Posts Tagged ‘healthcare reform’

ACA’s Future Unclear As It Celebrates Its 2nd Birthday

Tuesday, April 3rd, 2012

As the Patient Protection and Affordable Care Act (ACA) celebrates its second birthday, the Obama administration reminded senior citizens – one of the most reliable voter blocs — exactly how much healthcare reform has helped them.  Coverage of the “donut hole” in prescription drug plans saved five million seniors and disabled people $3.2 billion.  According to data from the Centers for Medicare and Medicaid Services (CMS), through the first two months of 2012, roughly 103,000 Americans saved $93 million in the donut hole.  “Without the healthcare law, more than 5.1 million seniors would have faced $3.2 billion in higher drug costs,” Health and Human Services Secretary Kathleen Sebelius said.  The donut hole is a gap in coverage for prescription drugs under what is called Medicare Part D.  Part D covers 75 percent of the cost of prescription drugs until total medication spending for the patient hits $2,800.  Then the hole opens, and seniors must pay out of pocket until they have spent $4,550.  After that, Medicare pays about 95 percent of drug costs.

The ACA sent all seniors who hit the prescription drug donut hole a one-time $250 check.  In 2011 and 2012, seniors in the donut hole receive a 50 percent discount on brand-name drugs.  Additionally seniors covered by traditional Medicare received wellness check-ups and screenings for diseases like cancer and diabetes without paying anything out of pocket.  Under the law, the donut hole phases out in 2020.

The seniors’ lobby AARP launched its largest-ever outreach effort with ads and town-hall meetings aimed at defending Medicare and Social Security.  “We’re not leaving it up to chance” that the public hears about the law’s benefits, congressional Seniors Task Force co-chairwoman Jan Schakowsky (D-Ill.) said.  Democrats, Schakowsky said, have made it a “primary organization effort”…”to tell the truth (about the law) over the next several months.”

Writing in The Hill, Julian Pecquet says that “Democrats see the Ryan budget, which is expected to propose replacing Medicare with subsidies for people to buy insurance, as political gold ahead of the November election.  Republicans for their part will spend the week hammering the law’s ‘broken promises’ — higher premiums, employers dropping coverage and the soaring cost of insurance subsidies when compared to the earlier budget window Democrats highlighted when they were debating the law two years ago.  They’re also arguing that the healthcare law hastens Medicare’s insolvency by removing $500 billion from the program to pay for what they call an unsustainable new entitlements.”

In terms of implementing the law to meet the 2014 deadline, the ACA leaves it up to the states to set up health insurance exchanges.  In states that refuse to do that, HHS has the authority to create a federal exchange as a backup — but it could be stretched thin if it has to cover too many states.  At the moment, a number of states are not making plans and the federal exchange could end up covering as many as 15 to 25 states.

Other states are biding their time depending on the outcome of the Supreme Court case — and the elections — to decide what to do next.  There’s an excellent possibility that many of them won’t be far enough along by January of 2013, when HHS has to either certify the states’ exchanges or prepare to run a federal exchange in those states.  HHS has already extended the deadline for states to apply for the grants that will help them run exchanges.  And it’s taking other steps to help states that won’t be ready in time.  But if a lot of states refuse to create the exchanges –and more time won’t help them — HHS will be forced to act.

White House spokesman Jay Carney told reporters that President Obama is looking beyond past battles. “He is focused on a forward agenda right now, and working with Congress and doing the things he can through executive action to grow the economy and create jobs,” Carney said.

Republican leaders, who once accused the president of focusing too much on healthcare and not enough on jobs, now say the White House is moving away from the ACA because of uncertainty over whether or not its individual mandate is constitutional.  In terms of the upcoming Supreme Court oral arguments, Senator Roy Blunt (R-MO) said “I think we’ll win in the end.  Now the question is how long is it until the end.  There’s no question that the president’s plan will not work.”

A differing opinion was offered by Democratic Caucus Vice-Chairman Xavier Becerra (D-CA).  “I think as time goes by more and more people are beginning to support the reform because it starts to apply to them.  The more people see what the ACA does, the more they’re going to like it.”

Healthcare Jobs Still the Fastest-Growing Sector

Tuesday, February 7th, 2012

Job growth in the healthcare profession seems to be virtually recession-proof. In Florida, a state with a sizeable percentage of senior citizens, there are about 960,000 healthcare and social assistance jobs, approximately 13 percent of all nonfarm payroll positions in the state.

Some experts are not as optimistic about job growth in the healthcare sector.  “Reform may accelerate the trend toward healthcare’s being the dominant employment sector in the economy,” according to a recent New England Journal of Medicine (now known as NEJM) article.  A significant amount of the growth in healthcare that result from reform might be in support positions, rather than physicians and nurses, several economists said.  “As for jobs for health professionals, I doubt that this will or can increase the number of doctors or nurses.  While there will be greater demand for their services, there will also be offsetting effects as medically unnecessarily procedures are paid less,” said Amitabh Chandra, an economist and public-policy professor at Harvard University.

As the insured population grows under the federal Patient Protection and Affordable Care Act (ACA), healthcare workers will be in high demand.  These gains come on the heels of growth already required to serve an aging population.  In Florida, the aging population’s impact on healthcare employment is more dramatic than in the rest of the country: about 17 percent of the state’s population is older than 65, compared with a 13 percent average in the other states., according to the Census Bureau.

Other experts are far more sanguine about healthcare’s ability to create jobs.  “The big places we waste money is patients who are discharged and there’s not a lot of follow up and they end up in the hospital a month later,” said Leemore Dafny, an economist at Northwestern University whose expertise is competition in healthcare markets.  According to Dafny, reform will create new primary-care physicians and physician “extenders,” such as nurse practitioners; at the same time, it could decelerate growth in spending on medical specialists.  “If the ACA is repealed, it will be business as usual — except that more of the population is now uninsured — so the demand for primary-care professionals will increase much more slowly,” said Dafny.

In fact, according to the Bureau of Labor Statistics (BLS), the healthcare sector for some time has provided about the only bright spot in an otherwise drab report on job growth.  Healthcare employment created 205,100 new jobs in the first eight months of 2011.  Approximately 14.1 million people are employed in the healthcare sector with more than 4.7 million jobs at hospitals; more than 6.1 million jobs in ambulatory services; and more than 2.3 million jobs in physicians’ offices, according to BLS statistics.

According to Risa Lavizzo-Mourey, M.D., CEO of the Robert Wood Johnson Foundation, and Mark Pinsky, president and CEO of the Opportunity Finance Network, “The current economic recovery effort presents an opportunity to build stronger, healthier communities.  That’s a central goal, for example, of the Create Jobs for USA Fund that the OFN and Starbucks launched late last year to support job creation and retention.  Economic growth and job creation provide more than income and the ability to afford health insurance and medical care.  They also enable us to live in safer homes and neighborhoods, buy healthier food, have more leisure time for physical activity, and experience less health-harming stress.  The research clearly shows that health starts in our homes and communities and not in the doctor’s office.  In that way, economic policy is, in fact, health policy.  The end goal?  Create and sustain job growth across the country.  Improve communities.  Improve health.  Give people the opportunities to make smart, healthy decisions so that they can act in the best interests of their communities, themselves, and future generations.”

Healthcare added 17,200 jobs in November of 2011, an increase over the 11,600 jobs reported in October, according to BLS data.  Healthcare accounted for 14.3 percent of 120,000 new jobs created across all sectors in November.  On the whole, healthcare represented 24 percent of the 1.2 million non-farm jobs created this year and is expected to create 321,000 new jobs by year’s end.  That represents a 22 percent increase over the 263,400 healthcare jobs created in 2011.

Public Perceives Supreme Court Justices As Biased Over ACA’s Legality

Monday, February 6th, 2012

Approximately 60 percent of Americans believe that the Supreme Court justices who will hear the Patient Protection and Affordable Care Act (ACA) will base their judgments more on personal ideology than a legal analysis of the individual mandate, according to a recent Kaiser Family Foundation poll.

Only 28 percent believe the justices will base their decision on the mandate without regard to politics and ideology.  The poll also asked about general views of the Supreme Court and found that 75 percent of the public believe that justices sometimes let their personal politics sway their decisions.  Seventeen percent said justices more often than not decide cases based on legal analysis.  The court is expected to hear oral arguments in March in a case brought against the Patient Protection and Affordable Care Act (ACA) by 26 states.

The Kaiser poll found that the individual mandate, a requirement that most Americans purchase health insurance by 2014 or pay a fine, remains unpopular — 67 percent of Americans opposed the provision and just 30 percent supported it.  Overall, approximately 37 percent of Americans view the health law favorably, while 44 percent have an unfavorable view.

In terms of the “repeal and replace” agenda that House Republicans are pursuing, it’s not really winning over the public.  According to the Kaiser poll, 50 percent of respondents would prefer to expand the law or keep it in place; just 40 percent want to repeal it outright or replace it with an alternative.  That could be a problem, since House Energy and Commerce Health Subcommittee Chairman Joe Pitts said that a “replace” plan is on the subcommittee’s to-do list, at approximately the same time that the Supreme Court is expected to rule.  Pitts hopes that his caucus will be able to seize the opportunity to sway public opinion: “We’ll have a window of opportunity to — with everyone looking — to explain that the Affordable Care Act is not fully implemented yet.  A lot of people think it is.  So we’ll use that opportunity in that window to discuss the full ramifications of the Affordable Care Act and what we’ll replace it with.”

For example, Justice Elena Kagan (who was Solicitor General at the time the ACA was passed and has recused herself from the Supreme Court case) and noted Supreme Court litigator and Harvard Law Professor Laurence Tribe, who worked for the Justice Department at the time, had an email exchange in which they discussed the pending healthcare vote.  “I hear they have the votes, Larry!!  Simply amazing,” Kagan wrote to Tribe in an email.

“So healthcare is basically done!” Tribe responded to Kagan.  “Remarkable.  And with the Stupak group accepting the magic of what amounts to a signing statement on steroids!”  The “Stupak group” refers to then-Representative Bart Stupak (D-MI), who masterminded a group of House Democrats who had indicated they would not vote for the ACA if it permitted federal funds to pay for abortions.  Ultimately, Stupak and his allies voted for the bill, even though no additional language was added that would prevent federal funding for abortions.

Writing for, contributor Curt Mainwaring muses on what will happen if the Supreme Court upholds the ACA. “If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  Healthcare costs currently make up approximately 18 percent of gross domestic product.  If expenditures continue on their current trajectory, ‘the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.’  In more intimate terms, the Department of Health and Human Services demonstrates individuals paid approximately $1,000 per year in healthcare costs in 1960, more than $7,000 per year in 2007, and are projected to pay more than $13,000 per year by 2018.

“Simply put, this kind of a rise in healthcare costs is unsustainable — and these kinds of projections are part of the reason ACA was created in the first place.  Nevertheless, claims of ACA’s positive impact on the economy have likely been overestimated.  ACA focuses heavily on reducing the cost of health insurance — a factor that will likely result in reduced insurance costs.”

Showdown As Opposing Medicare Ads Debut

Wednesday, November 30th, 2011

A coalition of advocacy groups such as the Americans United for Change, Service Employees International Union, American Federation of State, County, the Municipal Employees and Service Employees International Union and recently started running a series of ads telling lawmakers not to cut Medicare benefits.  In particular, the ads target Representative Denny Rehberg (R-MT), Senator Dean Heller (R-NV) and Senator Scott Brown (R-MA).

“If you vote to cut Medicare, Representative Rehberg, I will remember it every time I visit my doctor.  I’ll remember you cut Medicare and Medicaid every time I fill my prescription,” says an elderly woman narrator in one of the ads.  “I’ll remember you cut Medicare every time I fall or get hurt. I’ll remember you protected millionaires over protecting my health. My friends will remember it, too — all of them.  Call Senator Heller.  Tell him to protect Medicare and Medicaid.”

Brian Walsh, the National Republican Senatorial Committee communications director, made light of the Democratic message, arguing that the half-trillion dollars they shifted out of Medicare to pay for healthcare reform makes their argument hollow.  “The irony of this pathetic attack ad is that in each of these three races, it’s actually the Democrat candidates who are all firmly on record supporting the $500 billion in Medicare cuts that were included in their massive healthcare overhaul,” said Walsh.  “The big labor unions funding this ad know that, but yet they are doing everything they can to mislead voters in Montana, Nevada and Massachusetts.”

In the meantime, the United States Chamber of Commerce is running commercials attacking Senators Sherrod Brown (D-OH) and Jon Tester (D-MT).  Friends of the U.S. Chamber criticize Tester for supporting “government-run healthcare” and challenges Brown on energy taxes.  The business community has been under unprecedented threat,” Rob Engstrom, part of a two-man team running the chamber’s political operation, said.  The trade group plans to break its previous political spending record — $50 million — to try to elect a more business-friendly Congress.  The Montana ad reminds viewers about Tester’s votes for “government-run healthcare” then urges voters to “call Senator Tester and tell him to stop supporting big government and start fighting for Montana’s families.”

Americans United for Change explains why it is running ads about protecting Medicare and Medicaid.  “For decades, seniors have relied on Medicare being a guaranteed benefit and those less fortunate have depended on Medicaid to provide long-term care and coverage for children.  These programs need to be strengthened to ensure they remain available for future generations, which means not gutting and decimating benefits, leaving low-income children, seniors, and people with disabilities out in the cold.  The key to making Medicare sustainable is reining in costs, not dumping more expenses onto seniors.  We are working to set the right priorities for an economically secure future while continuing to protect healthcare coverage for those who can least afford it.”

Writing for the Huffington Post, Sam Stein describes the Democratic ads as “Not exactly the most visually stimulating videos, the ads warn lawmakers that they will pay a political price for cutting Medicare or Medicaid.  That may prove to be popular politics — certainly, polls show that voters want the two healthcare programs protected — but the notion that cuts won’t ultimately be pursued is highly unlikely.  Aides on the Hill from both political parties have long agreed that there is room to trim down Medicare’s provider-side components.  Reforms to Medicaid, whether in the form of decreased help to the states or something more structural, have also been discussed.”

Uninsured Americans Uncertain About Healthcare Reform

Wednesday, September 14th, 2011

Americans have agreed to disagree about the efficacy of the Patient Protection and Affordable Care Act (ACA). According to Kaiser Family Foundation President and CEO Drew Altman, Americans agree about this one thing: “It really does help the uninsured; 32 million uninsured people will get coverage.”  The foundation’s recent tracking poll found that only about 50 percent of uninsured people have any idea that help is on the way.  Fewer than one-third (31 percent) think the ACA means they will be able to purchase health insurance.

Those two misperceptions are unmistakably connected.  Among those who currently lack insurance, 41 percent incorrectly think the law has no provisions to help people with modest means buy health insurance coverage; (seven percent said they didn’t know); and 37 percent believe the law doesn’t include an expansion of the Medicaid program to low-income, able-bodied adults; and (16 percent were unsure). 

The logical conclusion, Altman says, is an apparent “communications failure” on the part of the law’s supporters to explain how the ACA will actually work.  “What’s going on here is people who are uninsured are busy just trying to make it through the week, paycheck to paycheck,” he said.  “They’re listening to a confusing political debate.”  But the bottom line, Altman says, is that the healthcare overhaul will eventually start to become clearer in 2014, “when there are benefits out there, real coverage out there that people can look at — and can get.”  That’s when people without insurance will really be able to decide whether they can afford insurance or they like the law or it helps them.  “Until then,” Altman says, “it’s just a political debate.” 

Writing in The Hill, Sam Baker says that “Only 29 percent knew that the law eliminates cost-sharing for some preventive services, and half said the law did not provide that benefit.  The poll was conducted just two weeks after the Health and Human Services Department (HHS) announced that it would require plans to waive cost-sharing for contraception and other women’s health services.  And strong majorities approved of that decision, despite not being aware that the healthcare law includes preventive benefits.  Eliminating cost-sharing for birth control garnered 66 percent support in the Kaiser poll.  Although support was higher among younger respondents than their older counterparts, partisanship was the sharpest fault line.  Fewer than half of Republican respondents approved of HHS’s decision, compared with 64 percent of independents and 82 percent of Democrats.” 

On the Politico website, Jennifer Haberkorn writes that “The coverage expansion isn’t due to go into effect until 2014, but Altman says people are unlikely to be truly aware of the benefits until up to two years later.  The figures reflect the struggle supporters of the law will have in getting the word out to consumers who can benefit from it.   President Barack Obama and congressional Democrats focused much of their ‘pitch’ for the health law on the benefits for the uninsured.  They frequently cited the Congressional Budget Office estimate that the law would insure 32 million Americans.  But since the law’s passage, some have criticized that pitch, insisting that they should have focused instead on the benefits for the middle class and those who already have coverage.  Altman said the figures do not reflect a communications failure.  He says busy people — particularly those struggling to afford insurance now — will only understand the law when it becomes tangible for them.  The law’s least popular provision — the requirement that nearly all Americans have to buy insurance — remains one of its most recognizable.  About 65 percent of Americans know about the provision, the poll found.” 

At the beginning of 2011, any Republican suggestion of “repeal” was nearly always followed by “Obamacare”.  Since then, the debate has drifted into the background, morphing into a new regulatory repeal push.  A memo outlining the strategy, issued by House Majority Leader Eric Cantor (R-VA), includes a single paragraph on a grandfathering rule for health insurance plans that will become a target in the winter.   While Republicans are moving away from a health repeal agenda, Democrats appear to be having a hard time explaining what exactly the ACA will do for Americans.

Despite their best efforts, both political parties see their bases moving away from them on health reform.  The number of Republicans who have a favorable opinion has gone up by nine points, while Democratic approval ratings fell by 10 points.  Independent voters held on to their original opinions, with nearly the same number favoring the ACA was as when it was passed.  Both parties are running up against the same two challenges here. First, the health reform law is really complicated.  Other than “repeal and replace,” the ACA doesn’t lend itself easily to slogans that explain how it works.  This hurdle has been especially thorny for Democrats, who have seen low support for the ACA, despite the fact its individual provisions are polling extremely well.  

Tim Hoff of the Albany Times-Union believes that “Offering health insurance at reasonable prices is a key component of making the reform law cost-effective and able to reach millions of uninsured people.  The logic of getting private insurance companies to participate in state health insurance exchanges and offer good coverage at those reasonable prices predicates itself on having a balanced ‘risk pool’ of individuals in the marketplace — who must purchase health insurance.  Through a mix of healthy and sick purchasers, some who overuse their insurance and some who underuse, private insurers can be assured of not losing money (and thus exiting the market) by signing up only high-risk individuals.

“Without a mandate, many healthy uninsured people, as they tend to do, will continue to roll the dice and go uninsured.  This is even truer for the increasing number of Americans who are out of work or who work for employers who do not provide insurance, but earn too much to qualify for Medicaid.  For them, paying for health insurance is lower on the priority list.  That is, until they get sick,” Hoff said.

“Our country faces what may be an extended economic slump, a severe and perhaps more permanent absence of good jobs, rapid downsizing of the middle class and continued abdication by employers from offering benefits such as health insurance.  Yet, we leave it to lawyers and politicians to engage in armchair debates about what might or might not be ‘constitutional’ instead of supporting our government to do something beneficial that furthers the nation’s long-term health and prosperity.  Insuring every citizen is beneficial for our country.  It would do as much for our long-term future as a just, democratic society as any jobs program or debt reduction strategy would.  We are an increasingly sicker, unequal and less productive country in part because of the declining health and well-being of our citizenry, especially our poorer citizens,” according to Hoff.

 “How do we think we can fix the problem of the uninsured without requiring people to carry health insurance?  In our broken, polarized political system that is devoid of bold ideas, this health reform law and its insurance mandate were the best we could do to get health insurance to more people.  Asking almost everyone — citizens and legal residents — to have health insurance is fair, and subsidizing the poor’s ability to do it sensible.  At some point, everyone uses the health care system.  When the uninsured do, they cost us a lot more than those who are insured.  But the insurance mandate issue also speaks to how those of us with good health insurance often think selfishly about the role of healthcare in our own lives.”

Walgreens: One-Stop Shopping for Healthcare Insurance

Monday, August 15th, 2011

The nation’s largest drugstore chain is planning to begin selling health insurance this fall.  Walgreens, which operates 7,742 drugstores in all 50 states, the District of Columbia and Puerto Rico, will sell health insurance products with different price ranges and coverage levels nationally through a private health insurance exchange.

According to Walgreens officials, “As always, we’re looking at a number of options in light of healthcare reform as we continue to seek ways to help our customers better navigate today’s healthcare system.”  Health reform mandates the creation of federal and state-funded public health insurance exchanges by 2014 that will offer subsidized insurance for people who lack insurance. Multiple companies, many not typically associated with health insurance, are also expected to jump into the embryonic but lucrative market for health insurance exchanges — estimated to be worth billions of dollars — prior to 2014.  These include retailers, financial services providers and a major payroll processer that are actively planning to create their own private health insurance exchanges.  Walgreens neither confirmed nor denied the report,  but it’s expected that the insurance plans will be available online, in-store or via call centers and will be branded by national insurers in some instances.  Walgreens currently offers flu shots and vaccinations at its “take care clinics” so this new move is seen as a bid to become a one-stop shop for healthcare needs.

The investment banking firm TripleTree,  which focuses on the healthcare and technology market, estimates that between 2014 and 2019, as many as 36 million Americans will buy their health insurance from exchanges.  “For retailers, (creating a private insurance exchange) is a way to generate more revenue from a new business,” Chris Hoffman, TripleTree’s chief marketing officer, said.  “Those companies that get their exchanges up and running before 2014 could also succeed in stealing customers away from the public exchanges.”.

Hoffman pointed out one crucial distinction between public and private health insurance exchanges.  Consumers who qualify for government subsidies can participate only in public exchanges, and not private exchanges.  Still, Hoffman said that private exchanges will attempt to stay competitive with public exchanges by offering other incentives to join, such as loyalty programs that tie in discounts and bundling other types of insurance like life insurance along with their health insurance products.

By entering into a partnership with some of the nation’s biggest health insurers, selling health insurance is a natural evolution in Walgreens’ process of becoming a one-stop shopping destination for all healthcare needs.  Some forms of insurance will be branded by national insurers and others will be “private label” insurance products sold through Walgreens’ exchange.

Writing on the bizmology website, Alexandra Biesada says that “I wouldn’t be surprised if it’s true.  Walgreen has rushed to fill gaps in our nation’s fractured healthcare system, opening hundreds of in-store Take Care Clinics, worksite healthcare centers and by offering a slew of healthcare services, including immunizations and counseling for chronic conditions, such as diabetes.  It also provides products and services to pharmacy patients and prescription drug and medical plans through its Walgreens Health Services unit.  Already a leader in healthcare services, offering health insurance is a logical next step for Walgreen.  With the ranks of the uninsured and underinsured swelling, consumers are being steered to health insurance exchanges under the Patient Protection and Affordable Care Act (aka the healthcare reform bill) passed into law in March 2010.  In addition to the creation of federal and state-sponsored health insurance exchanges, the private sector, including retailers such as Walgreen, is expected to enter the market.  While only consumers enrolled in government-sponsored exchanges are eligible for subsidies, privately-sponsored exchanges could still be competitive by offering subscribers other incentives to join their network.  Some retailers, Sam’s Club comes to mind, already offer select customer groups services, including group health insurance.  So the idea of buying coverage from a retailer, rather than through an employer or broker, isn’t unprecedented.  Walgreen has moved quickly to capitalize on the transformation of our healthcare system and is looking for growth opportunities beyond its vast network of retail stores.”

Medicare Changes Would Hit Lower-Income Seniors Hard

Tuesday, August 2nd, 2011

At a time when concern about federal deficits and the national debt are growing,  few quarrel with the need to reform Medicare.  The health insurance program for seniors and people with certain disabilities accounts for 15 percent of the federal budget – in third place behind Social Security and defense spending.  That share is rising as healthcare costs continue to rise and more baby boomers retire, threatening the program’s long-term solvency.

Several of the most prominent solutions under discussion largely derive their savings by shifting a greater share of the cost onto beneficiaries.  The plan sponsored by Representative Paul Ryan (R-WI) and passed by the House of Representatives would significantly cut Medicare spending by capping the government’s contribution to the program and transforming it into a system of “premium supports” given to seniors to help subsidize their purchase of private insurance plans, with seniors paying additional costs.  This would double out-of-pocket spending by the average senior to $12,500 each year, according to Congressional Budget Office estimates.

The ability of a majority of seniors to shoulder that burden appears dubious.  Just five percent of Medicare beneficiaries make $80,000 or more, a figure that includes any income from a spouse. For the 47 percent of seniors who are at or close to poverty, on average they are already spending nearly 25 percent of their budgets on healthcare, according to an analysis by the Kaiser Family Foundation.

“There’s this impression that there’s a great deal of wealth among the Medicare population, this image of wealthy seniors playing golf and enjoying their retirement years,” said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare Policy Project.“But while some are lucky to do so, many are living on a fixed income, struggling to make ends meet…with really limited capacity to absorb rising costs.”

According to the Kaiser Family Foundation’s report, raising Medicare’s eligibility to 67 in 2014 would generate an estimated $5.7 billion in net savings to the federal government, but also result in an estimated net increase of $3.7 billion in out-of-pocket costs for 65- and 66-year-olds, and $4.5 billion in employer retiree healthcare costs.  In addition, the study projects that the change would raise premiums by about three percent both for those who remain on Medicare and for those who obtain coverage through health reform’s new insurance exchanges.  The study assumes both full implementation of the health reform law and the higher eligibility age in 2014 in order to estimate the full effect of both the law and the policy proposal.  In the absence of the health reform law, raising Medicare’s age of eligibility would result in an increase in the uninsured, according to other studies, as many older Americans would have difficulty finding affordable coverage in the individual market in the absence of Medicare.  With health reform, virtually all 65- and 66-year-olds would be expected to obtain alternative sources of coverage.”

Healthcare remains a major focus of budget talks on Capitol Hill,Senator Mark Kirk (R-IL) recently told the American College of Surgeons (ACS).  Every group that relies on federal funding should expect a 10 to 20 percent drop in that funding.  When Dr. L.D. Britt, president of the ACS, warned that such cuts could send some healthcare providers into a “tailspin,” Kirk responded that “the tailspin is the U.S. economy.  There is a new audience at play,” Kirk said, referring to U.S. creditors.  “The judgments they render, they are swift and severe.”  Kirk is optimistic that a solution to the country’s debt-ceiling dilemma “will have a way of concluding itself one day before the August 2 deadline.”

Nurse Burn-Out, Depression Can Be Fatal to Patients

Tuesday, July 26th, 2011

The horror began last September 14 when an experienced Seattle nurse realized she’d overdosed a fragile baby with 10 times too much medication. The stunned nurse told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had transpired.  “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse.  In the nurse’s 24-year career, all of it spent at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the sole serious medical mistake she’d ever made, according to the public investigation.  “She was devastated, just devastated,” said her partner and co-parent of their two children.  That mistake turned out to be the start of a life that unraveled, contributing not only to the child’s death, an eight-month-old girl, but also to Hiatt’s firing, a state nursing commission investigation — and Hiatt’s suicide at age 50.

This story highlights the twin casualties caused by serious medical errors: The patient is the first victim, the person hurt or killed by a preventable error.  The second victim is the healthcare professional who has to live with the aftermath of making it.

There is no question that patients are the primary concern in a nation where one in seven Medicare patients experience serious harm because of medical errors and hospital infections each year.  Another 180,000 patients die, according to a study by the Department of Health and Human Services’ Office of Inspector General.  That’s nearly twice the 98,000 deaths attributed to preventable errors in the important 1999 report “To Err is Human,” by the Institute of Medicine, which fired up the nation’s patient-safety movement.  In the real world, doctors, nurses and other medical workers who commit errors are often traumatized, with reactions ranging from anxiety and sleeping problems to doubt about their professional abilities – as well as thoughts of suicide, according to two recent studies.

This sad story raises the issue of healthcare provider depression and burnout.  Writing on the website, an anonymous nurse says “While visiting in the lounge one day, we discovered that every nurse there was on an anti-depressant.  I have had ‘Treatment Resistant Depression’ for about 20 years — as long as I’ve been a nurse.  Now I am totally burned out, on major meds, and am seeking disability due to depression/anxiety.  I believe years of long hours, high stress, high expectations and little appreciation (from management, not patients) has contributed to this.  How many other jobs consider you a traitor because you call in sick?  And trying to get off for a sick child is an unforgivable sin.  How many other jobs want you to work overtime on the days you are scheduled, call you at all hours of the night or day when you are off, first pleading with you to come in, then laying a guilt trip on you if you say “NO!”  And let’s not forget the mandatory in-services and CEUs (continuing education units) that take time away from your family.  If any profession should understand the importance of the individuals’ physical, mental, social and spiritual self it should be nursing — -after all we are taught in nursing school about treating the patient as a whole, not just a disease!  Why don’t we treat our staff the same way.”

According to Anthony Cirillo on the Hospital Impact website,“Two studies suggest that nurses working in hospitals are much more susceptible to depression than their counterparts in clinics, schools or other locations, especially if their hospital is high-volume.  A study in Journal of Clinical Psychiatry looked at the relationship between bed occupancy rates and absenteeism and found that those working in units that were 10 percent more crowded than the optimal rate had twice the rate of depressive illness than their counterparts in less crowded units.  The second study, appearing in Health Policy, is based on data from the 2005 National Survey of the Work and Health of Nurses in Canada. While looking at absenteeism in general, the report notes that depression is a “significant determinant” for missed work among RNs and LPNs, and that those who work in a hospital are more likely than those working in other settings to miss work.  One thing we might first observe is that with health reform, things will get much worse before they get better.  At some point, the estimated 35 million newly insured Americans will seek healthcare, potentially burdening the system.  And, of course this all impacts recruitment and retention and even further impacts whether folks choose to enter into the profession.”

According to the Nursing Center website, “Studies have also shown that nurses (the vast majority of whom are women) may be especially at risk.  This study surveyed 150 medical-surgical nurses from three hospitals to determine the prevalence and predictors of depression among female nurses.  All participants had at least a year of nursing experience and worked at least 20 hours per week.  Most (93 percent) were white; they averaged 38 years of age and 10 years’ hospital nursing experience.  Thirty-five percent of nurses had mild-to-moderate depressive symptoms; the most common included restless sleep, poor motivation, feeling bothered, and concentration problems; many reported feeling hopeful, happy, or joyful on only two days (or fewer) during the week before filling out the questionnaire.  Somatic symptoms, stressful major life events, greater occupational stress, and lower income were correlated with the presence of depressive symptoms.  Fatigue and low energy were bothersome to 43 percent of nurses; pain in extremities and joints, trouble sleeping, and back pain were also common.  Having a mortgage or loan of more than $10,000 within the previous year was the most commonly reported (43 percent) stressful major life event.  Others included changes in sleeping habits, vacation, and holidays.  The most highly ranked occupational stressors were having insufficient time to provide emotional support to a patient and to complete nursing tasks, being required to complete many non-nursing tasks (such as paperwork), and inadequate staffing.”

The Affordable Care Act: A Tale of Two Studies

Monday, May 23rd, 2011

A study of medical bills under the Patient Protection and Affordable Care Act (ACA) determined that most households will be able to afford premiums and related expenses after paying bills for food, child care, transportation and other necessities, according to the Commonwealth Fund. The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

Approximately 8.5 to nine percent of American families living closest to the poverty line could not afford basic necessities and typical medical bills proposed by the health reform law.  The ACA requires individuals to purchase insurance by 2014, although with occasional exceptions.  The ACA restricts household out-of-pocket costs and subsidizes plans available through insurance exchanges to people with low-incomes.  Fewer households in high cost-of-living states could afford healthcare expenses, according to the Commonwealth Fund study.  The report included projections of spending on necessities, premiums and out-of-pocket costs for households between the federal poverty line and 500 percent of the threshold.  Those insured by safety net or state run insurance exchanges were not factored into the study.

Even with implementation of the ACA, some families across all income levels would continue to struggle to afford coverage because of steep out-of-pocket costs.  According to the report, 17 percent of families of four earning up to $44,700; approximately 25 percent of families earning between $44,700 and $67,050, would struggle with healthcare costs.  The data examines costs in 2014, the first year the ACA will be fully implemented and the start of state-based health insurance exchanges.  The law provides federal subsidies for the lowest-income people to buy insurance.  Americans with incomes between 133 and 399 percent of the poverty level are eligible for income-based tax credits.  Some low-income people will be eligible for subsidies to make up for out-of-pocket costs.  Americans who make less than 133 percent of the poverty level are eligible for Medicaid.

“The Affordable Care Act is very good news for millions of Americans who are struggling to afford health care, going without health insurance, or skipping the care they need because they can’t afford it,” said Commonwealth Fund President Karen Davis. “The new law makes health insurance and health care affordable for nearly all families, and introduces delivery system reforms that have the potential to greatly improve quality and efficiency.  If implemented well, new entities like accountable care organizations may bring even greater savings and affordability than this report predicts.”

Although the Commonwealth report is positive about the likelihood that more families will be able to afford health insurance, Craig Pollack, M.D., M.H.S., assistant professor of medicine at Johns Hopkins, and Katrina Armstrong, M.D., from the University of Pennsylvania, are not as upbeat about the ACA.  The physicians warn that as a result of certain provisions in the ACA, wealthy hospitals and physician practices might “cherry-pick” similar institutions and create Accountable Care Organizations (ACOs).  In this way, they can avoid poor and minority-heavy patient populations who will be treated elsewhere to cut costs.  ACOs encourage patients to seek care within their own network, which highlights the disparities between networks.

According to Pollack, hospitals and physician practices that treat too many minorities may be unable to join ACOs and will fall further behind in the cost and quality of care that is likely to occur in such networks.  “There is ample evidence of racial and ethnic disparities in healthcare,” Pollack said.  “Hospitals and private practices that care for greater numbers of minorities tend to have larger populations of Medicaid and uninsured patients.  These patients have less access to specialists, and their hospitals and practices tend to have fewer institutional resources than their counterparts.”

Healthcare Construction Up 50 Percent

Thursday, May 12th, 2011

Healthcare construction rose nearly 50 percent to $12.6 billion in 2010, an increase from the $8.5 billion reported in 2009.  Many medical development experts are now saying that the industry has come back almost as strongly as prior to the recession.  Healthcare assets remain strong because of the fundamentals of its existence; essentially, the growing and aging population.  Additionally, consolidations have hit the industry hard, with successful mergers typically resulting in redevelopment or expansion plans.

Healthcare construction spending grew more than 10 percent for seven years, and then stalled.  The halt still represents an enhanced growth than almost any other construction market during the recession, which deepened as a result of the credit freeze that began in the fall of 2008.  Throughout the slowdown, hospital construction spending increased nine percent when compared with the period before the credit freeze; spending for specialized medical office buildings fell 17 percent.  The slowdown in medical office spending corresponds to trends in other developed financed sectors, although the slowdown began later and has been less severe.  Reduced income and unhealthy balance sheets caused some developers to lose access to credit.  Others lost credit because lenders had concerns about cash flow coming from new capacity in a depressed economy.

Healthcare construction spending should return to a 10 percent annual growth rate in 2011, a reflection of the usual cyclical surge that follows a recession.  The rebound for hospital construction spending is a result of delayed stimulus plan funding and the resumption of work that was put on hold while healthcare reform was debated in Washington, D.C.

The Urban Land Institute (ULI) has recognized that the growing demand for medical services – needed to treat aging baby boomers, combined with shifts in approaches to treatments to curb rising costs — will significantly increase the need for new and redeveloped medical office buildings.  According to a new report, The Outlook for Health Care, published by the ULI and Seavest Inc., the increase in investment and development to fill that demand will strengthen the healthcare industry’s role as an economic development engine throughout the United States.

The Outlook for Health Care, written by economist Gary Shilling, discusses long-term trends and drivers contributing to the demand for more medical facilities and all-new healthcare facility products such as wellness centers.  The reason is that baby boomers are living longer and need a greater range of services; technology changes have required retrofits or new development; growth in the number of insured Americans under the healthcare reform legislation; ongoing growth in healthcare-related jobs; the shift toward outpatient treatment facilities; and growth in the number of physicians employed by hospitals.

Shilling discussed the report at a forum, “Anchor Institutions as Catalysts for Urban Investments,” hosted by ULI in Washington, D.C.  “Both demand and supply factors point to rapid growth in spending on medical services and medical office buildings for many years.  Medical care will continue to grow rapidly and steadily for two basic reasons – it is an essential human service, and it is heavily supported by the government,” Shilling said.