Saturday, February 8, 2014

Update on ACA and other health care policy stories for the new year

As part of my opening to Unemployment insurance extension and the State of the Union, I mentioned that I was sitting on a backlog of material.
I watched tonight's State of the Union address and marveled that the entire speech was organized around the conflict between austerity and sustainability, with President Obama consistently coming down on the side of sustainability.  It fits what I've been blogging about here for the past three years, as I've written about every major topic Obama mentioned at least once, some of them, such as energy, education, healthcare, and technological innovation many times.  I felt validated.  It also reminded me that I have a long backlog of material from the past two months of Overnight News Digests on Daily Kos about healthcare and energy that I need to post here.
I took care of the energy news in More energy and the State of the Union, but got distracted by the Super Bowl, so I didn't get around to the healthcare items.  So, it's high time to update on the ACA for the first time since More ACA news from KPBS and UAB.  I begin with Maggie Fox of NBC News making her forecast on the topic with Think 2013 was a bad year for health politics? Just wait for 2014.
It was the gift that kept on giving: The disastrous roll-out of the health-insurance exchanges provided daily fodder for Republican opponents of Obamacare. And the dire state of U.S. health care, coupled with a headlong rush by people to get health insurance, gave Democrats ample opportunity to say “we told you so.”

So once it’s January 2014 and people can start having their new insurance and all the deadlines have passed, can we relax and talk about something other than health reform?

Not a chance, say experts. They predict 2014 will be, if anything, worse than 2013.
So far, that's been true, as this week's news about the ACA inducing people to reduce their hours has shown.

Follow over the jump for news from KPBS and other sources about health care policy, including the ACA, that I've included in Overnight News Digest on Daily Kos since New Years.

First, the news from KPBS and other source about the ACA and its implementation in California and elsewhere beginning with a post-mortem on the Second Opinion video and audio series.

KPBS: Second Opinion: What We Learned About Health Care — And Our Readers — in 2013
By Megan Burks
Wednesday, January 1, 2014
For six months, I left my comfort zone covering people (specifically, those in City Heights) to sift through insurance jargon, decipher tax laws and get a hold of the people whom you couldn’t reach on the phone.

Second Opinion answered questions about the Affordable Care Act from 24 San Diegans. The requirements to participate were simple: You had to have a question about Obamacare and you had to be willing to ask it on camera (the answers appeared on the web and on KPBS radio and television).

That last requirement significantly whittled down our pool of questions. It turns out, a lot of people aren't into sharing the details of their finances and health with millions of people.
Next, the University of Massachusetts Medical School chimes in with UMMS primary care physician explains ACA changes in 2014.
Affordable Care Act bringing extensive coverage for preventive services
December 31, 2013
Beginning on New Year’s Day, the Affordable Care Act will provide extensive insurance coverage for preventive health services. As a result, patients may find themselves receiving additional screenings and care at their primary care visits, with no additional cost.

Under the ACA, preventive services which must be covered include, among others:

· adult and childhood immunizations;
· screening for cancers, cardiovascular conditions, depression, diabetes, HIV and other sexually transmitted infections;
· early childhood screening for autism spectrum disorders;
· counseling for dietary issues, tobacco cessation, and domestic violence;
· osteoporosis screening, contraception, and comprehensive breastfeeding support and counseling for women, including coverage for breast pumps; and
· abdominal aortic aneurysm screening for men of specified ages who have ever smoked.
Now, the news about Covered California.

KPBS: Millions In California Remain Uninsured Despite Obamacare
By Kenny Goldberg
Tuesday, December 31, 2013
Officials say more than 1 million people have picked a health plan on the federal website, and some 400,000 Californians have enrolled through the state’s Covered California exchange.

Even though many California residents are eligible for subsidized health insurance, the California HealthCare Foundation predicts over the next two years, millions of Californians will remain uninsured.
KPBS: Covered California Finally Releases Spanish-Language Enrollment Form
By Kenny Goldberg
Friday, January 3, 2014
Enrollment in Covered California has skyrocketed the last few months, except among people whose primary language is Spanish.

Spanish-speakers make up 29 percent of California’s population. But exchange officials said so far, that group makes up only 5 percent of those who’ve signed up for a plan.
That's the bad news.  Here's the good news.

KPBS: Latino Enrollment In Covered California Picks Up
By Kenny Goldberg
Tuesday, January 21, 2014
The latest enrollment numbers from Covered California show more than 625,000 people have signed up for new health insurance plans.

Between Oct. 1 and mid-December, Latinos represented only 5 percent of total enrollment.

Things changed in the last two weeks of the year. By the end of December, Latino enrollment had risen to nearly 20 percent of the total.
More good news about a group that isn't enrolling, but needs to.

KPBS: Covered California Targets ‘Young Invincibles’
By Kenny Goldberg
Wednesday, January 15, 2014
About 500,000 Californians signed up for health coverage through the exchange as of Dec. 31.

Twenty-five percent of enrollees were between the ages of 18 and 34. Officials said more of these so-called "young invincibles" need to sign up to make Obamacare financially viable.

Covered California executive director Peter Lee said the exchange is on top of it.
Now, some disturbing news tied into the uncoupling of work and health insurance.

KPBS: Survey Reveals Disturbing Trends In Employer-Provided Health Benefits
By Kenny Goldberg
Monday, January 27, 2014
The survey shows 61 percent of California employers offered health benefits last year. That's compared with 73 percent in 2008.

The California HealthCare Foundation conducted the survey. The Foundation's Maribeth Shannon said it will interesting to see what happens next year.
There are other federal programs targeting health care besides the ACA.  Two of them made news this past month.

KPBS: Loan Repayment Program For Nursing Students Accepting Applications
By Deb Welsh
Friday, January 17, 2014
A federal program that partially repays school loans for nursing students in exchange for taking a job in an underserved area is now accepting applications.

Dr. Mary Wakefield of the Health Resources and Services Administration explain the program in an interview with KPBS Morning Edition anchor Deb Welsh:
KPBS: Veterans' Service Dogs To Get Free Veterinary Care
By Beth Ford Roth
Wednesday, January 29, 2014
Veterans with service canines can now get free pet health insurance for their dogs through a Veterans Affairs Department program. The insurance will cover virtually all medical costs for the dogs.

The Military Times reports the VA has contracted with pet health insurance company Trupanion to cover the veterans' cost for preventative care, emergency care, and medications.

To qualify, the dogs must be certified by the VA as service dogs. Dogs owned by the VA that provide assistance to veterans suffering from post-traumatic stress disorder (PTSD) are also eligible for the program.
The states also have a role beyond running state insurance exchanges under the ACA, as University of Virginia reports: Miller Center Report: States Can Transform Health Care System
January 8, 2014
The nation’s governors and other state leaders can transform the current health care system into one that is more coordinated, patient-centered, of higher quality and less costly, according to a new report. The report by the State Health Care Cost Containment Commission, organized by the University of Virginia’s Miller Center, aims to jump start health care cost containment in 2014 as 46 state legislative sessions get under way.
California serves as an example, even a bad one.

KPBS: California Gets Failing Grade In Children’s Health Report Card
By Kenny Goldberg
Tuesday, January 7, 2014
The report card measures how well California children are faring in three major areas: education, health and the welfare of foster youth. There are 27 categories in all, ranging from K-12 funding to obesity.

The health grades are especially bad. For example, health care access got a C-minus, while mental health got a D.
So, what was the response?

KPBS: Gov. Brown Visits San Diego To Propose Billions In New Spending
By Susan Murphy
Thursday, January 9, 2014
Gov. Jerry Brown will visit San Diego on Thursday to discuss his 2014-15 budget proposal, which includes an increase in spending on schools, health­ care and welfare for low-income Cali­for­ni­ans.

Brown's proposal, obtained by the Los Angeles Times, also includes a $1.6 billion rainy day fund to prepare for any future economic downfalls and $10 billion more than anticipated for schools and community colleges.
Capital Public Radio via KPBS: California Health Care Spending Could Be Shifting
By Pauline Bartolone, Capital Public Radio
Friday, January 10, 2014
A small spending item in Gov. Jerry Brown’s California budget proposal would pay for education about children’s dental care. This might be a sign of a shift in state spending on health care.
KPBS: California Doctors Praise Governor’s Move, But Say Medi-Cal Pay Still Too Low
By Kenny Goldberg
Thursday, January 9, 2014
California Gov. Jerry Brown's proposed budget eliminates a planned 10 percent Medi-Cal payment cut that was to be retroactive to 2011. But it still preserves a 10 percent cut to Medi-Cal rates going forward.

Approximately 8.5 million Californians have Medi-Cal coverage, including more than 350,000 people in San Diego County. And thanks to Obamacare, 1.4 million additional people are now eligible for it.

It’s not too tough for Medi-Cal patients to find a primary care doctor who’s willing to treat them, but it’s difficult to find a specialist.
KPBS: Brown Speech Touts Bioscience, Warns of Future Health Care Costs
By Pauline Bartolone / Capital Public Radio
Thursday, January 23, 2014
Health care wasn’t a big focus of Gov. Jerry Brown’s speech. But the governor did mention health care in terms of costs to the state, and how California is a leader in bioscience and medical technology.

Brown said “tens of billions [of dollars are] needed to cover retiree health care” and he sees this as a long term budget liability. New health care coverage under the Affordable Care Act, such as the Medicaid expansion, are a “future risk” to state spending, Brown said.

“We do have a large group of people who will rely on the pensions,” says Dorothy Rice, medical economist and Professor Emerita at UC San Francisco School of Nursing. Rice says the Governor is right to urge fiscal prudence.
Looks like Governor Brown is off to a good start, but it's only a start.

Finally, the University of Pittsburgh explains why having insurance is important in Uninsured Patients Less Likely to Be Transferred Between Hospitals, Pitt Researchers Find.
PITTSBURGH, Jan. 21, 2014 – Uninsured patients with a variety of common medical diagnoses are significantly less likely to be transferred between hospitals for treatment, according to a new study led by researchers at the University of Pittsburgh School of Medicine in collaboration with researchers at the University of Iowa and University of Toronto. They also found that women, insured or not, are less likely to be transferred between hospitals. The findings, published today in the Annals of Internal Medicine, suggest that non-medical factors, including patients’ sex and insurance coverage may influence care decisions and lead to potential health disparities.

“Federal law requires hospitals and physicians to care for and stabilize any patient with an emergency medical condition, regardless of the patient’s ability to pay,” explained Janel Hanmer, M.D., Ph.D., assistant professor of medicine at Pitt’s School of Medicine and lead author of the study. “While there’s been persistent concern about patients being transferred between hospital emergency rooms for non-medical reasons, our study is one of the first to look at inter-hospital transfers among patients who have already been admitted to the hospital.”

The researchers used data from the 2010 Nationwide Inpatient Sample (NIS), the largest all-payer inpatient care database in the United States, to examine the relationship between a patient’s insurance coverage and the hospital transfers for five common medical diagnoses: biliary tract disease, chest pain, pneumonia, sepsis and skin infection.
Stay tuned for more updates on health and health care this year.

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