Hedging Their Bets, Insurers Setting Up Health Insurance Exchanges

February 22nd, 2012

Health insurance companies are trying to play an important role in healthcare reform as the Patient Protection and Affordable Care Act (ACA) threatens to upend their marketplace in 2014 by creating their own exchanges. Health plans are trying to lock in business before government-sponsored health insurance exchanges go online in 2014.  According to Kaiser Health News and reported by Minnesota Public Radio, the largest insurers are creating their own private insurance exchanges to protect themselves against competition from the public exchanges.

The implementation of the ACA is the most significant change to healthcare since Medicare and Medicaid came on line in the 1960s – and the impact for health insurers is virtually unfathomable.  Less than two years from today, the federal healthcare law will bring more restrictions on premium increases, millions of new customers, and the ability for consumers to comparison shop online for the best deal on their health insurance.

According to Sabrina Corlette, research professor at Georgetown’s Health Policy Institute, these are just some of the changes coming in 2014. Just how insurance markets will shake out is anyone’s guess, she said.  “Insurance companies are grappling with the uncertainty like everybody else and trying to look two years down the road and how to position themselves,” Corlette said.  “(What) also needs to be watched closely (is) that it’s working for the consumer.”

According to the Obama administration, 28 states are in the process of establishing insurance exchanges under the ACA, despite multiple lawsuits and a spring date with the Supreme Court.  Fourteen states, including some with Republican governors, have passed legislation or have the authority in place to set up the regulated insurance markets, according to a report by the Department of Health and Human Services (HHS).  Other states have passed executive orders or authorized studies to demonstrate the value of exchanges.  The goal is to bring coverage to 16 million uninsured Americans in 50 states and the District of Columbia.

In their most recent demonstration of progress in health reform, administration officials promised to provide assistance to states that miss the 2013 deadline to ensure their participation.  “We’re going to meet states where they are, and…we’re going to work with them to get them as far down the path as we can,” said an anonymous administration official.

According to the report, some states such as Nevada, Alabama, Mississippi, all with Republican governors, and others are making significant progress.  The irony is that many of these “red” states are also suing the administration over the ACA’s constitutionality.

How does a red state that has taken a lead in lawsuits against the ACA reconcile these differences?  Writing in the Richmond Times Dispatch, Michael Martz says that “Six bills have been filed in the legislature proposing varying ways to set up a benefits exchange, which is required under the federal healthcare reform law that (Governor Bob) McDonnell opposes and the state hopes to overturn in the U.S. Supreme Court.  But the governor is discouraging legislators from approving any of the bills during this session, despite looming federal deadlines that some lawmakers and insurers fear will leave Virginia with a less-competitive federal exchange for individuals and small businesses to buy health benefits.  The state would have to submit a plan for the exchange this year to the U.S. Department of Health and Human Services (HHS) no later than January 1, 2013, to ensure that the entity can begin operating a year later.”

“There is plenty of time to act,” the McDonnell administration said in a series of “talking points” on why legislation is not currently needed.  “There is no need for members of the General Assembly to make untimely and unnecessary decisions surrounding creation of an exchange during the 2012 session.”

Donna Jarmusz

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States Want Feds to Move Faster on ACA Rules

February 21st, 2012

Although the Patient Protection and Affordable Care Act’s (ACA) major provisions don’t go into effect until 2014, states and insurers must be prepared to enroll some 32 million Americans who currently lack insurance coverage into Medicaid or private insurance programs.  According to Kaiser Health News, the fly in the ointment is that to successfully unveil their individual programs in just two years, the states must make important crucial decisions and take actions this year.

It will be difficult for many states to meet fast-approaching deadlines, and some may not make it, said Brett Graham, managing director at Leavitt Partners, a consulting firm.  Two years is surprisingly brief and many states need information from the federal government detailing the various insurance exchange options and precisely which benefits must be included in health plans.  Complicating the situation is the fact that states are competing for a limited pool of information technology vendors to give them the help they need.  “It’s a pressure cooker,” said Graham. States are “in a position where they have to act with imperfect information.”

Next New Year’s Day, the Department of Health and Human Services (HHS) will certify which states are ready to run their own exchanges.  To earn certification, a state must put in place laws to fund the exchanges’ continuing operations.  While the federal government is providing financial help up front for the creation of exchanges, states will assume the cost once they are underway.  HHS can issue a conditional certification for those states that are making progress but need more time.

Only 14 states and the District of Columbia have made significant legislative progress toward creating exchanges, according to a Robert Wood Johnson Foundation report prepared by the Urban Institute. The study’s authors reach the conclusion that because of the ACA, the percentage of the population that is uninsured will decline in all 50 states and Washington, D.C.

While some states are aggressively moving forward, “at the other end are states that say, ‘no way, no how, we’re not doing it.’  Montana, Texas, Louisiana, Florida, they are not going to build it and they’re playing a game of chicken,” said Graham.  “They’re waiting for the Supreme Court,” hoping it will declare the ACA unconstitutional in June.

The majority of states cannot make up their minds about whether to build their own exchanges and or participate in the proposed federal model. It’s ironic that some states that are participating in the Supreme Court challenge have taken action: Colorado, Washington and Nevada have set up exchanges.

According to the Robert Wood Johnson/Urban Institute report, “Without action by these states, their populations will still benefit from health reform through the expansion of Medicaid/CHIP, but will have to rely on the federal government to create exchanges, as called for under the ACA.  This creation will be dependent on adequate federal resources and political support.”

According to the Robert Wood Johnson Foundation and the Urban Institute, 15 states have made “little or no progress” implementing insurance exchanges where individuals and small businesses can buy private insurance.  The states that haven’t started working on creating exchanges are among the states with the most residents eligible for federal subsidies to help buy insurance.  According to the analysis, the federal government has the ability to establish and run a substitute in any state that does not establish its own exchange.

Creating a full or partial federal exchange also could be a problem, although some healthcare analysts are unsure whether it will be any easier for the federal government.  It faces the same brief timeline as the states.  While Obama administration officials say they have the money to fund exchanges, many healthcare analysts aren’t so certain.  Most state legislatures will adjourn for the year by March or April — before the Supreme Court hands down its ruling — according to the National Conference of State Legislatures.  Special sessions after the ruling would be virtually impossible in an election year.

John Driscoll

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New York Controversy Emerges Over Food Portion Size Campaign

February 20th, 2012

The New York City Department of Health recently launched a campaign to get New Yorkers to make their waistlines smaller by controlling their portion sizes when ordering food and beverages. “Consuming too many calories can lead to weight gain,” said city Health Commissioner Thomas Farley.  “If New Yorkers cut their portions, they can cut their risk.”  The “Cut your portions. Cut your risk” campaign is billed as “hard-hitting” and has the purpose of making certain that people understand that large meals cause obesity.  Even worse, obesity can cause diseases like diabetes.  In one city poster, a man whose leg has been amputated because of Type 2 diabetes sits behind a graphic showing how soft drink portions have grown over the years.

Over the last 40 years, according to the Health Department, serving sizes for sugary soft drinks have grown four times, and the amount of French fries in a single order has tripled.  As a result, “a single meal could balloon to contain many more calories than the amount an adult needs for an entire day” – roughly 2,000.

Writing on the friendseat.com blog, Spence Cooper takes a more cynical attitude. “The number of New Yorkers motivated to make healthier choices and forgo that next order of large fries because of ad nauseam public service ads is equal to the number of New York smokers who pay attention to the warnings on cigarette packs. You can count them on one hand.”

The new posters, available in both English and Spanish, bear the message “Cut your portions. Cut your risk,” providing New Yorkers with a clear strategy for preventing obesity and its health penalties.  While the City has made strides in combating the nationwide trend of growing obesity, the majority of adult New Yorkers (nearly 57 percent) and two out of every five New York City elementary school children remain overweight or obese and the health consequences are dire, ranging from hypertension to type 2 diabetes.  Nearly 10 percent of New Yorkers have been told they have type 2 diabetes, which can lead to blindness, kidney failure and amputations. In 2006, nearly 3,000 New Yorkers with diabetes were hospitalized for amputations. Obese children and adolescents also are more likely to become obese adults. Even while young, they are more likely to develop obesity-related conditions such as high cholesterol, high blood pressure, and type 2 diabetes.”

Not all are in agreement with Farley’s campaign. The New York ads create an “inaccurate picture” of the impact of soft drinks, argues Stefan Friedman, a spokesman for the American Beverage Association.  “Portion control is indeed an important piece of the solution to obesity,” he said. “Instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and new calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families,” he said.

The posters are appearing on subway stops around the city for the next three months. Mayor Bloomberg dismissed his critics who claim that the ads were too graphic and disturbing:  “What do you want to do? Do you want to have people lose their legs or do you want to show them what happens so that they won’t lose their legs? Take your poison. Which do you want?” said Bloomberg.

Many healthcare experts agree with Bloomberg. “Obesity rates in adults rose to 35.7 percent from 30.5 percent between 1999 and 2010, compared with rates that nearly doubled in the two previous decades, the Centers for Disease Control and Prevention (CDC) reported . The rate among boys climbed 29 percent, surpassing girls for the first time, according to the CDC.

More than 78 million American adults — as much as  one third of the population, and about 12.5 million children were considered obese in 2009- 2010, according to a series of studies reported in the Journal of the American Medical Association. The studies are part of a continuing CDC effort to track obesity rates with new numbers every two years.

John Driscoll

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Planned Parenthood, Susan G. Komen For the Cure Disagree, Then Make Up

February 14th, 2012

After setting off a firestorm by threatening to cut funding to Planned Parenthood, the founder and CEO of Susan G. Komen For the Cure — the nation’s largest breast-cancer advocacy agency — backtracked and promised to amend the criteria.  “We will continue to fund existing grants, including those of Planned Parenthood, and preserve their eligibility to apply for future grants,” Nancy G. Brinker said.  “We want to apologize to the American public for recent decisions that cast doubt upon our commitment to our mission of saving women’s lives.”  According to Brinker, the decision was not “done for political reasons, or specifically to penalize Planned Parenthood.”

Planned Parenthood president Cecile Richards expressed gratitude and said her agency could resume longstanding relations with Komen and that she anticipated continuing to receive ongoing funding.  “I really take them at their word that this is behind us,” according to Richards.  She gave credit to an outpouring of support, especially on social media sites, with forcing the reversal.  In just three days, Planned Parenthood raised $3 million and acquired 10,000 new Facebook supporters, Richards said.

Komen executives insisted that their decision was not compelled by pressure from anti-abortion groups.  Planned Parenthood said its national network of health centers performed more than four million breast exams over the last five years, including nearly 170,000 paid for by Komen grants.  The grants totaled $680,000 in 2011.  As the controversy developed, Planned Parenthood received $400,000 in smaller donations from 6,000 people, as well as a $250,000 pledge from New York Mayor Michael Bloomberg to match future donations.  Komen was flooded with negative emails and Facebook posts, accusing it of bowing to pressure from anti-abortion groups.

Although the dispute between the two sides appears to have reached an amicable solution, the debate continued as Carol Tobias, president of National Right to Life Committee, said Komen’s decision to reverse its decision will almost certainly cost the group contributions.  “I think right now pro-lifers are going to be reluctant to support them because the money may go to the country’s largest abortion provider,” Tobias said.

According to Mike Paul, president of MGP & Associates, a reputation management firm, Komen will have to “build up trust” following the commotion.  Komen was the world’s most valuable non-profit brand, according to a 2010 report by market-research firm Harris Interactive.  Now, the Komen brand could become a subject for political debate, Paul said.  “People wanted to be associated with every single thing they did,” he said.  “And now we hear politics and policy has influence.  The same affinity people had on the positive side became the same affinity they’ve having on the negative perspective,” he said.

“Politics should never come between women and their healthcare, and I am very glad that Komen did the right thing and reversed their misguided and deeply damaging decision,” Senator Patty Murray (D-WA), said.  Taking an opposite position was Senator David Vitter (R-LA), who originally applauded the move.  Commenting on Friday’s announcement, Vitter said that “While Komen now claims that they don’t want their mission to be ‘marred by politics,’ unfortunately it seems that Komen caved to political pressure from the pro-abortion movement and its enforcers in the media.”

The backlash is still adversely affecting the Susan G. Komen organization. Many long-time donors, irked by the foundation’s decision to pull their funding from Planned Parenthood, have said they’ll no longer give to the organization.  Others, disappointed that the decision was reversed, also will no longer provide financial support.  Melissa Berman, president and CEO of Rockefeller Philanthropy Advisors, is optimistic that the foundation will eventually recover.  “They changed their mind pretty quickly, and so they’re going to be able to make a recovery here,” Berman said.  “Susan G. Komen will have to tell the story of how many women they reach, how many women get access to care, how many women participate in their events, how much research they’re funding.  They’ll just have to continue to tell that story clearly and concisely,” according to Berman.

Writing in Forbes, contributor Davia Temin says that “In one of the more bizarre series of actions I have ever witnessed, Susan G. Komen for the Cure completely compromised its sterling reputation by first caving in to one set of political pressures, and then another.  And in the process, they left us all wondering who these people really are, and what they stand for.”

“Although, in their somewhat grudging apology requesting that ‘everyone who has participated in this conversation…help us move past this issue,’ they clearly want to put the past week behind them, it will never happen.  At least not for a good, long time.  I bet the folks at Komen wish they could have a do-over.  Or that in true Groundhog Day movie fashion, they could replay the week over and over again until they got it right.  Reputational suicide is not too extreme to call it.  Because no one is happy with them now.  And the questioning from all sides will continue, and spill over to their every action.  On this one, I predict our memories will be long.”

Donna Jarmusz

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Hospitals, CMS Butt Heads Over Too Many Readmissions

February 14th, 2012

Medicare has plans to penalize hospitals that frequently readmit patients who really don’t need hospitalization. According to one estimate, this practice costs the federal government $12 billion every year.  Medicare’s goal is to persuade hospitals to be certain that patients get the care they need following their discharge.  This new policy is likely to excessively impact hospitals, particularly those that treat low-income patients, according to a Kaiser Health News analysis of data provided by the Centers for Medicare & Medicaid Services.  Hospitals that admitted the most underprivileged Medicare patients were approximately 60 percent as likely to have significantly higher readmission rates for heart failure.  At these hospitals, lower-income people comprise a larger share of the patients than they do at 80 percent of hospitals.

“When some of our patients get home, their lights and gas are shut off,” said Roland Abellera, vice president of quality and corporate compliance at St. Bernard Hospital in Chicago’s blighted Englewood neighborhood.  “So what ends up happening is that the ambulance brings them back to us and we have to house them until our staff can help them get the utilities turned on.  We have a community in need.”

Within 30 days of discharge, 25 percent of Medicare patients with heart failure are readmitted to the hospital.  The Patient Protection and Affordable Care Act (ACA) has ruled that beginning next October, Medicare will fine hospitals whose patients who have had heart attacks, heart failure or pneumonia return to the hospital too soon.  By 2014, hospitals with high readmission rates can potentially lose up to three percent of their Medicare reimbursements.

Medicare has set aside funds so hospitals can more effectively plan patients’ post-discharge care.  According to Patrick Conway, Medicare’s chief medical officer, some funds will be targeted to hospitals that serve significant numbers of poorer people.  “We especially are concerned about safety-net hospitals that take care of a high portion of patients in poverty and racial and ethnic minorities,” he said.  At the same time, his agency is committed to the readmission penalties, in part because it is the law and because it believes the penalties will persuade hospitals to be certain that patients get the follow-up care they need.

Some hospital administrators are concerned that the new policy is too harsh.  “In essence, they are penalizing those hospitals and areas that need the most help and the most money to address these issues because we have the sickest, most noncompliant and vulnerable patient population,” said Guy Alton, chief financial officer at St. Bernard.  According to Abellera, St. Bernard’s heart failure patients usually have more than one serious conditions, such as kidney failure, hypertension and diabetes.  “A patient does not come here for heart failure alone,” he said.  “They have no less than six or seven diagnoses — we’ve had many with more than that.”

Dr. Ashish Jha, in the latest New England Journal of Medicine, makes the case that readmissions aren’t the best gauge of unnecessary care — even though they’re a natural target for budget-cutters.  The Harvard University professor points out that many hospitals with the highest readmission rates serve the poorest areas with the biggest health problems.  “Readmissions are caused by what hospitals do, who the patients are, and what’s happening in the community,” he says. “You want hospitals to fix the things they can, but you don’t want to punish them for taking care of poor people, and you don’t want to punish them for being located in a poor area.”

Two of the most frequent reasons for hospital readmissions are medication errors and failure to see a physician – both of which could be reduced if patients were supervised through home care visits following discharge.

John Driscoll

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New HHS Program Seeks to Cure Alzheimer’s in 13 Years

February 13th, 2012

A national Alzheimer’s disease advisory council has set  preliminary goals and  recommendations for a national strategic plan to slow — or even bring to an end to — the expected rise in new cases as the baby boomer generation ages. The plan’s goal is to prevent and successfully treat the disease as soon as 2025. The objectives include enhancing care quality and efficiency, expanding patient and family support, enhancing public awareness and engagement, and improving data to track disease progress.

The plan is part of the National Alzheimer’s Project Act that was signed into law on recently by President Barack Obama. The law created the Advisory Council on Alzheimer’s Research, Care, and Services. The new law requires the secretary of the Department of Health and Human Services (HHS) and the advisory council to create and maintain a national plan to defeat Alzheimer’s.  Members of the council’s subgroups on long-term services and supports (LTSS), clinical care, and research are meeting to comment on and provide recommendations to formulate the plan’s draft framework.

The council’s members support alternatives to Medicare coverage and physician reimbursement to encourage the diagnosis of Alzheimer’s and provide care planning to individuals diagnosed with the disease and their caregivers. Additionally, quality indicators for the care and treatment of individuals with Alzheimer’s need to be formulated. The group proposed medical home pilot projects specifically designed to improve medical management for Alzheimer’s patients using grants from the Center for Medicare and Medicaid Innovation (CMMI).

More than five million Americans have been diagnosed with Alzheimer’s, a brain disease that causes dementia and affects primarily elderly people.  Some experts estimate that treating the disease costs the United States more than $170 billion annually.  Australia, France and South Korea already have comprehensive Alzheimer’s plans, and worldwide experts have been urging the United States to assume a leadership role.

“We want to demonstrate that as a country we are committed to addressing this issue,” Dr. Howard Koh, assistant secretary for health at HHS, said.  “We know the projected number of patients is expected to rise in the future.  We know there are far too many patients who are suffering from this devastating condition and it is affecting them and their caregivers,” Koh said.

Other experts believe that the 2025 deadline is too close and unrealistic.  “No one set a deadline for the ‘War on cancer’ or in the fight against HIV/AIDS.  We make progress and we keep fighting.  The same should be true for Alzheimer’s,” said Dr. Sam Gandy, an Alzheimer’s researcher at Mount Sinai School of Medicine.  “In my mind, that provides the unfortunate sense that we will have ‘failed’ if we don’t have a cure by 2025.”  The National Alzheimer’s Project Act provides no new funding for research.  Although some drug companies have compounds in clinical trials, researchers say they are just beginning to understand the complex disease, which develops without any symptoms for 15 to 20 years before any memory problems begin to show.  “This means that if we had, today, already in hand, the funding, recruitment and the perfect drug, the trial would still take 15 to 20 years,” Gandy said.

According to P.J. Skerrett, Editor of Harvard Health, “Like a powerful wave, the Alzheimer’s epidemic is expected to crest in 2050. At that time an estimated 16 million Americans will be living with this mind-robbing disease. (About 5.4 million Americans have Alzheimer’s Disease today.)  In an effort to head off the explosion, President Obama has signed into law the National Alzheimer’s Project Act.

This ambitious project aims to attack Alzheimer’s on several fronts:

  • Improving early diagnosis.  The brain changes that lead to Alzheimer’s disease probably begin years before memory loss and other problems appear. Earlier diagnosis could help families better plan for the future, and could be especially important if better treatments become available.
  • Finding effective prevention and treatment strategies.  Today’s treatments relieve symptoms for only a short time; none prevent or stop Alzheimer’s-related mental decline. New treatments that are more durable would be a huge boon to current and future Alzheimer’s sufferers.
  • Providing more family support.  Spouses and adult children are the primary caregivers for many people with Alzheimer’s disease. The day-to-day challenges of caring for someone with Alzheimer’s can be daunting. Many caregivers have no training and don’t know what resources are available to them. The project would provide better education and support for caregivers.” Skerrett said.

Jeff Newkirk

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Healthcare Providers Must Innovate to Trim Costs

February 8th, 2012

A top official from the Centers for Medicare and Medicaid Services (CMS) recommended that providers — including hospital executives — should research technology-driven changes in their systems with the goal of improving care and reducing costs.  “We need to decide now whether to make the commitment to adopt innovation that will fundamentally change the way we operate, change the way we deliver care, change the way we think about these organizations that we run,” Dr. Richard Gilfillan, acting director of the CMS’ Center for Medicare and Medicaid Innovation, said.  “This is not an abstract notion; this is a very concrete question that each of us will have to answer.”

Healthcare leaders who join in such an overhaul in their care delivery will likely find that the main obstacle is in changing how they are paid, Gilfillan said.  “We can ask people to keep folks from going back to the hospital, but if we pay health systems for putting more people in the hospital, we’ll get what we have today: a lot of hospital care,” he said.  Medicare will encourage private payers to change payment approaches by undertaking its own changes.  Specifically, Gilfillan said, once his office identifies payment practices that result in improved clinical outcomes and reduced spending, the HHS secretary will implement those throughout Medicare administratively.  “As you can see, this is a powerful tool for changing the way we deliver care,” Gilfillan said.

The large number of senior citizens covered by Medicare and low-income Americans covered by Medicaid suggests that any changes that serve those patients could soon be adopted throughout the system.  “The reality is that over the years, the private sector has by and large followed Medicare’s lead in payment systems,” Gilfillan said.  “Medicare has been the most innovative payer if you look back over the last 30 years.”  With $10 billion in funding through the end of 2019, Gilfillan anticipates rolling out additional initiatives before too long.  These could encompass ideas that emerge at an “innovation summit”.

Created by the Patient Protection and Affordable Care Act (ACA), the Innovation Center works to test and support innovative new healthcare models that reduce costs and strengthen the quality of care.  “The Affordable Care Act gives us tremendous new tools to innovate and improve our health care system,” said Health and Human Services Secretary Kathleen Sebelius.  “We discussed how we can work together to make innovative ideas a reality in communities across the country.”

“The level of real excitement surrounding this conference shows not only that people who know healthcare recognize the urgent need for better health and better care at lower cost, they also are ready to move forward with solutions,” said CMS Acting Administrator Marilyn Tavenner.  “The fact that all of these disparate interests share the aim of better healthcare and are willing to work for it not only means that we’re going to have the best ideas on the table, but also that we’re going to have the expertise and the resources that will ultimately ensure better health at a lower cost will be within the reach of every American,” Gilfillan said.

In the meantime, the Obama Administration also released a new report highlighting the success of the Center for Medicare and Medicaid Innovation.  The Center for Medicare and Medicaid Innovation’s role is limited to testing payment incentives and healthcare delivery methods within Medicare and Medicaid, as well as the Children’s Health Insurance Program.

Donna Jarmusz

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Healthcare Jobs Still the Fastest-Growing Sector

February 7th, 2012

Job growth in the healthcare profession seems to be virtually recession-proof. In Florida, a state with a sizeable percentage of senior citizens, there are about 960,000 healthcare and social assistance jobs, approximately 13 percent of all nonfarm payroll positions in the state.

Some experts are not as optimistic about job growth in the healthcare sector.  “Reform may accelerate the trend toward healthcare’s being the dominant employment sector in the economy,” according to a recent New England Journal of Medicine (now known as NEJM) article.  A significant amount of the growth in healthcare that result from reform might be in support positions, rather than physicians and nurses, several economists said.  “As for jobs for health professionals, I doubt that this will or can increase the number of doctors or nurses.  While there will be greater demand for their services, there will also be offsetting effects as medically unnecessarily procedures are paid less,” said Amitabh Chandra, an economist and public-policy professor at Harvard University.

As the insured population grows under the federal Patient Protection and Affordable Care Act (ACA), healthcare workers will be in high demand.  These gains come on the heels of growth already required to serve an aging population.  In Florida, the aging population’s impact on healthcare employment is more dramatic than in the rest of the country: about 17 percent of the state’s population is older than 65, compared with a 13 percent average in the other states., according to the Census Bureau.

Other experts are far more sanguine about healthcare’s ability to create jobs.  “The big places we waste money is patients who are discharged and there’s not a lot of follow up and they end up in the hospital a month later,” said Leemore Dafny, an economist at Northwestern University whose expertise is competition in healthcare markets.  According to Dafny, reform will create new primary-care physicians and physician “extenders,” such as nurse practitioners; at the same time, it could decelerate growth in spending on medical specialists.  “If the ACA is repealed, it will be business as usual — except that more of the population is now uninsured — so the demand for primary-care professionals will increase much more slowly,” said Dafny.

In fact, according to the Bureau of Labor Statistics (BLS), the healthcare sector for some time has provided about the only bright spot in an otherwise drab report on job growth.  Healthcare employment created 205,100 new jobs in the first eight months of 2011.  Approximately 14.1 million people are employed in the healthcare sector with more than 4.7 million jobs at hospitals; more than 6.1 million jobs in ambulatory services; and more than 2.3 million jobs in physicians’ offices, according to BLS statistics.

According to Risa Lavizzo-Mourey, M.D., CEO of the Robert Wood Johnson Foundation, and Mark Pinsky, president and CEO of the Opportunity Finance Network, “The current economic recovery effort presents an opportunity to build stronger, healthier communities.  That’s a central goal, for example, of the Create Jobs for USA Fund that the OFN and Starbucks launched late last year to support job creation and retention.  Economic growth and job creation provide more than income and the ability to afford health insurance and medical care.  They also enable us to live in safer homes and neighborhoods, buy healthier food, have more leisure time for physical activity, and experience less health-harming stress.  The research clearly shows that health starts in our homes and communities and not in the doctor’s office.  In that way, economic policy is, in fact, health policy.  The end goal?  Create and sustain job growth across the country.  Improve communities.  Improve health.  Give people the opportunities to make smart, healthy decisions so that they can act in the best interests of their communities, themselves, and future generations.”

Healthcare added 17,200 jobs in November of 2011, an increase over the 11,600 jobs reported in October, according to BLS data.  Healthcare accounted for 14.3 percent of 120,000 new jobs created across all sectors in November.  On the whole, healthcare represented 24 percent of the 1.2 million non-farm jobs created this year and is expected to create 321,000 new jobs by year’s end.  That represents a 22 percent increase over the 263,400 healthcare jobs created in 2011.

Jeff Newkirk

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Public Perceives Supreme Court Justices As Biased Over ACA’s Legality

February 6th, 2012

Approximately 60 percent of Americans believe that the Supreme Court justices who will hear the Patient Protection and Affordable Care Act (ACA) will base their judgments more on personal ideology than a legal analysis of the individual mandate, according to a recent Kaiser Family Foundation poll.

Only 28 percent believe the justices will base their decision on the mandate without regard to politics and ideology.  The poll also asked about general views of the Supreme Court and found that 75 percent of the public believe that justices sometimes let their personal politics sway their decisions.  Seventeen percent said justices more often than not decide cases based on legal analysis.  The court is expected to hear oral arguments in March in a case brought against the Patient Protection and Affordable Care Act (ACA) by 26 states.

The Kaiser poll found that the individual mandate, a requirement that most Americans purchase health insurance by 2014 or pay a fine, remains unpopular — 67 percent of Americans opposed the provision and just 30 percent supported it.  Overall, approximately 37 percent of Americans view the health law favorably, while 44 percent have an unfavorable view.

In terms of the “repeal and replace” agenda that House Republicans are pursuing, it’s not really winning over the public.  According to the Kaiser poll, 50 percent of respondents would prefer to expand the law or keep it in place; just 40 percent want to repeal it outright or replace it with an alternative.  That could be a problem, since House Energy and Commerce Health Subcommittee Chairman Joe Pitts said that a “replace” plan is on the subcommittee’s to-do list, at approximately the same time that the Supreme Court is expected to rule.  Pitts hopes that his caucus will be able to seize the opportunity to sway public opinion: “We’ll have a window of opportunity to — with everyone looking — to explain that the Affordable Care Act is not fully implemented yet.  A lot of people think it is.  So we’ll use that opportunity in that window to discuss the full ramifications of the Affordable Care Act and what we’ll replace it with.”

For example, Justice Elena Kagan (who was Solicitor General at the time the ACA was passed and has recused herself from the Supreme Court case) and noted Supreme Court litigator and Harvard Law Professor Laurence Tribe, who worked for the Justice Department at the time, had an email exchange in which they discussed the pending healthcare vote.  “I hear they have the votes, Larry!!  Simply amazing,” Kagan wrote to Tribe in an email.

“So healthcare is basically done!” Tribe responded to Kagan.  “Remarkable.  And with the Stupak group accepting the magic of what amounts to a signing statement on steroids!”  The “Stupak group” refers to then-Representative Bart Stupak (D-MI), who masterminded a group of House Democrats who had indicated they would not vote for the ACA if it permitted federal funds to pay for abortions.  Ultimately, Stupak and his allies voted for the bill, even though no additional language was added that would prevent federal funding for abortions.

Writing for KSL.com, contributor Curt Mainwaring muses on what will happen if the Supreme Court upholds the ACA. “If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  Healthcare costs currently make up approximately 18 percent of gross domestic product.  If expenditures continue on their current trajectory, ‘the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.’  In more intimate terms, the Department of Health and Human Services demonstrates individuals paid approximately $1,000 per year in healthcare costs in 1960, more than $7,000 per year in 2007, and are projected to pay more than $13,000 per year by 2018.

“Simply put, this kind of a rise in healthcare costs is unsustainable — and these kinds of projections are part of the reason ACA was created in the first place.  Nevertheless, claims of ACA’s positive impact on the economy have likely been overestimated.  ACA focuses heavily on reducing the cost of health insurance — a factor that will likely result in reduced insurance costs.”

John Driscoll

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Will the ACA Survive the Supreme Court, 2012 Election?

February 1st, 2012

The 26 states that have challenged President Barack Obamas healthcare law face several dilemmas as they try to convince the Supreme Court to declare the law’s Medicaid expansion unconstitutional   The two lower courts that heard the Medicaid challenge ruled in favor of the Obama administration, even as those judges struck down the healthcare law’s individual mandate. Legal experts on both sides of the mandate debate were surprised that the Supreme Court agreed to also hear the Medicaid piece of the state’  lawsuit.  The healthcare law’s supporters claim that the states erred in their initial brief on the Medicaid expansion, which was filed with the Supreme Court.

According to the states involved in the lawsuit. the ACA’s Medicaid expansion is “coercive.” Although state participation in the program is strictly voluntarily, the brief argues, the healthcare law makes it impossible for states to opt out of Medicaid.  The brief tries hard to link the Medicaid expansion to the individual mandate, arguing that states won’t be able to exercise their legal right to leave Medicaid because it’s the only way for Medicaid-eligible residents to fulfill the mandate.

“While the (Affordable Care Act) purports to leave states’ participation in Medicaid nominally voluntary, multiple aspects of the Act evince Congress’ keen awareness that, in fact, no state will be able to reject its new terms and withdraw from the program,” the brief says. “Most obviously, the ACA’s individual mandate requires Medicaid-eligible individuals to obtain and maintain insurance.”  But most Medicaid-eligible people would be exempt from the mandate, said Timothy Jost, a law professor at Washington and Lee University and a supporter of the health law.

Then there’s the Supreme Court case, which will be heard in the spring and a verdict announced prior to the November presidential election. According to Kurt Mainwaring, a ksl.com contributor, “Far-reaching consequences of the court’s ruling will likely impact both the cost of healthcare and the outcome of the 2012 elections.  If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  At present, healthcare costs make up approximately 18 percent of GDP. If expenditures continue on their current trajectory, “the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.”  Translated to real numbers, the Department of Health and Human Services (HHS) notes that Americans paid approximately $1,000 annually in healthcare costs in 1960; more than $7,000 per year in 2007; and are projected to pay more than $13,000 per year by 2018.  This kind of increase in healthcare costs is not sustainable — and these kinds of projections are part of the reason ACA was enacted in the first place.

Beach Conger, a Vermont internist writing in the Burlington Free Press believes that “Medicare for All” — a possibility that was raised during the lengthy debate over the ACA — should be reconsidered.  According to Conger, “Medicare and I were born in the same year. Professionally speaking, that is. We were raised together, and we have been married to each other for what seems an eternity. As with any long-term relationship, we have had our ups and downs, but we have both matured over the years, and I believe we are both the better for it. Without being too vain, I have to say I have done a better job at providing health care, and I have to admit that Medicare has helped me do it.  At first, it just made sure that those retired people who wished to pay me the fees to which those in my line of work have become so accustomed, could actually do so. But eventually it realized that there was more to the business than just money, and it began to keep an eye over my shoulder, making sure I was not leaving undone those things which ought to be done and not doing those things which I ought not.  So I can’t help but think, why not Medicare for everyone? It would be so simple. And that’s when I realized.  It was too simple.”

Dr. Conge, it should be pointed out, lives in Vermont, to date the only of 50 states to enact a single-payer public option — Green Mountain Care.

John Driscoll

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