Category Archives: Health-care Policy

Medicare’s drug-pricing experiment stirs opposition

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By Julie Appleby
Kaiser Health News

A broad proposal by Medicare to change the way it pays for some drugs has drawn intense reaction and lobbying, with much of the debate centering on whether the plan gives too much power over drug prices to government regulators.

One of most controversial sections would set up a nationwide experiment, scheduled to start in 2017, to test a handful of ways to slow spending on drugs provided in doctor’s offices, clinics, hospitals and cancer infusion centers. The proposal would not affect most prescriptions patients get through their pharmacies.

The aim, the government says, is to maintain quality while slowing spending in Medicare Part B by more closely tying payments to how well drugs work, using methods drugmakers, insurers and benefit managers are already trying in the private sector.

One of the approaches included in the proposal would allow Medicare to earmark “therapeutically similar” drugs and set a benchmark, or “reference price,” that it would pay for all drugs in that category.

That amount might be the cost of the drug the agency considers the most effective in the group, or some other measure. It’s aimed at narrowing the wide variability — often hundreds or thousands of dollars a year — in what is paid for similar drugs. Continue reading

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To combat disease, states make it harder to skip vaccines

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Vaccine SquareBy Sarah Breitenbach
Stateline

When Jennifer Stella’s two children were babies, she made sure they got all the usual vaccines.

But when one started having seizures and the other developed eczema after they’d gotten immunizations, the Vermont woman decided her kids would no longer get shots required to attend school.

Stella, a co-founder of the Vermont Coalition for Vaccine Choice, is among a growing number of parents who are opting out of childhood vaccinations because they’re worried about their safety. Public health experts say the movement is leading to outbreaks of nearly eradicated dangerous diseases, such as measles and whooping cough, among clusters of unvaccinated kids.

All states require children to get vaccinated to attend school, and immunization rates across the nation remain high, with 92 percent of children between 19 months and 35 months getting the shots to protect against potentially deadly measles, mumps and rubella (MMR).

But even a small number of unvaccinated people can undermine the immunity of the larger population, which is leading public health officials and vaccine advocates to push for changes.

Some want to educate parents about the risks of forgoing vaccines and fight what they say is misinformation about the risks posed by the vaccines.

Others have pushed lawmakers to eliminate exemptions from state vaccine requirements and sought to make it more difficult for families to qualify for the exemptions that remain. Continue reading

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Most Texans and Floridians want Medicaid expansion, survey

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200px-Flag-map_of_TexasBy Carrie Feibel, Houston Public Media
Kaiser Health News

Americans who live in the two biggest states that haven’t expanded Medicaid have more complaints about health care costs and quality, according to a new survey released by the Texas Medical Center Health Policy Institute in Houston. They’d also like their states to expand Medicaid.

The survey, conducted by marketing research firm Nielsen, assessed attitudes about the health care system, and possible solutions, in five populous states: Texas, California, Florida, New York and Ohio.

“Both Texas and Florida, the residents there are hurting and are turning to the idea of Medicaid expansion.

The 5,000 respondents were also asked about their party affiliation and insurance status — and height and weight. Those measurements were used to estimate the rates of obesity, for questions about interventions.

320px-Flag_of_Florida.svgThe Affordable Care Act allowed states to expand Medicaid to cover more poor adults, but 19 states still have not done so.

In California, New York and Ohio, politicians took advantage of federal funding in the law to expand Medicaid. The survey showed most residents in those three states approved of that decision.

The Republican leaders of Texas and Florida refused to expand Medicaid. However, the survey showed two-thirds of people in those two states wanted them to do it anyway.

“Both Texas and Florida, the residents there are hurting and are turning to the idea of Medicaid expansion,” said Dr. Tim Garson, the director of the Health Policy Institute. Continue reading

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Doctor yearns for a return to the time when physicians were ‘artisans’

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stethoscope doctor's bag chest x-rayBy Michelle Andrews
Kaiser Health News

In his recent book, “The Finest Traditions of My Calling,” Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.

Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and practices on the adult inpatient psychiatric unit there. I recently spoke with him and this is an edited transcript of our conversation.

Q. Your book is in some ways a lament for times gone by, when physicians were “artisans” who had more time for their patients and professional independence. But you’re a young doctor and you must have known at the outset that wasn’t the way medicine worked anymore. Why do you stick with it?

A. The first thing I’d say was that I didn’t know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling. Continue reading

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New rules set limits for financial incentives used by employee wellness programs

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Twenty-dollar bill in a pill bottleBy Julie Appleby
Kaiser Health News

Employers seeking to get workers to join wellness programs and provide medical information can set financial rewards – or penalties – of up to 30 percent of the cost for an individual in the company’s health insurance plan, according to controversial rules finalized by the Equal Employment Opportunity Commission Monday.

Although such penalties or incentives could run into the hundreds or even thousands of dollars, the programs are considered voluntary — and therefore legal, the commission said.

The rules seek to ensure “wellness programs actually promote good health and are not just used to collect or sell sensitive medical information about employees and family members or to impermissibly shift health insurance costs to them,” the EEOC said.

But the final rules drew immediate concern from some groups.

Employers can set financial rewards – or penalties – of up to 30 percent of the cost of health insurance plan

Jennifer Mathis, director of programs for the Bazelon Center for Mental Health Law, says the new rule rolls back protections in existing law.

“Voluntary inquiries can now come with steep financial penalties, according to the EEOC, for choosing not to answer,” she said. “That’s a troubling precedent for the application of civil rights laws.” Continue reading

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Supreme Court sends health law birth control case back to lower courts

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U.S. Supreme CourtBy Julie Rovner
Kaiser Health News

When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.

In an unsigned opinion issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.

At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to  provide no-cost contraception for women.

The government made several changes to the rules over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage.

But dozens of religious nonprofit employers sued anyway, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful. Continue reading

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Five health issues presidential candidates aren’t talking about, but should be

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USA America buttonBy Julie Rovner
Kaiser Health News and USAToday

References to the Affordable Care Act — sometimes called Obamacare — have been a regular feature of the current presidential campaign season.

For months, Republican candidates have pledged to repeal it, while Democrat Hillary Clinton wants to build on it and Democrat Bernie Sanders wants to replace it with a government-funded “Medicare for All” program.

But much of the policy discussion stops there. Yet the nation in the next few years faces many important decisions about health care — most of which have little to do with the controversial federal health law. Here are five issues candidates should be discussing, but largely are not:

1. Out-of-pocket spending:

Millions more people — roughly 20 million, at last count — now have health insurance, thanks to the new coverage options created by the ACA. But most people are also paying more of their own medical bills than ever before. And they are noticing. A recent Gallup survey found health costs to be the top financial problem faced by adults in the United States, outpacing low wages and housing costs. Continue reading

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Shortages of emergency drugs increase, study

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Vaccine SquareBy Michelle Andrews
Kaiser Health News

At some hospitals, posters on the wall in the emergency department list the drugs that are in short supply or unavailable, along with recommended alternatives.

The low-tech visual aid can save time with critically ill patients, allowing doctors to focus on caring for them rather than doing research on the fly, said Dr. Jesse Pines, a professor of emergency medicine and director of the Office for Clinical Practice Innovation at the George Washington University School of Medicine and Health Sciences, who has studied the problems with shortages.

The need for such workarounds probably won’t end anytime soon. According to a new study, shortages of many drugs that are essential in emergency care have increased in both number and duration in recent years even as shortages for drugs for non-acute or chronic care have eased somewhat.

The shortages have persisted despite a federal law enacted in 2012 that gave the Food and Drug Administration regulatory powers to respond to drug shortages, the study found. Continue reading

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Patients’ assessment of their health gaining importance in treatment

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Stethoscope DoctorBy Michelle Andrews
Kaiser Health News

For Erin Moore, keeping her son’s cystic fibrosis in check requires careful monitoring to prevent the thick, sticky mucous his body produces from further damaging his lungs and digestive system.

Moore keeps tabs on 6-year-old Drew’s weight, appetite, exercise and stools every day to see if they stray from his healthy baseline. When he develops a cough, she tracks that, too.

It’s been nearly a year since Drew has been hospitalized; as a baby he was admitted up to four times annually. Erin Moore credits her careful monitoring, aided by an online data tracking tool from a program at Cincinnati Children’s Hospital Medical Center called the Orchestra Project, with helping to keep him healthy.

Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

Erin Moore, center, tracks the cystic fibrosis symptoms of her 6-year-old son, Drew, far left, using an online data tracking tool from Cincinnati Children’s Hospital Medical Center. (Courtesy of Holly Burkholder Photography)

“Now I have a picture of what health looks like for Drew,” said Moore, 35. “Tools like Orchestra that allow patients to take a more active stance in managing our health are still really undervalued.”

That may be changing, according to a study in the April issue of the journal Health Affairs that examines the movement to incorporate “patient-reported outcomes” into clinical care.

It may seem like a no-brainer to include patients’ assessments of their physical and mental conditions and quality of life into medical care, but such patient-generated data has traditionally been confined to research rather than clinical settings.

Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

However, as patient-centered medical care has taken hold in recent years, there’s been a growing interest in finding ways to use outcomes reported by individuals to help guide care.

“How are you feeling?” is a pretty standard conversation starter during a doctor’s visit. Continue reading

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Amid public feuds, venerated medical journal finds itself under attack

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New-England-Journal-of-MedicineBy Charles Ornstein
ProPublica.

The New England Journal of Medicine is arguably the best-known and most venerated medical journal in the world. Studies featured in its pages are cited more often, on average, than those of any of its peers. And the careers of young researchers can take off if their work is deemed worthy of appearing in it.

But following a series of well-publicized feuds with prominent medical researchers and former editors of the Journal, some are questioning whether the publication is slipping in relevancy and reputation.

The Journal and its top editor, critics say, have resisted correcting errors and lag behind others in an industry-wide push for more openness in medical research. And dissent has been dismissed with a paternalistic arrogance, they say.

In a widely derided editorial earlier this year, Dr. Jeffrey M. Drazen, the Journal’s editor-in-chief, and a deputy used the term “research parasites” to describe researchers who seek others’ data to analyze or replicate their studies, which many say is a crucial step in the scientific process. And last year, the Journal ran a controversial series saying concerns about conflicts of interest in medicine are oversimplified and overblown.

“They basically have a view that 2026 they don’t need to change or adapt. It’s their way or the highway,” said Dr. Eric Topol, director of the Scripps Translational Science Institute and chief academic officer at Scripps Health in La Jolla, California.

Topol and another cardiologist were called out by Drazen and his co-authors last year after they wrote an opinion piece in The New York Times saying the data behind a groundbreaking study about blood pressure treatment should be made available to doctors right away 2014 not delayed for journal publication.

“Most people are afraid to say anything about the New England Journal because they’re afraid they won’t get something published there,” said Topol, whose last piece appeared in its pages in 2011. “That’s part of this oppression.” Continue reading

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By not discussing cost issues, doctors, patients may miss chances to lower out-of-pocket costs

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Twenty-dollar bill in a pill bottleBy Shefali Luthra
Kaiser Health News

Talking about money is never easy. But when doctors are reluctant to talk about medical costs, a patient’s health can be undermined. 

A study published in Monday’s Health Affairs explores the dynamics that can trigger that scenario.

Patients are increasingly responsible for shouldering more of their own health costs. In theory, that’s supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous services alike.

Doctors could play a key role in instead helping patients find appropriate and affordable care by talking to them about their out-of-pocket costs. But, a range of physician behaviors currently stands in the way, according to the study. Continue reading

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UnitedHealth tries boutique-style health plan

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Harken Health members get free yoga at the clinic. (Phil Galewitz/KHN

By Phil Galewitz
Kaiser Health News

AUSTELL, Ga. — UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes. Services are delivered in stylish clinics with hardwood floors and faux fireplaces in their lobbies.

Harken Health is available only in Chicago and Atlanta, where it covers 35,000 members who signed up this winter on the Affordable Care Act’s insurance exchanges. UnitedHealth still sells traditional plans in those cities, too.

The plan spends twice as much on primary care as the average insurer,

Harken’s lush operation might seem puzzling for a cost-conscious company such as UnitedHealthcare, which said in November it lost hundreds of millions of dollars on its Obamacare plans in 2015 and threatened to drop out of the exchanges in 2017.

But it’s not crazy. Health care analysts say Harken demonstrates the insurer’s search for a better way to provide affordable care and attract more customers. Its mission is to prove that convenient, no-cost primary care, delivered with top-notch customer service, can lower hospitalization rates and overall health costs. Harken spends twice as much on primary care as the average insurer, according to the company.

“At the end of the day, United wants to know if this system can better control costs, as it’s a lot cheaper to prevent disease than treat one,” said Liz Frayer, an employee benefits consultant in Atlanta. Continue reading

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Workers’ Desire Grows For Wage Increases Over Health Benefits

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By Michelle Andrews
Kaiser Health News

Twenty-dollar bill in medicine bottleMore wages, less health insurance.

In a recent survey, one in five people with employer-based coverage said they would opt for fewer health benefits if they could get a bump in their wages.

That’s double the percentage who said they would make that choice in 2012.

“I do these surveys all the time, and it’s rare where you see things change that quickly,” said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, which conducted the survey of 1,500 workers with Greenwald & Associates.

Fronstin speculated that worker frustration with low wage growth may be driving the shift in attitudes.

Wage and salary increases have hovered around 2 to 3 percent in recent years, generally rising more slowly than cost increases of annual health care benefits.

Overall, two-thirds of people with employer-sponsored coverage reported that they were satisfied with their health insurance benefits in 2015, the survey found, lower than the 74 percent satisfaction figure in 2012.

Meanwhile, the percentage of people who would accept a smaller paycheck for better health insurance benefits was 14 percent last year, essentially unchanged from 15 percent three years earlier.

The growing willingness to trade health benefits for wages may be linked to some degree to the millennial generation’s growing share of the workforce, Fronstin said, referring to people born between roughly 1980 and 2000.

“The younger you are, the less important health insurance is to you,” Fronstin said.

As baby boomers retire and younger workers move in behind them, it may affect the mix of benefits that employers offer.

But as today’s “young invincibles” age, chances are they’ll see more value in their health insurance and the pendulum will swing back again, according to Fronstin.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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President’s task force aims to help end discrimination in mental health coverage

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headacheBy Jenny Gold
Kaiser Health News

Tucked in remarks the president made Tuesday on the opioid epidemic was his announcement of a new task force on mental health parity — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President  Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”

Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them. Continue reading

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Demand surges for addiction treatment during pregnancy

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sln_MapMarch25

BOSTON — As soon as the home pregnancy test strip turned blue, Susan Bellone packed a few things and headed straight for Boston Medical Center’s emergency room. She’d been using heroin and knew she needed medical help to protect her baby.

“I felt so guilty. I still do,” said Bellone, a petite, energetic woman. At 32, and six years into her heroin addiction, having a baby was the last thing on her mind. “I was not in the right place to start a family,” she said. “But once it was happening, it was happening, so I couldn’t turn back.”

Nationwide, the number of pregnant women using heroin, prescription opioids or medications used to treat opioid addiction has increased more than five-fold and it’s expected to keep rising. With increased opioid and heroin use, the number of babies born with severe opioid withdrawal symptoms has also spiraled, leaving hospitals scrambling to find better ways to care for the burgeoning population of mothers and newborns.

Among the most important principles is that expectant mothers who are addicts should not try to quit cold turkey because doing so could cause a miscarriage. Trying to quit opioids without the help of medications also presents a high risk of relapse and fatal overdose.

sln_PullOutBoxMarch25

Until the opioid epidemic took hold about eight years ago, most hospitals saw only one or two cases a year of what is known as neonatal abstinence syndrome. Now, a baby is born suffering from opioid withdrawal every 25 minutes in the U.S., according to the National Institute on Drug Abuse. Continue reading

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