In This Edition:
From Kaiser Health News:
Medi-Cal has become the payer of first resort for many Californians unable to afford the long-term care they need. (Anna Gorman and Barbara Feder Ostrov, 8/1)
Two Los Angeles area patients alleged a prominent UCLA spine surgeon harmed them by using Medtronic devices in experimental ways without their consent and failing to disclose his financial ties to the company. Both UCLA and Medtronic deny wrongdoing. (Chad Terhune, 8/1)
Insurance claims for medical services related to opioid dependence diagnoses rose more than 3,000 percent between 2007 and 2014, an analysis finds. (Julie Appleby, 8/1)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Are You Sure?'" by Rick Kirkman and Jerry Scott.
Here's today's health policy haiku:
NEED FOR MEDICAL SERVICES SKYROCKETING
We need to prepare.
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Summaries Of The News:
With the latest wave of closures, enrollees' coverage is being disrupted in the middle of the year, which can add extra costs and make it harder to keep the same doctor. Meanwhile, new data show small businesses are less likely to offer health benefits to their employees after the health law was passed.
The Hill: Frustration Mounts Over ObamaCare Co-Op Failures
A new wave of failures among ObamaCare's nonprofit health insurers is disrupting coverage for thousands of enrollees and raising questions about whether regulators could have acted earlier to head off some of the problems. Four ObamaCare co-ops have failed due to financial problems since the beginning of the year, the latest trouble for the struggling program. (Sullivan, 8/1)
Bloomberg: Small Employers Pulling Back On Health Benefits Since ACA
Small businesses have been pumping the brakes on offering health benefits to their employees since 2009, according to new data from the Employee Benefit Research Institute. “The fact is that small employers were less likely to offer these benefits to begin with,” Paul Fronstin, EBRI's director of health research and education program and author of the report, told Bloomberg BNA July 28. “While the ACA was designed to try to get more small employers to” offer health insurance, “it hasn’t.” (Knebel, 7/29)
In other news, those on Michigan's exchange could see a 17.3 percent rate hike —
Detroit Free Press: Affordable Care Act Rates May Jump 17.3% In Michigan
Health plans sold on Michigan's insurance exchange could see an average 17.3% increase next year, and if recent history is any guide, state regulators could approve the insurance companies' rate hike requests without many — if any — changes. The rate increases would mean a financial hit for taxpayers in general and the 345,000 Michiganders who buy their health insurance on the Healthcare.gov exchange, created under the Affordable Care Act, also known as Obamacare. (Reindl, 7/31)
Detroit Free Press: Quick Facts On Michigan's Obamacare Rate Hike
Many health insurers in Michigan are seeking double-digit rate hikes next year for their individual policies sold on the Affordable Care Act exchanges. The average rate increase would be 17.3% if state regulators approve the requests without changes. The new rates would boost the sticker price of the average "silver" plan to $477 a month for a 50-year-old male and nonsmoker. (Reindl, 7/30)
The government says doctors are incorrectly trying to collect deductibles, co-payments and other costs from these patients. Also in the news: A look at a lawsuit about Medicare billing that involves the head of the hospital chain Prime Healthcare Services, an article about Medicare's expansion of bundled payment programs, and a Washington state hospital is facing the loss of Medicare funding.
The New York Times: Doctors Are Improperly Billing Some On Medicare, U.S. Says
Doctors are improperly billing poor people on Medicare for deductibles, co-payments and other costs from which they are supposed to be exempt, the Obama administration says. Federal officials have warned doctors that they may be subject to penalties if they persist in these practices. They could, for example, be fined or excluded from Medicare. The people who are being billed improperly are “qualified Medicare beneficiaries” who are also enrolled in Medicaid. They are 65 and older or disabled and have low incomes, generally less than $1,010 a month for an individual or $1,355 for a married couple. (Pear, 7/30)
The Wall Street Journal: Hospital Chain’s CEO Faces Lawsuit Over Business Practices
Over the past decade and a half, California cardiologist Prem Reddy has built Prime Healthcare Service Inc. into one of the largest for-profit hospital chains in the U.S. by targeting distressed hospitals for acquisition. He boasts that his aggressive turnaround strategies have righted the finances of each and every one. But the chief executive has also attracted criticism, including claims that he plays hardball with insurers. Now Dr. Reddy is the central figure in a lawsuit brought by an employee and the Justice Department alleging that he strong-arms doctors in an effort to unnecessarily hospitalize patients at Medicare’s expense. (Evans, 7/31)
Modern Healthcare: Bundled-Payment Expansion Brings Providers More Risk—And Opportunity
The CMS announced a proposal last week to put three new episodes of care under mandatory experiments with bundled payments, potentially compelling hundreds of additional hospitals into becoming financially accountable for what happens to Medicare patients long after they leave the hospital. It was just one in a series of steps in an effort to move Medicare and the entire industry toward models that pay for the quality of healthcare rather than the quantity of services. (Whitman, 7/30)
The Seattle Times/Skagit Valley Herald: Skagit Regional Health Addressing Issues To Keep Medicare Funding
Skagit Regional Health is working to improve policies and practices that if left unaddressed could leave the hospital without Medicare funding. Skagit Regional Health gets about 70 percent of its revenue from Medicare and Medicaid, so losing that funding would be disastrous, said President and CEO Gregg Davidson. (Weinberg, 7/30)
The president will speak about his precision medicine initiative and other issues related to veterans' health care at the annual convention of the Disabled American Veterans in Atlanta.
The Associated Press: Obama Pointing To Strides In Veterans’ Health Care
President Barack Obama is touting strides in reducing homelessness among military veterans as his administration reaches the halfway point in building a massive database on veterans’ health. Overall veteran homelessness has been cut nearly in half, by 47 percent, although that’s still short of Obama’s long-held goal of getting it to zero by 2015. Credit also goes to first lady Michelle Obama and Vice President Joe Biden’s wife, Jill, for using their initiative on military families to challenge mayors and county officials nationwide to end veterans’ homelessness, the White House says. (Superville, 8/1)
In other news about veterans —
The Philadelphia Inquirer: N.J. Veterans Seek Medical Marijuana For PTSD
On June 16, the health committee voted 6-3 to release the bill to the floor. It is scheduled to be heard by the full Senate on Monday. The Assembly has already passed an identical bill with bipartisan support. Under the bill, a patient with PTSD symptoms would first have to try conventional medical therapy before qualifying for medical marijuana. Generally, that would involve psychotherapy or antidepressant or antianxiety medications. (Hefler, 7/31)
Doctors are looking at immunotherapy — which uses a patient's immune system to fight off cancer — as something akin to sending a man to the moon. But relapses plague a majority of the patients who turn to it in desperation. The New York Times offers patients' stories and more information about the treatment.
The New York Times: Immunotherapy Offers Hope To A Cancer Patient, But No Certainty
A cancer patient nicknamed the Steel Bull got his death sentence on a gloomy March Wednesday in 2015. He was 47, his given name Jason Greenstein, but he had earned the moniker from his oncologist for his stubborn will during more than four years of brutal chemotherapy and radiation treatment — all of which had failed. ... The oncologist, Dr. Mark Brunvand, said he excused himself to the hallway to gather his emotions. When he returned a moment later, he looked Mr. Greenstein in the eye. “You are going to die,” he remembers saying. “And because you’re my friend, it’s my job to make you as comfortable as possible.” ... What happened next qualified as well beyond “dramatic response.” A few days later, Mr. Greenstein agreed to try a last-ditch drug called nivolumab that was being tested for Hodgkin’s. It dripped into his veins, just like those body-racking chemotherapy treatments. But this time, there were no harsh side effects. And this time, the outcome was very different. (Richtel, 7/31)