- KFF Health News Original Stories 2
- UnitedHealth Warns Of Marketplace Exit – Start Of A Trend Or Push For White House Action?
- Medicaid Denies Nearly Half Of Requests For Hepatitis C Drugs: Study
- Political Cartoon: 'Senior Discount'
- Health Law 3
- UnitedHealthcare, Lowering Financial Forecast, Warns Of Possible Exit From ACA Marketplace
- Marketplace Challenges Spur Questions About Quality, Effectiveness Of Health Plans Offered
- CMS 'Willing And Eager' To Discuss Waivers To Encourage Medicaid Expansion In Georgia
- State Watch 4
- Consolidation Gives Florida Hospitals Leverage In Negotiations With Insurers: Analysis
- Few Iowa Hospitals, Doctors Appear To Sign Contracts With Privatized Medicaid Program
- Okla. Gov. Urges State To End Medicaid Contracts With Planned Parenthood
- State Highlights: Fla. Needle Exchange Program Gets State Senate's OK; Avera Health Will Be S.D.'s Second-Largest Insurer With Purchase Of Dakotacare
From KFF Health News - Latest Stories:
KFF Health News Original Stories
UnitedHealth Warns Of Marketplace Exit – Start Of A Trend Or Push For White House Action?
Some analysts and health policy experts view the move as an effort to compel the Obama administration to make changes. (Julie Appleby, )
Medicaid Denies Nearly Half Of Requests For Hepatitis C Drugs: Study
Researchers at the University of Pennsylvania found that Medicaid turned down requests for new expensive drugs to treat hepatitis C 46 percent of the time, while private insurers barred them 10 percent and Medicare 5 percent. (Michelle Andrews, )
Political Cartoon: 'Senior Discount'
KFF Health News provides a fresh take on health policy developments with "Political Cartoon: 'Senior Discount'" by Jimmy Margulies.
Here's today's health policy haiku:
DO THEY MEAN IT?
UnitedHealth warns
they’ll leave the marketplaces.
But will they really?
- Anonymous
If you have a health policy haiku to share, please Contact Us and let us know if we can include your name. Haikus follow the format of 5-7-5 syllables. We give extra brownie points if you link back to an original story.
Opinions expressed in haikus and cartoons are solely the author's and do not reflect the opinions of KFF Health News or KFF.
Summaries Of The News:
UnitedHealthcare, Lowering Financial Forecast, Warns Of Possible Exit From ACA Marketplace
Some view the insurer's Thursday announcement as an effort to compel the Obama administration to ease regulations and tweak certain aspects of the health law.
The New York Times:
UnitedHealth Lowers Forecast, Blaming Affordable Care Act
UnitedHealth Group, one of the nation’s largest health insurance companies, stunned investors on Thursday morning when it significantly lowered its profit estimates, placing the blame for an expected loss of hundreds of millions of dollars on selling individual policies under the federal health care law. In light of the losses, the company warned that it was also weighing whether it would continue to offer individual coverage through the online exchanges for 2017. (Abelson, 11/19)
The Wall Street Journal:
Biggest Insurer Threatens To Abandon Health Law
The industry’s woes, and broad rate increases aimed at stanching the red ink, are putting pressure on the Obama administration to tweak aspects of the law; the issues also risk pulling the ACA back into the political spotlight. Republicans, who have remained opposed to the health law, quickly jumped on the news. (Wilde Mathews and Armour, 11/19)
Kaiser Health News:
UnitedHealth Warns Of Marketplace Exit – Start Of A Trend Or Push For White House Action?
UnitedHealthGroup laid out a litany of reasons Thursday why it might stop selling individual health insurance through federal and state markets in 2017 — a move some see as an effort to compel the Obama administration to ease regulations and make good on promised payments.
Those problems, including low participation by healthy people, have led to financial losses, according to UnitedHealth. If not addressed, similar issues could affect other insurers, causing more to exit the market in the coming years, some Wall Street analysts and policy experts said. (Appleby, 11/20)
Modern Healthcare:
CMS Determined To Make Full ACA Fallback Payments
The CMS released a memo late Thursday that reiterated the federal agency's desire to pay out risk-corridor payments despite the massive shortfall in the near term. The notice came the same day that UnitedHealth Group, the nation's largest health insurer, said it was seriously considering pulling out of the Affordable Care Act's marketplaces. ... The memo states that if health insurers are still owed money under the risk corridors program for 2016, HHS “will explore other sources of funding for risk corridors payments, subject to the availability of appropriations. This includes working with Congress on the necessary funding for outstanding risk corridors payments.” ... However, the Republican-led Congress more or less tied the CMS' hands on risk corridors last December. The budget bill required the program to be budget-neutral. (Herman, 11/19)
USA Today:
UnitedHealth Warns It May Exit Obamacare Plans
The possible move by UnitedHealth Group raises new questions about the viability of President Obama's signature health law and follows the departure of more than half of the non-profit insurance cooperatives this year. If UnitedHealth drops out, consumers would lose one of the lowest-cost plans available in much of the country, and some wonder how smaller insurers could fill the void. “If they can’t make money on the exchanges, it seems it would be hard for anyone,” said Katherine Hempstead, who heads the insurance coverage team at the Robert Wood Johnson Foundation. (Bomey and O'Donnell, 11/19)
The Associated Press:
UnitedHealth Cuts Outlook, Casts Doubt on Overhaul Exchanges
Insurers are struggling to attract enough healthy customers into their still-new exchange coverage to balance sicker patients who signed up for coverage quicker because they use a lot of health care. Until that happens, the exchanges won't be a viable, long-term market for these companies, Morningstar analyst Vishnu Lekraj said. (Murphy, 11/19)
Los Angeles Times:
UnitedHealth May Dump Obamacare Plans, Putting California Expansion In Doubt
The announcement comes as UnitedHealth is seeking a toehold in California’s Obamacare market — after snubbing the state two years ago. Nationwide, UnitedHealth has more than 500,000 people enrolled on government exchanges out of about 10 million Americans who have signed up. Rivals Anthem and Aetna both have a bigger presence with a combined enrollment of about 1.6 million people. (Terhune, 11/29)
The Washington Post's Wonkblog:
UnitedHealth Group Says It Is Scaling Back Efforts In ACA Exchanges
If UnitedHealth were to exit the ACA marketplaces in a year , the immediate impact would be too small to topple the exchanges, according to several analysts. They said the announcement may be more important for what it implies about the ability of even large, well-established insurers to thrive in the marketplaces. (Goldstein and Johnson, 11/19)
Bloomberg:
Obamacare's Fate May Rest On Patience Of Insurers Aetna, Anthem
The fate of Barack Obama’s signature health-care law may depend on how long Anthem Inc. and Aetna Inc. are willing to wait before starting to make money off it. The two insurers are on the hot seat now that UnitedHealth Group Inc. appears unlikely to linger as a seller on the Affordable Care Act’s government-run markets. (Tracer, 11/19)
The Fiscal Times:
Obamacare May Lose UnitedHealth: Will It Hurt?
Obamacare had been heralded as a potential boon to major insurers, given the millions of new customers it would add to their rolls. It hasn’t worked out that way thus far, at least for UnitedHealth. Though nearly 10 million people bought coverage for 2015 as of June through the federal and state-run Obamacare exchanges, including more than 500,000 who have gotten plans from UnitedHealth, those new enrollees have in many cases been more expensive and less profitable. (Dent, 11/19)
Minnesota Public Radio:
UnitedHealth Says Losses May Force It Out Of Obamacare Exchanges
University of Minnesota Health Policy and Management Professor Jean Abraham says UnitedHealth's frank assessment of doing business on public exchanges will attract policy makers' attention. (Zdechlik, 11/19)
Marketplace:
Insurance Giant Shakes ACA Tree
Here we go again: another round of ‘Is this the beginning of the end for Obamacare?’ ... That news has shocked many in the industry and has reignited partisan debate about the long-term viability of the law. To ACA opponents, UnitedHealth’s announcement is further proof that insurance sold on the exchanges attracts too many sick and expensive consumers. (Gorenstein, 11/19)
The Associated Press:
Stocks End Lower, Dragged Down By Health Care Sector
U.S. stocks closed slightly lower Thursday after spending much of the day wavering between small gains and losses. Several companies reported earnings and outlooks that offered a mixed picture of the economy for investors. Health care stocks were among the biggest decliners, dragged down after UnitedHealth Group cut its full-year earnings forecast. The nation's largest health insurer also raised doubts about whether it will continue to participate in a key piece of the Affordable Care Act. (11/19)
Marketplace Challenges Spur Questions About Quality, Effectiveness Of Health Plans Offered
CBS News explores how some of the problems consumers are finding with marketplace plans square with the aspirations of the law. Also in news about enrollment are stories about coverage for some over-the-counter products, the penalties for not having insurance and Connecticut's success in signing up younger adults.
CBS News:
Is Anyone Happy With Obamacare's Exchanges?
For naysayers of the Affordable Care Act, the fall may be providing them with a "told you so" moment. The exchanges set up by the health care law were designed to bring choice and transparency to the process of buying health care insurance for Americans who need individual plans. Part of the idea was that the exchanges would sign up young Americans, and those healthier types would help even out the high treatment costs for the exchanges' sickest patients. Reality, however, has given those plans a more sober diagnosis. (Picchi, 11/19)
U.S. News & World Report:
What You Don't Know About Your Obamacare Coverage
While President Barack Obama's health care law requires insurance companies to cover some over-the-counter medications and devices, a small catch may be causing some patients to forgo care or spend more money than needed: You have to get a doctor's prescription to avoid out-of-pocket costs. The Affordable Care Act requires that insurers cover 10 so-called essential health benefits, some of which can come with no copay, including methods of contraception and smoking cessation tools approved by the Food and Drug Administration, as well as breast pumps for new moms. ... But because some of these medications or devices are also available over the counter, whether or how health insurance plans can step in to cover their costs can be unclear. (Leonard, 11/19)
CBS News:
No Health Insurance In 2015? Get Ready To Pay Up
Under the Affordable Care Act, almost everyone is required to be covered under a health insurance plan, or pay a penalty. And that penalty is set to rise steeply this year. (Martin, 11/20)
The Connecticut Mirror:
New Access Health Customers Skew Younger, Lower-Income, So Far
More than 5,400 new customers have bought private insurance through the state’s health insurance exchange since Nov. 1, a group that includes a larger share of young adults and people who qualify for subsidized coverage than the current customer base. (Levin Becker, 11/19)
And in Oregon -
The Oregonian:
Fight For Kitzhaber Emails Heats Up With Federal Grand Jury, Oracle
Former Gov. John Kitzhaber's lawyer, Janet Hoffman, did not expect a recent hearing concerning a hush-hush federal influence-peddling investigation of her client would be public. But it was, and now it's on YouTube. The Ninth Circuit Court of Appeals hearing gives new insight into Hoffman's fight to stop the state from turning over emails from the former governor's personal account to federal grand jury. The fight is relevant not just to the investigation of Kitzhaber and his fiancée, Cylvia Hayes. Many of the same arguments are set for a Friday hearing in the court fight between the state and Oracle America over who's to blame for Cover Oregon. (Budnick, 11/19)
CMS 'Willing And Eager' To Discuss Waivers To Encourage Medicaid Expansion In Georgia
Meanwhile, in Kentucky, health navigators want to discuss the state's low-income health program with the incoming governor to convince him of the importance of maintaining an expanded safety net for the working poor.
Georgia Health News:
Feds Vow Flexibility On Ramping Up Medicaid
A top federal health official said Wednesday that his agency would welcome talks with Georgia leaders about any proposal resembling a Medicaid expansion plan. (Miller, 11/19)
Louisville Courier-Journal:
Many Kentuckians On Medicaid Work For Low Pay
More than half of about 400,000 Kentuckians who gained Medicaid coverage under the federal law also known as Obamacare have jobs but did not have health insurance. "The reality is that lots of workers can't get health insurance through their employers," said Jason Bailey, executive director of the Kentucky Center for Economic Policy, a nonprofit research and policy organization in Berea. "They have a job but they're not getting health insurance through their job." With Gov.-elect Matt Bevin preparing to take office Dec. 8, health advocates hope to convince him of the importance of the Medicaid expansion under Obamacare — especially its role as a safety net for the working poor. (Yetter, 11/19)
Those Specialty Drugs Likely Cost More Than Your Household Income
A new report says a year's worth of specialty drugs now outpaces the U.S. median household income. Elsewhere, using brand-name drugs over generic equivalents doesn't often boost patient satisfaction. And the price of hepatitis C drugs may be holding back the eradication of the disease and playing a role as Medicaid denies nearly half of requests for the treatments.
The Washington Post's Wonkblog:
Specialty Drugs Now Cost More Than Most Household Incomes
The average annual retail cost of specialty drugs used to treat complex diseases such as cancer, rheumatoid arthritis and multiple sclerosis now exceeds the median U.S. household income, according to a report to be published Friday. The study of 115 specialty drugs found that a year's worth of prescriptions for a single drug retailed at $53,384 per year, on average, in 2013 -- more than the median U.S. household income, double the median income of Medicare beneficiaries, and more than three times as much as the average Social Security benefit in the same year. (Johnson, 11/20)
ProPublica/NPR:
Brand-Name Drugs Can Raise Costs Without Boosting Patient Satisfaction
In recent days, presidential candidates and even the American Medical Association have griped about rising drug prices, pointing to brand-name blockbusters with splashy ad campaigns. When it comes to patient satisfaction, however, there isn't much difference between brands and generics, according to data collected by the website Iodine, which is building a repository of user reviews on drugs. (Ornstein, 11/19)
Reuters:
Price Looms As Major Hurdle In Hepatitis C Eradication
New therapies can cure most cases of hepatitis C but lower drug prices, testing and better access to treatment are going to be needed to eliminate the liver-destroying virus worldwide, according to a New England Journal of Medicine editorial. The U.S. government is trying to attain that goal by discouraging states from limiting access to the drugs and encouraging drug companies to reveal their pricing agreements so states can get the best deal on the expensive therapy, said the director of the Centers for Disease Control and Prevention's (CDC) division of viral hepatitis, who coauthored the editorial. (Emery, 11/19)
Kaiser Health News:
Medicaid Denies Nearly Half Of Requests For Hepatitis C Drugs: Study
People with hepatitis C who sought prescriptions for highly effective but pricey new drugs were significantly more likely to get turned down if they had Medicaid coverage than if they were insured by Medicare or private commercial policies, a recent study found. Researchers at the University of Pennsylvania Perelman School of Medicine analyzed the hepatitis C prescriptions from 2,342 patients in Maryland, Delaware, Pennsylvania and New Jersey that were submitted between November 2014 and April 2015 to a large specialty pharmacy that serves the region. (Andrews, 11/20)
And, global prescription-drug spending is expected to rise to $1.4 trillion by 2020. Also, Pfizer considers a bid for Allergan, and a former Sanofi CEO gets set to financially back new experimental drugs -
STAT:
Global Spending On Drugs To Climb To $1.4 Trillion By 2020
By 2020, an estimated 4.5 trillion doses of prescription drugs will be used by patients, up 24 percent from this year. In particular, increased usage is expected to jump in China, Brazil, India, and Indonesia, where the middle class is expected to swell and have greater access to health care, according to the IMS Institute for Healthcare Informatics, a unit of IMS Health, the market research firm. (Silverman, 11/18)
Reuters:
Pfizer Discussing Allergan Offer At $370-$380 Per Share
Pfizer Inc is in talks to acquire Allergan Plc for $370-$380 per share, according to a person familiar with the matter, valuing the potential deal at around $150 billion, the healthcare sector's biggest. Talks between the sides have accelerated, though the U.S. Treasury's announcement on the tightening of the rules for tax inversions has made timing more uncertain and a deal is not imminent, the source said, asking not to be identified because the matter is confidential. (11/18)
Reuters:
Former Sanofi CEO Viehbacher To Bankroll New Drugs
Chris Viehbacher, ousted last year after six years as CEO of French drugmaker Sanofi, is settling into a new job that involves picking promising experimental drugs before they have been tested in human trials. Viehbacher, pushed out amid declining sales of Sanofi's top-selling diabetes drug, is now managing partner of Gurnet Point Capital, a healthcare investment fund started in 2013. The firm said on Thursday it had created a new drug-development company, Boston Pharmaceuticals, that can tap in to $600 million in available funds. (Person and Berkrot, 11/19)
Sanders Outlines Vision For 'Democratic Socialism' That Includes Medicare For All
Citing the example of Franklin D. Roosevelt, Democratic presidential candidate Bernie Sanders delivered a campaign-defining speech that defended his policies that have been attacked as "socialist." He used his plan to provide universal health care as an example of his overall philosophy.
Los Angeles Times:
Bernie Sanders Invokes FDR In Explaining Socialism As 'Foundation Of Middle Class'
He expressed bewilderment that his embrace of free public education, universal healthcare and an economic system that does not concentrate so much wealth among so few would be perceived as radical. The goals are in keeping with the American tradition of such programs as Social Security and Medicare, he said, and the rest of the industrialized world operates that way. (Halper, 11/19)
The Washington Post:
Sanders: Unlike Clinton, I Won’t Seek ‘Reckless Adventures Abroad’
Sanders devoted the bulk of his remarks Thursday to an explanation of what “democratic socialism” is — and isn’t — in his view. The term he uses to describe his politics has become a major topic of conversation, and drawn some derision, as he seeks the presidency. ... Sanders cited his plans to make public college tuition free, to provide universal health care through a “Medicare for all” system, and to raise the minimum wage to $15 per hour. Clinton has proposed addressing many of the same issues that Sanders cited, but she generally advocates programs that are less ambitious and less costly. (Wagner, 11/119)
Medicare Weighs Penalizing Doctors Who Routinely Order Prostate Screenings
The Wall Street Journal reports on a little-noticed proposal that is part of the federal effort to define quality in health care. Also, Reuters looks at a study showing a decline in U.S. funding for public health.
The Wall Street Journal:
Doctors Could Be Penalized For Ordering Prostate Tests
Medicare officials are considering a measure that would penalize doctors who order routine prostate-cancer screening tests for their patients, as part of a federal effort to define and reward quality in health-care services. The proposal, which hasn’t been widely publicized, has prompted a flurry of last-minute comments to the Centers for Medicare and Medicaid Services, including more than 200 in the past two days, virtually all in opposition. The official comment period began Oct. 26 and ends Friday. (Beck, 11/19)
Reuters:
U.S. Public Health Funding On The Decline
U.S. public health funding – which covers things like disease prevention, cancer screenings, contraceptives and vaccines – has been steadily falling in recent years and is expected to keep going down, a recent study projects. Real, inflation-adjusted public health expenditures surged from $39 per capita in 1960 to $281 per capita in 2008, then fell 9.3 percent to $255 per capita in 2014, according to the analysis published in the American Journal of Public Health. (Rapaport, 11/18)
Consolidation Gives Florida Hospitals Leverage In Negotiations With Insurers: Analysis
In other regional hospital news, medical groups in New Jersey appeal the state's approval of an insurer alliance. And in Louisiana, a judge throws out a lawsuit filed by LSU seeking to remove the manager of two of its university hospitals.
Health News Florida:
Negotiating Power Shifts As Florida Hospitals Consolidate
A new analysis of Florida’s health care markets finds that as the state’s hospitals consolidate and expand, new business models are shifting the negotiating power. “You have at least three major hospital systems in the state moving in the direction of becoming statewide hospital systems,” says Allan Baumgarten, the health care finance analyst behind the latest Florida Health Market Review. (Mack, 11/19)
The Associated Press:
Hospitals Appeal State Approval Of Tiered Health Care Group
A dozen medical groups are appealing the state's approval of a new alliance formed by its largest health insurer. The groups, including Capital Health Regional Medical Center, Trinitas Regional Medical Center and Virtua Health, filed their appeal against the Department of Banking and Insurance on Thursday in Superior Court. They say the department approved Horizon Blue Cross Blue Shield's OMNIA Health Alliance without holding public hearings, among other objections. (11/19)
The Associated Press:
Judge Rules Against LSU In Effort To Remove Hospital Manager
LSU's lawsuit seeking to oust the operator of its university hospitals in Shreveport and Monroe was thrown out Thursday by a state district judge who said the breach-of-contract filing was premature. Judge Todd Hernandez agreed with the hospitals' manager, Biomedical Research Foundation of Northwest Louisiana, that LSU didn't follow contract provisions for working to repair problems before declaring a breach. (Deslatte, 11/20)
Few Iowa Hospitals, Doctors Appear To Sign Contracts With Privatized Medicaid Program
In other Medicaid news, New Mexico lawmakers are contemplating cuts in various health and social programs to boost funding for Medicaid.
Des Moines Register:
Branstad Touts Medicaid Contracts, But Few Hospitals Signed
Gov. Terry Branstad, who is pushing to shift management of the state’s Medicaid program to private companies on Jan. 1, said Thursday that the firms have signed more than 12,000 contracts with pharmacies, doctors and other health care providers. But most Iowa hospitals and physicians have not signed contracts to participate in the new system, according to the Department of Human Services. The issue is important, because the managed-care companies are supposed to show they have broad networks of health care providers willing to care for the new plans' members. (Leys, 11/19)
Santa Fe New Mexican:
Lawmakers Back Cuts Elsewhere To Boost Medicaid
Legislative Finance Committee members are urging fellow lawmakers to cut spending for indigent health care and other purposes — such as drug courts — so the state can increase Medicaid funding. State Medicaid program managers are requesting $1.1 billion — or an increase of $86 million — for Medicaid funding in fiscal year 2016-17. The money would help pay for an expansion of Medicaid, covering New Mexico residents who formerly were not eligible. A report by the finance committee’s staff said the expansion would cost $43 million more by 2016-17 and up to $163 million more by 2020. (Nott, 11/19)
Okla. Gov. Urges State To End Medicaid Contracts With Planned Parenthood
Republican Gov. Mary Fallin has asked the Oklahoma Health Care Authority to terminate contracts with the reproductive health organization's affiliates in Oklahoma City and Tulsa.
Reuters:
Oklahoma Governor Wants Funding Cut To Planned Parenthood Affiliates
Oklahoma Governor Mary Fallin, a Republican, has requested that the state's Health Care Authority cut its contracts with two Planned Parenthood affiliates, citing high rates of billing errors, her office said on Thursday. Fallin's request comes as Republican governors of several states have moved to cut funding for Planned Parenthood after an anti-abortion group released videos that it said showed Planned Parenthood officials negotiating prices for fetal tissues from abortions it performs. (Krehbielf-Burton, 11/19)
The Associated Press:
Oklahoma Governor Seeks End Of Planned Parenthood Contracts
Oklahoma Gov. Mary Fallin is calling on the state to cancel its Medicaid contracts with Planned Parenthood, citing what she called a “high rate of billing errors.” The governor announced Thursday that she’s asking the Oklahoma Health Care Authority to terminate contracts with two Planned Parenthood affiliates in Oklahoma City and Tulsa. (11/19)
A selection of health care stories from Florida, South Dakota, Illinois, Massachusetts, Michigan, Missouri, Washington, Pennsylvania, Nevada and Maine.
Health News Florida:
Needle Exchange Program Gets Senate Backing
A Senate panel Wednesday unanimously approved a bill that would create a pilot needle-exchange program in Miami-Dade County to try to stem the spread of HIV and other infectious diseases. The Senate Health and Human Services Appropriations Subcommittee supported the measure (SB 242), filed by Sen. Oscar Braynon, D-Miami Gardens. Under the proposal, the University of Miami and its affiliates would run a program allowing intravenous drug users to exchange used needles and syringes for clean needles and syringes. (11/19)
The Associated Press:
Avera Health Buying The Dakotacare Health Insurance Company
Regional health system Avera Health announced Thursday that it plans to buy the Dakotacare health insurance company, creating what it said would be the second-largest health insurer in South Dakota. The two Sioux Falls-based companies said customers wouldn't experience any change in service or access to hospitals, pharmacies or doctors. Avera said the deal allows it to expand its insurance to cover not only its facilities, but to offer choice-base plans, which allow patients to choose any heath care provider in the state. (Lammers, 11/19)
Reuters:
Illinois Home Health Company Must Face Whistleblower Case: Judge
A whistleblower lawsuit accusing Illinois home healthcare company Home Bound Healthcare Inc of Medicare fraud can move forward, a federal judge has ruled. Ruling Tuesday on a motion to dismiss, U.S. District Judge Thomas Durkin of the Northern District of Illinois allowed federal whistleblower claims to proceed, though he threw out similar state law claims, as well as those alleging violations of federal anti-kickback law. (Pierson, 11/19)
STAT:
'No Way Out': As Patients Turn Violent, Doctors And Nurses Try To Protect Themselves
Conflicts between clinicians and patients and their family members have leapt onto the radar of health care administrators and policy makers this year. That’s partly the result of a traumatic episode in January in which a beloved Boston cardiac surgeon was killed by the son of a deceased patient. But it’s also because patient-on-clinician violence is on the rise, according to federal statistics. (Tedeschi, 11/19)
Detroit Free Press:
Commissioners Alter Controversial Health Care Perk
A controversial perk that guaranteed lifetime health care benefits to a select group of Wayne County retirees is being altered, and not to the administration's liking, according to the Wayne County Commission. The perk, known as Amann benefits, provides lifetime health care benefits for a group of employees who were appointed by former Wayne County Executive Robert Ficano. (Lawrence, 11/20)
Heartland Health Monitor:
Data Shows Gains In KC Health Outcomes But Still Room For Improvement
Last month the Robert Wood Johnson Foundation recognized Kansas City for its efforts to improve public health with its Culture of Health prize. Now a newly released report by the Big Cities Health Coalition comparing health outcomes in the country’s 26 biggest cities offers a boatload of data suggesting Kansas City has made strides in many areas but lags in others. (Margolies, 11/19)
Heartland Health Monitor:
KCMO Set To Raise Tobacco Age To 21
A Kansas City Council committee on Wednesday approved three anti-smoking measures that critics said wrongly include electronic cigarettes and premium cigars. Taken together, the three ordinances would raise the legal age for purchasing tobacco products and e-cigarettes in Kansas City, Mo., from 18 to 21 and add e-cigarettes, also known as vapes, to the city’s ban on indoor smoking, including in so-called vape shops that sell them. (Sherry, 11/19)
The News Tribune:
Pierce County Bans E-Cigarettes For Minors, Vaping In Public
As of January, it will be illegal for minors to possess electronic cigarette products, and vaping largely will be subject to restrictions imposed in the [Washington] state’s decade-old ban on smoking in public places. In a Wednesday meeting that included more than an hour of public testimony on the subject, the Tacoma-Pierce County Board of Health voted 5-0 to give Pierce County new restrictions on e-cigarette use in public places, including requiring vapor stores to buy permits to operate. (Nunnally, 11/18)
The Milwaukee Journal-Sentinel:
Groups Protest Trials With Medical Residents Working 28 Hours Straight
Two organizations are demanding an investigation into what they say are unethical clinical trials that have required medical residents around the country, including those at the Medical College of Wisconsin and the University of Wisconsin Hospital and Clinics, to work up to 28 hours or more at a time. The groups claim the trials have exposed the residents to sleep deprivation, depression and the risk of motor vehicle accidents, needle stick injuries and exposure to blood-borne pathogens while subjecting their patients to increased risk of medical errors, including potentially fatal ones. (Fauber, 11/19)
The Philadelphia Inquirer:
Phila. To Ban Smoking At Psychiatric Hospitals
Thousands of people who are hospitalized with mental illness in the Philadelphia region will soon experience what has long been the reality for everyone else: living smoke-free. All psychiatric hospitals that have contracts with the city must ban all forms of tobacco, inside and outdoors, among patients and staff, on Dec. 14. All but one is including visitors in the policy, as well. The conventional wisdom is that banning smoking could make matters worse by, among other things, aggravating behavioral problems. (Sapatkin, 11/18)
The Philadelphia Inquirer:
Pa. Leads Nation In Young Men's Overdose Deaths, N.J. 4th
Pennsylvania leads the nation - and New Jersey is fourth - in drug overdose deaths among young adult men, according to a new analysis, raising the level of urgency about an epidemic that over the last decade has killed more than twice as many Americans as homicide. Bucks and Gloucester Counties led their respective states in overdose fatality rates among males ages 19 to 25 - each of them nearly three times Philadelphia's rate. In the eight-county region, more than 100 young men a year are dying from overdoses of both illicit and legal drugs. (Sapatkin, 11/20)
The Associated Press:
Nevada Court Tells Hospital Not To Pull Plug In Reno Case
The Nevada Supreme Court ruled Thursday that a Reno hospital must keep a 20-year-old comatose college student on life-support, pending a review of the legality of a medical standard used to determine she was brain dead. The unanimous ruling granting an appeal by Aden Hailu's father returned the case to Washoe County District Court for hearings about whether American Association of Neurology brain death guidelines cited by Saint Mary's Regional Medical Center doctors conform to Nevada's Determination of Death Act. (Ritter and Sonner, 11/20)
The Associated Press:
Cancer Patient's Lawyer Says She Can Get Marijuana In Maine
A woman with late-stage lung cancer could get medical marijuana in Maine if New Hampshire health officials issue her an identification card saying she's eligible before the state opens its own dispensaries, her lawyer said Thursday in court documents. Linda Horan wants a judge to order the state to grant her a medical marijuana ID card now so she can buy marijuana legally in Maine. Lawyers for the state argue that would undermine New Hampshire's need to control distribution. (11/19)
Research Roundup: Long-Term Care Financing; Hospitals' EHRs; Doctors' Views Of Health Law
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Health Affairs:
Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending
Under current policies, ... individuals [needing long-term care services and supports (LTSS)] will fund roughly half of their paid care out of pocket. ... [R]elatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. ... [W]e looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. ... If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial. (Favreault, Gleckman and Johnson, 11/16)
Health Affairs:
Electronic Health Record Adoption In US Hospitals: Progress Continues, But Challenges Persist
We used 2008–14 national data ... to examine hospital [electronic health record] EHR trends. We found large gains in adoption, with 75 percent of US hospitals now having adopted at least a basic EHR system — up from 59 percent in 2013. However, small and rural hospitals continue to lag behind. ... We also saw large increases in the ability to meet core stage 2 meaningful-use criteria (40.5 percent of hospitals, up from 5.8 percent in 2013); much of this progress resulted from increased ability to meet criteria related to exchange of health information with patients and with other physicians during care transitions. ... Our findings suggest that nationwide hospital EHR adoption is in reach but will require attention to small and rural hospitals and strategies to address financial challenges. (Adler-Milstein et al., 11/11)
JAMA/The Kaiser Family Foundation:
Experiences And Attitudes Of Primary Care Practitioners After The ACA
Based on a survey of primary care clinicians in early 2015, this Visualizing Health Policy infographic examines the experiences and attitudes of primary care practitioners ... after the Affordable Care Act’s (ACA’s) major coverage provisions took effect in January 2014. ... [T]heir opinions about the health care law are sharply divided along political party lines. Generally, primary care physicians have a more negative view of health reform’s effect on the cost of patient care, but a more positive view of the law’s impact on patient access .... About 6 of 10 primary care clinicians say they’re seeing more newly insured patients or patients covered by Medicaid .... Large shares — 66% of nurse practitioners and physician assistants and 50% of physicians — report that they’re currently accepting new Medicaid patients. (Hamel et al., 11/17)
The Urban Institute/Robert Wood Johnson Foundation:
More Than 10 Million Uninsured Could Obtain Marketplace Coverage Through Special Enrollment Periods
Enrollment in health insurance marketplaces is generally limited to annual open enrollment periods (OEPs). However, some events, such as termination of health coverage due to job loss, can qualify consumers for special enrollment periods (SEPs) that let them sign up for marketplace plans at other times. We estimate [that about] 12.9 million people could enroll using SEPs who would otherwise lose coverage and be uninsured at the end of the year ... [and] [a]n additional 20.6 million could use SEPs to prevent temporary coverage gaps. ... Based on an August 2015 report from the Centers for Medicare and Medicaid Services (CMS), we estimate that fewer than 15 percent of these uninsured consumers are enrolling through SEPs for which they qualify. (Buettgens, Dorn and Recht, 11/17)
The Kaiser Family Foundation:
Women’s Health Insurance Coverage
Among the 97.5 million women ages 19 to 64 residing in the U.S., most had some form of coverage in 2014. However, gaps in private sector and publicly-funded programs left almost one in eight women uninsured. ... This factsheet reviews major sources of coverage for women residing in the U.S. in 2014, the first full year of the Affordable Care Act’s (ACA’s) major coverage expansion, and discusses the likely changes and impact of the law on women’s coverage in future years. (11/11)
Here is a selection of news coverage of other recent research:
Reuters:
Texas Law Leads To More Attempts At Self-Induced Abortions: Study
A Texas law aimed at restricting abortions, which took effect in 2013, has led to more women trying to end a pregnancy on their own, while the number of clinical procedures in the state has declined, according to a study released on Tuesday. The study showed that poor women bear the brunt of the law. "Poverty, limited resources, and local facility closures limited women's ability to obtain abortion care in a clinic setting and were key factors in deciding to attempt abortion self-induction," the Texas Policy Evaluation Project found. (Herskovitz, 11/17)
The Associated Press:
Rare TB Case Shows Difficulty Diagnosing, Treating Children
When a 2-year-old returned sick from a visit to India, U.S. doctors suspected tuberculosis even though standard tests said no. It would take three months to confirm she had an extreme form of the disease — a saga that highlights the desperate need for better ways to fight TB in youngsters in countries that can't afford such creative care. Drug-resistant tuberculosis is a global health threat, and it's particularly challenging for young children who are harder even to diagnose, much less treat. Doctors at Johns Hopkins Children's Center are reporting how they successfully treated one of the few tots ever diagnosed in the U.S. with the worst kind — extensively drug-resistant TB, or XDR-TB, that's impervious to a list of medicines. (11/16)
NBC News:
Women Still Spurn Most Effective Types Of Birth Control, CDC Finds
American women are still spurning the most effective methods of birth control in favor of the pill and sterilization, government researchers said Tuesday. But women almost universally use birth control of some sort, with 60 percent of women currently using contraception and 99 percent of women who have ever had sex having used it at some point, the team from the National Center for Health Statistics found. (Fox, 11/10)
Reuters:
Advising People About Heart Risk Genes Helped Cut Cholesterol: Study
People who were told their genetic risk for heart disease had lower levels of LDL, the so-called bad cholesterol, six months later, according to a new study that offers a first glimpse of how doctors might use genetic information in clinical practice. In the study presented on Monday at the American Heart Association meeting in Orlando, Florida, researchers at Mayo Clinic in Rochester, Minnesota, tested the theory that incorporating genetic risk information into an assessment of a person's heart disease risk could lead to lower levels of LDL, the portion of cholesterol that leads to heart attacks and strokes. (Steenhuysen, 11/9)
Views On UnitedHealthcare: Surprise Announcement Likely Won't Tank Marketplaces
Although the insurer's announcement that it might pull out of the health law's insurance exchange was a surprise, many commentators say such a move would have only small repercussions on the market. They point out, however, that it might be a catalyst for changes in the operations.
Bloomberg:
What UnitedHealth Doesn't Mean For Obamacare
UnitedHealth Group, the country's largest health insurer, says it might stop selling plans on state insurance exchanges, citing higher-than-expected costs. This news would be mostly unremarkable except for the fact that those state exchanges are part of Obamacare, and it doesn't take much to get people hyperventilating about the imminent death of Obamacare and speculating about its ramifications for the 2016 presidential campaign. Sorry to disappoint, but UnitedHealth's decision -- which is tentative -- doesn't mean much. The company covers less than 6 percent of the exchange population; if it does pull out, those people will be able to get other coverage. (11/19)
Los Angeles Times:
The Country's Largest Private Health Insurer Throws A 'Tantrum' Over Lower Profits
Will the company really quit the individual insurance market? Most experts I spoke with said this would be unlikely. "They're probably just sending a message," said Timothy McBride, a healthcare economist at Washington University in St. Louis. "They may be saying that to stay, they want to see higher premiums." If so, people buying insurance on Obamacare exchanges can look forward to paying more for coverage and being able to afford only policies with huge deductibles. That would be good for insurers and bad for patients, and it would represent yet another roadblock to creating a system that guarantees everyone access to affordable medical care. (David Lazarus, 11/19)
Bloomberg:
Obamacare Insurers Are Suffering. That Won't End Well.
Stephen Helmsley, the CEO of UnitedHealth, expressed concerns that the exchanges were seeing adverse selection anyway. Not just that the Obamacare insurance pool is sicker and more expensive than expected, which we already knew. But that the pool is experiencing adverse selection over the course of the year, as healthy people stop paying their premiums, and sicker people buy in. ... This is potentially extremely bad news for Obamacare. It may be that UnitedHealth simply had an especially bad experience, but with more than 500,000 people covered, that doesn’t seem actuarially likely. Which raises the worrying possibility that only two years in, people have figured out how to game the special enrollment process so that it’s safe for them to go without insurance, and then sign up for coverage if they get sick. (Megan McArdle, 11/19)
Huffington Post:
Bad Obamacare News Is Real. That Doesn't Mean Obamacare Is Dying.
The Affordable Care Act has already accomplished a great deal -- slashing the uninsured rate and providing millions with consumer protections like the guarantee of coverage regardless of preexisting conditions. But enrollment could stagnate. So what would happen then? It's impossible to be certain, but many experts think the subsidies would function as a built-in safeguard against a severe market collapse -- “the news about United does not presage a death spiral,” [Jon] Kingsdale said .... But the law’s architects and supporters had hoped enrollment would continue growing beyond where it is today .... If enrollment stalls, the law would still be helping millions of Americans, but it would also be coming up short of expectations. (Jonathan Cohn and Jeffrey Young, 11/20)
Forbes:
UnitedHealth's Warning Shows How Medicaid Is Taking Over Obamacare
United’s move follows data showing that the commercial insurers have largely scaled back their offerings, and taken significant price increases on their Obamacare plans, to offset losses that they’ve been taking on the exchanges. ... Meanwhile, it’s the Medicaid managed care companies that are growing the number of plans they market on the exchanges. They are also offering the best prices. The cheap health plans that they end up selling on the exchanges mirror what they offer in Medicaid – in terms of the skinny doctor networks, the closed drug formularies, as well as the basic design of the austere health coverage. In short order, Obamacare is evolving into a Medicaid marketplace. (Scott Gottlieb, 11/19)
Viewpoints: Concerns About Cures Act; Measuring Poverty; Make Dads Take Paternity Leave
A selection of opinions on health care from around the country.
The Washington Post:
The 21st Century Cures Act Could Be A Harmful Step Backward
Precision medicine is the next big thing in health care, and it’s also one of the few health goals that Congress and the White House agree on. But while we await treatments targeting the precise genetic makeups of individuals and diseases, medical researchers still are not paying enough attention to the most important kinds of differences among patients: those of sex, age and race. A clear example of this disconnect is the 21st Century Cures Act. (Susan F. Wood, and Diana Zuckerman, 11/19)
The Wall Street Journal:
Hounded Out Of Business By Regulators
[LabMD's] work required securely storing personal-health data and medical records in compliance with Health and Human Services Department regulations under the Health Insurance Portability and Accountability Act, often known as HIPAA. ... in May 2008, LabMD was contacted by Tiversa, a company that describes itself as a “world leader in P2P cyberintelligence,” alleging that it had found on the Internet a LabMD insurance-agent file containing the names, dates of birth and Social Security numbers of about 9,000 patients. ... the company demanded a fee of $40,000 to mitigate the situation. After leading its own thorough review that turned up no sign that any patient information had been exposed online, LabMD refused to pay. Little did it know that this would lead to a yearslong fight with the federal government that would bring down the company. (Dan Epstein, 11/19)
The Wall Street Journal:
Mismeasuring Poverty
Here’s good news for policy makers—on the right and left—concerned about poverty in the United States. A new study by economists Bruce Meyer of the University of Chicago and Nikolas Mittag of Charles University shows that public-assistance programs are far more effective in alleviating poverty than many government statistics suggest. The problem lies in the way the U.S. Census Bureau measures poverty. According to the bureau’s website, the government’s “official poverty definition uses money income before taxes and does not include capital gains or noncash benefits (such as public housing, Medicaid, and food stamps).” This has long been known to underestimate income sources and material well-being in low-income households. (Robert Doar, 11/18)
The Richmond Times-Dispatch:
The Medicaid Dilemma
Virginia Republicans made a mistake when they tried to spin a recent report on Medicaid inefficiency as a reason to continue opposing Medicaid expansion. But they stand on firmer ground when they point with alarm to a recent spike in Medicaid costs. Surging enrollment — 50,000 new enrollees in the past five months — will drive up the program’s cost to the commonwealth by just under $1 billion. That likely will squeeze out new spending on everything from education to state parks. (11/19)
Los Angeles Times:
We Should Look Less Hard For Cancer
There's a new cancer treatment strategy in the news: Wait and see. Time magazine ran a cover story on simply watching small breast cancers; the Wall Street Journal similarly reported on watching small thyroid cancers. So-called watchful waiting has been a long-standing option for early prostate cancers. (H. Gilbert Welch, 11/19)
Bloomberg:
Shrink The Gender Gap: Make Dads Take Leave
Talk to any executive at any large organization about gender equality and at some point they'll give the same reason/make the same excuse (take your pick) for the disparities between how men and women are treated in the workplace: Pregnancy. So maybe it's time to impose mandatory male parental leave to de-stigmatize pregnancy breaks to help crack the glass ceiling. (Mark Gilbert, 11/20)
Los Angeles Times:
Do We Have The Will To Stop TB?
Doctors swear to do no harm, but I knew I was about to inflict great suffering on my patient Gary, who had been diagnosed with extensively drug-resistant tuberculosis, or XDR TB. Many people wrongly assume that tuberculosis has been eradicated. In fact, according to the World Health Organization, tuberculosis killed more people in 2015 than HIV/AIDS. The strain affecting Gary is difficult to cure. Eighty percent or more of patients with XDR-TB die of their disease. There is grueling, toxic treatment available, but it doesn't guarantee a cure. Gary would be facing permanent nerve damage. Constant nausea. Kidney damage. Hearing loss. He would have to take 10 to 12 drugs at a time for almost a year, and his follow-up treatment would last for another two years. (Caitlin Reed, 11/18)
The New England Journal of Medine:
Graduate Medical Education In The Freddie Gray Era
Freddie Gray, a 25-year-old black man, died on April 19, 2015, from injuries he sustained while in the custody of the Baltimore Police Department. The details of his arrest spurred protests over the unjust treatment of black Americans by the police. As directors of an urban internal medicine residency program in Baltimore, we sought strategies to help our residents, faculty, and staff process these events and their social context. Inspired by our residents' desire to improve our hospital's neighborhood, we intend to translate their sense of urgency into meaningful action, in part by revising our curriculum to emphasize physicians' responsibility for improving community health. (Sammy Zakaria, Erica N. Johnson, Jennifer L. Hayashi and Colleen Christmas, 11/19)
Real Clear Health:
Congress Should Say No To Cutting Drug Subsidies For Low-Income Seniors
President Barack Obama and congressional appropriators are looking for savings to offset new federal spending programs. One proposal on the table – drawn from the president's budget plan – would disproportionately impact low-income seniors who rely on prescription medications for serious medical conditions. The measure, estimated to save $8.9 billion over ten years, would increase copayments for brand name drugs for Medicare Part D beneficiaries who receive extra financial assistance under the Low Income Subsidy (LIS) program. (Grace-Marie Turner, 11/20)
JAMA:
Engaging Patients Across The Spectrum Of Medical Product Development
The complex tasks of developing, evaluating, and determining the appropriate use of medical technologies occur in an evolving ecosystem of diverse stakeholders. However, as new medical therapies and diagnostics are designed and tested, the preferences and views of the patients and care partners who are most directly affected by these treatments are all too often overlooked. Individual patients often experience different effects of diseases and may have unique preferences about treatments or diagnostic procedures that differ from those of other patients or of their physicians or other health care practitioners; they may also have differing views about what kinds and degrees of risk are tolerable. ... Programs recently enacted at the US Food and Drug Administration (FDA) are focused on including patient perspectives throughout the continuum of medical product development. (Nina L. Hunter, Kathryn M. O’Callaghan and Robert M. Califf, 11/19)
The New England Journal of Medicine:
Measuring The Value Of Prescription Drugs
Escalating drug prices have alarmed physicians and the American public and led to calls for government price controls. Less visibly, they have also spawned a flurry of private-sector initiatives designed to help physicians, payers, and patients understand the value of new therapies and thus make better choices about their use. Programs recently introduced or advanced by nonprofit organizations, including leading medical professional societies, represent an important innovation in the United States, but they have also revealed numerous analytic and implementation challenges. (Peter J. Neumann and Joshua T. Cohen, 11/18)
The New England Journal of Medicine:
Value-Based Cancer Care
In June 2015, the American Society of Clinical Oncology (ASCO) published a proposed framework for assessing the value of various cancer treatments. The goal was to evaluate selected treatment regimens on the basis of their clinical benefit, toxicity, and cost. ... the cost of cancer care has been growing rapidly: though it accounts for a relatively small portion of overall U.S. health care expenditures, it is expected to increase from $125 billion in 2010 to $158 billion in 2020. The costs of cancer drugs amount to only 5 to 20% of the total costs of cancer care, depending on how many of the multiple cost components are included. But the average cost of some newer cancer drugs is now $10,000 to $30,000 per month. ... The costs of copayments, out-of-pocket expenses, and rising insurance premiums exceed many patients' capacity to pay. (Robert C. Young, 11/18)