How The Republicans Might Reshape Medicaid If They Win The White House And Congress

Topics: Insurance, Marketplace, Medicaid, Politics, Health Reform, States

Jul 31, 2012

The Los Angeles Times reports on how the GOP is readying a push to scale back the health insurance program for the poor if it takes control of the White House and Congress next year. Meanwhile, the insurance industry is paying $1.1 billion in rebates to consumers under the health care law and eyeing congressional efforts to overhaul the tax code next year as its best chance to roll back a new health insurance tax.

Los Angeles Times: Medicaid Could Be Scaled Back Sharply Under GOP Plans
Nearly half a century after President Lyndon Johnson signed Medicaid into law, conservative critics of the massive government health insurance program for the poor are readying a new push to dramatically scale it back if Republicans control the White House and Congress next year (Levey, 7/30).

Reuters: Obama Administration States Will Join Medicaid Expansion
The Obama administration on Monday said it expects that U.S. states will eventually join its planned expansion of the Medicaid healthcare program as they evaluate the benefits of providing health coverage to more low-income people. U.S. Medicaid director Cindy Mann said states will likely spend the next several months analyzing the plan, which under President Barack Obama’s healthcare law, would extend health coverage to about 16 million uninsured people based on new criteria that broadens eligibility to people with incomes of up to 133 percent of the federal poverty line (Morgan, 7/30).

The New York Times: Insurance Rebates Seen As Selling Point For Health Law
The law requires insurers to give out annual rebates by Aug. 1, starting this year, if less than 80 percent of the premium dollars they collect go toward medical care. For insurers covering large employers, the threshold is 85 percent. As a result, insurers will pay out $1.1 billion this year, according to the Department of Health and Human Services, although most of it will not go to individuals. The average rebate will be $151 per household, with the highest in Vermont ($807 per family), Alaska ($622) and Alabama ($518). No rebates will be issued in New Mexico or Rhode Island, because insurers there met the 80/20 requirement (Goodnough, 7/30).

Los Angeles Times: In-Store Clinics Look To Be A Remedy For Healthcare Law Influx
If you thought it was hard getting a doctor’s appointment now, just wait until 30 million more Americans join the line. Nearly 3 in 4 California counties already lack a sufficient number of family physicians, and by 2020 the U.S. faces an estimated shortage of 40,000 primary-care doctors with no way to remedy that in just a few years (Terhune, 7/30).

Politico: Insurers Eye Tax Reform To Nix Fees
With GOP repeal efforts stalled out this year, health insurers are eyeing an expected effort to overhaul the nation’s Tax Code next year as their best shot to get rid of a tax they’ll have to pay under President Barack Obama’s health care law. Lobbyists for the health insurance industry are calling on lawmakers to make repeal of the “health insurance tax” a priority during those discussions, arguing that a rewrite of the Tax Code is the best time to re-examine the tax that is expected to help pay for health care reform (DoBias, 7/30).

CQ HealthBeat: Hash Elaborates On Exchange Effort At Bipartisan Policy Center
Michael Hash, the top Centers for Medicare and Medicaid Services official in charge of implementing health insurance exchanges, elaborated on that effort Monday, telling a Washington, D.C., forum that within a few weeks virtually all states will be getting money to set up the new marketplaces. Hash addressed a meeting sponsored by the Bipartisan Policy Center on the health care law; the center also announced a new effort to control health care costs. Former Senate Majority Leader Democrat Tom Daschle, who co-chairs the Center along with former Senate Majority Leader Republican Bill Frist, called the new project “an urgent and absolutely essential endeavor” (Reichard, 7/30).

Also in the news –

CQ HealthBeat: Health Law Birth Control Coverage To Launch Wednesday As Legal Battle Continues
New attention was focused Monday on a federal rule requiring employers to provide free coverage for birth control in their employee health insurance policies following a federal court ruling that temporarily barred enforcement of the rule for a business in Colorado. Religious leaders who back the rule warned that a preliminary injunction that a federal district judge granted on Friday may be applied to other pending lawsuits and the leaders said that women’s rights to use contraceptives should not be restricted (Norman, 7/30).

Massachusetts committee releases health care bill


July 31, 2012 • Reprints

BOSTON (AP)Massachusetts House and Senate negotiators have filed the final version of a bill they say will save up to $200 billion in health care costs over the next 15 years and help guarantee the future of the state’s landmark 2006 health care law.

The bill rejects a proposed “luxury tax” for hospitals that charge more than 20 percent above the state median price for a service, but includes $135 million in grants to help community hospitals make the transition to new electronic medical records systems.

Another goal of the bill is to allow residents better access to their own medical records and cut down on unnecessary and expensive repeat medical testing.

Sen. Richard Moore, an Uxbridge Democrat and one of those working on the final bill, said another top aim of the bill is to set a cost growth goal close to the state’s rate of inflation, far less than current year-to-year increases in insurance and medical costs.

“I think it’s a very good bill,” Moore said.

The bill would also encourage the creation of so-called “accountable care organizations” — health care networks that take a more coordinated approach to medicine. There are already five accountable care organizations in Massachusetts.

Such organizations are considered key to the transition away from more piecemeal medical care that rewards doctors for each test or procedure to care that looks at the entire patient and the best way to maintain overall health.

Rep. Steven Walsh, D-Lynn, also worked on the final version of the sweeping bill and said he’s confident it will benefit patients, health care providers and business — which could see a reduction on the cost of health premiums.

He said the bill should also win the approval of Gov. Deval Patrick, who has made health care cost control a top priority.

“I’m very confident that the governor will sign this,” Walsh said, noting that every member of the conference committee working on the compromise legislation — both Democratic and Republican members — signed off on the final bill.

Patrick told reporters mid-afternoon on Monday, that he hadn’t seen the final language of the bill but that the administration was working closely with the conference committee charged with drafting the final bill.

The 342-page bill, which was filed late Monday, is expected to be voted on Tuesday, the final day of the Legislature’s formal session.

That decision to wait until the absolute last minute before releasing the final version of such a complicated piece of legislation irked some lawmakers, even some on those on the conference committee.

“I have a lot of concerns,” Senate Minority Leader Bruce Tarr, a Gloucester Republican who also sat on the committee, said just hours before the final bill was filed. “I have concerns about being able to understand what’s being put before us, not from an intellectual standpoint, but just from a substantive standpoint.”

One of the most contentious proposals was the “luxury tax” aimed at addressing the wide price differences that hospitals charge for the same operation or procedure in Massachusetts.

The House version of the bill included the tax which essentially targeted bigger name Boston hospitals that can charge more than 20 percent above the state median price for a service.

Under the proposal, those hospitals would be levied a 10 percent surcharge that would go into a fund to help support hospitals serving the poor and most vulnerable. The proposal, which did not appear in the Senate version of the bill and came under fire by those hospitals, was dropped from the final bill.

But Walsh was quick to point out that the final bill included help for community hospitals.

The bill takes other steps to control costs.

It expands the role of physician assistants and nurse practitioners to act as primary care providers to guarantee access to more affordable care and creates a new “wellness tax credit” for businesses that adopt programs to combat preventable chronic diseases like obesity, diabetes, and asthma.

The bill also seeks to control medical malpractice costs by creating a 182-day “cooling off” period to give both sides a chance to negotiate a settlement, and bans the use of mandatory overtime for nurses in hospitals except in emergency situations.

By trying to bring spiraling insurance and other health costs under control, the bill seeks to help ensure the success of the Massachusetts health care law signed in 2006 by then-Gov. Mitt Romney.

That law — which became the blueprint for the federal health care law signed by President Barack Obama in 2010 — expanded access to health coverage in Massachusetts, but did little to rein in premiums and other health care costs that have threatened to undermine its long-term fiscal stability.


Associated Press Writer Shannon Young contributed to this report.

One in 10 employers to drop health coverage


July 24, 2012 • Reprints

About one in 10 employers in the United States say they’ll drop health coverage for employees in the next few years as the major provisions of the Patient Protection and Affordable Care Act take effect, and more indicated they may do so over time, a survey by consulting company Deloitte finds.

Opponents of health reform have argued that employers dropping health coverage is an unintended consequence of the law that will negatively affect employees who want to stick with the coverage they know and like.

Employer-sponsored health insurance covers more than 160 million Americans.

There’ve been conflicting reports over how many employers will drop coverage for employees, with Deloitte’s report predicting a lesser impact than some. Last year, consulting firm McKinsey & Co. drew fire from when they stated 30 percent of respondents will “definitely” or “probably” stop offering employer-sponsored health insurance after 2014.

According to the Deloitte survey, 9 percent of companies said they expect to stop offering insurance in the next one to three years. Around 81 percent said they plan to continue providing benefits, and 10 percent weren’t sure. Most employers said they offer health benefits to attract and retain employees and sustain job satisfaction.

But more employers said they might drop coverage if state health insurance exchanges and other elements of the law are implemented and effective. Using Deloitte’s Health Reform Impact Model, the Center for Health Solutions examined the effects of an employer exit from benefits, as well as three other possible scenarios resulting from the likely impact of the PPACA on health insurance coverage. Under the different scenarios, it was estimated that potentially between 23 million and 65 million individuals may join a health insurance exchange by 2020.

But for the most part, the survey found, employers aren’t big fans of health reform. The majority, at 60 percent, say it’s a “step in the wrong direction.” Thirty percent say it’s a good start. Most employers also say their company isn’t well prepared to implement the 2014 provisions of the law. They also say they don’t fully understand it.

Overall, employers believe the U.S. health care system underperforms. Thirty-five percent of employers surveyed grade system performance as an “A” or a “B,” while 64 percent give it a “C,” “D,” or “F.” Employers hold favorable views about the system’s clinical capabilities and medical innovation and unfavorable views center on its wastefulness and high costs.

Employers say high health costs are driven most by hospital costs, followed by inefficiencies, unhealthy lifestyles, prescription drug costs, insurance company costs, and government regulation.

The study, conducted between February and April, surveyed corporate and human-resources executives from 560 companies currently offering benefits.

Health savings accounts top $14.1 billion

Assets surge 21 percent over year before


July 31, 2012 • Reprints

Health savings accounts have grown to more than $14.1 billion in assets, representing 7.1 million accounts through June 30, according to research from broker/dealer Devenir.

That’s a 12 percent increase in accounts and a nearly 21 percent jump in assets from just a year ago.

Average account balances in the first half of 2012 grew to $1,996 from $1,807 at the end of 2011, a 10 percent increase, the research shows. By eliminating identified zero balance accounts that average rises to $2,176.

HSA investment dollars also continue to grow. HSA investment assets reached an estimated $1.3 billion in June, a 35 percent increase since the end of 2011 and 51 percent increase from June 2011. Additionally, HSA accountholders have retained 30 percent of their contributions so far in 2012, up from 24 percent during 2011.

Devenir surveyed the top 50 HSA providers in the health savings account market.

The numbers are even a significant jump from the firm’s last HSA report in February, which found by year-end 2011, HSAs surpassed $12.4 billion in nearly 6.8 million accounts.

The Devenir survey adds to the evidence that HSAs are experirencing record-growth; Fidelity, JP Morgan, Bank of America and Wells Fargo all reported earlier this year huge boosts in HSA accounts.

Industry insiders have long promoted these accounts for consumers as a way to take control of their health care dollars.

Future health care costs and funding retirement consistently rank among individuals’ top financial concerns, with health and wealth becoming two sides of the same coin,” Justin Raniszeski, health benefit solutions executive for Bank of America Merrill Lynch said earlier this year. “Approaching your financial life in this integrated fashion, and using multiple tax-advantaged saving vehicles in the workplace, can help chip away over time at what may seem like insurmountable savings needs.”

More HSA articles:

Five reasons to enroll in an HSA

Five reasons not to enroll in an HSA

2013 HSA and FSA cheat sheet

Helping employees understand HSAs

Consumers driving health care

IRS announces 2013 HSA limits

Drawing Health Policy Distinctions Between Obama, Romney

Topics: Insurance, Marketplace, Politics, Health Reform

Jul 30, 2012

The National Journal notes the two presidential candidates offer clear contrasts when it comes to their positions regarding health insurance. Meanwhile, Roll Call notes that the reported differences in opinions among the Supreme Court justices when they reviewed the health law continue to reverberate during this campaign season.

National Journal: Obama, Romney Contrasts Clear On Insurance
When the Obama campaign hits expected Republican presidential nominee Mitt Romney for being the candidate supporting the rich, they aren’t often talking about health insurance. But they could be. It is one place where a comparison between Obama and Romney’s health policies can be easily seen. And it fits right in with the narrative the Obama campaign has been weaving: Obama is for the everyman, and Romney is for the rich. The details on Romney’s plan are vague. His campaign website says he wants to “end the discrimination against the individual purchase of insurance.” Under current law, people who get their insurance through employers pay their premiums tax-free. The 30 million Americans who buy insurance on their own don’t get those same benefits (McCarthy, 7/28).

Roll Call: Health Care: The Justices Underscore A Divide
California is not exactly the epicenter of the controversy surrounding the 2010 health care law. None of the lawsuits that led to the Supreme Court’s decision last month upholding the law came from the West Coast. Unlike so many other governors, the state’s chief executive, Democrat Jerry Brown, has supported the law and plans to implement it. Other issues, particularly the economy, are dominating the political discourse there. Still, the two national parties and their allies are hoping that the tremors of the debate will be felt in several of the state’s Congressional districts, an unusually large number of which are competitive this year as a result of redistricting (Adams, 7/30).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

New Federal Transportation Law Encourages Stricter Teen Driving Regs

Topics: Insurance, Marketplace

By Michelle Andrews

Jul 30, 2012

Susan Vavala’s 15-year-old daughter, Kim, went to the movies one rainy night in 1995 with a 16-year-old friend who had just gotten his driver’s license and two other kids. They weren’t more than five minutes away from Vavala’s Wilmington, Del., home when the new driver, distracted by his friends’ conversation, lost control of the car. Kim was killed instantly in the crash.

In most states today, such a novice driver would not be allowed to drive with a car full of friends and would have other driving restrictions, thanks to regulations implemented over the past decade. But safe-driving advocates say more needs to be done.

They hope that safety provisions included in the transportation bill signed into law by President Obama this month will encourage states to adopt or strengthen laws intended to protect teenage drivers — and everyone who shares the road with them.

It is an effort strongly supported by Susan Vavala, who has worked in Delaware to stiffen regulations. “We knew [the driver] was a good kid. He’d been driving Kim to school every day the week before,” she said. But the combination of “inexperience, a wet road, distraction and four kids in the car” led to tragedy.

More From This Series Insuring Your Health

Car crashes remain the No. 1 cause of death among teenagers, killing roughly 3,000 15- to 19-year-olds in 2009. Teens’ lack of driving experience combined with their use of distracting devices such as cellphones make them the riskiest of drivers, four times more likely to crash as older drivers are, according to the Centers for Disease Control and Prevention and the U.S. Department of Transportation.

Every state and the District has its own graduated licensing program for teen drivers, according to the Insurance Institute for Highway SafetyThe programs spell out the age at which a young person can get a learner’s permit and generally require a certain number of hours of supervised training before a learner can take a driving test. After passing the test, teens enter an intermediate stage that allows them to drive without supervision but generally limits late-night driving and the number of passengers they can have in the car. These restrictions exist until the teen driver has reached a minimum age, often 17 or 18.

State programs vary considerably. In North Dakota, for example, a person can get a learner’s permit at age 14, and there are no restrictions on the number of passengers an intermediate-stage driver can have in the car, according to the insurance institute. New Jersey residents, by contrast, must be at least 16 to get a learner’s permit, and they can’t drive unsupervised with more than one passenger in the car until they get their unrestricted license at age 18.

States have also moved to address distracted driving, a problem for both new and experienced drivers. Forty-four states and the District ban text messaging by novice drivers (39 states and the District ban texting by all drivers), and 32 states and the District ban all cellphone use by novice drivers, according to the Governors Highway Safety Association.

After eight years of declining fatalities, teen motor vehicle crash deaths rose 11 percent to 211 in the first six months of 2011 compared with the same period the previous year, according to preliminary data from the association, which represents state highway safety offices.

The explanation might be as simple as an increase in the number of teens who are driving as economic conditions improve, says Barbara Harsha, the association’s executive director. Other experts speculated that the increase could also mean that current teen driver safety programs may have achieved all they can.

And graduated driver licensing programs, even strong ones, may have their limitations.

A study published last year in the Journal of the American Medical Association examined the incidence of fatal crashes between 1986 and 2007 involving drivers between ages 16 and 19. It estimated that 1,348 fewer fatal crashes involving 16-year-old drivers occurred during that time because of graduated licensing programs than would have occurred without them. But the study also estimated that there were 1,086 more fatal crashes involving 18-year-old drivers over the same period, largely offsetting the improvements for younger drivers.

What’s going on? One theory is that teenagers may be waiting until they turn 18 to get their license, bypassing the restrictions of the graduated licensing system altogether. They then have full license privileges, but they’re as inexperienced as a 16-year-old.

“We know that new drivers have more crashes than more experienced ones,” says John Ulczycki, group vice president at the National Safety Council, an advocacy group.

Still, safety experts are encouraged that the new highway law provides $46 million for incentive grants for states to implement or strengthen distracted-driving programs for all drivers over the next two years. It also includes $27 million for states that adopt certain standards, including prohibiting cellphone use or communicating by device in non-emergency situations, for their graduated licensing programs.

This marks the first time the federal government has spelled out such standards. States can use the grant money for education, training and enforcement, among other things.

“We’re offering a carrot” to states to strengthen their laws, says Jackie Gillan, president of Advocates for Highway and Auto Safety, an advocacy group. “This was a big step forward,” she says.

Please send comments or ideas for future topics for the Insuring Your Health column to

Views On AIDS: More Funding Will Be Needed For New Attack On HIV; The Epidemic Hits Hard In The South

Topics: Delivery of Care, Health Costs, Public Health, Quality, States

Jul 30, 2012

Several news outlets mark the end of the International AIDS Conference with commentaries.

The New York Times: The Long, Uphill Battle Against AIDS
The international AIDS conference in Washington has already made two points clear. There is no prospect that scientists will any time soon find the ultimate solutions to the AIDS epidemic, namely a vaccine that would prevent infection with the AIDS virus or a “cure” for people already infected with the virus. Even so, health care leaders already have many tools that have been shown in rigorous trials to prevent transmission of the virus, making it feasible to talk of controlling the epidemic within the foreseeable future. The only question is whether the nations of the world are willing to put up enough money and make the effort to do it (7/27).

The New York Times: Imagine a World Without AIDS
The beginning of the end of AIDS? The article with that title jumped out at me last week, as I did my weekly table-of-contents scan of The New England Journal of Medicine. I wasn’t prepared for the flood of emotion that overcame me. The beginning of the end? Could it really be (Danielle Ofri, 7/27)?

Des Moines Register: Mayer: HIV Law Should Reflect Medicine’s Reality
HIV criminalization laws are a particularly strong source of stigma. These laws generally require HIV-positive people to disclose their HIV status to potential partners before any exposures occur. Research has shown these laws don’t work. HIV-positive people living in states with HIV criminalization laws were no more likely to disclose their status than those who lived in states without such laws. … We treat no other infectious disease in this way (Randy Mayer, 7/28).

Dallas Morning News: The Deep South, Stigmas And The AIDS Epidemic
More than 30 years into the AIDS epidemic, a combination of safe-sex education and a new generation of pharmaceuticals has left many Americans convinced that HIV/AIDS is a problem that, if not solved, has at least been addressed. But that’s certainly not true in the South, which accounts for nearly 50 percent of all new HIV infections in the United States. The South has the highest rate of AIDS deaths of any U.S. region. It also has the largest numbers of adolescents and adults with HIV and the fewest resources to fight the epidemic (Lisa Biagiotti, 7/30).

Journal of the American Medical Association: Ethical Challenges Of Preexposure Prophylaxis For HIV
(Truvada) became the first drug approved by the US Food and Drug Administration (FDA) for preexposure prophylaxis (PrEP) of human immunodeficiency virus (HIV) for adults at high risk. … Despite empowering patients and promoting the public’s health, PrEP could exacerbate health care inequalities. High cost and intense medical monitoring could exclude individuals with low income, unstable housing, drug dependence, or mental illness. This challenge is even greater in low-income countries with limited resources and infrastructure (Jonathan S. Jay and Lawrence O. Gostin, 7/27).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.