State Highlights: States Seek Health Care Autonomy; L.A. Nursing Home Audit; Promoting Overdose-Reversal Drug

McClatchy: 9 States Sign Compact To Run Health Care Without Congress

Kansas, Missouri and seven other states have signed on to a movement that would wrest regulation of most of the nation’s health care insurance systems from the federal government. Those state legislatures want to be part of a proposed interstate Health Care Compact. The compact would let participating states use federal funds — in the form of block grants — to design and operate their own Medicare, Medicaid and other health care programs, except the military’s (Stafford, 8/28).

Earlier KHN coverage: Some States Seeking Health Care Compact (Gugliotta, 9/18/11).

Los Angeles Times: Audit Finds Some L.A. County Nursing Home Cases Prematurely Closed

Los Angeles County auditors have found problems with the way the public health department investigates nursing home complaints involving issues of safety, neglect and other problems that could jeopardize the well-being of residents. After reviewing a sampling of cases from 2012 to this year, they found that some were “inappropriately” closed without a full investigation, according to an audit report released this week. In others — including five that involved patient deaths — inspectors wrote up problems or issued citations, but the findings were downgraded by department supervisors, sometimes without discussing the changes with the issuing inspector (Sewell and Brown, 8/28).

California Healthline: Statewide Rural Health Association Returns

The numerous far-flung health care providers and community organizations that make up California’s rural health landscape may soon once again have a single, integrated association working to bring a cohesive voice to all. After closing last year with insufficient funding and soaring debt, the California State Rural Health Association is slowly becoming active again. A website was launched this week, a 13-member board has been established and the group is planning a conference by the end of the year (Mack, 8/28).

PBS NewsHour: On The Front Lines Of Care For Undocumented Children Who Cross The Border

The U.S. Border Patrol has apprehended nearly 63,000 unaccompanied children at the southwest border just this year.  Many of them are then relocated to various cities across the country, creating a growing need for health care and education (8/28).

Kaiser Health News: Calif. Bill Would Protect Estates Of Many Who Received Medicaid

A bill passed by the California legislature this week is putting Gov. Jerry Brown in a delicate position: Sign the measure and support consumer demands for a change in the state’s policy on recovering assets from Medicaid enrollees or keep the current system that generates about $30 million used to provide Medicaid benefits to more residents (Bartolone, 8/28).

Kaiser Health News: Capsules: In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday

A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers. The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions” (Feibel, 8/28).

The Wall Street Journal: States Expand Access To Overdose-Reversal Drug

Faced with an unrelenting epidemic of heroin and pain-pill deaths, many states are pushing to make more widely available a drug called naloxone that can reverse overdoses from such opioid drugs within minutes. … There are now 24 states, along with the District of Columbia, that have passed laws expanding access to naloxone, 17 of them in the last two years, said Corey Davis, deputy director of the Network for Public Health Law’s Southeastern region, who tracks such policies. The measures vary, but common provisions include allowing doctors to prescribe naloxone to a drug user’s friends and family members, and removing legal liability for prescribers and those who administer the medication (Campo-Flores and Elinson, 8/28).

The Washington Post: Justice Officials Call For Release Of Monitoring Of St. Elizabeths

The Justice Department said Thursday that St. Elizabeths Hospital has made “significant improvements” in the care of its patients and asked a federal judge to discontinue the agency’s monitoring of the facility (Alexander, 8/28).

Miami Herald: Low-Income Patients Face Hurdles To Care At Public Hospital In Miami

Demanding onerous paperwork from low-income applicants is just one way that Jackson has barred eligible Miami-Dade residents from accessing the charity care program, according to administrative complaints filed this week with the Internal Revenue Service and the U.S. Department of Health and Human Services. The complaints lodged by Florida Legal Services and the National Health Law Program, nonprofit groups that provide civil legal help to the indigent, allege that Jackson fails to meet new requirements for nonprofit hospitals under the Affordable Care Act and other laws (Chang, 8/28).

Georgia Health News: State Health Agency Outlines Spending Increases

A state health agency is budgeting an extra $24 million this fiscal year, and a similar amount next year, to pay for costly hepatitis C drugs in Georgia’s Medicaid program. The state is also expected to pay $14.1 million more this year, and $37.9 million in fiscal 2016, for lengthening the time between eligibility reviews for Medicaid and PeachCare beneficiaries, as required by the Affordable Care Act (Miller, 8/28).

Boston Globe: Boston EMS Workers OK Pay Raise

Workers in Boston’s Emergency Medical Services will receive a pay raise of nearly 15 percent over six years under a newly settled contract with Mayor Martin J. Walsh. The deal will cover roughly 315 paramedics, emergency medical technicians, and their supervisors. It includes 14 percent in raises spread over six years in addition to a 0.75 percent increase in weekly compensation for hazardous duty pay in July 2016 (Ryan, 8/29).

State Highlights: States Seek Health Care Autonomy; L.A. Nursing Home Audit; Promoting Overdose-Reversal Drug

Research Roundup: Benefits Of Hip Surgery; Preventing Surgical Infections

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Clinical Orthopaedics And Related Research: Surgery For Hip Fracture Yields Societal Benefits That Exceed The Direct Medical Costs

Surgical treatment of hip fractures can achieve better survival and functional outcomes than nonoperative treatment, but less is known about its economic benefits. … We estimated the effects of surgical treatment for displaced hip fractures through a Markov cohort analysis of patients 65 years and older. … Estimated average lifetime societal benefits per patient exceeded the direct medical costs of hip fracture surgery by $65,000 to $68,000 for displaced hip fractures. With the exception of the assumption of nursing home use, the sensitivity analyses show that surgery produces positive net societal savings (Gu, Koenig, Mather and Tongue, 8/5).

JAMA Surgery: The Preventive Surgical Site Infection Bundle In Colorectal Surgery

Surgical site infections (SSIs) are associated with increased morbidity, length of hospitalization, readmission rates, and health care costs. They represent a particularly important problem in colorectal surgery, for which SSI rates are disproportionately high, ranging from 15% to 30%. … To a large degree, the focus [of reducing SSIs] has been on improving adherence to evidence-based practices … The preventive SSI [systemic, evidence-based measures called] the bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs (Keenan et al., 8/27).

Medicare and Medicaid Research Review: Financial And Quality Impacts Of The Medicare Physician Group Practice Demonstration

[The health law's Accountable Care Organization program] was built directly on its predecessor, the Medicare Physician Group Practice (PGP) demonstration …. This article presents the results of the comprehensive CMS-funded evaluation of the PGP demonstration … The overall impact … was a savings of $171 per assigned beneficiary person year during the demonstration performance period …. This represents a savings of 2.0 percent of assigned beneficiary expenditures. CMS paid performance bonuses to the participating PGPs that averaged $102 per assigned beneficiary person year across the five demonstration years (Pope et al., 8/28).

Medical Care: The Intended And Unintended Consequences Of Quality Improvement Interventions For Small Practices In A Community-based Electronic Health Record Implementation Project

Despite the rapid rise in the implementation of electronic health records (EHR), commensurate improvements in health care quality have not been consistently observed. …  The study included 143 practices that implemented EHRs …. 71 practices were randomized to receive financial incentives and quality feedback and 72 were randomized to feedback alone. … Technical assistance and financial incentives—alongside EHR implementation—can improve quality of care. Financial incentives for quality may not result in similar improvements for incentivized and unincentivized measures (Ryan et al., 8/27).

Infection Control and Hospital Epidemiology/Rand Corp.: The Association Of State Legal Mandates For Data Submission of Central Line–Associated Bloodstream Infections In Neonatal Intensive Care Units With Process And Outcomes Measures

[This cross sectional study was designed] to determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures. … Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). … Mandates were predictors of ≥95% compliance with all practices (Zachariah et al., 8/22).

Here is a selection of news coverage of other recent research:

MedPage Today: Surgery No Help For Mild Knee OA

Arthroscopic surgery for degenerative meniscal tears in patients with mild knee osteoarthritis had no benefit for function or pain, a meta-analysis determined. In randomized trials that included 805 patients, the standardized mean difference for function at 6 months was 0.25, which was converted to a Knee Injury and Osteoarthritis Outcome Score of 5.6. That did not reach the minimally important difference of 10 (Walsh, 8/27).

Fox News: Teens With Depression Benefit From ‘Collaborative Care’

For teenagers with depression, finding and sticking with an effective treatment strategy can be an uphill battle. Their families often struggle to find a professional who can treat depression in adolescents, is accepting new patients and is covered by their insurance. … But an idea called “collaborative care” — which increases communication between families and doctors — may help bridge that gap, said [Dr. Laura Richardson, a professor of pediatrics at Seattle Children's Hospital and the University of Washington in Seattle], who co-authored a new study detailing the findings, published today (Aug. 26) in the journal JAMA (Geggel, 8/26).

MinnPost:  Study Links Early-To-Midlife Obesity To Increased Risk Of Dementia

People who are obese in their early to midlife adult years have an increased risk of developing dementia, and the risk is especially high for people who are obese in their 30s, according to a study published [last] week. The study also found that people who become obese late in life have a decreased risk of developing dementia, particularly Alzheimer’s disease (Perry, 8/22).

Reuters: More Parents Think Their Overweight Child Is ‘About Right’

Between 1988 and 2010, the number of parents who could correctly identify their children as overweight or obese went down, according to a new study. … In the 1988 to 1994 data set, 78 percent of parents of an overweight boy and 61 percent of parents of an overweight girl, identified the child as “about the right weight.” That number increased to 83 percent for boys and 78 percent for girls in the 2005 to 2010 period (Doyle, 8/26).

Reuters: Medicaid Payouts For Office Visits May Influence Cancer Screening: Study

In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study. “States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others,” said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International (Doyle, 8/26).

Medscape: Futile Treatment Delays Care For Others Waiting For ICU Beds

Patients in intensive care units (ICU) receiving futile treatment delayed or prevented ICU treatment for others in need of intensive care, a study published in the September issue of Critical Care Medicine has revealed (Laidman, 8/28).

Research Roundup: Benefits Of Hip Surgery; Preventing Surgical Infections

Farm Bureau Financial Services Supports Life Insurance Awareness Month

In recognition of September as Life Insurance Awareness Month, Farm Bureau Financial Services is focused on helping consumers better understand their life insurance options and secure the coverage they need for long-term financial stability.

According to the 2014 Life Studies report by LIMRA, a financial industry research company, less than one quarter of middle-market consumers are comfortable with their knowledge of financial-services including life insurance.¹

“Life is complicated, but buying life insurance shouldn’t be,” says James P. Brannen, Farm Bureau Financial Services’ Chief Executive Officer. “The best first step is contacting a licensed agent and leveraging his or her industry and product knowledge and experience to help guide you.”

There are many misperceptions about life insurance and the extent to which it can make a difference for individuals, families and businesses. Farm Bureau Financial Services is celebrating Life Insurance Awareness Month by providing the facts that bust some of the most common myths and make life insurance easier to understand for today’s time constrained consumers.

Myth #1: Life insurance is too expensive.
BUSTED: Up to 85% of Americans overestimate the actual cost of life insurance¹ and may not realize there are many options from which to choose. A $250,000 15-year level term policy for a healthy 30-year old costs just $250 a year.²

Myth #2: Only families with young children need it.
BUSTED: Life insurance can be the foundation of financial security for your family or business. Proceeds from a life insurance policy can help cover outstanding debt like a mortgage and credit cards or fund financial objectives including retirement.

Myth #3: Children don’t need life insurance.
BUSTED: Buying life insurance for children guarantees their insurability into the future and can be an affordable way to purchase additional coverage as they grow into adulthood. It’s a great way for parents and grandparents to give the young people in their lives the gift of financial security.

Myth #4: I’m young and healthy and don’t need it right now.
BUSTED: Buying life insurance when you’re young and healthy is best! You can benefit from lower rates and also ensure that you have the coverage – and financial security – you need for the long haul.

Myth #5: The life insurance I purchase at work is enough.
BUSTED: The general rule of thumb is that 5-8 times your salary is needed to replace your income if you have dependents (some experts recommend 10-12 times).³ That said, employer benefits, are often just 1-2 times the employee’s annual salary and typically end when your employment ends.

Myth #6: Term insurance can’t be converted to permanent.
BUSTED: Many term policies are renewable and convertible to a permanent policy. After holding your term policy for a set period of time, it may be possible to convert it with a special credit for doing so. The credit helps offset any increase in premium and the usual health assessment may be waived.

Myth #7: Stay-at-home parents don’t need insurance.
BUSTED: Don’t underestimate the importance of a stay-at-home parent; the value he or she adds to the financial stability of the family is substantial. If the person responsible for child care and general household management is no longer in the picture, money will be needed to cover all of those bases so you concentrate on keeping the family grounded and focused on more important things.

 

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Farm Bureau Financial Services Supports Life Insurance Awareness Month

Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County

This KHN story can be republished for free. (details)

Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week.

The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required.

“The quality and integrity of investigations is impaired when surveyors’ conclusions are changed without their knowledge,” according to the audit.

The audit was the latest of several reviews showing problems with how the county Department of Public Health oversees residents’ health and safety at about 385 nursing homes. The county, the most populous in the state, contracts with the state and the federal government to inspect the facilities and to investigate complaints from residents, family members and staff.

Earlier this summer, the California Department of Public Health determined that the county wasn’t following state policies on inspections, leading to incomplete and delayed investigations. The county issued an audit in April that documented a lengthy backlog of investigations and concluded that a lack of central oversight contributed to the delay. At the time, about 945 cases, had been open for more than two years.

The scrutiny of the department came after a Kaiser Health News investigation found the county was instructing inspectors to close cases without fully investigating them.

The most recent audit was based on a review of a small sample of cases — about 20 of the more than 3,044 that were open in March 2014 and 30 of the 1,124 cases that had been closed between July 2012 and April 2014. The audit found that five of the 30 cases were closed inappropriately without “conducting or completing the investigations.”

In addition, supervisors downgraded inspectors’ findings in 12 of the 30 closed cases, meaning that the nursing home got a less serious citation or a smaller fine. In most of those cases, there was no documentation for the reason.

The audit didn’t give many specifics on the problems found at the nursing homes but noted that five cases involved deaths. In one, an inspector found the death could have been prevented. Others involved nursing homes not complying with doctors’ orders or checking whether a patient had negative reaction to medications.

The auditor-controller recommended that the department’s inspectors, managers and doctors improve documentation and communication to “ensure the quality and integrity of their investigations.”

“Without adequate documentation, it is very difficult to ensure that deficiencies and citations are handled in a consistent, thorough and equitable manner,” the audit read.

The audit also found that the public health department failed to reassign a case when an inspector retired.

The county Department of Public Health responded to the audit with a letter saying that it agreed that the documentation was “sometimes lacking” and that improvements were necessary. Officials also said that they had already made several changes, including putting new people in charge of the division responsible for inspections and improving the tracking and prioritization of complaints.

But, as in the past, county public health officials also wrote that the department is underfunded and “severely understaffed.”

The county public health department is responsible for reviewing one-third of the state’s facilities but only receives 15 percent of the funding, according to the response. If the state doesn’t provide “sufficient resources” for the program, county public health officials wrote, the department may not be able to continue its contract to oversee the nursing homes.

The April audit found, however, that the county did not spend  all the money at its disposal — more than $2 million of the roughly $27 million in state funds in each of the last two fiscal years.

agorman@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County

In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday

This story is part of a partnership that includes Houston Public Media, NPR and Kaiser Health News. It can be republished for free. (details)

A federal judge in Austin, Texas, will issue a decision in the next few days about whether clinics that perform abortion in the state must become outpatient surgery centers.

The Texas law is part of a national trend, in which state legislatures seek to regulate doctors and their offices instead of women seeking abortions.

The laws are collectively known as TRAP laws for “Targeted Regulation of Abortion Providers.”

“They do just that,” said Rochelle Tafolla, a spokeswoman for Planned Parenthood Gulf Coast in Houston. “They ‘trap’ providers into very tight, medically unnecessary restrictions.”

The Texas law that passed in 2013 requires doctors who perform abortions to first obtain admitting privileges at a hospital within 30 miles. Many clinics, especially rural ones, found it difficult to comply with that rule by the November deadline. The number of Texas clinics that perform abortions has dropped from 41 to 20.

Now the law’s final rule requires doctors’ offices to meet the standards of ambulatory surgical centers, including an array of rules that govern hallway widths, the presence of showers and lockers, heating and cooling specifications. The rules also require conformance with other construction codes that can cost millions of dollars.

The rule goes into effect on Labor Day, unless federal Judge Lee Yeakel of the Western district in Austin issues an injunction to stop it. He is expected to issue a decision by Friday. If he stops the surgery center rule, Texas Attorney General Greg Abbott could quickly appeal to reinstate it.

One Houston doctor, who asked not to be identified because he fears being targeted by abortion protestors, says he will have to stop providing abortions if the final rule goes into effect.

Abortions are a small but important part of his practice: he delivers babies, gives well-women exams, performs gynecological surgery, and even offers tummy tucks.

“Abortion is part of what we’re trained to do as obstetricians-gynecologists. That’s the medical point of it,” he said. “When the politicians get into the mix, it becomes a completely different story.”

Planned Parenthood’s Tafolla said only eight clinics in Texas would meet the newest requirement, and they’re all in the major cities: two are in Houston (including Planned Parenthood Gulf Cost), two in San Antonio, two in Dallas, and one each in Fort Worth and Austin.

Women in East Texas, the Rio Grande Valley, and west of San Antonio would have to drive hundreds of miles for multiple visits, because a 2011 law put in place a 24-hour waiting period following a mandatory ultrasound, plus follow-up visits for women using the abortion pill.

“So it isn’t as simple as saying ‘Oh, there’s that one place in Houston, there’s that one place in Austin or Dallas.’ There simply isn’t enough capacity, there aren’t enough physicians,” Tafolla said.

The Guttmacher Institute, a research organization that studies reproductive rights, says TRAP laws really took off in 2010. Twenty-six states now have them.

Groups that oppose abortions say the new laws make the practice safer and therefore protect women.

Melissa Conway, spokeswoman for Houston-based Texas Right to Life, said if the number of abortions and the number of clinics drops in Texas, that’s something she’s glad about, but it wasn’t the intent of the law. She said the regulations are about making abortion safer, so abortion providers should invest in the required upgrades.

“The choice to have fewer clinics comes down to the abortion providers,” Conway said. “If they choose to have disregard for the health of women, and the safety standards, which are practical, common-sense and best standards, that’s their choice. But that points highly to the fact that they care more about their bottom line than they do their patient care.”

The American College of Obstetricians and Gynecologists’ position is that “what those laws do is they limit women’s access and expose women to increased risk by not enabling them to have a procedure near where they live,” said ACOG CEO Dr. Hal Lawrence.

Lawrence said low-income women can’t afford to travel, and may try to self-induce an abortion or carry an unwanted pregnancy to term. He added that other outpatient procedures, such as colonoscopy, carry a fatality risk that is 40 times greater than first-trimester abortion, yet colonoscopy does not receive the same unwarranted scrutiny from lawmakers.

Tafolla said legislatures are passing TRAP laws because laws targeting demand for abortion were ineffectual. Other “demand-focused” laws include mandatory ultrasounds, a requirement that the patient listen to the fetal heartbeat and waiting periods before abortions.

Legislators who oppose abortions “thought they could reduce abortion by focusing on women and shaming them,” she said. “Now they’re focusing on the providers and doing everything they can to shut them down.”

In Texas, New Doctor-Restrictive Abortion Law Could Kick In Monday

Urgent Care Centers Opening For People With Mental lllness

LOS ANGELES, Calif. — Hoping to keep more people with mental illness out of jails and emergency rooms, county health officials opened a mental health urgent care center Wednesday in South Los Angeles.

The goal of The Martin Luther King, Jr. Mental Health Urgent Care Center is to stabilize and treat people in immediate crisis while connecting them to ongoing care. Run by Exodus Recovery, it will be open 24 hours a day, seven days a week and can serve up to 16 adults and six adolescents. During their stay of up to one day, patients will undergo a psychiatric evaluation, receive on-the-spot care such as counseling and medication and be referred for longer-term treatment.

The center can take people in severe crisis and expects many will be brought in by police and paramedics, said Connie Dinh, vice president of nursing services for Exodus. But she said it cannot accept people who are incoherent, extremely aggressive or need emergency medical attention. They will still need to be treated at hospitals or inpatient psychiatric facilities.

Staff will be able to place people on 72-hour psychiatric holds if they are a danger to themselves or others.

Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned.

L.A. County’s mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are “more humane” and a smarter approach.

Hospitals statewide saw a 47 percent increase in encounters with patients with mental health needs between 2006 and 2011, compared to a 14 percent increase in all patients, according to the California Hospital Association. Mental health urgent care centers can help relieve the burden on emergency departments, get patients the care they need and reduce health care costs, said Sheree Kruckenberg, vice president of behavioral health at the association.

“As we are trying to bend the cost curve, to me this is a slam dunk,” she said.

Ron Honberg, policy director for the National Alliance on Mental Illness, said that the centers are a great place to respond to crises, but the centers are “just one piece in a more complicated puzzle” and people need to be linked to community services.

The Martin Luther King Jr. center is a two-story building near the campus of a community hospital expected to open next year. The first floor has reclining chairs surrounding a nursing station, a kitchen, seclusion rooms and offices for mental health providers.

Upstairs, there are rooms for family meetings, counseling and support groups on topics including  anger management and independent living skills.  There will also be substance abuse counseling and a social services worker who can help enroll people in cash assistance and other programs.

The center will also serve as a medical clinic. Patients ideally will see the clinic as their “medical home” and return often, said Dr. Mark Ghaly, director of community programs with the county Department of Health Services.

Ghaly said it makes sense to have a primary care clinic at the urgent care center.  “People with mental illness don’t like cookie cutter clinics,” he said. “This is familiar.”

Jo Helen Graham, whose 36-year-old son has schizophrenia and has spent time in hospitals and jails, said she believes he and others like him will benefit from the center.  “We need some place our mentally ill children can go,” she said. “We need ongoing supports.”

Urgent Care Centers Opening For People With Mental lllness

CBO: Smaller Deficits Projected As Medicare And Medicaid Spending Declines Slightly

In the Congressional Budget Office’s latest forecast, reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion.

<a href="http://online.wsj.com/articles/cbo-offers-mixed-forecast-of-u-s-budget-economy-over-next-decade-1409150020?KEYWORDS=Medicare“>The Wall Street Journal: Deficit Forecast Trimmed As Rates Stay Low

Smaller deficits are the result of a variety of factors, including higher tax revenue and economic growth, budget cuts and new limits on government spending. The agency forecast the government would spend slightly less on Medicare and Medicaid over the next decade than it estimated earlier this year. Still, the changes were relatively minor—less than 1% of total spending on the programs. CBO expects the deficit to shrink for several years before starting a steady expansion in 2018, driven by the aging U.S. population, higher health-care costs and increasing subsidies for certain federal programs (Paletta, 8/27).

<a href="http://capsules.kaiserhealthnews.org/index.php/2014/08/cbo-projects-lower-Medicare-and-medicaid-costs/” target=”_blank”>Kaiser Health News: Capsules: CBO Projects Lower Medicare and Medicaid Costs

Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday. Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast (Carey, 8/27). 

The Associated Press: US Economy Forecast To Grow By 1.5 Percent In 2014

The Congressional Budget Office on Wednesday forecast that the U.S. economy will grow by just 1.5 percent in 2014, undermined by a poor performance during the first three months of the year. The new assessment was considerably more pessimistic than the Obama administration’s, which predicted last month that the economy would expand by 2.6 percent this year even though it contracted by an annual rate of 2.1 percent in the first quarter (Taylor, 8/27).

CBO: Smaller Deficits Projected As Medicare And Medicaid Spending Declines Slightly

Viewpoints: Medicare No Longer 'Busting' The Budget; A 'Nightmare' Trying To Get Coverage In D.C.

<a href="http://www.nytimes.com/2014/08/28/upshot/Medicare-not-such-a-budget-buster-anymore.html?emc=edit_tnt_20140827&nlid=58462464&tntemail0=y&_r=0&abt=0002&abg=0″ target=”_blank”>The New York Times‘ The Upshot: Medicare: Not Such A Budget-Buster Anymore

You’re looking at the biggest story involving the federal budget and a crucial one for the future of the American economy. Every year for the last six years in a row, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a report from the budget office on Wednesday morning. The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion (Margo Sanger-Katz and Kevin Quely, 8/27). 

The Washington Post‘s Plum Line: Yes, Obamacare Is Cutting The Deficit

Today the Congressional Budget Office released its latest economic and fiscal projections, and guess what: The news is pretty good. In fact, all the “deficit hawks” out there who are deeply concerned about too much borrowing and the terrible choices our grandchildren will confront might want to write a letter of thanks to one Barack Hussein Obama. To start things off, the CBO says the deficit this year will be $506 billion, or 2.9 percent of GDP. In 2013 it was $680 billion, so that’s a pretty steep drop. And in terms of GDP, not only is that slightly lower than the average deficit of the last 40 years (3.1 percent), it’s also a 70 percent decline from Obama’s first year in office, where because of the Great Recession, which brought both the need for more spending and a plunge in tax revenues, the deficit peaked at 9.8 percent of GDP (Paul Waldman, 8/27). 

The Washington Post‘s Plum Line: On Obamacare, Democrats Should Attack, Not Defend

Yesterday, state treasurer Doug Ducey won the GOP nomination for governor to replace Jan Brewer in Arizona. Brewer was one of eight GOP governors who accepted the expansion of Medicaid, something Ducey had opposed. Ducey’s comments on the subject are vague … when asked whether he’d repeal the expansion, he bobs and weaves. And it isn’t hard to understand why. Looking at this race in combination with other close races, you see that the politics of health care have shifted profoundly in recent months. As Democrats are stroking their chins wondering whether they can turn the Affordable Care Act into a winning issue this fall, and if so how to do it, the answer is simple: Don’t defend, attack (Paul Waldman, 8/27).

The Washington Post: Even A Harvard-Educated Lawyer Has ‘Nightmare’ With D.C. Health Insurance Site

Diana Daniels’s experience with the District’s health insurance Web site is the sort that gives government bureaucracy — and Obamacare — a bad reputation. The Northwest Washington mom filed her online application for medical coverage for her two teenage daughters on June 4. The process supposedly requires three weeks at most. No coverage materialized for nearly three months, despite Daniels’s numerous calls to D.C. Health Link trying to sort things out (Robert McCartney, 8/27). 

The Washington Post: Early Tax Planning May Be Needed Because Of The Affordable Care Act

Having gone through tax season not that long ago, you may not want to face any issues related to your tax situation until next year. But some of you may need to do some tax planning now nonetheless. It has to do with the Affordable Care Act (Michelle Singletary, 8/26).

The Wall Street Journal: An $8.3 Billion Rebuke To The FDA

Amid this summer’s M&A fever, Roche’s agreement Monday to buy the San Francisco biotech InterMune deserves special notice. The tie-up is an $8.3 billion guided missile into the fortified bunker that is the Food and Drug Administration. InterMune has never turned a profit in 16 years of existence and other than its clinical expertise the company holds a single asset: an idea for treating a lethal lung disorder called idiopathic pulmonary fibrosis with no known cause, cure or approved therapy—at least in the U.S. An InterMune drug called pirfenidone that slows the progression of irreversible lung scarring is on the market in Europe, Japan, Canada and even China (8/27). 

The New England Journal Of Medicine: A VA Exit Strategy

The VHA’s [Veterans Health Administration] current crisis provides an opportunity to dramatically rethink the role that the agency plays in improving access to high-quality, high-value care for its service population. To simply go on doing more of the same is to fail to recognize the challenge that the VHA’s cost and population structure pose in the longer run. Just as they plan for new roles for the federal government as part of an exit strategy from a war that is winding down, politicians with longer-term views might envision a new way for the VHA to work with other federal departments and the private sector to reduce its overall and per capita costs, shed costly and unproductive assets, save taxpayers money, reduce veterans’ health care expenditures, and improve veterans’ outcomes (Dr. William B. Weeks and David Auerbach, 8/28).

The New England Journal Of Medicine: Updating Cost-Effectiveness — The Curious Resilience Of The $50,000-per-QALY Threshold

For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. … Invoking thresholds, however, means acknowledging limits  … It also suggests that more of our spending should focus on underutilized interventions with ratios below the threshold; substituting more cost-effective interventions for less cost-effective ones could improve health outcomes and save money (Peter J. Neumann, Joshua T. Cohen and Milton C. Weinstein, 8/28).

JAMA: Legalizing Medical Marijuana May Reduce Opioid Deaths

Opioid-overdose deaths increased in states across the country between 1999 and 2010, but states that legalized medical marijuana saw less-steep increases than those without, according to a study published in JAMA Internal Medicine this week. Growing use of prescription opioids over the past 2 decades to treat chronic pain has helped drive increasing rates of opioid overdoses. … Marcus A. Bachhuber, MD, a Robert Wood Johnson Foundation Clinical Scholar at the Philadelphia Veterans Affairs Medical Center, and his colleagues analyzed opioid overdose rates in states with or without legalized medical marijuana (Bridget Kuehn, 8/26). 

JAMA: What Near-Death Experience Can Tell Us About Medical Care

In 2005, a survey was conducted examining how aggressively physicians treat patients near the end of life. Some 1500 primary care physicians and cardiologists were presented a scenario describing an 85-year-old man with severe congestive heart failure. … Recently, the responses to this survey were analyzed by me, Ariel Stern, PhD; Jonathan Skinner, PhD; David Wennberg, MD, MPH. Although the data are nearly a decade old, there is no reason to think that answers today would be any different. Our analysis of these responses reveals the troubled state of American health care—as well as the possibilities … No one is trying to do the wrong thing, but the consequences of unstandardized and often excessive care is wasted money and unnecessary pain. Establishing the right systems, realigning payments, and pushing for the right care can accomplish far more than many think is possible (David Cutler, 8/27).

Viewpoints: Medicare No Longer 'Busting' The Budget; A 'Nightmare' Trying To Get Coverage In D.C.

First Edition: August 28, 2014

Today’s headlines include reports about the Congressional Budget Office’s latest projections regarding Medicare and Medicaid spending.

Kaiser Health News: Health Law Spurs Focus On Faster Drug Development

Kaiser Health News staff writer Daniela Hernandez reports: “Imagine if scientists could recreate you—or at least part of you—on a chip. That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and hefty health care costs that accompany arriving at the right treatment. Right now, at the University of California, Berkeley, researchers in bioengineer Kevin Healy’s lab are working to make that happen. Funded under a provision of the health law, they’re trying to grow human organ tissue, like heart and liver, on tiny chips” (Hernandez, 8/28). Read the story, which also ran in Wired.

Kaiser Health News: Capsules: CBO Projects Lower Medicare and Medicaid Costs; Urgent Care Centers Opening For People With Mental lllness

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on the <a href="http://capsules.kaiserhealthnews.org/index.php/2014/08/cbo-projects-lower-Medicare-and-medicaid-costs/”>CBO’s latest projections for Medicare and Medicaid: “Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday. Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast” (Carey, 8/27). 

Also on Capsules, Anna Gorman reports on how urgent care centers are opening to treat people with mental illness: “Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned. L.A. County’s mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are “more humane” and a smarter approach” (Gorman, 8/28). Check out what else is on the blog.

The Associated Press: 3 Ways Insurers Can Discourage Sick From Enrolling

Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling. Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul (8/27).

The Washington Post: Health-Care Premiums Fall In Arkansas

Arkansas Gov. Mike Beebe’s office said Wednesday that most health-care customers will pay less for their plans next year, a relief to state residents — and to the Democratic senator trying to hold onto his seat in one of the country’s most expensive elections. Health-care premiums will decline about 2 percent next year, Beebe (D) wrote in a statement Wednesday. Beebe helped lead an at-times reluctant Republican legislature to expand Medicaid. In his statement, he said insurance costs nationwide “historically rise by six-to-ten percent annually.” The state used federal funds to launch a private Medicaid option that has been described as a potential model for conservative-leaning states (Ferris, 8/27).

The Washington Post’s Wonkblog: The Obscure Part Of Obamacare That Takes On Executive Pay

We all know Obamacare is a pretty big law, with plenty of obscure provisions that don’t get much attention. For one, the law targets big executive pay packages at health insurance companies — and based on data released Wednesday, the provision is already going a long way. Companies have long been able to deduct salaries to top executives from their federal tax bills, although since the early 1990s — in an effort to reduce excessive pay — the government has limited the amount to $1 million (Millman, 8/27).

USA Today: Consumers Deal With Insurance Deadline, Site Glitches

Hundreds of thousands of people risk losing their new health insurance policies if they don’t resubmit citizenship or immigration information to the government by the end of next week — but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying. Consumers are being forced to send their information multiple times, and many can’t access their accounts at all, immigration law experts and insurance agents say (O’Donnell, 8/27).

The New York Times: Expansion Of Mental Health Care Hits Obstacles

The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces (Goodnough, 8/27).

The Washington Post: How You End Up Spending $800 Million On Healthcare.Gov

Signed into law by President Obama on March 23, 2010, the Affordable Care Act has proven to be its own kind of jobs act, especially when it comes to the Washington-area IT community. When, in several places, the bill called for the creation of an “Internet website” to allow Americans to find and sign up for new health insurance coverage, it opened the tap on hundreds of millions of dollars that would eventually go to creating HealthCare.gov’s front end and back end, as well as a small universe of accompanying digital sites. On Wednesday, the office of Daniel Levinson, the inspector general of the Department of Health and Human Services, put out a report detailing the dozens of contracts that went into building out the Federal Marketplace project. And a look at each in the disaggregate paints a picture of an effort far more sweeping than even that suggested by the half-billion dollars the federal government has already paid out to implement the digital side of the health insurance law (Scola, 8/27).

The Washington Post: Why That One Democratic Obamacare Ad Didn’t Signal A New Trend

When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it’s become clear: there’s little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign (Gold, 8/27).

<a href="http://online.wsj.com/articles/cbo-offers-mixed-forecast-of-u-s-budget-economy-over-next-decade-1409150020?KEYWORDS=Medicare“>The Wall Street Journal: Deficit Forecast Trimmed As Rates Stay Low

Smaller deficits are the result of a variety of factors, including higher tax revenue and economic growth, budget cuts and new limits on government spending. The agency forecast the government would spend slightly less on Medicare and Medicaid over the next decade than it estimated earlier this year. Still, the changes were relatively minor—less than 1% of total spending on the programs. CBO expects the deficit to shrink for several years before starting a steady expansion in 2018, driven by the aging U.S. population, higher health-care costs and increasing subsidies for certain federal programs (Paletta, 8/27).

The Associated Press: US Economy Forecast To Grow By 1.5 Percent In 2014

The Congressional Budget Office on Wednesday forecast that the U.S. economy will grow by just 1.5 percent in 2014, undermined by a poor performance during the first three months of the year. The new assessment was considerably more pessimistic than the Obama administration’s, which predicted last month that the economy would expand by 2.6 percent this year even though it contracted by an annual rate of 2.1 percent in the first quarter (8/27).

The Washington Post: New Obama Plan Calls For Implanted Computer Chips To Help U.S. Troops Health

When President Obama on Tuesday highlighted 19 executive actions he says he is taking to improve the mental health of U.S. troops and veterans, one of them centered on a particularly novel effort: The development of new computer chips designed to modulate the nervous system to help with everything from arthritis to post-traumatic stress (Lamothe, 8/27).

NPR: Life After Ice Buckets: ALS Group Faces $94 Million Challenge

The ALS ice bucket challenge continues to bring in huge donations this summer for efforts to cure and treat what’s commonly known as Lou Gehrig’s disease. As of today, the viral campaign has raised more than $94 million for the ALS Association. That’s compared with $2.7 million raised by the group during the same time last year. Now the association faces a challenge of its own: figuring out the best way to spend all that money (Fessler, 8/27).

The New York Times: Heroin’s Death Toll Rising In New York, Amid A Shift In Who Uses It

A heroin crisis gripping communities across the country deepened in New York last year, with more people in the city dying in overdoses from the drug than in any year since 2003. In all, 420 people fatally overdosed on heroin in 2013 out of a total of 782 drug overdoses, rising to a level not seen in a decade in both absolute numbers and as a population-adjusted rate, according to preliminary year-end data from the city’s health department (Goodman, 8/28).

The Associated Press: Deal On Health Care Aids Port Contract Talks

Negotiators hoping to forge a new contract for dockworkers and keep hundreds of billions of dollars in cargo moving smoothly through West Coast seaports made significant progress with a tentative deal on health care benefits, a knotty issue that tied up talks for months. West Coast dockworkers already have unusually generous health benefits — so generous, argue their employers who pay for the coverage, that the insurance plan has become riddled with fraud (8/27).

The Associated Press: Firm Allegedly Gipped Workers Out Of Jobs, $100K

Prosecutors hammered a Brooklyn contractor Wednesday with allegations he cheated workers out of $100,000 and reneged on promises of permanent jobs and health care. Contractor Anthony Miller and his firm Bael Out Enterprises were arraigned in Brooklyn Supreme Court on charges they schemed to defraud more than 70 workers and failed to obtain workers’ compensation insurance (8/27). 

 

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First Edition: August 28, 2014

CBO Projects Lower Medicare and Medicaid Costs

Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday.

Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast.

Despite the long-term projected drop, federal spending for major health care programs will jump this year by $67 billion — or about 9 percent —  the agency estimated.  The largest increase will be for Medicaid, which is projected to grow by $40 billion, or 15 percent. Most of this short-term increase is attributable to the Affordable Care Act, including its Medicaid expansion and the financial assistance to help people purchase Health Insurance.

More than half of the states and the District of Columbia have opted for the health law’s Medicaid expansion. Subsidies to help eligible individuals purchase health on the law’s online marketplaces, or exchanges, and related expenses (mostly grants to states to establish exchanges) would total $17 billion this year, according to CBO.

CBO and the Joint Committee on Taxation’s projections of outlays and revenues arising from the health law’s provisions related to Health Insurance coverage have not changed substantially since the spring for 2014 or over the 2015–2024 period, according to CBO.

CBO also said it expects Medicare outlays to increase this year by about $12 billion — or 2 percent — which is similar to the rate of growth in 2013 and below the growth in the number of Medicare beneficiaries.

A Medicare physician payment “fix” remains a relative bargain compared to the 2012 estimate from CBO. Holding Medicare physician payment increases to the current rate through 2024 would cost $131 billion, CBO found.  For years, lawmakers have struggled to replace the current Medicare physician payment formula, known as the sustainable growth rate or SGR, and have repeatedly passed legislation to avoid heavy scheduled cuts.

While the price of an SGR replacement has dropped in recent years — CBO estimated the 10-year cost at $316 billion in 2012 — and there’s bipartisan support to replace the formula, Congress has yet to agree on how to pay for a replacement. Many policy analysts and lawmakers have recommended that Medicare physician payments be based on the quality of care provided, rather than the volume of services.

CBO Projects Lower Medicare and Medicaid Costs

Report: Health Law Ups Taxes On Insurers With Big Pay Packages

While average compensation for top Health Insurance executives hit $5.4 million each last year, a little-noticed provision in the federal health law sharply reduced insurers’ ability to shield much of that pay from corporate taxes, says a report out today.

As a result, insurers owed at least $72 million more to the U.S. Treasury last year, said the Institute for Policy Studies, a liberal think tank in Washington D.C.

Researchers analyzed the compensation of 57 executives at the 10 largest publicly traded health plans, finding they earned a combined $300 million in 2013. Insurers were able to deduct 27 percent of that from their taxes as a business expense, estimates the report. Before the health law, 96 percent would have been deductible.

UnitedHealth Group, which paid CEO and President Stephen Hemsley about $28 million in pay and stock options in 2013, had the biggest tax bill among the 10 companies, the report found. Hemsley’s compensation accounted for nearly $6 million of the firm’s estimated $19 million in taxes that the report says it owed on  pay packages for five executives under the health law.

“They’re paying more in taxes just to protect these pay packages,” said Sarah Anderson, global economy project director at the institute.

The insurers’ lobby opposed the provision, saying deductibility rules should be consistent across all industries.

“Requiring plans to pay higher taxes does nothing to make coverage more affordable or accessible,” said Brendan Buck, spokesman for the trade group, America’s Health Insurance Plans, which had not seen the report.

Under the 2010 law, insurers can deduct only the first $500,000 of annual compensation per employee from corporate taxes, down from $1 million allowed before the law’s passage.  The law also requires insurers to include so-called “performance pay,” such as stock options, which often represent a hefty portion of an executive’s pay.

The provision is similar to limits Congress imposed on executives at the banks that took Troubled Asset Relief Program funds.  Most other industries can still deduct the first $1 million in compensation — and can exclude performance pay from their income tallies.

Using compensation figures from filings with the U.S. Securities and Exchange Commission, the institute estimated the amount of compensation that is no longer deductible. They calculated taxes owed on that amount using a model that assumed a 35 percent corporate tax rate. The report found:

– On average, the insurers owed $1.3 million more in taxes per executive.

– So-called “performance pay,” which is no longer deductible for health insurers, accounted for more than $204 million of the compensation awarded.

– Executive pay rose to an average of $5.4 million per person in 2013, up from $5.1 million in 2012.

The provision on executive pay was added to the health law by former Democrat Sen. Blanche Lincoln of Arkansas, who called it “a fair policy aimed at encouraging Health Insurance companies to put premium dollars toward lower rates and more affordable coverage, not in the pocketbooks of their executives” in a December 2009 press conference.

Lincoln was defeated in the November 2010 election by Republican John Boozman and now runs a lobbying firm.

Another health law provision also limits how much of consumers’ premiums can go towards administrative costs, which include executive compensation, by requiring plans to spend at least 80 percent of premiums on medical care.

Report: Health Law Ups Taxes On Insurers With Big Pay Packages

Viewpoints: Check Out Those Nursing Home Stars; Rove A 'Bleeding Heart Liberal' On Medicare?

<a href="http://www.nytimes.com/2014/08/26/opinion/Medicares-flawed-ratings-for-nursing-homes.html?emc=edit_tnt_20140825&nlid=58462464&tntemail0=y” target=”_blank”>The New York Times: When Five-Star Care Is Substandard
Medicare has devised a rating system for nursing homes that portrays many of them as much better than they really are. Consumers should be aware that a top five-star rating from Medicare, achieved by a fifth of the more than 15,000 nursing homes nationwide, may mask serious and potentially dangerous deficiencies (8/25). 

The Washington Post’s Plum Line: Bleeding Heart Liberal Karl Rove Attacks Senate Dems From The Left

The other day, I noted that Karl Rove’s Crossroads GPS is up with a new ad that slices and dices Dem Senator Mark Pryor’s quotes to create the impression he supports raising the Social Security retirement age in ways that should frighten today’s seniors. Just as they have in the last two cycles — in which Republicans have built national campaigns around dishonest attacks on Obamacare’s provider-side cuts to Medicare — this ad shows Republicans once again hitting Dems from the left on entitlements (Greg Sargent, 8/25). 

Los Angeles Times: Another GOP State May Be Signing Up For Medicaid, And The Reason Is Obvious

Reports out of Cheyenne say that Wyoming is finally talking to federal officials about expanding Medicaid. That would make Wyoming the 12th state with a Republican governor to expand Medicaid under the Affordable Care Act, leaving 16 with GOP leadership still in the “no expansion” column. The reason for Wyoming’s wavering is clear: It’s money (Michael Hiltzik, 8/25).

Bloomberg: Loving And Hating Obamacare With One Muddled Mind

For those of us who pay close attention, it may seem weird that someone could hate Obamacare while loving almost every part of it. There must be one overriding opinion hidden in there — pro or con — that good research can isolate, no? Well, no. Sometimes, incoherence in the polls simply reflects incoherence among voters. We just have to live with that (Jonathan Bernstein, 8/25). 

Los Angeles Times: A Women’s Rights Victory As California Nixes An Attack On Abortion Coverage

With minimal fanfare, California state officials have nixed an underhanded effort by two Catholic-affiliated universities and their insurers to deprive the universities’ employees of insurance coverage for abortions. The move by the Department of Managed Health Care is one of the strongest statements in favor of women’s reproductive health rights you’re likely to hear from officials of any state, at a time when those rights are under systematic attack. So it’s proper to pay attention (Michael Hiltzik, 8/25). 

Los Angeles Times: Trying To Save The Contraception Mandate By Changing Its Address

Here’s a prediction: The next legal battle over the Obama administration’s contraception mandate will be over who has to write what kind of letter to whom. The administration announced Friday the latest tweaks to the requirement that all new employer-sponsored health plans include coverage for female contraception with no out-of-pocket costs. The changes, which respond to a pair of Supreme Court rulings, are designed to keep the coverage in place for female employees while allowing more religious-affiliated nonprofits and some privately held for-profits to distance themselves further from the transaction (Jon Healey, 8/25).

Viewpoints: Check Out Those Nursing Home Stars; Rove A 'Bleeding Heart Liberal' On Medicare?

At Home Or In Facilities, Care For Elderly Changing Rapidly

News outlets cover the reliability of nursing home ratings, the growth of home health care aides and the return of the house call.

<a href="http://www.nytimes.com/2014/08/25/business/Medicare-star-ratings-allow-nursing-homes-to-game-the-system.html” data-mce-href=”http://www.nytimes.com/2014/08/25/business/Medicare-star-ratings-allow-nursing-homes-to-game-the-system.html”>The New York Times: Medicare Star Ratings Allow Nursing Homes To Game The System

What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. … But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes. The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify (Thomas, 8/24).

The Wall Street Journal: Help Wanted (A Lot): Home-Health Aides

Dolores Streater works in one of the fastest-growing professions in the country. It is also among the lowest-paying and most-demanding. And, not coincidentally, it has particularly high turnover. Ms. Streater is a home health-care aide. … No major segment of the workforce is expected to expand faster in coming years than that of the paid caregivers who assist aging Americans at home. The jobs typically don’t require a high-school diploma, there is little required training and the average workweek is 34 hours. The U.S. Labor Department predicts the profession will grow by nearly 50%, or the equivalent of nearly a million new jobs, by 2022 (Portlock, 8/22).

The Associated Press: House Calls For Elderly Save Money

Ten or 12 times a year, Beatrice Adams’ daughter would race her frail mother to the emergency room (ER) for high blood pressure or pain from a list of chronic illnesses. Then Adams found a doctor who makes house calls, and the 89-year-old hasn’t needed ER care in the nearly two years since. … The old-fashioned house call is starting to make a comeback as part of an effort to improve care for some of Medicare’s most frail and expensive patients. While it may sound like a luxury, bringing team-based primary care into the homes of patients like Adams, according to a new study, actually could save Medicare money (Neergaard, 8/24).

At Home Or In Facilities, Care For Elderly Changing Rapidly

Viewpoints: Spreading Ebola Treatments; Dems Can Win Running On Health Law

The New York Times: New Thinking About Ebola Treatments

A radical but promising proposal to help treat victims of the Ebola epidemic in West Africa appears to be gaining support among knowledgeable experts. There are currently no approved drugs to treat infection with the Ebola virus, and only a handful of potential drug therapies in the very earliest stages of testing in humans or animals, with little likelihood that they could be produced on a large scale any time soon. The new proposal would fill the gap by using drugs that have already been approved to treat other diseases and repurposing them to treat Ebola as well (8/24).

The Washington Post: Obamacare Has Growing Support, Even If Its Name Does Not

Election results, like scripture, can be interpreted in a variety of ways. You can bet that foes of expanding health insurance coverage will try to interpret every Republican victory as a defeat for Obamacare. But as Mark Pryor knows, the president’s unpopularity in certain parts of the country doesn’t mean that voters want to throw his greatest accomplishment overboard — even if they’d be happy to rename it (E.J. Dionne Jr., 8/24).

The New Republic: Republican Lawyers’ Latest Sneak Attack On Obamacare Is Their Most Brazen Yet

On Monday August 18, Affordable Care Act opponents’ legal champion, Michael Carvin, filed a little-noticed brief with the District of Columbia Circuit Court of Appeals, … challenging the legality of tax credits and subsidies for health insurance purchasers on federally operated exchanges. The D.C. Circuit’s decision on this procedural issue could play an outsized role in deciding the ultimate fate of the litigation, and determine whether those exchanges—currently covering several million Americans in 36 states—will continue their currently impressive growth, or collapse outright (Simon Lazarus, 8/24).

Winston-Salem Journal: More Evidence Of The Foolish Choice On Medicaid Expansion

When you consider all the bad choices made by the General Assembly and Gov. Pat McCrory in the last two years — and there have been too many to mention — the one that may make the least sense was the decision not to expand Medicaid under the Affordable Care Act and therefore provide health coverage for more than 400,000 low-income adults who are currently uninsured (Chris Fitzsimon, 8/23).

The Tennessean: Hacking Is Bad For Your Health

When you are sick or injured, the security of your personal information probably is not top of mind, so it adds a distressing dimension to the news that hackers were able to bypass security measures for Community Health Systems Inc., potentially affecting 4.5 million patients (8/23) .

<a href="http://www.publicintegrity.org/2014/08/25/15345/docs-drug-companies-insurers-drive-Medicare-costs” target=”_blank”>Center for Public Integrity: Docs, Drug Companies, Insurers Drive Up Medicare Costs

[T]he Hospital Trust Fund accounts for only about half of total Medicare spending. Most of the rest goes to cover physician fees, prescription drugs and to provide incentives for health insurance companies to participate in the Medicare Advantage program and administer the Medicare drug program. The Affordable Care Act could have done much more than it does to curb spending in those areas. Because it doesn’t is a testament to the power and influence of the lobbyists who represent doctors, pharmaceutical companies and health insurers (Wendell Potter, 8/25).

Viewpoints: Spreading Ebola Treatments; Dems Can Win Running On Health Law

First Edition: August 25, 2014

Today’s early morning highlights from the major news organizations include reports on Medicare ratings of nursing homes, the growing demand for home-health aides and accounts of the Obama administration’s new contraception coverage rules.

Kaiser Health News: Obamacare Still ‘Red Meat’ For GOP Candidates But Focus Of Attacks Shift

Kaiser Health News staff writer Phil Galewitz reports: “Heading into the first congressional election since millions of Americans gained coverage under the health law, many Republican candidates are taking a more nuanced approach to how they criticize the law. Rather than just calling for repeal, they are following [North Star Opinion Research President Whit] Ayres’ recommendations to focus on arguments about how the law is hurting consumers, government budgets or the economy” (Galewitz, 8/25). Read the story, which also appears on The Daily Beast.

<a href="http://www.nytimes.com/2014/08/25/business/Medicare-star-ratings-allow-nursing-homes-to-game-the-system.html” data-mce-href=”http://www.nytimes.com/2014/08/25/business/Medicare-star-ratings-allow-nursing-homes-to-game-the-system.html”>The New York Times: Medicare Star Ratings Allow Nursing Homes To Game The System

What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood’s five-star status — the best possible — places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction. But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes (Thomas, 8/24).

The Wall Street Journal: Help Wanted (A Lot): Home-Health Aides

Dolores Streater works in one of the fastest-growing professions in the country. It is also among the lowest-paying and most-demanding. And, not coincidentally, it has particularly high turnover. Ms. Streater is a home health-care aide. … No major segment of the workforce is expected to expand faster in coming years than that of the paid caregivers who assist aging Americans at home. The jobs typically don’t require a high-school diploma, there is little required training and the average workweek is 34 hours. The U.S. Labor Department predicts the profession will grow by nearly 50%, or the equivalent of nearly a million new jobs, by 2022 (Portlock, 8/22).

The Associated Press: New Obama Birth Control Fixes For Religious Groups

Seeking to quell a politically charged controversy, the Obama administration announced new measures Friday to allow religious nonprofits and some companies to opt out of paying for birth control for female employees while still ensuring those employees have access to contraception. Even so, the accommodations may not fully satisfy religious groups who oppose any system that makes them complicit in providing coverage they believe is immoral (Lederman, 8/22).

The Wall Street Journal: Administration Offers Contraception Compromise For Religious Employers

The Obama administration outlined a new compromise Friday aimed at shielding religious business owners and Christian universities and charities from the health law’s contraception-coverage requirements, but a chilly initial response from Roman Catholic bishops suggested the move wouldn’t assuage their concerns. … Catholic bishops, who have led a campaign against the contraception-coverage provision that has included numerous legal challenges since its announcement in August 2011, indicated the new rules make only minor changes and are insufficient (Radnofsky, 8/22).

Bloomberg: Obama Provides Birth-Control Coverage Plan For Nonprofits

Women who work for religious nonprofits will have access to birth control at no cost under a procedure the Obama administration said would also relieve their employers of any moral objections to the coverage. The nonprofits will now only have to notify the U.S. government of their objections in writing, the administration said in a regulation published yesterday. Coverage will be arranged separately by the government through health-benefit managers (Wayne, 8/23).

The Washington Post: Administration Offers New Tweak To Birth Control Rule

The administration also intends to offer a similar work-around to for-profit businesses after the Supreme Court’s bitterly debated 5-4 decision in June that owners of closely held firms could refuse contraception coverage if it conflicts with their religious beliefs (Millman, 8/22).

Politico: New Contraceptive Coverage Plan To Be Offered For Religious Nonprofits

The new plan, which addresses a high-profile component of the health care law, essentially adds HHS to the notification process for any group that objects to the coverage requirement. The legal challenges brought by scores of organizations across the country have put contraceptive coverage at risk for some women but not threatened the health care law itself (Norman, 8/22).

The New York Times: Administration Proposes New Health Rules Addressing Religious Objections

The United States Supreme Court said this summer that the government could not force a private, closely held company to pay for insurance coverage for contraceptive services at no cost to their employees if the owners of the company expressed religious objections. In a separate decision, the court also said that previous religious accommodations for some nonprofit organizations did not go far enough. For President Obama’s administration, the court rulings presented a dilemma: how to stand by their insistence that all women should have easy access to contraceptive services at no cost, while also recognizing the religious objections of organizations and companies as determined by the court (Shear, 8/22).

The Associated Press: Tax Refunds May Get Hit Due To Health Law Credits

Taxes? Who wants to think about taxes around Labor Day? But if you count on your tax refund and you’re one of the millions getting tax credits to help pay health insurance premiums under President Barack Obama’s law, it’s not too early. Here’s why: If your income for 2014 is going to be higher than you estimated when you applied for health insurance, then complex connections between the health law and taxes can reduce or even eliminate your tax refund next year (Alonso-Zaldivar, 8/24).

The Associated Press: Oregon Sues Oracle Over Failed Health Care Website

The state of Oregon filed a lawsuit Friday against Oracle America Inc. and several of its executives over the technology company’s role in creating the troubled website for the state’s online health insurance exchange. The lawsuit, filed in Marion County Circuit Court in Salem, alleges that Oracle officials lied, breached contracts and engaged in “a pattern of racketeering activity” (Cooper, 8/22).

Los Angeles Times: Oregon Sues Oracle, Blaming Tech Giant For Failed Healthcare Website

The Oregon attorney general sued Oracle America Inc. on Friday, charging that the technology giant committed what “amounts to a pattern of racketeering activity” that cost the state hundreds of millions of dollars during the faulty rollout of its troubled health insurance exchange. In a scathing, 126-page civil complaint, Oregon Atty. Gen. Ellen Rosenblum accused the company and several of its high-level executives of repeatedly lying to state officials, of failing to deliver on contracts and of filing an estimated $240 million in false claims after it was hired to build the Cover Oregon website (La Ganga, 8/22).

Los Angeles Times: Covered California Officials, Insurance Chief Clash Over Prop. 45

California’s Obamacare exchange and the state insurance commissioner are on a collision course over Proposition 45, a popular ballot measure aimed at reining in health insurance rates. Covered California officials lashed out at the statewide ballot initiative this week and warned that it could be disastrous to the state’s implementation of the federal healthcare law. … Until now, the state-run exchange had largely avoided a public clash over Proposition 45 with [Insurance Commissioner Dave] Jones, a Democrat who supports the health law. That restraint disappeared at an exchange board meeting Thursday, and officials there will take up a vote next month to formally oppose it. These moves thrust Covered California into the middle of what’s expected to be a highly contentious and costly campaign (Terhune, 8/22).

The Associated Press: California: Insurers Must Cover Elective Abortions

Health insurance companies in California may not refuse to cover the cost of abortions, state insurance officials have ruled in a reversal of policy stemming from the decision by two Catholic universities to drop elective abortions from their employee health plans. Although the federal Affordable Care Act does not compel employers to provide workers with health insurance that includes abortion coverage, the director of California’s Department of Managed Health Care said in a letter to seven insurance companies on Friday that the state Constitution and a 1975 state law prohibits them from selling group plans that exclude the procedure. The law in question requires such plans to encompass all “medically necessary” care (8/23).

The Washington Post: Md. Approves Smaller Rate Hikes For CareFirst, Lowers Rates For 3 Others

Maryland officials approved final insurance rates Friday for consumers buying individual health plans next year under the federal health-care law. Regulators cut proposed premiums by more than half for CareFirst, the region’s dominant insurance company, and approved lower rates for three other carriers (Sun, 8/22).

The New York Times: Blood Industry Shrinks As Transfusions Decline

Changes in medicine have eliminated the need for millions of blood transfusions, which is good news for patients getting procedures like coronary bypasses and other procedures that once required a lot of blood. But the trend is wreaking havoc in the blood bank business, forcing a wave of mergers and job cutbacks unlike anything the industry, which became large scale after World War II, has ever seen (Wald, 8/22).

The New York Times: Chicago And 2 California Counties Sue Over Marketing Of Painkillers

As the country struggles to combat the growing abuse of heroin and opioid painkillers, a new battlefield is emerging: the courts. The City of Chicago and two California counties are challenging the drug industry’s way of doing business, contending in two separate lawsuits that “aggressive marketing” by five companies has fueled an epidemic of addiction and cost taxpayers millions of dollars in insurance claims and other health care costs (Schwartz, 8/24).

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First Edition: August 25, 2014