From Health Care

A Tale Of Two States: California, Texas And The Latest ACA Repeal Bid

The GOP’s latest attempt to repeal the Affordable Care Act wobbled on Friday as Sen. John McCain (R-Ariz.) said he could not support it. But the bill known as Graham-Cassidy isn’t dead yet. And whatever its fate, the long-held Republican goal it embodies — to fundamentally change how the government funds Medicaid — will survive.

Graham-Cassidy would dramatically redistribute federal funds to states. And, generally, states that expanded Medicaid — like California — stand to lose billions of dollars as that money is doled out to states that didn’t — like Texas.

“For a state like California or a Massachusetts or a New York — exactly the states that might be most motivated to at least try to preserve the ACA coverage gains — those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, a senior fellow with the Center on Budget and Policy Priorities.

The bill’s authors said their plan gives states more flexibility to build their own health systems. But health officials in California released a strongly worded analysis on Friday, predicting dire consequences if the measure were to pass.

Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote, emphasizing their words in italics.

They cited the significant shift in costs from the federal government to the states, forcing California to pay nearly $4.4 billion more in 2020 to maintain current coverage levels. In 2027, when the federal block grants would end, the state’s additional burden would grow to $53.1 billion, according to the analysis.

All told, from 2020 through 2027, “the impact would total $138.8 billion in federal funding cuts,” the officials wrote.

“If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs, [which] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide,” the health officials said.

California’s overall uninsured rate dropped by more than half since the ACA’s coverage expansion.

Meanwhile, Texas looks like one of the bill’s big winners. It gets a windfall of more than $35 billion to help replace Obamacare exchanges and other programs, more than any other state. State officials get to decide how they want to spend that money.

But experts in the state said that could present its own set of problems.

“Regardless of the size of the block grant, there’s just no assurance that it would translate into good coverage or coverage that’s [as] affordable as what we have today,” said Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities in Austin.

Texas has replaced California as the state with the highest number of uninsured people. Pogue said the state doesn’t have the infrastructure in place to expand coverage to more people. It didn’t expand Medicaid, and the state didn’t set up its own Obamacare exchange.

To sell ACA policies, Texas uses healthcare.gov, which will cease to exist if Graham-Cassidy passes.

“There’s no planning and no thought put into how would we create affordable coverage for low-income Texans,” Pogue said. “Texas would be starting from scratch.”

For comparison, it took Massachusetts four years to set up its pre-Obamacare insurance market.

Pogue said the political will needed to expand health insurance to more Texans has been lacking among state lawmakers for years. In order to get the block grant, states would need to create something workable by 2020.

Another issue is how the grants would be calculated. The federal government would pay a fixed amount up to a cap for each Medicaid enrollee.

“We have very low per capita costs already, and we [would] get locked into that forever,” said Stacy Wilson, president of the Children’s Hospital Association of Texas. “We are very concerned.”

The Texas Public Policy Foundation, a conservative group, also said it was not happy about the bill. Its concern is that it doesn’t go far enough to repeal Obamacare.

“In the end, this rushed legislation will not lead to the creation of a functioning free market,” said Drew White, a senior policy analyst with the group.

This story is part of a partnership with NPR, local member stations and Kaiser Health News.

Categories: Repeal And Replace Watch, States, The Health Law

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HHS To Close Insurance Exchange For 12 Hours On Sundays During Enrollment

The Trump administration plans to shut down the federal health insurance exchange for 12 hours during all but one Sunday in the upcoming open enrollment season. The shutdown will occur from 12 a.m. to 12 p.m. ET on every Sunday except Dec. 10.

The Department of Health and Human Services will also shut down the federal exchange — healthcare.gov — overnight on the first day of open enrollment, Nov. 1. More than three dozen states use that exchange for their marketplaces.

HHS officials disclosed this information Friday during a webinar with community groups that help people enroll.

The Trump administration has come under attack from critics who say that it is intentionally undermining the Affordable Care Act, through regulatory actions. It shortened the enrollment period, withdrew money for advertising and cut the budget for navigators to help people shop for plans.

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The fact that HHS is now closing the site for a substantial portion of each weekend, supposedly for maintenance, seemed the last straw. Many working patients — the prime target group for ACA insurance — might be shopping at just that time.

“The Department of Health & Human Services is actively trying to prevent people from signing up for healthcare coverage,” Rep. Don Beyer (D-Va.) tweeted. “This is outrageous.”

“Argh” was the reaction of Shelli Quenga, program director at the Palmetto Project in South Carolina, a nonprofit group that received about $1 million to help with outreach and enrollment in the past 12 months. This month, HHS cut her budget in half for this year’s open enrollment.

Open enrollment season this year runs from Nov. 1 to Dec. 15, less than half the time people have had to sign up during the first four years of the exchanges created under the Affordable Care Act.

More than 12 million people enrolled on the state and federal marketplaces for 2017 coverage, including more than 9 million on the federal exchange. Some customers give up coverage over the course of the year.

Advocates were already nervous that fewer people would sign up during the shortened period this time around.

“I could see this really impacting the ability of people to complete an application sign-up in a single sitting, which is so important,” said Jason Stevenson, spokesman for the Utah Health Policy Project, an Obamacare navigator group. He noted that 10 p.m. Mountain Time is often a relatively popular time for people to enroll online.

“Health insurance is complicated, and in the past couple of years we had an administration that made it easier to sign up, but that has really changed in the past six months, with more hurdles not only for consumers but for those whose job it is to help them,” he said.

A spokesman for the federal Centers for Medicare & Medicaid Services, which oversee the exchanges, said the shutdowns should not cause too many problems.

“Maintenance outages are regularly scheduled on healthcare.gov every year during open enrollment. This year is no different,” the official said. “The maintenance schedule was provided in advance this year in order to accommodate requests from certified application assisters. System downtime is planned for the lowest-traffic time periods on HealthCare.gov including Sunday evenings and overnight.”

Categories: Insurance, The Health Law

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GOP Health Bill’s Changes Go Far Beyond Preexisting Conditions

The latest GOP effort to “repeal and replace” the Affordable Care Act is getting a lot of attention, even if its passage seems unlikely. But there is far more to the measure than its changes to rules regarding preexisting health conditions.

In fact, the bill proposed by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) would disrupt the existing health system more than any of the measures considered so far this year, according to supporters and critics.

For backers of the bill, that disruption is a good thing. But others are appalled. As insurance industry analyst Robert Laszewski put it in a note to clients this week, “Would you rather lose your Republican Senate seat because you couldn’t pass an Obamacare repeal-and-replace plan or because you blew up the health insurance system?”

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Some of those alterations have generated little discussion but would have major impacts. Here are four unheralded changes:

The Bill Caps Federal Funding To Medicaid

Much focus has been placed on the bill’s funding formula, which would take money from states that expanded the Medicaid program for the poor. Less notice has been paid to the fact that this bill, like some other GOP options over the summer, would, for the first time, cap overall federal Medicaid funding. The federal government has provided an open-ended funding match since the program’s creation in 1965 — meaning the federal government has provided its share of whatever states spend to care for low-income children, pregnant women, seniors and people with disabilities. More than 70 million people are covered by Medicaid, including those added as a result of the ACA.

Republicans have been pushing unsuccessfully to limit the federal government’s funding of Medicaid to states since the 1980s.

State Medicaid directors — including both Republicans and Democrats — are alarmed at the idea that something of such magnitude could be done with so little debate or consideration. “Graham-Cassidy would completely restructure the Medicaid program’s financing, which by itself is three percent of the nation’s Gross Domestic Product and 25 percent of the average state budget,” said a statement from the group.

The Congressional Budget Office estimated in June that an earlier version of the cap would reduce federal Medicaid spending 35 percent by 2036. As a result, said CBO, states would “uneed to … decide whether to commit more of their own resources, cut payments to health care providers and health plans, eliminate optional services, restrict eligibility for enrollment, or adopt some combination of those approaches.”

“There won’t be enough money to do what’s authorized under current law,” said Jessica Schubel of the left-leaning think tank the Center on Budget and Policy Priorities.

— The Bill Gives Unprecedented Power To The Secretary Of Health And Human Services

Republicans complained bitterly about the power delegated by Congress to the secretary of Health and Human Services in the ACA. But conservative analyst Chris Jacobs pointed out that the Graham-Cassidy bill gives the HHS secretary more power still.

The bill creates a dizzyingly complex formula for the funds now being spent on the ACA, which is intended to draw money away from wealthier states (that mostly expanded Medicaid under the health law) toward poorer ones (that mostly did not). But there is a huge loophole, noted Jacobs. The bill gives the HHS secretary authority to change the formula on his or her own.

“That’s a trillion-dollar loophole that leaves HHS bureaucrats with the ultimate say over how much money states will receive,” Jacobs wrote.

And, he said, it’s the opposite of “federalism,” or giving states more authority, which the bill’s sponsors claim to be advancing.

“Draining the swamp shouldn’t involve distributing money from Washington out to states, whether under a simple formula or executive discretion,” he wrote. “It should involve eliminating Washington’s role in doling out money entirely.”

— The Bill Cuts Off All ACA Funding After 2026

The bill would lump together all funds being spent under the health law to help people pay premiums, out-of-pocket health costs and expand Medicaid to non-disabled adults and redistribute those funds to the states in the form of block grants. States could then use that money for almost anything health-related.

What few people have noticed, however, is that those block grants end abruptly after 2026. Originally, many thought this was because of congressional budget rules that limit new programs to no more than 10 years.

In fact, those rules say that a program cannot add to the deficit after 10 years and don’t affect the length of the program. The block grant is paid for by continuing taxes from the ACA, so there is no budget need to cut it off.

The reason seems to be a desire to require Congress to come back and revisit the program. A spokesman for Cassidy said the program “just has to be reauthorized in 2026 just like the CHIP program.” CHIP is the Children’s Health Insurance Program, also created in a budget bill in 1997. Congress was supposed to reauthorize that program by the end of September, although it looks as if lawmakers will miss that deadline, despite bipartisan support.

Others, however, worry that cutting the money off after 2026 means Congress could no longer use the current funding mechanism. Instead, lawmakers would have to come up with massive cuts to other programs or new tax increases if they wanted to continue providing the money for health care.

— The Bill Could Roil The Individual Insurance Market In Some States By Banning Abortion Coverage In Private Health Plans.

In keeping a promise to anti-abortion lawmakers, the bill would prohibit all private insurance plans receiving any federal funds from providing abortion coverage.

As part of a delicate compromise that got the ACA enacted in 2010, states were given the option to ban abortion coverage in plans on their health exchanges. Half of them did.

But some states, notably California, New York and Oregon require plans they regulate to offer coverage of elective abortions.

The problem is that the deadline for insurers to opt into coverage under the ACA is next Wednesday. If Congress were to pass the bill after that, it is unclear what would happen to those plans. In California, the requirement for abortion coverage is based on the state’s Constitution, so it would be possible that no plans could be offered to people who are eligible for federal help.

“There aren’t clear answers” to what would happen if the bill becomes law in its current form and takes effect in January, said Debra Ness, president of the National Partnership for Women and Families, a reproductive rights advocacy group. “I think it’s going to create chaos.”

Categories: Medicaid, Repeal And Replace Watch, The Health Law

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McCain: ‘I Cannot In Good Conscience Vote For The Graham-Cassidy Proposal’

Sep 22 2017

With Sen. John McCain’s opposition to the last-ditch repeal-and-replace efforts, Republicans are left with no room for error.

Politico: McCain To Oppose Graham-Cassidy, Likely Sinking Obamacare Repeal
The legislation, drafted by GOP Sens. Bill Cassidy of Louisiana and South Carolina Sen. Lindsey Graham — McCain’s closest friend in the Senate — is the Senate GOP’s last best chance at passing a bill dismantling the Affordable Care Act before a Sept. 30 deadline. But in a lengthy statement Friday, McCain reiterated concerns about the process in which the legislation was drafted that he laid out in July when he voted against another Obamacare repeal plan. (Kim, 9/22)

The Hill: McCain To Vote No On ObamaCare Repeal
McCain’s announcement leaves GOP leadership with no room for error. They need 50 GOP senators to support the legislation, which would let Vice President Mike Pence break a tie. Sen. Rand Paul (R-Ky.) has already said he opposes the bill. Sen. Susan Collins (R-Ky.) said earlier Friday she is “leaning against” it, and several other key senators — including GOP Sen. Lisa Murkowski (Alaska) — remain on the fence. (Carney, 9/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Facebook Live: What’s Happening With The Children’s Health Insurance Program?

KHN Chief Washington Correspondent Julie Rovner and Bruce Lesley, a Capitol Hill veteran who heads First Focus, a bipartisan children’s health advocacy group, break down the current state of play on CHIP reauthorization and other congressional issues.

For more in-depth conversations with KHN reporters, check out our Facebook video archive.

KHN’s coverage of children’s health care issues is supported in part by a grant from The Heising-Simons Foundation.

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Viewpoints: Nursing Homes And Hurricanes; Winning The War On Drugs

A selection of opinions on health care from around the country.

Miami Herald: Protect Nursing Home Residents, Not Bad Facilities
When they get together in Tallahassee on Friday, the members of Florida’s nursing-home industry can either circle the wagons or lay the groundwork to take a deep, honest look at how best to confront the one the worst tragedies the industry seen. The Florida Health Care Association has called a “summit” to address emergency preparedness. This comes after eight, then nine and, as of Thursday, 10 elderly residents in a Hollywood Hills nursing home were left to suffer and die because they were in an stiflingly hot facility that lost electricity as Hurricane Irma blew through. (9/22)

USA Today: In Hurricane Irma, Why Did Nursing Home Patients Have To Die?
The deaths have set off the predictable round of finger-pointing among the nursing home, the electric utility, state agencies and the governor over responsibility for decisions and ineptitude that turned deadly. This blame game avoids the real problem. The facility had one operable backup generator, which did not run air conditioning. And no one — not the federal government, not the state and not the county — required the facility to have an emergency generator dedicated to keeping fragile residents cool in a state that regularly experiences hurricanes, flooding and sweltering heat. (9/21)

USA Today: Florida Health Care Association: We’re Dedicated
As caregivers dedicated to helping Florida’s frail elders, all of us at Florida Health Care Association grieve the loss of nine elderly residents of a single, non-member South Florida nursing home in the wake of Hurricane Irma. Our members accept the enormous daily responsibility of caring for Florida’s frailest residents. Ever since Florida’s horrendous storm season of 2004, we have committed to ongoing intensive disaster response training — most recently, the week before Hurricanes Harvey and Irma struck. (Emmett Reed, 9/21)

Bloomberg: Tom Price Flies Blind On Ethics
Under the lax ethical standards President Donald Trump brought to the White House, rampant conflicts of interest are treated with casual indifference. This disregard has sent a message to his entire administration that blurring lines — between public and private, right and wrong — will be not just tolerated but defended. At least one cabinet member appears to have taken the message to heart. (9/21)

The New York Times: How To Win A War On Drugs
Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue. … Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began. (Nicholas Kristof, 9/22)

The New England Journal Of Medicine: The Fate Of FDA Postapproval Studies
Both Congress and the Food and Drug Administration (FDA) have sought to accelerate the availability of new drugs by allowing sponsors to wait to resolve many questions about safety and benefit until after their drugs receive marketing approval. As a result, most approval letters require phase 4 studies to address issues such as optimal dosing, potential long-term side effects, and use in children or to confirm the clinical benefit of drugs that receive conditional approval on the basis of preliminary evidence. (Steven Woloshin, Lisa M. Schwartz, Brian White, and Thomas J. Moore, 9/21)

Chicago Tribune: Will Rauner Complete A ‘Full Obama’ On Abortion Rights?
Common usage notwithstanding, a flip-flop is actually a double inversion: First the flip — a reversal on an earlier position — then the flop — a return to the original position. A 360, to put it geometrically. A classic example is Barack Obama on same-sex marriage. In February 1996, when he was running for the state Senate, he expressed unequivocal support for gay marriage in candidate questionnaires, writing that he “would fight efforts to prohibit such marriages.” … A big question in Illinois these days is if Gov. Bruce Rauner will end up performing a “Full Obama” on the issue of Medicaid and state-employee health insurance funding of abortion services. (Eric Zorn, 9/21)

The New England Journal Of Medicine: A Nicotine-Focused Framework For Public Health
With the tools provided to the Food and Drug Administration (FDA) under the Family Smoking Prevention and Tobacco Control Act of 2009, the agency has taken consequential steps to prevent sales of tobacco products to children, expand the science base for understanding traditional and newer tobacco products, and conduct public education campaigns. But the agency needs to do more to protect Americans; in particular, we must shape a regulatory framework that reduces their use of combustible cigarettes. (Scott Gottlieb and Mitchell Zeller, 9/21)

Chicago Tribune: Cook County’s ‘Health’ Lie, In Black And White
Let Michael Bloomberg spend his millions to defend Cook County’s hated sweetened beverage tax. Opponents don’t need to pay a dime for advertising. That’s because taxpayers get a written reminder of this brazen cash grab every time they make a purchase. County Board members who are on the fence about next month’s vote to repeal the tax should keep that in mind. (9/21)

The New England Journal Of Medicine: Tuberculosis Elimination In The United States — The Need For Renewed Action
Once called “the captain of all these men of death,” tuberculosis continues to kill 1.8 million people globally each year. In 2014, the World Health Assembly embraced an ambitious resolution to reduce deaths from tuberculosis by 95% by 2035. But despite such global concern, tuberculosis has all but vanished from the U.S. public’s mind as a perceived threat. Although this lack of attention is understandable, given the substantial decrease in disease burden over the past several decades, it jeopardizes the prospect of tuberculosis elimination in the United States — a goal established by the Department of Health and Human Services in 1989. Critical ethical and policy questions must be addressed if elimination is to be pursued in earnest. (Ronald Bayer and Kenneth G. Castro, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Policy Implications: The GOP Bill’s Math Problems; The Importance Of Funding CHIP

Editorial pages include policy analysis of the Graham-Cassidy health care bill and examine some of the key policies now in play.

The Washington Post: Tens Of Millions Of Americans Could Lose Obamacare Tax Credits Because Thousands Of Alaskans Won’t
American politics is always a math problem. If you have a group of x people, you need (x/2) + 1 votes to win the most votes. That holds true for most elections pitting two candidates against each other, and it holds true for passing legislation. In the case of Cassidy-Graham, the clumsily named bill that is the latest and last iteration of Republican efforts to gut the Affordable Care Act, also known as Obamacare, the x is 100 — the number of votes in the Senate. Thanks to two quirks of the process, the legislation would pass with just (x/2) votes, with the +1 being added by VPOTUS-ex-machina Mike Pence. (Philip Bump, 9/21)

Los Angeles Times: Believe It Or Not, Graham-Cassidy Socializes The Cost Of Health Insurance
There are plenty of things wrong with the Graham-Cassidy-Heller-Johnson proposal to overhaul Obamacare (and Medicaid, while it’s at it), from its cockamamie approach to helping people not insured by their employers to its blithe indifference to the rising cost of medical care. But give sponsoring Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) credit for doing something remarkable: They got even the most conservative of their Republican colleagues to agree to socialize more of the cost of health insurance. (Jon Healey, 9/21)

The Washington Post: Republicans’ Brave New Strategy For Fixing The U.S. Health-Care System
Republicans have unveiled their brave new strategy for fixing the U.S. health-care system: Make someone else deal with it. Of all the god-awful Obamacare-repeal-and-replace plans that Republicans have proposed, Cassidy-Graham might be the god-awfulest. It’s definitely the most cowardly. Republicans spent nine months fighting over how to repeal Obamacare without shafting the poor and enraging voters, and they failed. So instead they’re passing the buck. (Catherine Rampell, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Political Perspectives: Pleas For Truth Talk Regarding Graham-Cassidy; Does Panic On Left Suggest Progress On Right?

Opinion writers express outrage at the contents of the Senate GOP’s latest attempt to repeal and replace Obamacare and explore the political motivations for pursuing the measure’s passage.

The New York Times: Senator Cassidy, Please Stop Lying About Health Care
Here’s a giveway about how bad the new Senate health care bill is: Bill Cassidy, one of its authors, keeps trying to sell it by telling untruths. “The relatively new phenomenon of just ‘up is down’ lying about your bill’s impacts is jarring,” says Loren Adler of the USC-Brookings-Schaeffer Initiative on Health Policy. Most egregiously, Cassidy is claiming that the bill would not ultimately deprive sick people of health insurance. That’s false, as NPR calmly explained when Cassidy said otherwise. (David Leonhardt, 9/21)

The Wall Street Journal: The Panic Over Graham-Cassidy
Senate Republicans must be making progress on their latest attempt to reform health care, because the opposition is again reaching jet-aircraft decibel levels of outrage. The debate could use a few facts—not least on the claims that the GOP is engaging in an unfair process. Republicans are scrambling to pass Lindsey Graham and Bill Cassidy’s health-care bill before Sept. 30, when the clock expires on the budget procedure that allows the Senate to pass legislation with 51 votes. The bill would devolve ObamaCare funding to the states, which could seek waivers from the feds to experiment within certain regulatory boundaries, and it also repeals the individual and employer mandates and medical-device tax. (9/21)

The New York Times: Cruelty, Incompetence And Lies
Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good. (Paul Krugman, 9/22)

The Washington Post: This Republican Health-Care Bill Is The Most Monstrous Yet
Motivated by the cynical aims of fulfilling a bumper-sticker campaign promise and lavishing tax cuts on the wealthy, Republicans are threatening to pass a health-care bill they know will make millions of Americans sicker and poorer. Do they think we don’t see what they’re doing? Does Sen. Charles E. Grassley (R-Iowa) think we didn’t hear what he said Wednesday? “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” he told reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.” (Eugene Robinson, 9/21)

The Wall Street Journal: The Graham-Cassidy Show Is Like ‘Jaws’—And You’re The Swimmer
If you’ve been following the congressional health-care “debate”—an overly kind word, to be sure—you may now be getting an eerie feeling. It’s sort of like “Jaws.” You thought it was safe to go back into the health-care waters. The poor and the powerless seemed to be out of harm’s way. Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) were reporting progress on a bipartisan compromise. Then the Graham-Cassidy bill came out of nowhere, like a great white shark, accompanied by a bit of ominous music. (Alan S. Blinder, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Hospital Transportation; Medicaid Expansion; Obesity Treatment

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

Urban Institute: The Affordable Care Act Medicaid Expansions And Personal Finance 
Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing. (Caswell and Waidmann, 9/17)

Health Affairs: Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care
Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. (Zhu, Zhang and Polsky, 9/1)

Pediatrics: Cost-Effectiveness Of Family-Based Obesity Treatment 
We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. … For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group. (Quattrin, Cao, Paluch et. al., 9/1)

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State Highlights: In Calif., Gubernatorial Candidates Try To Prove Health Care Street Cred; Death Toll Rises In Fla. Nursing Home Tradgedy

Media outlets report on news from California, Florida, Texas, Illinois and Pennsylvania.

Los Angeles Times: The Push For Single-Payer Health Care Just Went National. What Does That Mean For The California Effort?
When Vermont Sen. Bernie Sanders visited Beverly Hills last May, he made a full-throated appeal for California to “lead the country” and pass a pending state proposal to establish single-payer health care. On Friday, he’ll return here for a San Francisco speech trumpeting his own higher-stakes plan — a bill to drastically overhaul the nation’s health-care system by covering everyone through Medicare. (Mason, 9/22)

Los Angeles Times: Two Top Candidates For California Governor Have Been Touting Their Healthcare Wins. Here’S What They Really Did
Gavin Newsom and Antonio Villaraigosa are depicting themselves as Democratic healthcare visionaries as they campaign to become California’s next governor. To prove his healthcare mettle, Newsom points to Healthy San Francisco, a first-of-its-kind universal system adopted while he reigned as the city’s mayor in 2006. Newsom’s work on the program helped him land an endorsement from the influential California Nurses Association, and a boast or two will surely punctuate his speech at their convention on Friday as hyper-partisan politics intensify over efforts to repeal the Affordable Care Act and implement a national single-payer plan. (Willon, 9/22)

Reuters: Death Toll From Overheated Florida Nursing Home Rises To 10
A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday. The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details. (Simpson, 9/21)

Los Angeles Times: Multiple Cases Of West Nile Virus In Glendale Prompt Education Campaign
With eight cases of West Nile virus reported in Glendale so far this year, health officials took part in a door-to-door education campaign Wednesday, informing residents of what they can do to protect themselves from infection. Conducted by the Greater Los Angeles County Vector Control District, the effort informed residents in Glendale, Los Feliz and Atwater Village about the preventive measures they can take to reduce the risk of being bitten by mosquitoes. Levy Sun, a spokesman for vector control, said wearing insect repellent and dumping out any stagnant water near homes are measures people should take regularly. (Nguyen, 9/21)

Houston Chronicle: Residents Near Houston Superfund Site Await Answers After Hurricane Harvey
Bonner and others in Channelview, Baytown and Highlands neighborhoods along this industrial stretch of the river south of the Lake Houston dam worry about the toxicity of murky water, white dust and the foul-smelling sludge covering their properties. The question for dozens of people, who a week after the storm still guard wrecked riverfront properties from marauders seeking scrap, is whether their neighborhoods are now too contaminated to recover. (Olson, 9/22)

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Football Player Who Was Convicted Of Murder Found To Have Severe Brain Damage

The severity of former NFL player Aaron Hernandez’s CTE, a degenerative disease believed to be caused by concussions, is usually found in players in their 60s. He was 27 when he committed suicide in jail.

The New York Times: Aaron Hernandez Found To Have Severe C.T.E.
The brain scan came as a surprise even to researchers who for years have been studying the relationship between brain disease and deaths of professional football players. Aaron Hernandez, the former New England Patriots tight end and a convicted murderer, was 27 when he committed suicide in April. Yet a posthumous examination of his brain showed he had such a severe form of the degenerative brain disease C.T.E. that the damage was akin to that of players well into their 60s. (Belson, 9/21)

Los Angeles Times: Disgraced Ex-Patriots Player Aaron Hernandez Found To Have CTE And Early Brain Atrophy
In an announcement Thursday, Boston University’s CTE Center said doctors diagnosed Hernandez with Stage 3 CTE. Stage 4 is the most serious. Both stages, usually found in much older former players, are associated with aggressiveness, impulsivity, depression and memory loss. The effort, led by Dr. Ann McKee, also found he had “early brain atrophy” and “large perforations” on a central membrane in his brain. (Fenno, 9/21)

The Boston Globe: Learn The Symptoms In The Four Stages Of CTE
A statement released by the BU CTE Center stated that Hernandez was found to have Stage 3 CTE, with Stage 4 being the most severe. According to a 2012 BU study, CTE begins with simple symptoms such as headaches and difficulty concentrating, but as the disease progresses, other, much more worrying conditions appear. (Ortiz, 9/21)

Dangers of such diseases put the spotlight on how schools handle young players —

San Francisco Chronicle: How California Puts High School Athletes At Great Risk
According to a recent study published in the Orthopedic Journal of Sports Medicine and conducted by the University of Connecticut’s Korey Stringer Institute, a nonprofit dedicated to minimizing preventable death on the playing field, California ranks second to last in the nation — ahead of only Colorado — when it comes to implementing policies that help prevent the leading causes of sudden death in high school athletes. (Saracevic, 9/21)

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Hospital Cracks Down On Inconsistencies With Prescribing Opioids As It Tries To Battle Crisis

Anne Arundel Health System joins hospitals across the region and the state of Maryland in attempting to eradicate a problem medical institutions now realize they helped create. Meanwhile, the Senate HELP Committee will plan on a hearing to address the epidemic next month.

The Hill: Senate Health Committee Schedules Hearing On Opioid Crisis
The Senate Health Committee will hold a hearing on the opioid crisis next month. The committee will focus on the federal response to the crisis and conduct oversight of the Comprehensive Addiction and Recovery Act, a law passed in 2016 that supports efforts to address the issue. (Hellmann, 9/21)

And in other news —

The Associated Press: Opioid Epidemic Laws Lead Panel To Revisit Recovery Schools
A fire led to the eventual end of Phoenix — a groundbreaking Maryland public school program for children with addiction that closed in 2012 — but the state could see institutions like it rise again from the ashes. Recent spikes in the Maryland heroin and opioid epidemic have triggered calls for substantial changes in education systems statewide, and a state work group is weighing the return of recovery schools after a Sept. 7 meeting. (Slater, 9/21)

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Massive Data-Gathering Project Strives To Be Inclusive Where So Many Studies Have Failed In Past

The National Institutes of Health’s wide-sweeping data-gathering project, called “All Of Us,” has set a goal of ensuring that more than half of the participants come from communities that are historically underrepresented in biomedical research. In other public health news: brain science, diabetes-related amputations, kidney disease and more.

Stat: To Advance Precision Medicine, NIH Turns To Long-Mistreated Communities
The National Institutes of Health would like six vials of your blood, please.Its scientists would like to take a urine sample, measure your waistline, and have access to your electronic health records and data from the wearable sensor on your wrist. And if you don’t mind sharing, could they have your Social Security number? It is a big ask, the NIH knows, and of an equally big group — the agency eventually hopes to enroll over 1 million participants in the next step of what four researchers referred to in a 2003 paper as “a revolution in biological research.” (Facher, 9/22)

Stat: Zapping The Brain For Stroke Rehab: Pivotal Clinical Trial Begins
Despite being forced by Hurricane Irma to close its outpatient facilities for several days, the Mayo Clinic in Jacksonville, Fla., is expected to forge ahead this month with a pivotal clinical trial testing whether an electrical implant can rewire the brains of stroke patients so they can use their arms and hands again. (Begley, 9/22)

Los Angeles Times: UC Irvine To Debut Brain Research Center With Advanced MRI Machine
UC Irvine’s Campus Center for Neuroimaging will have a grand opening next month for its new research center that aims to make breakthroughs in human brain research. The centerpiece of the center — dubbed FIBRE, or Facility for Imaging & Brain Research — is a $3-million Siemens Prisma 3T magnetic resonance imaging, or MRI, machine noted for its technology that collects higher-quality images in a shorter time. It came to UCI with help from Siemens and the National Institutes of Health. (Zint, 9/21)

inewsource: Diabetes-Related Amputations Increase In California — And San Diego
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California — and San Diego County in particular — in a “shocking” trend that has mystified diabetes experts here and across the country. Though they often prolong lives, diabetes-related amputations deprive patients of independence, increase the need for social services and add to disability and medical costs.Explore the rate of amputations in California.Statewide, lower-limb amputations increased by more than 31 percent from 2010 to 2016 when adjusted for population change. In San Diego County, the increase was more than twice that: 66.4 percent. (Clark, 9/20)

The New York Times: Air Pollution Tied To Kidney Disease
Add a new potential ill to the list of problems linked to air pollution: kidney disease. Previous studies have linked high levels of the fine particulate matter known as PM 2.5 to cardiovascular disease and stroke. A new analysis, in The Journal of the American Society of Nephrology, followed 2,482,737 veterans for an average of eight and a half years. The Department of Veterans Affairs database includes information on glomerular filtration rate, or G.F.R., a measure of kidney function. (Bakalar, 9/21)

The Washington Post: She Chose To Die So She Could Give Birth. Now Her Newborn Is Dead, Too.
The headaches began in March. The couple didn’t think much of them — until Carrie DeKlyen began vomiting. An initial scan showed a mass in her brain. More tests showed that it was a form of cancer, possibly lymphoma, but treatable. But a pathology exam revealed a more grim diagnosis. The 37-year-old mother of five from Wyoming, Mich., had glioblastoma, an aggressive form of brain cancer. If lucky, she could live for five more years. (Phillips and du Lac, 9/21)

California Healthline: FDA Approves Scope With Disposable Part Aimed At Reducing Superbug Infections
Seeking to prevent superbug outbreaks, federal health officials said they have approved the first gastrointestinal medical scope with a disposable cap for use in the U.S. The Food and Drug Administration said that the design of the new duodenoscope by Japanese device maker Pentax should make it easier to remove dangerous bacteria that can become trapped inside these reusable instruments. (Terhune, 9/22)

NPR: Pee In The Pool Can Cause Breathing And Eye Irritation
Water parks can be fun, but they also can pose unexpected health risks – in this case, eye and respiratory problems. And that shower you never take before you get in the pool plays a role. In July 2015, patrons at an indoor water park resort in Ohio started to complain about eye and respiratory problems. Local health officials surveyed patrons and water park employees, who reported issues like eye burning, nose irritation, difficulty breathing and vomiting. The Centers for Disease Control and Prevention then stepped in to investigate. (Jochem, 9/21)

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VA Steps Up Efforts To Screen And Treat Veterans For Hepatitis C

With a higher rate of infection reported among vets than the general population, the Department of Veterans Affairs started taking proactive measures three years ago to cure patients. Meanwhile, Agent Orange exposure and a wrongful death case are also in veterans health news headlines today.

KQED: In The Battle Against Hepatitis C, The VA Takes The Lead
The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers. (Klivans, 9/2!)

Kansas City Star: VA Medical Center In Kansas City Focus Of Wrongful Death Suit Alleging Allergic Reaction
An 84-year-old patient developed pustular lesions on his face and died after a Veterans Affairs hospital in Kansas City treated him with a drug he was allergic to, according to a lawsuit filed Wednesday. The suit filed in federal court by Kansas City lawyer Leland Dempsey alleges that staff at the VA Medical Center on Linwood Boulevard caused Mark Beemer’s death last year by giving him Ceftriaxone, and the death could easily have been prevented. (Marso, 9/21)

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Drug’s $475K Cost Highlights Pricing Problems With Unique, Breakthrough Therapies

“We need a new payment model,” Steve Miller, chief medical officer at Express Scripts Holding Co., said while criticizing Novartis’ new drug.

Bloomberg: Novartis’s $475,000 Price On Cancer Therapy Meets Resistance
The $475,000 price tag on Novartis AG’s latest breakthrough cancer therapy came under fire from one of the biggest managers of drug costs in the U.S., underscoring the challenges the Swiss drugmaker will face in promoting the potential blockbuster. The cost of the leukemia treatment, called Kymriah, is “dramatically higher” than other such complex treatments, and the health-care system isn’t ready to pay for it, Steve Miller, chief medical officer at Express Scripts Holding Co., said Thursday in a blog post on his company’s website. Gene therapies like Novartis’s are targeted at a small number of patients and typically used just once, meaning that drug companies have limited chances to recoup their investment. (Lauerman and Paton, 9/22)

In other pharmaceutical news —

Bloomberg: FDA Warns Doctors After 19 Deaths On Intercept Liver Drug
Nineteen patients died after taking a liver-disease drug from Intercept Pharmaceuticals Inc., the U.S. Food and Drug Administration said, warning doctors about risks from a product that the company is seeking to make into a blockbuster. Shares of the drugmaker sank 24.9 percent to $73.70 at 4:00 p.m. in New York, the company’s biggest loss since November 2014. (Langreth, 9/21)

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Money-Saving Offer For Medicare’s Late Enrollees Is Expiring. Can They Buy Time?

Many older Americans who have Affordable Care Act insurance policies are going to miss a Sept. 30 deadline to enroll in Medicare, and they need more time to make the change, advocates say.

A lifetime of late enrollment penalties typically await people who don’t sign up for Medicare Part B — which covers doctor visits and other outpatient services — when they first become eligible. That includes people who mistakenly thought that because they had insurance through the ACA marketplaces, they didn’t need to enroll in Medicare.

Medicare officials are offering to waive those penalties under a temporary rule change that began earlier this year, but the deal ends Sept. 30.

On Wednesday, more than 40 groups, including consumer health advocacy organizations and insurers, asked Medicare chief Seema Verma to extend the waiver deadline through at least Dec. 31, because they are worried that many people who could be helped still don’t know about it.

They also say more time is needed because of application delays at some Social Security Administration (SSA) local offices, where beneficiaries request the waiver.

“We know there are people who can still benefit from it,” said Stacy Sanders, the federal policy director at the Medicare Rights Center, a Washington-based advocacy group that coordinated the request to Medicare. “We know there have been delays, and those are good reasons to extend it.”

Counselors at the Medicare Rights Center have helped seniors apply for the waiver in Arizona, California, Florida, Minnesota, Missouri, New Jersey and New York, she said.

Since the marketplaces opened in 2014, the focus has been on getting people enrolled, Sanders added. “There’s no reason to expect that people would understand how to move out of the marketplace into Medicare.”

The waiver offer applies not only to people over 65 who have kept their marketplace plans, but also to younger people who qualify for Medicare through a disability and chose to use marketplace plans.

The waiver also allows Medicare beneficiaries who earlier realized their mistake in keeping a marketplace plan and have switched to ask for a reduction or elimination of the penalty.

In all cases, people had to be eligible for Medicare after April 1, 2013.

Officials at the Centers for Medicare & Medicaid, which runs Medicare, would not provide details about the number of waivers granted or pending applications. Nor would they comment on the likelihood of an extension.

Barbara Davis said that when she initially applied, a Social Security representative didn’t know about the waiver. She eventually contacted the Medicare Rights Center, where a counselor interceded on her behalf in June. A day later, a Social Security representative told her she would not have a penalty.

“My advice would be, find out your rights before you apply,” said Davis, 68, who lives with her husband in rural western New York. “Because they don’t seem to want to give you information to help you, you have to know this on your own.”

A Social Security spokeswoman said the agency is processing waiver applications from “across the country” but does not keep track of the number. She declined to comment on whether SSA employees know about the waiver.

Sanders suggested that people applying for the waiver ask Social Security officials for it by using its official name: “time-limited equitable relief.”

Since Medicare’s Part A hospitalization benefit is usually free, some seniors who liked their marketplace coverage thought — incorrectly — that they had nothing to lose by signing up for Part A and keeping their marketplace plan.

Some people receiving Social Security retirement or disability benefits opted to keep their marketplace plan and drop Part B after the Social Security Administration enrolled them automatically in Medicare when they became eligible.

If the temporary waiver expires, the only other way for beneficiaries to get an exemption is by proving they declined Part B because a government employee misinformed them.

The groups writing Verma argue that keeping the waiver in place past Sept. 30 could also help many beneficiaries who may be surprised by a little-known rule that will affect 2018 marketplace policies.

For the first time, insurers will be prohibited from issuing a marketplace plan if they know the member is eligible for Medicare and the 2018 policy is significantly different.

Those who find themselves without a marketplace plan could be in for another surprise: They won’t have insurance for outpatient care until July 1 because Medicare imposes a waiting period before Part B coverage kicks in for latecomers.

Extending the deadline “would lessen a significant hardship for many people … [who] are unaware of the repercussions that could result from keeping their marketplace coverage,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, an industry group.

For information on how to apply for the time-limited equitable relief waiver, go to the Medicare Rights Center’s Medicare Interactive webpage or call the center’s helpline at 1-800-333-4114.

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation and coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Cost and Quality, Insurance, Medicare, The Health Law

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First Edition: September 22, 2017

Sep 22 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: Narrow Networks Get Even Tighter When Shopping For Mental Health Specialists
If you’ve got a plan offered on the federal health law’s insurance marketplace and you’re looking for a therapist, you may have to look really hard: The average provider network includes only 11 percent of all the mental health care providers in a given market, according to a recent study. An average marketplace plan’s network, the study added, includes just under a quarter of all psychiatrists  and 10 percent of all non-physician mental health care providers. Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants, and  behavioral specialists, counselors and therapists with master’s or doctoral degrees. (Andrews, 9/22)

Kaiser Health News: Uncertainty Over Health Care’s Future Hobbles Entrepreneurs
Stinson Dean is used to taking risks. The entrepreneur from Independence, Mo., says coping with the ups and downs of the market is an inevitable part of his business. But when he started his company about a year and a half ago, he laid down a firm rule. “One of the things I wasn’t willing to risk was the health of my family,” Dean said. (Smith, 9/22)

California Healthline: A Nail-Biter: California Nervously Awaits U.S. Senate’s Verdict On Obamacare
Congressional Republicans are giving repeal of Obama’s signature health law one more try. They have until the end of the month to garner enough votes to pass the so-called Graham-Cassidy bill, which would fundamentally change how health care is funded nationwide. Its effects would be especially far-reaching in California and other states that bought heavily into the Affordable Care Act. (9/21)

California Healthline: FDA Approves Scope With Disposable Part Aimed At Reducing Superbug Infections
Seeking to prevent superbug outbreaks, federal health officials said they have approved the first gastrointestinal medical scope with a disposable cap for use in the U.S. The Food and Drug Administration said that the design of the new duodenoscope by Japanese device maker Pentax should make it easier to remove dangerous bacteria that can become trapped inside these reusable instruments. (Terhune, 9/22)

The New York Times: Latest Obamacare Repeal Effort Is Most Far-Reaching
For decades, Republicans have dreamed of taking some of the vast sums the federal government spends on health care entitlements and handing the money over to states to use as they saw best. Now, in an 11th-hour effort to repeal the Affordable Care Act, the party has come up with a way to repackage the funding for the law it loathes into a trillion-dollar pot of state grants. The plan is at the core of the bill that Senate Republican leaders have vowed to bring to a vote next week. It was initially seen as a long-shot effort by Senators Lindsey Graham and Bill Cassidy. But for all its ad hoc, last-minute feel, it has evolved into the most far-reaching repeal proposal of all. (Zernike, Abelson and Goodnough, 9/21)

The Wall Street Journal: Q&A: How The Graham-Cassidy Plan Would Change Health Coverage
The Graham-Cassidy bill would lump together the money spent on two ACA programs to expand health coverage: subsidies for private insurance and an expansion of the Medicaid program. That funding would be redistributed as block grants to states that could use it to fashion their own health systems. All of the bill’s health spending would end in 2027 and need to be reauthorized by Congress. The bill also makes structural changes to Medicaid by capping how much federal money states can get. A similar proposal, contained in the Republicans’ last effort to repeal parts of the ACA, would have resulted in 15 million people losing health coverage in a decade, according to the Congressional Budget Office. (Hackman, 9/21)

The Washington Post: How Many With Preexisting Conditions Would Be Priced Out Of Coverage Under Cassidy-Graham?
The easiest way to understand the debate over preexisting conditions in health-care coverage — a debate fueled this week by Jimmy Kimmel’s repeated disparagement of the new Republican plan to overhaul Obamacare — is to look at the Obamacare website. As of writing, Healthcare.gov explains what protections the Affordable Care Act provides to those with conditions that, before the bill’s passage, may have resulted in denial of coverage or sharply increased premiums. (Bump, 9/21)

The New York Times: The G.O.P. Bill Forces States To Build Health Systems From Scratch. That’s Hard.
In 2003, health care policy makers in Massachusetts agreed that the state should build a system to expand coverage to its uninsured residents. It took four years before Romneycare was fully up and running. In between, politicians had to think hard about how they wanted the system to work: how money would be raised and spent, what benefits would be offered, whether and how markets should be used to distribute coverage, whether people who didn’t buy coverage should be penalized. (Sanger-Katz, 9/21)

The Washington Post: Federal Estimate Shows Big Win-Loss Gap Among States Under Cassidy-Graham Bill
An internal analysis by the Trump administration concludes that 31 states would lose federal money for health coverage under Senate Republicans’ latest effort to abolish much of the Affordable Care Act, with the politically critical state of Alaska facing a 38 percent cut in 2026. The report, produced by the federal Centers for Medicare and Medicaid Services, focuses on the final year of a block grant that states would receive under the Cassidy-Graham legislation. It shows that government funding for such health insurance would be 9 percent lower overall in 2026 under the plan than under current law. (Goldstein and Eilperin, 9/22)

NPR: Latest Senate Health Bill Would Cut Funds To Blue States
Senate Republicans’ latest plan to overhaul the U.S. health care system ends with a massive shift of federal money from states that expanded Medicaid — and are largely dominated by Democrats — to those that refused to expand. Several analyses of the bill show the pattern. (Kodjak, 9/21)

The Hill: Which States Could Win And Lose From The New ObamaCare Repeal Bill
The ObamaCare repeal bill set for a possible vote next week in the Senate would create winners and losers among the 50 states that would be asked to implement their own health-care plans with block grants of federal funding. The bill, sponsored by Republican Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.), ends federal funding for ObamaCare’s Medicaid expansion and the subsidies that help people afford coverage, as well as the law’s insurance mandate. (Hellmann and Weixel, 9/21)

The Hill: GOP ObamaCare Repeal Takes New Step In Nixing Medicaid Expansion
The Senate GOP’s last-ditch effort to repeal ObamaCare goes farther than past bids to rein in the law’s Medicaid expansion, barring states from extending the expansion past 2019 even if they use their own money. An earlier GOP repeal bill would have let states keep the program, but that is eliminated under the legislation crafted by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), which could come up for a Senate vote next week. (Sullivan, 9/21)

The Washington Post: Cassidy-Graham Bill Provision Would Exempt Alaska, Montana From A Cap On Medicaid Spending
As GOP leaders continue to drum up support for the health-care proposal written by Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.), a provision buried deep in the 140-page bill benefiting Alaska has begun to draw greater scrutiny. Beginning on page 95, the bill has a provision that exempts low-density states whose block grants either decrease or stay flat between 2020 and 2026 from the Medicaid per capita cap. Under that scenario, Alaska and Montana would be exempted from the funding cap that applies to all other states during that period. (Eilperin, 9/21)

The Hill: Graham And Cassidy Go Into Overdrive To Win Murkowski Vote
Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are going into overdrive to win over Alaska Sen. Lisa Murkowski (R), a pivotal vote for their bill to dismantle ObamaCare and give states more authority over healthcare. The two have seen Murkowski, one of three Republicans to sink the GOP’s last repeal bill, as a critical vote for some time. (Bolton, 9/22)

The Hill: Pence Urges Alaskans To Contact Murkowski, Sullivan For Repeal Bill
Vice President Pence urged Alaska residents on Thursday to contact the state’s Sens. Lisa Murkowski and Dan Sullivan, who are among the Republicans undecided on the new ObamaCare repeal plan, and ask them to support the bill. Pence said in an interview with Anchorage radio host Mike Porcaro that “now is the time to reach out to Sen. Dan Sullivan and Sen. Lisa Murkowski and let them know that you’d be grateful if they’d stand with President Trump and they’d vote in favor of Graham-Cassidy when it comes to the Senate floor next week.” (Delk, 9/21)

Politico: Trump Publicly Backs Healthcare Effort, Privately Harbors Doubts
In public, President Donald Trump is all-in on the Senate’s final chance to repeal Obamacare. But privately, there’s ambivalence in the White House about the bill’s contents and its chances of clearing the tightly divided chamber next week. Trump spent time between meetings at the United Nations calling senators and other senior White House officials about the Graham-Cassidy bill, asking for updated vote tallies and how to woo senators for the bill. White House officials have considered tweaking the state funding to win a vote from GOP Sen. Lisa Murkowski of Alaska — and others. Trump has also publicly excoriated Kentucky Sen. Rand Paul for voting against the legislation, telling aides he would go after other senators. (Dawsey and Everett, 9/22)

Politico: McConnell Lays It On The Line
He’s been battered by President Donald Trump and had his vaunted legislative acumen called into question. Now, Mitch McConnell has a chance to put his cruel summer behind him. Over the next week, the Senate majority leader will try one last time to rescind the Democratic health care law. At the same time, he’s put his political reputation on the line in Alabama, where his chosen candidate, incumbent Sen. Luther Strange, faces off against anti-establishment Roy Moore in a special Senate election on Tuesday. (Everett and Bresnahan, 9/21)

The Associated Press: Iowa Sen. Ernst Hopes, But Isn’t Sure, Health Bill Has Vote
Republican Sen. Joni Ernst said Thursday she isn’t sure her party’s last-ditch effort to repeal Barack Obama’s health care law has the votes to pass, as she faced tough questions from Iowa constituents about the political drive for the measure. “If it’s brought up, I hope we have the votes to pass it,” Ernst told reporters after a meeting with constituents in northern Iowa. “I hope there’s consensus on the bill.” (9/21)

The Hill: Nevada GOP Gov Rips ObamaCare Repeal Bill: Flexibility It Promises ‘A False Choice’
Nevada Gov. Brian Sandoval (R) on Thursday amped up his criticism of the new plan to repeal and replace ObamaCare, saying the GOP bill would “pit Nevadans against each other.” “Flexibility with reduced funding is a false choice,” Sandoval said in a statement to The Nevada Independent. “I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada’s healthcare delivery system proposed by the Graham-Cassidy amendment.” (Carter, 9/21)

The Hill: Medicaid Directors Issue Warning On New ObamaCare Repeal Bill
The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate’s latest ObamaCare repeal bill would place a massive burden on states. The bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would eliminate ObamaCare’s Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants. (Hellmann, 9/21)

The New York Times: Jimmy Kimmel Accused A Senator Of Lying About His Health Care Bill. Who’s Right?
Jimmy Kimmel, the talk show host who has become the unlikely face of opposition to Senate Republicans’ latest health care push, insisted he had done his homework. Mr. Kimmel spent a second straight night arguing against the proposal on Wednesday. Senator Bill Cassidy of Louisiana, a co-sponsor of the bill, responded by telling news outlets that “Jimmy doesn’t understand.” (Qiu and Victor, 9/21)

The Associated Press Fact Check: Kimmel’s Take On Health Care Harder To Refute
Who’s right — President Donald Trump and Sen. Bill Cassidy, or late-night host Jimmy Kimmel? None has really captured the complexity of the debate over who might lose insurance protections in the latest Republican health care bill. But of the three, the TV guy is the hardest to refute. Trump insists in a tweet that the bill covers pre-existing conditions, a point also made by Cassidy, a sponsor of the legislation. But there’s a catch. It allows states to get a waiver from “Obamacare” requirements that insurers charge the same to people with health problems as they do to healthy people. (Alonso-Zaldivar, 9/22)

The Associated Press: Jimmy Kimmel Transforms Debate, And Shows Comedy’s New Role
If the latest Republican attempt to repeal Obamacare doesn’t work, it may become known as the Jimmy Kimmel Non-Law. The comic’s withering attacks this week have transformed the debate over the bill (sponsored by Sens. Lindsey Graham and Bill Cassidy) and, in the process, illustrated how thoroughly late-night talk shows have changed and become homes for potent points of view. (9/21)

Politico: Kimmel Tells Viewers: ‘We Have Until Sept. 30’ To Stop GOP Health Bill
Jimmy Kimmel on Thursday said it’s not his job to talk about health care — but he’s doing it anyway, until Senate Republicans’ last-ditch bill to repeal Obamacare is stopped. “I should not be the guy you go to for information on health care,” the late-night TV host said on Thursday’s show. “And if these guys … would tell the truth for a change, I wouldn’t have to.” (Diamond, 9/21)

The Hill: Jimmy Kimmel Becomes Thorn In The GOP’s Side
Republicans racing against the clock to repeal ObamaCare are fighting against Democrats, angry patient advocates and a who’s-who of health industry groups. Yet one of the most formidable opponents they face is an unlikely wild card: the comedian Jimmy Kimmel. (Lillis, 9/21)

The Hill: CNN To Host Health-Care Debate With ObamaCare Repeal Sponsors
CNN will host a town hall-style debate Monday night where senators will face off over the new ObamaCare repeal bill. The network announced that Sens. Bernie Sanders (I-Vt.) and Amy Klobuchar (D-Minn.), opponents of the bill, will debate its co-sponsors, Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.). (Concha and Sullivan, 9/21)

Los Angeles Times: The Push For Single-Payer Health Care Just Went National. What Does That Mean For The California Effort?
When Vermont Sen. Bernie Sanders visited Beverly Hills last May, he made a full-throated appeal for California to “lead the country” and pass a pending state proposal to establish single-payer health care. On Friday, he’ll return here for a San Francisco speech trumpeting his own higher-stakes plan — a bill to drastically overhaul the nation’s health-care system by covering everyone through Medicare. (Mason, 9/22)

The Washington Post: How Tom Price Decided Chartered, Private Jets Were A Good Use Of Taxpayer Money
After Tom Price was sworn in as health and human services secretary, the Georgia Republican faced an inconvenience known to millions of Americans: His flight was delayed, an aide said, and he was forced to spend hours at an airport. The delay left Price a no-show at an early public appearance his office helped plan. Price knew well the pain of flying to and from Washington as a member of Congress for 12 years. But now he was the head of a trillion-dollar federal agency and one of President Trump’s point men to fulfill the campaign promise of repealing the Affordable Care Act. Flight delays and no-shows would not do. (Davis, 9/22)

Politico: Price Traveled By Private Plane At Least 24 Times
Health and Human Services Secretary Tom Price has taken at least 24 flights on private charter planes at taxpayers’ expense since early May, according to people with knowledge of his travel plans and a review of HHS documents. The frequency of the trips underscores how private travel has become the norm — rather than the exception — for the Georgia Republican during his tenure atop the federal health agency, which began in February. The cost of the trips identified by POLITICO exceeds $300,000, according to a review of federal contracts and similar trip itineraries. (Pradhan and Diamond, 9/21)

Stat: HHS Hints At Major Changes To Medicare That Could Mean Higher Costs For Patients
The Trump administration is signaling it will pursue significant changes to Medicare that could put beneficiaries on the hook for higher costs. In an informal proposal on Wednesday, federal health officials hinted at several new pilot programs it may implement in the months ahead. One idea would give doctors more latitude to enter into so-called private contracts to charge Medicare beneficiaries more for certain services, if the patients were willing to pay. (Mershon, 9/21)

Stat: Without Congressional Action, Hospital Payments At Risk Of Expiring
Drive around this city long enough, and you’ll see the billboards that have become a staple of the skyline. They read: Atlanta can’t live without Grady. For many here, that’s indeed the case. Grady Memorial Hospital, a safety net hospital with more than 950 beds, is where people go if they come down with the flu or if they suffer a gunshot wound, but can’t afford care anywhere else. (Blau, 9/22)

Stat: To Advance Precision Medicine, NIH Turns To Long-Mistreated Communities
The National Institutes of Health would like six vials of your blood, please.Its scientists would like to take a urine sample, measure your waistline, and have access to your electronic health records and data from the wearable sensor on your wrist. And if you don’t mind sharing, could they have your Social Security number? It is a big ask, the NIH knows, and of an equally big group — the agency eventually hopes to enroll over 1 million participants in the next step of what four researchers referred to in a 2003 paper as “a revolution in biological research.” (Facher, 9/22)

Reuters: Death Toll From Overheated Florida Nursing Home Rises To 10
A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday. The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details. (Simpson, 9/21)

The New York Times: Aaron Hernandez Found To Have Severe C.T.E.
The brain scan came as a surprise even to researchers who for years have been studying the relationship between brain disease and deaths of professional football players. Aaron Hernandez, the former New England Patriots tight end and a convicted murderer, was 27 when he committed suicide in April. Yet a posthumous examination of his brain showed he had such a severe form of the degenerative brain disease C.T.E. that the damage was akin to that of players well into their 60s. (Belson, 9/21)

Los Angeles Times: Disgraced Ex-Patriots Player Aaron Hernandez Found To Have CTE And Early Brain Atrophy
In an announcement Thursday, Boston University’s CTE Center said doctors diagnosed Hernandez with Stage 3 CTE. Stage 4 is the most serious. Both stages, usually found in much older former players, are associated with aggressiveness, impulsivity, depression and memory loss. The effort, led by Dr. Ann McKee, also found he had “early brain atrophy” and “large perforations” on a central membrane in his brain. (Fenno, 9/21)

Los Angeles Times: UC Irvine To Debut Brain Research Center With Advanced MRI Machine
C Irvine’s Campus Center for Neuroimaging will have a grand opening next month for its new research center that aims to make breakthroughs in human brain research. The centerpiece of the center — dubbed FIBRE, or Facility for Imaging & Brain Research — is a $3-million Siemens Prisma 3T magnetic resonance imaging, or MRI, machine noted for its technology that collects higher-quality images in a shorter time. It came to UCI with help from Siemens and the National Institutes of Health. (Zint, 9/21)

Stat: Zapping The Brain For Stroke Rehab: Pivotal Clinical Trial Begins
Despite being forced by Hurricane Irma to close its outpatient facilities for several days, the Mayo Clinic in Jacksonville, Fla., is expected to forge ahead this month with a pivotal clinical trial testing whether an electrical implant can rewire the brains of stroke patients so they can use their arms and hands again. (Begley, 9/22)

Los Angeles Times: Two Top Candidates For California Governor Have Been Touting Their Healthcare Wins. Here’S What They Really Did
Gavin Newsom and Antonio Villaraigosa are depicting themselves as Democratic healthcare visionaries as they campaign to become California’s next governor. To prove his healthcare mettle, Newsom points to Healthy San Francisco, a first-of-its-kind universal system adopted while he reigned as the city’s mayor in 2006. Newsom’s work on the program helped him land an endorsement from the influential California Nurses Association, and a boast or two will surely punctuate his speech at their convention on Friday as hyper-partisan politics intensify over efforts to repeal the Affordable Care Act and implement a national single-payer plan. (Willon, 9/22)

The Hill: Senate Health Committee Schedules Hearing On Opioid Crisis
The Senate Health Committee will hold a hearing on the opioid crisis next month. The committee will focus on the federal response to the crisis and conduct oversight of the Comprehensive Addiction and Recovery Act, a law passed in 2016 that supports efforts to address the issue. (Hellmann, 9/21)

The Associated Press: Opioid Epidemic Laws Lead Panel To Revisit Recovery Schools
A fire led to the eventual end of Phoenix — a groundbreaking Maryland public school program for children with addiction that closed in 2012 — but the state could see institutions like it rise again from the ashes. Recent spikes in the Maryland heroin and opioid epidemic have triggered calls for substantial changes in education systems statewide, and a state work group is weighing the return of recovery schools after a Sept. 7 meeting. (Slater, 9/21)

The New York Times: Air Pollution Tied To Kidney Disease
Add a new potential ill to the list of problems linked to air pollution: kidney disease. Previous studies have linked high levels of the fine particulate matter known as PM 2.5 to cardiovascular disease and stroke. A new analysis, in The Journal of the American Society of Nephrology, followed 2,482,737 veterans for an average of eight and a half years. The Department of Veterans Affairs database includes information on glomerular filtration rate, or G.F.R., a measure of kidney function. (Bakalar, 9/21)

NPR: Pee In The Pool Can Cause Breathing And Eye Irritation
Water parks can be fun, but they also can pose unexpected health risks – in this case, eye and respiratory problems. And that shower you never take before you get in the pool plays a role. In July 2015, patrons at an indoor water park resort in Ohio started to complain about eye and respiratory problems. Local health officials surveyed patrons and water park employees, who reported issues like eye burning, nose irritation, difficulty breathing and vomiting. The Centers for Disease Control and Prevention then stepped in to investigate. (Jochem, 9/21)

The Washington Post: She Chose To Die So She Could Give Birth. Now Her Newborn Is Dead, Too.
The headaches began in March. The couple didn’t think much of them — until Carrie DeKlyen began vomiting. An initial scan showed a mass in her brain. More tests showed that it was a form of cancer, possibly lymphoma, but treatable. But a pathology exam revealed a more grim diagnosis. The 37-year-old mother of five from Wyoming, Mich., had glioblastoma, an aggressive form of brain cancer. If lucky, she could live for five more years. (Phillips and du Lac, 9/21)

inewsource: Diabetes-Related Amputations Increase In California — And San Diego
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California — and San Diego County in particular — in a “shocking” trend that has mystified diabetes experts here and across the country. Though they often prolong lives, diabetes-related amputations deprive patients of independence, increase the need for social services and add to disability and medical costs.Explore the rate of amputations in California.Statewide, lower-limb amputations increased by more than 31 percent from 2010 to 2016 when adjusted for population change. In San Diego County, the increase was more than twice that: 66.4 percent. (Clark, 9/20)

Los Angeles Times: Multiple Cases Of West Nile Virus In Glendale Prompt Education Campaign
With eight cases of West Nile virus reported in Glendale so far this year, health officials took part in a door-to-door education campaign Wednesday, informing residents of what they can do to protect themselves from infection. Conducted by the Greater Los Angeles County Vector Control District, the effort informed residents in Glendale, Los Feliz and Atwater Village about the preventive measures they can take to reduce the risk of being bitten by mosquitoes. Levy Sun, a spokesman for vector control, said wearing insect repellent and dumping out any stagnant water near homes are measures people should take regularly. (Nguyen, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

FDA Approves Scope With Disposable Part Aimed At Reducing Superbug Infections

Seeking to prevent superbug outbreaks, federal health officials said they have approved the first gastrointestinal medical scope with a disposable cap for use in the U.S.

The Food and Drug Administration said that the design of the new duodenoscope by Japanese device maker Pentax should make it easier to remove dangerous bacteria that can become trapped inside these reusable instruments.

“We believe the new disposable distal cap represents a major step toward lowering the risk of future infections associated with these devices,” said Dr. William Maisel, the acting director of the FDA’s Office of Device Evaluation, in a statement Wednesday. “We encourage companies to continue to pursue innovations that will help reduce the risk to patients.”

But some medical experts questioned whether this design change goes far enough to protect patients.

“This new scope will probably reduce the infection risk, but I’m not sure by how much,” said Lawrence Muscarella, a hospital-safety consultant in Montgomeryville, Pa.

In addition, he and other experts said, this is just one scope, and its modest redesign will not address the shortcomings that plague many different medical scopes on the market and continue to put patients at risk of antibiotic-resistant infections.

Pentax didn’t provide any details Thursday about when the new duodenoscope will be available or what it may cost. In general, duodenoscopes can cost up to $40,000 apiece, and they can represent a major expense for hospitals that handle a large volume of procedures.

In a statement, the company said “the disposable distal cap design represents a significant advancement in infection control.”

One advantage of a removable cap is that it would allow hospital cleaning staff better access to tiny crevices and small parts at the tip of the scope. Some areas are hard to reach with brushes and washing machines, increasing the risk of bacteria being passed from one patient to another.

While the scope tip has proven troublesome, experts say harmful bacteria also have been found in other areas, such as biopsy ports and instrument channels.

“I think it may be a step in the right direction to have single-use components whenever possible. But we still have gaps here,” said Cori Ofstead, a researcher and epidemiologist in St. Paul, Minn.

She and other infection-control experts are urging manufacturers and regulators to move toward sterilization for all medical scopes, which would involve gas or chemicals and be a step above the current federal requirement for high-level disinfection. That change would likely require further design changes to enable complex scopes to withstand the process.

Other device manufacturers have gone in a different direction, developing scopes that are fully disposable, rather than just enabling the cap to be thrown away. The FDA recently approved two colonoscopes that are designed to be used just once. Other companies are promoting similar devices for use in the lungs and kidneys.

Doctors put duodenoscopes down a patient’s throat to diagnose and treat problems in the digestive tract, such as gallstones, cancers and blockages in the bile duct. There are about 700,000 of these ERCP procedures done annually in the U.S.

Since 2015, U.S. prosecutors, lawmakers and government regulators have been investigating dozens of infections and deaths tied to duodenoscopes.

The Los Angeles Times broke the news about a superbug outbreak at the Ronald Reagan UCLA Medical Center in February 2015, which triggered an FDA warning the next day. Those infections involved the industry’s leading scope maker, Tokyo-based Olympus Corp. The newspaper later reported that Olympus knew about infections and potential flaws with its duodenoscope as early as 2012 but failed to alert American hospitals or regulators.

Last year, the FDA said that as many as 350 patients at 41 medical facilities in the U.S. and worldwide were infected or exposed to tainted duodenoscopes from January 2010 to October 2015.

A U.S. Senate report in 2016 identified four outbreaks tied to Pentax duodenoscopes at hospitals and clinics in Illinois and Massachusetts.

More recently, in January, the FDA issued a safety alert about Pentax’s current duodenoscope model. The agency warned medical providers that cracks and gaps can develop in the device’s tip that “could allow fluids and tissue to leak into the duodenoscope.” The FDA urged hospitals to immediately remove scopes from service that showed signs of damage.

Muscarella, the hospital-safety consultant, said it was surprising the FDA “didn’t require removal of the product from the market considering the risk of superbug infections. It would seem Pentax was prodded by the FDA to come up with another solution, and this disposable cap design might be the company’s response.”

In a statement last year, Pentax said, “We are dedicated to patient safety and are consistently evaluating advancements in flexible endoscope design.”

A number of recent studies have found evidence of persistent contamination in a wide range of reusable devices, including colonoscopes and ureteroscopes.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: California Healthline, Cost and Quality, Health Industry

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High On Drugs? Anthem Cites Soaring Drug Costs To Justify 35% Rate Hike in California

Health insurance giant Anthem predicts Californians will pop a lot more pills next year.

To make the case for a hefty premium hike in the state’s individual insurance market, Anthem Blue Cross has forecast a 30 percent jump in prescription drug costs for 2018. Such a sharp increase is nearly double the estimates of two other big insurers, and it runs counter to industry trends nationally.

Prescription drug spending in the U.S. grew 6.1 percent over the 12 months ending in July, according to Altarum, a nonprofit think tank. That’s down from 12.9 percent in 2014, when expensive new hepatitis C drugs sharply lifted overall pharmaceutical spending.

“I can’t understand why Anthem is predicting 30 percent,” said Charles Roehrig, a health economist and founding director of Altarum’s Center for Sustainable Health Spending. “There are examples of egregious price increases for particular drugs that have gotten a lot of well-deserved attention. But those haven’t characterized what’s happening as a whole,” he added.

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The advocacy group Consumers Union also questioned why Anthem’s cost projections are so much higher than its competitors, and it has asked state regulators to demand additional documentation from the nation’s second-largest health insurer.

Overall, Anthem is proposing a 35 percent rate increase for about 135,000 consumers who buy their own insurance in and outside the Covered California exchange. It’s the largest increase statewide and assumes that federal subsidies for copays and deductibles will continue to be paid. The second highest, also assuming the U.S. government will continue paying those subsidies, is 28.6 percent by Molina Healthcare.

Some of Anthem’s rivals aren’t as pessimistic on the outlook for drug costs. Two other large insurers, Blue Shield of California and Health Net, projected drug costs will rise by 16.4 and 15 percent, respectively. Anthem came in even lower than that in its rate filing for Colorado’s individual market, projecting an 11.4 percent increase in prescription drug costs.

The company said it stands by its California cost projections in light of growing market volatility. In documents filed with regulators, the company expressed concern that declining enrollment in the individual market would saddle it with a sicker group of policyholders.

“As it pertains to pharmacy, our rates reflect the increasing utilization and rising cost of prescription drugs we have experienced in this market over the last couple of years,” said company spokesman Colin Manning.

In fact, Anthem emphasizes rising drug utilization over higher drug prices when justifying its rate increase — an argument Consumers Union challenged as unusual. Most other insurers in California have cited rising prices as a bigger factor in filings to state regulators.

“Anthem projects an extraordinary increase in its enrollees’ use of prescription drugs at four or more times the rate of enrollees at other carriers,” said Dena Mendelsohn, a staff attorney for Consumers Union in San Francisco.

The California Department of Managed Health Care said it is scrutinizing Anthem’s “underlying medical costs and trends” as part of its review of 2018 rate increases. The state agency, which expects to finish its review next month, can pressure insurers to reduce their rates, but it doesn’t have the authority to block them.

“We may ask [Anthem] questions and for additional information to support the plan’s proposed rate change,” said Rodger Butler, a spokesman for the Department of Managed Health Care.

Anthem is significantly curtailing its presence in Obamacare marketplaces nationally next year amid ongoing uncertainty from the Trump administration and Congress over whether they will continue the federal subsidies that lower out-of-pocket costs for low-income consumers.

In August, Anthem announced a partial withdrawal from California’s individual market, saying it will sell policies in only about half of the state’s counties.

Anthem’s chief executive, Joseph Swedish, told investors and analysts at a conference this month that the company may re-enter certain ACA markets across the country if Congress and the White House take steps to stabilize them.

Some experts wonder if Anthem made a mistake in its California rate filing. It wouldn’t be the first time.

In 2010, an outside actuary working for California regulators found a critical error in Anthem’s proposal to raise rates by up to 39 percent. President Barack Obama seized on the public outcry over that double-digit increase to help get the Affordable Care Act passed in Congress. Anthem later withdrew the increase after David Axene, an actuary in Murrieta, Calif., discovered problems with the company’s calculations.

Axene said this latest filing for 2018 health plans raises plenty of questions.

The pharmacy estimate “does seem high,” he said. “It’s a more mature marketplace now, so hopefully everybody knows how to price it. But I’m sure stupid mistakes still happen.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Categories: California Healthline, Cost and Quality, Health Industry, Insurance

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Narrow Networks Get Even Tighter When Shopping For Mental Health Specialists

If you’ve got a plan offered on the federal health law’s insurance marketplace and you’re looking for a therapist, you may have to look really hard: The average provider network includes only 11 percent of all the mental health care providers in a given market, according to a recent study.

An average marketplace plan’s network, the study added, includes just under a quarter of all psychiatrists  and 10 percent of all non-physician mental health care providers. Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants, and  behavioral specialists, counselors and therapists with master’s or doctoral degrees.

Michelle AndrewsInsuring Your Health

In addition, the researchers reported that fewer than half of all psychiatrists and a fifth of non-physician providers participated in any marketplace plan.

The problem isn’t unique to marketplace plans, said study co-author Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. However, this study, which was published in the September issue of Health Affairs, sheds more light on the challenges insurers face in trying to develop networks of mental health care providers, he said.

At the same time, the narrow networks — those that generally have fewer than 25 percent of participating doctors and other health providers in the area — that many insurers have adopted to help keep marketplace plan premiums lower may exacerbate the problem of finding mental health services, Polsky said.

High demand for services, a shortage of practitioners and low insurance reimbursement rates have all contributed to mental health care providers’ general lack of enthusiasm for joining provider networks, according to the study.

For comparison, the study also analyzed the average network participation of primary care providers in marketplace plans. It found that the average network for ACA plans included 24 percent of all primary care providers in a given market, more than twice the proportion of mental health care providers.

The study examined 2016 data for 531 provider networks offered by 281 insurance carriers in the marketplaces in every state plus the District of Columbia using data from the Robert Wood Johnson Foundation.

The Mental Health Parity and Addiction Equity Act of 2008 requires that health plans’ mental health services be at least as generous as medical/surgical services. That has provided financial protection for consumers, but access to in-network providers remains a problem.

In recent years, primary care physicians have increasingly provided mental health services. The study suggests that enhancing the collaboration between primary care physicians and mental health specialists is vital to improving access to mental health care.

“I would argue that the challenge isn’t necessarily a lack of primary care physicians, it’s a need to reorganize care to meet the needs of the population,” Polsky said. “Team-based care is an opportunity to meet those needs.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health, Mental Health

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Uncertainty Over Health Care’s Future Hobbles Entrepreneurs

Stinson Dean is used to taking risks. The entrepreneur from Independence, Mo., says coping with the ups and downs of the market is an inevitable part of his business.

But when he started his company about a year and a half ago, he laid down a firm rule.

“One of the things I wasn’t willing to risk was the health of my family,” Dean said.

Dean is the proud father of three young children — two girls and a boy. Playing with them in the front yard before dinner, he and his wife, Stephanie, talk about the possibility of another.

Like many Americans, Dean has nervously watched this year’s national health care debate. He credits the Affordable Care Act for making it possible to start his business, which involves buying Canadian lumber and selling it to U.S. lumberyards. Now, uncertainty about the ACA’s future affects his business’s potential for growth.

In May 2016, Stephanie was pregnant with their daughter Julie, and Dean was working as a commodities risk consultant.

A few months before a baby’s due date is typically not the time for a big career move, but it happened to mesh with a once-in-a-lifetime opportunity in the lumber market to buy low and sell high.

Encouraged by the availability of affordable insurance through the ACA, the family took the plunge. Dean left his job and started his company. The move paid off, as new construction boosted Dean’s business far beyond what he imagined.

He’s now ready to expand and bring on three or four new people, but there’s a problem.

“There’s a huge unknown with the ACA and what that’s going to look like,” Dean said.

President Trump and many members of Congress campaigned with promises to repeal and replace the Affordable Care Act, and they’ve spent much of this year attempting to do so.

That’s meant hardship for Dean. He’s having trouble persuading people with steady jobs and great benefits to take a chance and work for him.

Repeal-and-replace efforts are again alive in the Senate, and the president has threatened to withhold certain payments to insurers. That strain, on top of already unstable insurance markets, has led Dean to worry about whether decent insurance coverage will be available in the long run for him, his family and potential new employees

“What that’s doing for me is preventing me [from luring] folks who are in a similar situation to where I was — a nice corporate job, making good money, with great benefits, with kids — convincing them to leave that to come work for me with no benefits,” he said. “They’re going to have to go on the individual marketplace, on healthcare.gov, just like I did, and pick a plan.”

Exactly how the ACA has affected entrepreneurs and job growth remains unclear, said Dean Baker, co-director of the left-leaning Center for Economic and Policy Research, based in Washington, D.C. But there’s been a sharp increase in entrepreneurial activity since 2013, when the insurance marketplaces started.

Baker says the ACA has helped entrepreneurs by leveling the playing field in the competition for hiring talent. Before the health law, entrepreneurs had been at a disadvantage compared with larger businesses, who were more likely to be able to afford to offer insurance.

“Once [an entrepreneur’s] workers are able to get insurance through the exchange, much of that disadvantage goes away,” Baker said.

Baker said uncertainty is poison for any business, but all the questions about the ACA’s future have made 2017 especially toxic for entrepreneurs.

“For a lot of small businesses, they are sitting there with some trepidation, saying, ‘OK, how does this work out? Where are we a year from now? Where are we two years from now?’ And presumably, at least some of them are going to be putting their plans on hold,” Baker said.

That’s the case for Stinson Dean. He sees big opportunities opening in his field again, but he may not be able to take advantage of them, even if the ACA survives this year.

“What about 2019, 2020?” Dean said. “These are the questions I’m being asked by these folks I’m trying to recruit, and I don’t have an answer for them.”

This story is part of a reporting partnership with NPR, KCUR and Kaiser Health News.

Categories: Repeal And Replace Watch, States, The Health Law

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Viewpoints: The Promise And Price Tag Of A New Cancer Drug; Medicaid In Indian Country

A selection of opinions on health care from around the country.

JAMA: FDA Approval of Tisagenlecleucel: Promise and Complexities of a $475 000 Cancer Drug
Unlike most cancer therapies that are identical from patient to patient, CAR-T therapies are made by removing the T cells of a patient, genetically modifying them to respond to certain targets expressed on the patient’s cancer cells, and then reinfusing the cells. When the T cells come into contact with the relevant target (for instance, CD19 in the case of ALL), they proliferate while secreting a number of programmed substances including inflammatory cytokines that destroy the cancerous cells. Targeted killing of tumor cells by lymphocytes was first suggested by the graft-vs-leukemia effect in bone marrow transplantation, but that effect and the infusion of donor T cells more generally has no effect on solid tumor malignancies or most hematologic cancers. The innovation underlying CAR-T involved exploiting the specificity of antibody-mediated recognition of tumor antigens, and then engineering CAR-T cells to have the relevant antibody fragment fused to the T-cell receptor. Thus, the “living drug” infused into the patient is the patient’s own T cells altered to express a receptor that is specific for the target antigen on the tumor. (Peter B. Bach, Sergio A. Giralt and Leonard B. Saltz, 9/20)

High Country News: How Will Medicaid Cuts Affect Health Care In Indian Country?
In the legislation introduced by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., on Sept. 12, federal Medicaid and health insurance subsidy dollars would be given as a lump sum to states, which would have wide discretion in how they were spent. Nowhere would this be more devastating than in Indian Country. … In Medicaid expansion states, from Alaska to Maine, the Affordable Care Act has meant that the Indian Health Service, which provides care to 2.2 million of the nation’s 5.3 million American Indians and Alaska Natives, has been able to provide preventive services. Those include screenings for breast and colon cancer, never before available to non-elderly adult patients. Now IHS can provide those services and get reimbursed by Medicaid, instead of having the cost of the services come out of IHS’s grossly inadequate budget. (Tanya H. Lee, 9/20)

The Charlotte Observer: Protests At Charlotte Abortion Clinic Go Too Far
Our government has a responsibility to protect people’s First Amendment right to assemble and peacefully protest. It is also incumbent on government to enforce people’s right to make their own decisions about their medical care. At A Preferred Women’s Health Center in east Charlotte, these two fundamental rights are clashing. Anti-choice protesters are harassing and obstructing people who attempt to perform and to gain access to abortions. And the city is giving an unfair boost to the protesters, compromising the health and safety of thousands of women. (Lisa Levenstein, 9/20)

Bloomberg: Defying Ethics Norms Flies With Trump
Health and Human Services Secretary Tom Price has been taking fancy charter flights when previous secretaries flew commercial. Well, what do you expect? Just think about the incentives in a normal administration and in this one. Normally, the president sets a reasonable example of good ethics practices. Oh, there are sometimes controversies, but normal presidents avoid conflicts of interest, follow the guidelines of ethics officials and other best practices, and generally act as if they care about the appearance, at least, of playing by the rules. This president has basically ignored ethics laws and norms from the beginning. It must be hard to care about saving the government a few dollars when the president is using his office to, for example, advertise his business interests. (Jonathan Bernstein, 9/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Thinking About A Single-Payer System: Pros And Cons Of ‘Medicare For All’

Opinion writers offer their ideas about the health care plan advanced by Sen. Bernie Sanders (I-Vt.).

USA Today: Bernie Sanders Medicare-For-All Plan Is All Wrong For America
My 93-year-old father recently came home from the hospital proudly harboring a life-saving $50,000 aortic valve paid for by Medicare, though he rode home in a wheelchair that Medicare didn’t pay for. This gap in services is growing, as Medicare struggles to cover emerging technologies that are not one-size-fits all while at the same time continuing to provide basic care. If Medicare is converted to single-payer or Medicare for all, as Sen. Bernie Sanders of Vermont proposes, tens of millions more patients will be added to an already faltering system, and the gap between the promise of care and actual care delivered will widen. (Marc Siegel, 9/20)

Los Angeles Times: There Are 3 Types Of Single-Payer ‘concern Trolls’ — And They All Want To Undermine Universal Healthcare
Some of the naysayers are conservatives who simply abhor “big government.” Some have perfectly valid reasons to question the merits of single payer in general or Sanders’ methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a “concern.” They are “concern trolls” — broadly defined as “a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion.” (Adam H. Johnson, 9/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Perspectives: Outlooks Are Not Rosy Regarding The On-The-Ground Impact Of The Current GOP Repeal Plan

Newspapers offer their members of Congress a bleak picture of what would happen in their states if the Graham-Cassidy proposal were to become law.

The Kansas City Star: No, Sen. Pat Roberts, This Awful Health Care Bill Isn’t The Only Obamacare Alternative
The Category 5 Hurricane known as Graham-Cassidy is a man-made disaster that may yet be avoided. But if you’re asking why even the craziest storm chaser wouldn’t steer clear of the direct hit that this latest health care bill would amount to, well, talk to our own Sen. Jerry Moran, who remains undecided. Or better yet, listen to his fellow Kansas Republican, Sen. Pat Roberts, whose explanation of this final attempt to blow up the Affordable Care Act is daft but highly instructional. (9/20)

The Des Moines Register: Senate’s Latest Health Bill Offers No Lifeline For Iowa
Gov. Kim Reynolds jumped aboard the latest Republican effort to repeal most of Obamacare as if it were the last lifeboat off the Titanic. “You know, this can work and I believe right now, this is the only vehicle we have to address Obamacare, that’s failing,” she said Tuesday. She was talking about legislation co-sponsored by Republican U.S. Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The bill would put states in charge of designing their own health-care systems, with federal money from existing Obamacare taxes. Expansion of the federal program for low-income Americans, Medicaid, would end in 2020 and states would get block grants instead. (Kathie Obradovich, 9/20)

Lexington Herald Leader: Latest GOP Bill Greatest Threat To Ky. Health Care Coverage
The latest attempt to repeal the Affordable Care Act is known as Cassidy-Graham, and it very well may be the greatest threat to Kentucky’s health care. The state’s success in getting people coverage, and even health-care gains achieved decades ago, are at risk of being undone with this legislation. The bill, sponsored by Sens. Bill Cassidy and Lindsey Graham, is perhaps the final attempt at tearing up the ACA and doing permanent damage to Medicaid. It’s being rushed through before policymakers and the public can understand its implications. That’s because after Sept. 30, the Senate can no longer pass a partisan repeal bill with only 51 votes, due to chamber rules. (9/19)

Kansas City Star: Cassidy-Graham Health Care Bill Would Hurt Kansans
Now, in a last ditch effort to repeal the ACA by September 30, the end of the federal fiscal year, Congress is back with another destructive bill. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina have introduced legislation that, like its failed predecessors, will result in coverage losses, higher costs, and elimination of consumer protections. (Sandy Praeger, 9/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Parsing The Policies: Is This Just Another ‘Lousy’ Bill Or Does It Advance A ‘Great Idea’?

Editorial pages offer a variety of ideas about the Graham-Cassidy bill now pending in the Senate, with some saying it’s “poison” and others praising its intent to give states flexibility.

Los Angeles Times: Graham-Cassidy: Another Day, Another Lousy GOP Healthcare Bill
The latest proposal — by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) — suffers from the same fundamental problems as all of its predecessors. Aiming to lower insurance costs for the healthy, it would allow states to herd people with preexisting conditions or potentially expensive risks — say, women who might want maternity coverage — into insurance gulags with egregiously high premiums. (9/21)

USA Today: Last-Ditch Obamacare Repeal Would Be Poison
Given up as a lost cause this summer, the Republican effort to repeal and replace Obamacare is back, this time in the form of a last-ditch effort led by GOP Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson. Like previous efforts, this measure would strip tens of millions of people of their health coverage. It would gut Medicaid, the program responsible for funding nearly half of baby deliveries and most of nursing home care. It would allow insurers in some states to deny coverage based on a previous medical condition. And it would allow insurers to skip coverage of essential services, including maternity care. (9/20)

USA Today: Let States Tailor Health Care Plans
Under Obamacare, insurance premiums in the individual market have more than doubled nationally, and without billions of additional taxpayer dollars, many of those markets are at risk of collapse. Obamacare was never designed to be patient-friendly. In fact, one of the key tenets of Obamacare is taking power away from patients and local officials. Obamacare gives this decision-making power to the federal government, allowing bureaucrats to call the shots. (Sen. Ron Johnson, 9/20)

The New York Times: Graham-Cassidy Has One Great Idea
In the timid sense, the proposal would keep much more of Obamacare’s taxes and spending in place than previous Republican plans this year. Yet Graham-Cassidy makes more sweeping changes by turning money currently used on insurance subsidies and the Medicaid expansion into block grants to states. This change would give states more flexibility to design their own health care systems. (Philip Klein, 9/20)

The Washington Post: Cassidy-Graham Is Attractive In Theory. But It Has A Giant Flaw.
A group of Republican senators, led by Bill Cassidy (La.) and Lindsay O. Graham (S.C.), have revived GOP efforts to repeal and replace Obamacare. Their bill has a number of attractive attributes: It would repeal Obamacare’s individual mandate, for example, and make important reforms to Medicaid. But Cassidy-Graham also has an important, albeit fixable, flaw — what we might call “asymmetric federalism.” (Avik Roy, 9/20)

Los Angeles Times: The Disastrous Impact Of The GOP’s Obamacare Repeal Plan, In Three Devastating Charts
The healthcare consulting firm Avalere on Wednesday released the latest in a series of independent analyses of Senate Republicans’ new effort to repeal the Affordable Care Act. The findings are beyond ugly. They show devastating cuts in healthcare funding for adults, children and the disabled — in effect, almost every population category in the U.S. other than seniors enrolled in Medicare. (Michael Hiltzik, 9/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.