Tagged Medicare

Perspectives On The Trump Budget: Examining The Charged Language Used To Respond To It; And What Does That Budget Say About Trump And His Voters?

Opinion writers take on a variety of fiscal issues advanced by President Donald Trump’s budget proposal, including how it treats Medicaid and Social Security’s disability program.

The New York Times: It’s All About Trump’s Contempt
For journalists covering domestic policy, this past week poses some hard choices. Should we focus on the Trump budget’s fraudulence — not only does it invoke $2 trillion in phony savings, it counts them twice — or on its cruelty? Or should we talk instead about the Congressional Budget Office assessment of Trumpcare, which would be devastating for older, poorer and sicker Americans? There is, however, a unifying theme to all these developments. And that theme is contempt — Donald Trump’s contempt for the voters who put him in office. (Paul Krugman, 5/26)

Boston Globe: Baby Boomers Beware: GOP’s Medicaid Cuts Could Hurt You Later
But there’s a giant hole in Medicare coverage, a hole that many aging American seniors eventually fall into: Nursing home care isn’t generally covered, and neither is full-time assistance at home. But if you live to 65, there’s a 40 percent chance you’ll enter a nursing home in the future. And it’ll cost you $80,000 to $90,000 a year on average. So where does that money come from if Medicare won’t pay? The answer is Medicaid, the other government insurance program, the one more often associated with the poor than the elderly. About 60 percent of nursing home residents rely on Medicaid. Which means that if the Republican plan to slash $834 billion from Medicaid goes forward, it could have a devastating impact on seniors with critical health needs. (Evan Horowitz, 5/25)

Chicago Tribune: Social Security’s Disabling Disability Program
Whhen the White House unveiled its 2018 budget on Tuesday, plenty of Democrats were quick to characterize it as stingy and cruel. Among the exhibits for the prosecution was the plan for Social Security Disability Insurance, whose projected outlays the administration would cut by 5 percent by 2027. White House budget director Mick Mulvaney started the argument in March. “It’s the fastest growing program,” he asserted. “It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.” He was promptly accused of factual sloppiness and heartlessness, and some of the criticism was justified. But Mulvaney is onto a real problem that demands attention. (5/25)

The Kansas City Star: Truth From Mick Mulvaney
Cutting health care for the poor is a dream come true for many congressional Republicans. And that’s not an exaggeration, but a direct quote: “So Medicaid, sending it back to the states, capping its growth rate, we’ve been dreaming of this” since college, House Speaker Paul Ryan said in March. So, what are food stamp recipients who do work but don’t earn enough to feed their families to do? Get “the right mind-set,” says HUD head Ben Carson, since poverty is largely “a state of mind.” (Melinda Henneberger, 5/25)

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

Perspectives On The Trump Budget: Questionable Math; Who Feels The Most Pain?

Editorial pages across the country include analysis and review of President Donald Trump’s fiscal blueprint, including some tough talk about its political and policy implications.

The New York Times: Trump’s Budget: The Math Is Phony But The Cruelty Isn’t
Phony math is a time-honored tradition in the Washington world of budget making, but the first full fiscal plan from the Trump administration breaks new ground. The bottom line: A budget that the White House says will be in balance by 2027 would, in reality, remain deeply in red ink throughout the coming decade and ultimately add trillions of dollars to the national debt. … This budget’s blatant disregard for intellectual integrity is matched by the extraordinary extent to which it seeks to slash social welfare programs, including another $616 billion out of Medicaid on top of $800 billion that would be sliced as part of the Republicans’ health care plan. That’s a 28 percent reduction to the existing Medicaid budget plan. (Steven Rattner, 5/24)

Chicago Tribune: Trump’s Budget: A Slow Boat To Disaster
The plan has been assailed by Democrats and various activist groups for coddling the rich, punishing the poor and shortchanging important functions. Trump proposes to cut outlays for Medicaid, food stamps, Head Start and Social Security disability. Ditto for Environmental Protection Agency enforcement and State Department security. He would close the National Endowment for the Arts, the National Endowment for the Humanities and the Corporation for Public Broadcasting. (Steve Chapman, 5/24)

Forbes: Trump’s Budget For Seniors: Bad, But It Could Have Been Worse
The best that can be said about President Trump’s 2018 budget and older adults: It could have been worse. In a fiscal plan focused on historic domestic spending cuts, programs for older adults were hit by substantial reductions, though not slashed as deeply as other domestic programs. Medicare was largely untouched. So was Social Security for seniors, although Trump would tighten eligibility and reduce some benefits in the Social Security disability program. (Howard Gleckman, 5/23)

The Des Moines Register: Donald Trump 2018 Budget Could Turn Off His Voters And Sink His Approval Rating
The best way to think about the fiscal 2018 budget released by the White House is as a Trump political campaign rally on paper. The budget was clearly developed to make a statement to President Trump’s base of voters in the hope that they will see it as him keeping his campaign promises. According to Office of Management and Budget Director Mick Mulvaney, the budget will be in surplus in 10 years, construction will start on the wall between the U.S. and Mexico, there will be more money for enforcing immigration laws, and there will be much more for the Pentagon. Meanwhile, wasteful government spending will be cut and taxes will be reduced. (Stan Collender, 5/24)

Louisville Courier-Journal: Tell Congress The Budget Must Provide For The Poor
“A preferential option for the poor” is a fundamental concept in Catholic social teaching. Though the phrase itself is only 50 years old, it derives from Jesus’ Gospel message to pay special attention to poverty. … The concept is shared by many religions and has become part of the ethos of the United States. Whether through Social Security, Medicaid, food stamps or foreign aid, our nation has recognized that our worth is judged by how we treat the most vulnerable among us. … The U.S. Congress is now considering a budget proposal by the current administration. So many helped in this country and abroad would be devastated by this budget. (Archbishop Joseph E. Kurtz, 5/24)

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

Perspectives On Doing The Math: Trying To Add Up ‘Trumponomics;’ The Trump Budget’s ‘Best New Idea’

Opinion writers take a hard look at how health and safety net programs fare in the Trump administration’s proposed budget plan.

Los Angeles Times: Surprise, Surprise: Trump’s Budget Punishes The Sick And The Poor While Rewarding The Wealthy
One factor holding back economic growth is that too many working-age Americans have fallen out of the labor force. The administration’s proposed budget for the fiscal year that begins Oct. 1 tries to tackle that problem, as well it should. But rather than grapple with some of the challenges underlying the disappearance of millions of Americans from the workforce — in particular, the technological changes and globalization that have caused so many blue-collar and middle-class jobs to evaporate, and the gap between the education and training Americans have received and the skills demanded by today’s employers — the Trump budget seeks to force people back into the workforce by making it harder to obtain or keep food stamps, Medicaid and Social Security disability benefits, while reducing federal support for welfare and children’s health. (5/23)

The Washington Post: Trumponomics: The Philosophy That It Doesn’t Suck Enough To Be Poor
For months, pundits and political advisers have tried to figure out what “Trumponomics” really stands for. Even President Trump himself struggled to characterize it, saying, “It really has to do with self-respect as a nation.” Now that we have the president’s budget in hand, we have a more definitive answer: Trumponomics — like Ryanonomics — is based on the principle that living in poverty doesn’t suck quite enough. That is, more people would be motivated to become rich if only being poor weren’t so much fun. (Catherine Rampell, 5/23)

The New York Times: Trump’s Budget Doesn’t Make Sense
Yes, Republicans have a blind spot when it comes to acknowledging that revenues must be a part of the fix. But to their credit, many Republicans — including, notably, Paul Ryan, the speaker of the House — have made the case for why we have to reform our largest entitlement programs, including Social Security and Medicare (though there has recently been a disquieting silence on the topic). And many Republicans are taking the responsible position that tax reform should at least be revenue neutral. Democrats, many of whom too often act as demagogues on entitlement reform, are clear that taxes must increase (though they also must stop pretending it is just millionaires who will be affected). They also have been admirable in their commitment to the pay-as-you-go principle in recent major legislation, which at least keeps us from digging the hole deeper. (Maya MacGuineas, 5/23)

The New York Times: Why Work Requirement Became A Theme Of The Trump Budget
The new White House budget proposal is built on a deep-rooted conservative belief: The government should help those who are willing to work, and cull from benefit rolls those who aren’t. That emphasis on work underlies deep cuts and proposed changes to food stamps, cash assistance and health benefits for the poor in a budget that boosts spending for the military and border security. Expect the poor to work in exchange for aid, the White House argues, and antipoverty programs will work better while costing the government less. (Emily Badger, 5/24)

USA Today: Trump Budget’s Best New Idea
Since the passage of the Family and Medical Leave Act in 1993, American parents working for companies with at least 50 employees have had a right to 12 weeks of unpaid leave after the birth or adoption of a child. But many don’t take advantage of that option for the simple reason that they can’t afford to go that long without a paycheck. The Trump administration, at the urging of first daughter Ivanka Trump, has included in its budget released Tuesday a plan for paid medical leave of up to six weeks. (5/23)

USA Today: Trump’s Parental Plan Will Hurt
President Trump’s budget includes a proposal for six weeks of mandated paid family leave for new parents. Despite its superficial appeal, this idea is likely to harm families more than it helps. The initial Trump proposal, floated in September, would have limited mandated leave to mothers, thereby likely engaging in unconstitutional sex discrimination. Key aspects of the new plan are still unclear. But it avoids legal problems by covering fathers, too. Yet it has serious flaws, nonetheless. (Ilya Somin, 5/23)

Bloomberg: Trump’s DOA Budget Has Two Silver Linings
It also breaks Trump’s campaign commitments to spare Social Security and Medicaid from budget cuts. Budget Director Mick Mulvaney explained this problem away (with Trump in Israel) by asserting in a Monday night briefing that proposals in the plan to cut Social Security disability benefits don’t count because they’re not retirement payments. (Albert R. Hunt, 5/23)

The Kansas City Star: Trump Budget Replicates Disastrous Kansas Approach. This Won’t End Well.
But tax cuts were only one half of the [Gov. Sam] Brownback experiment. Aided by conservatives in the Legislature, Kansas eviscerated the state’s social safety net: privatizing Medicaid, imposing new restrictions on welfare benefits, insisting on a tough food stamp work requirement. Humiliating the poor seemed to be a particular focus. For a time, the state told welfare recipients they could withdraw only $25 at a time from an automated teller machine, a decision that prompted anger and derision across the nation before it was repealed. (5/23)

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State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Media outlets report on news from Arizona, Texas, California, Minnesota, Georgia, Colorado and Florida.

Sacramento Bee: Health Care For Illegal Immigrants Proposed By California Senator
State Sen. Ricardo Lara doesn’t only want to reconstruct the way health care is delivered and paid for in California. As the debate around publicly funded universal health care heats up in the Capitol, Lara is also seeking to expand the state’s low-income health program to undocumented adults up to age 26. (Hart and Miller, 5/23)

Georgia Health News: State AG Backs Wider View Of Records In Hospital Court Fight 
The state’s attorney general has urged the Georgia Supreme Court to reverse a lower court opinion that barred access to Northside Hospital’s financial records. Chris Carr, in office since late last year, said in a Monday court filing that the Georgia Open Records Act is broader in its applications than what Northside Hospital has argued. (Miller, 5/23)

Atlanta Journal Constitution: GA Attorney General Weighs In On Northside Hospital Open Records Case 
Georgia law requires open government even when a private party is carrying out the public’s work, Attorney General Christopher Carr argued in a brief filed Monday in the Northside Hospital open records case before the Georgia Supreme Court… The Georgia Supreme Court asked the Attorney General’s office to file an opinion in the hotly-contested case that started when attorney E. Kendrick Smith requested documents from Northside under the state’s sunshine law. (Teegardin, 5/23)

Texas Tribune: Grieving Mom “Humbled” And “Relieved” After Senate Passes Autopsy Bill 
As the Texas Senate passed a bill on Tuesday that would ensure parents can view their deceased child’s body before an autopsy is conducted, a grieving mother shed tears from the gallery… Currently, parents need permission from a justice of the peace or medical examiner to see their deceased child if his or her death occurs outside a hospital or health care institution. (Mansoor, 5/23)

Austin American Statesman: Texas Senate Approves Bill Aimed At Identifying Postpartum Depression
The Texas Senate on Tuesday approved a bill aimed at increasing identification of postpartum depression among mothers participating in federally backed health care programs for low-income families. Under House Bill 2466 by Rep. Sarah Davis, R-West University Place, mothers who bring their kids in for checkups can get screened for postpartum depression by their children’s pediatricians. (Collins Walsh, 5/23)

Denver Post: New Leadville Hospital Dealt Major Setback After Feds Withhold Loan 
Lake County’s only hospital, St. Vincent in Leadville, has put plans to build a new facility on hold after financial projections came up shorter than expected, indicating the small hospital has recovered from the financial brink but still needs to improve its balance sheet before a much-needed building upgrade. In 2014, the hospital announced it would be shutting down because of critical building repairs and declining revenues, but service cuts and a partnership struck several months later with Centura Health — which also runs St. Anthony Summit Medical Center in Frisco — kept the 138-year-old hospital open. (5/23)

Sacramento Bee: Abortion Reversal Therapy Grows More Popular Despite Doubts
Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping. More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. (Caiola, 5/23)

Kansas City Star: Kansas Records: Several Hotline Calls Still Didn’t Save Adrian Jones 
The head of Kansas’ child welfare agency said earlier this month that social workers’ last contact with the family of Adrian Jones was in February 2012. But records obtained by The Kansas City Star on Tuesday show that social workers with the Kansas Department for Children and Families investigated a hotline call 10 months later, in December 2012. (Baurer and Woodall, 5/23)

Kansas City Star: Missouri Hospital And Clinic Settle Medicare Fraud Suit 
A Missouri hospital, clinic and infusion center have agreed to pay $34 million to settle a federal lawsuit that alleged they defrauded Medicare. The suit alleged that Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, had an improper financial agreement that provided kickbacks to oncologists based on the value of their chemotherapy referrals to the infusion center. (Marso, 5/23)

KQED: Valero Outage Prompts Benicia To Consider Industrial Safety Ordinance 
City officials would have greater oversight over the Valero refinery under a proposal set to be unveiled at the Benicia City Council meeting on Tuesday—a potential reform prompted by the major outage at the facility earlier this month. Mayor Elizabeth Patterson is proposing the city develop regulations similar to those in Contra Costa County, home to several refineries. That county’s industrial safety ordinance, considered to be one of the strongest in the country, requires oil refining facilities to undergo safety audits and have risk management plans. (Goldberg, 5/23)

Miami Herald: John Morgan ‘Prepared To Invest $100M’ In Medical Marijuana 
John Morgan spent nearly $7 million pushing two statewide ballot initiatives to expand medical marijuana throughout the state of Florida. But that’s a drop in the bucket compared to what the wealthy Orlando attorney and possible gubernatorial candidate says he’s prepared to invest in the industry now that it’s about to explode. (Smiley, 5/23)

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Viewpoints: ‘Taxpayer-First Budget’ Inflicting Pain; Slow Rollout Of Menu Calorie Counts

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

The New York Times: A Budget That Promises Little But Pain
If President Trump’s 2018 budget, to be unveiled on Tuesday, was worthy of praise, you can bet Mr. Trump would be in Washington to bask in it. But his overseas trip keeps him at a distance physically, if not politically. As detailed in a preview on Monday by Mick Mulvaney, the White House budget director, the budget is a naked appeal to far-right Republicans aiming for a partisan rallying cry, even as a legislative victory most likely remains out of reach. Of 13 major initiatives in the budget, nine are drastic spending cuts, mostly aimed at low-income Americans. The biggest of those, by far, is an $866 billion reduction over 10 years in health care spending, mostly from Medicaid. (5/23)

The Washington Post: Another Bad Budget From Trump Targets The Poor
President Trump released a proposal for fiscal year 2018 discretionary spending — the “skinny budget” — two months ago, and the $1.1 trillion plan garnered deservedly poor reviews. In a nutshell, Mr. Trump would have gutted the Environmental Protection Agency, the National Institutes of Health and similarly crucial domestic agencies to fund a big boost in defense spending and border security. On Tuesday the White House releases its ideas for the remaining $3 trillion or so in federal spending, including large-scale entitlements such as Medicaid, and the early indications are that the priorities embodied in this sequel will be no more humane or rational. (5/22)

Miami Herald: The Federal Budget Released Today Puts Taxpayers First
This Tuesday, the president will release his Fiscal Year 2018 budget request. The title on the cover reads “A New Foundation for American Greatness.” But it’s what’s inside that’s more important. What people will see there is something that has been missing from Washington for a long time: “A Taxpayer First Budget.” … For years, we’ve focused on how we can help Americans receive taxpayer-funded assistance. Under President Trump’s leadership, we’re now looking at how we can respect both those who require assistance and the taxpayers who fund that support. For the first time in a long time, we’re putting taxpayers first. (Budget director Mick Mulvaney, 5/22)

The Washington Post: Trump’s First Budget: Why Attention Must Be Paid To It
So, with two partial exceptions, the President’s budget cannot be viewed as anything other than the standard issue, highly partisan, thoroughly uncompromising budgets we’ve seen from Republicans since the rise of Paul D. Ryan. The purpose of these budgets, which even Ryan himself has characterized as more “visionary” than realistic, is to shrink government outside of defense and give the savings to their wealthy donors in the form of regressive tax cuts. Their ultimate targets are Social Security, Medicare, and Medicaid, and with this budget, we can see that strategy evolving. (Jared Bernstein, 5/22)

Los Angeles Times: Trump’s Budget Plan Continues His Deceitful Attack On The Disabled — And Violates A Campaign Pledge
We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.” Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability. (Michael Hiltzik, 5/22)

Forbes: This Week’s Rollout Of Trump 2018 Budget Could Be His Biggest Failure Yet
On top of everything else, the Trump 2018 budget and OMB Director Mulvaney’s first testimony about it, which is currently scheduled for Wednesday before the House Budget Committee, is virtually certain to get much less attention because the Congressional Budget Office is now expected to release its estimates of the impact of the House-passed American Health Care Act that same day … and those numbers are very likely to be devastating. … CBO’s new AHCA numbers took on dramatically increased importance last week when the Republican leadership let it be known that the House might have to vote on the bill a second time because, as reported, it might not satisfy all of the Senate’s Byrd rule requirements. (Stan Collender, 5/21)

Philly.com: Slash Medicaid And You Jeopardize Care For Everyone
Just before launching his presidential campaign, Donald Trump promised that if elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on. Trump’s budget proposal calls for more than $800 billion in cuts. … But even more is at stake than the lives of poor and disabled Americans, something the architects of these plans don’t seem to care much about. The cuts would jeopardize the entire health care system. (Robert I. Field, 5/23)

The Washington Post: Trump’s Budget Is So Cruel A Russian Propaganda Outfit Set The White House Straight
Trump, who once vowed “no cuts” to Medicaid, would now cut Medicaid by more than $800 billion, denying support to 10 million people. He lops a total of $1.7 trillion off that and similar programs, including food stamps, school lunches and Habitat for Humanity. Mulvaney, defending the budget Monday, made a frank admission: “This is, I think, the first time in a long time an administration has written a budget through the eyes of people who actually are paying the taxes. Too often in Washington I think we often think only on the recipient side.” (Dana Milbank, 5/22)

USA Today: Calorie Labeling Isn’t Rocket Science
Watching your weight while grabbing a bite at your favorite chain restaurant, supermarket food bar or convenience store was supposed to get easier under a 2010 federal law requiring that certain businesses post calorie counts. This isn’t rocket science. But after seven years, the final posting rules are still on hold, and this month the Trump administration delayed compliance again. If the newest date — May 7, 2018 — holds, it will have taken nearly as long to post calorie counts as it did to put a man on the moon after President Kennedy announced this ambitious goal in 1961. (5/22)

USA Today: Pizza Makers Weigh In On Calories
America’s pizza delivery companies want a reasonable 21st century solution to the nutrition labeling challenge: We simply want approval to put the information where our customers look for it. At Domino’s, we’ve been posting nutritional information on our website for nearly 14 years because it’s the easiest way to provide the information to our customers where they will most likely see it. Unfortunately, the menu labeling rule as written does not make accommodations for brands whose majority of orders come from people who order online. The rule seems better suited to sit-down chains and fast-food joints. (Tim McIntyre, 5/22)

Forbes: North Carolina Poised To Reform Welfare Programs To Protect Truly Needy
A provision in the [North Carolina] Senate’s budget proposal, spearheaded by Sen. Ralph Hise, would rein in frequently-exploited loopholes in the state’s food stamps and Medicaid systems, bringing overdue protection to valuable resources for families who need them most and protecting the system from abuse. North Carolina’s current broad-based eligibility expansion in food stamps has been ripe for reform since 2010 when former Gov. Bev Perdue took advantage of a loophole that expanded welfare eligibility beyond the federal limits. (Josh Archambault, 5/22)

The New York Times: Hey Parents, Surprise, Fruit Juice Is Not Fruit
Many American children consume more than half of their fruit as juice, and the American Academy of Pediatrics has issued new guidelines clarifying its stance on that substitution: For most kids, it’s a bad thing. The new guidelines aren’t just intended to persuade pediatricians to talk to parents about the disadvantages of the ubiquitous juice box. They also take aim at the federal government’s Dietary Guidelines for Americans, which are the basis for the nutritional guidelines in the Department of Agriculture’s School Lunch Program — guidelines that allow for the replacement of half of the recommended daily servings of fruits with 100 percent fruit juice. (KJ Dell’Antonia, 5/22)

Louisville Courier-Journal: Fighting The Opioid Epidemic
As many as two million Americans are struggling with prescription drug addiction across the nation. Tragically, heroin and opioid overdoses claim an average of 91 lives every day. This startling trend continues to get worse, especially here in Kentucky. … I made securing crucial new resources to help combat heroin and prescription opioid abuse a top priority in the government funding bill that was recently signed into law. These new resources, which dedicates substantial funding through the appropriations process to address this crisis, will allow us to take another step towards ending it. (Senate Majority Leader Mitch McConnell (R-Ky.), 5/23)

Stat: Training Medical Students How To Teach Helps Them Embrace Ambiguity
In volunteering to help teach the course, neither of us anticipated that questions asked by first-year medical students would heighten our curiosity and passion for medicine. But they did. We looked for answers and followed up with the students who asked them. In the process, we also reflected on how to be better self-directed learners and more effective teachers. (Jasmine Rana and Taylor Freret, 5/22)

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

Viewpoints: Opening For Medicare Long-Term Care?; Texas Seeks Planned Parenthood Money

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

Forbes: Congress May Open The Door To Some Medicare Long-Term Care
Congress is taking a small, but important, step towards expanding Medicare to include some long-term supports and services. … the biggest changes would apply to the care provided by managed care programs. One would expand the use of those special needs plans, which are explicitly aimed at people with chronic conditions and high medical needs. Some of these programs already provide supports and services as part of their benefit packages but they remain relatively small. The other would give Medicare Advantage plans important new flexibility to offer social supports and other non-medical services to their members. (Howard Gleckman, 5/17)

Los Angeles Times: Texas Wants To Use Federal Money To Attack Planned Parenthood — And Might Get It
Five years ago, Texas voluntarily gave up $30 million a year in federal funding for women’s health programs, just so it could exclude Planned Parenthood from the roster of approved providers. Instead, the state established its own so-called Healthy Texas Women program in which it could set its own rules. Now, staggering under the cost of the program and hopeful that the Trump administration will see things its way, Texas is applying for a restoration of the federal subsidy under the same terms. Signals from the White House and the Department of Health and Human Services suggest the state might succeed. If so, some other states may follow, and the cause of women’s reproductive health will suffer a major blow. (Michael Hiltzik, 5/18)

Des Moines Register: Health Has No Religion; Health Care Shouldn’t Have One Either
A policy with wide-ranging consequences for patients of Mercy Medical Center was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S. How are these institutions fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars? (Rekha Basu, 5/18)

Next Avenue: Aging at Home Will Be Harder With Medicaid Cuts
Proposed cuts to Medicaid under the American Health Care Act passed by the House recently could change life for (Ti) Randall and many others. Medicaid is not only an insurance program for low-income people. It’s a lifeline for older adults like Randall who need supportive services to stay at home. At-home services are a lifeline for Medicaid as well, which would otherwise be paying for more expensive care in an institutional setting. (Beth Baker, 5/17)

Stat: Doctors Must Be Honest About Their Own Biases When Treating People In Pain
Many doctors enter medicine to prevent and treat suffering. Yet it seems that as we advance in our training, the more bothersome and frustrating evaluations of pain become. We want to make people feel better, but we don’t always know why or how much someone is hurting. And there are consequences of both prescribing too much or too little pain relief. So we turn to this language to minimize the pain we don’t understand or can’t fix. Unfortunately, this tends to occur more often with patients of color. (Katherine Brooks, 5/17)

Stat: Why Taking Drugs To Treat Addiction Doesn’t Mean You’re ‘Still Addicted’
My patient was lucky: He didn’t die because of a widely held, and completely inaccurate, definition of addiction — one that was recently supported by remarks from Health and Human Services Secretary Tom Price, who disparaged medication use as merely “substituting one opioid for another.” But until politicians, the media, and the public catch up with addiction science, we will not be able to stop the epidemic of overdose deaths. (Sarah E. Wakeman and Maia Szalavitz, 5/18)

JAMA: Primary Care Of Patients With Chronic Pain
Primary care physicians have the responsibility for the care of patients with chronic pain, often in follow-up to an episode of acute pain treated in an urgent care center, emergency department, or specialty clinic setting. The lack of a full understanding of how chronic pain differs from acute pain can lead to all pain being treated as acute pain, often with opioids. The current widespread use of opioids is essentially a case-finding system that identifies the roughly one-sixth of the adult population particularly susceptible to opioid misuse, sometimes leading to escalating doses, a shift to illegal nonprescription opioids, addiction, and unintentional overdose. (Jill Schneiderhan, Daniel Clauw and Thomas L. Schwenk, 5/18)

Des Moines Register: Iowa Should Allow Needle Exchange Programs
The Iowa Department of Public Health in February released its first report on hepatitis C infections in this state. The number of Iowans diagnosed with the liver-damaging virus that can lead to death has increased nearly three-fold, from 754 cases in 2000 to 2,235 cases in 2015. The number of infected Iowans aged 18 to 30 has quadrupled in recent years. … preventing the spread of the virus is so important, and Iowa is not doing all it can. Unlike several other states, we do not have a needle exchange program, which is an important part of infection prevention. (5/18)

The (Eugene, Ore.) Register-Guard: Oregon’s Medicaid Mess
“Troubling” doesn’t begin to describe the current situation at the Oregon Health Authority, which, state auditors have discovered, has been doling out hundreds of millions of dollars to tens of thousands of Medicaid recipients who may or may not be eligible for the benefits. … About three years ago, Oregon got permission from federal regulators to temporarily quit verifying that each OHP patient still qualified for Medicaid. At the time, the state was in the throes of extricating itself from Cover Oregon, which failed spectacularly in setting up an online program to enroll people in health care. Somehow, the state never got around to resuming these routine eligibility checks. (5/19)

Morning Consult: Turning Up The Volume On Over-The-Counter Hearing Aids
Hearing aids currently cost around $5,000 per pair. Fitting and tuning are not covered by Medicare or most private insurance plans. Unable to afford these out-of-pocket costs, nearly 80 percent of Americans with hearing loss choose to suffer on their own. … It shouldn’t be this way. The technology exists to deliver relief to these patients and the families that love them. But government has to act to ensure that those who stand to gain the most from that innovation are able to access it. The Over-the-Counter Hearing Aid Act of 2017 would be a needed update to federal policy. (Rep. Joe Kennedy III (R-Mass.) and Rep. Marsha Blackburn (R-Tenn.), 5/18)

The Kansas City Star: Vital Diabetes Device Denied By Medicare
I’m angry because people like me are being denied an essential medical treatment by Medicare, the federal program that’s supposed to be supporting seniors, not forcing them to abandon an essential medical device. The device I use is called Omnipod. It’s a wireless insulin delivery pump. … A few months before turning 65, I was told that unlike almost all private insurers in this country, Medicare wouldn’t pay for Omnipod. And I was even more confused to learn that this was the only FDA-approved insulin pump not covered by Medicare. (Susan Vietti, 5/18)

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Like Hunger Or Thirst, Loneliness In Seniors Can Be Eased

It’s widely believed that older age is darkened by persistent loneliness. But a considerable body of research confirms this isn’t the case.

In fact, loneliness is the exception rather than the rule in later life. And when it occurs, it can be alleviated: It’s a mutable psychological state.

Only 30 percent of older adults feel lonely fairly frequently, according to data from the National Social Life, Health and Aging Project, the most definitive study of seniors’ social circumstances and their health in the U.S.

The remaining 70 percent have enough fulfilling interactions with other people to meet their fundamental social and emotional needs

Judith GrahamNAVIGATING AGING

“If anything, the intensity of loneliness decreases from young adulthood through middle age and doesn’t become intense again until the oldest old age,” said Louise Hawkley, an internationally recognized authority on the topic and senior research scientist at the National Opinion Research Center (NORC) at the University of Chicago.

Understanding the extent of loneliness is important, insofar as this condition has been linked to elevated stress, impaired immune system function, inflammation, high blood pressure, depression, cognitive dysfunction and an earlier-than-expected death in older adults.

A new study, co-authored by Hawkley, highlights another underappreciated feature of this affliction: Loneliness is often transient, not permanent.

That study examined more than 2,200 Americans ages 57 to 85 in 2005 and again in 2010. Of the group who reported being lonely in 2005 (just under one-third of the sample), 40 percent had recovered from that state five years later while 60 percent were still lonely.

What helped older adults who had been lonely recover? Two factors: spending time with other people and eliminating discord and disturbances in family relationships.

Hawkley explains the result by noting that loneliness is a signal that an essential need — a desire for belonging — isn’t being met. Like hunger or thirst, it motivates people to act, and it’s likely that seniors reached out to the people they were closest to more often.

Her study also looked at protective factors that kept seniors from becoming lonely. What made a difference? Lots of support from family members and fewer physical problems that interfere with an individual’s independence and ability to get out and about.

To alleviate loneliness, one must first recognize the perceptions underlying the emotion, Hawkley and other experts said.

The fundamental perception is one of inadequacy. People who are lonely tend to feel that others aren’t meeting their expectations and that something essential is missing. And there’s usually a significant gap between the relationships these people want and those they actually have.

This isn’t the same as social isolation — a lack of contact with other people — although the two can be linked. People can be “lonely in a marriage” that’s characterized by conflict or “lonely in a crowd” when they’re surrounded by other people with whom they can’t connect.

Interventions to address loneliness have received heightened attention since 2011, when the Campaign to End Loneliness launched in Britain.

Here are two essential ways to mitigate this distressing sentiment:

Alter perceptions. Loneliness perpetuates itself through a gloomy feedback cycle. We think people don’t like us, so we convey negativity in their presence, which causes them to withdraw from us, which reinforces our perception that we’re not valued.

Changing the perceptions that underlie this cycle is the most effective way to relieve loneliness, according to a comprehensive evaluation of loneliness interventions published in 2011.

Heidi Grant, associate director of the Motivation Science Center at Columbia University, described this dynamic in an article published in 2010. “If co-worker Bob seems more quiet and distant than usual lately, a lonely person is likely to assume that he’s done something to offend Bob, or that Bob is intentionally giving him the cold shoulder,” she wrote.

With help, people can learn to examine the assumptions underlying their thoughts and ask questions such as “Am I sure Bob doesn’t like me? Could there be other, more likely reasons for his quiet, reserved behavior at work?”

This kind of “cognitive restructuring” is an essential component of LISTEN, a promising intervention to treat loneliness developed by Laurie Theeke, an associate professor in the school of nursing at West Virginia University. In five two-hour sessions, small groups of lonely people probe their expectations of relationships, their needs, their thought patterns and their behaviors while telling their stories and listening to others.

Joining a group can be effective if there’s an educational component and people are actively engaged, experts said.

Invest in relationships. With loneliness, it’s not the quantity of relationships that counts most. It’s the quality.

If you’re married, your relationship with your spouse is critically important in sustaining a feeling of belonging and preventing loneliness, Hawkley said.

If you haven’t been getting along, it’s time to try to turn things around. Remember when you felt most connected to your spouse? How did that feel? Can you emphasize the positive and minimize the negative? If you’re badly stuck, seek professional help.

Investing in relationships with family members and friends is similarly important. This is the time to move beyond old grievances.

“If you want to recover from loneliness, try to deal with difficulties that are disrupting relationships,” Hawkley said.

Also, it’s a good idea to diversify your relationships so you’re not depending exclusively on a few people, according to Jenny de Jong Gierveld and Tineke Fokkema, loneliness researchers from the Netherlands.

Training in social skills can help lonely people deal with problems such as not knowing how to renew contact with an old friend or initiate conversation with a distant relative. And learning coping strategies can enlarge their arsenal of adaptive responses.

Both of these strategies are part of a six-week “friendship enrichment program” developed in the Netherlands. The goal is to help people become aware of their social needs, reflect on their expectations, analyze and improve the quality of existing relationships and develop new friendships.

One simple strategy can make a difference. “If you have good news, share it,” Hawkley said, “because that tends to bring people closer together.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Medicare, Navigating Aging

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UnitedHealth Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim

The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans.

In a 79-page lawsuit filed in Los Angeles, the Justice Department alleged that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved. The government said it had “conservatively estimated” that the company “knowingly and improperly avoided repaying Medicare” for more than a billion dollars over the course of the decade-long scheme.

“To ensure that the program remains viable for all beneficiaries, the Justice Department remains tireless in its pursuit of Medicare fraud perpetrated by healthcare providers and insurers,” said acting U.S. Attorney Sandra R. Brown for the Central District of California, in a statement announcing the suit. “The primary goal of publicly funded healthcare programs like Medicare is to provide high-quality medical services to those in need — not to line the pockets of participants willing to abuse the system.”

Tuesday’s filing is the second time that the Justice Department has intervened to support a whistleblower suing UnitedHealth under the federal False Claims Act. Earlier this month, the government joined a similar case brought by California whistleblower James Swoben in 2009. Swoben, a medical data consultant, also alleges that UnitedHealth overbilled Medicare.

The case joined on Tuesday was first filed in 2011 by Benjamin Poehling, a former finance director for the UnitedHealth division that oversees Medicare Advantage Plans. Under the False Claims Act, private parties can sue on behalf of the federal government and receive a share of any money recovered.

UnitedHealth is the nation’s biggest Medicare Advantage operator covering about 3.6 million patients in 2016, when Medicare paid the company $56 billion, according to the complaint.

Medicare Advantage plans are private insurance plans offered as an alternative to traditional fee-for-service option.

Medicare pays the health plans using a complex formula called a risk score, which is supposed to pay higher rates for sicker patients than for people in good health. But waste and overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity concluded that improper payments linked to jacked-up risk scores have cost taxpayers tens of billions of dollars.

Tuesday’s court filing argues that UnitedHealth repeatedly ignored findings from its own auditors that risk scores were often inflated — and warnings by officials from the Centers for Medicare & Medicaid Services (CMS) — that it was responsible for ensuring the billings it submitted were accurate.

UnitedHealth denied wrongdoing and said it would contest the case.

“We are confident our company and our employees complied with the government’s Medicare Advantage program rules, and we have been transparent with CMS about our approach under its unclear policies,” UnitedHealth spokesman Matt Burns said in a statement.

Burns went on to say that the Justice Department “fundamentally misunderstands or is deliberately ignoring how the Medicare Advantage program works. We reject these claims and will contest them vigorously.”

A spokesman for CMS, which has recently faced congressional criticism for lax oversight of the program, declined comment.

Central to the government’s case is UnitedHealth’s aggressive effort, starting in 2005, to review millions of patient records to look for missed revenue. These reviews often uncovered payment errors, sometimes too much and sometimes too little. The Justice Department contends that UnitedHealth typically notified Medicare only when it was owed money.

UnitedHealth “turned a blind eye to the negative results of those reviews showing hundreds of thousands of unsupported diagnoses that it had previously submitted to Medicare, according to the suit.

Justice lawyers also argue that UnitedHealth executives knew as far back as 2007 that they could not produce medical records to validate about 1 in 3 medical conditions Medicare paid UnitedHealth’s California plans to cover. In 2009, federal auditors found about half the diagnoses were invalid at one of its plans.

The lawsuit cites more than a dozen examples of undocumented medical conditions, from chronic hepatitis to spinal cord injuries. At one medical group, auditors reviewed records of 126 patients diagnosed with spinal injuries. Only two were verified, according to the complaint.

The Justice Department contends that invalid diagnoses can cause huge losses to Medicare. For instance, UnitedHealth allegedly failed to notify the government of at least 100,000 diagnoses it knew were unsupported based on reviews in 2011 and 2012. Those cases alone generated $190 million in overpayments, according to the suit.

While Medicare Advantage has grown in popularity and now treats nearly 1 in 3 elderly and disabled Medicare patients, its inner workings have remained largely opaque.

CMS officials for years have refused to make public financial audits of Medicare Advantage insurers, even as they have released similar reviews of payments made to doctors, hospitals and other medical suppliers participating in traditional Medicare.

But Medicare Advantage audits obtained by the Center for Public Integrity through a court order in a Freedom of Information Act lawsuit show that payment errors — typically overpayments — are common.

All but two of 37 Medicare Advantage plans examined in a 2007 audit were overpaid — often by thousands of dollars per patient. Overall, just 60 percent of the medical conditions health plans were paid to cover could be verified. The 2007 audits are the only ones that have been made public.

CMS officials are conducting more of these audits, called Risk Adjustment Data Validation, or RADV. But results are years overdue.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Health Industry, Medicare

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It’s Time To Take The Pulse Of Our Readers

Even the most exalted among us realize health care policy is complicated.
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KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Health Industry, Insurance, Medicaid, Medicare, Multimedia, Pharmaceuticals

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Former Insurance Executive Details How Companies ‘Rigged’ Medicare Payments

In an interview with The New York Times, former UnitedHealthcare official Benjamin Poehling talks about his allegations that Medicare Advantage plans would list patients as very sick to get better federal payments. In other Medicare news, some groups representing health care providers are asking federal officials to give more consideration to the process of removing Social Security numbers from Medicare ID cards and John Oliver uses his show to skewer a dialysis provider.

The New York Times: A Whistle-Blower Tells Of Health Insurers Bilking Medicare
When Medicare was facing an impossible $13 trillion funding gap, Congress opted for a bold fix: It handed over part of the program to insurance companies, expecting them to provide better care at a lower cost. The new program was named Medicare Advantage. Nearly 15 years later, a third of all Americans who receive some form of Medicare have chosen the insurer-provided version, which, by most accounts, has been a success. But now a whistle-blower, a former well-placed official at UnitedHealth Group, asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system. (Walsh, 5/15)

Modern Healthcare: Medicare ID Overhaul Sparks Fears Of Patients Being Denied Care
Providers warned the CMS on Thursday that its plan to remove Social Security numbers from Medicare ID cards could cause patients to be denied care. The American Medical Association, American Academy of Family Physicians and several other provider groups on Thursday called on the CMS to undergo a formal rulemaking process before changing Medicare ID cards so providers can weigh in on the transition plan. (Dickson, 5/15)

Stat: John Oliver Riffs On Dialysis Controversies On ‘Last Week Tonight’
After imploring viewers to not press the “Dear God Literally Anything Else” button on their remotes, comedian John Oliver devoted most of Sunday’s “Last Week Tonight” to the for-profit dialysis industry. The segment focused on one of the country’s largest providers, DaVita, which has settled lawsuits about kickbacks to physicians, Medicare billing discrepancies, and the overuse of a medication. (Oliver also spends some time ruminating about DaVita CEO Kent Thiry’s personal eccentricities, such as making dramatic entrances riding a bicycle or horse while wearing a medieval costume.) (Sheridan, 5/15)

The Washington Post: John Oliver On Kidney Dialysis, Taco Bell And Death
Megallan Handford, a former DaVita nurse who claims he was fired for trying to unionize its employees, told Oliver the company’s focus “was all about numbers,” sometimes at the expense of patient safety. “When I was working at DaVita, the priorities for transitioning patients was to get them on dialysis and get the next patient on as soon as possible,” Handford told Oliver. “You would have sometimes 15, maybe 25 minutes to get that next patient on the machine, so you were not properly disinfecting.” (Wang, 5/15)

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