Overruns Forcing Lower Payments to Some Providers in Stopgap Health Program - NYTimes.com

 

WASHINGTON — The Obama administration said Monday that it was cutting payments to doctors and hospitals after finding that cost overruns are threatening to use up the money available in a health insurance program for people with cancer, heart disease and other serious illnesses.

The administration had predicted that up to 400,000 people would enroll in the program, created by the 2010 health care law. In fact, about 135,000 have enrolled, but the cost of their claims has far exceeded White House estimates, exhausting most of the $5 billion provided by Congress.

Under a new policy issued by Kathleen Sebelius, the secretary of health and human services, “health care facilities and providers will get paid less” for providing the same services to patients in the federal program, known as the Pre-Existing Condition Insurance Plan.

In most cases, payments to health care providers will be capped at Medicare rates, which are substantially less than the commercial insurance rates they have been receiving. The new policy generally prohibits doctors and hospitals from increasing charges to consumers to make up the difference.

Michael T. Keough, the executive director of the North Carolina Health Insurance Risk Pool, said the new policy was one of several steps taken recently by federal officials to control spending.

“They are trying to stanch the hemorrhaging,” Mr. Keough said.

The federal government notified some states last month that it was setting a ceiling on costs that would be reimbursed from June through December of this year. In effect, state officials said, the new limits shift the financial risk of the program from the federal government to those states.

Congress established the program to provide coverage to people with pre-existing conditions who had been uninsured for at least six months, and Ms. Sebelius has said, “It literally saves lives.”

The program provides a transition to 2014, when most consumers will be able to obtain insurance regardless of their pre-existing conditions.

Federal officials froze enrollment in the program in February, but costs continued to grow rapidly.

Overruns Forcing Lower Payments to Some Providers in Stopgap Health Program - NYTimes.com

It is worth remembering, that these patients had run out of options for access to treatment before the program.

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Market, insurers will keep premiums low, analysts say

Just how much premiums will change depends on the state you live in, Kingsdale said.
Individual premiums decreased when Massachusetts' health care took effect, he said, because the state already had high-priced and insurers were not allowed to turn away the sick and could not charge large premium differences based on age, gender and health.
"Other states will see exactly the opposite happen," he said. "Their premiums tend to be quite low, but they're getting skimpy insurance."
In Oregon, Ario said, large differences in premium prices have already appeared.
In one case, a 40-year-old non-smoker in Oregon could buy a low-cost or bronze-level plan for $162 a month from one company or the same plan from another for $400 a month, Ario said. Anti-trust laws prevented the insurers from comparing pricing before developing their premiums.
When the companies with the higher rates saw their competitors' lower premiums, he said, they asked the state to allow them to file for reduced premiums.
"The good news is that in most marketplaces, there will be some carriers that will be bold and price competitively to get more market share," Ario said.

Market, insurers will keep premiums low, analysts say

For a quick rundown on what the "gold, silver, and bronze" plans will cover, go here.

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Public in Deep South supports expanding Medicaid, poll finds, but lawmakers don’t - KansasCity.com

WASHINGTON — Even though governors and lawmakers in five Deep South states oppose a plan to cover more people through Medicaid under the health care overhaul, 62 percent of the people in Alabama, Georgia, Louisiana, Mississippi and South Carolina support expanding the program, according to a new poll.
The level of support for expanding Medicaid – the state and federal health insurance program for the poor and disabled – ranged from a low of 59 percent in Mississippi to a high of 65 percent in South Carolina, according to the poll by the Joint Center for Political and Economic Studies, a leading research and public policy think tank that focuses on African-Americans and other people of color.
Brian Smedley, director of the center’s health policy institute, said the findings show that lawmakers who are blocking Medicaid expansion in the five states are “out of step with their constituents.”

Public in Deep South supports expanding Medicaid, poll finds, but lawmakers don’t - KansasCity.com

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How Austerity Kills - NYTimes.com

 

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity. (Germany preaches the virtues of austerity — for others.)

As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions. Over the past decade, we mined huge data sets from across the globe to understand how economic shocks — from the Great Depression to the end of the Soviet Union to the Asian financial crisis to the Great Recession — affect our health. What we’ve found is that people do not inevitably get sick or die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life or death.

How Austerity Kills - NYTimes.com

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Obama Administration Mulls Rule To Give Home Health Aides Better Wages - Kaiser Health News

 

The average yearly salary for home health aides in 2012 was $21,830, according to the Labor Department.

Only 21 states and the District of Columbia extend minimum wage guarantees to at least some in-home care workers. Among them, 12 states have a minimum wage that is higher than the federal standard – $7.25 an hour.

The administration wants to change that, however. In December, 2011, President Barack Obama proposed a revision to the Fair Labor Standards Act that would extend both overtime and minimum wage protections to home-care workers employed by third parties, such as home care agencies. "They work hard and play by the rules and they should see that work and responsibility rewarded," Obama said.

The proposal has been under protracted review by regulators and is now being analyzed by officials at the Office of Management and Budget. Thousands of comments have been filed with the government on the plan.

When a 90-day review window came and went on April 15, key supporters of the proposal organized a conference call urging the Obama administration to expedite the change.

Bruce Vladeck, who ran Medicare and Medicaid under President Bill Clinton and is now a senior adviser at the consulting firm Nexera, pointed in that call with reporters to the political power of the home care industry, which is opposing the proposal. In a subsequent interview, he said, "Based on my understanding, the OMB folks have met with industry representatives who have raised concerns publicly about the impact on them with the proposal." He added, "It will take until somebody at the political level decides to either issue a regular order or bury it. There’s absolutely no telling."

The plan has been criticized by some Republican lawmakers and Medicaid directors. In addition, some disability advocacy groups have complained that it will increase the health care costs for people who want to remain in their homes and avoid moving to institutional care.

Obama Administration Mulls Rule To Give Home Health Aides Better Wages - Kaiser Health News

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Want to know the future of Obamacare? Take a look at Fort Dodge, Iowa.

 

In Fort Dodge, this is changing. UnityPoint Health (which was, until this week, named Iowa Health System) is one of the 32 Pioneer Accountable Care Organizations that volunteered to have part of their Medicare payments tethered to a set of quality metrics.

While UnityPoint has hospitals across the state, it decided to focus its ACO effort on a relatively small segment of its population to limit the health system’s exposure to the possibility of losing money on the endeavor.

“If we completely missed the mark, we knew it wouldn’t be disastrous from a financial standpoint,” UnityPoint President Bill Leaver said. “We knew it wouldn’t be overwhelming, but a good size to start with.”

The Pioneer ACOs launched Jan. 1, 2012, and for the first year, the program only required them to report quality metrics. Their payments would not yet depend on how well they met 33 measures.

The most difficult part of preparing to move to a system that pays for value rather than volume in Fort Dodge was asking doctors to rethink how they do their jobs. They would be encouraged to delegate relatively routine care, for example, to other advanced practitioners, while focusing their own work on care management.

“That is harder work than we thought,” Leaver said. “For physicians, they run the office and they’re the captain of the ship. Instead of seeing a strep patient now, you might have other people working for you that you’re going to deploy.”

Overall, Leaver describes his experience with the ACO Pioneer program as “generally positive.” What he likes most about the program is that, when the hospital gets a lump sum for each patient, it has more control over treatment. The health system can prescribe treatments that Medicare would not traditionally reimburse.

Want to know the future of Obamacare? Take a look at Fort Dodge, Iowa.

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PAFP/F: Access to Primary Care in Pennsylvania

Survey findings from the Pennsylvania Academy of Family Physicians, January 2013

PAFP/F: Access to Primary Care in Pennsylvania

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