They Wind up With Big Out-Of-Pocket Costs
Jul 29, 2014 By Julie Appleby
Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.
“They said, ‘We take the old plan, but not the new one,’” said Perez, an attorney in Palo Alto, Calif.
But Disability Program is on Brink of Insolvency
Jul 29, 2014 By Julie Rovner
Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act.
Unlike Medicare, however, the part of Social Security that pays for people getting disability benefits is in far more immediate danger. The Disability Insurance Trust Fund is projected to run out of money in 2016, just two years from now, unless Congress intervenes, the trustees said.
No Estimates On Those Who Previously Lacked Coverage
Jul 29, 2014 By Phil Galewitz
About 10.3 million Americans gained health coverage this year, primarily as a result of the Affordable Care Act, according to a study by the federal government and Harvard University, published Wednesday in the New England Journal of Medicine.
The estimate of newly insured adults — the largest to date — is the first published in a major medical journal and authored by some federal health researchers.
Pro-ACA States Enjoy Economic Expansion
Jul 22, 2014 By Bryan Thompson
A study released earlier this month by the White House Council of Economic Advisers says the decision not to expand Medicaid is costing Kansas and other Midwest states billions of dollars and tens of thousands of jobs.
Wisconsin, Iowa First States to Obtain Medicaid Waivers
Jul 22, 2014 By Michael Ollove
By his own admission, for many years Cyrus Napolitano’s mental illness—bipolar disorder—did not make him an ideal employee. Perhaps the worst moment came when he walked into the Brooklyn McDonald’s he was managing to discover some now-forgotten worker infractions.
“Whatever it was,” he said, “it triggered an explosion where I was screaming at the top of my lungs and beating a path of destruction all the way to the back, knocking everything off shelves and kicking the back door with my boot.”
They Say Repeating The Arduous Process Doesn't Make Them Better Doctors
Jul 22, 2014 By Roni Caryn Rabin
Many specialist physicians are balking at what they say are onerous new rules to get recertified, warning the demands will force some physicians out of practice at a time when the nation faces a shortage.
Doctors say the new requirements have made maintaining specialty certifications a process that never ends. Younger doctors already retake the arduous certification exam every seven to 10 years to keep their credential, long considered the gold standard of expertise. But physicians of all ages must now complete a complex set of requirements every two to three years, or risk losing their certification.
CMS Wants Eligibility Delays Ironed Out
Jul 15, 2014 By Dave Ranney
Federal officials have asked six states, including Kansas and Michigan, to submit plans for resolving issues that appear to be delaying the processes to determine Medicaid eligibility, primarily for pregnant women, children and people with disabilities.
Letters were sent to each state’s Medicaid director on June 27.
Eight out of 10 are out of work
Jul 15, 2014 By Jenny Gold
Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003.
That’s an unemployment rate of more than 80%.
Focusing On Keeping Patients at Home
Jul 8, 2014 By Michael Ollove
Three years after the demise of the long-term care piece of the Affordable Care Act, some states are retooling their Medicaid programs to maximize the number of people who can get care at home and minimize the number who have to become poor to receive help.
They also are trying to save state dollars. Medicaid is a joint state-federal program, and long-term care for the elderly is putting an ever greater burden on state budgets: Total Medicaid spending for long-term services rose from $113 billion in 2007 to nearly $140 billion in 2012.
Could Affect Nine Other States
Jul 8, 2014 By Jake Grovum
The U.S. Supreme Court’s recent ruling in a case brought by home healthcare aides in Illinois casts doubt on labor agreements between such workers and state governments in nine other states.
It also closes off—or at least complicates—one of labor’s clearest paths to reversing a decades-long trend of declining ranks and shrinking clout.
Liberals, Conservatives Have Different Interpretations
Jul 8, 2014 By Julie Rovner
The U.S. Supreme Court’s opinion last week holding that some for-profit firms do not have to provide women the contraceptive coverage required under the Affordable Care Act if they have religious objections addressed only half of the ongoing legal battle over the birth control mandate.
But those on both sides of the issue think the court’s majority may have telegraphed which way it could rule when one of those other cases reaches the justices.
Many Had Lacked Coverage For Years, According to Survey
Jun 24, 2014 By Julie Appleby
Nearly six in 10 Americans who bought insurance for this year through the health law’s online marketplaces were previously uninsured—most for at least two years, according to a new survey that looks at the experiences of those most affected by the law.
That finding is higher than some earlier estimates, and counters arguments made by critics of the law that most of those who purchased the new policies were previously insured.
Midwest Hospitals Defend Business Practices
Jun 24, 2014 By Mary Agnes Cary
A federal program designed to allow certain safety net hospitals and clinics to save money on drug purchases is under fire from critics who say the facilities are using that money to pad profits rather than help patients.
The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25% to 50% discount. Participants can then charge higher rates to insured patients and keep the additional revenue.
Making Group Reconsider Vaccinations
Jun 24, 2014 By Sarah Jane Tribble
The Amish countryside in central Ohio looks like it has for a hundred years. There are picturesque pastures with cows and sheep, and big red barns dot the landscape. But something changed here when, on an April afternoon, an Amish woman walked to a communal call box. She called the Knox County Health Department and told a county worker that she and a family next door had the measles.
ACA is credited with enrollment boost
Jun 17, 2014 By Ron Shinkman
Although controversial in many parts of the country, the Affordable Care Act has been a boon in Minnesota, as the federal reform law helped reduce the number of uninsured by more than 40%.
A new study by State Health Access Data Assistance Center (SHADAC) at the University of Minnesota concluded that the number of uninsured statewide dropped by 40.6% between September of last year and the start of last month.
Requirements For Risk Assessments, Co-Pays Do Not Deter Enrollment
Jun 17, 2014 By Phil Galewitz
Delayed by state lawmakers, Michigan did not expand Medicaid until the day after the federal online insurance exchange closed March 31 – a move advocates feared would undermine signups.
Turns out, enrollment is exceeding expectations, which has pleased officials who seek to make the state among the first in the nation to add a heavy dose of “personal responsibility” to the federal-state entitlement program.
Result of Hospitals Buying Physician Practices
Jun 17, 2014 By Julie Appleby
Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.
Patients say, “‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 -- and I was in the same room with the same doctor same nurse and the same length of time’,” said Donald Fischer, M.D., chief medical officer for Highmark, the largest health plan in Pennsylvania.
Most Costs Covered by State, Federal Funds
Jun 10, 2014 By Michelle Andrews
The effects of a sexual assault can be long-lasting, but the medical bills shouldn’t be. Yet a new study finds that despite federal efforts to lift that burden from rape victims, a hodgepodge of state rules means some victims may still be charged for medical services related to rape, including prevention and treatment of pregnancy or sexually transmitted infections.
"If you're exposed to HIV as a result of the attack, that’s something the state should be paying for, especially if we can give you prophylaxis to prevent infection," said Ilse Knecht, deputy director of public policy at the National Center for Victims of Crime.
Across America, Many Say Healthcare Costs Too Much
Jun 10, 2014 By Jenny Gold
Recently, I moved across the country, from Washington, D.C., to San Francisco. I drove the Southern route and decided to conduct an informal survey, asking folks I met along the way a question relevant to the health care reporting I've been doing for the past five years.
The question: What bugs you most about your medical care?
Application Backlogs Are Substantial
Jun 10, 2014 By Phil Galewitz
While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states.
The scope of the problem varies widely. California, the most populous state to implement the health law’s expansion of Medicaid, accounts for a lion’s share of the backlog with 900,000 applications still pending as of early June. The next biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all.
Snyder Administration Looking to Save Money
Jun 3, 2014 By Karen Bouffard
The Affordable Care Act is expected to save Michigan hundreds of millions of dollars annually in mental health costs, but there’s a growing dispute over whether the money should be immediately reinvested in mental health programs, or banked.
As part of major changes associated with the healthcare overhaul, Michigan opened Medicaid to nearly 500,000 additional residents. That moves their healthcare costs — including mental health — off the state’s books and onto the federal government’s.
Second Only to Wyoming
Jun 3, 2014 By Virginia Young
Missouri is seeing a bigger decline in its Medicaid rolls than nearly any other state, a ranking that the administration of Gov. Jay Nixon attributes to an improving economy and critics blame on application snafus.
A new federal report compares Medicaid enrollment in March to the average for the three-month period of July through September 2013. Missouri’s caseload declined 3.9 percent, a drop second only to Wyoming, which declined by 5.6%.
Moving Past Stigma of Death Panels
Jun 3, 2014 By Michael Ollove
The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.
A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.
They Hold Most Americans With The Disease
May 19, 2014 By Michael Ollove
The U.S. is in the midst of a hepatitis C epidemic with as many as 3.9 million Americans infected with the liver-damaging virus. Aggressively targeting a concentrated population with the contagious but curable disease could be the best approach to eradicating the deadly virus.
The most logical place to launch the counterattack is in the country’s jails and prisons, where the infection rate is about 17 percent, compared to 1 percent to 2 percent overall in the U.S., said Josiah Rich, a Brown University infectious disease physician. A recent study estimated that 1.86 million people with the virus were incarcerated.
Workers Said They Read, Played Games
May 19, 2014 By Tara Kulash and Chuck Raasch
A former employee at an Affordable Care Act processing center in Wentzville, Mo., recalls having so little work to do that she played board games while some co-workers slept.
Lavonne Takatz, 42, worked at the center in Wentzville from October to April.
Rising Fees a Serious Consideration
May 20, 2014 By Sarah Jane Tribble
AmeriMark Direct in Cleveland started its mail order catalog business here in the 1960s, and for decades, everyone assumed that health insurance came with the job.
These days, the 700-employee company doesn’t assume anything.
CT Scans, MRIs For Headaches Top List
May 13, 2014 By Jordan Rau
Medical overtreatment is the inverse of former Supreme Court Justice Potter Stewart’s definition of pornography: while easy to define in concept, it can be hard to know it when you see it.
A treatment that is appropriate for one patient can also be unnecessary or even counterproductive for another, depending on the patient’s condition.
Study of Massachusetts Suggests Expanding Insured Pool Cuts Deaths
May 13, 2014 By Christine Vestal
The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act.
In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that “health reform in Massachusetts was associated with a significant decrease in all-cause mortality.”
Primary Care System Meeting Needs of Newly Insured
May 13, 2014 By Phil Galewitz
The headlines were ominous: Good luck finding a doctor under the Affordable Care Act. Not enough doctors for newly insured. The ACA-related doctor shortage could crash health system.
Despite these dire predictions, the nation’s primary care system is handling the increased number of insured patients without major problems so far, according to interviews with community health centers, large physician practices and insurers nationwide.
Patient Spending Also Rises
May 6, 2014 By Phil Galewitz
A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.
The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007. The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.
About 200,000 Nationwide Are Eligible Until Age 26
May 6, 2014 By Christine Vestal
One of the Affordable Care Act’s successes is a provision that allows young people up to 26 years old to remain on their parents’ health insurance. Under a similar, but less-known provision, young adults who have been recently released from foster care can also get Medicaid coverage, regardless of their incomes. An estimated 180,000 foster care alumni became eligible on Jan. 1.
About 26,000 young adults 18 to 22 years old are released from foster care each year and left to fend for themselves without state protections. The age that a young adult in foster care loses benefits varies across the states. The new health care provision for former young people without parents in the picture grants them full Medicaid coverage until age 26 in the state where they lived when they left foster care.
Committee Vote Was Mostly Symbolic
May 6, 2014 By Virginia Young
In what Missouri House Insurance Committee Chairman Chris Molendorp acknowledged was a symbolic move, a Medicaid expansion measure gained its first committee endorsement of the year last week.
Molendorp, R-Belton, and the four Democrats on his committee combined to recommend a wide-ranging bill that would expand the public health insurance system to about 300,000 low-income adults. The vote was 5-2, with five Republicans absent.