Legislation and Policy- Collection of Great Pool Side Reading

Obama Administration Releases Guidance On Medicaid Expansion.

The New York Times  (10/2, Pear, Subscription Publication) reported that the Obama Administration has released its first “definitive guidance” regarding Medicaid expansion since the Supreme Court ruled on the Affordable Care Act in June. The director of the Center for Medicaid and State Operations, Cindy Mann, said in a letter, “A state may choose whether and when to expand, and if a state covers the expansion group, it may decide later to drop the coverage.” She added that, “there is no deadline,” but states “would pay a price for delay.” The Times notes that even with this guidance, “the Administration left major questions unanswered.”

Study: Obama’s Healthcare Plan “Outperforms” Romney’s.

In continuing coverage, The Hill  (10/3, Viebeck) “Healthwatch” blog reports on the new Commonwealth Fund study  which “evaluated the candidates’ healthcare policies and found Obama’s proposals ‘outperform’ Romney’s when it comes to expanding coverage and lowering costs.” Researchers found that “even compared against a baseline scenario in which the Affordable Care Act had not been implemented, Romney’s plans ‘are estimated to increase the number of uninsured people by 12 million.'”

CQ  (10/3, Adams, Subscription Publication) adds that the “report comes with lots of caveats, in part because Romney has not released a enough details about his plans to know for sure how coverage would be affected.” As such, researchers had to make several assumptions about what would happen under Romney’s watch.

The CNN  (10/3, Young) “The Chart” blog details the seven issues examined for the study: “whether the plans would increase the number of Americans with health insurance; whether they made insurance more affordable; if consumers were protected; whether consumer choice was improved; whether they helped small businesses; if they improved Medicare; and if they improved quality of care and reduced costs.”

Politico  (10/3, Norman) adds that in response, “the Romney campaign said the ‘flawed report’ doesn’t accurately reflect Romney’s proposals and represents ‘a fantasy world where Obamacare has been a success.'”

NFIB Warns Small Businesses About ACA.

The Richmond (VA) Times-Dispatch  (10/3, Martz) reports, “Small businesses will bear the brunt of a tax on insurance companies aimed at helping to pay for the Patient Protection and Affordable Care Act, better known as Obamacare, members of a national business group said Tuesday at two informal meetings in the Richmond area.” The National Federation of Independent Businesses (NFIB) told audiences that “the provision could costs small-business owners an average of $500 per employee.”

Simpson-Bowles Would Bring “Dramatic Changes” To Healthcare.

CQ  (10/3, Reichard, Subscription Publication) reports that as politicians search for ways to deal with the deficit, and head off the looming sequester cuts, some have been looking toward the “unsuccessful Simpson-Bowles commission as the eventual basis of compromise.” The article then assesses what this would mean for healthcare. Among the “dramatic changes” Simpson-Bowles would bring: “taxation of health benefits, a cap on overall health care spending by the federal government, an end to Medigap coverage in its current form, and possibly a premium-support based overhaul of Medicare.”

Defense Contractor Warns Against Sequester.

In a post for the Washington Post  (10/3, Brown) “On Small Business” blog, Kimberly Brown, CEO of Amethyst Technologies, a defense contractor, argues against the “looming” sequester. She writes that her company, which focuses on “expansion in health care and development of innovative technologies,” would suffer greatly if defense spending were cut. She also warns that she would have to look for foreign investors if she cannot get enough funding at home.

Physician Groups Oppose Proposed CMS Rule Expanding Nurse Anesthetist Role.

The Wall Street Journal  (10/3, A3, Martin, Subscription Publication) reports that by the first of next month, the Centers for Medicare and Medicaid Services (CMS) may rule on whether to directly reimburse nurse anesthetists from Medicare for the evaluation, diagnosis, and treatment of chronic pain through the use of opioid painkillers or by epidural injections. The CMS ruling is expected to affect some 45,000 US nurse anesthetists, the majority of whom are employed by surgical centers and hospitals. Should the CMS decide to reimburse nurse anesthetists for providing such treatments for chronic pain to Medicare patients, the rule would go into effect on Jan. 1, 2013. The proposal is strenuously opposed by the American Medical Association, along with other physician groups, who claim that nurse anesthetists lack the education and training to provide such care and such a ruling by the CMS may result in even more potential for opioid painkiller abuse.

NYTimes Column Examines Value Of Government Health Benefits.

On the front page of the New York Times  (10/3, Porter, Subscription Publication) business page, the “Economic Scene” column looks into the recent decision by the Congressional Budget Office to reclassify the value of government-provided health benefits, now factored into income “at every penny they cost.” The decision, according to the column, “stoked a long-simmering debate about how much health care is really worth to poor families who may not have enough to eat.” After examining both sides of the debate, the column concludes that the way one see the change in formula goes a long way in determining how favorably one views the Affordable Care Act.

Romney Adviser Details “Failures” Of Affordable Care Act.

Dr. Scott W. Atlas, a Senior Fellow at the Hoover Institution at Stanford University, an author, and an adviser to the Romney for President campaign, writes an op-ed for Forbes  (10/3) discussing the “widespread” failures of the Affordable Care Act. He details these failings, ranging from the CLASS entitlement, the ACO model, the medical device tax, and the medical loss ratio. He also downplays recent news that the rate of uninsured Americans is declining. He concludes, “The record is clear – since its rush to passage by President Obama and the Democrat-controlled Congress in 2010, the ACA is doing harm.”

Report Identifies Changing Marketplace For Insurance Following ACA.

Reuters  (10/3, Humer) reports on a new study from PwC Health Industries, released Tuesday, which found that the expanded market for healthcare that stems from the Affordable Care Act will be more difficult for insurers to navigate. Thirty million Americans will gain access to insurance from various provisions of the ACA, and as author Vaughn Kauffman explains, this group “is a little bit less educated with lower incomes.” The report also includes recommendations for insurers to keep up with the shift, including changing their marketing practices and taking better advantage of available technology.

NPR Looks Into Progress On State Insurance Exchanges.

The NPR  (10/3) website carries a transcript of an “All Things Considered” piece from Tuesday, which examined the progress various states are making on implementing the health insurance exchange provision of the Affordable Care Act. One of the hosts, Melissa Block, reported that though states are required to inform the Federal government whether they will run their own exchange by November 16, many “appear to be waiting until the last minute to give their answer to see who wins the White House.” Block, and cohost Audie Cornish, then spoke with Alan Well, the executive director of the National Academy for State Health Policy. According to Well, 12 states and the District of Columbia have said they will run their own, 16 states “have either said they won’t or have shown so little activity that they likely couldn’t run an exchange,” and the rest “fall somewhere in between.” The post includes imbedded audio of the entire piece.

Florida Amendment Blocking Insurance Mandate Still On Ballot.

The Tampa (FL) Tribune  (10/3, Shedden) reports on a proposed constitutional amendment in Florida, on the ballot in November, which would “block the controversial insurance mandate in the federal health care law.” Though Amendment 1 was “render[ed] moot” by the June Supreme Court ruling, groups from both sides are still trying to push voters on the issue. According to the article, “a handful of guest columns in Florida media” have highlighted the power that a yes or no vote could wield, even if just symbolically. One health policy analyst said, “This may be to a lot of people in Florida about making a statement.”

BCBS Plan Will Serve As Alabama’s Benchmark.

The Birmingham (AL) Business Journal  (10/3, Belanger, Subscription Publication) reports that “Gov. Robert Bentley’s decision not to adopt an essential benefits plan required by the Affordable Care Act will not prevent the establishment of an insurance coverage benchmark in the state.” Citing a report from Kaiser Health News, the article says that “absent a choice by the state government, Alabama’s largest small-group plan will serve as the benchmark.” The Journal adds that “in Alabama, the benchmark plan will be the 320 Plan offered by Blue Cross and Blue Shield of Alabama, Koko Mackin, BCBS of Alabama’s vice president of corporate communications, confirmed today.”

Presidential Race’s “Biggest Impact” In South Carolina Will Be On Medicaid.

The Rock Hill (SC) Herald  (10/3, Beam) reports, “The next president’s biggest impact on South Carolina could be found in the future of Medicaid.” Medicaid in South Carolina covers 1.1 million people and costs $6 billion annually. The article details the plans of both presidential candidates stating that Romney “wants to turn Medicaid into a grant program” where “states would get a specific amount of money – and no more,” although there would be more flexibility in administration of the coverage. Obama’s plan is to eliminate multiple reimbursement rates by “combining all of South Carolina’s rates into one ‘blended rate.'” The president believes the plan would “save $100 billion in federal spending over 10 years.”

Flowers: At-Home Care May Solve Alabama’s Medicaid Budget Problem.

The Jacksonville (AL) News  (10/3) carries Steve Flowers’ “Inside the Statehouse” column where he argues the state’s new budget “will be horrendous.” There will be “draconian cuts to basic state services” as a result of Alabama’s constitutional requirement to have a balanced budget. Flowers says, “This fiscal year may well be the worst dilemma since the Great Depression.” Flowers argues that “at home care appears to be one obvious solution” because of the cost savings that it offers but Alabama is currently ranked 50th in the nation for long term care services by the AARP.

Tomblin “Punts” On Essential Benefits But Deadline “Flexible.”

In continuing coverage, the Charleston (WV) Daily Mail  (10/3, Rivard) reports that rather than comply with HHS’ Sunday essential health benefits deadline, West Virginia Governor Earl Ray Tomblin “punted and asked seven questions.” Still, “the governor appears to have wiggle room,” as an HHS spokesman said Monday the deadline was “flexible.”

West Virginia Paper Urges Tomblin To Refuse Further Action On ACA. In an editorial, the Wheeling (WV) News-Register  (10/3) commends West Virginia Governor Earl Ray Tomblin for declining to move forward with provisions of the Affordable Care Act without further guidance from the Federal government, and urges him to continue in this vein. Further, they write that Tomblin and the state’s legislators “should refuse to implement any provisions of ‘Obamacare’ that are not clearly beneficial to Mountain State residents as a whole.”

Experts Debate Whether “Nebraska Option” Could Work Under ACA.

CQ  (10/3, Norman, Subscription Publication) looks into whether the so-called “Nebraska option,” which Governor Dave Heineman submitted to HHS as his essential health benefits benchmark, could work in a state insurance exchange. The option is a “high-deductible plan combined with a Health Savings Account,” and experts say that as long as the plan meets requirements of the ACA, it could be approved. However, the deductible would have to be less than “the $2,000 limit for individuals and $4,000 limit for families the law sets for small group plans.”

California Exchange Seeking Insurers’ Input.

CQ  (10/3, Adams, Subscription Publication) reports that the California healthcare exchange is seeking the input of insurers via a draft solicitation, and the companies “have until Oct. 12 to submit letters of intent.” California’s solicitation “is the first glimpse insurers got of what information exchange officials want from those plans that would like to offer coverage in the exchange for part or all of the state.” After reviewing the input of insurers and the public, California officials are “expected to release a final document on Oct. 18.”

NPR Looks Into The Future Of Medicaid Under Both Parties.

NPR  (10/3, Rovner) “Shots” blog reports on Medicaid, a program they explain “is putting increasing strain on the budgets of states.” Regardless of who wins the Presidential election in November, given its scale and expense, the program is “likely to undergo a major change.” The blog looks into what these potential changes are: expansion if President Obama is reelected, and likely scale-back if Mitt Romney wins, and examines how they would affect the various populations that rely on Medicaid.

Daily Finance Examines “Lurking Danger” Of ACA’s Medical Device Tax.

In the Daily Finance  (10/3), the Motley Fool staff write about the “lurking danger in the Affordable Care Act,” the law’s 2.3% tax on medical devices. The tax, which the article explains is used to pay for the ACA’s “grandiose vision for expanded national insurance coverage,” is set to kick in January 1. Though the article doesn’t expect the tax to cripple industry giants like Johnson & Johnson, it worries that “smaller players in the medical device industry…stand to lose big.”

Polls Indicate Democrats’ Medicare Strategy Is Working.

The Hill  (10/3, Lillis) reports that efforts by Democrats to make Medicare “a central focus of the 2012 campaign appears to be paying dividends, as polls show voters – particularly in key swing states – are wary of Republican plans for the popular seniors’ healthcare program.” Recent polls “indicate that voters are skeptical about the Republicans’ vision for Medicare. A Gallup poll from late September found that voters in 12 battleground states trust Obama on Medicare over Romney by 50 to 44 percent. The national figures also favored Obama, 51 to 43 percent, according to that poll. More recent surveys indicate that the gap could be growing.”

House Democrats, DCCC Ads Hit Republicans On Medicare.

The National Journal  (10/3, Mershon, Subscription Publication) “Influence Alley” blog reports that Tuesday, the Democratic Congressional Campaign Committee released “a smattering” of new ads focused on Medicare, to be aired in “swing-districts.” The “spots slammed candidates like Reps. Brian Bilbray, R-Calif., and Judy Biggert, R-Ill., for supporting legislation, including budget proposals from Rep. Paul Ryan, R-Wis., that would end the Medicare guarantee.” Also Tuesday, Minority Leader Nancy Pelosi and “a smattering” of other House Democrats held a hearing, despite the Congressional recess, to make similar attacks on Mitt Romney.

Ryan Launches Healthcare Ad In House Campaign.

The Hill  (10/3, Viebeck) “Healthwatch” blog reports that Republican vice presidential candidate Paul Ryan is “launching a TV spot on healthcare issues” in Wisconsin, where he is simultaneously running for his eighth term in Congress. The ad, “Patient Centered Solutions,” shows Ryan discussing his plan to “get insurance and government bureaucrats out of the way and force healthcare providers to compete for our business.” Healthwatch notes that Ryan does not mention the Affordable Care Act, or President Obama.

Debate Continues Over Hospital Responsibility For Patient Re-Admittance.

The Colorado Public Radio (CO)  (10/3, Whitney) reports that beginning this week, “Medicare started docking payments to hospitals that have too many repeat customers.” According to the Federal government, “Medicare alone pays $17.4 billion a year for unnecessary return visits.” Proponents of the idea, such as cardiologist Harlan Krumholz at Yale School of Medicine, say hospitals should face some of the burden because they “get more revenue than anyone else, and with that position comes great responsibility.” Critics of the new policy argue that “investing in better relationships with outside providers…takes money, and the Medicare penalties mean money is harder to find.”

Public Health and Private Healthcare Systems

Billionaire Teams Up With Blue Shield Of California To Improve Patient Care.

In its “Money & Co.” section, the Los Angeles Times  (10/3, Terhune) reports that “Los Angeles billionaire and healthcare entrepreneur Patrick Soon-Shiong has partnered with insurer Blue Shield of California to accelerate medical breakthroughs to doctors in an effort to improve patient care and reduce costs.” The article says that “Soon-Shiong, a former UCLA surgeon and drug company executive, announced the agreement between his company NantHealth and Blue Shield, a nonprofit insurer with 3.3 million customers in California.” The companies will “partner with St. John’s Health Center in Santa Monica to create a ‘continuous learning center’ to work on spreading personalized medicine and best practices to more healthcare providers.”

Modern Healthcare  (10/3, Evans, Subscription Publication) adds that “Blue Shield of California has reached an exclusive agreement with a company founded by billionaire Dr. Patrick Soon-Shiong to provide information technology services for a newly created accountable care organization.” Citing a news release, the article said, “the ACO will include Access Medical Group, an independent physician association in Marina del Rey, Calif., and St. John’s Health Center, Santa Monica, Calif.”

Analysis Compares Health Insurance Plans In Different States.

The US News & World Report  (10/3, Sternberg, Young) reports that US News analyzed almost 6,000 health insurance plans, finding “many of the consumers who enroll in these plans may confront budget-wrecking out-of-pocket costs that deplete their savings.” The analysis found that “large numbers of plans severely limit coverage for such services as prescription drugs, maternity coverage, mental health treatment, and rehabilitation therapy.” The plans being rated are those “sold to individuals and families who have no access to employer or public coverage.” US News notes Massachusetts and New York have a high number of plans receiving four out of five stars with plans in Washington and Alaska receiving lower scores.

Miller: Medicare Part D Beneficiaries Should Shop Around During Enrollment Period.

Reuters  (10/3) carries a column from Mark Miller arguing that seniors will see fee increases for some Medicare prescription drug plans. However, seniors will have time to decide on a different plan during the Medicare Part D enrollment period that runs from October 15 to December 7. Seven of the top plans, which includes 80 percent of Part D beneficiaries, will see increases in their premium rates. The largest increase will be a 23 percent hike from the Humana WalMart Preferred Rx plan. Miller lists a few tips for seniors to consider when shopping for plans during the enrollment period.

Hartford Hospital, UnitedHealth Group Engaged In Dispute Over New Contract.

The Hartford (CT) Courant  (10/3, Sturdevant) reports, “Hartford Hospital and UnitedHealth Group…are in a hard-fought contract negotiation that could leave thousands of customers facing higher out-of-pocket expenses if the current agreement.” Hartford Hospital is asking for a 30 percent increase in payments for services over the next three years, according to a UnitedHealth spokesman. Both the insurer and the hospital sent letters out explaining the situation and blaming the other party for delaying a new contract.

Los Angeles Officials Work To Include UCLA, Cedars-Sinai In New Plans.

The Los Angeles Times  (10/3, Terhune) (10/3, Terhune) reports, “A health-benefits panel at the city of Los Angeles recommended restoring some access to UCLA and Cedars-Sinai doctors in response to worker complaints.” Although it will continue with its previous move to “adopt an Anthem Blue Cross Select HMO plan that excludes all UCLA and Cedars-Sinai medical groups,” a city benefits committee “approved a proposal to reintroduce the full network of medical providers under its Anthem Blue Cross PPO plan and add a more expensive Anthem HMO plan” that will include those institutions. The article notes that details have not been fully release and “a final decision on these issues may not come until next week.”

MSSNY President Dr. Robert Hughes Discusses Cash-Upfront Physician Payments.

In “A Possible Price to Pay if Doctors Spurn Insurance,” the New York Times  (10/3, Rabin) reports on the growing trend in some affluent metropolitan areas toward upfront payments to physicians in response to efforts by insurers to rein in healthcare costs by holding down physician fees. A recently published national survey of 13,575 doctors found that “over the next one to three years, more than 50 percent plan to take steps that reduce patient access to their services, and nearly 7 percent plan to switch to cash-only or concierge practices.” Medical Society of the State of New York President Robert J. Hughes, MD, an otolaryngologist practicing in Saratoga Springs, explained why beleaguered physicians are being forced to switch to a cash-only policy. He said that physicians are feeling increasingly shortchanged by insurance companies. “Insurance companies do not negotiate with physicians. It’s all take-it-or-leave-it contracts,” he said.

Baltimore Sun: Health Cooperatives Hold Potential For “Excellence.”

In an editorial, the Baltimore Sun  (10/3) discusses the potential of nonprofit health cooperatives to provide low-cost care to millions of Americans. Maryland recently received $65 million in Federal loans to set up its own, to be called the Evergreen Health Cooperative Inc. Evergreen’s “mission will be to serve tens of thousands of Marylanders whose incomes are too high to qualify for Medicaid but who can’t afford the monthly premiums charged by private insurers.” The Sun then explains why Evergreen could become “a model of excellence not only for Maryland but the nation.”

UnitedHealthcare Funds Health IT Upgrades For Rural Hospitals.

The Hartford (CT) Courant  (10/3) reports, “UnitedHealthcare provided $20 million in financing to rural hospitals in California that will allow them to upgrade their health IT systems, which includes a shift from keeping medical records on paper to electronic files.” Raymond Hino, chairman of the California Critical Access Hospital Network Advisory Board and CEO of the Mendocino Coast District Hospital, remarked, “With this critical funding from UnitedHealthcare, patients in these remote areas will have access to much of the same quality of care and technological advancements benefiting people who live in more populated areas of the state.”

Also in the News

Former Topeka Physician Put On Probation For Healthcare Fraud.

The Kansas Health Institute  (10/3) reports on its website that “a former Topeka physician who pleaded guilty to federal charges of health care fraud and unlawfully prescribing controlled substances was put on probation for two years and banned from receiving federal health care benefit program funds, according to US Attorney for Kansas Barry Grissom.” In a statement, the US Attorney’s Office said “Diana L. Carver, 47, admitted that after the Kansas Board of Healing Arts suspended her medical license on July 8, 2010, she continued to practice medicine through November 2010, submitting false claims to insurance programs including Medicare and Blue Cross Blue Shield of Kansas for services she no longer was licensed to provide,” the article adds.

Walgreens Offers Free Flu Vaccinations For Low Income, Uninsured Individuals.

The Pegasus News  (10/3, Sheffield) reports that “Walgreens Co., in cooperation with the city of Dallas and the Dallas County Health and Human Services, has mounted an initiative to provide more than 5,000 free flu shots this fall to uninsured or underinsured residents of Dallas County.” According to the article, “these vaccinations will be available at 12 Walgreens locations around the county.” The report notes that in 2011, “in its first year of the program, Walgreens provided $10 million in vouchers for flu shots nationwide.”

Tuesday’s Lead Stories

 • States Respond To September 30 Essential Health Benefits Deadline.
Medicare Launches Two “Pay-For-Performance” Initiatives.
Americans Visiting Doctors Less Frequently Than A Decade Ago.
Grassley Questions Use Of 340B Funds By North Carolina Hospitals.