March 17th, 2010

March 16: Health Care Reform News

By Kelley Luckstein

Top stories

 

House May Try to Pass Senate Health-Care Bill Without Voting On It

The Washington Post

March 16, 2010

After laying the groundwork for a decisive vote this week on the Senate's health-care bill, House Speaker Nancy Pelosi suggested Monday that she might attempt to pass the measure without having members vote on it.

Nancy Pelosi's Strategy for Passing Health-Care Reform

The Washington Post
March 16, 2010

 

Ezra Klein on the “deem and pass” strategy being considered by Pelosi: 'The House will vote on reconciliation explicitly and the Senate bill implicitly, which is politically easier, even though the effect is not any different than if Congress were to pass the Senate bill first and pass the reconciliation fixes after. This is all about plausible deniability for House members who don't want to vote for the Senate bill, although I doubt many voters will find the denials plausible.'

 

Obama Tries to Personalize the Health Care Bill

The New York Times
March 16, 2010

 

Declaring that “every argument has been made” on his health care overhaul, President Obama sought to seal the deal with Congress and the American people Monday by focusing on a single patient: a self-employed cleaning woman who dropped her costly insurance plan and just discovered she has leukemia.

 

Obama Stumps as House Brass Grasp for Votes

USA Today
March 16, 2010

 

President Obama made a campaign-style trip Monday to Ohio to stir up support for his health care legislation, as congressional allies scrambled for votes and began mulling arcane parliamentary tactics to pass the measure.

 

Insurance

 

Insurer Details its Unequal Payments

The Boston Globe

March 16, 2010

 

Newly released documents from MA-based insurer Harvard Pilgrim Health Care Inc. detail how certain hospitals and doctors are paid dramatically more than others for the same types of services, sometimes as much as three times higher. The inequalities emerged in documents filed by Harvard Pilgrim before the start of Massachusetts hearings investigating why healthcare costs are rising so rapidly.

 

Bill Gives Insurers a Younger Market (subscription required; full text below)

The Wall Street Journal
March 15, 2010

Although insurers generally oppose the Democrats' health-care bill, an overhaul would give the industry a chance to boost its diminishing rolls with an influx of young customers who tend to be healthy and profitable to cover.

Novel Health Plans Try To Help Uninsured

Kaiser Health News
March 16, 2010

 

A county program known as "three share" provides low-cost coverage to employees of small businesses by spreading health insurance premium costs among the community, the employer and the worker.

 

Transparency/Safety

 

New Focus on Averting Errors: Hospital Culture

The Wall Street Journal

March 16, 2010

Hospitals are taking what might seem like a surprising approach to confronting medical errors: Not only are they trying to improve safety and reduce malpractice claims, they're also coming up with procedures for handling—and even consoling—staffers who make inadvertent mistakes.

California Health Agency Works With Hospitals to Reduce Errors

The Los Angeles Times

March 15, 2010

 

The state began requiring medical centers to report preventable errors in 2007. Patient advocates say that such mistakes increase the cost of healthcare.

 

Group Resists Push for Forced Disclosure of Hospital-Quality Data

The Des Moines Register

March 16, 2010

 

The Iowa Hospital Association is objecting to attempts to have a state agency collect and publish information about the quality of services performed by hospitals and other health care providers.

 

Wellness/Chronic Care

 

Study: Doctors Need Tools to Help Patients Slim Down

USA Today
March 15, 2010

 

Physicians know they're on the front lines in the fight against obesity, but many say they don't have staff able to help patients with weight loss, according to a survey of 290 primary-care physicians by Harris Interactive.

 

State news

 

Fla: Jackson Memorial Hospital Retreats on Cutbacks

The Miami Herald

March 16, 2010

 

In a major reversal from her first proposal, Jackson Memorial Hospital Chief Executive Eneida Roldan presented a new restructuring plan with much smaller cuts, eliminating about 650 jobs and keeping two satellite hospitals open. The new plan depends on several items not yet solidified, including a union agreeing to $30 million in unspecified cuts over the next six months and the University of Miami accepting the delay of $29 million in payments from Jackson.

 

About 1 in 4 in California Lack Health Insurance, a UCLA Study Finds

The Los Angeles Times
March 16, 2010

 

Nearly 1 in 4 Californians under age 65 had no health insurance last year, according to a new report. The state's uninsured population jumped to 8.2 million in 2009, up from 6.4 million in 2007, marking the highest number over the last decade,

 

Medicare/Medicaid

 

With Medicaid Cuts, Doctors and Patients Drop Out

The New York Times
March 16, 2010

 

With states squeezing payments to providers, patients are finding it increasingly difficult to locate doctors who will accept their coverage.

 

Memo to Congress on Health Care Reform: Fix Medicare First

The Hill

March 16, 2010

 

In an opinion piece, Patrick Cobb, M.D., president of Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana, writes that Congress is merely kicking the can down the road, ignoring a solution to appropriately reimburse physician providers for their services to Medicare beneficiaries.

 

Reform efforts

 

Another View: 'The Only Sensible Choice'

USA Today
March 16, 2010

 

Kathleen Sebelius, secretary of Health and Human Services, has an op-ed in USA Today: For Americans who support these goals -- reducing health care costs, increasing choice and competition, preventing insurance abuses, and covering more than 30 million uninsured Americans -- the only sensible choice is to support the president's plan, too.

 

AAMC Urges Congress to Pass Reform Bill

AAMC

March 15, 2010

 

A statement from AAMC President and CEO Darrell G. Kirch, M.D., calling for the House of Representatives to pass the Senate's health care reform legislation and a companion bill.

Nancy Pelosi Done Playing 'Deal or No Deal'
Politico
March 16, 2010

The speaker warns members that she won't be sweetening the pot for health care holdouts.

Pro-Life Groups Mount Final Push

Politico
March 15, 2010

 

Two of the nation's most prominent pro-life groups have launched separate efforts to push Democratic House lawmakers to support the House-passed restrictions on federal funding for abortions.

 

What if Obama Fails on Healthcare Reform?

The Christian Science Monitor

March 16, 2010

In the end, Democrats may simply not have enough votes to pass healthcare reform. If that happens, the rest of Obama’s agenda would be cast into doubt, and the possibility of a tidal-wave election this fall would increase.

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Bill Gives Insurers a Younger Market (subscription required; full text below)

The Wall Street Journal
March 15, 2010

 

Although insurers generally oppose the Democrats' health-care bill, an overhaul would give the industry a chance to boost its diminishing rolls with an influx of young customers who tend to be healthy and profitable to cover.

The legislation, which Congress will vote on soon, is designed to get millions of young people to buy health insurance, using a mixture of subsidies to make coverage more affordable and penalties for people who remain uninsured. The industry has stepped up efforts in recent years to get those people covered, but so far its free-market approach has met with a tepid response.

The reasons young people forgo coverage are many, according to consumers and consultants. Policies are too expensive, too skimpy or too complicated to persuade the roughly 13 million uninsured people between the ages of 19 and 29 that it is worth their money. Most simply gamble that they won't get sick enough to need expensive treatment. In industry circles, they have come to be known as "young invincibles."

" 'Should I spend money on a ski trip or health-care premiums?' " said Paul Markovich, chief operating officer of Blue Shield of California, describing the rationale. "It's hard to see the value of insurance if you see yourself as healthy."

But consumers like Jenny Pham, a 27-year-old violinist and teacher from New York, says she doesn't lack coverage by choice. She makes about $3,000 a month teaching and performing. After rent of $1,200, she says insurance—which she has priced at about $250 a month—is out of her reach.

Depending on a person's income, federal subsidies envisioned by the Senate bill now under consideration could reduce that dollar figure significantly. Senate leaders have designed a young invincible policy for health-insurance exchanges that would offer young Americans catastrophic coverage and a few routine doctor visits.

Critics of the legislation say it is a giveaway to insurance companies because it hands the industry a sizeable new market without restricting profits or forcing it to compete with a government-run plan. But America's Health Insurance Plans, the industry's trade group, opposes the bill because of new taxes and regulations, and worries that the penalties are not stiff enough to make sure that younger people buy policies. The group says bringing young people into the system is essential to bringing down costs for everyone.

"If you are 25 and relatively healthy and have a choice between a $95 penalty and several thousand dollars for health insurance, it's not a hard choice to make," says Robert Zirkelbach, a spokesman for AHIP. The penalty starts at $95 for the first year and increases to $750 in 2016, says Mr. Zirkelbach.

Nearly one-third of the uninsured are between the ages of 18 and 29, according to the 2008 Census. But 17% of individual insurance policyholders, or 2.5 million people, are between the ages of 18 and 29, according to consulting firm McKinsey & Co. This group is worth $4 billion in annual sales for insurers, according to McKinsey. If insurers could lure in the additional 13 million young Americans, that would mean $21 billion in revenues, McKinsey says.

It could be the industry's last frontier for growth. Health-plan enrollment has been declining since 2006, as employers lay off workers or go without insurance, and rising premiums scare off many individuals. Of the major publicly traded insurers, all but Aetna Inc. have seen declines in commercial risk enrollment, which includes individual memberships. WellPoint Inc.'s enrollment dropped to 12.4 million at the end of last year, from 14.2 million at the end of 2006, while UnitedHealth Group Inc. is down to 9.4 million from 11.3 million over the same period, according to Goldman Sachs Group Inc.

"If you are presiding over a shrinking market and there's an opportunity to triple the size of a piece of it, it gets pretty exciting," said Paul Mango, head of McKinsey's health-care consulting practice.

In the past several years, insurers have been competing for this "good risk" in the market with new plans meant to seem hip. Market leader WellPoint in 2004 launched its "Tonik" policies—with tiers of coverage called "daredevil" and "risk taker"—in California, and has since expanded to six states and sold 224,800 plans. Aetna, which just started a Facebook page, bought a student-health company several years ago and boasts of doubling membership to 500,000.

UnitedHealth started pitching short-term policies to recent graduates last spring, while Blue Cross plans in Pennsylvania and Vermont are pitching policies on college campuses. Last month, HealthNet Inc. landed a contract for Stanford University's 8,000 students.

But many young consumers still find health insurance too expensive and confusing. Andria Tieman of Providence, R.I., was uninsured for the majority of her 20s as a graduate student and now is uncovered in a part-time job at age 30. Of health insurance she says, "I don't understand most of it, and I know I can't afford it, so I don't even look. Why tease myself?"

The plans say they have tried to design policies to include coverage that young people might use, such as dental and dermatology. At UnitedHealth, prices on short-term policies start as low as $45 a month. Blue Shield of California has a plan for $52. It's hard to reduce prices by much more, say insurance executives.

But the trade-offs are off-putting: high co-pays and deductibles (Blue Shield of California's is $2,900), and big benefit gaps. Blue Cross Blue Shield of Minnesota, for instance, is promoting a plan in university areas that doesn't cover maternity, and members can't switch out of it if they get pregnant.

Some insurers are seeing moderate growth. UnitedHealth says applications by 18-to-30-year-olds were up 12% in the fourth quarter of 2009, compared with a year earlier. And Highmark Blue Cross Blue Shield says members between 19 and 29 are its fastest-growing market, increasing 12% last year.

But plans can experience high turnover—Blue Shield of California sold about 47,000 policies to the 19-to-29 crowd last year, but only 17,000 re-upped when their policies lapsed. Overall, individual plan enrollment for people between the ages of 18 and 29 has increased by just 140,000 members between 2004 and 2008, according to McKinsey.

Tags: health care reform, Health Policy, Health Policy

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