January when 50 percent of people disliked it.

Support for the law in July remained about the same as in June, with 37 percent supporting it. The change came from the number of people who had previously told pollsters they did not know or refused to discuss their opinions: while 16 percent fell into that group in June, only 11 percent did in July.

The poll did not provide any definitive answers for the change but noted that people reported that their informal chatter with friends and family was more than four times as likely to be negative as supportive toward the law.

Public opinion was evenly divided on the Supreme Court’s decision that closely held companies such as the Hobby Lobby craft stores could refuse to provide workers with birth control through their insurance because it violated the religious beliefs of the company. Women and men also saw things pretty much the same. Seven of 10 Republicans hailed the decision, and Democrats disliked it just as strongly. The public was split about whether the decision will make it harder for women to get prescription birth control. Few people said the court’s action would make them more likely to vote in the fall mid-term elections.

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August 1st, 2014, 5:55 AM by Jordan Rau

Health Care In The States

Covered California Rates Up Modest 4.2 Percent

Covered California says health care premiums will go up modestly for most people buying coverage on the state exchange next year by an average of 4.2 percent.

People get information at a Covered California table at Union Station on the health insurance exchange's opening day (Photo by Anna Gorman/KHN).

“We enrolled a lot of people, they’re healthy, and that’s kept rates down,” Covered California Executive Director Peter Lee said at a press conference on Thursday in Sacramento to announce the rates.

About 1.4 million people purchased insurance on the marketplace in California for 2014, the first year Affordable Care Act insurance was available. California is one of the states that created its own exchange, and it is an “active purchaser” under the law, which means it can negotiate with insurers directly on rates.

The low rate hike is an average, Lee noted: “Not everyone is going to see only a very small increase.  Health care is personal. For some, premiums might go up 15 percent, not very many. But for them, they have the ability to shop.”

Lee says the rates were developed over time though rigorous negotiation with insurers. The marketplace barred insurers from changing geographic areas and incorporated children’s dental care in every plan, he said.

Insurers say Covered California’s active role did help keep rates lower. But Charles Bacchi of the California Association of Health Plans says the industry is not expecting medical costs to rise dramatically either.

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August 1st, 2014, 5:00 AM by Pauline Bartolone, Capital Public Radio

Short Takes On News & Events

6 States Extending Medicaid Pay Raise Next Year To Primary Care Doctors

Correction: This story has been updated to note that the District of Columbia in 2015 is not extending the Medicaid pay increase for physicians. The story originally listed D.C. with the six states that are keeping doctor pay higher next year. The District will allow Medicaid pay rates to fall back to earlier levels.

Just six states will use their own money in 2015 to sustain the federal Medicaid pay raise to primary care doctors, which was a key provision of the Affordable Care Act intended to make sure millions of low-income people enrolling in the expanding insurance program have access to a physician.

Interestingly, two of the states extending the pay raise are Alabama and Mississippi — neither of which expanded Medicaid under the health law. The other states extending the pay raise next year are Colorado, New Mexico, Iowa and Maryland, according to interviews with state officials and the American Medical Association. Those four states expanded their Medicaid eligibility to cover everyone with incomes less than 138 percent of the federal poverty level, or about $15,900 for an individual.

Alaska and North Dakota paid primary care doctors in Medicaid the higher rates even before the health law’s provision took effect in 2013.

The other 42 states and the District of Columbia will let the Medicaid pay rates revert back to their 2012 levels.

Under the law, Medicaid fees for primary care increased in 2013 and 2014 to the same amount paid under Medicare. While Medicaid fees vary by state, the change meant an average 73 percent pay increase nationally, according to a 2012 study by the Kaiser Family Foundation and the Urban Institute. (Kaiser Health News is an editorially independent program of the foundation.)

Nationally, it’s unclear whether the higher fees attracted more doctors into Medicaid or made doctors more willing to treat more Medicaid patients. The Obama administration is not collecting any data to show the impact of the higher fees, said a spokeswoman for the Centers for Medicare & Medicaid Services. State Medicaid officials also have not studied the impact.

For years, some states have struggled to attract doctors to Medicaid, largely because of their low pay. About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study published in 2012 in the journal Health Affairs. New Jersey had the nation’s lowest rate at 40 percent, while Wyoming had the highest, at 99 percent, according to a survey of doctors by the U.S. Centers for Disease Control and Prevention.

Physician groups, while pleased with the extra funding, have said for years that the two-year cap would limit its impact on persuading more doctors to treat Medicaid patients.  Still, they worry about what happens when the short-lived pay raise goes away in most states.

“Yes, the money has made a difference,” said James Perrin, president of the American Academy of Pediatrics. “Anecdotally we are hearing about more doctors seeing more Medicaid patients and using extra money to add staff.”

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July 31st, 2014, 5:00 AM by Phil Galewitz

Health Care In The States

Rx For Clarity: Calif. Considers Bilingual Drug Labels

Every Saturday morning, a steady stream of Chinese and Vietnamese patients line up at the Paul Hom Asian Clinic in Sacramento, Calif. Most of them speak little to no English.

Patient assistance director Danny Tao says people come here to get free medical consultations and drug prescriptions. But, he says that when patients take those prescriptions to be filled, they don’t understand the instructions on the label.

“They go pick them up, and we don’t exactly know if they’re taking it or not — or if they know how to take it,” Tao said.

Tao says drug labels at most pharmacies in California are printed only in English. That puts patients in danger of making any number of errors — taking too much medication or not enough, taking it at the wrong time of day or with the wrong food. Such mistakes can cause serious harm or even death.

Tao says that for the drugs his clinic supplies directly, all have a bilingual label.

“It’s going to be English/Chinese or English/Vietnamese,” he said. “By the time they get home they know exactly how to take the medication, because it’s in their own language.”

This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles. Statewide, 44 percent of Californians speak a language other than English at home. New York approved a similar rule last year to make it easier for non-English speakers to take their medications properly and avoid costly mistakes.

But the California board’s executive officer Virginia Herold says the move is very controversial. For starters, there is a concern that bilingual labels would mean larger bottles of pills to fit all the text. Patients, she says, don’t like larger bottles.

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July 30th, 2014, 6:30 AM by April Dembosky, KQED

Short Takes On News & Events

Survey Finds 1 In 5 Uninsured Don’t Want Coverage

Though millions of people gained health coverage this year as a result of the Affordable Care Act, millions more remain unaware of their options or have no interest in getting insured, a new survey has found.

Among those who were uninsured last year and remain uninsured, only 59 percent were familiar with the new Obamacare marketplaces and 38 percent were aware of federal subsidies to lower their insurance costs, according to the survey conducted in June by the nonpartisan Urban Institute.

About 60 percent of respondents list cost as the main reason for not having insurance. But 20 percent say they don’t want health insurance or would rather pay the fine for not having coverage.

The survey estimated about 8 million people gained health care coverage since last fall. In the past month, a New England Journal of Medicine study found that 10 million people gained coverage. The Rand Corp. has estimated 9.3 million people gained coverage.

“A lot of people who remain uninsured never looked on the marketplace,” said Stephen Zuckerman, co-director of the Urban Institute Health Policy Center. “If you build it, they do not always come.”

Zuckerman said while many people say health insurance costs are too high, many don’t understand its value. “People are paying for something but not seeing an immediate return,” he said.

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July 29th, 2014, 4:57 PM by Phil Galewitz

Short Takes On News & Events

Moving Children From CHIP To Exchange Plans Would Increase Costs: Study

Cost sharing would increase and the  number of child-specific services covered would decline if millions of low-income children now enrolled in the Children’s Health Insurance Program (CHIP) were forced to receive coverage through the health law’s insurance exchanges, according to a study released Tuesday.

CHIP enrollees in some states could see their cost sharing increase 10-fold if they were transitioned to exchange plans, according to the analysis from the Wakely Consulting Group done for the Robert Wood Johnson Foundation. Those costs include substantial increases in estimated out-of-pocket costs, including deductibles, co-pays and co-insurance. The impact could be even more costly for families who have children with special health care needs.

CHIP provides health insurance to an estimated 8 million low-income children who don’t qualify for Medicaid. The study looked at a subgroup of that population — 5.7 million children who were eligible for CHIP in June 2013. The 2010 health care law funded the program through Sept. 30, 2015, and requires states to maintain eligibility thresholds through Sept. 30, 2019, for children under Medicaid and CHIP that were in place in March 2010, when the law was passed. Sen. Jay Rockefeller, D-W.Va., who played a leading role in creating CHIP in 1997, has sponsored legislation to fund the program through 2019.

According to the study, CHIP plans offer richer coverage for key pediatric dental and vision services than most exchange plans. In more than half of the states studied, children moving from CHIP to exchange plans would likely need to purchase stand-alone dental plans in order to have comparable coverage. Those children also would be faced with more cost sharing than was required in CHIP plans.

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July 29th, 2014, 11:16 AM by Mary Agnes Carey

Short Takes On News & Events

Study Estimates 10 Million Americans Gained Health Coverage

About 10.3 million Americans gained health coverage this year, primarily as a result of the Affordable Care Act, according to a study by the federal government and Harvard University, published Wednesday in the New England Journal of Medicine.

The estimate of newly insured adults — the largest to date — is the first published in a major medical journal and authored by some federal health researchers.

The federal government had previously reported that about 8 million people bought private health plans on the state and federal exchanges and 6.6 million additional people enrolled in Medicaid since last October. But it has not estimated how many of those had been previously uninsured.

The Obama administration took pains yesterday to say that the views of the study’s authors are not those of the administration – even as it hailed their findings.

“We are committed to providing every American with access to quality, affordable health services and this study reaffirms that the Affordable Care Act has set us on a path toward achieving that goal,” Health and Human Services Secretary Sylvia Burwell said in a statement. “This study also reaffirms that expanding Medicaid under the Affordable Care Act is important for coverage, as well as a good deal for states.”

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July 24th, 2014, 9:46 AM by Phil Galewitz

Short Takes On News & Events

Advocacy Groups Say Medicare Should Negotiate With Drugmakers

Medicare could save billions if Congress overcame its reluctance to anger the drug industry and allowed the program to demand rebates or negotiate prices, Rep. Henry Waxman, D-Calif., said Wednesday. He added that’s something polls show many Americans support.

Rep. Waxman (Photo by Jason Merritt/Getty Images for UCLA)

Expensive new blockbuster drugs, such as a $1,000-a-pill hepatitis C treatment called Sovaldi, highlight the need to do something soon, the California Democrat said, backing recommendations made in a report released Wednesday by two advocacy groups, the Medicare Rights Center and Social Security Works.

“We could save money, lower the deficit and not ask seniors to pay more,” said Waxman, a long-standing drug industry critic who is retiring at the end of this session. “The only opposition is from drug companies because they will make a little less money if they have someone negotiating prices with them.”

He spoke just hours before the maker of Sovaldi — Gilead Sciences — reported record sales of $5.7 billion in the first six months of the year.

The drug industry has long opposed price controls, or allowing the government to negotiate for Medicare drug prices.

Imposing price controls on Medicare could hurt seniors by altering “the competitive nature of the program” and “could increase beneficiary premiums, cause job loss, and reduce incentives for innovation,” said Robert Zirkelbach, a senior vice president at  the Pharmaceutical Research and Manufacturers of America.

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July 24th, 2014, 8:05 AM by Julie Appleby

Short Takes On News & Events

What’s Next In The Wake Of Conflicting Federal Court Decisions

KHN’s Julie Rovner and SCOTUSblog’s Tom Goldstein joined Gwen Ifill on PBS NewsHour Tuesday to discuss the implications of two federal court decisions that disagreed about the legality of selling subsidized insurance on healthcare.gov.

Watch the video below.

July 23rd, 2014, 8:17 AM by KHN Editors