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Newsletter, What's Going On, October 12, 2010

October 12, 2010

Amid the wave of Republican nostalgia for Bill Clinton's moderate instincts, it's worth reminding people that Barack Obama's health-care plan was the moderate Republican plan that emerged as a counter-proposal to Clinton's big-government vision.  From Ezra Klein.  The blog post contains a beautiful comparison between elements of the Affordable Care Act and Republican John Chafee’s proposal in 1993. 

There’ve been several legal discussions of the constitutionality of mandates in the Affordable Care Act.  One last spring in the New England Journal is here.  A federal judge has now ruled the new health care law is constitutional; the hyperlink is to Timothy Jost’s scholarly analysis of the decision.  Of course, this is only the earliest of federal court decisions, decisions that will be appealed and ultimately, inevitably, wind up before the Supreme Court.  Yes, that Supreme Court.  From the Wonkbook and the Health Affairs blog..

There is a second legal question, discussed a week ago in the New England Journal.  Does the federal government have the power to regulate inactivity?  States can clearly force activity…vaccinations, for example, or the purchase of health insurance, as in Massachusetts.  There appears to be no case law regarding whether the federal government has that power, or so argues the author of the NEJM article and some attorneys general.  The analogy is offered: if the federal government can compel citizens to purchase health insurance, could it also compel citizens to purchase newspapers in order to benefit the failing newspaper industry? 

The Kaiser Health News asks, “Are 'Mini-Med' Plan Waivers A Good Idea?”  It continues: “Is some health coverage — even if it's extremely limited —better than none at all?  In an apparent effort to avoid having some employers end workers’ coverage, Obama administration officials this (past) week said they will grant waivers to about 30 insurers, employers and union health plans to continue offering what are dubbed  "mini-med" insurance plans,  many of which  fall short of benefit requirements stipulated in the new health law.  Such plans are inexpensive, but they limit coverage by setting daily or annual caps, which can be as low as $100 a day for hospital care or $2,000 a year for all medical treatment.  Employees whose medical care costs exceed those limits must pay the difference themselves.  The administration granted one-year waivers. Insurers or employers will have to seek waivers again each year if they want to continue offering the plans. The waivers, the administration said, could help keep coverage for about a million employees until 2014 when much of the health law — including tax credits to help people afford coverage on their own through insurance exchanges — is implemented.”

The Wall Street Journal: "Health insurer Aetna Inc. (AET) is developing plans to pay a major San Diego medical group enhanced fees for providing extra services to keep patients healthier, and to share any resulting cost savings. With a similar cost-saving goal, UnitedHealth Group Inc. (UNH) has started to base payments to its network providers partly on cost and quality measures, and Cigna Corp. (CI) guarantees corporate clients it will lower employee health risks. Fueled by the weak economy, the health overhaul and anxious clients, insurers are taking steps to lower medical costs, including introducing new pay structures to encourage care that averts hospitalizations. They are also offering employers narrower, lower-cost provider networks, prodding enrollees to form healthier habits and pick less expensive doctors, and getting tougher in hospital price negotiations" (Brin, 10/7).   Kaiser Daily Health Policy Report.

Improving health care at a lower cost will require doctors to make many changes — working weekends and consenting to quality management are two clear ones.  This from a New York Times op-ed by Peter Orszag. titled “Health Care’s Lost Weekend”

Rand Paul, the physician who’s running for the Senate in Kentucky, isn’t backing down from his proposals to cut Medicare and Social Security.  He’s presently slightly in the lead in political polling. 

Researchers from Massachusetts General Hospital and from New York’s Sloan-Kettering Cancer Center have released a proposal to use Comparative Effectiveness Research to govern Medicare reimbursement for procedures.  That use of comparative effectiveness research is presently specifically barred under the Affordable Care Act; their proposal would require the law to be changed.  Their proposal is published in Health Affairs and reported in The Hill.

The Wall Street Journal: "3M Co. confirmed it would eventually stop offering its health-insurance plan to retirees, citing the federal health overhaul as a factor. The changes won't start to phase in until 2013. But they show how companies are beginning to respond to the new law, which should make it easier for people in their 50s and early-60s to find affordable policies on their own. While thousands of employers are tapping new funds from the law to keep retiree plans, 3M illustrates that others may not opt to retain such plans over the next few years" (Adamy, 10/4). Kaiser Daily Health Policy Report.

Birmingham News op-ed supporting single payer insurance, chiefly from a business point of view.   I wrote it and I’m proud of it. 

PNHP’s report on the One Nation rally in Washington last weekend.  Sounds as if it was a great success.  Here’s a nice slide set of pictures.

HealthDay/Yahoo: Coverage and race can mean better or worse care for cancer patients, a series of studies has found. "The reports, documenting financial and racial factors that impact diagnosis, treatment and survival, were scheduled for presentation this weekend at a meeting of the American Association for Cancer Research in Miami. Lack of private health insurance made a marked difference in survival outcomes of women with uterine cancer, researchers from the American Cancer Society and the University of California, Irvine found." Black patients were also likely to fare worse (10/3). Kaiser Daily Health Policy Report.

The Washington Post: "Federal employees will see their health insurance premiums increase at a far higher rate than their pay next year, but less than many private sector workers." The Office of Personnel Management announced Friday that the average increase for Federal Employee Health Benefits Program enrollees will be 7.2 percent. That amount is "significantly more than their average pay raise, which is slated to be 1.4 percent in 2011." Last year the average increase was 8.8 percent (Davidson, 10/1). Kaiser Daily Health Policy Report

The Cincinnati Enquirer: Low insurance reimbursements for mental health providers is a problem for many of the professionals. Charles Roberts, one of the owners of a practice, tells the Enquirer that "most clinicians in the field are making about what they made in 1997. ... Psychologists, therapists and counselors across Greater Cincinnati and Northern Kentucky are experiencing payments as low as half of what the treatment costs, making it hard for many of them to pay the bills. With more people out of jobs or experiencing more stress paying the bills, behavioral health care is needed more than ever, said Paul Keck, president and chief executive officer at the Lindner Center of Hope in Mason" (Peale, 10/3). Kaiser Daily Health Policy Report

A section of the health care law that went into effect Sept. 23 expanded coverage for young adults under their parents' policies, but military families weren't included—and it's not clear how soon they will be able to take advantage of the popular provision.  The Commonwealth Fund.  And: The Wall Street Journal: Glenn Franco is a retired worker who wanted to enroll his 24-year-old daughter in his health plan. But it turns out she was ineligible for the benefits of a provision of the new health law that allows children up to age 26 to be in their parent plans. Retiree health plans are exempt from the provision, as well as the broader law. "A retiree health plan is one that provides coverage until age 65, after which it either phases out or acts as a supplement to Medicare. While the health-care overhaul doesn't cover retiree-only plans, it does cover retirees with individual policies, as well as health plans that include both employees and retirees" Among the retirees affected are those in state and federal government plans and those for military families and unions (Schultze and Silver-Greenburg, 9/10). Kaiser Daily Health Policy Report

Some parents struggle to comply with pediatrician's orders A survey presented at the AAP conference in San Francisco showed 13% of parents said they could not comply with at least one of their pediatrician's recommendations in the past year because they could not afford it. The survey of almost 2,000 parents also found children with private insurance were about two times as likely as those in public programs to be underinsured. Los Angeles Times/Booster Shots (10/3   American Academy of Pediatrics Smart Briefs.

The Commonwealth Fund has launched a new series of Fund issue briefs that examines the way the Affordable Care Act of 2010 (ACA) will benefit different populations and groups, as well as improve insurance coverage and change the delivery of care. Published briefs include: 

Women and the Affordable Care Act of 2010. Analyzes how, over the next decade, the ACA is likely to stabilize and reverse women's growing exposure to health care costs. Up to 15 million women who now are uninsured could gain subsidized coverage under the law. In addition, 14.5 million insured women will benefit from provisions that improve coverage or reduce premiums. 

Small Businesses and the Affordable Care Act of 2010. Highlights several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance.  Pre-Existing Condition Insurance Plans Created by the Affordable Care Act of 2010. Examines eligibility, benefits, premiums, cost-sharing, and oversight of the state PCIP programs, as well as variation in the plans from state to state.  Young Adults and the Affordable Care Act of 2010. Analyzes several short- and long-term provisions that promise to stem the rapidly 
rising tide of uninsured young adults, one of the largest uninsured segments of the population.

Kaiser Health News: Nurses clamoring for a larger role in providing care for Americans got a powerful ally in the Institute of Medicine Tuesday as the institute released a report empowering nurses. "The Institute of Medicine report says nurses should take on a larger and more independent role in providing health care in America, something many doctors have repeatedly opposed, citing potential safety concerns. It calls for states and the federal government to remove barriers that restrict what care advanced practice nurses -- those with a master's degree -- provide and includes many examples of nurses taking on bigger responsibilities. ... The new federal health care law provides more funding for nursing education and nurse-led clinics, but this study could also propel the nurses' argument for more authority to deliver care independently from physicians." Such "scope of practice" considerations are the source of significant tension between doctors and nurses around America in who provides what care to which patients (Villegas and Carey, 10/5).

The Washington Post: AFL-CIO President Richard Trumka said Democrats would have an easier time getting re-elected if they were more ambitious with their health care legislation. "'What I hear on the ground is that people didn't say, "You went too far on health care,"' Trumka said. 'They say: "You didn't do enough; you should've had a public option; you should've had this; you should've had that."' Trumka said union members would be more apt to vote for Democrats had they included a public option in the health bill (Rucker, 10/5). Kaiser Daily Health Policy Report.

The HHS announced roughly $100 million in federal grants under the Affordable Care Act to support the construction and renovation of school-based health clinics.  Smart Briefs. American Academy of Pediatrics.  

REFORM GOES SOUTH UP NORTH?- Alaska's Democratic state senators are dogging Gov. Parnell and his administration for passing on numerous reform grant opportunities, underscoring how rambunctious anti-reform states can be in health reform implementation. "Your opposition to the law should not result in damaging the health of your constituents, their pocketbooks, or the pocketbook of the state," state Sen. Hollis French wrote to Parnell on Monday, listing three grants that the state has passed up: exchange planning, rate review and consumer assistance. This came on the heels of a letter from Senate Majority Leader Johnny Ellis in late September, pressing insurance director Linda Hall to apply for an exchange planning grant. Hall declined and later told PULSE she did so because Alaska opposes the law and "is part of the suit against the federal government to stop the [individual] mandate." 

--Alaska looks ready to opt-out of the reform law in every way it can. French thinks it only gets worse from here as the governor has to sign off on any implementation legislation: "He can veto any bill, or red line any appropriation. For all intents and purposes, this is going to be impossible...you're just really stymied."  From Politico PULSE.

QD: News Every Day--Are doctors' political leanings changing?  The growing trend of doctors as salaried employees instead of business owners might also be shifting their political beliefs to the left.  From ACP Internist

The New York Times examines the impact of the Affordable Care Act on Medicare Advantage plans in an editorial

Six points physicians should consider before joining an Accountable Care Organization.

American Medical News reports that 20 states enacted Medicaid pay reductions for physicians in 2010, while also struggling "to cope with strong Medicaid enrollment growth, according to an annual survey of state Medicaid programs. Meanwhile, 11 states, six of which also cut pay in 2010, and the District of Columbia have enacted physician pay cuts for fiscal 2011, which in many states began June 30. But the worst of Medicaid pay cuts may be yet to come" as additional Medicaid funding from the 2009 economic stimulus package dries up. "Some states' Medicaid costs could increase by 25% or more in fiscal 2012" (Trapp, 10/11).

High costs are leading patients to abandon prescription drugs, reports Jonathan Rockoff: "A review of insurance-claims data shows that so-called abandonment--when a patient refuses to purchase or pick up a prescription that was filled and packaged by a pharmacist--was up 55% in the second quarter of this year, compared with four years earlier. The phenomenon coincides with rising co-payments for many drugs and increasing enrollment in high-deductible insurance plans that require patients to pay hundreds or thousands of dollars out of pocket before insurance kicks in."  Wonkbook.

The Young Invincibles with a cute video talking about “coverage”

The American Medical Association reports that 31% of primary care physicians who responded to its survey limit the number of Medicare patients in their practices. 

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Wednesday, October 13, noon.  Get acquainted session, NAHA members and Dr. Wally Retan. Panera Bread, Airport Road, Huntsville. 

Thursday, October 21, 2010.  @5:30 PM.  Third Thursday happy hour (social gathering), at 801 Franklin (Huntsville).

Wednesday, October 27, 2010.  Lunch, (social gathering) Panera Bread, Airport Road, Huntsville.  Wednesday before each monthly meeting.

Thursday, October 28, 8 PM CDT.  PNHP’s monthly activist phone call.  Please call me for the phone number and access code. 

Saturday, October 30, 2010.  Baylor University, Faith & Future of Healthcare Symposium.  Pippa Abston to participate.

Monday, November 1, 2010  @ 5:30 PM.  North Alabama Healthcare for All Monthly Meeting —Huntsville/Madison County Public Library, 901 Monroe Street  (downtown).  The meeting is in Room AB, on the first floor. After you enter the library’s front door, turn right towards the auditorium.

Are you ready for Leadership Training? New PNHP members - and longtime members who want to take the next step and get active - are invited to come to Denver the day before the Annual Meeting to participate in PNHP's popular crash course in health policy and politics starting on Friday, November 5, at 1:00 p.m. We look forward to working with you! Contact Matt Petty at matt@pnhp.org or 312-782-6006 to register.

Please join PNHP in Denver for our Annual Meeting on Saturday, November 6, at the Sheraton Denver Downtown Hotel. The Annual Meeting is PNHP's most important, energizing and inspiring gathering of the year. This year's theme is "From PPACA to Single Payer: Next Steps for Single-Payer Activists in the Wake of the Obama Health Plan." Speakers will include Amy Goodman, PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, and more. A limited number of travel scholarships are available for medical students.

Sunday, November 7 (probably),  7PM CDT.  Healthcare-NOW monthly activist phone call. Please use this Dial-in Number 1-218-862-1300 and Conference Code 441086. To mute and unmute the line, please hit *4.

Healthcare-NOW National Strategy Conference.  When: Saturday, November 13th and Sunday, November 14th  Where: William Way Community Center, 1315 Spruce St., Philadelphia, PA Time: Sat, 4pm to 9pm; 
Sun, 8am to 4pm
 Fee: $30 for Healthcare-NOW! Members and $50 for Healthcare-NOW! Non- Members  Go to our National Strategy Conference page to register and more information.

Saturday, November 20, 9 AM.  Pippa Abston’s home.  Vision 2011 Workshop to develop roadmap and plan of action for 2011 activities of NAHA, North Alabama Healthcare for All, the north Alabama Chapter of PNHP, Physicians for a National Health Program.

Wednesday, December 1, 2010.
- B'nai Shalom Temple, Women's Group, anticipates about 30 people. Pippa Abston to present.

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