Some Boston Marathon Bomb Victims Will Face Insurance Coverage Limits

Boston Marathon (Photo credit: Wikipedia)

Topics: Delivery of Care, Health Costs, Insurance, Marketplace

Apr 23, 2013

Payments for prosthetics, rehabilitation and a range of other
treatments may fall outside some insurance limits and could continue
long into the future.

The New York Times: For Wounded, Daunting Cost; For Aid Fund, Tough Decisions

Many of the wounded could face staggering bills not just for the trauma
care they received in the days after the bombings, but for prosthetic
limbs, lengthy rehabilitation and the equipment they will need to
negotiate daily life with crippling injuries. Even those with health
insurance may find that their plan places limits on specific services,
like physical therapy or psychological counseling (Goodnough, 4/22).

Politico: Coverage Limits Are Harsh Reality For Amputees

Those who lost limbs in the Boston Marathon bombings now need care to
learn to navigate the world in a new way — and navigate a thorny area of
health care coverage, too. In the case of the Boston bombings, pledges
and offers of support have poured in to help with the health care costs
of the 14 people who reportedly lost all or part of a limb. But for some
amputees, covering the staggering cost for prosthetics care can be a
struggle (Smith, 4/23).

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.

Viewpoints: ‘Big Risks’ Of Buying Private Insurance With Medicaid Dollars; One Month Of Sequestration

US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

Topics: Medicaid, Medicare, Health Reform, States, Health Costs, Women’s Health, Uninsured

Apr 01, 2013

The New York Times: Using Medicaid Dollars For Private Insurance
The Obama administration and Republican officials in several states are exploring ways to redirect federal money intended to expand Medicaid, the main public insurance program for the poor, and use it instead to buy private health insurance for Medicaid recipients. The approach could have important benefits for beneficiaries and for the future of health care reform. But the idea also carries big risks. Federal officials will need to enforce strict conditions before agreeing to any redirection of Medicaid dollars that were originally intended to enlarge the Medicaid rolls (3/31).

Forbes: The Arkansas-Obamacare Medicaid Deal: Far Less Than It First Appeared
When Arkansas Gov. Mike Beebe (D.) first announced that he had reached a deal with the Obama administration to use the Affordable Care Act‘s private insurance exchanges to expand coverage to poor Arkansans, it seemed like an important, and potentially transformative, development. … A Good Friday memo from the U.S. Department of Health and Human Services, however, splashes cold water on that aspiration. It’s now clear that the Beebe-HHS deal applies a kind of private-sector window dressing on the dysfunctional Medicaid program, and it’s not obvious that the Arkansas legislature should go along (Avik Roy, 4/1).

USA Today: ‘Sequester’ Still Looks Stupid, As Planned: Our View
Congress and the White House exempted some programs when they finalized the original deal, and the spending bill they agreed to last month to keep the government open to Sept. 30 spared some vital functions — food inspections, for example. But not enough. Nor does the sequester seriously address the major spending driver: health care costs. The best outcome would be for the sort of anger that forced Congress and the White House to re-open the government in 1996 to push Congress and the White House back to the table on a realistic budget deal this year. The outlines of that deal have been obvious for too long: Trim entitlement programs such as Medicare and Social Security, overhaul the hopelessly inefficient and corrupt tax code to bring in more money, and cut defense and domestic programs with a scalpel instead of an ax (3/31).

USA Today: ‘Sequester’ Needed To Rein In Spending: Another View
Let’s get real on the “sequester.” One month in, not much has changed. Nor is it likely to. Rather than devastating the federal government, the sequester is necessary to rein in the unbridled growth of federal spending. The sequester is certainly flawed. It’s a blunt instrument leaving the biggest spending drivers, entitlements, virtually untouched (Alison Fraser, 3/31).

The Wall Street Journal: The Liberal Medicare Advantage Revolt
A big political story this year is likely to be Democrats turning on their White House minders as the harmful and unpopular parts of the Affordable Care Act ramp up. On the heels of the recent 79-20 Senate uprising against the 2.3% medical device tax, now comes the surge of Democrats pleading on behalf of Medicare Advantage. Liberals have claimed for years to hate this program, but by now Advantage provides private insurance coverage to more than one of four seniors. And those seniors like it (3/29).

The Chicago Tribune: Scrubbing Medicaid
In January, Illinois launched an effort to scrub ineligible people from the state’s Medicaid rolls. … The initial results of this audit are … astonishing: Of the first 20,500 recipients screened by an outside contractor, the auditors recommend that 13,709 be removed from the rolls. Yes, that’s two-thirds of the first group screened, flagged as ineligible to receive their current Medicaid benefits. How so? In some cases, the recipients make too much money to qualify. In other cases, they don’t live in Illinois (3/31).

The New York Times: The Campaign to Outlaw Abortion
Anti-abortion groups have been trying to re-impose restrictions on abortion rights for 40 years, but the Legislature and governor of North Dakota have taken this attack on women’s reproductive health and freedom to a shocking new low … The clear message is the need for a stepped-up effort to hold state officials electorally accountable for policies that harm women in states where right-wing Republicans control the machinery of government (3/29).

The Seattle Times: State Senate Health Care Committee Should Vote On Abortion Measure
After the Senate Health Care Committee hearing on the Reproductive Parity Act Monday, members should vote for it before a key deadline Wednesday. State lawmakers do not need to complicate this issue. House Bill 1044 would maintain insurance coverage for women seeking abortions after federal health reforms take effect (3/31).

Los Angeles Times: The Starbucks Syndrome In Healthcare
Medicare statistics, for example, reveal that Los Angeles leads the nation in the amount of medical services provided during the last six months of a person’s life. Healthy seniors here are also big consumers of healthcare, getting about 65% more MRI studies and utilizing ambulances three times as often as seniors elsewhere. Commercial insurance data point to similar patterns in the healthcare of the younger population in Southern California. What explains such avid use of medical services. … Part of the problem is that Angelenos approach healthcare as they do other kinds of consumption. They expect their CT scans, when they want them, in much the same way they expect their decaf caramel extra hot low-fat macchiatos. (Daniel J. Stone, 3/31).

Los Angeles Times: Bump In The Road For Healthcare Law
One figure in a new report neatly summarizes the potential pitfalls for Obamacare: 30.1%. That’s how much premiums could rise next year, on average, for the roughly 1.3 million moderate- and upper-income Californians who buy individual health insurance policies. Most of that increase is attributable to the insurance reforms in the 2010 law, also known as the Affordable Care Act. The bill’s title is not ironic — its provisions will slow the growth of healthcare costs and lead over time to a more rational and efficient system. But the transition will have some rough patches, and we’re about to hit one (3/29).

Houston Chronicle: The Affordable Care Act Is A Poor Solution
Senator Orrin Hatch has speculated that the Affordable Care Act was designed to fail. A close look at the Act’s contents and history suggests he may be right. The Affordable Care Act is nothing more than a political stopgap, a waypoint on the road to something that might work. Republicans could stand around complaining or we could seize this opportunity to determine what comes next (Chris Ladd, 4/1).

Richmond Times-Dispatch: Moving Forward On Medicaid: More Important Than Ever
As a community physician for more than eight years, I’ve seen how medical care helps keep families strong and secure. When parents and their kids can access health care — and have a way to pay for it — they are much less likely to face unpaid bills or have to put off doctor visits. Instead of worrying about how their family is going to survive, they can focus on how their family is going to thrive. Unfortunately, too many Virginians — more than a million, in fact — find that getting health care is a real challenge because they don’t have insurance (Dr. Christopher Lillis, 4/1).

The Wall Street Journal: The Skinny On Anti-Obesity Soda Laws
New York Mayor Michael Bloomberg’s anti-obesity campaign to ban the sale of certain sugary drinks in large servings, especially sodas, was struck down last month in state court. A proposal for a penny-per-ounce excise tax on sweetened beverages also floundered in Vermont’s House of Representatives in February. … As an economist, I have two big gripes with such paternalistic public-health initiatives: The proposals aren’t grounded in data or compelling economic models, and soda taxes might catalyze a dismal chain reaction, with escalating government intrusions on personal freedom (Michael L. Marlow, 3/31).

Oregonian: Don’t Take Portland’s Sick-Leave Mistake Statewide: Agenda 2013
By voting to mandate paid sick leave last month, Amanda Fritz and her city council colleagues furthered Portland’s reputation as a place where businesses fear to tread. One way to protect city employers burdened by this mandate is to adopt a similar requirement statewide, erasing a competitive advantage a restaurant in, say, Beaverton might have over one in Portland. In other words, bail out Portland by making things tougher all over (3/31).

USA Today: ER Key To Curb Painkiller Abuse
Most opioids are prescribed in the doctor’s office, which has prompted some states to restrict primary care physicians like myself from prescribing them and to encourage referrals to pain specialists. New York City Mayor Michael Bloomberg has taken these curbs a step further by focusing on emergency departments. In January, he announced a voluntary initiative to limit prescription of opioid painkillers in the emergency rooms of the city’s 11 public hospitals. This approach should be expanded across the nation. From 2004 to 2009, the number of emergency visits in New York City hospitals related to opioid abuse or misuse more than doubled (Dr. Kevin Pho, 3/31).

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.

As Hyperactivity Diagnoses Rise, Concerns Grow About Overmedication Of Children

Topics: Public Health, Quality, Health Disparities

Apr 01, 2013

New CDC data shows that nearly one in five boys have a medical diagnosis of attention deficit hyperactivity disorder. Other public health issues highlighted by news outlets include stroke risks in younger people, prescription-drug deaths and OSHA policies.

The New York Times: More Diagnoses Of Hyperactivity In New C.D.C. Data
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention. These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children (Schwarz and Cohen, 3/31).

NPR: As Stroke Risk Rises Among Younger Adults, So Does Early Death
Most people (including a lot of doctors) think of a stroke as something that happens to old people. But the rate is increasing among those in their 50s, 40s and even younger (Knox, 4/1).

Los Angeles Times: Prescription Drug-Related Deaths Continue To Rise In U.S.
Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show. Figures from the U.S. Centers for Disease Control and Prevention reveal that drug fatalities increased 3% in 2010, the most recent year for which complete data are available. Preliminary data for 2011 indicate the trend has continued (Glover and Girion, 3/29).

The New York Times: As OSHA Emphasizes Safety, Long-Term Health Risks Fester
OSHA, the watchdog agency that many Americans love to hate and industry often faults as overzealous, has largely ignored long-term threats. Partly out of pragmatism, the agency created by President Richard M. Nixon to give greater attention to health issues has largely done the opposite. OSHA devotes most of its budget and attention to responding to here-and-now dangers rather than preventing the silent, slow killers that, in the end, take far more lives. Over the past four decades, the agency has written new standards with exposure limits for 16 of the most deadly workplace hazards, including lead, asbestos and arsenic. But for the tens of thousands of other dangerous substances American workers handle each day, employers are largely left to decide what exposure level is safe (Urbina, 3/30).

English: Percent of Youth 4-17 ever diagnosed with Attention-Deficit/Hyperactivity Disorder: National Survey of Children’s Health, 2003 (Photo credit: Wikipedia)

Concerns Raised About Effect Of Medicare’s Readmission Penalty

English: Created by vectorizing Image:Medicare and Medicaid GDP Chart.png with Inkscape (Photo credit: Wikipedia)

English: (Photo credit: Wikipedia)

Image via CrunchBase

Topics: Delivery of Care, Health Costs, Hospitals, Marketplace, Medicare, States

Apr 01, 2013

The New York Times explores the new policy that penalizes hospitals if they have too many patients return within 30 days. Meanwhile, in Maryland, officials are weighing an ambitious plan to control hospital costs.

The New York Times: Hospitals Question Medicare Rules On Readmissions
While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing chorus of critics is asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They are also questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care (Abelson, 3/29).

Kaiser Health News: Maryland’s Tough New Hospital Spending Proposal Seen As ‘Nationally Significant’
Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state’s powerful hospital industry. The blueprint, which needs the Obama administration’s approval, would use Maryland’s unique rate-setting system to keep hospital spending from growing no faster than the overall economy — roughly half its recent rate of increase (Hancock, 4/1).

In other health industry news, federal officials release more details about hospital problems and a federal watchdog focuses on Medicare spending for equipment.

The Associated Press: Reports Of Hospital Mistakes Now Available Online
At St. Charles Medical Center in Bend, (Oregon) employees failed to notice that a cleaning machine was accidentally reprogrammed to leave out the disinfection cycle. Eighteen patients received colonoscopies with scopes that had been only rinsed with water and alcohol. … Hospitals make mistakes. When they are reported — by patients, employees or family members — state and federal officials investigate. Now, for the first time, the U.S. Centers for Medicare and Medicaid (CMS) has released those inspection reports for hospitals nationwide from the past two years. The release was in response to requests from the Association of Health Care Journalists, which has compiled them into a searchable database available to the public
(Peterson, 3/31).

Kaiser Health News: Capsules: IG Report Slaps Medicare For Not Recouping More Overpayment For Equipment
Medicare has made nearly $70 million in overpayments to suppliers of consumer medical equipment and more than half of that money is unlikely to be recovered, according to a new report from the Department of Health and Human Services Inspector General (Carey, 4/1).

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.

State Roundup: Federal Audit Calls For N.Y. Medicaid Program To Repay Funds

English: Newsroom of the New York Times (Photo credit: Wikipedia)

Topics: Delivery of Care, Health Costs, Hospitals, Medicaid, Mental Health, Politics, Women’s Health, States

Mar 26, 2013

News outlets report on health care developments in California, Colorado, Georgia, Massachusetts, New York, North Carolina and Texas.

Boston Globe: Report Hails Mass. Biotech Spending As Job Creator
Halfway through a decade of investment promised by Governor Deval Patrick’s 10-year, $1 billion life-sciences initiative, launched in 2008, the state has spent only about a third of the money targeted to promote the biotechnology and medical device industries in Massachusetts. But the authors of a report set to be released Tuesday by the Boston Foundation, a philanthropic group, say the effort has helped stimulate a key sector of the state’s economy, creating more than 8,000 jobs through capital grants, tax incentives, and business loans. They urge state government leaders to continue funding the initiative in the face of stepped-up competition from other life-sciences hubs, such as California, Maryland, and New Jersey (Weisman, 3/26).

The New York Times: U.S. Wants State To Pay After Audit Of Youth Care
In another critical assessment of New York’s multibillion-dollar Medicaid program, a federal audit says the state improperly claimed $27.5 million in reimbursements for services to mentally ill and emotionally disturbed children and teenagers (McKinley, 3/26).

The New York Times: Caregiver For Disabled People Sues New York State
A New York State-employed caregiver for people with developmental disabilities sued the state on Monday, accusing it of retaliating against him for whistle-blowing. The employee, Jeffrey Monsour, has brought to light a number of questionable practices by the state, as varied as routinely falsifying fire drills and turning a blind eye toward abuse of those in the state’s system of care for people with developmental disabilities. He was one of the people interviewed and featured in a 2011 series of articles by The New York Times examining problems of abuse and corruption within the system (Hakim, 3/25).

Georgia Health News: Senate Limits Abortion Coverage In State Health Plan
A bill that would allow the Georgia World Congress Center Authority to provide its own insurance plan added an amendment Monday that would restrict abortion coverage for state employees. The amended legislation passed on a 34-15 vote in the Republican-dominated Senate. It would bar coverage for abortion in the 650,000-plus-member State Health Benefit Plan. The only exception would be for situations in which the life of the mother is in danger or it’s needed “due to the mother’s medical necessity.” The bill still must be reconciled with the House version of the legislation, which does not address abortion (Miller, 3/26).

The Texas Tribune: Senate Approves Overhaul Of Long-Term Medicaid Care
The Texas Senate unanimously approved an overhaul of long-term and acute care Medicaid services on Monday in an effort to expand care to more Texans with disabilities while saving millions of state dollars. … SB 7 is expected to save $8.5 million in Medicaid costs in the 2014-15 biennium by expanding managed care services, establishing pilot programs to try to provide services at capitated costs and implementing measures to ensure more efficient monitoring of services (Aaronson, 3/25).

Health Policy Solutions: Colorado Third State To Ban Discrimination Against LGBT Patients
Colorado is the third state to prohibit discrimination in health coverage. California and Oregon have barred the practice along with the District of Columbia. The federal Affordable Care Act calls for equity in LGBT health care, but very few states have taken action thus far to codify these rights (Kerwin McCrimmon, 3/25).

San Jose Mercury News: Fremont’s Washington Hospital: Joint Replacement Patients, Doctors Excluded From New Facility
When Robert Cantley needed both knees replaced in August, he was expecting to recover from the surgery at Washington Hospital’s fancy, new $42.7 million Center for Joint Replacement. According to hospital marketing brochures, the center offered “A Higher Level of Care” in a 20,000-square-foot space featuring 25 private patient rooms, a “breathtaking physical therapy space” and a beautifully landscaped therapy garden. Instead, Cantley did his physical therapy sessions in a dimly lit hallway on the sixth floor of the main hospital in what he described as “a miserable set of circumstances.” What Cantley and many other patients at the public hospital didn’t know was that access to the new center, the only facility of its kind in the Bay Area, is restricted to just two orthopedic surgeons at the hospital — the only ones on the Washington staff who met 24 criteria set by the hospital (McGlone, 3/25).

North Carolina Health News: Medicaid Schools’ Tout High Numbers Of Primary Care Grads, But The Numbers Tell A Different Story
Medical schools in North Carolina are touting the high numbers of students they graduate who go on to primary care specialties. But those numbers aren’t the whole story. … In North Carolina, numbers released by the state’s four medical schools claim that from each, upwards of 42 percent of students will be headed into primary care. But Morris-Singer said matching for primary care doesn’t mean those doctors will practice in primary care (Hoban, 3/26).

California Healthline: California Rural Health Association Closes Shop
The California State Rural Health Association, a unifying voice for the state’s disparate rural health care providers for almost two decades, has laid off staff and closed its Sacramento office. The 16-member board of directors hopes to keep the trade association alive and active, “but it’s becoming more difficult in this environment,” said Dave Jones, president of the volunteer board (Lauer, 3/25).

Questions From High Court Suggest Concerns About ‘Pay-For-Delay’ Deals

Image via CrunchBase

English: The United States Supreme Court, the highest court in the United States, in 2010. Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg. (Photo credit: Wikipedia)

Topics: Supreme Court, Marketplace

Mar 26, 2013

The Supreme Court heard arguments yesterday in a case which pits brand name and generic drug manufacturers against the Federal Trade Commission.

Reuters: Supreme Court Justices Signal Uncertainty On Drug Settlements
Supreme Court justices on Monday signaled uncertainty over how they would rule on whether brand-name drug companies can settle patent litigation with generic rivals by making deals to keep cheaper products off the market. Eight justices, lacking the recused Justice Samuel Alito, asked questions that indicated concerns about such deals, but several seemed unsure how courts should approach the matter (Hurley, 3/25).

MedPage Today: SCOTUS Questions FTC Stance on ‘Pay-for-Delay‘
Several Supreme Court justices had hard questions about the Federal Trade Commission’s (FTC) stance against “pay-for-delay” drug patent settlements during arguments before the court on Monday (Pittman, 3/25).

In other courtroom action –

The New York Times: Salesmen In The Surgical Suite
It is not the first time patients have claimed they were harmed by Intuitive’s robotic surgical equipment, called the da Vinci Surgical System. But the Taylor case, set for trial in April, is unusual. Internal company e-mails, provided to The New York Times by lawyers for the Taylor estate, offer a glimpse into the aggressive tactics used to market high-tech medical devices and raise questions about the quality of training provided to doctors before they use new equipment on patients. Intuitive, based in Sunnyvale, Calif., declined to comment on the lawsuit but said studies showed that its robotic equipment results in better outcomes than conventional open surgery (Rabin, 3/25).

Long-Term Care: Expense, Emotions Part Of Planning Dilemma

English: Spending on U.S. healthcare as a percentage of gross domestic product (GDP). (Photo credit: Wikipedia)

English: House Bill and Senate Bill subsidies for health insurance premiums. (Photo credit: Wikipedia)

US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

Topics: Delivery of Care, Health Costs, Insurance, Aging

Mar 26, 2013

In other news, NPR explores the nation’s high disability rate.

The New York Times: Expense And Emotions In Preparing For Long-Term Care
The emotional impact of witnessing the decline of a family member or helping to care for one is often the reason people seek coverage for long-term care, people who work in the aging field say (Carrns, 3/25).

The Fiscal Times: The Health Care Dilemma That Could Bankrupt Women
Nancy S. Buck, a 62-year-old divorced woman from Aurora, Colorado, wants to purchase long-term health care insurance because she doesn’t want to be a financial burden on her children. But right now, that’s not possible, since she’s self-employed, earns only $20,000 a year (too much to qualify for Medicaid), and can barely afford the $450-a-month payment for basic health insurance…As difficult as it has been for single women like Buck to afford long-term health care insurance, it’s about to get harder (Halpert, 3/25).

NPR: Unfit for Work: The Startling Rise Of Disability In America (A four-part series)
In the past three decades, the number of Americans who are on disability has skyrocketed. The rise has come even as medical advances have allowed many more people to remain on the job, and new laws have banned workplace discrimination against the disabled. Every month, 14 million people now get a disability check from the government (Joffe-Walt, 3/26).

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Stakeholders See Health Law Benefits, Challenges

insurance broker (Photo credit: Elva Keaton)

Topics: Health Costs, Insurance, Marketplace, Health Reform, Delivery of Care

Mar 26, 2013

News outlets explore issues emerging from the health law’s implementation, including how the costs of insuring full-time employees could be a boon for temporary staffing agencies, how nurse practitioners are seeking a greater role in primary care and how some clinics are fighting to benefit from the law’s changes.

Kaiser Health News: Temp Agencies See Opportunity In Health Law
The rush to implement the Affordable Care Act, which is generating billions for insurers, hospitals and technology vendors, also looks like a boon for staffing companies, whose share prices have soared. But some suggest that exceptions for temporary employees could leave holes in the health law’s expanded coverage (Hancock, 3/26).

Marketplace: The Nurse Practitioner Will See You Now
It can be tough to see a primary care physician today. Just wait till next year when another 30 million patients or so get insurance under Obamacare. “We need all hands on deck. We need more family physicians. We need more primary care nurse practitioners, we need more physicians assistants…we need pharmacists. Everyone with a focus on the patient,” says Dr. Wanda Filer, a physician in York, Penn., and board member of the American Academy of Family Physicians. The nation is facing a shortage of primary care physicians. Estimates range from several thousand today to 52,000 by 2050. Annual spending on primary care is approximately $200 billion (Gorenstein, 3/25).

HealthyCal: Feminist Clinic Fights To Be Included In Health Care Reform
As millions of Californians are projected to gain coverage over the next several years, the independent clinics that have traditionally served the uninsured are in for some big changes. Soon, many more low-income patients are expected to have private insurance, following the roll out of the Affordable Care Act’s signature reforms in 2014. That’s putting some clinics, like those in the Women’s Health Specialists network, in a quandary. They want to be a part of the system that’s creating a boon of paying patients – but in a way that allows them to hold onto their guiding principles (Bartos, 3/26).

The Hill: Study: Health Law Has Imposed 111 Million Hours Of Paperwork
In its first three years, President Obama’s healthcare law has imposed more than $30 billion in costs and 111 million hours of paperwork burdens, according to a new study from the American Action Forum. The forum, a conservative think tank led by former Congressional Budget Office Director Douglas Holtz-Eakin, said the law will raise premiums and hurt small businesses (Baker, 3/25).

The Hill: GOP Lawmaker Wary Of Voter Registration Questions In Obama Health Law Forms
A Republican lawmaker is concerned about voter registration questions buried in a draft application to receive benefits under President Obama’s healthcare law. Rep. Charles Boustany (R-La.), who leads a House subcommittee on oversight, said the questions’ placement could lead some to believe that voter registration is tied to eligibility for the law’s insurance exchanges (Viebeck, 3/25).

Meanwhile, the New York Times looks at how employers are using worker’s health care premiums on incentives programs –

The New York Times: Companies Get Strict On Health Of Workers
Employers are increasingly trying to lower health care costs by using incentives to persuade workers to make better lifestyle choices, a new survey shows, but what remains less clear is whether a reward is better than a punishment — or whether the programs work at all (Thomas, 3/25).

Supreme Court To Hear Case About ‘Pay To Delay’ Deals Between Generic And Branded Drug Makers

U.S. Supreme Court building. (Photo credit: Wikipedia)

Topics: Supreme Court, Marketplace

Mar 25, 2013

Generic and the brand-name drug companies — usually fierce competitors — will be on the same side as they argue their case against the federal government. At issue is whether brand name drug manufacturers may pay generics to keep generic competitors off the market.

The New York Times: Justices To Look At Deals By Generic And Branded Drug Makers
Just about anyone who has gone to a pharmacy and paid for a prescription knows that a generic copy costs much less than the brand-name drug. The makers of those two versions of a drug, therefore, usually compete fiercely for market share and profits. But at the Supreme Court on Monday, the generic and the brand-name drug companies will be on the same side, arguing against the federal government in the legal equivalent of a heavyweight title bout (Wyatt, 3/24).

NPR: Supreme Court Hears ‘Pay To Delay’ Pharmaceutical Case
The U.S. Supreme Court hears arguments on Monday in a case worth billions of dollars to pharmaceutical companies and American consumers. The issue is whether brand name drug manufacturers may pay generic drug manufacturers to keep generics off the market. These payments — a form of settlement in patent litigation — began to blossom about a decade ago when the courts, for the first time, appeared to bless them (Totenberg, 3/25).

The Associated Press/Washington Post: High Court Weights Drug Companies‘ Payments To Delay Release Of Cheaper Generic Drugs
The Obama administration, backed by consumer groups and the American Medical Association, says these so-called “pay for delay” deals profit the drug companies but harm consumers by adding 3.5 billion annually to their drug bills (3/25).

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 Rules For ‘Obamacare’ Scrutinized By Insurers, Employers, States, Consumers

Topics: Health Reform, Insurance, Quality, States

Nov 21, 2012

Long-awaited draft regulations offer new guidance to insurers, states and employers.

USA Today: Administration Unveils Health Care Regulations
The Obama administration released new health care regulations Tuesday that preclude insurers from adjusting premiums based on pre-existing or chronic health conditions, tell states what benefits must be included in health exchange plans, and allow employers to reward employees who work to remain healthy (Kennedy, 11/20).

The Washington Post: Obama Administration Officials Propose Altered Rules For Health Insurers
The Obama administration proposed new rules Tuesday that would loosen some of the 2010 health-care law’s mandates on insurers while tightening others. Certain health plans, for instance, would be able to charge customers higher deductibles than originally allowed under the legislation. But all plans would be required to cover a larger selection of drugs than under an earlier approach outlined by the administration (Aizenman, 11/20).

The New York Times: Administration Defines Benefits That Must Be Offered Under The Health Law
The proposed rules, issued more than two and a half years after President Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign (Pear, 11/20).

Los Angeles Times: Administration Affirms Key Mandates Of Healthcare Law
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law’s requirements as the federal government races to implement the legislation by the end of next year. But the proposed rules issued Tuesday hew closely to the Affordable Care Act (Levey, 11/20).

Kaiser Health News: Administration Releases New Health Law Rules For Insurers, Employers
[A] quick review showed that no one group won everything it wanted. For example, insurers did not succeed in getting the government to phase-in a requirement that limits their ability to charge older applicants more than younger ones. And consumer groups, which wanted specific details on the benefits required in 10 broad categories, instead saw continued discretion given to state regulators to pick “benchmark” plans and benefits (Appleby, Hancock and Carey, 11/20).

The Wall Street Journal: States Get A Say In Health Law
The federal government also expanded requirements for prescription-drug coverage from previous proposals, but it left states with different options to choose from, as well as responsibility for enforcement. Some employer groups praised the rules for keeping new plan benefits in line with what is already offered by small businesses. But the insurance industry said the rules didn’t go far enough to keep insurance costs down, particular for younger consumers (Radnofsky, 11/20).

Modern Healthcare: HHS Releases Proposed ACA Insurance Regulations
Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage (Zigmond, 11/20).

NPR: Administration Lays Down Rules For Future Health Insurance
[T]he administration is laying out rules to govern the use of employer-provided “wellness programs.” These popular programs encourage employees to meet certain health goals, such as losing weight, quitting smoking, or lowering cholesterol. The rules spell out that programs must not be “overly burdensome” and must provide a “reasonable alternative means of qualifying for the reward” for individuals whose medical conditions “make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard” (Rovner, 11/20).

Kaiser Health News: Obama Administration Gives Smokers A Way Out Of Higher Insurance Premiums
[The rules] effectively nullified a provision of the federal health law that would have allowed insurers in the small group market to charge smokers up to 50 percent more than nonsmokers. Under the proposed regulation, employees who use tobacco can avoid paying those higher premiums if they participate in a program to quit (Galewitz, 11/20).

The Associated Press: HHS Details Overhaul Rules And Required Benefits
Having the federal government set minimum standards for what health insurance must cover is a departure from normal practice. Usually, insurance companies, their state regulators and employers play that role. But the Affordable Care Act requires that Washington establish a baseline for minimum coverage in areas that include inpatient and outpatient care, emergency services, maternity and childhood care, prescription drugs, preventive screenings and lab work  (Murphy, 11/20).

The Hill: HHS Releases Health Law Rules Requiring Pre-Existing Conditions Coverage
The regulations still leave key questions unanswered, including the structure of a federally run insurance exchange in the roughly 30 states that won’t set up their own. HHS officials said more information on the federal exchange will be coming soon. … While the new rules don’t answer some questions for states, they do provide much-needed specifics for insurance companies that must prepare for new mandates set to take effect in 2014 (Baker, 11/20).

Medpage Today: HHS Proposes Rules On Key Parts Of ACA
The rules also mandate that insurers maintain separate statewide risk pools for the individual and small-employer markets, unless a state wants to combine the two. Premiums and rate changes would be based on the health risk of the entire pool (Pittman, 11/20).

McClatchy: Insurers’ Duties Under Health Care Law Taking Shape
The rule’s final provision insures that young adults and people who can’t afford insurance will have access to catastrophic health coverage in the individual insurance market. Many of today’s proposed rules will help “ensure that consumers are protected from some of the worst insurance-industry practices,” [Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services] said (Pugh, 11/20).

Politico Pro: Essential Benefits Rule: No Surprises, Some Gaps
The health care industry waited 11 months for the Obama administration’s follow-up act to its essential health benefits bulletin. For many, Tuesday’s EHB proposed rule felt like a repeat performance. Credit the administration’s bulletin last year for spelling out what the proposed rule itself would look like. States will get to set benefits from a choice of certain plans, insurers will have some flexibility and HHS will be there watching over it all in some capacity (Millman, 11/20).

Politico Pro: HHS To States: Costs Of New Rules ‘Minor’
In a section of its proposed rule titled “Costs to States,” HHS estimates that although states “may need additional resources” to ensure that health plans in their exchange meet minimum coverage requirements, “these costs will be relatively minor.” In the rule, HHS also notes that federal law prohibits Washington from imposing an “unfunded mandate” on states in excess of $139 million in a given year (Cheney, 11/20).

CQ HealthBeat: Lots Of Regs, But What About The Federal Exchange?
Missing from Tuesday’s massive release of hundreds of pages of proposed rules filling in the details of the sweeping redesign of the insurance market, set in motion 32 months ago by passage of the health care law, were details on an entity looming ever larger in delivering the fruits of that legislation: the federally facilitated exchange. By the end of the day, however, it appeared that officials had made considerable progress on the regulatory front, with insurers and states now having to scramble to conform to the new mandates (Reichard, 11/2).

CQ HealthBeat: Obama Administration Rolls Out Proposed Rule On Insurance Market Changes
The long-anticipated next steps in a complicated regulatory dance involving the federal government, states and health insurers were laid out by the Obama administration on Tuesday, and federal officials acknowledged that there is much more work ahead (Norman, 11/20)

CQ HealthBeat: Essential Health Benefits Proposal Gives States Flexibility, Expands Prescription Drug Requirements
The proposed rule also included standards on how the actuarial value of plans would be determined. Separately, the Centers for Medicare and Medicaid Services issued a guidance to states on the types of benefits that Medicaid programs must include if they expand coverage under the health care law. Under the essential benefits proposed rule, health plans in the individual and small-group markets — both in and outside of the new exchanges — would have to provide coverage in the 10 categories of services that the health care law requires (Adams, 11/20)

CQ HealthBeat: Proposed Rule Sets Standards For Wellness Programs
[T]he maximum permissible rewards would increase in 2014 from the current ceiling of 20 percent of the cost of health coverage to 30 percent. However, the proposed regulation says that when it comes to programs designed to prevent or decrease tobacco use, the maximum reward could be increased to as much as 50 percent (Reichard, 11/20).

Reuters: U.S. Releases New Health Insurance Reform Rules
The proposed measures were likely to come under fire from healthcare reform opponents including a growing number of Republican governors who have rejected the provisions calling on states to operate their own healthcare exchanges beginning January 1, 2014. States have until December 14, under a newly extended deadline, to tell the Department of Health and Human Services whether they intend to pursue their own healthcare exchanges (Morgan, 11/20).

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