Posts Tagged ‘Kaiser Health News’

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

Monday, 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.”

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Obama Administration Reverses Itself on Patient Disputes With Insurers

Wednesday, July 13th, 2011

The Obama administration has fine-tuned rules that give patients greater clout in disputes with health insurers, changing the standards in ways that disappointed leading advocates for healthcare consumers.  The rules are designed to guarantee patients the same rights to appeal if their insurers do not cover care that is considered necessary.  The federal standards, part of the Patient Protection and Affordable Care Act (ACA), replace a patchwork of varying state policies.  The rules allow patients to protest to their health plans; if they do not succeed, they can take their complaints to an outside arbiter.  Department of Health and Human Services (HHS) officials issued the rules 11 months ago, but they have revised them.  Insurers and employers have long wanted limited appeal rights; conversely, consumer groups have argued for stronger patient protections.  In the new version, the grounds to protest an insurer’s decision are narrower than consumer groups prefer.

Writing on the Becker’s Hospital Review website, Rachel Field says that “The earlier rules governed consumers’ right to appeal denials by health plans.  The overhaul gave members in group and individual health plans the right to appeal the denial of coverage to an independent review panel.  The administration’s new rules give beneficiaries less time to prepare an appeal, less information about the reason for the denial and limitations on which denials can be appealed.  According to the report, patients can still appeal if their coverage is cancelled by an insurer, and decisions by external review panels are still binding.  Employer-sponsored plans that are self-insured will have to use at least two independent review organizations to make sure decisions remain unbiased.”

Because states lack the authority to regulate self-insured health plans, there has been no requirement allowing beneficiaries to appeal denials to an independent panel.  The health law extends that right to more than 44 million Americans covered by self-insured plans that will lose their exempt status this year.  “The right to an external appeal is considered one of the most important consumer protections that you can have,” said Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the HHS.  “Consumers do not want insurance companies making medical decisions for them or for their families.”  According to Larsen, states will have extra time to revise local external appeals rules so that they can conform to the federal standards.  Insurers won’t have to comply with new state rules that incorporate federal requirements until January 1, 2012.

The revised rules come at an appropriate time.  Although few people want to a fight with their health insurer, it may be worthwhile.  A recent Government Accountability Office report found that more claims problems resulted from annoying but often clear-cut billing and eligibility issues than from disagreements over whether care was medically necessary.  Plus, the odds are about 50/50 that if a patient appeals an insurer’s decision, the patient will win.

Not everyone agrees with the action. “The Obama administration gave in to the insurance industry and large employer lobby on rules that would, for the first time, give rights to patients with certain employer-paid health plans to challenge a healthcare denial.  These consumers need the protection of independent reviews the most because they usually have no legal remedy for a wrongful decision to deny care under an errant 1987 Supreme Court ruling.  Health reform was intended to strengthen the public’s ability to make insurers provide the coverage patients are promised.  The administration should reverse the changes in this regulation that undermine that promise,” said Carmen Balber, Washington director for Consumer Watchdog.

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Is the Physician Shortage Easing?

Wednesday, June 29th, 2011

The current physician shortage has implications in terms of a lack of medical care for a greater number of insured patients over the next few years, physician workload, and difficulties with recruitment.  There is, however, hope on the horizon.  Enrollment in family residency programs rose in 2011, rising 11 percent from 2010.  The University of California, San Francisco (UCSF), saw a 20 to 25 percent increase in medical applicants, according to Kaiser Health News. “Primary care has always had the strongest connection with public service and a public health agenda,” said Andy Bindman, professor of medicine at UCSF and chief of general medicine at San Francisco General Hospital.

According to Kaiser Health News’ Jenny Gold, “As the shortage of primary care doctors worsens in the U.S., experts are carefully tracking the interest of today’s medical students and residents in primary care, to see if a new generation of family doctors might be emerging.  By 2020, the Association of American Medical Colleges predicts that the country will be short 45,000 primary care physicians.  Some say the focus on primary care in the federal health overhaul law, called the Affordable Care Act, deserves much of the credit for rising interest in family medicine.”

Where will future doctors come from?  Today’s teenagers show little interest in healthcare and science careers, according to an online survey by Harris Interactive for University of Sciences. Forty-nine percent of 9th to 12th graders definitely or probably would not consider a career in healthcare or science, an 8.9 percent increase from the previous year.  Sixty percent of younger teens (age 13 – 15) also said they were not interested.  The survey found that those who were interested in pursuing healthcare- and science-based careers were primarily women and minorities.  Respondents interested in healthcare careers cited reasons, including financial motivations (“earning good money”), general interest, and public service (“want to help people”).  “It is essential that the sciences remain top of mind for America’s teenagers,” said Russell J. DiGate, Ph.D, provost at University of the Sciences.

The fact that states are slashing their budgets could force medical schools to cut back on admissions in 2012 is making a bad situation worse.  Texas medical schools are facing $500 million in combined cuts in the 2012-13 academic year, making them unable to fully fund students already enrolled, reports the Texas Tribune.  These schools are poised to see state payments for medical education fall by more than $12,000 per student per year, putting future admissions on the chopping block.

Some sources are not so certain that an end to the physician shortage is at hand.  Twenty-three percent of general internists and 40 percent of subspecialists are not renewing their internal medicine board certification,  according to research from the Journal of American Physicians and Surgeons. Older physicians especially will stop practicing than recertify, faced with extensive requirements and time commitments.  According a 2009 Association of American Physicians and Surgeons (AAPS) survey, just 30 percent reported that recertification improved their performance; just 22 percent would voluntarily do it again.

“This number will most likely increase as these processes become more expensive and more time-consuming, and continue not to reflect clinical practice,” Dr. Martin Dubravec said.  “Recertification has become a cottage industry of bureaucrats and testing agencies, dragging with them a few university physicians,” said AAPS President Lee Hieb.  “Accrediting bodies increasingly require continuous physician competency, and more boards require certification.  Hesitant physicians exiting practice could pose a significant problem that would leave a vacuum for physicians during times of shortage.”

“We cannot afford to drive our most seasoned, experienced physicians into early retirement,” said AAPS executive director Jane M. Orient, M.D. “They simply cannot be replaced.”

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High-Deductible Health Plans Equal Less Healthcare

Tuesday, May 3rd, 2011

Americans who have high-deductible health plans tend to not get necessary medical treatments whether they are low-income people with chronic health problems or healthier or higher-income people, according to a study by RAND, a non-profit research group, and Towers Watson, a consulting firm.  The researchers analyzed healthcare claims data from 59 large companies, examining first-year experiences with high-deductible plans comprised of more than 800,000 families nationally between 2003 and 2007.

Medical spending declined among all families with high-deductible and consumer-driven health plans, compared with those in traditional plans, according to the study published by the journal Forum for Health Economics & Policy. Families who live where the median income is 200 percent less than the federal poverty level, and those with one of the five most costly chronic conditions — cancer, diabetes and heart disease — spent approximately the same on healthcare than families with high-deductible plans.  The families all had at least one member working full time in a job that included health benefits, the researchers noted.

“One important issue is whether high-deductible health plans will leave low-income and chronically ill patients with inadequate access to healthcare,” Amelia Haviland, the study’s lead author and a RAND statistician, said.  “The evidence suggests that non-vulnerable families, low-income families and high-risk families are equally affected under high-deductible plans.  We discovered that costs go down dramatically during the first year people are enrolled in high-deductible health plans, as long as the deductible is at least $1,000 per person.  “But we also found concerning reductions in use of preventive care. This suggests people are cutting both necessary and unnecessary care.”

The researchers determined that deductibles of at least $1,000 per person led to an average of a 14 percent decrease in spending when compared with families who had lower deductibles.  The RAND study notes that “The drop in preventive care happened even though the high-deductible plans in the study waived a need to pay a deductible when receiving such care.  This suggests that enrollees in high-deductible plans either did not understand this part of their policy or some other factor discouraged them from getting preventive care.”

According to the RAND study, “High-deductible and consumer-directed health plans have been gaining favor as one way to help control health care costs.  By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in such plans.  A 2010 survey found that more than 54 percent of large employers offered at least one high-deductible health plan to their employees.  Healthcare reform is expected to further encourage enrollment in high-deductible health plans as such plans are expected to be a key offering in the insurance exchanges being set up in many states to help the uninsured find health coverage.”

As families cut their medical spending, they eliminated some forms beneficial care, the researchers found.  Although childhood vaccination rates rose in families who had traditional health plans, they fell among families in high-deductible health plans.  Mammograms, cervical cancer screening and colorectal cancer screening also declined among those with high-deductible health plans.

Writing on Kaiser Health News, Jonathan Cohn, Senior Editor of The New Republic, says “Conservatives think traditional health insurance provides too much financial protection from medical expenses.  They also think that the Affordable Care Act will make this situation worse.  That’s one reason they want to repeal it.  The problem, according to the conservatives, is that insurance dulls the average person’s consumer instincts.  When medical care is cheap or free, people don’t bother to shop around for the best prices — and they don’t think twice before seeing the doctor.  In other words, they end up with too much care at too high a price.  Insurance and government programs spread that cost around, so that eventually all of us end up paying more in the form of higher premiums or taxes over which we have little individual control.  The solution, as this argument goes, is to redesign insurance so that it forces people to pay more out-of-pocket expenses.  And, within reason, it’s not a bad idea.  Most economists, even those on the left, would agree that excessive coverage leads to higher health care spending.”

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Nearly 50 Percent of Americans Think the Healthcare Law Has Been Repealed – They’re Wrong!

Wednesday, March 9th, 2011

Defying the odds – and facing President Barack Obama’s veto pen – the Republican-controlled House of Representatives voted to repeal the Patient Protection and Affordable Care Act (ACA); a move that was DOA in the Senate.

Despite considerable evidence to the contrary, approximately 50 percent of Americans are convinced that the healthcare law has been successfully repealed.  A poll by the Kaiser Family Foundation found widespread public confusion about the law, with 22 percent of Americans incorrectly believing it has been repealed and another 26 percent unsure or unwilling to say. Even after extensive media coverage of the repeal effort, only 52 percent of Americans accurately responded that the healthcare law remained intact.  According to the Kaiser Family Foundation, “There remains no consensus about whether to keep, expand, replace or repeal the law.  Forty-eight percent are opposed to the law, while 43 percent favor it.  Sixty-one percent of those polled oppose Congress cutting off funding of the law in order to block it, as many Republican lawmakers are considering.”

The Republican-sponsored repeal bill, curiously named the “Repealing the Job-Killing Health Care Law Act,” passed 245 – 189 with assistance from three Democrats.  Majority Leader Harry Reid (D-NV) has refused to bring repeal to the Senate floor for a vote.  President Obama has vowed to veto any repeal effort.  Republicans have not introduced an alternative bill, although Speaker of the House John Boehner (R-OH) said Republicans will ask congressional committees to make “common-sense reforms” to expand coverage and cut costs, but told reporters no “artificial deadlines” were needed.

“As has been true since early in the debate, individual provisions of the new law are more popular than the law itself, complicating the debate over repeal,” the study notes. “So while the public in general is divided over whether to keep or repeal the legislation, if they could pick and choose, the large majority (roughly eight in 10 Americans) would keep the provisions providing tax credits to small businesses, and upward of seven in 10 would keep the provisions that close the Medicare doughnut hole, provide coverage subsidies to those of low and moderate income, institute the new voluntary long-term care insurance program known as the CLASS Act, and prohibit insurance companies from denying coverage based on pre-existing conditions.”

According to a USA TODAY/Gallup Poll, 32 percent of Americans would like to see the law repealed; 13 percent want to see the bill left as it stands. The poll found that 29 percent of Americans want to see minor changes and that 24 percent want major changes.  Representative Ben Chandler, (D-KY), who voted against the law last year, said he voted against repeal because he thinks the law’s “bad” parts should be repealed piece by piece.  “I will not vote to repeal parts of the law that protect central Kentuckians by preventing insurance companies from dropping people if they get sick, ending lifetime caps on coverage and eliminating pre-existing condition exclusions,” Chandler said.

Implementation of the law is continuing as planned, according to Health and Human Services Secretary Kathleen Sebelius.  “I want the people who are benefiting from the Affordable Care Act — including families, seniors and small business owners — to know that this vote does not change the law and that this department will continue to work every day to implement this vital law.”

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Medical Residents Need Enhanced Training, Shorter Work Hours

Tuesday, February 15th, 2011

Medical residents should receive expanded training as part of an effort to make America’s healthcare more effective.  Dr. Jay Crosson, senior medical director of the Permanente Foundation at Kaiser Permanente, who served on the Medicare Payment Advisory Commission, announced the initiative.  According to Crosson, medical residents will now receive additional training in office-based care competencies, care coordination, continuity of care; leadership and management skills; providing analysis by identifying needs and priorities; increasing the number of primary-care providers; investing in top-quality training; and placing physicians in under-served areas.  “Which of these can we expect from residency programs, and what is naturally on-the-job training?” Crosson asked.

The advanced training could be funded in part by $320 million in grants authorized by the Patient Protection and Affordable Care Act.  Department of Health and Human Services Secretary Kathleen Sebelius said “Investing in our primary-care workforce will strengthen the role that wellness and prevention play in our healthcare system.  With these grants, Americans from all backgrounds will have new opportunities to enter the healthcare workforce.”  Mary K. Wakefield, Ph.D, R.N. and administrator of the Health Resources and Services Administration (HRSA) says “These grants will provide much-needed support for increasing primary-care capacity by expanding training programs for primary-care providers, vital to our future healthcare workforce.”

In another move that will impact their training, medical residents now work slightly shorter shifts and have tighter supervision in a bid to improve quality. According to Kaiser Health News, “The Accreditation Council for Graduate Medical Education’s (ACGME) board of directors approved new rules for more than 110,000 new physicians being trained at American hospitals.  The goal is to improve patient safety and reduce medical errors caused by junior doctors working extremely long hours.”  Doctors in their first year of residency will be limited to 16 consecutive hours of work with “strategic napping.  The maximum shift length remains 24 hours for residents in their second year of training and beyond.  Also, medical residents are to tell patients they’re being supervised by more experienced physicians, and the hierarchy should be spelled out to patients,” according to the revised rules.

“My body is not made to work 30 hours or more,” said Dan Henderson, a third-year medical student at the University of Connecticut. “If I’m truly going to do no harm as I pledged, I need a system to protect patients against errors caused by my fatigue.”

“Resident physicians working 30-hour shifts make 36 percent more medical errors caring for women in the intensive care unit…including 460 percent more serious diagnostic mistakes than those scheduled to work for 16 hours,” said Chuck Czeisler, M.D., of Harvard and Brigham and Women’s Hospital.  “They are also 73 percent more likely to stab themselves with a scalpel or needle.”

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Expectant Parents Beware! Not All Health Plans Cover NICU

Wednesday, January 19th, 2011

The majority of expectant parents know that their obstetrician and the hospital where their baby will be born participate in their health insurance network.  If the baby is born prematurely or needs special care in the neonatal intensive-care unit (NICU), however, the new parents may get a nasty surprise — this level of care may be out of their network.  “Some hospitals do contract with other clinical provider groups to run their NICUs,” said Marie Watteau, the American Hospital Association’s (AHA) director of media relations.  “When selecting a hospital, pregnant women should…verify that all hospital care, including NICU care and physician services, are in network.”

Three quarters of babies who require costly NICU care are born prematurely; the remaining 25 percent have other medical problems.  In 2009, one baby in eight was born prematurely, defined as before 37 weeks of gestation, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.  Although premature birth rates have fallen recently, they are still 30 percent higher than in 1981.  The Institute of Medicine reports that medical bills and other premature-related costs totaled $26.2 billion in 2005.  That’s $51,600 per premature baby.

Depending on weight and other medical criteria, some premature babies needing NICU care could be declared disabled under the Supplemental Security Insurance program.  That would make the baby eligible for Medicaid.  Although families typically must meet income guidelines to be eligible for Medicaid, “while the child is in the institution, the child’s income alone is what’s looked at for Medicaid purposes,” according to Mary Kahn, a spokeswoman for the Centers for Medicare and Medicaid Services.  After the baby is discharged, however, it is no longer eligible for Medicaid unless the parents meet the income guidelines.

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HHS Issues Proposed Rules Requiring Healthcare Insurance Increase Disclosure

Thursday, January 6th, 2011

The Department of Health and Human Services (HHS) has issued proposed regulation that – thanks to the Patient Protection and Affordable Care Act – would obligate health insurers to provide additional information about rate increases.  Beginning in 2011, insurers who raise rates by 10 percent in the individual and small group markets would have to publicly disclose the increase and justify their reasoning. Additionally, HHS wants state-specific thresholds to be set for rate disclosure in 2012, “using data and trends that better reflect cost trends in that particular state.”

Summaries of the 10 percent or greater reviews would be posted on the HHS website; insurers seeking these increases would be required to post their justifications on their corporate websites.  Evidence “suggests that the majority of increases in the individual market have exceeded 10 percent each year for the past three years,” greatly surpassing national measures of cost inflation, according to HHS.   After a public comment period, the final rules will be issued in approximately six months.

Not surprisingly, America’s Health Insurance Plans (AHIP), the insurance industry’s lobbying group, argues that the proposed rules don’t account for new benefit mandates and the recession.  “For example, data from the state of Oregon show that prices of many medical services have increased at an average annual rate exceeding 10 percent,” says AHIP CEO Karen Ignagni.  “California data show that prices for a hospital stay increased by more than 150 percent between 2000 and 2009 — an average annual growth rate of 11 percent.  Trends like these are being seen across the country.”

Consumer advocates, on the other hand, contend that the proposed rules are not strong enough.  “The whole point of this regulation, as the HHS secretary has said, is to shine a light on the actuarial assumptions…in the hope that public scrutiny will shame insurers into doing the right thing,” says Carmen Balber, director of Consumer Watchdog in Washington, D.C.. “If full data is not disclosed, in many cases we’re left with the status quo.”

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Temporary High-Risk Pool Short on Funding

Wednesday, July 7th, 2010

healthcare20reformAlthough between 5.8 and seven million Americans may qualify for healthcare coverage through the temporary high-risk pool program created as part of healthcare reform, the $5 billion set aside for use between now and 2014 may cover only 200,000 patients annually.

The high-risk pool, created by the 2010 Patient Protection and Affordable Care Act, provides subsidized coverage to uninsured individuals with pre-existing medical conditions.  One portion of the law provides income-based subsidies so healthcare coverage is more affordable and accessible.  Because most of the provisions do not become effective until January of 2014, however, the limited funding means available dollars will have to be stretched as far as possible, said Paul B. Ginsburg, Ph.D., NICHR director of research.  The National Institute for Health Care Reform (NIHCR) has identified key policy considerations in its Health Coverage for the High-Risk Uninsured:  Policy Options for Design of the Temporary High-Risk Pool policy analysis.

According to Kaiser Health News, many people with medical conditions may be unable to obtain coverage.  “That fear — along with partisan considerations — prompted officials in 20 states to decline to establish their own federally financed pools, opting to leave the task to Washington.  Officials in those states, predominantly Republicans, worry that they would face intense pressure to pick up the burden if the money runs out.”

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